Joy, EMT/RN, writes:

The opportunity to provide medical care brings with it risks unimaginable before the actual practice of care is begun. The timber and nails of the academic and the practicum seem, at first glance, to create a sturdy dwelling, a safe place from which to work. But when the winds of crisis blow, when the unexpected occurs, the house, if it has no sure foundation, if its framework is not both supple and strong, will fall.

The following story illustrates what happens when a nurse builds beyond the books and the gadgets and into true nursing.

Sunday, 1500, my pager tones. ‘Medic 1, Rescue 2, Engine 3, Engine 4. Respond MVA with injuries.’ I shovel the last bite of food into my mouth and put on my jacket. My partner meets me in the ambulance bay. We do not speak. It’s Christmas and there is a crash. There is nothing to say. We leave two minutes ahead of the other units.

Enroute we learn the location and nature of the crash. We do not look at each other. I request two more ambulances and additional rescue assistance. I move to the back of the rig to hang fluids. I put three constricting bands into one pocket and stuff a pair of heavy gloves into another. A couple of trauma dressings go into other pockets.

We arrive to an obvious high-speed, off-set head-on collision. A small pickup and a small, 2-door car are separated by 25 yards, one headed east in the west-bound lane, the other crosswise in the east-bound.

I run to the closest, the pickup. The passenger door is bent out of frame and is immovably 5 inches ajar. In the broken seat a middle-aged woman, sparkling with glass dust, sits with eyes closed, arms limp. When asked, she says she is at the mall. She is pale, breathing OK, has a rapid, thready pulse, no significant external bleeding. Move.

I go to the driver. He is enmeshed, the front of the vehicle folded around him like frosting on a cake. Awake, he looks at me with huge eyes. He does not speak. He is breathing OK, has a strong radial pulse of less than 100, no visible bleeding. Move.

I race to the other vehicle. Oh, Dear God. The two young adults in the front seat look like my oldest children. They are dead. Move.

I look at the back seat. The approximately 18-months old baby in the car seat in the middle of the bench appears boneless. He is slumped forward; his struggle to breathe is weak and uneven. His lips are white. Both eyes are purpled shut. Time stops. He looks like my Matthew. The doors are crumpled. I can’t reach him through either shattered window. Move.. Almost two minutes have passed. Move.

I straighten up and key my mike. As the first units arrive, I call for life-flight, activate the trauma system at the closest hospital, and request increased scene and traffic control.

I then order the scene. You guys, use ‘jaws’ on this door. You, the kid is yours, life-flight ETA 15 minutes. You and you, help him with the kid. You guys, use the other ‘jaws’ on the driver’s side of the pickup over there. You, that man is your patient. You, you, and you, get the woman out of the pickup. I’ll be right there.

I use the mike again to contact the second-arriving units. Rescue 6 and Engine 7, set up a landing zone. Medic 8, help them with Matth’ with the baby. Get the baby out of the car. Medic 2, find me at the pickup. You will take control of the scene.

I sprint back to the pickup. My partners yank off the door as I hand over the scene. Move. We are losing her. Never mind the c-collar. Move. We slide her onto a spine-board, place the board on a gurney, and leave.. Eleven minutes from time of arrival we are screaming down the highway. Move.

Her eyes are closed. Her breathing is peaceful. She has a fluttery carotid pulse that comes and goes. She moves her feet when asked. I give high flow oxygen and place two large bore IVs with blood tubing, NS wide open. Time now for a secondary exam. I cut off her clothes. Her anterior chest is crushed. The skinny woman has a round abdomen. I prepare to intubate.

She speaks. She is still at the mall buying pretty things. I listen to the woman. I put the laryngoscope away. I update the ED. The woman is taken into the OR within 10 minutes of our arrival. She dies there.

I ask an ED nurse to keep me company as I race-walk the parking lot and tell my story.

Two days later a critical incident stress debriefing is held. A cop says he has had about all of this he is going to take. His partner nods. A dispatcher says, ‘It was awful listening to what was happening. It was Christmas, this shouldn’t happen on Christmas.’ She can’t sleep. A cop jokes that she sleeps on the job all the time. She smiles and threatens, ‘I’ll send you out on the next barking dog complaint!’

The paramedic to whom I had assigned the baby says to me, ‘I knew the kid was bad when you walked away. I knew you’d never leave him if he had a chance. As soon as the helo took off, I went behind the ambulance and vomited.’

Someone says everything happened too fast, another too slow. A firefighter talks about the incredible noise of the scene. Another says he did not hear a thing, all he remembers is the stillness of the baby as he held his head for intubation. Another whispers in horror as she recalls the man in the pickup saying, ‘I did not hurt anyone.’

It’s my turn to talk. I thank them for being on scene. I thank them for coming to the debriefing. I thank them for talking. I say that I feel as if I had killed the baby.

A paramedic immediately and emphatically states, ‘You were first on scene. You had to triage. You did the right thing by walking away. You gave that lady the best and only chance she had. You did good.’ A few nod. A few look into the distance. A cop says, ‘That’s right.’ Someone puts a hand on my shoulder.

We tell our stories again. We listen. We joke. Some of us cry, others curse. Some do both. The next day, we go back to work. And I think about buying pretty things.

Welcome to this edition of Grand Rounds! I haven’t hosted since last year, but this is codeblog’s 3rd time around. Without further ado, here we go:

What Is Inside of Dr. Charles?
THE EXAMINING ROOM OF DR. CHARLES—One man’s perspective on the cacophonous coffin.

Breaking The News To Your Thanksgiving Turkey That It May Not Make It To The Holidays
DOC AROUND THE CLOCK—Is the Chinese Health Ministry lying about the true number of cases of avian flu? What impact will this have on a potential epidemic?

Founder of Modern Alienism First to Describe Down’s Syndrome
MEDGADGET—Had John Haydon Langdon-Down known that his syndromic namesake had been described almost 30 years earlier by Jean Etienne Dominique Esquirol, I suppose we would be calling it Esquirol Syndrome. Doesn’t have quite the same ring, though.

Tamiflu Causing Delirium, Hallucinations, Encephalitis…
DR. ANDY—…Oh wait, but so can having the flu. Is olsetamivir safe?

Nurse Realizes Her Family Has No Idea What Her Job Entails
HEAD NURSE—Nurses see death and the dead day in and day out. It’s an experience that our friends and family can’t fully relate to. So the next time we come home sad – realize that maybe we had to help usher someone from this world to the next. How would you feel about such a responsiblity?

Homeless Alcoholic Finds Refuge in Non-Judgemental ER
EMERGIBLOG—After sleeping in the rain for 4 hours, this patient lucks into an emergency physician who practices compassionate medicine.

White Coat, Wrong Time
SCIENCE CREATIVE QUARTERLY—Do you wear your scrubs/lab coat out in public places? Do you work in a level 3 lab? I sure hope not.

Medicare Part D(isaster)
OVER MY MED BODY—Listen, people – the government likes to make things HARD. “It is going to take time for seniors to become comfortable with the drug benefit.” Sure, but it shouldn’t take the rest of their lives. When you’re done being confused reading about Part D, go ahead and take a practice run.

Eliza Jane Died of AIDS… But Parvovirus B19 is Still A Possibility
RESPECTFUL INSOLENCE—Let’s see – the first 10 differential diagnoses are AIDS, but there’s always someone out there looking for zebras in a land of horses.

Headway Made On Vaccine For Ancient Disease
AETIOLOGY—Inadequate vaccines could increase the virulence of malaria, but once they figure out that pesky little issue I’m sure the malaria vaccine will be a big hit.

Termination or Reassurance/Preparation?
RED STATE MORON—Results of the FASTER study are out – testing for Down’s at 11 weeks is just as accurate as testing for it at 20 weeks. Even if women with “positive screens” opt to use that information to prepare rather than terminate, will that peg them as unethical – knowingly bringing a less-than-perfect child into the world?

When The Pandemic Hits, Make Sure You Bring Your Lawyer When You Get Your Vaccination
GRUNT DOC—There’s only one manufacturer in all of the US that can produce influenza vaccine. Hmmmm… I wonder why that is.

37 Year Old Woman Nearly Dies From Heart Attack. Doctors Stunned.
CLINICAL CASES AND IMAGES—The number one cause of death in women is cardiovascular disease – not breast cancer. Follow the link on this blog to read about a young woman who always thought she’d die of cancer, but instead almost died of heart disease.

Nurses “In The Weeds”
PIXEL RN—Even the most experienced nurses find themselves in the weeds. But what if you aren’t experienced?

Monsters In The Bedpan Room
IMPACT ED NURSE—We nurses come across all manner of … fluids. Here’s what happens when the fluids leave your room and come into ours.

Just Chill With The Antibiotics Already
PARALLEL UNIVERSES—Do we need yet another reason for judicious use of antibiotics? Make sure to read the follow up post for clarification/correction of several erroneous news articles.

Blogger Instrumental In Changing Someone’s Life
DIABETES MINE—How many of you bloggers out there can honestly say that you’ve changed someone’s life?

Doctors Behaving Badly
THE CHEERFUL ONCOLOGIST—What really happens during the “sign out.”

Insurance Companies Come Between Patients and Their Doctors
HEALTHY CONCERNS—”You know you’ve got a disconnect when the doctor asks: ‘would you be willing to pay for service?’ and I ask:’Aren’t I already paying? Where’s my $3K going then?’”

What A Sweet Job These Docs Must Have
HEALTH BUSINESS BLOG—Call up a random doctor and then hang out for 3 hours waiting to actually speak to someone.

News Flash: Press Lacks Nuance and Perspective In Reporting on Medicine and Health
NOTES FROM DR. RW—Irresponsible reporting confuses consumers. What could save your life one day could harm you the next.

The Genomic Revolution Persists Despite Pessimistic Review in WSJ
GENETICS AND PUBLIC HEALTH BLOG—Using gene research to tailor someone’s medical treatment is futuristic – but does the complexity mean we should stop trying?

Sometimes It’s Actually About Helping People
HOSPITAL IMPACT—In a world where the bottom line is usually the only line, some hospitals and clinics are going against the grain.

What Will They Write Next
POLITICAL CALCULATIONS—These are the kinds of things written when one has been up all night. Maybe this is why it’s so hard to get one’s medical records

Do You Really Want To Know How Much That Urinalysis Costs?
INSUREBLOG—An interview with Aetna’s “go-to guy” about their new program to inform insureds about common medical costs.

Peer Review Goes Online
SUMER’S RADIOLOGY SITE—Let’s just get rid of those silly little paper journals.

Harvey Cushing: A Life in Surgery
OXFORD UNIVERSITY PRESS—Isn’t it amazing that someone had to come up with the concept of monitoring blood pressure during surgery?

Whew! Tune in next week when Graham at Over My Med Body will be hosting!

Nick at Blogborygmi is of course the “father” of Grand Rounds. He’s been very diligent in trying to get the word out about our weekly compendium. Most recently, that has included writing an article for Medscape (registration required) called “Pre-Rounds,” where you can find out all kinds of information about that week’s host and their blog. This week the article is all about codeblog – how this site came to be and what my master plan is all about. :) Welcome, Medscape readers!!

Happy Thanksgiving!

PermaLink

Grand Rounds version 2.08 is being hosted by Doc Shazam this week! Go read the best of the medical blogs for this week.

For next week, Grand Rounds 2.09 will be hosted right here at codeblog! Email me at geena -at- codeblog -dot- com with your submissions by next Monday at 8pm PST. Please put “grand rounds” in the subject line.

When I ask a new patient what brought them to the hospital that day, I of course get many different answers. I get a lot of “I woke up with chest pain at 3am and came in.” When I ask how they came in, I get a variety of answers, the worst being, “I had my wife/husband drive me.” No, no wait – the worst is “I drove myself.”

Now, as perfectly healthy people driving around, do any of you feel comfortable sharing the road with someone possibly having a heart attack? I think not. You see, to simplify things, a heart attack is when the heart muscle is deprived of oxygen. When deprived of oxygen, the heart muscle begins to die. If a certain area of the heart begins to die, the person not only feels chest pain, diaphoresis (sweating), short of breath, etc. – their heart may go into a fatal rhythm. A rhythm not conducive to safe driving. Or driving at all.

So while the patient started out with a mere heart attack, he may end up with a car accident to boot…. not only taking out himself, but possibly others.

There are many reasons to call for an ambulance. Symptoms of a heart attack or stroke are high on that list. Another equally important reason to call for an ambulance is as Kim at Emergiblog touched upon in a recent post. An ambulance is a mini ER on wheels. People who know what they’re doing come to your house and start taking care of you WHILE transporting you to a place that you need to be. They have nitroglycerin, IV fluids, EKG’s and can start to diagnose and treat your condition en route. And if your heart stops beating, they can try to shock it back to life right there. Last I checked, defibrillators had not been added as options on modern cars.

If you feel as though you are having a heart attack or stroke, definitely don’t drive yourself to the hospital. Don’t have your spouse drive you. Please call 911 to get an ambulance. It could save your life and the lives of others.

I actually came across this story on a nursing message board that a member had written as a post. The topic was whether nurses dress up for Halloween at work. Many nurses wrote saying that they wear Halloween scrubs, but not costumes. Our manager has pretty much barred us from wearing any Halloween costumes at work, but some of us do wear print scrubs. Anyway, I thought it a very cute story and asked the author for permission to post it here. Sarah, RN who works in NICU (Neonatal Intensive Care Unit) writes:

We have to wear the hospital’s surgical scrubs on our unit, so people really can’t dress up. Many have Halloween-themed warm-up jackets around the holiday, and some nurses wear those funny headbands. Nothing too crazy though, it is an intensive care unit after all.

BUT…

We do dress up the babies!!!

Sometimes the parents bring in little costumes, but more often than not, we make them. Nothing fancy – we usually just use those squares of felt and cut out little costumes that can lay on top of the babies. On the night of Oct. 30th, a bunch of us will bring in glue guns, felt, ribbons, pipe cleaners, fabric, etc.

There are some parents who don’t celebrate Halloween for religious reasons, and we are always respectful of that. And if there is a baby that is very very sick, we’ll make a costume, but then ask the parents if they want to lay it over the baby or not. Most do – they long for something “normal” like dressing up their child for Halloween.

The best was the year I made a Harry Potter costume for my primary baby – all 1200 grams of him! He had a robe, broomstick, and “scar” on his forehead made of Duoderm. I even got doll glasses, painted them black, and put tape on the nosepiece! There were nurses from all over the hospital coming up to the unit and asking if they could please see the Harry Potter baby? It was huge for his mom, too. Up until that point, everyone would always say, “Oh, your son is so small, is he going to be okay?” because this baby had been born at 495 grams. But on Halloween, she sat next to his incubator all day while dozens of people came by to rave about how adorable her kid looked. She said that was the day she finally started to believe that he was going to be okay.

15 years ago in my CCU, long before I arrived, a young girl of 12 was admitted with “sudden death.” She was revived before coming to our unit, but was ultimately declared brain dead. She became an organ donor. I don’t know the specifics of her situation.

All I know is that for the last 15 years, her father has delivered a dozen peach-pink roses to the nurses in CCU on the anniversary of his daughter’s death.

The roses showed up yesterday. They’re beautiful.

About a year after starting in ICU, I was expected to take care of post-op open heart patients. I took a class, and I’d already been helping out with them after surgery, but had never been the primary RN. If I’d had my way, I never would have taken them. I was fairly comfortable with being in ICU by that point, but still not really mentally ready to take on the responsibility of recovering fresh open heart patients. The more experienced nurses did that kind of thing! I’d only been at this for a year! Didn’t matter, I had to do it anyway.

My first fresh open heart patient was one that I had admitted on a Saturday. He’d had an emergency cardiac cath and it was determined that he needed some bypass grafting. He was sent to my ICU for monitoring, but it was clear by Sunday that he could have gone to a stepdown unit. He was really very stable, walking around his room and such. But we didn’t need the bed for another patient, and figured he’d be back in a day or so after surgery anyway, so I took care of him all weekend. During that time, I’d say I developed a pretty good rapport with the patient and his wife.

The cardiac surgeon who saw the patient, Dr. A, was fairly new to this particular physician practice that had been established about 10 years prior. As he already had cases scheduled for Monday, he put the patient on the surgery schedule for one of his partners, Dr. Z, to do first thing Monday morning. All day Sunday I did pre-op teaching and answered questions.

Monday came, and I was very nervous about taking “my first heart.” I had a preceptor with me, of course, so at least I knew I wouldn’t do anything wrong. As I walked in at 7:30am, my patient was being wheeled off to surgery. The family was very emotional and it was a touching send-off. I had another patient at that time, so I busied myself with taking care of them, thinking that I had til about noon until “the heart” came back.

I was wrong. The heart came back at 8am.

Apparently, Dr. A didn’t inform Dr. Z that he had a surgery that morning. When Dr. Z found out, he was very angry. Dr. Z had had Monday morning office hours since the dawn of time, but no one thought that it was odd that there was a surgery scheduled for him. So the patient arrived to the OR that morning, had begun to be prepped, but no surgeon showed up. Dr. Z was the kind of doctor who, when consulting on a patient who needed open heart surgery, gave the patient a whole big informative speech on what that entailed, why the surgery was necessary, alternatives to the surgery, etc. Never have I come across another cardiac surgeon so involved in teaching and preparing patients.

To say that Dr. Z was angry with the situation wholly pales to the anger of the patient and family. Dr. A was able to come by and apologize for the mix-up, but that did very little to allay the family’s intense anger. I could understand their feelings – they were sending their husband/father/brother off to have his chest sawed open and his heart stopped – would it be too much to ask for a surgeon to show up at the appointed time?? It wasn’t like the surgeon was sick, or an emergency had come up… It’s just that no one showed up to do what could be the most stressful surgery in someone’s life. Questioning the competency of a hospital that could do such a thing would surely cross one’s mind….

And boy did it cross theirs. Although I had taken care of the patient all weekend, although I had a good rapport with them before surgery, even I was not immune to the many comments that were hurled at anyone who dared enter the room. That family made it VERY clear that they were mad at anyone and everyone who worked for that hospital, even down to glaring at the housekeeper. At one point, I had to go in the room to test my patient’s blood sugar, and I still count that as one of the hardest things I have ever had to do.

As soon as I walked into the room, 6 sets of eyes watched my every move. I meekly told the patient that I would be checking his blood sugar, and as soon as the words came out, I heard one of the family members tell another that he wondered if they could sue for such incompetence. Another wondered aloud if it was too late to change hospitals, since we “clearly did not have our act together here.” I know they were just expressing deep frustration, but it made me feel about 3 inches tall. Today I’m quite confident that I would be able to handle the situation and would certainly talk to the family and patient, but back then – I was pretty much still a new nurse, only having graduated a year and a half prior. I was quite easily cowed by confrontational family members. I didn’t want to make the situation worse, so I said nothing. At one point, I looked at my patient and he looked back at me with a mixture of sadness, anger, frustration and maybe even a little embarrassment for his family’s behavior in his eyes. They were definitely the ones raising hackles – the patient hadn’t said very much at all.

Lunchtime came and went and Dr. Z came to see the patient. The family had only somewhat calmed down, but after talking to the doctor decided to go ahead with the surgery that day. I don’t know what it was that Dr. Z said, but it seemed to go a long way. The tension in the room was cut in half and I was actually able to look some of them in the eye without being glared into a blubbering mass of shame.

The patient went to surgery and came back about 4 hours later. I was still incredibly nervous about this being my first open heart patient, and my nerves were also still a little extra-frayed by the morning’s events. Nevertheless, my preceptor was absolutely wonderful and we got the patient settled quickly. After that, it was time to call the family into the room to explain all of the various tubes, wires, and machines that were connected to the patient. I love teaching, so I knew this would be my favorite part under normal circumstances, but this time I was dreading it. My preceptor asked if I wanted her to do it, but I said I would go ahead and talk to them as long as she stayed in the room. I called for them and nervously waited for everyone to file into the room. I gave them a few minutes to look the patient over and then told them that his surgery went very well, he was very stable at that point, and everything was going as well as it could.

The remaining tension and anger almost visibly drained from their faces and I was able to get through my little teaching session not feeling as though I was standing in front of a firing squad. After all of their questions had been answered, everyone but the patient’s wife left the room. She came up to my preceptor and I and apologized for all of the harsh words and comments from earlier in the day. I was immensely relieved by this – I mean, who wants to go home feeling as though they were practically hated by their patient and family?

I had a few days off after that, so I never saw the patient again. And although I took several more hearts at that job, I have never had the desire to do them at my current job and have thus far been able to go about my career without having to do that particular task.

Oh yeah – and did I mention that Joint Commission was there that day, surveying the hospital? And that they were in our unit, witnessing the entire show? Could it have possibly been more stressful?

This post might be a little weird, but here goes. I was thinking the other day about when you’re concentrating on something in front of you, and you look up for no particular reason and are faced with something dreadful or funny.

For instance, once I was at work charting and heard a mechanical noise next to me. I didn’t really think anything of it (I’m surrounded by machines!) but decided to look up when I heard the noise stop. In ICU rooms, there are monitors mounted to the wall next to the beds. They’re high up, maybe 6 1/2 feet. I’m 5′5″ and I always have to reach way up to adjust alarms, etc. When I looked up, I saw that my patient had found the button that raises the entire bed – all the way up to the monitor. He could have started playing with it if he’d had the inclination. I didn’t realize that the beds could go that high.

Other things I see aren’t so humorous. This just happened the other day and it always makes my stomach drop with dread. I walked into my patient’s room, looking at her medications as I did so, and looked up to see a pool underneath her bed – of liquid poo. When there is so much poo that it actually starts falling off the bed to form a puddle below, things have simply taken a turn for the worse.

It’s always a treat to look up and see your vest-and-wrist-restrained patient hanging upside down over the side rail of their bed. Completely tangled.

This last one didn’t happen to me, but I heard plenty about it. We had a patient who fell at home and broke his neck. The doc decided that he needed Gardner-Wells tongs (scroll down a bit for a picture) until surgery could be done. These are tongs that are secured into the head to provide traction for the cervical spine. I don’t know if they’re screwed into the skull, but suffice it to say that you don’t want those suckers comin’ out.

Can you see where this is going? The night shift nurse looked up and saw her previously flat-on-his-back patient sitting up in bed, tongs off to the side of the bed. The patient stated that they were really bothering him and he felt much better having them off, thank you. He also relayed that it was really difficult to get them off, but it was worth it to be free of them!

No harm done; the patient had his tongs replaced, had surgery later that day and did just fine. Still… what a sight.

RN writes:

I want to share my experience as a nurse taking care of wounded coalition forces and insurgents near Baghdad, Iraq. It was the most meaningful thing I ever did and the most horrible. I carry mental scars that I hope will heal.

11 military nurses and I deployed to a field hospital just outside of Baghdad in Jan 2005. The stress levels and workload we carried were incredible. We staffed a 75 bed ward with just the 12 of us, around the clock. A normal patient load was 13 to 16 patients each (Gasp). We took care of patients with traumatic amputations, chest tubes, bullet wounds, drowning victims, children and infants who were in the wrong place at the wrong time, prisoners…and we did the best we could. Did we give good patient care? By stateside standards a resounding no! We worked six 12 hour shifts each week and we were just plain exhausted. We were attacked by missiles and mortars daily. I became convinced I was not coming home; that I would never see my husband or children ever again…especially after a missle landed 10 feet away from me…and it did not detonate!

The Iraqi patients threw urine and feces at us, and spit on us (and those were the “good guys”). One nurse was bitten. Three of us were sexually assaulted (we were the only females on the base who were not armed and were easy targets). We cared for patients in tents, with minimal medical equipment, and we saved a lot of lives (1100 patients in 4 months). Some we couldn’t…and we cried.

One patient, a middle aged obese Iraqi woman did not deserve what fate handed her. She was a mother and a wife, and just wanted what each of us wants out of life – to keep her children safe, and love her family. As you can imagine, work is hard to find in Iraq right now, and people need money to eat. My patient had a daughter who spoke English. Her daughter gained employment as a translator for the Army. The insurgents planted a bomb just outside the family’s front door to discourage others from doing the same. My patient stepped out her front door (she thanked her gods repeatedly that it was not one of her children) and lost both her legs and her right arm. We saved her….but only temporarily. She developed infection after infection. We did as much as we could for her, but in the end, had to send her to the Iraqi hospital in Baghdad; which had few staff members and few medications. I know we sent her off to die somewhere else.

Events became interconnected there. An Iraqi National Guard Major led his men into a skirmish where American soldiers were slowly being picked off. He saved them. The insurgents planted a bomb in the Major’s house. He was killed; but a visiting female relative, a 1 month-old and a 3-year-old survived (all others in the house were killed). The 3 survivors were severly burned. The newborn and the mother spent several weeks with us and both were discharged healthy but scarred. The 3-year-old died after 6 weeks. We were devistated. Fast forward a couple of weeks. Coalition forces captured the insurgent who planted the bomb and shot him 3 times in the process. We saved him. I wanted to hurt that man, at the very least I wanted to withhold pain medicine, food, etc. But I did not. None of us did.

An Iraqi soldier/patient began touching one of my young nurses inappropriately. I had a gun placed against his head while I explained to him that touching was not allowed. I help people, I don’t hurt people.

I have been home 4 months now. I do not laugh easily any more. I don’t sleep.

If you know a nurse that went to Iraq, be kind, invite her out for a cup of coffee…and listen if she wants to talk about the horrors she lived through. Help her heal.

Wow. Think of this next time you have a bad day at work.

…Over at Medscape Nurse Blogs!

They’re blogging about Katrina and what they’re doing in the shelters and the kinds of people they’re helping. Very interesting. Here’s an excerpt:

Sunday afternoon, September 4, 2005: I am blessed to be a nurse. I was tired and had been out of town most of the week on business, returning to numerous e-mails and phone calls literally begging with pleas to help. I felt compelled to assist. My first intention was to donate clothes, pillows, etc. So, my 8 year old daughter and I gathered things up and we headed to the Austin Convention Center to drop them off.

As we pulled in, the chaos was immediately evident. Too exhausted to cry, the masses of people stared blankly in confusion after the military aircraft dropped them off. They were ALL in shock and they ALL needed help. I debated whether or not to take my daughter back home but they were in such desperate need for medical personnel that we made the decision to stay. I borrowed a stethoscope from an EMT, dug out the nursing skills I hadn’t used in years, and began to triage patients, choking back my tears after hearing horrific stories one after the other.

There’s much more!