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Katrina II

DaGoddess writes about the loss of her friend Jamie to hurricane Katrina:

“From the moment I saw Jamie, I knew there was something about her I liked. She always appeared to be the no-nonsense kind of nurse I like to work with and she was really sharp. Sharp enough to know I wasn’t one of the frightened little bunnies. As a traveler, you have to be highly skilled, work well with others, and be flexible. The fact that she had extended her assignment on our unit twice before I came along was my good fortune.”

Read the whole post – it’s a very sweet tribute.

I’ve already donated to the Red Cross. You can, too.

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Katrina

I was thinking the same exact thing.

Good luck to those who were/are in her path.

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Oh, A Granola Mom!

First of all, thanks SO MUCH to NurseWeek for the wonderful article in which Codeblog was mentioned. It’s very exciting to see something that you’ve worked hard on in print! If there are any nurses out there that want to share a story, you can do so here.

“Jules” has already taken advantage of the Submit Your Story link and this is her submission:

I work in recruitment for a large health system – sometimes we tend to look more at the paper credentials, and forget the humanity behind what you all do – I have the highest respect for nurses!

I’d like to share my experience as a patient, though. Hopefully any of you who have cared for someone like me will know how lasting the impressions are, and know how much the things that you do to treat the whole person are appreciated!

I was pregnant with my first son, and was utterly convinced (and still am, frankly), that women’s bodies were built to bear children, and that we don’t need medical intervention to help us along in a normal situation. Further, I was convinced that once you start intervening, the interventions keep coming until you end up with (gasp!) a C-section. I had a very supportive husband, an excellent direct-entry midwife, plans to give birth in water at a free-standing birth center, yada-yada. What I didn’t do, was listen to everyone’s advice to prepare myself in case the birth didn’t go exactly as I pictured.

Fast-forward to my 37th week of pregnancy. Picture lots of edema (I had to wear men’s shoes because women’s shoes weren’t “tall” enough for my swollen feet), a HUGE belly (something about too much amniotic fluid), labs that were off in many many ways (high uric acid, anemia, etc) and the beginnings of preeclampsia. Long story short, I ended up being admitted and induced, which was the second-to-the-last worst outcome I could imagine.

You L&D nurses are probably smiling to yourselves thinking, yep – I’ve treated her. And I’m sure it will come as no surprise that I marched onto the L&D unit with all kinds of demands – rolled into a “birth plan” – - no pain meds, hold baby ASAP, don’t cut cord until it stops pulsing…. Silly me, I still thought I could control what was happening!

I had some fantastic nurses. There must be some kind of communication that goes on with you-all, because everyone seemed to both know and respect my wishes. With one exception, all of the 28 nurses who cared for me during my week at the hospital hotel (my friend counted) treated not only my physical condition, but my emotional state as well. I had expected to have the nurses roll their eyes and say “Oh, a granola mom” or “Ha, Natural Birth. She doesn’t know what she wants” – - I NEVER felt as though this was the case. In fact, every one of my nurses bent over backwards to welcome my midwife into the room (though she didn’t have hospital privledges), and help me make sense of what the OB was ordering. One even said to me “You know, you can wait to have that done if you want” when he wanted to break my waters on the second day.

After 65 hours of labor (yep, not a typo – we finally succombed to an epidural at Hour 59 – blissful sleep!), my husband and I finally decided to have a C-section. Both our decision to continue with the labor, as well as our decision to have the surgery were unconditionally supported by our nurses. I was very frightened of the surgery, and the nurse who would be assisting took extra time to hold my hand, stroke my forehead (amazing what touch can do to calm a patient who’s frightened!), and explain over and over what exactly I would be experiencing, who would be there, etc. Even though I know she must have been incredibly busy to coordinate two nurse-anesthesists, the OB, two additional nurses, a resident, a clean OR room, etc, etc – she took the time to make sure I was comfortable, and to listen to my fears. In the OR, she made an extra effort to ensure that I could see my baby the whole time they were fiddling with him on the table, and brought him over as soon as possible. For
her kindness, I will be forever grateful, as she truly helped ease my fears.

I also remember a night shift nurse who had been assigned to me for two of the three nights I was in labor. After my son was born, she popped in my room to check on me, even though I was assigned to a different nurse (so appreciated!). Later that night my son woke up and started crying. My husband, who was staying with us in the hospital got up to get him and bring him to me, but I was having a hard time sitting up. I remember being so distraught that I couldn’t even sit up in bed to help my newborn son – I was so upset and discouraged. The nurse, who was not even assigned to me, answered the call button and both she and my assigned nurse helped me sit up in bed and nurse our son.

The other item that I want to share, which I truly think is a kindness, was the postpartum nurse who we had in the days following my son’s birth. What I appreciated most about her was how matter-of-fact she was. She helped me stand and take my first few steps after the surgery. She helped me shower. She helped to clean me up after I went to the bathroom for the first time post-cathater. Never was I embarrassed by the VERY INTIMATE things that she was doing, because she did not make a big deal out of it at all. It was just “You need to get up and go to the bathroom. Great job, now let’s get you cleaned up.” Ditto to the help we had learning to breastfeed. Fourteen months later, my son is a pro, but it took a bit for both of us to get the hang of things.

I am so thankful to all of the nurses who helped bring my son into this world, and helped me let go of my pre-conceived (get it!) notions of a hospital birth setting. I am humbled and amazed by the caring, compassion and love that we received while spending a week in the “hospital hotel.” Thank you for educating me, respecting our wishes, and coordinating the meals, labs, visitors, visits from the OB, and lactation consultant. Thank you for holding my hand, brushing my hair, encouraging me to take a shower, and cleaning me up. Thank you for welcoming my midwife, my family, and allowing my husband to stay overnight. Thank you for keeping me safe and healthy, for watching over me, for helping my son take his first breath, for teaching me the finer points of being a mom, and for turning a very scary situation into a powerful and empowering experience. Thank you.

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Nursing Grand Round Submissions

I’ve been asked to get the word out about Grand Rounds this week! There’s been a special request for submissions from nursing blogs! Send your submissions by tomorrow (Monday) midnight to corturnix1@aol.com.

Grand Rounds this week will be held at Circadiana on Tuesday.

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Going Outside

We had a patient for 6 months. Yep, 6 months. As one doctor said, “If you can’t fix whatever’s wrong with a 6 month stay in ICU, you aren’t likely to ever fix it.” Indeed. This patient knocked on death’s door several times, and even entered once or twice, only to be brought back to earth for more bedrest and bedsores.

We were really confused as to why the family would want to keep him alive in this state – they’d brought in pictures of him and he was really a very vibrant and almost regal man. Now he sits in a bed every day, breathing through a hole in his neck, being fed through a tube in his stomach. His bed was pretty nifty – it would transform into a chair position at the touch of a few buttons. We’d try to put him in this position for a few hours every day.

He’d stopped trying to communicate with us months ago. Well, he was already unable to talk because of the trach and ventilator, but he wouldn’t even look at us. He wouldn’t respond to his family either. I had the feeling that he was really in there, but was just mad. At life, at us, at his family. At his situation. But the medical system is what it is, and when he became “unresponsive,” many tests were done – CT’s, MRI’s. He was put on antidepressants, but after a couple of months was taken off because there was absolutely no change in his affect.

We carried on taking care of him. We talked to him, turned him, cleaned him – all with no response. His eyes would open, but he wouldn’t look at anyone, didn’t seem to focus on anything in particular. It was like the human-ness had just dissipated from his body. He almost became just a body that we took care of. His family would visit every day, for several hours, inquiring about his condition, asking countless questions. They’d try so hard to get to him, but he never responded. Doctors would come and go, day in and day out, and they’d try to get him to respond. He’d only rarely open his eyes. When he did, it was just to stare off into some faraway place.

This went on for months. Gradually, his labs improved. His condition overall improved and somewhat stabilized. His bedsores started healing. It soon became clear that the only thing holding him back was, well, him. We tried to tell him this, but as usual, we were only met with a blank stare, if he even bothered to open his eyes at all. I still felt that he was “in” there.

Last week, he was sitting in the bed, which was in chair position, and one of his doctors stopped by. She suggested getting him up into a chair that had wheels and she wanted me to take him outside. It was a sunny, lovely day, but I admit – I was quite sure it would be lost on him. He hadn’t been outside, breathing fresh air, for over 6 months. I was very resistant to the idea – it’s a lot of work, and I didn’t even think it would help.

But the doctor went in to talk to him and his wife, and although his face never changed when she asked if he wanted to go outside, his wife got used to the idea immediately. From getting to know her over months, I knew she wouldn’t let it go until I followed the “doctor’s orders.” Great.

I rounded up some nurses and got him into the chair. We disconnected his monitoring equipment (with the doctor’s OK) and loaded up an oxygen tank. Then we went outside.

As I said, it was a lovely day. We pushed him a few yards from the hospital, to a safe place in the shade. There was a light breeze. There were squirrels and birds. My patient had no response to this change in environment. None whatsoever. I wasn’t surprised in the least. His wife and I started talking about being outside excitedly. We started pointing out birds and trees. I felt absoutely stupid, trying to get this man who seemed so mentally and emotionally detached, who had been through some unimaginable stuff, excited about being outside.

His wife and I started talking to each other, just the usual small talk, when I looked down and noticed that my patient’s eyes were open. Well, that’s a step in the right direction at least. His wife decided to run with it – she started speaking to him in their language. Just then, a really wonderful breeze blew by, a bird sang – and he opened his eyes a little wider. He seemed to start focusing. He started moving his eyes – he was looking around! His wife was really excited, and started talking to him in that same language – he eventually looked at her, and then reached his hand out to grab hers. I doubt that I could fully explain in words the look on her face when he did that. It was the first time in months that he had communicated in any way to her.

We stayed there, outside in the sun and breeze, for awhile longer. My patient’s wife continued to talk to him in words that I could not understand. Unbelievably, to my great and utter shock, he started talking back. By this point in his hospital stay, we had been capping his trach for a few hours at a time. We would tell him repeatedly that he could talk, but he never tried – until that day. All he could manage was a whisper, and his wife was beside herself. I asked her what he’d said and she replied, “He said he wants to go home.” He managed to whisper that same phrase several more times, never uttering anything else.

After about 15 minutes, I noticed that he was starting to get a bit droopy, so we wheeled him back in and put him to bed. He fell asleep almost immediately.

After 6 months of caring for this patient, I had almost ceased to see him as human. I figured that he was so depressed he’d never snap out of it. And for all we knew, he may have had some brain damage from all those times that his blood pressure was too low – something that wasn’t showing up on all the scans. After 15 minutes of simply having him outside, he became human again. It was the greatest thing I’d seen in a long time.

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Shocking

Wow. It was surprising and wonderful to see that Codeblog made it to the Forbes.com list of reviewed Medblogs. I’m in great company :) (And by the way, Forbes.com – I DO have archives. They’re right over there to the left, under “navigation.”) Funny that they saw the search box but not the “archives” link directly above it!

Unfortunately for this blog, CCU has been quite dull for the last couple of months. I’ve been grateful to have some very well-written and interesting story submissions to post. Here are a couple more:

Submitted by “Gypsybobocowgirl”:
On one late night emergency in the cath lab we had a patient who spoke no English, only Spanish. When we opened up the coronary artery, he promptly went into V-Tach (reperfusion arrythmia). The nurse promptly called out the rhythm, said “Charging, 360 Joules” and shocked. The patient converted, but a few moments later, he went back into V-Tach. Another, “Charging 360 Joules” (the old days before biphasic) and a shock. Another conversion. Shortly thereafter, the patient went into V-Tach a third time. The nurse called out, “charging, 360 Joules.”

From the table, the patient cried out in a loud, heavily accented voice, “No, No, No, no 360 Joules!”

He learned that phrase in english pretty fast.

Another submission I had actually came from the blogger at Nurse Practioners Save Lives:

While talking to the current group of nursing students, one asked if I had a particular patient that stuck in my mind. I told her that I had many patients that have touched me in some way but the first as a new nurse was a woman in her 70′s who had suffered an aphasic stroke.

She couldn’t speak at all and could only smile or nod. During the three days I took care of her, the tech and I would do her daily care and the assessment would commence. All the while, I would talk to her constantly even though she couldn’t respond.

On the third day, she was to be sent back to the nursing home. Right before transport arrived, I went over to her and leaned in and said that it was nice to meet her but I hoped not to see her again her in the hospital. Slowly, she raised her good hand and stroked my face and smiled. Tears ran down my face as I gave report to the transport personnel and I knew that they must have thought that I lost my mind.. I never did see her in the hospital again because she passed a few weeks later at the nursing home. I like to think that she felt that she was cared for while I had her…

I also found some great stories on these nursing blogs:

Mediblogopathy weighs in on “rodeo nursing,” which can be a very fitting term for taking care of patients withdrawing from alcohol.

DisappearingJohn also has a great post about when alcohol withdrawal patients go bad on the medical floors. Alcohol addiction is an extremely powerful thing, and those patients can be dangerous to care for if they aren’t treated appropriately.

And lastly, Jen, SN recently posted about her “nurse residency day” in the ICU. She seems to have run through quite a few emotions. A lot of what she wrote really resonated with my own memories of my first few days working in an ICU. It can be very overwhelming.

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Some stories have no simple happy endings

W.B., paramedic, writes:

One evening, I went out on a call for a self-inflicted shotgun wound to the head. I arrived as the wife and children of the victim were hurrying to the door. They looked horrified and the wife asked me if her husband was dead. I told her that I didn’t know and that she should take her kids to the neighbors house.

It was dark out and the lights of the arriving emergency vehicles bounced off the house. I made my way down the hall, then down the stairs to the basement. A cop was holding the man’s shotgun and the patient lay in a pool of blood in the corner. He lay on his side away from me. An EMT was kneeling beside the man and told me that the patient had a pulse, so I decided that we would do what we could to preserve his life. It wasn’t a long thought out choice, it was just the obvious next move.

I instructed another EMT to set a back board next to the patient and we rolled the patient onto his back. I would later learn that the man was upset about his wife threatening to leave him for his drinking and temper. He knelt down and put the shotgun under his chin, his son ran down the stairs hearing a commotion and begged his father not to do it. Apparently, in kneeling down, he tipped his head back too far.

The patient’s face split open in two halves. His jaw was gone, nose off on one half, one eye gone, the other hanging into a socket on one side. I had help suctioning as I intubated the patient, secured the tube and bandaged the face. We carried the man out and as we placed him in the back of the ambulance I asked him to squeeze my hand. I was shocked when he did.

On the ride to the hospital the other medic began asking questions and worked out a way for the man to answer giving one finger for yes and two for no. We started IV’s and his vital signs stayed stable. He stayed conscious and alert the whole time and responded that he was not in pain.

At the hospital they determined the man’s blood alcohol level was over 0.20. A helicopter arrived shortly after to take the man to a trauma center. The man’s wife arrived and talked to the patient who chose to flip her off with his middle finger.

The man recovered with no neuro deficit. After a lot of reconstructive surgery the man returned home. I saw him once after. I go by his house a lot, but I never see him. The house is closed up, shades drawn. I want to talk to him and hear that I did a good thing, but I don’t know what I will hear. It was a call that was flawless in the way that the intubation went so well and the patient survived with no physical or mental deficit. Not so flawless in the aftermath when I think about the reality of who this guy is, what he did and what effect this all has on him and on his family.

I wonder how he feels now over a year later. I wonder how his family feels. I wish that stories had simple happy endings.

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Calm to Panic to Elation to…

I received a few great story submissions, thank you! This one is from Dom, a paramedic:

Much is made in the press of cardiac arrest victims that EMS saves in the prehospital field. The recognition is great, and much deserved for the guys who manage to save a patient, but the reality is a bit more stark. Nationally, if you suffer a cardiac arrest outside the hospital, your chance of surviving ranges from 4% to 20%. Your chance of walking out of the hospital neurologically intact is even less. I’ve been a paramedic for 13 years in a high call volume area. Out of the 40 or 50 cardiac arrests I’ve treated over the years, I’ve had exactly two walk out of the hospital as if nothing ever happened. One of those cases really stands out in my head.

We were called to a report of a 35-year-old female with chest pain. 35 year-olds without past medical history aren’t typically at high risk for heart attacks, so we rolled in assuming it was something minor. We saw a very petite woman lying in bed, telling us her chest had been hurting for the last hour. All of her vital signs checked out, nothing was abnormal. Since we couldn’t pinpoint any other cause of the chest pain, we told her we should take her to the hospital for an exam, although we were sure it was “probably nothing.” We started an IV line and gave the patient some nitroglycerin, standard procedures for anyone with chest pain. The nitro failed to reduce the patient’s chest pain. As I’m on the phone to the hospital, I’m telling the ER nurse the patient’s story and telling her what we’ve done. As I wrap up the call I state, “I think this is probably just some pleuritic chest wall pain, Chris, we’ll be there in about 5 minutes…hold on, shit, I think she just coded.”

I was glancing at the patient’s EKG while on the phone and noted her previously normal rhythm suddenly went into what looked like ventricular fibrillation, in other words, cardiac arrest. Initially thinking a wire had come loose, I looked over at my patient, who was doing the “fish out of water” guppy breathing as her eyes rolled back in her head.

Things had suddenly gone terribly, terribly, wrong. Not only had I told this nice woman that this was most likely “nothing,” but I had just embarrassed myself on the phone with the charge nurse by giving her this story about how it was probably “nothing,” only to have the patient crash and burn right in front of me. This was not going to be easy to live down. My pride was going to have to take a back seat for the moment, however. I ripped open the woman’s nightshirt and grabbed the defibrillator paddles. Since I was caught so off guard, I didn’t “grease the paddles,” which increases electrical conduction and reduces skin inflammation and burns. Not only that, but I hadn’t checked to see that the energy level was set at a maximum 360 joules (we usually give initial shocks much lower). I spark her at 360 joules and these little puffs of smoke wisp up off her chest from burning her chest slightly. This was not my day. Like someone flipping a light switch, the woman immediately looked up at me standing over her and said, “What’s going on? Why are you standing over me? Why does my chest burn? What are those in your hands?” Looking at the paddles in my hands, and the two oval red burns on her chest, I put them behind my back with a sheepish look.

“Uh, well, you had a little bit of a spell, and I had to, uh, use some electricity to make you come back around.” The poor woman burst into tears crying, “You told me everything was going to be okay!” Considering how much stress I had just gone through in the last 20 seconds, I nearly burst into tears as well.

I’ve never since had a call where I went from calm to panic to elation to embarrassment so quickly. The bottom line was I had saved a patient, truly saved one, and I knew that was pretty rare. The last I heard about the patient, she had been diagnosed with a rare heart condition and was given an implanted defib. She’s doing fine now.

Ah, I love the happy endings!

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Hellllooooooo Newsweek Readers!!!

Whilst perusing my list of hits yesterday, I came across this link… And thought nothing of it. Newsweek? Huh, interesting. It wasn’t until I mentioned it to my husband tonight that he clued me in – the content on the website is the same content that’s in the magazine!!

Yep, right there in the June 20th edition, page 12. Yes, my mother is proud.

Anyway, if you’re here for the gritty blood-spattered bittersweet stories, far be it from me to disappoint! Here are a few of my favorite posts:

Looking for something gritty? A Day In The Life could certainly be described as such. It’s a very long post, and days like that don’t come along often. (Thank goodness!) Or maybe you’d rather read about the difficult conversations that we have in CCU?

Are you more into gore and blood? Watching my first (and only!) C-Section seemed a bit gory, even more so because it was happening to my very good friend. It was fascinating to be on the other side of the sterile drape. A much sadder post describes an exceptionally horrendous call as written by an EMT. This stuff happens every day.

If bittersweet is more your speed, this post about a nurse who took care of her former nursing instructor as she lived out her final hours could qualify. Ummmm, yeah – only one bittersweet post in 2 1/2 years. Sorry!

Have you ever wondered what it’s like to be in an ICU sedated on a ventilator? Here’s a patient’s perspective. I’m surprised she even remembered it.

Of course, it’s not all stress and sadness. There are plenty of funny moments to be had in the CCU. Patients who wake up after prolonged cardiac arrest are a real plus. And it’s all worth it when the person you coded yesterday is brushing her hair today.

So. Any other medics have any stories to share??

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Nursing Moments II

Welcome to Nursing Moments II, the 2nd installment of the Carnival of Nursing! These posts are written mostly by nurses, or by others about nurses or nursing. Because codeblog focuses mainly on personal experiences in the healthcare world, most of these posts follow in that vein. (Ha ha! Get it? Vein!!) Anyway, we have a great array of posts for you to read. Enjoy!

I’m sure most of you know the popular saying that “nurses eat their young.” This post from Head Nurse has touched upon a few instances where that wasn’t the case, and has some handy tips as well. New grads would be smart to read it.

Mediblogopathy writes about a very smiley baby that followed her from one clinical to the next. As nursing students, you rarely come across the same patient twice, so it’s interesting when you do.

Nurse Ratchett’s Alter Ego lulls a child to sleep and explains why some children in psych wards fear the night.

Thinking Nurse engages in a debate with RNegade about the extent to which social consciousness should influence nursing, and the degree to which this should be encapsulated in Nursing Theory – for example a ‘Theory of Nursing as Human Solidarity’. Thinking Nurse warns that this is “meaty stuff.”

Blue pads (or “chucks” as they’re sometimes called) come in handy for an array of disasters. The Unlikely RN says she will feel a twinge of aviary sadness when using these pads in the future after what happened to her on a home visit.

About A Nurse describes how easy it is to become overwhelmed as a newbie nurse. Heck, it sounds a bit overwhelming to this not-so-newbie nurse.

Crzegrl is a Nurse Practitioner who was hired explicitly for her “nursing intuition.” She relates a scary story about a nurse she came across who lacks this intuition, and how she averted what could have ended up in disaster.

Time To Lean had an especially odd nursing moment involving a patient’s mother’s fear of the poison fluoride. Yes, you read right – that stuff that’s put into tap water.

Next up is a post from The Babalu Bark, written by a woman who is learning to take care of her ill mother. The post that I have chosen is not the one she submitted, because I think this post really describes what it’s like to start taking care of someone who used to do the same for you.

Lastly, Coral writes: “Yesterday towards the end of my shift, I wheeled a diabetic patient to the male toilet in a commode. When I wheeled him back and parked him right next to the bed his eyes looked towards the bed next to his bed vaguely and he stated: “There’s a pair of legs on the bed” I said, yes, there’s a patient, a man on that bed. There was a pause while I looked at him and noticed his eyes were squinting slightly and out of focus.. Then he said, “Well if there’s a man on my bed I don’t think I want to sleep on it anymore.” I showed him that his bed was empty (Uncle, this is your bed) and proceeded to transfer him, but his eyes kept wandering to the other bed longingly…
Needless to say I was reminded of one of those stories in Oliver Sacks’ book (The Man Who Mistook His Wife For a Hat) about a man who kept insisting that the legs in his bed are not his and would someone take them away from his bed!”

Thus concludes this edition of Nursing Moments! Check out July’s edition, which will be hosted by Nurse Ratchett’s Alter Ego.

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  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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