Galen’s Log has announced that the website for their company is now operational!

GPI’s product is Medi Binder and I think it’s an extremely helpful product. As Grunt Doc says, “I like this product idea, and personally recommend it, especially for people who have more than 3 medicines / allergies, more than 3 doctors, or more than three surgical scars on the body.”

I have to say that I completely agree. This is a great tool that can guide you in keeping important medical information up-to-date and handy. As a nurse, I can tell you with 100% certainty that if all of my patients handed one of these to me when they rolled into the unit, my job would be SO much easier.

Lynn, RN, writes:

I am an RN living and working in a rural area. I am DON (Director of Nursing) of a mid-sized (80-ish) nursing facility; I have been in this position here for 6 years. I have been turned in to the Nursing Board by the state that I live in and would like to tell my story.

Every 9-15 months we have what is called an Annual Survey done by the State. The US Government (CMS) is actually charged with doing this survey, but they contract with the State for the State to do it. Therefore, on 5% of the State surveys, the feds come in to survey the surveyors. This is what happened to us. This is called a FOSS (Federal Oversight) survey, and it isn’t pretty. State surveyors’ jobs are on the line, they are being surveyed while they inspect us. The problem is, in order to impress the feds, they become even more picky and punitive than usual, and that is a more extreme stance than you can imagine. I understand the survey process and the need for it, but things do get out of hand, and it is not unusual for surveyors to exaggerate or fabricate errors on our part to create deficiencies to cite.

It was even worse this time, even with the feds there watching. I knew the system was corrupt, but I had no idea that the worst behavior of the surveyors were supported by the feds. Just a quick example–in the kitchen they were measuring the temperature of the food to be served. Our kitchen manager had a thermometer, and the surveyors had a thermometer. Well, the temps displayed differently on the different thermometers, so the surveyor immediately said to the kitchen manager that her thermometer was wrong. She challenged this, saying “how do we know OURS is wrong and not yours?” So the surveyor told her to check hers in ice water “and it should read 0 degrees,” which of course is wrong. The kitchen manager checked hers in ice water, it registered 32 degrees and she showed this to the surveyor, who said, “Oh, of course, that is correct.”

Then two weeks later when we received our deficiencies in the mail, that temperature was recorded as incorrect and we still got the deficiency. I won’t bore you, but there were over a dozen instances like that during this survey, some written as deficiencies. Anyway, to the real story. We had a resident in our facility who had been admitted about 9 weeks before the surveyors came. In the first two weeks of his stay with us, he kept insisting he had to leave, and kept trying to leave. This is not unusual in long term care, the man had dementia and did not understand who we were, where he was, or what was happening to him. Actually he was much better off than some residents in this situation–his wife had already been at our facility for two years (also dementia, plus a couple of bad strokes brought her to us) and he had 2 grown children, both retired, living nearby with plenty of motivation to spend time with their ailing parents, and who visited frequently.

But still, his transition to the facility was a problem. Twice he left the building, staff in tow, and went down the street. We got him back, once in a staffer’s vehicle and once by calling in the daughter who helped talk him into coming back. Eventually we got a handle on this behavior and he quit trying to leave. He only got off the premises twice, but during the first month he was with us he probably got out the door a hundred times. We have an alarm system on the door which is the only reason he never actually got away from us completely. Staff MOVE when they hear that alarm, find him just walking out the door and bring him back. So the problem was that we allowed a resident to leave the facility (elope, they call it) without adequate controls to keep him in the facility. The thing is, it is standard practice, at least in this area, to let them go outside and walk with them, let them get tired then bring them back. The deficiencies as written by the State say that we are located on 4 busy streets, which is not true. We are actually located on 3 dead-end streets and one other street that runs from the main street of town and dead-ends at our facility (3 blocks) so is technically also a dead-end street.

Anyway, what I am interested in, is if anyone out there has had similar experiences and knows how the Board responds to such incidents and allegations. I have been an RN since 1976 and actually have another career in the works as small business owner, but surely had no plans for giving up my nursing license. This is an incredibly emotional issue for me, it is terrifying to have your license/career threatened in this way. And let me say that this family is so supportive of us–they met with the State surveyor for almost an hour while they were here, and the surveyor tried really hard to get them to say awful things about us, and they defended us totally. Each of the 2 grown children has written letters of support and the letters state how attentive we have been to the resident’s needs and special behavior problems, and I will be including this letter in my response to the Board. I am writing my response to the Board, which is due NOW and I am not sure how to frame it. It sure is hard not to be defensive. I would welcome comments from those in long term care who deal with this stuff daily and understand the problems and needs of our special old people.

Rissa asks:

I recently earned my bachelor’s degree in Biology. I would like to either become a nurse or a PA. I am conflicted. What do you suggest? What are the pitfalls in nursing? What do you like about it? Would you encourage others to go into nursing?

I can only speak for hospital nursing, which really is only a part of the many different directions you can go. I’m glad to answer this question now, because I’m starting to get a little burned out and I need to remind myself what I like about my job. I haven’t posted much lately (well, I never post much) because all of the posts in my head lately have been negative.

I like learning how people react to illness and stress. I LOVE to educate people about ICU, the monitors and tubes and wires, and the specific disease process that they’re experiencing. That’s my favorite part of the job. Just the other day, my patient was dying, and I educated the (rather large) family about signs of death and how they related to what the patient was doing. They later told me that they felt that I supported them the most, just by educating them and answering their questions.

The pitfalls… hmmm. My particular unit ROCKS. We work very well together as a team. Other units, however, can be cliquish or simply be so busy that it’s hard to find help. That can make for a very long, hard shift.

I would encourage others to go into nursing. It’s not the perfect profession, but if you like interacting with people and are interested in the medical field, you should consider it. Compared to being a PA – the nurse spends the absolute most time at the bedside of a patient. PA’s, like doctors, spend a few minutes here and there, but they see a much greater number of patients. It all depends on how much time you want to spend. I’m not sure of the hours that a PA works, if they’re closer to shifts, as a nurse works, or more like a doctor, where sometimes they can be at the hospital all day.

Anyone else have any suggestions?

And another plug for you to visit Tsunami Hope: My friend Donna is working on a hospital ship near Indonesia and has been sending updates and photos to her blog pretty much every day. Very interesting reading.

Well, from a ship near the shore, that is. My friend Donna was accepted into a volunteer mission on the military ship Mercy via Project HOPE.

She has started a blog called Tsunami Hope to chronicle her experiences. She will be working as an RN in the ship’s ICU. She arrived there safe and sound on Sunday and has already emailed us with an update. She will either be updating the blog from the ship, or will email me with updates to post for her.

If you’re interested in following her experiences, the RSS feed for her blog is here!

A post in 2 parts today! Firstly, I wanted to direct your undivided attention to this week’s Grand Rounds at Intueri. Maria has clearly spent hours in the kitchen whipping us up some yummy medical treats.

Nextly, Alwin weighed in on a pet peeve of his. I can’t say that I’ve ever personally been in this situation. Maybe Al does “look like Maverick in Top Gun, ready to perform the medical equivalent of an unauthorized control tower flyby every time I move to the bedside.” ‘Course, I haven’t been doing this for over 20 years. His post contains a little quote which fits critical care nursing to a T: “Nothing is so quickly or thoroughly punished in any work environment as competence.” More on that in some other post.

My personal irritation at work is family phone calls. Not the usual one or two per shift that I get: a husband, wife, or son/daughter calling to ask about my patient. Their loved one. They certainly should have access to updates about the patient’s status. And like Al, I love to educate patients and families about the nuances of whatever disease that has befallen them.

No, I’m talking about the patient that has a wife and 4 grown children. This one particular patient I had was really quite very stable and even had transfer orders. Unfortunately, his destination had no beds and he stayed with us until the evening. Well, I say “unfortunately,” but he really was a nice guy with a good sense of humor. I enjoyed having him as a patient.

After the first hour of my shift, that is.

Besides him, I was also assigned to a critically ill patient requiring a good measure of my attention. I quickly assessed my stable patient, and then went to my unstable patient, because he would take the most time to assess and straighten out. In the first hour that I was there, I received no less than FOUR (4) phone calls from Stable Patient’s grown children. One from each! In an hour!! First damn thing in the morning!!

Each time one of them called, I was taken away from the bedside of my other patient to go and tend to them. I was happy to take the first phone call, annoyed by the second phone call, irritated with the 3rd, and downright pissed at the fourth. By the third call, I told the caller that I had already received two calls that morning and it was getting difficult to get things done. To which she replied, “Well, if my father has a direct line, I’d be glad to call it instead.” No lady, there aren’t direct lines in this ICU. Are there direct lines in ANY ICU??

I’m assuming that each caller was not aware of the other callers, because the fourth one came a few minutes after the third. It’s still annoying. The Stable Patient was sitting up eating breakfast and reading the paper. I’ve gotten less calls from family members of patients who were knocking on death’s door. In almost every case, they didn’t want to talk to me, they wanted to talk to their father. So I would just have to “park” them and then transfer the call into his room. (This does not mean that I parked them and then dialed a few more numbers. This means that I had to park them and then physically walk into my other patient’s room and punch in the code I had parked it with.) There are no direct lines into patient’s rooms; we take phones in for patients that can talk to people, and take them out when those patients leave.

Just add “switchboard operator” to my long list of responsibilities as a nurse.

My advice to anyone reading this: No matter what unit your loved one is in, pick ONE PERSON to make a phone call and then have that person update the rest of the family. I found myself giving the exact same update to four people. Most nurses would have told the 2nd caller to call up the first, but I kept thinking that “this will be the last one.”

Those aren’t words you want to hear over the loudspeaker of your place of employment.

The alarm sounded, but although it’s usually cleared within a few moments, this time it just kept going. Ding. Ding. Ding. What the heck was going on? The rumors filtered down over a matter of minutes. A doctor who had been on the Floor In Question came down to ICU with stories of patients being evacuated. Huh? If patients are being evacuated, why are you down HERE telling us about it instead of up there? We thought he was full of it, trying to pull our collective legs.

But then we heard the announcement, and it cemented everything he’d said. We were having an Internal Disaster. “This is not a drill.” Soon, we heard our charge nurse’s Vocera chime in: “Please have all evacuation litters and chairs ready to go when the transporters come for them.”

!!!!

This was real! A real, live emergency! An honest-to-goodness-break-out-the-red-safety-binder-and-look-up-what-to-do-in-an-internal-disaster emergency! Not being one to miss such excitement, I asked my charge nurse if I could go and help out. I’ve never been in a situation like that, and I wanted to see what was going on. She said that would be okay – so I went and asked 2 fellow nurses to watch my patients while I was gone and they agreed.

Off I went to the stairwell. On my way there, I encountered other employees going the opposite direction – out. They didn’t look panicked and weren’t in a hurry, but it was a little disconcerting. If they weren’t up there helping out, why would they need me? But I went anyway, and ran into Someone In Charge. I asked if I could help out and she directed me where to go. (Yes! I get to go!) When I got to that floor, they had already evacuated it laterally across the hall. I discovered that patients were being moved on litters and evac chairs down 2 flights of stairs. There were beds and people wrapped in blankets everywhere. There was no panic, no distress among patients. They were just sitting there calmly waiting their turn to be carried down the stairs.

It was decided to evacuate another part of the floor as well, so I went to help with that. When everyone had been carried off, I went back to where I started. I saw that a nurse was helping a very elderly lady go from a wheelchair to an evac chair. Since the lady looked unsteady, I supported her until she got settled. Right as I was turning around to see if someone could carry her down the stairs, the nurse I’d been helping said, “Ready?” As in… “Are you going to help me carry her down now?” I looked around, but saw no one else that wasn’t already doing something, and I felt like I was holding things up, so… I helped her carry that woman down 2 flights of stairs.

I am very sore. Very very sore. My back feels just fine, but my arms and shoulders hurt. I’m positive that I did not sustain an actual injury (in fact, no one had), but those muscles had not been used for such an activity, ever. The patient wasn’t heavy by any means, but navigating around tight corners was a little harrowing. We set her down in the hallway of the unit we were evacuating people to and someone hurried over to “check her in.” People were going around with lists of names and checking them off when the patient was accounted for.

After that, another nurse and I went back to CCU to get portable monitors so that we could hook up the patients that had been on heart monitors. When we returned to the floor, we found that everyone had been accounted for. Care plans were being printed off and matched to each patient. Patients had been told to keep their own charts, and as I walked down the hallway, I noticed little old ladies in chairs clutching their charts as though they were life preservers. I guess they took instruction well :-)

We went patient to patient, assessing those with heart conditions for chest pain from the excitement and assessing those with respiratory problems for their oxygen levels. There were lots of portable oxygen tanks around, and there were people constantly looking at how full each tank being used was.

Someone from the kitchen brought up cases of bottled water, which I was SO thankful for. Eventually, the Floor In Question was secured, but not deemed habitable just yet. So we faced the task of moving patients around to empty beds on other units, and opening up overflow units to accomodate the rest. Housekeeping was called to clean beds that had been left behind, and they came out in full force. I’ve never seen so many Environmental Servicers at one time, in one place. Beds were cleaned and re-sheeted faster than we could move them.

Finally things started to really settle down. The patients on surrounding floors that had been evacuated went back to their rooms. The others were placed in overflow units. I went back to my unit 2 hours after I had left it and tried to focus on my patients. There was a debriefing session that afternoon where we were told exactly what happened. We went over the things that went well, and there was time to go over what we learned for next time. The Voceras were invaluable. You could get hold of anyone, anywhere – no phones necessary. One thing I’d like to share with other healthcare workers out there that may be faced with a similar situation, though: Although there were patients that could walk, some had a really hard time navigating the staircase in all the commotion. They kind of held up those that were carrying patients down. It might be best to go ahead and carry everyone to avoid this problem. It all seemed to go fast to me, but maybe the slower patients were already evacuated by the time I arrived.

I am so proud of my hospital. There was absolutely no panic, just efficient and expediant work. No one sustained injuries, and no patients had untoward effects. Although some patients were sent to the ER, it was for the closer monitoring that they could provide (CCU had NO beds available to do this). Although we have drills to practice this sort of thing, we never actually haul the patients out of their beds and down the stairs during those times, so this was a true test. It could have been a lot worse, but luckily, it wasn’t.

Some food for thought next time you’re enjoying a pee:
J, RN writes:

Ever ponder the miracle of urine? I mean, really ponder, with utter amazement, the beauty of producing waste? I know, as medical personnel, we tend to get overly excited about bodily functions. But, never before have I ever been so fascinated by a living body to produce something as mundane as urine.

Now, needing to pee is both a blessing and a curse for most of us. A curse as we run from activity to activity without a spare moment to relieve ourselves. That constant tick-tick-ticking of an untapped bladder can drive a person near-insane with the NEED TO PEE. And, upon the moment of actually being able to release that urine, we become one with the universe and thank our lucky stars for the immense joy we feel with the act of voiding.

But what if you couldn’t do that? Not, perhaps, due to a screaming bout of cystitis. Rather, in a renal failure sort of way. Your kidneys shut down and you no longer micturate. The only balance you have in your life is measured by a formula given by a doctor to a dialysis nurse. One liter off. Two liters off. Three. Whatever is called for by the nephrologist.

And then, let’s jump forward a bit and say you’re a candidate for transplant. Suddenly, you’ve been given hope that a kidney will appear and your life will be “normal” again.

Anticipation and disappointment are your constant companions. “Today will be THE DAY,” you wake up thinking. The day ends without a new kidney and you fall asleep thinking with the hopes that dawn will bring you salvation from endless needles, dialysate, heparin flushes, and visits to one doctor after another.

Finally the day arrives. You get your kidney! At long last, you will control your life again. Except that you have to get through the first 48 hours post-op.
Forget sleep during those two days: blood pressure checks every 15 minutes. Then every hour. Then every two. The foley isn’t sitting in your urethra right. It’s pulling and hurting and that damn nurse insists on fiddling with it every two minutes. “Perhaps if we set it here…”

Then, your new kidney does the most incredible thing. It’s actually filtering your blood, removing wastes, and MIRACLE OF ALL MIRACLES, you begin to produce urine.

Everyone on the floor gathers around to measure the amount, color, and specific gravity of the product of your….well….loins.

“It’s too bloody,” claims one.

“No,” says another. “That’s what we expected.”

Yet another medical professional jumps in with an opinion. “Perhaps we should give it some time and see what happens next. Just check every fifteen minutes for the next two hours and let me know what happens.”

Whatever you produce is subject to as much intense scrutiny as the first time. Every two hours, the same people utter the same things.

It’s a waiting game. All you want to do is sleep. All they want you to do is pee. Thankfully, that foley means you all get what you want. Sort of. The constant parade of healthcare providers through your room awakens you. And, really, they can’t wait a full fifteen minutes to check. They’re obsessed with your ability to filter.

Eventually, Someone In Charge will determine that you aren’t producing enough of your precious fluids and order 120mg of Lasix. That’s followed by 12mg of Bumex. Water and juices are set in front of you and you’re encouraged to drink up, “it’s good for you!”

At some point, it’s decided that you’re either in ATN (acute tubular necrosis) or that your transplant has taken. If the transplant has taken, everyone’s happy, but still they watch you like a hawk. Ever vigilant is the staff’s motto. However, if it’s decided that you’re in ATN, that’s when they pump you full of fun diuretics.

For the nurses, monitoring the patient’s urine output becomes a game of sorts. We stand there, watching and waiting. Measuring and recording every drop. Is it enough? Has the patient met the goals for output? When given diuretics, has the patient maintained adequate systolic blood pressures? Have we given appropriate/adequate urine replacement IV fluids? Why is this patient not resting better? Those are just a few of the questions we ask as we assess the fresh kidney.

I’m still new enough to transplants that I get excited over the fact that a patient has gone from the anuric state to one of actual production. I am amazed by the technology and medical advances that allow someone else’s kidney to be placed into my patient, blood vessels connected, and filtration to occur.

I watch as the foley tubing fills with urine. I manipulate the tubing to facilitate more drainage. I’m mesmerized by every drop. The entire process fills me with wonder that modern medicine can do this.

Not every transplant goes smoothly. Sometimes we wait weeks or months to see the kind of results that some of my patients are lucky enough to experience right away. Either way, the fact that we can change a person’s life so drastically is something that never ceases to amaze me – just like the urine my patients suddenly produce.

As you may know, for over a year I had the position in my unit of “break nurse.” By law, ICU nurses can only have 2 patients at any one time, and so a position was created to cover nurses for their breaks or other time away from the unit. The worst part was that it was 5 days a week. Most nurses work 4 days a week, some work three 12 hour shifts. And I know that the majority of adults who have jobs go to them 5 days a week. Personally, I was on a one-way road to burnout doing that schedule and have recently changed to the coveted three 12′s.

Being there 5 days a week, I started noticing that I was doing funny things on my off-time from work. For instance, in the hospital, if the patient has an IV running, the RN keeps track of the patient’s intake/outputs. (Show me an ICU patient that doesn’t have some kind of IV going and I’ll show you a patient that has transfer orders.) Everything that goes in the patient, from a can of soda to a cup of juice, needs to be documented on the flow sheet. Every time they go to the bathroom, that needs to be accounted for as well. It was getting to the point where I was automatically going to write down my “intake” every time I drank a glass of water.

When I worked night shift many years ago, we drew our AM labs at 4am. Now I think that that’s a really stupid time to draw them, but that’s what we did. I remember that on my nights off, when I was in my bed asleep at home, I would wake up almost every night at 4am, look at the clock and think, “Ack! Time to draw the labs!”

We recently started using Voceras at work. They’re little phones that we wear around our necks. There’s a little button on them to press every time you want to talk to someone or answer a call, a la Star Trek style. We use them to tell someone on the other side of the unit that they have a phone call, we call the transporters to pick up labs or help us transfer patients, and we use them to call other personnel in the hospital who don’t usually frequent their desks: the clinical nurse specialist, our boss, the care coordinator, etc. It’s kind of nice because we can use them anywhere – we don’t have to be near a phone. My point is that I use it several times a day :-) One night I was at home in the living room thinking about going to bed, and my husband was somewhere else in the house. I wanted to find out if he was going to bed also; if not, I was going to leave the lights and TV on.

I actually pressed my chest, thinking that there would be a Vocera there. You know, to call him. Unbelievable.

All of the sinks at work are operated by foot pedal. It cuts down on spreading disease and all. Yes, I have walked up to my kitchen sink and have tried to turn my faucet on by stepping on a non-existent foot pedal.

Anyone else? :-)

Oh, how I long to read story submissions. Whenever one lands in my inbox, I inwardly squeal with delight.

Unfortunately, procrastination pretty much takes over from there and so they sit in my inbox, read only by me. I am so sorry to have held your submissions hostage from codeblog. Let me try to rectify that immediately.

From Angie:

On August 5, 2004, my brother was overcome by his bi-polar disorder and subsequent drug addiction. He chose to end his life by overdosing on Tylenol PM. He was a wonderful and caring person, but was never able to overcome his demons. My family loved him terribly and will never stop loving him or forget him. I am writing this to try to encourage others to allow compassion in their hearts when dealing with those who suffer from these family diseases.

Make no mistake, these are family diseases and can destroy families if allowed. When you have a family member dealing with mental illness and they try to self-medicate to overcome the mental illness you can tend to harden your heart. Please don’t harden your heart, open your heart with compassion and try to understand that this is an illness. Most of us feel compassion to those who suffer from cancer because we feel it is not that persons fault. Well I want you to understand that mental illness is not a persons fault either. If there is one thing that has come out of this tragedy, it is my family’s final understanding and compassion to just how badly my brother suffered. As I have often said no one would choose to live their life this way and I truly believe that he hated his illness and his resulting behavior more than anyone realized. He died at the age of 39 and had struggled since he was 16. He suffered for 23 years and it saddens me to say most of these 23 years were in loneliness.

Very well written advice from one who has obviously been there.

From Coral, Student Nurse in Singapore:

Story: Understaffed on a public holiday in Singapore (or Asian country, etc)

Yesterday was Hari Raya Eve. (Hari Raya: Malay festival of lights) The ward was grossly understaffed. Making up for my medical leave a week ago, I had to return to work on a Saturday. Everyone was very busy.

I was persuaded to station myself at male cubicle P3, full of dementia patients either climbing out of bed, tearing out their pants or, spitting on the floor or at nurses. Relatives stared at this clumsy nurse pushing an overladen trolley filled with blood-stained pyjamas, dirty flannels and adult diapers. Changing the patients in the last cubicle, I had to stop many times to catch my breath. Speaking or shouting in the patient’s ears in a variety of languages and dialects, I turned patients or changed diapers alone with great frustration. Even maids took day off today.

A while later, I was taking parameters. The second last patient was elderly and frail, with sallow skin like paper. As I wrapped his bony arm with the blood pressure taking cuff, he looked at me with a mixture of pain in gratitude. Hollowly he said, “It’s no use, why continue? I’m already so old, don’t make so much effort” I said to him almost with tears , “Uncle, don’t ever say that. Don’t ever say it’s too much effort..” Somehow, I got through the day…

Holidays are notoriously short-staffed. There is almost always less resource and support staff. However, after reading this, I don’t think I shall take my nice comfy hospital for granted again.

And from Christopher, who seems genuinely interested in infusion technology:

Just wanted to say I’ve read through a few archives and this place seems like a great forum for honest, insightful real-world medical diatribe…good work!

[Ed: Thanks!]

I haven’t found anywhere else to talk about my experience in the realm of device manufacturing. Specifically, infusion technologies. A fascinating realm, I must admit, but one that somehow provides more questions than answers.

A practitioner, I’m most definitely not, but I am educated enough to know the difference between safety and reality. I’m wondering if any of you out there have had any experiences with the sorts of pumps I’m working with. I really am interested in hearing about any and all of your nightmares, success stories, questions, concerns…

You can leave your comments for Christopher here, as I’m not sure that he wants me to broadcast his email address. Let’s see… infusion pumps… Huh. A lot of current pumps actually work quite well. They obviously have to have free-flow protection of some sort. Calculations are nice – enter the patient’s weight and concentration of drug, and there you go! Good for emergencies. I think the thing that is most lacking in infusion pumps right now is the weight. They’re just way too heavy. Anyone else?

There are more story submissions sitting in my inbox, but I shall dole them out in a few days. Patience!

Before I start this story submission, I want to congratulate all of the 2004 Medical Weblog winners! Great job!

I also want to point out that I have added several more buttons to the sidebar. I discover more and more medblogs every day! As Beth from The Senior Practicum Experience (link off to the side there!) said, “The links on the right of your site definitely reflect an abundance of medical blogs and a scarcity of nursing blogs.” I’ve changed that… when I started making buttons there was only one other nursing blog (Alwin’s Code; The Web Socket), but I’m quite happy that there are enough now for Nurse Blogs to have its’ own category.

Now on to the story submission. Sadie of Foxglove Formulary writes:

I have now been an RN for ten months. I work on a medical/surgical unit on the 3-11 shift. When people see me in my oh-so-fabulously-hip scrubs, they ask me, “Are you a Nurse?” And for a brief moment I feel all giddy, like, yes, Nurse. Sadie the Nurse. (Imagine James Bond music). When they ask me if I like being a nurse, then it gets hard. Because I do- I love my patients for the most part (my husband will vouch for me coming home proclaiming I’m leaving him for some stunningly blue-eyed WWII veteran with a great sense of humor and some kick-ass faded tattoos) and I love being able to do small things to make them feel better. Like give pain meds. It’s my favorite part of the job, other than sitting there and gabbing about nothing, like we are two people stuck in line at the supermarket, not a patient and a nurse in a hospital. That happens rarely, as all of you know, as our workload does not promote socialization with the patients.

If I have enough time to introduce myself and explain that I’ll be providing care for them for the evening before the unit secretary is shrieking her head off that Dr. So and So in on the phone about the patient in 416 bed 2 (never mind that I came on shift 4 minutes ago and don’t know the first thing about this patient cause I haven’t gotten report yet because the day nurse is still expaining it slowly to my darling charge nurse, a very sweet girl who is smart and funny and a great nurse and who will, one day if the day shift doesn’t straighten up, bring a gun and pistol whip the living ..feces.. out of the day charge nurse due to her condescending attitude and the way she talks to her as though she is a deaf dog or something) then the day is off to a good start. But then we get admissions. Because the best time for the ED to send up admissions is 3:00. Sometimes I think they sit there and giggle “it’s change of shift, let’s really mess with them!” It’s also a great time to announce that the patient in 414 is going to a nursing home and the ambulance is here and what
do you mean I didn’t fill out the transfer form? She’s leaving at 3:15 and since I’ve been here for 15 minutes, clearly I should have used my psychic powers to suss out that the paperwork needed to be done. [Ed: And spent the last 15 minutes working on it, of course!]

Though I never eat dinner and run around like a mad woman, I’ve lost no weight. (Not counting the severe abdominal pain I had over the summer which resulted in going to the ED at midnight and getting a CT and ultrasound which proved that I was “anxious and did I want some Xanax?”)

My psychic powers remain weak, as I constantly must remind the unit secretary and the family members of patients, though that must be done in tasteful and diplomatic way.

I no longer am amazed at any pain medication prescription. We have a frequent patient with 30someodd abdominal adhesions, who has had over 20 surgeries and has a permanent mucoid fistula and has a port-a-cath for her seven-times-a-year admissions so she can get PPN and Demerol PCA. In 24 hours she gets an average of 1250 mg of Demerol. [Ed: !!!!!!!] And Ativan 1 mg. And Klonopin 1 mg. And Ambien 10mg. And if you just spoke to her, you’d never in a million years guess that she had that many drugs in her system. She’s actually one of my favorite patients- she’s a very sweet, very sad lady. Some people get upset and go on drinking binges or spend tons of money on Manolo Blahniks. She gets admitted to the floor for 10 days. Then one day she’ll call her doctor from her phone, get dressed, and go home . She kind of breaks my heart.

Out of work right now with a (non-work related) injury. Torn tendon in foot. Accomplished this by walking in the driveway to the car to go to work, wearing “Professional” Clogs by Dansko. Perfectly reasonable shoes, but I still rolled my ankle and messed up my foot. Got a text message from my Charge nurse buddy, who for future reference I’ll call Selena- she told me that one of our favorite patients died last night. A sweet 90 year old man who had the unfortunate luck to break the acetabulum and spend the last 6 weeks of his life with 50lbs of skeletal traction to his leg. He’d sing in his room, humming and harmonizing all night long. A lovely man. “You’re a good girl!” He’d say to us as we cleaned him up and straightened up his bedclothes, giving him pain meds when he finally admitted he had some pain. And then he’d thank me. “From the very bottom of my tomato, you sweet girl you!”

I’ll miss you. RIP.