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New Arrival

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Our son was born on November 24, 2006 after an induction for PIH. He’s healthy and adorable and I simply cannot keep my eyes off of him :-)

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The Heart Attack Grill

Introducing the Quadruple Bypass Burger – and would you like a side of valve replacement with that?

Don’t expect medical care if you experience your heart attack at the grill:

As a courtesy, the restaurant offers its “best customers” a wheelchair service to their cars by waitresses dressed in slinky nurses’ outfits.

The idea, however, has not gone down well with the Arizona State Board of Nursing which has expressed concern that some patrons may confuse the waitresses with real nurses.

How do you get to be a “best customer?” Multiple bypass surgeries?

(Added December 12th): Wow, lots of hostile comments!! For the record, I am not “railing” against the Heart Attack Grill or the fact that the waitresses are dressed up as slinky nurses. I was merely putting it out there as something interesting. I’m more or less in agreement with these two bloggers: Emergiblog and Disappearing John. Basically, it’s not offensive to me because it’s a parody! I actually kind of think it’s a funny premise for a restaurant. Unhealthy? Yes, of course, but funny nonetheless.

And hey – I’m all for the health of the masses, but if you ALL were healthy, wouldn’t that put me out of a job?

(Eating unhealthy foods might cause heart disease. If you already suffer from this, learn about the benefits of the Coronary Artery Bypass Surgery and don’t forget to take care of your heart!)

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Checking In

Hello! Just wanted to check in and let you all know that I’m doing great. The little one is just fine and is due in the next few weeks. We’ve been busily getting ready over the last few months. Being on LOA has been really nice… I’ve been enjoying sleeping in almost every day, especially knowing that it’s my last chance to do so for a very very long time. Anyway, here’s a little story submission from awhile ago that I’m getting around to posting now. Enjoy!

In July of 2005, when I was 24, I was diagnosed with a pituitary tumor. The following November I underwent surgery for it. I was told before surgery that I may or may not end up in ICU afterwards, but that I shouldn’t be surprised if I did. I had a wonderful surgeon (almost a year later, it still looks like he got all of the tumor), but unfortunately developed a roaring case of diabetes insipidus post-op. Instead of the expected day in ICU, I was there for three.

I don’t remember much about those three days. I had a foley, and I remember that I wasn’t allowed out of bed at all. I remember how noisy the ICU was, especially during shift changes, and I remember all of the beeps. I have vague memories of Respiratory Therapy being called for the first day, because I was having trouble breathing due to my packed nose. Mostly I recall that the room was dark and I didn’t want the window blinds opened, and I didn’t want the TV on.

The biggest memory I have, though, is how my day nurse, Kevin, took care of me. He always had a joke and a smile for me, and he always made sure that he was close-by during visiting hours in case my parents had questions. And I remember how on the third day, someone asked him how I was doing… I don’t know who it was. His answer, “She isn’t smiling anymore.” That just wasn’t acceptable to him. He came in, he opened the blinds on the windows, and he turned the TV on. He put it on a John Wayne movie that was halfway through, and he went to go get me something to eat. When he came back, I was still watching the John Wayne movie, and he told me, “You know, you can change the channel!” I grinned and asked him what was wrong with John Wayne, and he grinned back and said, “Nothing, but he walks funny.” It was the exact same answer that my best friend gave me a month later when I recounted the experience.

That same day I was moved out of ICU, and 4 days later they finally sent me home. I hate to think what things would have been like if Kevin hadn’t made such an effort to make me smile and to really take care of me. I’m tearing up right now, just thinking about it.

I just wanted to tell ya’ll my story, so that you can know that there’s one more person out there who truly appreciates everything you do. It’s amazing the difference that one person can make in what could otherwise be a pretty miserable experience.

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Why Aren’t You Watching This?

I know I’ve written before about futile care and about keeping people alive past the time when they should have passed from this world. News flash: I’m going to write about it again. Right now.

When I first began nursing in an ICU, I was very naive. I remember one of my very first long-term patients. He was having a second heart bypass surgery. Or maybe it was his third. I remember thinking, “Just how many times can one have bypass surgery in one’s life?” Well, in this guy’s case – three.

The surgeons and perfusionist could not get him off of the heart-lung bypass machine after the surgery. He just didn’t tolerate it. This necessitated them bringing the patient over to CVICU while still on it. Then it apparently turns into a VAD – a “ventricular assist device.” The hope was that it would take some of the strain off of the ventricle so that it could rest and then we could wean him off the machine over a day or so instead of over a few minutes.

I remember how busy he was and how complex it all looked. He was truly the sickest individual I had ever seen.

Call it blind naive optimism or too many TV medical shows, but …

It never crossed my mind that he would not recover from this.

He remained on the VAD for a few days or so. When he came off the VAD, he still required multiple pressors. He was swollen, sedated, and still the sickest person I had ever seen. He then followed a course that I was to witness many, many more times over my career: trach, PEG, weeks and weeks in the ICU, and once he finally left ICU he would come back several times before finally dying.

One thing I remember about him was that we would feed him ice chips with blue food coloring. In that way we could tell if the stuff he was coughing up from his trach was aspirated ice chips.

It was. Every time. Blue phlegm.

The other thing I remember is that his wife came to see him every single day and would stay for a long time. Maybe she had no other obligations, maybe she did but made him a priority. I don’t know – all I know is that she was there.

This brings up a few things that I’ve been thinking about lately. I realized that for the majority of my patients and their family members, their loved one being critically ill is the first time they’ve ever seen anyone so sick before. Through hope and a misguided sense of medical science’s abilities to cure, they have unbridled optimism. They don’t see the same cases day in and day out. Just as when I was first exposed to someone so ill, they don’t realize that there’s really a chance that the patient won’t recover.

This realization has gone a long way towards clarifying the thought process that goes into making someone who is obviously (to me) terminal a “full code.” With the patient that I described above – I think it would have really shocked me if someone had suggested stopping treatment and letting him die.

The other thing that has been on my mind recently is the availability of those making decisions for the patient. We recently had a patient that was in ICU for over 3 months. It was clear to many of us nurses that she would never, ever leave the hospital (and turns out, didn’t leave the ICU for more than a day or so on transfer before she’d be back). The family was adamant that everything be done for her and she lay in that bed and wasted away day after day. Her labs became increasingly abnormal. She developed bedsores despite frequent turning and skin care. She was trached and was on the ventilator. She was fed through tubes. She closed herself off from almost everyone, even nurses that she used to smile at before. She would barely look at her family… but there’s the thing. The family. That family was there every single day to watch this unfold. Did that make it right? I don’t think so, personally. But it made it a little better in my mind. At least they were taking responsibility for their decisions. They were at the bedside every day, watching the patient deteriorate as the months went by. That really meant something to me.

Yet a few rooms down, there is another patient in a similar situation. This patient is also trached and is fed through tubes. It’s impossible to get him off the ventilator. The times that he has communicated with us through writing, he has told us that he’s ready to die. Ready for this to be over. But his family is making the decisions. They’ve decided that everything is to be done for this patient. If his heart stops, we’re going to pump his chest and try to get it restarted. Yes, the family knows his wishes – they’ve seen what he’s written. They won’t accept it.

The difference? The family very rarely comes to see this patient. Maybe once or twice a week for a few minutes. They’ve put this patient in hell and now they won’t watch it. They won’t watch what they’re doing to him. They aren’t present for the times he coughs and needs suctioning. They aren’t there to step out of the room so that we can clean up his incontinent bowel movements.

They just aren’t there. I think it’s one of the saddest things I have ever seen.

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The “project” that I’ve been working on…

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After 4 rounds of fertility drugs, 3 IUI’s, 2 years and 1 IVF cycle (none of which even worked), we are finally parents-to-be!!! We had the “big” ultrasound today and found out that this little guy is, well, a guy. I’ll spare the whole darn internet the picture which confirmed THAT. :-)

We are beyond thrilled and can’t wait to meet him late this year.

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I Think I’m On Summer Vacation …

… from my blog. Sorry for the absence. I’ve been working on a project that has taken some precedence over the blog. I’ve been very sad to see some of my favorite bloggers decide to throw in the bloggy towel – Medpundit and Shrinkette. Best wishes to them both!

Work has been very busy as usual. There are a few posts floating around in my head, but for now I will leave you with some story submissions! Enjoy.

Sam, Student Nurse writes:

This happend to me last week and is a message for all you RNs. I work on a PACU unit at a university hospital and often we bring people to the floor after they get the ok to leave recovery. I was asked to bring a 16 year old girl up to the Neuro floor. She was reporting pain her pain at 8 but the RN’s were ready for her to leave recovery and giving pain meds delays the process 20 more mins. So I push her bed up to the 7th floor and I could tell she was hurting. I explained how we were going to move her into her bed. The floor was busy and a few RNs popped in and out of the room as I waited for more lifters. I could tell the pain was getting worse and I started to talk to her. I was only 19 and it looked like we could have been friends. I asked her about school and told her to breathe through the pain and once we got her in bed we could give her something and let her family in. Suddenly she reached for my hand. I was shocked, no one had ever reached out for me before. I held her hand, I stroked her arm and talked to her for 20 minutes when finally more people came to help move her. Her nurse told me “Sorry it took so long, I bet you had better things to do”. My honest reply was “NO, I think someone needed me to be here more”.

Nurse Steph writes:

I work on busy telemetry unit, and the shift had just started. We had just finished taking report from the off-going day shift and were walking out of the breakroom when I heard some loud but beautiful singing. As I neared the nurse’s station I saw a large lady with her hair sticking straight up sitting in a wheelchair at the desk and singing her heart out. Several nurse aides invited her to return to her room and she refused, they tried pushing her wheelchair and she planted her feet on the ground and wouldn’t budge. One of the nurse aides was standing behind a plastic utility cart and the Singing Lady grabbed it and pinned her to the wall. Now, this is shift change and there are Dr.’s, nurses, family members, etc at the nurse’s station. The Singing Lady became louder with singing and intermittent cursing that would make anyone blush. We all tried to no avail to get her to her room and put her tele back on (which we discovered she had placed in the trash).
Finally, we had to call security for assistance. It took 4 security, 2 nurses, and 2 male nurse aides to get the lady to bed. We all thought that the night would calm down and we could get busy. We were very wrong. I had a patient having chest pain, and went to attend to him (nitro, stat ekg, labs, vitals, etc.) While I am assessing the patient’s pain level and finding that his chest pain is completely gone, I hear a blood curdling scream “Stephanieeeeeeee”. I go running down the hall to my schizophrenic patient’s room (where nurse aide Stevy is assigned as a 1:1 sitter) and find the aide with her head on the bedside table. My patient had grabbed her ponytail and put her head to the bedside table and was scratching her face. Several people had run in by then and we got the lady calmed down and Stevy free. Stevy had to go to employee health because of nasty scratches to her neck. In the meantime another nurse had the Singing Lady and a foley was ordered for her. Well, you can only imagine how that went. You could hear her all over the floor! She was yelling obscenities about her private parts to the nurse and the tech helping. She described her privates in a way we had never heard. We couldn’t believe our ears, this is a elderly lady soliciting the young male tech assisting the nurse, who quickly left the room.
Another nurse had been looking for a patient for an hour or more and the patient in the next bed said he saw him and his foley (urinary catheter) bag leave the room. Well, we called security, house supervisor, Dr., patient’s family, etc. About 30 minutes later we receive a call from the local police department asking if we had a pt by the name of ——. They had found him 2 city blocks away carrying his foley bag. When they stopped him, he threatened them with his foley bag raised in the air. Needless to say they called EMS to return him to the hospital. Upon his return when the nurse asked him why he left, he stated he was going to get help for the lady that was being killed down the hall (the singing, screaming lady). All of this happened in a period of 3 hours and then the night finally settled down. We still laugh about that night 3 years later. You never know what is going to happen from one hour to the next. And just because you don’t clock in on psych doesn’t mean you don’t work on one.

(Oh, that last sentence is so very true.)

Last one, from “CICU Nursie:”

I was reading your post about the meat fibers and it sounded so familiar. One woman in particular comes to mind. I came in and got report from D. She was telling me how this lady came in to the ICU confused and hypotensive and that it was all downhill from there. O2 was now 100% NRB and she looked like she was gonna buy a tube. I went in to assess her and her posture just jumped out at me. It looked like she was gasping for air, neck arched and head thrown back. Decided to perform oral care first when I peeped the dried secretions making a ring around her mouth. I had to assemble the sponges, water and moisurizer because no one had taken the time to do so in the nearly 72 hours she was with us. I started by removing large hunks of dried secretions from her mouth and eventually got my fingers on a three inch long hunk of what looked like meat only it wasn’t meat…it was mucus that dried and built up on the prior dried bits to eventually block her airway. I can’t really recall how many times I have received patients in severe respiratory distress due to an easily removed blockage. How many times do these elderly NPO patients have to code before some of these practitioners realize that a little regular mouthcare goes a long way.

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Nursing Wiki!!

This was written and sent in by Joe, who is a nursing teacher and Nursing Science student. I have already made an account with the Nursing Wiki, but have not really contributed anything yet. I think it’s a great idea and could be a great asset to the online nursing community. If you want to add your nursing blog to the list on the wiki, go to the blog page.

On May 1st, 2006 a new Internet project for nursing was started. Since then, a community-driven free database with nursing-specific content is being developed at http://en.nursingwiki.org. Anybody is welcome to contribute. The articles, which are written, extended and edited by volunteers, are freely accessible by anyone, and the contents may be used by anyone without charge.

Thanks to the free encyclopedia Wikipedia, this principle of “free information” has been a well-known phenomenon among Internet surfers for a while. Wikipedia’s English version has more than 1 Million entries and is being supported by more than 200,000 volunteers. Since not only the contents but also the software that runs Wikipedia (MediaWiki) are available for free, anyone who is interested can start his or her own Wiki project. The “NursingWiki” was started because Wikipedia articles are limited to encyclopedic entries. For this reason articles containing specific instructions (for example for setting up a nursing plan) are not appropriate for Wikipedia entries.

“Wiki wiki” is the Hawaiian expression for “fast – quick” and illustrates the principle of the projects to quickly and easily create new articles and link them to existing articles. No computer programming background is necessary. Anyone who has ever written an online email before should be able to find their way around the way Wikis work. With the offering of the NursingWiki a development is making its debut in nursing that has been established in other areas for a long time. In software development, the free exchange of information has been common for a long time and has turned out to be a great success. Volunteers collaborate on projects and constantly extend and optimize their work. The NursingWiki works in a similar way. Volunteers create new articles, extend or correct existing articles to keep them current, all without any commercial interest. Since articles in the NursingWiki cannot only be read but also edited, there is a certain kind of “self-cleaning effect” inherent in the
Wiki way: only things that gain the approval of the large critical readership will be able to survive in the Wiki. All changes – corrections of simple typos as well as complete re-writings – are being logged in the version history of each article. This offers an overview of the history of each page and makes it possible to undo any potential vandalism through the restoration of previous versions.

At this time there are innumerable discussion forums, blogs and web pages offering nursing-specific information on the Internet. NursingWiki’s advantage is that visitors can correct mistakes in the articles right away in an easy manner, and they can also add more information from their own expertise. The NursingWiki site is not meant as competition to other nursing sites, but rather a central place for nursing-related information and tutorials.

The NursingWiki volunteers collaborate on this project for different reasons:

* Nursing students put their class notes and papers on the wiki. For their exams they know where to find all the necessary information to prepare for each exam. Chances are high that the entries have already been edited and extended by other users.

* Many nurses and nursing teachers enrich the wiki with their specific expertise and experience, which are often missing from common nursing textbooks.

* Patients and their family members can find information about diseases, therapies and medicine, and can share their experiences with others.

After about one and a half years (March 2006) the German language sister project “PflegeWiki”, which started in August 2004, has more than 2900 articles about different nursing topics. For example there are entries with concrete instructions (“How to put on sterile gloves”), special procedures (“Replacing a tracheal cannula”), profiles of well-known nurses (“Patricia Benner”), information about diseases (“Morbus Parkinson”), and anatomy (“Heart”) as well as nursing theories (“Self-nursing deficit”), nursing models (“ATL/AEDL”) and articles about nursing science (“nursing research”). Many articles contain photographs or other visual aids, which can also be freely used on home pages as well as for lectures as long as credit is given to PflegeWiki.

The English version NursingWiki has been started to give an international touch to the freely available nursing information. These projects are sponsored by the German organization “Verein zur F?rderung freier Informationen f?r die Pflege e.V.”, which is officially hosting the web sites and coordinates user activities and does the necessary PR work.

Since NursingWiki has not been around for a long time, many fundamental articles still have to be written. Therefore we need your help:

Be brave. Contribute and make your knowledge available to everyone.

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Pacing

Working in an ICU, there are of course instances when we decide to stop aggressive measures for our patients. One of the newer nurses (to ICU) had a patient whose family decided to stop ventilation and pressors. When the patient was extubated and pressors discontinued, we began waiting for the inevitable.

The patient had a permanent pacemaker, however. While he was being supported, his heart rate was sufficient enough to not need the pacer… but when we took it away, his heart rate started to slow down, as was expected. This is when the pacer started to kick in. The nurse asked how she would know when he died (from outside the room, just looking at the monitor) if the pacemaker just kept going. We told her that sometimes the heart just stops responding to the pacer and all she would see is pacer spikes on the monitor with no resulting heart rhythm.

One of the more experienced nurses mentioned that it was possible years ago to just put a magnet over the pacemaker (which is implanted in the patient’s chest, but is usually visible as a lump under the skin) to shut it off. She then added, “But with these newfangled pacemakers, you probably have to turn it off using a computer.”

Can you imagine emailing your pacemaker to tell it what to do? That would be a bad address for the spammers to get their hands on.

Several years ago, I came to work and took report on a patient that was very close to dying. For some reason, the curtain to the room was mostly closed, and I couldn’t see the patient well. When I looked at the monitor, I saw that he had a pacemaker and had pacer spikes, as well as “capture.” Capture is when the heart responds to the pacemaker and beats accordingly. I finished getting report – the offgoing nurse said that she last checked on the patient about an hour before and he was unconscious but breathing. I decided to check on my other patient first and got caught up in doing tasks, but every time I came out to the desk, I would glance at the dying patient’s rhythm and it was always the same – pacer spike, capture.

By the time I got into his room to see him, I found that he had been dead for quite some time. He had that lifeless look about him, and the absence of respiration also tipped me off. There was of course no pulse, but up there on the monitor was a consistent and unwavering spike-capture rhythm. I learned a very important lesson that day – you can be in PEA with a pacemaker too.

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From A to DD

Every procedure done in a hospital has risks. You even have risks going into a hospital. It’s a pretty germy place, seeing as how people usually go there when they are ill. And even the most seemingly innocuous treatments or procedures can lead to more problems. IV sites can become infected and phlebitis can occur. You may have allergic reactions to the medications that are routinely administered for your condition.

Some people just have bad luck, I guess. We recently had a patient, a very elderly woman, who fell and needed surgery. While doing a workup for surgery, all kinds of labs and tests are done to make sure that the patient will survive anesthesia. Of course, this is usually the point at which some elderly people are diagnosed with a plethora of conditions. She did have some issues with her bloodwork and while correcting those issues, she had a bad reaction to the treatment. This reaction was the reason she came to ICU.

We worked to correct her imbalances but it became clear that she would not be able to go to surgery that day. She was in a lot of pain, which we tried to manage as best we could. The pain medicine made her itch. The other pain medicine we tried made her confused.

When she finally had surgery, it was determined that she would need invasive lines to monitor pressures in her heart and lungs. I shall qualify this by saying that she weighed about 100 lbs … and putting invasive lines into someone so thin runs the risk of puncturing a lung.

Where do you think this is going?

She did fine after surgery, was extubated in the recovery room and returned to our unit (with invasive monitoring line still in place) on nasal cannula. A few hours later, however, she developed respiratory distress. Another chest x-ray was done and it showed a very large pneumothorax. Her lung had been punctured. Yet another doctor was consulted to put a chest tube in.

She certainly wasn’t thrilled by the prospect of having a doctor come to insert a large plastic tube into her pleural space, but if it would help her breathe more easily, then… well… how could she say no?

The chest tube insertion went smoothly and we all expected things in that room to calm down. And they did. I kicked the family out and the patient napped off and on and seemed more comfortable overall, although still not as comfortable as I’d expected. The post chest x-ray showed that the chest tube had gone more towards her back than up towards her collarbone, but the doctor was hoping it would work well enough.

A few hours after all the drama, my patient put her light on. When I went to answer it, she said that she felt as though her “boob was bigger.” Her chest wall on the tube side definitely looked a bit larger and had the rice crispie characteristics of subcutaneous emphysema, which can be a complication of chest tube insertion.

I notified the doctor and was told that she was elbow-deep in someone else’s chest in surgery. As my patient was not in any distress, we agreed to keep an eye on it for the time being.

Another hour went by and I went to check on my patient, who appeared to be napping calmly. She awakened when I smacked her bedside table with my leg (ow) and I casually looked at her chest again. The swelling had definitely increased and it was very visible on her small frame. She appeared as though she’d been bench pressing, but on that side only. I called the doctor again, who still couldn’t come. I called her partner, but he was far away at another hospital. My patient still wasn’t in much distress, so I just decided to get another chest tube setup ready to go for when the doctor could get there.

The next time I went to check on my patient, I could see from the door that her chest was still bigger yet. We discussed how she was feeling and she looked down at her chest and said…

“Well, you tell those doctors that they have another thing coming if they think that I’m going to pay for this implant!”

Even though she’d endured complication after complication (and complications from the treatments for the previous complications), she still had a sense of humor. I love patients like that!

I called the doc again and informed her that our patient had gone from an A cup to a double D and that she really needed to come and fix her. She came over as soon as she could, still in surgical cap, shoe covers and face mask. We got another chest tube in the patient and she was finally 100% comfortable with her breathing (well, as well as you can be with two large plastic tubes sticking out of your chest.)

I was off for a few days after that, and when I came back to work I noticed she had been transferred.

Hopefully she got out alive.

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Extracting Meat

Imagine this: a very thin elderly woman in a hospital bed. A list of her medical problems would be longer than your forearm in 12 point type. She’s been very ill for months. She can’t eat and is fed through a tube. At one point she couldn’t even breathe on her own and was on life support. Her kidneys are failing and she is on almost-daily dialysis, which she sometimes cannot tolerate without the use of vasopressors. Her circulation is bad. She has a massive bedsore on her tailbone and her foot is starting to turn colors. Bad colors.

Over the last few days, she has grown increasingly unresponsive. Sure, she’ll open her eyes when you say her name, and she’ll barely move her head in response to questions. But for the most part, this woman who would clearly call “Nurse!!! I know I want something, but I don’t know what it is!” last week is no longer even verbal now.

As I go about my day, preparing her medications and changing various dressings, I wonder what the point is. She’s clearly dying. She has tremors, so the pulse ox on her finger sometimes doesn’t read correctly; I have already gone in the room 20 times to adjust it. Usually it shows that her oxygen saturation goes from 98% to 60% in the space of 10 seconds, which is just not altogether possible… hold your breath for 10 seconds. I can guarantee you’d still be in the 90% range.

Except for this time. This time, I’m sitting in front of the monitors charting, and I hear the familiar dong-dong-dong and look up. My patient’s pulse ox is reading 80%. I figure that her tremors are acting up again for the billionth time (and resolve to put the damn thing on her ear next time I go into her room) and continue charting.

Dong-Dong-Dong.

Perhaps 30 seconds have gone by. The monitor now senses that her pulse ox has gone to 60%. (DING! DING!! DING!!!) We’ve been here before, several times. I sigh and look up from my charting just in time to see her heartrate go from 110 to 54.

Crap!!

I run into the room where I see that her pulse ox has a nice, even waveform. Definitely accurate. Although her heartrate has come back up to the 80′s while I was rushing into the room, her pulse ox is definitely in the 60′s, and although her chest is moving, there is no condensation on the inside of her oxygen mask. She isn’t breathing effectively.

I have some choices at this point. It would be entirely appropriate to find an ambu-bag and put the form-fitting mask over her mouth to force air into her lungs while I call for help. But for some reason, my instinct tells me to grab the Yankauer suction and stick it into the back of her throat.

Her eyes are open, but they are staring past me. I watch as the Yankauer fills with copious amounts of pale yellow/tan mucus. Part of me is relieved – this will surely fix her right up. But it just keeps coming and coming – where was all of this crap stored for heaven’s sake??

Then it stops. I’ve lost suction. I look at the suction head on the wall. It’s still set to high. I look up at her sats. They’re firmly in the 80% range. I look at her mask. There’s condensation on the inside. Good. She’s moving air.

I pull out the Yankauer. What was on the end of it may very well haunt me for the rest of my days. It was long and the matter at the end was the size of a large marble. It was black and somewhat solid, not like sputum or mucus. I wiped it off with a paper towel, regained suction and stuck it back in her throat. More mucus, more sputum. Sats up to 92%, definite air movement. Whew.

I didn’t figure sending the product of my suctioning session for culture would quite help us figure out exactly what it was. After showing the doctor, he suggested that we send it to pathology.

After the excitement died down, I wondered just what I did for my patient. Sure, I kept her from suffocating, but if that had happened in a nursing home, where she wasn’t on a monitor… I can’t really say I felt great about “saving” her. Does that sound a bit callous? I’m just not sure what I saved her for. More bedrest? An amputation of her foot? More infection? More dialysis?

Interestingly enough, she became a different person after our little incident. She began speaking again within the hour. She began calling out for the nurse again. Her children came to see her and marvelled at how she was so much more alert and responsive than in days past. She insisted she wasn’t in any pain.

I had a few days off after that. I came back to work to find that she had coded and was reintubated the day after I had taken care of her. She remains that way now.

I also found out that what I pulled out of the back of her throat was described by the pathologist as “meat fibers.”

Meat fibers. In a woman who hadn’t eaten anything in weeks. No wonder it was unrecognizable.

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Author

  • 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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