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The Hidden Danger of Candied Pecans

This is a story submission from The Gypsy Nurse.

The following was originally written back in April 2005. I’d been traveling for about a year at this time. Working in McAllen, TX. McAllen was a mixed contract for me. I had some minor difficulties on the job with a co-worker but met some wonderful and lasting friends while there.  There are so many experiences that I attribute to having worked as a Travel Nurse. Things that I don’t know if I would have ever seen or done if I had remained a staff nurse in my hometown.

The Hidden Danger of Candied Pecans

Yep…candied pecans! Made fresh on the street in a boiling pot of oil, sweet, hot and so very innocent looking. Very yummy and you know my love for sweets! I couldn’t pass them up. However….as wonderful as they are, I will never eat them again. I picked up a small bag of these delectable yet dangerous goodies in Progresso, Mexico today and saved them for an evening snack. Upon crunching on my first bite….yes, my FIRST bite…I chipped a tooth!! Guess I need to go back to Mexico and see the dentist next time. So, no more candied pecans for me! Guess I should have passed them up this time as the waistline doesn’t need them anyway! Maybe someone is trying to tell me something?

My new Travel Nurse friends; Theresa, Ed and Paul joined up with me for a day-trip to Progresso Mexico. We drove to Progresso today and had a great time. We stopped in a little cafe and had breakfast while listening to a Mariachi band, then we wandered the streets and attempted to make a few deals with the street vendors. All over town, you can hear the hawkers calling out “almost free” as they attempt to sell whatever trinket they have for sale. I picked up some sort of noise maker/toy for my daughter for “almost free!”  She will love them but I’m sure that her Dad will want to kill me for sending them.

After shopping all morning we landed at a local place named Poncho’s for beer and margaritas. Live music today included some really BAD country singer!!  We were more than happy when the Mariachi band wandered into the bar and gave a slight reprieve from the bad karaoke type country music! After a couple of drinks, we wandered down the street for some fresh taquitos from one of the street stands. One of my favorite things when visiting a new place is to savor the food. The street vendor didn’t disappoint. Final stop included the liquor store as everyone knows that no trip to Mexico is complete without cheap alcohol…and of course noisemakers touted ‘almost free’.

It makes me sad that the safety along the Mexico border has changed so very much since I was there in 2005. I don’t know if it’s even feasible to drive across the border anymore.

I recently spent some time in the south-central area of Mexico and felt perfectly safe there.  I just don’t know if I would cross over from the US at this time. If you do happen to make it to Progresso…stop in at Poncho’s for a cheap (yet tasty) Margaretta and find your own trinket “Almost FREE!!”, but be sure to stray away from the candied pecans…they really are dangerous.


I’d love to get more stories from travel nurses!  If you’re a travel nurse and have some good stories, use the “submit your story/contact” link at the top to send ‘em my way!  Happy New Year everyone!

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Is Your Stethoscope Naked?

Recently, I was contacted by Dr. Jennifer Namazy who came up with a very cute way to decorate your stethoscope.  Dr. Namazy started CharMED, which sells sparkly crystal cuff charms for your stethoscope.  The “about” page on her site says, “From ugly scrubs to dreary white lab coats, ask any woman in the medical field and they will agree…there are few opportunities to sparkle.”

Besides jewelry (which we are normally encouraged NOT to wear), medical professionals really don’t have many ways to jazz up their wardrobe for work.  Dr. Namazy graciously gave me a charm to review AND is giving one away to any codeblog reader that leaves a comment on this post stating what color charm they’d like to have.  More on that later!

I recently received my iridescent charm in the mail and immediately went to put it on my stethoscope.  It fits well and looks great.  It does slide up and down the tubing, but it came with a foam insert that you can also use to help it stay put.  It’s very sparkly and quite pretty.



I asked Dr. Namazy a few questions about her charms.  She says that she and the other medical professionals she works with felt limited in terms of being able to show some style and bling in the workplace.  Knowing how popular charm bracelets are with the staff (giving them the opportunity to show off their favorite colors, initials, etc) she thought it would be cool to have charms for stethoscopes!

The charms needed to be seamless, preferably without clasps that could loosen or come open.  She designed the shape of the charm herself so that it would fit snugly on the stethoscope’s pliable tubing.

Of course there is always concern about germs, especially in hospitals.  To head off any problems there, Dr. Namazy chose a metal that is naturally antibacterial for the base of the charm.  It can be easily cleaned with an alcohol pad and doing so will not damage the crystals that adorn it!

The charms have been available for about 5 months and are already popping up in hospital gift shops around San Diego.  She has plans to expand nationally soon, but the charms are available now in her online store at get-charmed.com.  You can also find her on Facebook and Twitter.

And as I mentioned before, there’s a giveaway for codeblog’s readers.  Just leave a comment stating which color you like best, and one commenter will be randomly chosen to receive that charm.  Good luck!  The contest ends on Wednesday, December 12th.  (12/12/12!)


(Update:  Contest CLOSED!  The winner is Megan, who left the 7th comment.  Thanks everyone!)

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I knew this day would come…

Submitted by Margaret Gambino RN BSN

As a teacher in a small community you are bound to run into your students while out to dinner, at Wal-mart, or at church from time to time. This is the joy of teaching, to see a student you taught many years ago who is now a successful working professional. To know that you as a teacher played a small role in that person’s life and helped to propel them into the field of nursing is rewarding.  I have worked with former students side by side, who are leaders in the profession, while training new students who are just starting out. To walk on a unit and see a former student working as a charge nurse is teacher bliss!

However, as a Health Occupations Teacher who, from time to time, needs medical care in a small community you are bound to run into a former student. Yes, we teach patient confidentiality and HIPPA but we never expect or let’s say “hope” to be the patient of our former students. I began to stress about an upcoming medical appointment where I knew two former students worked. They worked at the facility because I placed them there during their internship for school. The physicians liked them so much they were hired. That was several years ago and they are still employed at the medical office while working towards their BSN at our local university.

I was very stressed about having to be weighed, measured and pricked by a student for whom I taught these skills. The skills are simple enough, but this was not the issue. The issue was the students had always regarded me as their teacher. How would they feel when the roles changed? Would they always view me as their teacher or would they see me as their patient?

The day of the appointment I went to the office and there to greet me was a former student. We were both apprehensive at first about our new role as nurse and patient instead of teacher vs. student. However, the student treated me professionally and with utmost respect. Wow! It was great to be taken care of by a health care worker that I personally trained! The field of nursing is so rewarding and to be privileged to teach it as well is the icing on the cake! I hope to continue in this role as RN/Health Occupations Teacher for many years to come. I am proud to be a nurse, it was simply one of the best decisions I ever made, but combined with education is it also gratifying and humbling.

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Walking for Food Allergies

I’ve written about my son’s peanut allergy several times before.  It’s obviously a cause near and dear to my heart.  When a friend asked if I wanted to do a 5k sponsored by FAAN (Food Allergy & Anaphylaxis Network), I thought it was a great idea.  FAAN’s mission is to raise public awareness, provide advocacy and education, and to advance research on behalf of all those affected by food allergies and anaphylaxis.

So I signed up, and I have a donation page if anyone would be interested in helping me reach my goal (I’m almost halfway there!)  The 5k is this Saturday and I’m looking forward to participating in my first one :)

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Rookie Mistake

My new hospice job is going pretty well.  I really like it.  It’s been an adjustment, but worth the stress of change.

Overall, I’ve been pretty surprised at how little I know/knew about how people die naturally.

In ICU, if you are actively dying, you look terrible.  In most cases, people dying in the ICU are there because we were or are trying to save their life.  This requires some treatments that cause other problems.  The fluids and medications we give cause pretty severe swelling.  Add in mechanical ventilation and the patient may even end up with scleral edema – where the whites of the eyes fill with fluid from pressure and swell to the point of not allowing the eyelids to fully close.

Don’t Google it.  It isn’t pretty.

The medications can also cause the circulation in the extremities to shut down, leaving them cool (or cold) and discolored.  Really discolored… we’re talking blue. And even if the patient is on a ventilator, they can still do what we call “fish breathing” which looks exactly how it sounds.  It looks like the patient is gasping for air, even if 100% oxygen is being forced into their lungs 20 times a minute.

That is what dying looked like to me for 14 years.  Turns out it’s a pretty exaggerated version of how it is when people naturally die without life-saving interventions.

On my second night out sans preceptor, I was called to a house early in the evening to help with symptom management.  I was told that the patient was minimally conscious and was starting to have labored breathing.  The family had started giving oral morphine liquid to help with this and were panicking about the whole thing a little.  I went and assessed the patient.  She was mostly unconscious, her breathing a little labored.  I provided a lot of education about what they could expect as the process continued and how often to give medications.  I really spent a lot of time talking with them about what was happening.

The family’s greatest concern was that she was going to die that night.  They just weren’t ready.  They didn’t want to fall asleep only to wake up and check on her in the middle of the night to find her gone.  Things that are already difficult are made all the more so for some people when they happen in the quiet loneliness of night.

They asked me if I thought it would be that night.  Honestly, despite being unconscious and breathing a little differently… ok, maybe her color wasn’t great, but it wasn’t awful – her feet felt only the tiniest bit cool and weren’t discolored at all (there was no mottling, which is when the skin becomes discolored and blotchy).  Compared to what I was used to seeing in patients who were dying, she didn’t look too bad.

So with my inexperienced eye and a desire to tell them what they wanted to hear, I fairly confidently said that I couldn’t say for sure, but I didn’t believe she would die that night.  Their relief at hearing this was obvious.  The taut faces and bodies in the room eased a little.  The aura of the entire room changed.  An actual hospice nurse just said that their mom would probably make it through the night.

Show of hands – how many of you reading that just slapped your foreheads in disbelief?  I did as soon as I got back into my car and spent the drive home beseeching death to keep its scythe to itself until after the sun had risen again.

I was on all night.  I went to bed a couple of hours later after again offering up a silent request that she make it through the next 8 hours.  I didn’t mind having to go out in the middle of the night.  I just didn’t want to be wrong.  “Ok, I get it,” I said to the universe.  “I shouldn’t have said that and I will never say anything like it ever again please just don’t let her die tonight please please please thanks.”

The chime of my phone woke me up a few hours later. It could have been for anything, for any of the patients that we have on service.  “I have a time of death visit for you,” the triage nurse said.  My fogginess cleared up in an instant. “…. Who?” I asked.  When she spoke the familiar name, my shoulders slumped.

I felt awful.  I drove to the home in the darkness, nervous about what to expect.  Would they be angry with me?  I would have deserved it.

I arrived at the home and when they answered the door I told the teary daughter that I was so sorry for her loss.  She just nodded.  I asked if I could go back to see the patient and confirm the death.  She opened the door to let me through.  After looking at the patient, I turned to the daughter and said I was sorry about what I’d told them earlier.  She nodded again and was quiet.  But then said, “You did a great job telling us what to expect, though.  Her breathing changed a few hours after you left and we checked her feet – they were cold and didn’t look right.  I knew it was close.”  That made me feel a little better.

I would say that “When do you think it will be?” is by far the question I am asked the most.  Interestingly, sometimes patients I think are pretty close actually hang on longer than I expect, and the opposite is true – patients who seem to be far from dying die much sooner than I would have guessed.  The best example of this is a patient I went to see one night.  He had been conscious that afternoon but was mostly unconscious by the evening.  I was called out because he’d been having periods of apnea (not breathing).  The entire time I was there his breathing was perfect.  His vitals were perfect.  I felt a very strong radial pulse.  His extremities were warm and pink. The family asked me in about 10 different ways when it was going to happen.  I just said that he had some signs of death being close, but not others and that it was hard to say.

He was dead by morning.

So I have learned that a dying person’s condition can change very rapidly.  This is different from what I’m used to for sure.  The ICU course follows a fairly predictable pattern most of the time.  Not so predictable outside of the hospital!






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Asking for Stuff

I get a lot of email asking me for stuff.  Ad requests, what my thoughts are on this or that, could I post this link?  Would I like a guest post?  Hey, we’ve linked to you, can you link back to us?  And really a whole lot of “we are positive that your readers will find this link very interesting!  You should post it!”  Sometimes someone does actually send something interesting, and I’ll read it and think, “Oh, this sounds neat” but then I’ll get distracted and forget and then I go back to reading through all the email a week later and it’s too late.  Anyway, my point is that I’m terrible at answering email, even when I find it interesting.

But today I got a different sort of email, and the sender asked me to share his personal fundraiser on my blog.  “Seriously?” I thought.  But something caught my interest (and both kids were napping, so that helped) and I clicked his link.  It’s an interesting back story and that last perk there at the bottom just made me laugh, so I made a deal with the guy – I’d post his link if he gave me some stories to go along with it.  And he did.

So the email said this:  “My name is Paul Sebring and I am currently enrolled at the Ida V. Moffett School of Nursing at Samford University because after having helped in Haiti after the earthquake and leading a cleft lip/palate mission in Ecuador, I realized that becoming a nurse was the most important thing I could do in this life.”

And then he provided a link wherein he asks for money.  So here are some stories he wrote about his experiences in Haiti.  If you like them, throw a few bucks his way.   He gave me a few choices – I found these interesting:

Burr Hole Boy:  06/11/2010

On Monday night we went to the Plaza Hotel  to check emails and such when Gabe from IMC pulled me to the side and asked if there was anything we could do to help a 16 year old boy that needed a Neurosurgeon.  It turns out that 3 days earlier this kid was in a motorcycle accident in Gonaive and his family finally got him to the General (state run hospital).  He had a pretty bad head injury and he seemed to be somewhat stable but he still needed a Burr Hole procedure.  This is a simple procedure where they drill a few holes into your head to relieve pressure on the brain.  Anyway, so Gabe tells me what’s going on and what the kid needs when the attending doc at the General calls me to tell me about the kid too.

It’s apparent now that we need to get this kid to a Neuro team to save his life.  Medishare hospital wasn’t an option since they were right in the middle of being moved to their new facility and Adventist hospital didn’t have a Neuro team at their facility either.  I knew that the hospital in Milot (I was there a few weeks ago doing a supply run) had a Neurologist showing up soon so I called Jo and asked her if they could take the kid.  She was really excited to take him since their Neuro team was showing up the next day, but when she talked to the local hospital administrator he denied our request because he felt they were not well equipped to do brain surgery.  The problem is that this kid didn’t need brain surgery, just a decompression.  Jo tried her hardest but knew there was no way to change this guy’s mind so Jo took it upon herself to call a hospital in the Dominican Republic and she actually got the hospital there to accept the kid, a full Neuro team to receive him, and she lined up an ambulance to pick him up from the heliport.  Jo, you’re amazing.

This is where it got good.

I called up Sam from Grass Roots United because I needed his help with getting a helicopter and he had a connection.  Keep in mind that Grass Roots is about as big an NGO (Non Governmental Organization) as ourselves.  When he heard of what was going on he called up his contacts and got the helicopter.

Now all we have to worry about is how are we going to get this kid through customs and out of Haiti.

Back to Jo, she’s now working with the Dominican Republic to get his papers approved, I’m working with the General to get the kid’s papers ready and Sam is working with Haitian customs to put it all together.  At 10am the next morning we had all the paperwork in order, a green light from Haitian customs, a green light from the DR customs, a helicopter, a doctor to go with the kid, a medical team to receive the kid and an ambulance to take him to the hospital.   Time to put everything in to play.

Christina and Micaela go to the General and scoop up the kid and take him to the airport.  When they get there, guess what, the Haitian official “claims” that she never received the email with paperwork and it would cost $100 USD to get the kid out of the country.  Sam pays the $100 fee (bribe) and gets the kid on the helicopter, which just happens to be the size of a VW bug, and gets him to the DR.  When they arrive in the DR it was a bit of fiasco with the Immigrations department but the receiving hospital got them to accept the kid, they loaded him into their rig and got him to their facility to do the procedure.

Now, let’s put this in perspective.  What we did for this kid saved his life and it was all done by 2 small NGO’s with no funding.  You all know how I feel about this topic, and I’m not going to go on another tirade about how ineffective the big NGO’s can be.  All I have to say is thank you Jo and Sam for helping us get this kid to a medical team that saved his life.


All in a days work:  Haiti update from 8/2/10

Let’s start off by saying that the Haiti diet is the best way to lose weight. Between the flop sweating, mass consumption of water and overall repetitive diet I have lost almost 65 pounds since my first trip here. Jenny Craig ain’t got nothin on Haiti. The bad thing is that I am still out of shape. Granted I’ve had to have people bring me new clothes because all my original pants would fall off me and the 3-4x shirts looked like tents on me. I’m now at a 40 inch waist and a 2x shirt.

Now, back to the out of shape thing.

This morning a few of us had to go to the General (state run hospital) today to transfer a pre-term momma to Adventist hospital. She is TB positive and about 30 weeks along. Contractions were 10 minutes apart so we had to get her to a place that was much more well equipped to handle the mom and baby.

LP (co-founder of MMRC) was dropping Tuwanda, Jeanne and Ellen off at a clinic near the Embassy so we had to walk to the hospital. It’s only about 1.5 miles but the fun part is that you get to dodge traffic and pedestrians while walking at a very brisk pace. I was on the phone with the TB Clinic Doc about this patient and it was apparent that we had to get her out of there and to Adventist ASAP. About 6 blocks from the hospital I told the boys we had to pick it up so we started running. Now please try and picture this: 2 marines and a fat guy running the streets of Port Au Prince. The marines look like they are in great shape. They’re running in unison, have great form and are weaving through cars. They don’t even look tired and they’re barely breathing hard.

And then there’s the fat guy…. ME

I’ve got one hand on my backpack to keep it from flailing everywhere and the other on my belt to keep my pants from falling off. I’m trying to not get hit by cars that I can’t see because the sweat is flowing so profusely down my face it is blinding me. I’m beet red and am huffing and puffing so hard that the locals can’t stop staring at me. And the best part is, you can’t stop this much momentum without a few hundred yards notice.

So after about 3 blocks I holler at Sully (one of the marines) that he can run if he wants but poppa bear is going to have to keep it at a brisk pace. We finally arrive at the General and I am sweating so bad and I’m so hot I can’t even form complete sentences. Oh ya, I almost forgot, my pants are soaking wet and my grey shirt is dripping.

After being there for about 15 minutes we get the ok to use an ambulance, we load up the patient and Michelle (RN), Sully (Marine), Riaan (Corpman) and myself head over to the Adventist hospital with her. The best part is that I still can’t stop sweating but now I have to wear gloves and a mask the whole time we are en route and try to comfort a very scared mother. Brooke (RN) was expecting us when we arrived and she made sure everything went through smoothly.

As we drove back I had a chance to look down at myself and it is apparent that I’m a hot mess. I just wish I had video of this so I could just see what the locals got to witness.

I found out 2 days later that both the mom and her new baby daughter are just fine.  The family brought the mother back to the TB ward 24 hours after the delivery.


Good luck, Paul!


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True Hospice Story **

I parked my white Prius in the gravel driveway and looked around.  “Since when are there cornfields in this area of California?” I wondered.

I walked up to the faded and windblown farmhouse and knocked on the screen door.  There was no immediate answer so I took a moment to look around.  It was beautiful out here.  Quiet.  It was late afternoon, the sun was shining, there was a nice breeze.  I knocked again.

A heavyset woman in a dingy white nightgown came and peered at me through the screen door.  “Hi, I’m Gina, here from hospice?”  She nodded and opened the door.

I followed the woman into the living room.  Despite there being a large front window, the curtains were closed, so there was very little daylight coming through them.  The room was small and dim.  I could make out a hospital bed and when my eyes got used to the dark, saw an elderly woman laying in it.

The woman in the bed had wet, ragged respirations.  “You told the triage nurse she’s been doing this all day?” I asked the woman who had let me in.  She wearily looked at me and nodded.  “Do you have any of the medicine left?”  She shook her head no.  I looked back to the woman in the bed, …. what the heck?  She was now laying on her stomach, her back bare.  How did she do that?

I was a little confused, but got back to the issue at hand.  “She definitely needs the medicine.  How long has it been since she took any?”  The woman shrugged.  “Okay,” I said, “I can call some medicine in.  Are you able to pick it up in town at the pharmacy?”  Before the woman could respond, a man appeared in the doorway.  He said, “Oh yeah, we can pick it up.  We have a whole bunch of errands to run.  So you’ll stay here with her” – he jerked his thumb towards the woman in the bed – “and we’ll just take your car.  Be back soon.”  He smiled sort of eerily.


“Well, actually, sir, I can’t just stay here with her; I have other visits to make.  And you can’t take my car….”  I instinctively glanced out the front window to look at my car parked in the driveway.  Hadn’t the curtains just been closed?  Well, now they were open and I could see the car just fine – enough, in fact, to notice that the door to the gas tank was open.

“Well you’re the nurse, and you need to stay with her.  And we need to get that medicine.  So yeah, you’ll stay here and we’ll just be gone for a little bit.”

I started towards the door.  “No, that isn’t going to hap-” At that moment, a teenaged boy came into the room grinning from ear to ear.

“Hey thanks for the gas, lady.  The tank in my car has been empty for MONTHS.  Now I can leave!!”

I’m not sure what happened next, but the next thing I knew, I was speeding down the road in my white Prius, gas light blinking, thinking that I was going to be leaving one heck of a voicemail for the team soon…

** In that it’s true that I really dreamt it :)  I guess this is the new hospice nurse’s version of an anxiety dream?  Instead of merely dreaming about showing up at a patient’s house without supplies, I dream about almost having my car accosted by the patient’s family!

I’ve been at this new job for a month so far.  It’s going pretty well.  I’m almost off orientation, actually.  It’s a much different world and it’s taken some getting used to.  I abhor being the new girl and not knowing things, you know?  I don’t know how traveling nurses do it, actually.   You have to figure out new computer systems, new paperwork, the way each doctor likes to have things done.  About half of our patients are in their homes, and half are in facilities.  And each facility has to have things done in their own way, so it’s a lot to learn.  I’m looking forward to getting more comfortable with the nuts & bolts.

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PICC dressing change tips

I’ve already learned a couple of things this first week in my job!  Mostly related to changing the dressings on PICC lines.  Since I was reminded several times that “Hey, it’s just you out there in the field – no stopping Jane RN who’s passing in the hallway to ask if she can grab you a Biopatch” I thought I’d share the two main tips I learned.  (Hang in there – fun story at the bottom of the post!)

First is in regards to the statlock.  I was in the habit of taking the entire tegaderm dressing off, then fiddling with getting the statlock off and unstuck from the patient.  This sometimes jostled the PICC, which is obviously not a good thing.

I learned to take off the tegaderm until it was clear of the statlock, (but still covering the catheter at the insertion site) THEN take the statlock off.  Once that’s off, tape down the ports and finish removing the tegaderm.  This keeps the PICC nicely in place under the tegaderm while you’re messing with the Statlock.

The second thing I learned – and I am completely embarrassed to admit that I never really gave it any thought, thereby ensuring that the next person to change the PICC dressing I’d done probably cursed me – is to always put the slit of the Biopatch around the PICC line itself.  That way, when you take off the tegaderm, the Biopatch just comes right off with it.  I was in the habit of putting the Biopatch on then rotating it for whatever reason – to make sure it stayed on?  Like it was really going to go anywhere under the tegaderm?  Here‘s a great picture of what it should look like. I *KNOW* I am not the only person who does it wrong, because I have changed many PICC dressings wherein the tegaderm was stuck to the Biopatch and it took forever to get it all apart while trying to preserve the PICC line.

I was beyond (BEYOND) happy to find out that hospice nurses at this organization do not start peripheral IV’s.  We may do venipuncture for labs, but no starting IV’s.  I am very bad at starting IV’s.  I will even go so far as to admit that I have not successfully started an IV in over 5 years.  To qualify, though – I was only working one day per week in all that time, and I worked in CCU.  CCU patients have central lines and PICCs.  And I always seemed to be working with nurses who were masters at starting hard IV’s so all I had to do was ask, and someone would come do it for me.

My IV-starting mojo was damaged early on, and I will tell you why.  When I was working in my very first job as a nurse, my grandfather had to come to the hospital I was working at for carotid surgery.  I went to visit him on the med/surg floor during a break from my shift and his nurse noticed that his IV had infiltrated.  He needed a new one.  She tried 2 or 3 times, but couldn’t restart it.  Another nurse was sent in – she also tried several times without success.  With the nurse’s permission (and my grandfather’s), I then tried to start the IV.

I found a suitable vein and prepped the skin.  Right before I stuck the the needle in, I offered up a silent prayer: “Please, if the gods are listening – I really want to get this IV in.  If I never start another IV again, please PLEASE let me be able to start this one.”

I got it in on the first try…. and the gods were listening.  Although I have successfully started many IV’s since that day, I have never been very good at it overall.  Ah well.  I was good at it when it really counted :-)

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On Leaving CCU

Recently I made an announcement that may have made a few people think I was half a bubble off level.  I’m leaving CCU.

I’ve worked in CCU (and CVICU) for 14 years.  5 years ago I had a baby, and reduced my hours to one day per week.

It took me just about all of those 5 years to fully comprehend that one just can’t keep up with all there is to learn working only one day a week in CCU.  The basics come back to you if you have enough experience with them (ventriculostomies, for example) but the New Stuff is coming in droves and is being implemented constantly – new therapies, new monitoring machines, new procedures.  When you can’t make the in-services given during the week, it falls to the weekend coworkers to bring you up to speed, and I was feeling very guilty about that.

“Why not just put the kids in daycare and work more?” one could ask.  And one would have a point.  But…

I recently had a patient that almost any CCU nurse would thrive on – unstable, many drips, lots of titrating.  In years past, I enjoyed the dance we do when trying to stabilize a patient, my brain happily bathed in adrenalin.  But this time, although my brain was still bathed in adrenalin, I found the dance… boring.  Tedious even.  Now that is an interesting feeling – all jazzed up and bored about it.

Thinking about it later, I realized that although my last several employee reviews were good, I could never come up with “new goals for the next year.”  I had no desire to be an open heart nurse, take care of patients on balloon pumps, get my CCRN, or learn anything else, really.  Although I have plenty of skills, I just didn’t want to learn any more about critical care.

So although I had a great-paying job with great flexibility and seniority, I found myself contemplating leaving it all behind.  But to do what?

Over the course of my career, I realized that I enjoy working with the patients that are close to having or are having life support removed.

Why?  I’m not sure.  Why does anyone like anything?  All I know is that I felt a great deal of satisfaction when I was able to see a patient through to passing peacefully.  You form an almost instant bond with others when in that situation, and not just the patient, who was usually unconscious by that point.  I have always enjoyed working with family members.

So I decided to become a hospice nurse, and there was a company out there nice enough to hire me despite my total lack of any actual hospice experience.

When you tell someone you’re a nurse, they usually ask “what kind; what do you do?”  When I would respond, “critical care,” they’d say, “Oh! Wow.”  When I told my coworkers I was leaving to become a hospice nurse, I got a few “Oh… uh, interesting…” and lots of “oh, you’ll be great at that.”  But the prize for best answer goes to one particular doc:

Me: “This is my last weekend.”

Doc:  “Oh, why?”

Me:  “I’m going to hospice.”

Doc: “…. but you don’t look sick.”

Ah, hospice humor.

I have nothing but the highest respect for my former employer and my former coworkers.  They are a huge reason why I stayed so long and I consider several of them family.  But every time I think of the new direction I decided to go in, I feel a little thrill of excitement to learn something completely new.  Hopefully with enough tweaking and HIPAA-nating, I can share some of my experiences with you all.

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Interview – Humanitarian Nursing

I had the opportunity to interview Sue Averill RN, BSN, MBA, CEN who is the president of One Nurse At A Time.  The goal of the organization is this: “to reach out to nurses and help them get involved in the humanitarian and volunteer arena.”

Sue is a 32 year veteran of Emergency Room nursing.  She also worked in the business world as a manager for a cruise line and in that role created the medical department for ships, designed ship hospitals, hired staff, and wrote protocols.  For the past 13 years she’s done volunteer humanitarian nursing all around the world.

Sue started in the ER as a senior for her student practicum in 1979.  “Those were the days before certification, before ACLS or PALS when the only ‘specialty’ areas of nursing were cardiac, surgery and pediatrics.  I thought doing a semester in the ER would give me a well rounded view of all aspects of nursing and then I could choose.  But I fell in love with ER and stayed.”

As a volunteer humanitarian nurse, Sue works for Doctors Without Borders and other non profit organizations as nurse, Medical Coordinator (program in charge), or Project Coordinator.  Since starting as a humanitarian in 1999, she’s worked mostly in subSaharan Africa, but also in Asia and Latin America.  She’s done about 25 missions so far and has loved most.

Tell me about your missions:  how long is a typical mission?

Surgical and teaching missions are typically 1-2 weeks.  Disaster response will usually be a month or more at a time.  MSF/Doctors Without Borders missions are minimum 6 months, although I’ve gone as a “troubleshooter” for 1-4 months. When I first started in 1999, I went for 1 week trips.  In 2004 I went to Liberia for 1 month and thought that was nearly impossible to be gone from home for so long and work so intensely.  Later that year, I committed to 6 months in Darfur with MSF and did four 6 month missions back to back.

What do you do during a mission?

On the surgical missions, I normally work PACU (Recovery Room).  When I’m on MSF missions I’m normally the medical coordinator – this is the highest level medical position as it’s the person overall in charge of all the projects in a given country.  This position sets policy and sets the medical objectives for the field teams.  I’ve also worked as a field nurse and project coordinator.

How many other nurses are with you? 

On surgical teams, there’s usually a scrub and circulating nurse, perhaps one other PACU nurse.  Most organizations try to use local staff to work alongside to share out knowledge and the workload.  In MSF, the number of nurses varies by size of the project.  Most I’ve worked have been just one nurse per project.

What’s been a favorite place to go?

I absolutely love Guatemala.

What’s the worst/scariest thing you’ve seen?

I stumbled into a war zone in south Sudan and triaged and treated 100 wounded soldiers.  We were in the area to help civilians displaced by the resurgence of armed conflict between northern and southern troops, but was faced with immediate livesaving needs of these individuals.

Is there an example of something you’ve done where you saw an immediate benefit? 

Probably the difficult delivery situations stand out in my mind the most.  On hands and knees helping women with troubled labor in dark huts with dirt floors.  I saw some successful outcomes, and some not.  One of my biggest joys was taking lay population in our remote village in Darfur and training them to become medical personnel.  It was an amazing transformation to be part of.

What would someone who’s interested in humanitarian work need to do to get started?

Take that leap of faith!  Know your skills are adequate to the task, steel yourself for leaving home, comfort, and everything you love – know that this will be a life changing experience!  Find an organization that fits your beliefs and skill base (see “Organizations” on this page).  Learn as much as you can about the country, people, society, culture, and language of where you plan to go.  Research common diseases in the area.  Stay flexible and have fun!

What frustrates you about your job?

Politics.  It’s there in hospitals, the humanitarian world, business.

Was there any extra training besides on-the-job learning that you were required to complete? 

In humanitarian work, I’ve done many tropical medicine courses, security training, infectious disease, etc.

Curious to read more personal accounts from people who have volunteered abroad?  You should definitely check out Nurses Beyond Borders, which is an anthology of international nursing stories.  I myself am about halfway through the book – if you’re more into electronic reading, you can pick up the Kindle version at Amazon.com: Nurses Beyond Borders: True Stories of Heroism and Healing Around the World. (affiliate link)

Thanks to Sue for her insights about humanitarian nursing!

If you are or know of a nurse that works in a nontraditional setting and are interested in being interviewed, email me at codeblogrn@gmail.com.  My post about this project and a list of interviews done so far is linked here.





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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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