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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

He learned that phrase in english pretty fast.

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

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

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

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

I also found some great stories on these nursing blogs:

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

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

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

W.B., paramedic, writes:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ah, I love the happy endings!

From H-guy, the Tanfastic MD:

When I did my sub-internship month earlier this year, I had one of those “wake-up call” moments that are embarassing at the time, but in hindsight you’re glad to have happened. I walked into the room of one of my ICU patients and noticed that the pulse oximeter was reading 75%. After having a momentary freak-out, I looked at the patient and was puzzled by the fact that he didn’t look like he was in any distress. As I was struggling with whether I should bring this up with a real doctor, the nurse walked in. I asked her why the pulse-ox was so low. She looked at me like I were an idiot. She asked me if I bothered to check if it was even attatched to the patient–which it wasn’t. So, while I was running down the differential for hypoxia, I tossed common sense right outta the window.

A comment about the nurse. This was my first time meeting this nurse and she sure as hell never let me live that incident down. She was rude to me for the whole month after that, but that was just how she was, and I learned to find her attitude humorous. She had seen my type come and go for the past 25 years. I was just another snot-nosed uptight med-student to her, and she was a hard core ICU nurse from whom I learned alot. Fortunately, I learned early on to be friendly with the nurses from the outset, b/c among other things, they can really make your life a living hell if you don’t give them their due props. By the end of the month I had eventually killed her with my kindess, and I even got a smile out of her. I felt I owed her that much for knocking some sense into me.

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.

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.

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.