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When You Look Up

This post might be a little weird, but here goes. I was thinking the other day about when you’re concentrating on something in front of you, and you look up for no particular reason and are faced with something dreadful or funny.

For instance, once I was at work charting and heard a mechanical noise next to me. I didn’t really think anything of it (I’m surrounded by machines!) but decided to look up when I heard the noise stop. In ICU rooms, there are monitors mounted to the wall next to the beds. They’re high up, maybe 6 1/2 feet. I’m 5’5″ and I always have to reach way up to adjust alarms, etc. When I looked up, I saw that my patient had found the button that raises the entire bed – all the way up to the monitor. He could have started playing with it if he’d had the inclination. I didn’t realize that the beds could go that high.

Other things I see aren’t so humorous. This just happened the other day and it always makes my stomach drop with dread. I walked into my patient’s room, looking at her medications as I did so, and looked up to see a pool underneath her bed – of liquid poo. When there is so much poo that it actually starts falling off the bed to form a puddle below, things have simply taken a turn for the worse.

It’s always a treat to look up and see your vest-and-wrist-restrained patient hanging upside down over the side rail of their bed. Completely tangled.

This last one didn’t happen to me, but I heard plenty about it. We had a patient who fell at home and broke his neck. The doc decided that he needed Gardner-Wells tongs (scroll down a bit for a picture) until surgery could be done. These are tongs that are secured into the head to provide traction for the cervical spine. I don’t know if they’re screwed into the skull, but suffice it to say that you don’t want those suckers comin’ out.

Can you see where this is going? The night shift nurse looked up and saw her previously flat-on-his-back patient sitting up in bed, tongs off to the side of the bed. The patient stated that they were really bothering him and he felt much better having them off, thank you. He also relayed that it was really difficult to get them off, but it was worth it to be free of them!

No harm done; the patient had his tongs replaced, had surgery later that day and did just fine. Still… what a sight.

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Yes, they screw into the skull. I’d want mine off, too!

One night I was precepting a new RN (not a new grad, a new hire with ICU experience). Since I was the charge nurse that night I told this orientee that I would take the first admit and I assigned him to care for only one patient, a relatively stable female on a ventilator who was having a procedure in the am – nothing difficult, some Zantac and antibiotics to hang, mouth care, bath/bed change, etc. Piece of cake, right?

Well, this woman, while restrained, managed to extubate herself not once, not twice, but three times in four hours. Anesthesia would come, sedate her, reintubate, and as soon as the sedation wore off she’d do it again. Three times. And since it was technically my patient, I was the one who had to wake up the pulmonary doc three times to tell him. I thought for sure he was going to reach through the phone and choke me the third time. I thought anesthesia was going to choke me the third time, but he just smacked my newbie on his butt with a big Mac blade. ;-)

That patient was the first thing that came to my mind when I read about your patient with the bed controls. Oh, well – at least there weren’t any ‘oh no, suddenly the thoraseal is full’ moments.

Every time I consider going back to ICU nursing, I get a mental image of looking up to see a patient squirmed out of restraints and trying to pull their ET tube out. Then I get over my impulse to go back to ICU nursing!

How about a baby hanging off the side of the bed by his ETT and a restraint?

My significant other told me about a patient that was brought in for swallowing various things such as razor blades. Well, after having the various nasty items removed the patient received a follow up x-ray. Oops, he had swallowed some more things. In particular he swallowed several of the metal curtain hangers. After those were removed guess what happened. Yup, he found some more curtain hangers, a pen, and a few other items to swallow.

I remember my Mom (a nurse) telling me about a patient that had pulled his catheter (with a balloon on the end that’s inflated once it gets into your bladder) halfway out of his penis, but the balloon was too big to make it out. Apparently he had some mental problems.

Picture this: Triage in a big pediatric hospital during RSV season.
The waiting room is packed & wait times are 8+ hours. I’m scanning the waiting room for temp re-checks & respiratory reassessments, agitated moms are getting up in my face to ask how much longer (for the millionth time), babies are crying, coughing & some are running around like little monkeys. Amidst the chaos I see a 3ish year old sitting there, parent nowhere to be seen. What’s that he’s playing with? Oh, a plastic bag…oh shit! He’s pulling the plastic bag over his head!! I don’t know how I got from the triage desk to the kid
thru the sea of people between us
but I got there. I snatched the bag off the kid’s head and glared daggers at the adults that were ignoring him. The kid was fine, I walked shakily back to the desk & finished my shift on the adrenalin
left in my bloodstream thanks to my
little friend with the plastic bag.

Extubated three times in an hour… man, I’d be getting out the staple gun after the second!

Have looked up more than a few times to see an enterprising two year-old with one leg over the cot sides and a “What? What’d I do?” expression on their face.

Then there’s the “No, I’m not really going to pull my ETT out, I’m just… resting my hand on it. Yeah that’s it, resting…” routine.

i always like when they pull out ng tubes and just seen so totally amazed that tube keeps coming and coming and coming!

Thanks for a great blog. Good to see it from the nurses side of things rather than the patients. Looks like you have exactly the same frustrations!

So, what brought you to the hospital today?

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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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