code blog: tales of a nurse

"milly rn" writes:

Another day, another patient - of kuwaite nationality. No surprise I work in an icu in a private hospital in london uk. kuwaite families ship their loved ones out to london when given any kind of grim diagnosis in the misguided hope that we over here will be able to fix the problems! they usually arrive half dead having been rotting in one of their own country's hospitals for weeks ( tip - dont get ill next time you visit kuwait) all paid for by the kuwaite government (nice lot arent they!)

Anyway mama m arrived, supposed to be very sick ventilated unstable blah blah blah........... in a wheelchair launched herself into her bed on arrival with no assist (we didn't have time to get near her such was the speed of her action all we saw was a blur of black cloth) and proceeded to mime the urgent need for food and beverages moi moi moi sista!!!( translation -water water water sister!!)

moi & munchies were obtained, mama was happy, family were happy. doctor not happy - mama had a K of 7 and no percievable kidney function at all. cue bit of action.....insertion of 1 vascath, trundling out of 1 Prisma CVVHD machine....priming of machine ........attachment of mama to said machine. followed by 12 hrs of machine alarming constantly..... stopping constantly... generally not doing its stuff..mainly due to the fact mama was a rolling around in the bed...as you in the know will know, not good for flow in a vascath not good for attempting cvvhd (or to the uninitiated the sort of continuous dialysis thingy we do in icus for clapped out kidneys & clapped out patients)

mama could not sleep (nurses could not read gossip magazines), due to the godamned racket the prisma machine was making & also probably if im honest due to the nurses (me & collegue) stomping up to the machine cursing & restarting it approximately 500 times every hr.......for 12 hours........

mama who supposedly spoke not one word of english apart from the term sista (nurse) announced wearily in the morning-'mama no sleep machine crap!' i was very impressed! that woman will go far in this city of ours.

I wasn't sure if I should post that submission, because it is a bit insensitive and because I don't have the patience to edit it enough to read smoothly. It's literally been in my inbox for 2 YEARS and every time I read it, the end just cracks me up. Because sometimes the CVVH machine is crap. -ed.

"Catheter Commander LVN" writes:

Having worked for 2 years in the ER, my experience became most helpful when I went into Correctional Nursing. You ask, "why do they fake a seizure?" They fake it for several reasons here: To get out of their cell when the facility has been locked down. To get the attention of staff. To get to an outside facility (hospital) where the women are much more abundant and prettier and the FOOD is sooooo much better.

We now on a case by case basis use the hand drop, pen across the nailbeds and brushing of eyelashes to determine validity of the "seizure." We're running about 95% on the FALSE side now. Before, we just tossed in an IV, threw on some O2 and out the door they went to the hospital. Since we started doing these checks, the seizure activity has slowed tremendously, go figure. Its nice to see them walk back to their cells, head hanging with a write-up for attempted staff manipulation.

And finally, "loved nursing RN" submitted this:

My mom, an active 83yo was fine till she got hit by the truck called CNS Lymphoma. Getting her admitted to , we thought she had a good chance at recovery. The last 7 months have been a nightmare with hospital acquired infections, 3 rounds of pulmomary edema, poor transfer of info at change of shift, blatant lies by staff from nurses up to and including administrators.

The infection control standards are appalling, compassion lacking in most of the doctors and NPs even knowing I am a nurse with a wide variety of technical skills did not put them on guard to do the right thing. No they would argue that keeping a used red rubber suction cath in a liter bottle of saline on the FLOOR was acceptable clean technique. Administration would never acknowledge a mistake. When I suctioned mom myself because of a 2 hour wait for the nurse, I was reprimanded and threatened with my license. The large medical centers are not what they should be.

Yikes.

Submitted by My Own Woman:

It was one of those rare nights on midnight shift where the ER was eerily quiet. The quiet and calm doesn't happen often in the ER and the nurses try to take advantage of it when it occurs. After all the supplies were stocked in each room and the trauma carts and the Zoll monitors were checked to make sure all was functioning properly; the nurses sat down together for a rare moment of rest. It was 4 AM, the time on night shift where the wind starts to go from your sail before you catch your second wind about 5AM.

As we sat and talked about non-nursing related things in our lives the Ambulance phone went off. I got up to take the call. "This is A-1 Ambulance. We're bringing in a 20ish year old male with severe injuries to both of his legs. He was hit by a car while riding on the back of a garbage truck. His heart rate and respiratory rate are within normal limits. His blood pressure is slightly elevated and he rates his pain in both legs at a 10 out of 10. He has an IV established with Normal Saline at 100 and we have him on high flow oxygen. We'd like to give some Morphine. He has no allergies. ETA 5 minutes." I relayed the information to the ER doctor who authorized Morphine 2mg IV and we will re-evaluate upon arrival.

The patient arrives to the ER 5 minutes later without any relief from the previous Morphine. His legs are deeply cut and crushed at the level of the knees where the car clipped him while he was riding on the back of the truck to collect garbage. His vital signs were stable except his blood pressure was elevating probably in response to the increased pain. After an assessment by the nurse and the ER physician, Dilaudid 2 mg IV was ordered and given along with some IV fluids. X-ray came to the department for a series of xrays on his legs. The Patient Care Technician came into the room to draw blood and do an EKG. All the while the patient kept asking me if he was going to lose his legs. "Please, am I going to lose my legs? Please tell me." I couldn't answer him, I had no way of knowing at that time but the prospect of him losing his legs was a good probability. He had no pedal pulses and no sensation below his knees. I told him, "I don't know right now, we have to wait to see what the tests tell us." It was an honest answer. He turned to the Patient Care Technician and asked her the same question, she immediately responded, "No, you're not going to lose your legs, quit thinking like that. Everything is going to be fine." I wanted to scream at her but held my tongue and tended to his immediate care.

We cleansed his gaping wounds behind his knees and bandaged them with sterile water and gauze. We gave him repeated dosages of Dilaudid as we prepped him for surgery. It was horrible watching this young man with his whole life in front of him crying because of the pain and the uncertainty of his diagnosis that must surely have been going through his mind. After a short time we shipped him off to surgery and the Emergency Department was relatively quiet once again. We had added a few more patients in the time I spent in this man's room, but everything seemed to be under control.

I couldn't get the young man off of my mind and the scene and conversation I had witnessed between the Patient Care Technician and him. Finally, after wresting with my conscience, I took her aside and told her that telling him he was not going to lose his legs was not a very good thing to do. I told her that she could have very well given him false hope and that is the last thing you want to do to a patient. She apologized to me and told me "she just wasn't thinking."

The night ended without any more trauma and we all went home to our beds. I had the following day off and went about my normal routine. The following day I returned to work and my arm was grabbed by the Patient Care Tech that had helped me with the young man two days earlier. Her eyes were red and swelling with tears. "He lost both of his legs," and as she spoke the words the tears rolled down her face. "They cut off both of his legs, they couldn't save either one of them." At first her words were not registering in my mind until I realized what she was talking about. The young man who she told would be just fine had lost the very thing he was so concerned about and wanted reassurance about. The tears welled up in her eyes more. "How could I have done that, how could I have said everything was going to be ok?" My heart went out to her. In her attempts to ease his mind, she let him down and herself. "How can I ever make this up to him?"

I shook my head back and forth and said, "You can't do anything for him, but you can learn from him and never tell anyone things that you don't know for sure. You learned, and learning is a good thing." She replied, "Yeah, I learned, but I still have both of my legs."

This is a very good lesson. However, I can't help but wonder if despite her comments, the patient really knew deep down that he was going to lose his legs. Denial is a double-edged sword. It can keep one from seeing what's really going on, but it's also a highly effective coping mechanism meant to protect us from knowledge that we aren't ready to process. I doubt that the young man took the tech at her word. I'm not condoning what she did, but really? Truly? Deep down, I don't think he was surprised at the outcome. So tragic. -geena

I've updated the sidebar links again. My loooovely husband got me my Image Manipulation Program of Choice for Christmas and it's been so very nice playing around with it again. I've added some blogs, deleted some, and in checking to make sure the links work, I've noticed that some of your blogs underwent a makeover. So if the mood struck, I went ahead and redesigned your button.

As always, if you don't like your button please feel free to make one of your own and I'll replace it. You need to stick it in a .jpg file that's 90 pixels x 25 pixels. Yeah, it's small.

Here's a story submission from "traumanurse," and she sent it almost an entire year ago:

I am a fun-loving person. I work in a Level One trauma unit. We have a lot of fun as all the RN's and MD's are great people and we make a great team. This helps a lot with all the drama in trauma.

We have a few resus' every week. And these are fine - training and adrenalin take over and we actually manage to maintain a sense of humor before, during and after- but it's going home that gets me.

How do I explain to my small children that I am not a mommy right the moment I get home? That I need a couple of minutes to myself just to become a mommy again? I am the highly professional person that has just witnessed the life seep away from someone's husband, father, child, and now I have to be the referee in the fighting, dish up equal portions and put Barbie's shoes on- so they stop slipping off. I think is the main reason I prefer night shift is because you get home when everyone is asleep - so I can do mindless things like water the garden or feed the cats - or just sit and stare into space.

To explain to a non-medical person what it's like is very difficult. In a resus- it is not a human being. It is not someone's dad. It is an airway, a chest, a blip on the ECG; a vein to put a drip up. A pupil that may or may not react to light. These are the patients that you leave behind when you go home - nonsensical and they don't haunt your dreams. It's the ones that grab your hand, that make you look at them, that make you SEE them, who make it difficult. How do you explain this to your five year old? That fine line between life and death. That fight to keep someone from going to the "light." There is no light in the trauma unit/ICU - there is only the adrenaline taking over - the clear instructions, there is no pain - no emotion - until it's over. Until someone said those words: "time of death".

How do I explain this?

--------------------------------

I've sometimes found it very difficult to come home and act as though something emotionally earth shattering hadn't just happened. Sometimes it's hard to get back to "life" because whatever has your brain scrambled won't leave your thoughts. Sometimes I've found that it's because it doesn't feel right to go back to normal life. After witnessing and being a part of a profound moment in someone's life, it feels like you literally have to take some time and process it and honor it in a way before you can get back to your normal life.

I usually take the drive home as an opportunity to absorb events that happen at work. Sometimes it takes me a lot longer - days, even. There are some situations at work that still haunt me years later. I have a feeling it's like that for almost everyone.

From "psychosis buster, RN:"

(For the longest time I kept reading it as "psychosis butter.")

Way back in the eighties I was working on a 40 bed acute psychiatry ward in a fairly large Canadian city. One day, one of our repeat customers, a chronic paranoid schizophrenic patient, was admitted from Emergency. She hadn't been looking after herself and she was covered in lice, as was her (expensive) fur coat.

Two of my co-workers figured they'd do her a favor and send the coat down to our laundry department for cleaning. Unfortunately, they thought it would be a really good idea to send it in a red "contaminated laundry" bag - this was before the advent of universal precautions. What they didn't know was that the laundry department didn't open those bags - they just tossed the whole kit and kaboodle in the washer, along with very hot water and strong soap.

The next day, a plastic bag arrived on the ward from the laundry department. It contained what looked like a hairy collar, with several strings dangling from it and some ratty fur, with a note asking "what was this?"

Well, it had been a fur coat valued at something like five thousand dollars. Fortunately, the hospital agreed to reimburse the patient. To this day, I don't know which was funnier: the pathetic remains of that coat or the expressions on my colleagues' faces when they saw it.

Suzi has a question for ya'll:

I had a kidney stone episode January 2007 which took me to the hospital unexpectedly. My urologist could not remove the stone because there was massive infection caused by the stone rubbing up against the "wall." I spent five days in the hospital with fever, passing blood, on IV antibiotics, oxygen, and with incredible "sweats" that required clothes and bedding changes several times in a 24 hr. period. I couldn't get out of bed alone to use the bathroom. I was terribly weak.

After 5 days and under medical advice I was sent home to bed. I was to continue oral antibiotics, and a "stent" was put in place until the stone could be removed. A week or two later I did have the surgery and the stone was removed and another "stent" was inserted. My doctor told me I had been very very sick and I was to do exactly as he said, which was basically to stay in bed until the second "stent" was removed.

Now, heres the question: How long should I expect to be "recovering" until I am back "up to speed?" The doctor told me it would be about 30 days after the surgery. This estimate was way off!

It is now the middle of July and while my recovery seems to be steadily improving, I continued to experience loss of strength and energy (I can now run up 15 steps X 3 without getting winded) But I cannot power walk the distances I used to. I also "break out" in sweats when I use physical energy. Have any of you had a similar recovery experience from a blood infection (sepsis) and if so, would you share it with me? I just want to know if I'm in the "normal" range.

I knew someone who had sepsis and was hospitalized. It took her MONTHS to fully recover enough to come back to work. At least 6, I believe. Any other experiences?

Donna, RN writes:

A young man died this weekend. He had a loving wife and a bouncing 10-month-old baby girl. Like all of us, he had a promising life, with many friends, many challenges, many opportunities and many wonderful dreams.

He came to us ill, but strong willed and hopeful. He had a medical team that was strong willed and hopeful. He had a family that was strong willed and hopeful, he had nurses that were strong willed and hopeful.

And yet, this young man died this weekend.

That day, amidst the turmoil and growing clutter of medical equipment crowding his ever shrinking hospital room there was a sense of collaboration, creativity, intelligence, hope and humanity.

It was the humanity that I clung to as we brought in the crash cart and began the final battle for his life.

He was young, maybe he could make it.

I let hope push back reality. Denial gave strength to our chest compressions. He was young, and his young daughter's picture on the wall facing him gave that much more hope so I wouldn't face despair.

We battled for him, with drugs, ventilation, compressions, anything and everything we had. We collaborated and encouraged each other. As I was getting exhausted from my turn at compressions, I felt the humanity in the room around me, and I heard myself saying, "Come on, M." as I looked at his face and into his young eyes. The words felt naive and innocent, yet I had to give him the humanity and dignity of his fight. I knew I was saying goodbye.

This young man died this weekend. We all felt wounded as we were ripped from a delicate fabric, fraying ends weaving a bad dream. The nightmare for his wife and family had just begun.

It was cathartic to remove the signs of battle from that room, to restore calm and dignity to him and for his family. The emotional resonance of his death was palpable throughout the unit, as tears, anger, hugs and quiet sighs prevailed.

A young man died this weekend, and he put life and all its wonder into grand perspective.

I embrace the pitfalls, the pettiness, and the disappointments life can harbor, as the brighter, grander enlightenments of life prevail. The chubby hand of my granddaughter, the fighting heart of my biking husband, my dog's warm, wet tongue, the "volunteer" rose that grew up amongst the lavender. These are what matters in life. This is the symphony that blends discord and harmony. Anything else is just so much noise.

A young man died this weekend, And he reminded me to let my heart sing.

Patricia, RN writes:

In nursing practice, I have found that a sense of humor is one of the most valuable instruments of healing. In a caring event, it provides relief and hope as an alternative to the pain and fear of the illness. For me, the nurse, humor provides a self-healing outlet from the intensity of focused energy needed to be fully present with the patient regardless of the outcome. The same healing instrument is used, although differently, to meet the needs in both the nursed and the nurse during the caring event. Drawing on the healing instruments of laughter and play within the midst of tears and high technology has provided me with some of the most memorable moments in my nursing career.

When I went home to care for my mother during an acute and potentially life-threatening phase of her illness, I took Ruggles, a large, soft, and very huggable therapy bear on the plane with me. Although we boarded the plane together, it was the last I saw of him until after landing. I seemed as though everyone, even businessmen, in formal three-piece suits, wanted a chance to enjoy a moment with Ruggles.

He was treated to his own ‘Pilot Wings’, given special treatment by the flight attendants, and asked to assist in the cockpit during the landing procedures. Due to his celebrity status, we were given BIP treatment through the airport to catch our connecting flight. The news of Ruggles and our mission had gone before us. After our final landing we were transported directly to the hospital in a special airline limousine.

The story of our most ridiculously fun flight experiences and the formality of our arrival, via limousine, brought back my mother’'s smile and a twinkle of mischief in her eyes. Fortunately, this was the perfect tonic to initiate the courage and strength needed to cope with the immediate health crisis. There was nothing within my training that could have provided a more positive healing environment than bringing her Ruggles.

Ruggles continued to enjoy his celebrity and healing status throughout her hospital stay. There were photographs, articles in the hospital review, and special visits to the pediatric, adolescent, and oncology inpatient units. One bear and a nurse, with a fun sense of the ridiculous, brought healing, love, and laughter to people from New York to Illinois. My mother recovered to the point that she could return home and continue at a more comfortable level of wellness for several more months.

My mother flourished in ways that would not have otherwise been possible and kept this piece of fantasy and fun as a charm to help her though the bad days. Her medical care interventions were completely met during that time at home by a wonderfully caring and competent Hospice treatment team. Although proud of my technical skills and knowledge, she didn't need that part of my nursing practice. It was my ability to live nursing as an art form of care and caring that allowed her to share life, laughter, joy and healing during those last few weeks. My development into a highly skilled artisan within the caring practice of nursing intuitively allowed for the need to share tears of sorrow and loss as well as the hope there would be joy.

I am a nurse: I don’'t just provide nursing care, it is who I am. I became aware of the uniqueness that belonged only to nursing. I didn't settle for nursing, I actively chose nursing as my vocation and profession. Florence Nightingale's vision of nursing excellence enabled me to understand that no one can be what nurses are except a nurse. It was so easy, so clear. Nurses nurse. My nursing practice is an art form of caring within a highly scientific and technologically based health care environment. It is through nursing that I facilitate, enable, and empower the nursed.

In the final analysis, I believe a successful treatment outcome within our high technological care environment is ultimately patient defined and reflects how well the nurse’'s technical care was balanced by the interpersonal art of caring. This, from my perspective, defines nursing excellence in practice.

Here's a story submission from a loooong time ago. My apologies for not posting it sooner.

"She says she's depressed. What she needs is to get a life."

"She only comes to the hospital for drugs. Take a look at all the psych drugs she's on."

"Hey, take a look at this list of medications, she must really be crazy."

"Depressed? What does she have to be depressed about? She has a great husband and two kids that are never in trouble. She must just want some sort of attention."

All of us, at one time or another, have said these things about our patients; if not out loud, then to ourselves. Each and every one of us has a preconceived idea about depression and the people who say they are depressed. I'm sorry to say, but most health care professions hold a somewhat negative view when it comes to mental health issues.

I have been more aware of these kinds of stereotypical comments about people who are being treated for depression than ever before. The comments that people make hurt me down deep into my soul. It helps perpetuate the myth that being physically ill is acceptable, but being mentally ill is not. Insurance companies will cover the cost of lab work ordered for a physical illness at 100%; whereas lab work ordered for a mental illness is covered only at 80%, if at all. What kind of message does that give the general population? I'll tell you, it continues to keep depression in the dark ages. I think one of the reasons I have become more aware of how health care workers and the general population treat people who are depressed is because I am one of those "drug-seeking, crazy people who needs a life and wants attention." What is worse is that I am a health care professional. Yes, that is right, I have been treated for Major Depression and lived to tell about it.

Surprisingly to most people, depression is just a chemical imbalance that can be treated, in some ways just like an electrolyte imbalance. What is the major difference? An electrolyte imbalance is acceptable, a chemical imbalance is not. The real scary part is that people like me - and you - can get it!

Let me start by telling you my story. Last year, I was hospitalized in the "Psych Ward." Apparently I had been depressed for some time and didn't know it. I, like so many others, held the view that a person would know if they were depressed. They did not have to be told. You see, I was always so confident and self-assured, always smiling and laughing, not the picture of a depressed person. A person who was depressed was a weak individual with no self-confidence or self esteem; I had both, so I could not be depressed.

A few months prior to my psychiatric hospitalization, I started to have some "serious health problems." I call them serious because I couldn't get a definite diagnosis about what was wrong with me. Every time I ate, I got terrible abdominal pains, nausea, and at times I would vomit. My gastrointestinal disorders were so bad, I was sure I was dying of some exotic disease that only occurred in one out of 100 million people. I had all the "tests" that accompany a GI problem. That's right. I had an endoscopy, colonoscopy, upper GI, and a lower GI. The only thing that I can remember from those tests is that the doctor was surprised at the amount of Versed and Demerol he had to give me to calm me down and even then I was carrying on a somewhat intelligent conversation. In fact he told me, "You must really be anxious to require all the meds I gave you." A light should have gone on then, but it didn't. I was sent home with medications to help my "Irritable Bowel Syndrome."

Well, the GI problems continued despite my compliance with the medication. In the meantime, my family and close friends started to notice a change in my personality. I had become more quiet and withdrawn. Apparently, I was no longer able to convince myself or others that I was happy and I retreated into myself. I talked only when absolutely necessary and my mind was often preoccupied and I would just stare out into space. My family kept asking me what was wrong, but I kept telling them "nothing" and "I'm fine." You see, I didn't know what was happening. I didn't realize how quiet and withdrawn I had become. I thought everyone else had gone crazy because I was the same as I had always been - or so I thought.

In many ways, I am more fortunate than most because if it were not for my family and friends who know me so well, I would not be here today to tell you this story. Slowly, without realizing it, I had become suicidal. I had thoughts of driving my car off of a cliff, into a tree, or into the path of a rapidly moving 18 wheel semi-truck. The only problem I had with those ideas was that I was afraid that I wouldn't die, but become a quadriplegic and then I would be unable to finish the job. Were these rational thoughts? No! But to me, they were real options, very real. A good portion of my waking hours were spent thinking about ways to kill myself; and I did have a good portion of "waking hours" because I could no longer sleep. I felt my whole life was falling apart and the only rational thing to do would be to end it all.

Why was my life falling apart? I don't know. My children were not on drugs, they had not been sexually molested by any of their relatives and they were not terribly misbehaved. My husband was kind, attentive, supportive, and helpful. He was not having an affair with one of my close friends or relatives like the people on Jerry Springer, so what could be wrong? I didn't know.

After several office visits to my family doctor for my stomach ailments, he told me he thought I was depressed. Of course I told him he was crazy because I did not have anything to be depressed about. You see, even then, I would not accept the idea that I had a chemical imbalance and was depressed. There had to be some reason, some precipitating event, some physical problem that brought on depression and I had none of those. I couldn't be just plain depressed. I wasn't "weak."

As the days progressed, I became more and more despondent. I had essentially quit talking to everyone except while I was at work, and then, only when necessary. I could not make simple decisions, like what clothes I should wear, without going through a major crisis in my mind. My mind was overloaded. My head was spinning. Help me! By now, I knew something was wrong. I knew I was having some severe emotional problems. Yes, I had a brain tumor, what else could it be? I couldn't go on like this. I was scared. My family was scared. My friends were scared.

I allowed myself to be locked up in the "crazy ward." I was led blindly down death row accompanied by my husband and doctor. I was being locked up. I had gone mad never to return to sanity again. I would be the "mad housewife" for all eternity. I was hospitalized for about 10 days. I can't remember much about my stay except that I cried a lot, was hugged a lot, and was made to feel absolutely safe - and sane. I was comforted not only by my family and friends, but the staff as well. During the night when I could not sleep, the staff was there to help me. During the day when I couldn't make simple decisions, the staff was there.. When I needed to cry, there they were. Easy job? I don't think so.

It has been well over a year since my bout with Major Depression. I no longer require medications to help keep me "sane;" but right now I do live with a little fear that the depression that sucked the life out of me will return. By far, my experience with depression is the most devastating thing that I have been through to date. It's not only the depression that was devastating, but what I knew people's perception of depression to be.

A year ago, I would not have told my story. I have come a long way and still have a long way to go. I tell you this story in hopes that the hidden comments and giggles will stop when you see a diagnosis of "depression" or have a patient who is on "Pamelor or Mellaril." You allow me to hear your comments because you do not know I am one of them. If you only knew . . . . . . . .

________

This is a true story that I wrote almost 15 years ago. Although it's an old story, it is still something that needs to be said.

In response to this post about the mountain of paperwork that we as nurses have to deal with, Mary Anne wrote this:

I thought hospital nurses had it easier with paperwork, boy was I wrong! I'm a geriatric nurse in long term care. Have been for my 12 years in nursing, and the amount of paperwork has increased 10 fold especially in these last 7 years.

I tried to figure out, once, how many times I write my name or initials, or any type of entry, on various forms, but lost count quickly.

First, there's the sign-in sheet, then the narc book, med and treatments sheets (there are currently 41 residents on my unit and 1-7 pages for each). Then you have the POC book, in which I as an 11-7 nurse must generate hand-written I&O sheets (both daily and weekly), glucometer check sheet, toileting sheets, assignment sheet, elimination and food/nutritional sheets (all three done monthly), the charts, the log book, and God forbid someone falls! Then you have the incident report, statement sheet, chart entry, care plan update, injury to extremity and/or head injury flow sheets, update of the fall risk assessment, call to the MD/NP and family or all the transfer paperwork if you have to send them out to the hospital.

There are weekly skin check sheets and incident report if you find a skin issue, and department copies for that. In with the med sheets (or MARS), are the prn pain monitoring sheets, behavior sheets, and O2 sats and lung sounds monitoring sheets (for use with any inhaler and nebulizer treatment).

Needless to say, the majority of my night is spent writing SOMETHING. I have been feeling like I'm pulled further and further away from the bedside and I'm getting very sad about it. Guilt when I take even more time away from my residents? I have it. Especially on Book Night. It's the last day of the month going into the new month. And it's hell!

We must turn over all the old month's sheets into the new month's sheets. Actually, leading up to it is worse. That's where the pharmacy we use sends us all the Residents MARS AND TARS (med and treatment sheets) and we have to edit them. It's not easy especially when they screw them up from one month to the next or a resident has a lot of new orders, or the pull doesn't get done on time. We have to check the accuracy of every med and treatment the person has ordered along with allergies, doctor, birthdate, diagnosis, room etc.

Then there's the Nursing Summaries. Oh joy!

These are monthly consolidated reports about what the resident has gone through in the last month, and it shows their acuity level, but it isn't accurate if the CNA's flowsheets are wrong which is often. This is how we get paid. If they are wrong, we lose points and money. It's a lot of pressure when you're not able to spend a lot of time on them.

And as an 11-7 nurse, I'm responsible for the weekly drug order for all the residents on my unit. It takes about 2-3 hours if done right. We also change the CD foley bags every 2 weeks, the O2 tubing and other equipment every week, G-tube supplies every night, do treatments, pass meds and soothe emotional or out of control residents.

Cleaning and restocking the Treatment and Med carts andordering supplies are all put aside until there's time. No one on the other shifts ever does it. So I'm left with no supplies when I come on duty.

I'm sure I've missed something, there's so much. Eight hours is definitely not enough time to get it all done. If I didn't have to get home to get my husband off to work and child off to school, I'd leave about 9-930am everyday. As it is, I sometimes have to get my family taken care of and go back to work to finish. Sometimes I get paid and sometimes I don't. The head honchos think we should get out on time, and they won't pay overtime anymore. So we get in trouble if the work isn't done, but we volunteer our time to get finished. And it cuts into my precious sleep time.

Why do I stay where I am? It's all I know. Hospital nursing scares the hell out of me at this point. I feel dumbed down. The place is 5 minutes from my house and son's school. I like my nighttime co-workers. And still another reason to stay is that it looks good on a mortgage application to have stayed a long time at one place, something we're going to be facing soon.

I always wanted to be a 'Scrub'. I loved the OR in school. LOVED IT! I know they have more surgical techs now and nurses have different roles in the surgical ward, but that's all I ever wanted to be. Right by the doctor's side passing instruments, watching the surgery. Cool.

When my mother lay dying from end stage chronic hepatitis, she was screaming at me "get out while you can!" She was referring to nursing. She was a nurse until the day she died, she kept up her CEU's even though she'd stopped practicing a long time before. I wonder, should I get out or stay?

I don't know what else to be.

It's never too late to learn something new. Get your mortgage, then get a new job! I know, easier said than done.

I suppose this is a silly spin-off of Kevin MD's "Doctors Gone Wild" category. "Chocoholic" submitted a story about how nurses helped her during a particularly bad time:

Over a year ago, I was admitted to ICU after a suicide attempt. Although I was only there for twelve hours, the saintliness of some of the nurses stick in my mind.

I arrived late at night, tired and confused. The first thing that struck me was the calm and quiet of the place. I always imagined the ICU to be noisy and frantic like in the movies. I think the fact that it was only a small unit in a country area helped. The only sounds were a breathing machine and the occasional beep, and someone making coffee. After the frenetic activity of the emergency department, where I had spent the past few hours, it was bliss, and I immediately fell asleep in the extremely soft, warm bed!

The first thing I found wonderful about the nurses was something simple, yet wonderful to me. While in the emerency department, I had to use a pan, and due to the fact that they had stuck me on a drip, I had to go quite often!! After waking in the night and holding on for as long as possible, I buzzed the ICU nurse and told her I needed the loo. She disconnected the monitors, unplugged the drip and said, "OK, let's go." I was amazed. Something so simple, yet so dignifying. I was suffering no symptoms, and felt completely well in myself and was stable, so she had let me up. The reason I felt like this is that in the emergency department, I felt so vulnerable and like all my dignity had been stripped away using a pan. We chatted about life as we walked, and I complained that the drip was worse to push than a shopping trolley, and she told me I was a card!

The second nurse I had came on around breakfast. After seeing my plate of watery, tasteless scrambled eggs on cold toast, she said, "You can't eat that," and made me some hot peanut butter toast. Later that morning, she sat with me and we talked. I told her about my life, where I was from, what I was studying, about my life living on-campus at the university and the crazy things students get up to. I told her about the emotional hurt I was suffering and how I was frightened of the future, and frightened to go back to university. I told her about a song I had heard on the radiio that morning that had epitomised the way I felt and I told her of my passion for music. After my 18 hours of monitoring was up, she took me and my drip out onto the veranda so I could use my mobile to catch up on things at the university.

When she delivered me, fully dressed and freshened and neat (the way I always like to dress and feel), to the Psych ward that afternoon, she stopped and took my hand.

"You are an inspiration," she told me, "You are a beautiful, sensitive determined person. I just hope now you can get the help you need, and I wish you luck in finishing your degree, which I know you will."

When she finished, she started to tear up. I hope she knows that I am finishing my degree, and loving every minute of it, and I remain greatful to this day of all the nurses - in Emergency, ICU and Psych-and their compassion, humanity and sensitivity.

That was sweet, huh? It's nice to know that we've really helped someone out, even if they don't or can't tell us at the time.

This is a very well-written submission from "smack." She cites several examples of intolerance and unhelpfulness from her instructors and the nurses she's supposed to be learning from:

I am a "non-traditional" nursing student. Nursing is not my first career. Like many others in my generation, in our restless quest to find deeper meaning in our lives, I have chosen to pursue an emotionally fulfilling life rather than to continue to pursue the Holy Grail of financial success. My former preoccupation with my career and financial success cost me a marriage, caused major burnout, left me feeling hollow and unfulfilled, and contributed to my becoming a grandmother before I was 40.

Not for the first time in nursing school, I am wondering if I am cut out to be a nurse. Do not get me wrong, I love the art and science of nursing.. I have worked as both a “tech” and a unit secretary on a medical-surgical floor for over a year now. The small hospital where I work has become a second home and the nurses I work with, a second family. I love the rich mix of skills needed to provide care for patients. I enjoy the challenge of giving a smile or laugh to a grumpy or blue patient. I love caring for people.

Where I begin to question my ability to fit in has come beyond the safe cocoon of the hospital floor where I work. I have witnessed other students struggle with some of the same issues as I have. I just do not know if I can work with some of the nurses who care for clients but lack the capacity for caring for anyone else. My first experience with this type of behavior came from one of my instructors.

At the time, my daughter was a 15-year old high school student and a new mother without a car. We had just recently moved to the state. I was saddled with the responsibility of transporting both my daughter and grandson to wherever they needed to go. During class, I received a desperate call from the babysitter saying that she thought that my grandson was having an allergic reaction to something he ate. I pulled my instructor aside, explained the situation, and apologized for my having to leave. She tersely advised me not to allow my family situation to interfere with my education. By the way, the class I was missing was intended to teach us how to “care” for patients in the non-traditional emotional and spiritual sense.

The next experience came from a registered nurse who I was to assist during an obstetrics rotation. When I arrived at the clinical site, she was in hysterics and crying over her assignment for that evening. She told my instructor that she did not want a student following her. My instructor forced the issue and the nurse spent the rest of the evening literally sneaking behind me into the patient’s room and coming back out and reporting that she had "already taken care of things". I was assigned to follow her on two different occasions. I have had the misfortune to be assigned to two other nurses in two other hospitals who have had the same type of "stay out of my way" attitude. Some have been downright rude and condescending. I wonder how it is that these particular nurses, who do such a wonderful job teaching their patients, are so awful at helping to teach the next generation of nurses.

My most recent experience of this behavior came in a one-two punch. It is the first semester of my senior year. In my one clinical class this semester, we are learning about community nursing. I am learning about what community nursing is and am finding that I like it a lot. My first clinical experience as a visiting nurse was great success and I thoroughly enjoyed it.

However, the instructors of this class are grappling with a heavy clinical schedule and more students than they are used to. There have been several mix-ups in the dates posted for clinical assignments. Like several other students, I am struggling to make sense of the various assignments and where I am to go and when.

Nevertheless, I am excited about my clinical assignments for the next day.. In the morning, I am to follow a school nurse and learn about what she does. I will have the opportunity to follow this nurse several times during this semester. In the afternoon, I will travel to a local elementary school and participate in a grant program that teaches the children there about nutrition. The program is exciting because I get to orchestrate a physical activity along with teaching. I even get to give the kids a taste-test of some unusual good for you foods. I had chosen the lessons carefully and practiced them with my three-year old over the past week and a half. I was ready to rock and roll!

About 1:30 a.m. the night before my clinical, my three year old woke up coughing, gagging, and crying. I ran in to check on her and in my half-sleep panic, I tripped over an electrical wire and wrenched my back. As I hobbled in to calm her down, I thought that maybe she had had a bad dream. Fifteen minutes after tucking her back in, I was changing bed sheets and cleaning up vomit. I did this about every fifteen minutes until almost four a.m. because, apparently my daughter has failed to develop good vomit aiming skills. I was very disappointed because I knew there was no way I could take my daughter to preschool in the morning. I was going to miss the clinicals. All that preparation was for naught.

I called my instructor's office sometime after three a.m. and left a message explaining the situation. She had instructed us to use her cell phone over her office phone, but I was hesitant to call her at that hour, lest I wake her and her family, so I called her cell phone later in the morning before the clinical and explained the situation. The news of my impending absence was met with stony silence. Next was the question of "Are you going to miss the afternoon clinical too?!" I was sleep-deprived and frustrated. I wanted to tell her that I felt sorry for her kids if she ships them exhausted, miserable, vomiting, fever, and all, to daycare when she has a big day planned. After all, that is just what a good nurse would advise a patient to do?

The second punch occurred during my call to the school nurse who was organizing the grant program teaching I was to do. After I explained why I would not be able to come in, she said mildly, that nursing school sure had changed since she was a student. They were not allowed to be married or have children. If they missed a clinical, they were met with fire and brimstone not to mention possible expulsion from the program. She lamented how things had changed. I wanted to tell this nurse that preventing women with children from learning or working is called discrimination, and is immoral and illegal.

I want to point out that the majority of nurses I have had the opportunity to work with have been supportive, kind, wonderful, and great teachers. Many of my professors have children too and are mindful of the challenges parenthood provides to those trying to better themselves. I have the pleasure work with one of the best nurses in the state. This amazing woman has all the virtues that a good nurse aspires to have: patience, expert skill, ever-expanding knowledge, kindness, and empathy. She has love in her heart for all people but is strong enough not to be taken advantage of.

In the end, what I am hoping for are the nurses who exhibit this type of behavior to question the reasons for it. When you are in a position of power, you are teaching student nurses whether or not you intend to. What you have to decide is whether the lessons you are teaching are worthy of a professional nurse. Your attitude toward students teaches them what behavior is expected of professional nurses toward patients as well as others.. Utilize those caring skills not only for patients, but also in interactions with those you have to work with. It may be useful to keep in mind that the student who is shadowing you now may soon be your co-worker or may even eventually be your nurse. My professionalism professor gave a quote at the beginning of the class, "nurses like to eat their young". I am hoping my writing will help some of those nurses lose their taste for us.

I don't remember ever calling in sick for a clinical during nursing school, but I know of others who did and were met with the same stony silence. There are only so many clinical opportunities to be had in school and skipping one for almost any but the most dire of reasons was frowned upon.

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.

... 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.

I haven't gone anywhere :) I was out of town for the holidays, and the rest of my time has been filled up with other adventures. Nothing interesting has happened at work; at least nothing I find interesting. Same kinds of patients. Henceforth, I have little more to offer you than some short story submissions. I suspect most blogs go through extended dry periods at times. I briefly entertained the idea of quitting codeblog, but I don't think I want to do that.

"JLo" writes:

I had been an LPN for about 5 years when I decided I had had enough of taking crap from RNs [Ed: Well then!!], so I went back to school to be one. I didn't realize I'd still be taking crap, just from a different group of people.

Anyway, while I was an LPN I did enjoy the patient care and took pride in my patient's appearence. I had a patient that for whatever reason was difficult to understand at times (it came and went). He was trying to tell me something during his a.m. care, I really did attempt to understand him, but I couldn't make it out and had to keep moving. He was scheduled for physical therapy and looked rather scruffy so I got him bathed and shaved. He was looking good when he headed down to physical therapy. I saw him being wheeled back some time later, and when he saw me he shook his finger, and said, "YOU, YOU SHAVED OFF MY MUSTACHE EVEN THOUGH I TOLD YOU NOT TO!!"

Whoops that's what he was trying to say!! Well my intentions were good.

Doesn't sound very good, but I'm sure it's done every day across the nation. I have certainly done my share of misinterpretation. Anyway, "Gina" writes:

I'll always remember the day I took shampoo in to one of the other nurse's patients. I heard that the patient had given birth while crossing the border. She and her family cut the cord with a calling card, wrapped the baby in her sweater, and walked on. What an ordeal! I expected an exhausted, disheveled woman.

However, when I walked in with the shampoo, I saw an island of happy faces. Two of them were young enough women that one of them must be the patient, but they looked equally healthy and energetic, and neither one was wearing a hospital gown. I had to clandestinely look to see who was wearing hospital armbands. She was going to be sent back to Mexico for now, but at least her baby was going to be able to stay with family in the U.S., since the baby would be a U.S. citizen. I have to say, I admired her family support and her strength, even though she did take a big risk with her own life and the life of her baby. After all, plenty of American women take similar risks giving birth at home just for the thrill of it. And I'm sure she meant to give birth at the hospital, not outside in the dirt.

Well, I'm not sure I'd say that homebirthing women do so for "the thrill of it." Probably more that they view birth as a normal, natural process that does not need medical intervention. And here is a true confession from "A.D.":

Well as horrible and embarassing as it is to admit, at one time I became so addicted to pills and shots that I would receive in the ER after my many laparoscopies. I became so addicted to narcotics that I would feign illnesses once a week. It became so embarassing to me that I actually started to hurt myself intentionally so that I would be able to go to the ER with a clear (if you can call it that) conscience. The worst of the worst (and I say this with much shame, behind an anonymous name) has to be the time in which I actually took a .22 revolver and blew a hole through my right foot. Luckily it went clean through without touching a bone. I was sent home with Demerol....probably enough to kill a small elephant. I'm no longer like that and I find it frightening to think that I would ever do that. No therapy, I just snapped out of it. My hat's off to those medical professionals that have to put up with the likes of me... Weeding out dope fiends while taking care of genuinely ill people. All I can say is....thank you and I'm sorry.

The ER sends people home with Demerol???

Okay, that's all I have for you for now. Sorry for the recent absence and I promise to be more updative in the future :-)

Joy, EMT/RN, writes:

The opportunity to provide medical care brings with it risks unimaginable before the actual practice of care is begun. The timber and nails of the academic and the practicum seem, at first glance, to create a sturdy dwelling, a safe place from which to work. But when the winds of crisis blow, when the unexpected occurs, the house, if it has no sure foundation, if its framework is not both supple and strong, will fall.

The following story illustrates what happens when a nurse builds beyond the books and the gadgets and into true nursing.

Sunday, 1500, my pager tones. 'Medic 1, Rescue 2, Engine 3, Engine 4. Respond MVA with injuries.' I shovel the last bite of food into my mouth and put on my jacket. My partner meets me in the ambulance bay. We do not speak. It's Christmas and there is a crash. There is nothing to say. We leave two minutes ahead of the other units.

Enroute we learn the location and nature of the crash. We do not look at each other. I request two more ambulances and additional rescue assistance. I move to the back of the rig to hang fluids. I put three constricting bands into one pocket and stuff a pair of heavy gloves into another. A couple of trauma dressings go into other pockets.

We arrive to an obvious high-speed, off-set head-on collision. A small pickup and a small, 2-door car are separated by 25 yards, one headed east in the west-bound lane, the other crosswise in the east-bound.

I run to the closest, the pickup. The passenger door is bent out of frame and is immovably 5 inches ajar. In the broken seat a middle-aged woman, sparkling with glass dust, sits with eyes closed, arms limp. When asked, she says she is at the mall. She is pale, breathing OK, has a rapid, thready pulse, no significant external bleeding. Move.

I go to the driver. He is enmeshed, the front of the vehicle folded around him like frosting on a cake. Awake, he looks at me with huge eyes. He does not speak. He is breathing OK, has a strong radial pulse of less than 100, no visible bleeding. Move.

I race to the other vehicle. Oh, Dear God. The two young adults in the front seat look like my oldest children. They are dead. Move.

I look at the back seat. The approximately 18-months old baby in the car seat in the middle of the bench appears boneless. He is slumped forward; his struggle to breathe is weak and uneven. His lips are white. Both eyes are purpled shut. Time stops. He looks like my Matthew. The doors are crumpled. I can't reach him through either shattered window. Move.. Almost two minutes have passed. Move.

I straighten up and key my mike. As the first units arrive, I call for life-flight, activate the trauma system at the closest hospital, and request increased scene and traffic control.

I then order the scene. You guys, use 'jaws' on this door. You, the kid is yours, life-flight ETA 15 minutes. You and you, help him with the kid. You guys, use the other 'jaws' on the driver's side of the pickup over there. You, that man is your patient. You, you, and you, get the woman out of the pickup. I'll be right there.

I use the mike again to contact the second-arriving units. Rescue 6 and Engine 7, set up a landing zone. Medic 8, help them with Matth' with the baby. Get the baby out of the car. Medic 2, find me at the pickup. You will take control of the scene.

I sprint back to the pickup. My partners yank off the door as I hand over the scene. Move. We are losing her. Never mind the c-collar. Move. We slide her onto a spine-board, place the board on a gurney, and leave.. Eleven minutes from time of arrival we are screaming down the highway. Move.

Her eyes are closed. Her breathing is peaceful. She has a fluttery carotid pulse that comes and goes. She moves her feet when asked. I give high flow oxygen and place two large bore IVs with blood tubing, NS wide open. Time now for a secondary exam. I cut off her clothes. Her anterior chest is crushed. The skinny woman has a round abdomen. I prepare to intubate.

She speaks. She is still at the mall buying pretty things. I listen to the woman. I put the laryngoscope away. I update the ED. The woman is taken into the OR within 10 minutes of our arrival. She dies there.

I ask an ED nurse to keep me company as I race-walk the parking lot and tell my story.

Two days later a critical incident stress debriefing is held. A cop says he has had about all of this he is going to take. His partner nods. A dispatcher says, 'It was awful listening to what was happening. It was Christmas, this shouldn't happen on Christmas.' She can't sleep. A cop jokes that she sleeps on the job all the time. She smiles and threatens, 'I'll send you out on the next barking dog complaint!'

The paramedic to whom I had assigned the baby says to me, 'I knew the kid was bad when you walked away. I knew you'd never leave him if he had a chance. As soon as the helo took off, I went behind the ambulance and vomited.'

Someone says everything happened too fast, another too slow. A firefighter talks about the incredible noise of the scene. Another says he did not hear a thing, all he remembers is the stillness of the baby as he held his head for intubation. Another whispers in horror as she recalls the man in the pickup saying, 'I did not hurt anyone.'

It's my turn to talk. I thank them for being on scene. I thank them for coming to the debriefing. I thank them for talking. I say that I feel as if I had killed the baby.

A paramedic immediately and emphatically states, 'You were first on scene. You had to triage. You did the right thing by walking away. You gave that lady the best and only chance she had. You did good.' A few nod. A few look into the distance. A cop says, 'That's right.' Someone puts a hand on my shoulder.

We tell our stories again. We listen. We joke. Some of us cry, others curse. Some do both. The next day, we go back to work. And I think about buying pretty things.

I actually came across this story on a nursing message board that a member had written as a post. The topic was whether nurses dress up for Halloween at work. Many nurses wrote saying that they wear Halloween scrubs, but not costumes. Our manager has pretty much barred us from wearing any Halloween costumes at work, but some of us do wear print scrubs. Anyway, I thought it a very cute story and asked the author for permission to post it here. Sarah, RN who works in NICU (Neonatal Intensive Care Unit) writes:

We have to wear the hospital's surgical scrubs on our unit, so people really can't dress up. Many have Halloween-themed warm-up jackets around the holiday, and some nurses wear those funny headbands. Nothing too crazy though, it is an intensive care unit after all.

BUT...

We do dress up the babies!!!

Sometimes the parents bring in little costumes, but more often than not, we make them. Nothing fancy - we usually just use those squares of felt and cut out little costumes that can lay on top of the babies. On the night of Oct. 30th, a bunch of us will bring in glue guns, felt, ribbons, pipe cleaners, fabric, etc.

There are some parents who don't celebrate Halloween for religious reasons, and we are always respectful of that. And if there is a baby that is very very sick, we'll make a costume, but then ask the parents if they want to lay it over the baby or not. Most do - they long for something "normal" like dressing up their child for Halloween.

The best was the year I made a Harry Potter costume for my primary baby - all 1200 grams of him! He had a robe, broomstick, and "scar" on his forehead made of Duoderm. I even got doll glasses, painted them black, and put tape on the nosepiece! There were nurses from all over the hospital coming up to the unit and asking if they could please see the Harry Potter baby? It was huge for his mom, too. Up until that point, everyone would always say, "Oh, your son is so small, is he going to be okay?" because this baby had been born at 495 grams. But on Halloween, she sat next to his incubator all day while dozens of people came by to rave about how adorable her kid looked. She said that was the day she finally started to believe that he was going to be okay.

RN writes:

I want to share my experience as a nurse taking care of wounded coalition forces and insurgents near Baghdad, Iraq. It was the most meaningful thing I ever did and the most horrible. I carry mental scars that I hope will heal.

11 military nurses and I deployed to a field hospital just outside of Baghdad in Jan 2005. The stress levels and workload we carried were incredible. We staffed a 75 bed ward with just the 12 of us, around the clock. A normal patient load was 13 to 16 patients each (Gasp). We took care of patients with traumatic amputations, chest tubes, bullet wounds, drowning victims, children and infants who were in the wrong place at the wrong time, prisoners...and we did the best we could. Did we give good patient care? By stateside standards a resounding no! We worked six 12 hour shifts each week and we were just plain exhausted. We were attacked by missiles and mortars daily. I became convinced I was not coming home; that I would never see my husband or children ever again...especially after a missle landed 10 feet away from me...and it did not detonate!

The Iraqi patients threw urine and feces at us, and spit on us (and those were the "good guys"). One nurse was bitten. Three of us were sexually assaulted (we were the only females on the base who were not armed and were easy targets). We cared for patients in tents, with minimal medical equipment, and we saved a lot of lives (1100 patients in 4 months). Some we couldn't...and we cried.

One patient, a middle aged obese Iraqi woman did not deserve what fate handed her. She was a mother and a wife, and just wanted what each of us wants out of life - to keep her children safe, and love her family. As you can imagine, work is hard to find in Iraq right now, and people need money to eat. My patient had a daughter who spoke English. Her daughter gained employment as a translator for the Army. The insurgents planted a bomb just outside the family's front door to discourage others from doing the same. My patient stepped out her front door (she thanked her gods repeatedly that it was not one of her children) and lost both her legs and her right arm. We saved her....but only temporarily. She developed infection after infection. We did as much as we could for her, but in the end, had to send her to the Iraqi hospital in Baghdad; which had few staff members and few medications. I know we sent her off to die somewhere else.

Events became interconnected there. An Iraqi National Guard Major led his men into a skirmish where American soldiers were slowly being picked off. He saved them. The insurgents planted a bomb in the Major's house. He was killed; but a visiting female relative, a 1 month-old and a 3-year-old survived (all others in the house were killed). The 3 survivors were severly burned. The newborn and the mother spent several weeks with us and both were discharged healthy but scarred. The 3-year-old died after 6 weeks. We were devistated. Fast forward a couple of weeks. Coalition forces captured the insurgent who planted the bomb and shot him 3 times in the process. We saved him. I wanted to hurt that man, at the very least I wanted to withhold pain medicine, food, etc. But I did not. None of us did.

An Iraqi soldier/patient began touching one of my young nurses inappropriately. I had a gun placed against his head while I explained to him that touching was not allowed. I help people, I don't hurt people.

I have been home 4 months now. I do not laugh easily any more. I don't sleep.

If you know a nurse that went to Iraq, be kind, invite her out for a cup of coffee...and listen if she wants to talk about the horrors she lived through. Help her heal.

Wow. Think of this next time you have a bad day at work.

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.

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