Oh, how I long to read story submissions. Whenever one lands in my inbox, I inwardly squeal with delight.

Unfortunately, procrastination pretty much takes over from there and so they sit in my inbox, read only by me. I am so sorry to have held your submissions hostage from codeblog. Let me try to rectify that immediately.

From Angie:

On August 5, 2004, my brother was overcome by his bi-polar disorder and subsequent drug addiction. He chose to end his life by overdosing on Tylenol PM. He was a wonderful and caring person, but was never able to overcome his demons. My family loved him terribly and will never stop loving him or forget him. I am writing this to try to encourage others to allow compassion in their hearts when dealing with those who suffer from these family diseases.

Make no mistake, these are family diseases and can destroy families if allowed. When you have a family member dealing with mental illness and they try to self-medicate to overcome the mental illness you can tend to harden your heart. Please don’t harden your heart, open your heart with compassion and try to understand that this is an illness. Most of us feel compassion to those who suffer from cancer because we feel it is not that persons fault. Well I want you to understand that mental illness is not a persons fault either. If there is one thing that has come out of this tragedy, it is my family’s final understanding and compassion to just how badly my brother suffered. As I have often said no one would choose to live their life this way and I truly believe that he hated his illness and his resulting behavior more than anyone realized. He died at the age of 39 and had struggled since he was 16. He suffered for 23 years and it saddens me to say most of these 23 years were in loneliness.

Very well written advice from one who has obviously been there.

From Coral, Student Nurse in Singapore:

Story: Understaffed on a public holiday in Singapore (or Asian country, etc)

Yesterday was Hari Raya Eve. (Hari Raya: Malay festival of lights) The ward was grossly understaffed. Making up for my medical leave a week ago, I had to return to work on a Saturday. Everyone was very busy.

I was persuaded to station myself at male cubicle P3, full of dementia patients either climbing out of bed, tearing out their pants or, spitting on the floor or at nurses. Relatives stared at this clumsy nurse pushing an overladen trolley filled with blood-stained pyjamas, dirty flannels and adult diapers. Changing the patients in the last cubicle, I had to stop many times to catch my breath. Speaking or shouting in the patient’s ears in a variety of languages and dialects, I turned patients or changed diapers alone with great frustration. Even maids took day off today.

A while later, I was taking parameters. The second last patient was elderly and frail, with sallow skin like paper. As I wrapped his bony arm with the blood pressure taking cuff, he looked at me with a mixture of pain in gratitude. Hollowly he said, “It’s no use, why continue? I’m already so old, don’t make so much effort” I said to him almost with tears , “Uncle, don’t ever say that. Don’t ever say it’s too much effort..” Somehow, I got through the day…

Holidays are notoriously short-staffed. There is almost always less resource and support staff. However, after reading this, I don’t think I shall take my nice comfy hospital for granted again.

And from Christopher, who seems genuinely interested in infusion technology:

Just wanted to say I’ve read through a few archives and this place seems like a great forum for honest, insightful real-world medical diatribe…good work!

[Ed: Thanks!]

I haven’t found anywhere else to talk about my experience in the realm of device manufacturing. Specifically, infusion technologies. A fascinating realm, I must admit, but one that somehow provides more questions than answers.

A practitioner, I’m most definitely not, but I am educated enough to know the difference between safety and reality. I’m wondering if any of you out there have had any experiences with the sorts of pumps I’m working with. I really am interested in hearing about any and all of your nightmares, success stories, questions, concerns…

You can leave your comments for Christopher here, as I’m not sure that he wants me to broadcast his email address. Let’s see… infusion pumps… Huh. A lot of current pumps actually work quite well. They obviously have to have free-flow protection of some sort. Calculations are nice – enter the patient’s weight and concentration of drug, and there you go! Good for emergencies. I think the thing that is most lacking in infusion pumps right now is the weight. They’re just way too heavy. Anyone else?

There are more story submissions sitting in my inbox, but I shall dole them out in a few days. Patience!

Before I start this story submission, I want to congratulate all of the 2004 Medical Weblog winners! Great job!

I also want to point out that I have added several more buttons to the sidebar. I discover more and more medblogs every day! As Beth from The Senior Practicum Experience (link off to the side there!) said, “The links on the right of your site definitely reflect an abundance of medical blogs and a scarcity of nursing blogs.” I’ve changed that… when I started making buttons there was only one other nursing blog (Alwin’s Code; The Web Socket), but I’m quite happy that there are enough now for Nurse Blogs to have its’ own category.

Now on to the story submission. Sadie of Foxglove Formulary writes:

I have now been an RN for ten months. I work on a medical/surgical unit on the 3-11 shift. When people see me in my oh-so-fabulously-hip scrubs, they ask me, “Are you a Nurse?” And for a brief moment I feel all giddy, like, yes, Nurse. Sadie the Nurse. (Imagine James Bond music). When they ask me if I like being a nurse, then it gets hard. Because I do- I love my patients for the most part (my husband will vouch for me coming home proclaiming I’m leaving him for some stunningly blue-eyed WWII veteran with a great sense of humor and some kick-ass faded tattoos) and I love being able to do small things to make them feel better. Like give pain meds. It’s my favorite part of the job, other than sitting there and gabbing about nothing, like we are two people stuck in line at the supermarket, not a patient and a nurse in a hospital. That happens rarely, as all of you know, as our workload does not promote socialization with the patients.

If I have enough time to introduce myself and explain that I’ll be providing care for them for the evening before the unit secretary is shrieking her head off that Dr. So and So in on the phone about the patient in 416 bed 2 (never mind that I came on shift 4 minutes ago and don’t know the first thing about this patient cause I haven’t gotten report yet because the day nurse is still expaining it slowly to my darling charge nurse, a very sweet girl who is smart and funny and a great nurse and who will, one day if the day shift doesn’t straighten up, bring a gun and pistol whip the living ..feces.. out of the day charge nurse due to her condescending attitude and the way she talks to her as though she is a deaf dog or something) then the day is off to a good start. But then we get admissions. Because the best time for the ED to send up admissions is 3:00. Sometimes I think they sit there and giggle “it’s change of shift, let’s really mess with them!” It’s also a great time to announce that the patient in 414 is going to a nursing home and the ambulance is here and what
do you mean I didn’t fill out the transfer form? She’s leaving at 3:15 and since I’ve been here for 15 minutes, clearly I should have used my psychic powers to suss out that the paperwork needed to be done. [Ed: And spent the last 15 minutes working on it, of course!]

Though I never eat dinner and run around like a mad woman, I’ve lost no weight. (Not counting the severe abdominal pain I had over the summer which resulted in going to the ED at midnight and getting a CT and ultrasound which proved that I was “anxious and did I want some Xanax?”)

My psychic powers remain weak, as I constantly must remind the unit secretary and the family members of patients, though that must be done in tasteful and diplomatic way.

I no longer am amazed at any pain medication prescription. We have a frequent patient with 30someodd abdominal adhesions, who has had over 20 surgeries and has a permanent mucoid fistula and has a port-a-cath for her seven-times-a-year admissions so she can get PPN and Demerol PCA. In 24 hours she gets an average of 1250 mg of Demerol. [Ed: !!!!!!!] And Ativan 1 mg. And Klonopin 1 mg. And Ambien 10mg. And if you just spoke to her, you’d never in a million years guess that she had that many drugs in her system. She’s actually one of my favorite patients- she’s a very sweet, very sad lady. Some people get upset and go on drinking binges or spend tons of money on Manolo Blahniks. She gets admitted to the floor for 10 days. Then one day she’ll call her doctor from her phone, get dressed, and go home . She kind of breaks my heart.

Out of work right now with a (non-work related) injury. Torn tendon in foot. Accomplished this by walking in the driveway to the car to go to work, wearing “Professional” Clogs by Dansko. Perfectly reasonable shoes, but I still rolled my ankle and messed up my foot. Got a text message from my Charge nurse buddy, who for future reference I’ll call Selena- she told me that one of our favorite patients died last night. A sweet 90 year old man who had the unfortunate luck to break the acetabulum and spend the last 6 weeks of his life with 50lbs of skeletal traction to his leg. He’d sing in his room, humming and harmonizing all night long. A lovely man. “You’re a good girl!” He’d say to us as we cleaned him up and straightened up his bedclothes, giving him pain meds when he finally admitted he had some pain. And then he’d thank me. “From the very bottom of my tomato, you sweet girl you!”

I’ll miss you. RIP.

Katy, RN, writes:

I am a two year RN who works in OB, though I only do post-partum and well-baby care, not Labor & Delivery. Tonight I baby-received at my first C-section where we had to transfer the baby to our level 2 nursery (we call it Special Care Nursery). The young mom had all ready lost a 23 weeker and this baby was 36.6 wks. This is the point of pregnancy where being off on your dates by two weeks can make a big difference and that may have been part of this baby’s problem, though he didn’t really look premature. She had to have a repeat C-section due to having a classical incision the first time and had gone into labor, which is why we sectioned her when we did.

It took a long time to get through all the scar tissue so we were waiting around forever. Once the baby was born they put it in my charge nurse’s arms and she ran with it to the table. He was blue, floppy and making no respiratory effort. I was rubbing his back and face and body as hard as I could and begging him in my mind to breathe while trying to appear calm so the dad wouldn’t freak. The other nurse asked the dad his name, and we called him by it while we told him to cry for us. We were about to ambu bag him (same concept as mouth to mouth, but with straight oxygen and more sanitary) when he started weakly crying. We kept rubbing and suctioning him and giving him blowby O2, and he was very slowly pinking up centrally, but his tone remained completely floppy. He was also flaring his nostrils and retracting with each breath.

We then tried to get an O2 saturation level on him but couldn’t find the sensors in this particularly infrequently used OR, then when I ran and
got one from another OR had a horrible time getting it to pick up. This whole time we are giving him oxygen and stimulating him (we were by then scratching his feet and being quite rough to get him to cry more). I had to check his heart rate and listen to lungs several times and once got my stethoscope all tangled up in my OR hat and it felt like HOURS till I could get it untangled and out so I could listen. After 10 min of this we called Special Care Nursery down to evaluate him. By then our O2 sensor was working and he was satting anywhere between low 70s without oxygen to almost mid 90s when I would cup my hand over his face with the oxygen tube in it to increase the concentration of oxygen he was getting.

We put him in the transporter and the level 2 nursery nurse pushed while I kept my hand inside it with the tubing in his little face. After I passed along what information I had, I returned to the nursery. At that point I started shaking and was near tears for a couple minutes while I relayed the story to the nurse who’d been watching the nursery for me. Even though I’d been gone for about an hour, she still told me to go sit down and take a break.

Shaking and still near tears I called my mom. I was just going into how scared and dumb I felt when I looked up at the greaseboard in our break room. We often leave general messages to the staff there and someone had written:
“Kudos to whoever had the great idea for putting a cut-down hat under the bili goggles.” And someone else had written in my name above it. It was an idea I came up with several weeks ago out of frustration with the little goggles our babies under bililites wear to protect their eyes. The dumb things never stay in place and we are constantly adjusting them. Now, I don’t actually think it is that big a deal if the things are slightly off for short periods of time, but it REALLY bothers the parents of these babies. One night I got the idea to chop off the top of a hat (since overheating is a concern with these kids) and put the soft band of it over there eyes and the goggles over that. It keeps the goggles in place a lot better. It has met with a really positive response from the other nurses and the parents, as well.

So, just when I was feeling really low and crappy and scared I got a major pick-me-up. A night nurse mentioned to me the other night that I had written her a little note wishing her a good night a few months ago as she was starting what promised to be a rotten shift. She told me that it had meant so much to her that night and that she had taken it home and put it on her bulletin board.
I guess what has struck me tonight is how you never know when something that seems small to you can mean so much to someone else. I hardly even remember writing that note, but it really touched that nurse and helped her through her night. It probably took the nurse who wrote the message on the greaseboard less than a minute to write it, but it made the difference between feeling really rotten and feeling okay to me. It’s like that book, “The Five People You Meet in Heaven” which is excellent, by the way.

I don’t know how the baby did.

At our hospital, we have Wow! cards. These are cards kept around the unit for us to use – we usually write one out and give it to a coworker who has done especially nice or helpful things for us. I’ve written them to nurses who have started IV’s for me on my patient when I was unable to. I’ve received them for being able to get especially difficult ABG’s on another nurse’s patient. (For some reason, I’m great at hitting the artery, but I suck at threading veins.) There are a zillion more reasons to give and receive these cards, but it’s always really nice to come to work and see a Wow! card in my mailbox from someone who has appreciated me. :-)

(Oh my gosh! Two posts in one day!)

Stacey writes:

My husband took me to the emergency room two months ago today, at about 4:30 am. I was having nasty abdominal pain and couldn’t walk well on my own because of it. No nausea or fever, just pain, and lots of it.
The admissions nurse asked me on a scale of 1 to 10, how badly did it hurt? I remember giving her a funny look, because honestly I had no idea how to answer that. But I gave it a shot, and said maybe 6 or 7.

Fast-forward 14 hours later. [Ed: !!!!!]I’m still in ER, and my second doctor comes in. Neither I nor my husband have gotten any sleep in well over 24 hours now. The doctor sits down and introduces himself, says he and my first doctor have been looking over the CT and MRI scans for the last 20 minutes. So, I ask, what’s going on?

Well, I had a liver riddled with tumors. That’s what was going on.

I’m 25 years old. I just got married 8 months ago. All my brilliant mind could think to come up with was, “What?”
Immediately after this, I was admitted into the hospital proper and given my very own room and some much-needed food. My husband settled in the chair by the bed. I sent him home- he needed real sleep too, not a nap in an uncomfortable chair. Myself, I passed out after eating. Tumors be damned, I was tired.

I was awakened at 4:00 am with a request for blood. Ah, the hospital- the only place where they demand body fluids before God himself is awake…
Around 11:00 am we got the news- BENIGN!
I was transferred to a huge teaching hospital that afternoon. The largest tumor was located in a place the doctors here dared not go. I was sent to one of the United States’ leading liver transplant surgeons. If he couldn’t do it, no one could, it seemed.

They had to transfer me by ambulance, I guess it was hospital policy. The EMT’s showed up around 3:45, gurney and all. I told them I could walk. One said I’d be more comfortable on the gurney. Funny, he was right, hehe.
As they strapped me in, one asked why I was in the hospital. Hey, I’m young, in damned good shape, and I looked perfectly healthy aside from the hospital gown, so I didn’t mind his curiosity.

“Liver tumors.”

I didn’t mean to be blunt or anything, but the look on his face really was priceless. I immediately said hey, they’re benign, s’ok buddy, but the damage was done…
I should have read deeper into his expression, it would have told me what was coming.

I got to the big hospital 4 hours later, give or take. You know, when you’re in pain, the worst way to travel is ambulance, I swear. All that bouncing and jouncing did me no good. I really feel for people in those things more than ever after that ride.
So, we got there, I checked in, I got my room, and my first doctor came in. He wanted to poke at my belly. I wondered loudly if that was such a good idea, considering the TUMOR and all. He tried again, and I pushed his hands away. I said it wasn’t necessary to poke at the tumor. Thankfully, I think he saw my reasoning.

From that experience, my husband (who showed up shortly after I got there) and I created the Room Rules.

Rule 1: Don’t poke the tumor.
Rule 2: See Rule 1.
Rule 3: Donations gladly accepted.

I would have paid good money to see these printed on a vinyl banner hung from the ceiling. As it was, we made do writing them on a small dry-erase board on the wall.
Anyhow, by this point it was getting late, and my husband had to leave for the night. He headed to his hotel, and I laid down, turned on the TV, and cried. Yeah, I sound all brave in this story, but I would immediately revert to a bawling baby when I was all alone.
The next day was a bit of a blur. Tests, paperwork, family phone calls, visitors, tests, tests, tests. I was tired. I hadn’t had a good night’s sleep in a few days, and was living off hospital food. I was cranky and wished this all over with so I could go home.

I kind of wish I didn’t make that wish, but whatever. Too late now.
The day after was uneventful until 7 pm. That was when I was notified that my surgery was scheduled a scant 12 hours from then. More paperwork to sign, a living will to fill out, complications to learn about, and my first-ever experience with a panic attack. The lead surgeon asked me to quit smoking. I told him that after all he’s had to tell me, whoever takes my nicotine away is getting a boot in the jaw. I can quit when my life isn’t immediately threatened, thanks. (Yes, I know how bad smoking is for me- that’s not a newsflash. I am in the process of slowly quitting right now. I will be a non-smoker by September.)
After I had calmed down (and had a cigarette) it was nearly 11 pm. My husband, and my brother who had just made it there, went to their hotels. I flipped on the tube and cried again. I was exhausted and didn’t want to sleep. Sleep only makes the inevitable come faster. I would get plenty of sleep later anyway, I reckoned.

I called the hospital chaplain at about 2 am. I was lonely and very scared, and had no one to talk to or sit with me. Maybe it was a bad thing to do, but she didn’t seem to mind. I’m not religious at all actually, but she was fine with that too. She sat and chatted with me until I drifted off to sleep about an hour later.
At 6:30 am they came to get me. My brother made it there to see me off, and for that I am forever grateful. As we hugged I began to cry a little. Then I was whisked out into the cold hallway and down to the elevators, naked except for the thin hospital gown. I caught a glimpse of a beautiful sunrise through the windows in the hall, and I remember thinking to myself, what if this is the last one I see?

I’m assuming the room they took me to then was pre-op. This was the most terrifying 5 minutes of my life. Cold, nearly naked, and hungry, I listened as the anesthesiologist told me what he was doing. This is going to make you a little tired, this is your epidural here, now I’m going to have you roll over, good, good, now count to 5.

1… 2… …………………………..

I woke up in the ICU in such excruciating pain I couldn’t even think. I knew I was in the hospital for something. There was something in my mouth and throat and something making my neck itch like crazy. The room was very dark and long like a dim hallway. Someone was holding my hand, but I couldn’t see who it was. Someone else ran out of the room. I passed out.
I woke up again and stayed awake a little longer. I found a button and pushed it, I didn’t know what it was for but my hands were kind of going on autopilot. My legs were moving a lot and I couldn’t stop them. My neck itched. Someone came in and told me not to scratch my neck, I could really hurt myself. I tried to stop but it itched so badly. Everything hurt, everything from my neck to my knees was screaming, but I was obsessed with the itchiness. At some point I passed out again.

I remember being extubated, but I don’t know when that happened. I didn’t hurt like I thought it would, but then again, I was full of morphine. I remember when they pulled out the tube in my neck, and that hurt like hell. The rest of my memories of ICU are like little flashes of light through a thick fog- my husband leaning over me, my brother asking me how I’m feeling, groaning a lot, wanting to ask what’s going on but can’t because I can’t remember how to talk.
Not being able to talk was really hard. For about 24 hours I was in so much pain and so full of drugs, I couldn’t give my name or tell them where I was. I knew where I was, I knew my name, I just couldn’t say it. You know what it’s like to have something right on the tip of your tongue? It’s like that, only a hundred times more frustrating.

To me, it seems like I was in ICU for about a week. My husband insists it was only a day. Well, time flies when you’re having fun, and crawls when you’re not.
I can’t describe the pain correctly no matter how I try. I was like someone reached inside my belly with an egg-beater and just went nuts with it. Everything stung, throbbed, and burned, all at once. No amount of drugs made it better, nothing made it ease off in the least. Sedation was a blessing.
And that 1-10 pain scale? Nothing rates above a 5 compared to this pain. Natural childbirth might hit 6, maybe. That pain scale is worthless.
When I was moved to my own room, my mother had just arrived from New York. She brought me a little pink stuffed elephant, which has stayed with me to this day, two months later. I named him “Courage.”

Courage the Fluffy Pink Elephant held my PCA pump button for me. I was so out of it I would easily lose the button in the bedclothes or onto the floor, so my mom helped me clip it to the the elephant so I’d never lose it. Courage held my liquid courage supply, haha!
The rest of my hospital stay is very jumbled in my mind. Time doesn’t work like normal when you’re in a lot of pain and on a lot of narcotics. I remember hanging out outside the hospital’s front doors with other smokers, listening to surgery stories and our PCA pumps beeping. I remember fighting to stand up on my own the first time, so frustrated that my body was so weak. I remember one doctor telling me not to smoke, when he reeked of it himself. I had nightmares a lot.

There are two things I remember most though. One, is that no matter how badly off you are, there’s always someone worse. Being in a hospital reminds you constantly of that fact. I simply could not have self-pity after meeting some of the patients there.
The other is that nurses are goddesses. They come when you call them because they know you need them, and they explain what exactly all those pills are for. They listen when you need someone, and they comfort you when you cry. They scare big bugs out of the room so you can sleep. They do a million things you never see, but they still have time for you.
I was discharged 9 days after the operation, and I was so scared I wouldn’t be able to take care of myself. I had a fistful of scripts to take to the pharmacy, but I could barely walk.

The first few weeks at home were really hard. I couldn’t lay down flat, and didn’t own an adjustable bed or a recliner. I slept sitting up on the futon with a bunch of pillows around me to keep me from falling over. I had a pillow across my belly at all times, in case one of my cats jumped on me. I couldn’t eat more than a cup of food at a time, and couldn’t sleep more than 2 hours without having to take a pain pill. It was hell.
Now, it’s been 2 months. The staples are out, the scar is fading into the pink range, and I only hobble a bit now. I’m still pretty sore and stiff, but I can lay down an sleep on the bed. I can even roll over on my own.

I look forward to working again. I’m almost ready to get out on my own again, and I can’t wait! I’ve lost so much time… I want to catch up, you know?

Next year I start nursing school. Wish me luck, OK?

Jean, an Emergency Department tech, writes:

On the lighter side: A 19 year old kid came into the ER with his approximately 16-year-old younger brother. He said the 2″ cut across his cheek happened while playing football.

Come to find out they were playing “Dave Madden Football” on the Playstation and he had been winning when the little brother whacked him in the face with the remote control…

Ha!

Veronica writes:

My story isn’t just a story, but a request for suggestions from the medical community.

I have a handful of piercings and tattoos: my navel and earlobs are pierced and I have a surface piercing on my left arm, as well as a tattoo on my lower left abdomen. I also play host to uncountable scars from my days as a cutter, scars that resurge when my depression overrides my meds.

I personally have not had much trouble with people and my scars/modifications. When I went to a dermatologist after a cutting binge, they did the whole “Are you a danger to yourself or others,” speech and I got to tell them that I was fine, but beyond that everyone has been great.

My fellow modified people, though, have had incredible difficulty receiving not only adequate but also professional medical care because of their piercings. One young man on a piercing site, BMEzine, writes of the time he was brought to the hospital after a car accident that killed his girlfriend and left him a paraplegic. He had a genital piercing when he came in. As a result, he could often, during his extended hospital stay, hear the doctors and nurses mocking him for it. Others have been forcibly admitted to psych wards because the on-call physician couldn’t believe that someone who wanted to modify his body was mentally sound. Yet another was flat out told that she deserved the infection she got (unrelated, as it turns out, to the piercing) because she had her nipples pierced. I fear that these stories are the norm and not the exception among the community.

Body modification can be dangerous. You poke holes in yourself, you risk infection. However, many young people have been dissuaded from seeking appropriate medical care because of the judgment that their providers pass on them. I do understand the need to assess whether your patient is of sound mind when performing these modifications…a tough call to make when someone desires castration, for example. On the other hand, it is no longer prudent to assume that someone who walks in looking like he or she was attacked by a box of needles is a drug-addict carrying every blood-borne pathogen on the planet. There are people who are otherwise totally mentally healthy, without delusions or pathology, who enjoy body modifications that are non-socially acceptable.

My question, which I direct to all medical personnel, regards how we can obtain better health care from you. To what, if any, treatment are we entitled? Should snide comments be expected if we have pierced unusual areas, or is it acceptable to request that the attending personnel keep their comments to a minimum? If our care is compromised because of our piercings/tattoos, i.e. being offered less pain medication or being “stabbed” with blood-drawing needles, how do we document and report it? How should we brush aside a psychological consult, especially those who do not possess a concurrent mental illness as I do? Piercers often have resources that mention modification-friendly medical personnel, but how could we go about finding those for ourselves? How should we prepare for medical emergencies that may involve the removal of unusual piercings, such as genital piercings or lobe-stretchings?

Thank you for your aid. If anyone wishes to contact me directly, I would like to compile answers and make them available to others so that our encounters with the medical profession are more pleasant.

Wow, that’s a lot of questioning! You are entitled to the same treatment as any other patient – respectful and complete. You don’t deserve to be ridiculed or made fun of. You deserve as much pain medicine as you need to be comfortable. I’d think it would be acceptable to request that your body not be discussed at the nurse’s station. People tend to talk about things they don’t understand to share their views with their coworkers to see what they think. It happens, but it’s not respectful to the patient. If you feel that your care is being compromised, ask to see someone in charge – this can be a charge nurse or shift/nursing supervisor. When reporting your concerns, be respectful, calm, and nonthreatening. People who get bent out of shape and start going off on us, regardless of whether they are tattooed or pierced, DO NOT get much sympathy from us nurses.

If after talking with someone in charge you still feel that your care is being compromised, by all means… ask to talk to someone even higher up. The manager of the unit, for example. I realize that hearing comments or feeling that your care is substandard would be extremely frustrating, but please try to keep your wits about you when speaking with Those In Charge. (And that goes for anyone with a gripe, btw). Unfortunately in this day and age, we can’t easily “vote with our feet” when we don’t like a hospital. A psychological consult should not be routinely requested just because a patient has a bunch of piercings, regardless of where they are. If one is requested anyway, just be yourself when the psychiatrist comes a-callin’. Don’t be argumentative, try not to be offended. If you are truly mentally healthy, a good psyciatrist will be able to determine this.

As for preparing for medical emergencies, I guess I’m not sure what you mean. If emergency medical treatment requires us to remove your piercings to provide care, I’m not sure what else you would have us do. Can you clarify the question?

And as always… if any readers have anything to add, please do so in the comments. My stance is this – to each his own. I have treated patients with unusual piercings (nipples, genitals) who were in comas… I just left the piercings alone and tried to clean around them when needed. Some nurses made some “ooooo, can you believe where she’s peirced?” comments, but they died down after a day or so. People like to talk about things that are unusual to them. Was it fair to the patient? No, but I didn’t see the comments as being disparaging, only curious. As always, if the patient were going for an MRI or something, all piercings would have to be removed to protect the patient. I don’t really think it’s a big deal and am not sure why others do.

OB RN writes:

I’ve had sleep issues, MAJOR sleep issues, for forever it seems. I know how important sleep is. I am treated for my sleep disorders and Thank God!, because I was such a menace to society and myself. I do not take my sleep for granted anymore. It’s not easy. I want to stay awake and work, and play and do things. Sleep seems like such a waste of time!

But oh the consequences of such thinking! I paid. I’m just lucky, very lucky that no once else ever paid in a major way. At least, nothing that I’ve seen. You never know how you may have effected someone unnoticeablly…read the book The Five People You Meet in Heaven to understand this concept.

Our unit just switched to 12 hours shifts. I work nights. After finally getting my sleep problems worked out, it’s back to sleep problems again. How to get enough sleep in that little space of time that I am off? I’m not one to just go to sleep. Even if I wanted to I couldn’t. It’s not simple.

This is the other big problem: 3am to 5am. I hit a wall. That time used to be a minor part of my problem. Now I hit that time and I feel like a zombie. I can’t react quickly. I am definitely impaired for this period of time.
I was working in Special Care Nursery a few days ago. It was really busy. Days had it even worse; I was happy it wasn’t me. I don’t know if I could have handled it.

I was very busy when all of a sudden we were getting twins in a crash c-section… born at around 4 am. I got my twin which was thankfully term, but was definitely depressed upon admission to the nursery.
Now, I’m not that experienced with newborn resuscitation. I still need lots of experience with the unstable neonate. That only comes with time, I know.

Anyway, I got this baby at around 4:25 am and my reactions were slow. Things I should have reacted to very quickly like getting that blowby 02 and suction going instantaneously didn’t happen. I was just plain foggy. Like I was working in syrup or something.

The NNP was there and she got things going and all was well but I’m still so bothered by this. I almost dropped a pulse oximeter on the baby’s table since I had moved the monitor that is usually there, closer to the Isolette that I had to put another baby in. Motor slowness and clumsiness. That really freaked me out. It didn’t happen but it could have and I felt, again, one of those times that I’m thinking “what am I doing in this crazy profession?” Why am I taking these risks with lives? I would just die if I ever hurt a newborn. That would be it for me…my life would be over.

Then I read an aritcle in Medscape about how we CAN’T adjust our body clocks. It’s intrinsic, and 3 to 5 am is when we absolutely should be sleeping. Our body doesn’t know any differently. Before I saw this, I was thinking…pondering… on how I am really having a hard time between 3 and 5 am. I had those exact times worked out. 3 to 5am. It’s especially difficult because I’ve already worked an 8 hour shift by then.

This is the absolutely worst time to tackle twins amidst an already busy assignment. All I can do is learn from this. I need to be more prepared and I’m anxious to get time in the delivery room to really learn neonatal rescusitation.

I’ve been a nurse since ’81 but I’m just learning in this SCN (Special Care Nursery) environment. And I haven’t been saturated in it like most of the other nurses who work it. I’ve just been dabbling in it until now. Just when needed, but now my role is expanding.

This is a scary job. My point? Who knows…just something about acknowledging that it’s not natural to fight mother nature. We do it all the time though.

Indeed we do, but it’s also important to recognize our limitations. If you aren’t a night person to the point that you’re actually regularly impaired for a certain part of your shift, you need to get another shift. The situation you described with the twins would typically induce adrenalin production – doesn’t sound like it did with you :-) Good luck.

Tammie, RN writes:

Picture a cold, dank, blustery early April day in 2002, Ohio. Ominous black clouds are rolling through, pushed along by a frigid breeze off Lake Erie. One thing exceeds the desolation outside and that is the scene in my daughter’s room in ICU.

L is beginning her third day on a respirator; she is all wires and tubes and we are crushed. The head of ICU has just told us that the composite effect of her stem cell transplant and the pneumonia, which followed, may be too much for her weakened immune system. She must rally in the next twenty-four hours, or you will probably leave her here, he said. Those devastating words had us all near the breaking point.

I was overwhelmed with grief but suddenly composure flowed over me. I may never understand from where, or how or why. I left her bedside and headed purposefully to the nurses station. There I obtained a poster-sized sheet of paper and a magic marker. In bold letters I wrote, Quiet Please, Miracle in Progress! I returned to L’s room and hung it on the window, hoping somehow that those words would comfort us all. The day wore on without any sign of improvement, but in the afternoon the shift changed and a beautiful young nurse who we had not seen before came in.

She had a soft smile and a caring manner. I’ll be helping L tonight, she announced, and I felt less ominous. Speaking words of reassurance to our comatose daughter she checked the values on all the gauges and rearranged the tubes leading from the life giving medications on the pole to L. She patted L’s head and gently cleaned her face. Her manner exuded caring, competence, compassion and composure. After a few minutes of tending to L, she turned to leave but stopped abruptly when she noticed our sign. She read it out loud, her face broke out in a radiant smile, she gave a little flip of her head and announced, You know . . . that’s my name . . . Miracle . . . Tammy Miracle.

An involuntary shiver passed through my body. What were the chances of a nurse named Tammy Miracle being assigned to L on a day when we had put up a sign asking for a miracle. It was as though heaviness had been lifted from our shoulders and we couldn’t help but wonder if an answer to our prayers was on the way.

The next morning we hurried over to ICU hoping that the news would be better. As were heading in, L’s oncologist was coming out with joy in her eyes. She’s better! with that she gave us thumbs up and added, She’s going to make it, I just know it.

I think back often to that day and was further astounded to learn that Tammy Miracle was not on the hospital’s permanent staff but had been called in from a temp agency due to a shortage of ICU nurses.

God surely does work in mysterious ways. We will always remember and be grateful that Tammy Miracle was sent to us. So if you despair, try to believe that an angel may be looking out for you too.

Do not forget to entertain strangers, for by doing so some people have entertained angels without knowing it. – Hebrews 13:2

My name is Tammie Mericle and I am the nurse in this story. I was overwhelmed with joy as this story came to me at a time in my life when I was not sure if I wanted to continue my career in nursing.

Received via submission:

Had IVP for possible Kidney Stones. Dye was inserted into tissue & muscle instead of vein. Arm became enlarged approx. 2 1/2 times and was very hard. Started having severe headache and hearing loss within 1 1/2 hrs.

Doctors are stumped. Could this have been a result of the dye being injected into the arm rather than the vein?

I receive questions like this every so often and feel bad that I cannot give advice. I am not a physician and would be very surprised to see a physician actually respond to this question via the internet. Clearly this person has already consulted a doctor and has had numerous tests to try to determine what’s going on. It’s natural to turn to the internet to find answers. I’ve done it myself.

How disconcerting it must be to find yourself with such abrupt and substantial hearing loss. I am very sorry that this has happened to you and I hope you find the cause of it soon.

Thor writes:

In 1969 I was shot in the right shoulder. The bullet (possibly deliberately notched before being fired) hit and destroyed the ball and part of the socket. It fragmented into hundreds of tiny fragments of lead and copper. In addition to damaging the shoulder joint the bullet caused heavy bleeding. The surgeons who treated me were more concerned with saving my life and my arm if possible. They did a good job, but they had to leave a lot of lead fragments in the shoulder.

The top of the humerus was fused to the scapula and eventually I reagained pretty good use of the right arm. The fused shoulder left me with some limitation of movement but I have to say there is a lot more I can do with the right arm and what I can’t do right handed I do left handed. I was left with ugly scars on my shoulder. On part of the shoulder it looks like someone scooped out abbout 3 inches of flesh.

It may seem foolish but I’ve always felt very self-conscious about the deformity and always wear at least a t-shirt to cover it. After I first recovered from the injury I took off my shirt so I could swim at a beach with friends. Big mistake- people stared and often asked “Man, what happened to you?”
What happened to me was the worst experience in my entire life and even to this day answering questions about it often triggers vivid and upsetting dreams and memories of a place and time I definitely do not want to revisit. On occasion I still see my wife wince when she catches a glimpse of my right shoulder.

I keep my shoulder covered up, don`t go to the beach, and try to avoid questions. Even when fully clothed an occasional sharp-eyed indivdual spots the deformity and asks questions. I try to give a polite but but noninformative reply but am capable of telling off a really offensive questioner.

That still leaves me with the problem of dealing with medical personnell. Yeah, my doctor & his nurses have seen it, asked their questions, and now leave me alone about it. I was hospitalized twice in the past year for heart and lung problems and have gone to see specialists at a famous hospital in Vermont. Every time I see a new medical worker I either have to take my shirt off or get X-rays. I guess they do not mean any harm but I am sick and tired of being expected to entertain them with the story of how I got the scars or why they see what seems to be a million lead flakes whenever they take a chest X-ray!

The first day of my cardio-pulmonary rehab program I ran into some problems. My left arm got tingly, I was sweaty and not feeling good. I got sent to the emergency room. Naturally they took chest X-rays. Shortly thereafter a doctor came in and even without examining me asked in a very loud voice, “When did you get shot?”. A number of things went through my mind like saying I’m here for heart trouble not a gunshot wound but instead replied 1969, what`s it got to do with what`s going on now? He said nothing, if it happened more than 90 days ago.

I was using a nitropatch, which left a lot of red marks on my chest and between that and the X-ray he assumed I got shot with a shotgun. Mind the man never saw me. But some nurse did, tried to put two and two together and got 47, and made an erroneous report of what he saw.

Things eventually got straightened out, but I`d like to share an observation here-New scars are usually livid red. Old scars lose their redness in time. My scars are so old they are a silvery white. I`m not sure I`m reassured by medical personnel who can`t tell the difference between old and new scars. And yes that night I returned in my dreams to a place and time I don`t want to revisit. Thank you for hearing me out.