Lost on the Floor

As I was cleaning this afternoon, I came across a journal I kept for nursing school. It was only a few short pages, I later realized it was easier to type it up and print out my "journal" to hand in with the infamous care plans we were required to submit after every clinical rotation. Reading those short passages brought back a flood of memories. Some good, some bad, some merely trivial. What struck me was the combination of awe, wonder and extreme trepidation expressed within those pages. Here I was embarking on an entirely new adventure, sailing into uncharted waters and it showed.

My first in-hospital clinical was the ER. As I wrote, "it was overwhelming, crazy and exciting." Or as my preceptor for the day summed it up, "go big, or go home." Crawling through the vault of memory I remember giving my first IV push, phennergan and morphine. I was shaking, hardly had my facts together as I approached the patient, clinical educator in tow, did the 5 rights, explained the medication I was giving, how it worked and why, then giving it. I was literally shaking in my scrubs. Compare that to current.

Last shift I gave IV antibiotics, IV push diltiazem, titrated a dilt drip, not to mention the regular cocktail of meds I pass on a near daily basis. All without giving much of a second thought past the required patient identifiers, reason, action and why. All of that was now internal, unless I had to explain to the patient (if they were able to understand me.) I had acquired the confidence to do this, automatically. Like many of things one does on a typical shift, assessments, line draws, manual BPs, dropping NGs and Foleys, starting IVs, the work of the registered nurse. While it is not automatic in a drone-like fashion, it is automatic in the technique. I can't really explain it without sounding like a robot or a dangerous nurse, but it is almost a Zen-like automaticity. I still have a looooong way to go though.

Confidence is a funny thing though. It comes and goes. Lately, I have had a string of great IV starts. Our facility has a dedicated IV team that will start a line when needed. This is a double edged sword. You have the resources tonot have to worry starting a line, but at the same time, your skills do not improve. It ain't like riding a bicycle. So I had a run of good starts, even on patients that were not easy. Then a runs of bad ones. I couldn't get a 20 guage in the healthy (albeit ETOH detoxing) guy who had great big veins, much less the geriatric renal patient. Then out of the blue, I had to get one of my patients ready for open heart. I figured, may as well have a look-see. And there it was, big juicy, right on top the of the forearm. Without a thought, the 18g went in, done. Confidence re-gained.


We'll see how long it lasts.

Thanks to Not Nurse Ratched for pulling me out of my blogging funk and tagging me. So here goes...count 'em, eight random facts/habits about yours truly.

1. I have given up driving. Yes, you heard me. No more driving. Well, as little as I can make it... Until today, I hadn't been behind the wheel for nearly a month and a half. I haven't driven to work for that long relying on my bike and local transit. Y'know, it's funny, I feel better when I get to work and when I get home. Maybe the whole stress/exercise axis really is something. It's not about the environmental thing (which is important), or the fact that gas is well over $3.25/gallon (it kind of is), but it's about my blood pressure, which until recently was fairly high. I'm a nurse, I know why my BP is high. I also know that not driving (and meds/lifestyle changes) have brought it down. But I like it so much more than sitting in traffic.

2. I'm a History Channel dork. In fact, it's on in the background right now. Consequently, no one will ever play trivial pursuit with me.

3. I am a movie buff. If I had time, I could put Netflix's policy on movies per month to the test, but alas I have a job. And a life. Still love the movies though. I love going to the movies, sure I hate paying the prices, but you can't beat the entertainment value.

4. I once built a pornographic snow sculpture. OK, maybe it was only a tasteful nude....

5. I joke that I got through nursing school with the help of the what I have termed the triad: caffeine, nicotine and alcohol. While I have cut way back on all three, I still enjoy a great cup of coffee (I don't classify Starbucks as coffee per se, I like coffee, not warm milk), a glass of 30 year Scotch and a nice cigar or pipe.

6. I like to read. Not books so much, but magazines and the web. For some reason (hmmm...nursing school?) I'm still not able to pick up and full-on book and read it like I used to. But I'm working on that.

7. I miss mixtapes. Yes, making mix CDs is nice, but I miss that tactile nature of recording a mixtape masterpiece for someone. Y'know that whole process of finding and editing the songs just right so they would flow, creating a mood. At one time it was nearly compulsive, but that time is long gone now. In that vein my dream job would still be to work in a used record store. (see High Fidelity).

8. I still own vinyl records. Not lots, but a good collection. Unfortunately since I moved, they do not have a place to live...yet. Really, you haven't listened to "Frampton Comes Alive!" unless it is the the double-gatefold vinyl....

There you have it. I know I have to tag some people now, but I can't think of who to tag yet. But I will. Soon.

As a final parting thought: Can you sue an elderly demented woman for sexual harassment for telling you to "wiggle it a little" as you walk past?

Too lazy to post. Although I've had plenty of material, I just can't get myself to sit down and write. So instead of having folks read my drivel, I figured I would point them over to real writers over at Change of Shift hosted at Nurse Ratched's Place.

Enjoy!

Oh yeah, I should be back next week. Maybe. If I can drag my lousy carcass to the keyboard...

I just read 2 very thought provoking posts. One over at Musings of a Highly Trained Monkey, that reinforced my already dim view of humanity. The second a touching post that went ahead and reaffirmed my faith in humanity can be found over at Nurse William.

Maybe it is a coincidence that these 2 popped up in the same reading session. Maybe someone felt I was getting tired and too cynical about the folks I encounter on a near daily basis. That I was worn out by the ETOH guy, shaking his way down the hall no matter how much Ativan I gave. That my back hurt from moving the 300+lb. woman around in bed because she wouldn't. That the news that a close friend of my wife and I was having a baby sent my wife and I into a spasm of heartache and despair over our own loss, which even 9 months after the fact tears us apart emotionally when we re-live it. Maybe though someone knew that I needed some hope to get through this recent dark cloud. Coincidence? I don't believe in them.

In spite of one night that was incredible busy, the week actually went well. No one crashed and burned. The chest pains turned out to be nothing but indigestion. The demented old woman was actually pleasant and didn't try to get out of bed. In the words of Ice Cube, "Today was a good day (week)".

I leave you with this:



To think the election isn't until next year...

As I have grown slightly more confident in my ability to treat folks, you get a curve every now and then. I'm getting to the point where I'm a little more confident with cardiac problems. Things like chest pain. I've finally gotten my head around that kind of crisis and am starting to function better and quicker rather than standing there with a dumbstruck look on my face. So when something new comes along, I get that deer in headlights look and feeling.

Case in point:
Older woman had been admitted to the floor for pneumonia and possible UTI, accompanied by that wonderful AMS. When I saw her first in the evening, things were OK. She was alert and mostly oriented, not too far out of it. But she could not hear. If a bomb went off in her room she would not have heard it. Luckily she read lips. But I digress. Lungs sounded diminished, maybe a little crackly, nothing to be very concerned about. But she looked at me and asked, "Am I going to die tonight?" Taken aback I said to her, "Not tonight, we're going to get you through just fine." Yeah, I had to say it.

Then came midnight rounds. It sounded like she had transplanted an aquarium into her chest. Not good. O2 sats were OK, not great, but OK. Tried to get her to cough, not much luck there as the cough was as weak as a newborn kitten. Call the doc, now. Unfortunately she was a hospitalist patient and the house officers were not covering her, so it took a little bit to get a hold of him. Finally did, gave him the report thing, got an order for Lasix. OK, sounds good to me. Well that did nothing, except maybe make her pee a bit. Lungs still sounded like crap. Call RT, just to get an idea of what they thought. One look and listen said it all...she was literally drowning in her own secretions. Again, not good.

Down the nose goes suction, up comes gobs and gobs of creamy yellow/brown sputum. RT remarked that it kind of smelled like Pseudomonas. Not entirely, but not far off. After you clear someone's airway, they breathe much better. Now instead of wet, we had wheezes. At least she was moving air. Call the doc again. New orders, nebs, suction as needed and drop a Foley. I think I've got it locked for the moment. Wrong. Throws me another curve. Temp spikes to over 39C and BP is dropping Call the MD back. By this time I'm sure he is getting tired of hearing my voice. Blood and urine cultures, labs, culture the sputum, get a work-up going, bolus of saline and bump the rate of the fluids after. Keep an eye on her. So I did.

Finished the bolus about 45 minutes before shift change,the Tylenol I had given earlier had brought the temp down to the 37C range. So at least we were making progress. As I was leaving I went back again to check on her. Lungs sounded better,the nebs had helped, sats were back up and BP was improving, but I could see she was tired. Very tired. I looked over at here and said, "Told ya' we'd make it through the night didn't I?" A wan smile and a nod of the head was all I got.

That night when I came back in I looked on the census for her name. Nothing. A cold chill swept over me. Did she go? Did I miss something last night? The knot churned in my stomach until I got out of report and talked her nurse who I was getting report from anyways. "No, she's OK," she said, " we shipped her to the Unit." A little sigh of relief. I heard they tubed her almost immediately on arrival to the Unit, which didn't surprise me at all...let something else do her breathing, at least for the moment. She was stable for the moment.

Once again, I learned. Not a day goes by where something new doesn't come up, a new crisis, a new system to relearn in the crisis, but that's life right now. It made my bleeding patient last night not such a big deal. Perspective is a funny thing ain't it?