Lost on the Floor

Once again, thanks to Digg for an insightful (I know Digg and insightful rarely appear in the same sentence, but sometimes the less puerile part of the community comes out on top) and somewhat enlightening article. Titled "What's Up Docs" it digs a little deeper into the lives and psyches of some docs currently practicing. My favorite part comes at the end where in a poll of 50 nurses, in speaking about arrogance and doctors, it came across that surgeons were the most arrogant of the lot. Not saying anything here. Just found it entertaining.

Over at Musings of a Highly Trained Monkey, she points out this gem of an article about a group of folks I had a little exposure when in nursing school. A little background here. Basically, Colorado City in Northern Arizona and its counterpart, Hilldale across the border in Utah, are the refuge of the Fundamental Church of Jesus of Latter Day Saints - in other words a fundie group of Mormons. They engage in polygamy, child rape/molestation through the marriage of extremely young girls (like 14 years old) to older men, and among other things they control the entire town. The whole place is owned by them. Not outsiders allowed. In effect they are a law and community unto themselves. The interesting thing is the stagnation in the gene pool which the article focuses on. Through rampant interbreeding and crossing of genetic lines, they continue to pass on genetic defects with alarming regularity. Again, not saying anything here. Just found it interesting.

Thanks to Suicidal Tendencies for the title...

Went shopping with my wife the other day (yes, besides work and sleep, I try to find time to do normal human things) and like always there are plenty of people on their Bluetooth headsets. You know the kind, talking to themselves and carrying on a loud conversation at the same time. You have to stop and wonder, "Are they altered? Schizo?" No, just inconsiderate.

I read this article ,via Digg the other day and was met with the news that now it is going to be even easier to link up Bluetooth devices. Yes, there are good things for this...maybe even some that apply to the health care environment. Like vital sign machines that transmit data directly to the computer chart without wires and without the interference of us worn out nurses, or that send the data that a lab has been collected instead of replying to the docs that, "Well, I saw phlebotomy here...they were in the room, so I have to assume they drew the AM Labs, they'll probably be up in a couple of minutes."

I try to remain positive, but I really know that what it means is more people on headsets, talking out loud to apparently no one in particular. I'm just going to have to try harder to not answer them so much...

As I've gotten more and more comfortable calling docs, I've really began to learn what is needed in situations. Before I was simply tongue-tied even talking to the MDs, much less able to know what to ask for. In fact I was in awe of the nurse who could call and say, "So and so has this going on, I need orders for this, this, and a little of that." I know that in time it will come to me. Every new situation is a time to learn this and file it away.

The other morning, one of my folks, a sweet older lady fours days out from an AVR called me saying "I feel like I can't get my breath, having a hard time with it." Let me tell you, this is one tough broad. Here she was just recently undergoing a standard AVR with her chest cracked, and the only thing she has asked for is Tylenol. I've had grown macho men in the same situation crying for their Oxycodone every 3 hours, so I knew something was not right. Sat her up, put on some O2, listened to her. And there it was, widespread crackles and just that wet blanket kind of sound of too much fluid on board. Told her, "I'll be right back, gonna call the doc. Call me if it gets worse." Lucky for me it was 6 in the morning, not that I care about waking docs up in the middle of night, but I like having my docs awake when they talk to me (had a friend where the doc tried to give him orders for a Vitamin K drip, before correcting himself to an insulin drip - he then called back and asked my friend what he had said.) Asked for Lasix and duonebs and got a basic panel thrown in too for good measure.Gave her the Lasix and by the time I was wrapping up to go home she was right as rain. The next night she had scheduled Lasix and potassium...guess they figured her CHF hadn't quite totally improved, but yes, but not quite there.

The thing that took me aback, was that I didn't hesitate, just did and got the problem fixed. Guess I'm learning.

The other night was a first: first time to float. We had so many empty beds it wasn't even funny, so I got the short straw and went to med-surg. Not that it was a bad night, in fact I did more sitting doing nothing than anytime lately on my home floor. The thing that really chapped my hide is that I was at 4:1, with fairly non-acute patients. Sure between the poly-substance OD 3 days out of the Unit, the the homeless gent with DVTs and the lady on ETOH withdrawal protocol, not to mention the rather large lady in acute renal failure with a rectal tube, it was enough to keep me busy. Compared though to the previous night on my floor, it was nothing. They were stable. No one was detoxing actively. They all slept. All night. With minimal requests. I turned to the other nurses and offered my free time, but they were pretty well wrapped up as well. I'm not complaining, it could have been worse. It was just unusual.

In other news...
You always hear about "pucker factor", how your sphincter can slam shut in response to unexpected events. In the case of males, things like rectal exams or mentioning the Jewish custom of bris, can cause this. So can seeing V-Tach live and in person on the monitor. It kind of makes you stand up and pay attention. Right after that showed on the screen, we heard overhead, "Rapid Response to room xxx." By luck it wasn't one of mine. So like a good co-worker, I went to see if I could help, saw they had enough help, realized I would only be in the way and skedadled.

'Til later...

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...