New and improved. Cleaner, shinier, with a sparkly new logo. Go ahead, you know you want to. Check out the latest edition of Change of Shift.
Oh yeah, forgot, there's one from me up there too...
As the gentleman wearing overalls, no drawers or shirt is settled in bed for after transport from ER:
Yes, Mr. COPD, I have to ask you all these questions over again. I am aware that you have gone over this approximately 15 times since you've been hanging out in our wonderful facility. But I have to do this. Again. No, the computers don't "just transfer" the information.
I know you waited 7 hours in the ER while in your so grateful words "the fat bitch just sat her fat ass behind the desk drinking Coke and eating chips." Not to mention the fact you couldn't see the drama unfolding across the ER from you where they were running a code to save someone's life, but they didn't look busy to you. I know that this was going on...you see us nurses kind of stick together every now and then, the nurse I got report from gave me the head's up all about your "displeasure" about your current situation. I guess I shouldn't point out that you called EMS to bring you in. For shortness of breath, cough and "coughing up yellow crap," that had been ongoing for 7 days. That would be rude of me to do and my verbal filter is still working. I know you want to sleep. I just have to get this history from you, take some vitals and look you over. How long's this cough been going on? Getting anything up? Not lately? If you do I want a sample, here's cup. I'm going to put you on some oxygen too. The amount of oxygen in your blood is kind of low and your lungs don't sound so good. No, I don't have a mask, but I'll try to track one down for you. Yes, I know your nose is stuffy, unfortunately this is all I have right now.
Guess what? They're going to come draw more blood from ya'. Do an EKG, try to give you a nebulizer treatment so that you aren't wheezing anymore, probably another chest X-Ray. That and the docs want you to be on telemetry. What? Oh yeah, the little sticky pads we put on your chest. We use them to watch your heart, make sure nothing bad is going on with it. Y'know, try to keep you alive at least one more night. And every time you tear those off, someone will be back in to re-attach them...it's our job. I know you would have left already if you had a way home, you've told me 3 times already and you've only been in the room 20 minutes. And yes, I think it is a little late at 0200 to call your daughter, but you dial "9" to get out.
So you have a list of meds? Great, that reduces the number of questions I have to ask you. But I have one more, when did you last take these? Oh, the only thing you've taken in the last month is your pain meds and stool softeners? What about that nice list of blood pressure meds? At least a month? Right, guess that's why your BP in the ER was 180's over 100's.
You know, we nurses hate it when you preference the question as "Don't freak out about this..." It's like hearing Jim Bob say "Hold my beer, this is going to be cool." So you want to take 100 Valium. OK, you have my complete attention. When? Not now? Later? Right, why? Oh, your life sucks? I guess I shouldn't tell you about the little old lady across the hall who may not last the night. Or the guy who had a massive heart attack last night and is lying in the ICU with a machine breathing for him. Yeah, you have some heavy-duty medical problems, but if you took care of yourself, y'know, be active in your health care, not expecting all of us to do everything for you, it might not be so bad. Death? No, in spite of everything I've been through in the last 18 months, I still have an allergy to pine boxes. So, do you feel like doing something about it now? No? OK. Do you want to talk to someone about it? No? Fair enough. Mental note, let still-wet-behind-the-ears intern know that we probably need a psych consult and I need to keep a close eye on him tonight.
OK, that's all for now. Yes, you can go back to sleep. But I'll probably be back in awhile.
A short while later at the nurse's station after RT came back and phlebotomy was waiting for me:
What? He refused the nebs? OK, I'll call to get them changed to PRN. He refused the lab draws? OK, I'll let house staff know, not much we can do right now.
And another short while later...
When do the docs come in the morning? Depends how many folks they have to see. Out by 9:30? Maybe, but I doubt it, they're a little worried about that nasty little pneumonia you're brewing, not to mention your lungs sound like a half-empty aquarium in a sandstorm. Again, I won't be so rude as to remind you, that you called EMS to bring you here though. I know, we keep waking you up, trying to do tests and whatnot, because after all, it is a hospital. It's kind of what we do, y'know, get you feeling better.
To the oncoming day shift nurse:
So that's about it. He refused AM labs, I already let the docs know. And yeah, he has a little SI, but he says he isn't going to act on it right now. Any questions for me? OH, almost forgot, he's going to try to leave, one way or another. My money's on going AMA. I put the form in the front of the MAR for you. Good luck and have a great morning.
Never found out how he left...unfortunately I don't particularly care.
In a quest to prove that I have a life outside of nursing, there's a new catchphrase..."nursing, it's not just a job, it's a lifestyle!" Too pretentious? Maybe a bit. Anyways in pursuit of that goal, I have been getting on my bike and riding. Nothing clears the smell of poop and yeasty nether regions better than a spin though a polluted urban core. Mmmmmm, smog.
Being the altruistic guy I am, also figuring I could do the ride for free and get a free T-Shirt (note the theme here...), I signed up to be a medical rider. Really all I was to be was a quick triage nurse, maybe a fixer of minor issues, but for anything major I was to call EMS. No heroics. It was a leisurely jaunt through urban Portland on what is usually and historically one of the hottest days of the year here in Stumptown. Not this year.
I got off the MAX in the morning and it was drizzling. Nothing to even worry about, just that damp haze of a fall morning here in the Northwest. But it was chilly, for summer. Got all settled in, picked up my fancy traffic vest and free t-shirt and headed back towards the back of the staging area. In front were the 40 milers, who were the usual group of hammerheads and folks who believe spandex is a fashion statement. Not us in the back. We were the cruisers. Families, folks hauling trail-a-bikes and kid trailers. We were there to have fun. Which I sure did. Were my medical skills needed? Nope. Only saw an issue once and it was all taken care of by the time I got there. I put my mechanical skills to work, once again wishing for the fable 3rd arm I was supposed to have been issued after nursing school. But that was it. No crises. Never had to call EMS. Never really got out of breath. All in all a fun ride. Even had a free sundae after the ride. How can you beat that? It was too early to grab a pint, so a sundae was the best I could do.
The funny thing is the difference 10-15 years can make on an area. Even though I had spent time in the neighborhoods we rode through before I left town for nursing school, I didn't realize how much of a change had overtaken some of the areas. It can only be described as the inexorable advancement of "progress", or as some will call it, gentrification. I earned my first degree in the middle of the 'hood. Right around where the ride took us. We had drive-by's and stabbings on the nearby blocks all through school. I regularly rode my bike through these neighborhoods, quickly. I got hollered at. I had to high-tail it a couple of times. Saw drug deals, hooker deals, stolen cars, knew the local crack houses (by reputation only!), it was not a great place. But it had a soul, a certain life to it. There was a bright side tot he darkness.
Now approx. 12 years later, it has changed. There has been an influx of folks snatching up the houses whose prices were depressed by the rampant criminal nature of the area and slowly changing the character of the area. The park where you could not walk at night and folks lit up crack in broad daylight in the benches now has families playing there. It's a different 'hood. Folks are more likely to roll the Prius than an Impala. It felt kind of weird being back there. The flavor has changed, but maybe not totally for the better. What happens to the folks that had traditionally lived there? Sure the bad element was pretty overpowering, but mostly they were good folks. I know they've been driven out due to rising housing costs that come along with gentrification. I understand that this happens in urban cores, but it made me feel bed for the vibrant community that had been displaced. But it was nice to be back. It was nice to ride on a grid versus the winding mayhem of suburban hell. I felt right at home. It also made me realize I need to move back there, suburban living is bad for my soul.
I have another couple of posts brewing...I just have to re-read and edit them until I'm happy. Til' later...
Nope you don't have shingles. Hope you don't have what this guy has!
About a week and a half ago, over at BikePortland.org, I saw a blurb about mountain bike short track racing. After reading and watching the videos, I said, "That looks like a blast. Maybe I should give it a shot." So Monday was my very first mountain bike race, of any kind (unless you count racing traffic to the next light). But first a little background.
I've been biking in one form or another for years. My involvement has waxed and waned as did my time. When I had no time, I didn't ride. When I had time I did. Then I moved to Flagstaff, Arizona. For those who haven't been there, Flagstaff is a near mecca for mountain biking. Plenty of trails, great weather, close proximity to places like Moab and great riding all over the West. I never rode. Granted, this was during nursing school where a little recreational riding would have done me a lot of good, for both stress relief and to start dropping the weight I had earned flying a desk for 4 years. But I didn't ride until the last summer I was there. Even then, I didn't ride much. After moving up here to the NW, I figured I would have time to ride. I did. But more it became transportation. A discount transit pass provided by work was a far cheaper alternative to $3/gallon gas, with a little bit of exercise thrown in for good measure. Unfortunately my off-road riding has been limited to very few dirt tracks I have found locally, nothing more really than shortcuts through fields. Not at all real mountain biking. But I figured I had a built a pretty good base fitness to at least give the race a try.
Yeah, right. Who was I kidding?
I got there on a balmy Monday afternoon with wife and MIL in tow. From the start I was surrounded in a sea of spandex. Nothing says "fashion" like glaringly gaudy neon colored spandex outfits. I nearly went blind before the race even began. Not me though. I was a little more "blue-collar". Granted, I had spandex bike shorts on. Underneath my baggy shorts. I'm not letting that freak flag fly, nobody needs to see that.
So I paid the entry fee and went out to pre-ride the track. Around the second turn hit a unseen divot, launched off the seat and jammed my crotch, just a little north and east of the jewels. Except for damaged pride, nothing to worry too much about. I thought, "At least I got a crash out of the way early." But thanks to the wonderful efficiency of public transit I only had about10 minutes to see the track, not a lot of time. So I headed to the starting line. The gun went off I started quite possibly the most painful 20 minutes of my life.
I didn't hurl. Thought I was going to. I didn't crash. I didn't pass anyone. Everyone passed me. I thought about dropping out. But I didn't. I made it through the 3 laps that my class (beginners...they didn't have a fat ass class) ran. I was the last off the track. In fact, they nearly had to shoo me off so that the next class of racers could think about getting going. The course was great. I had a blast. But I learned a couple of things.
- Get there early to pre-ride. That way you can scope where you can puke and no one will see. Also, it helps to crash early, thereby getting it out of the way.
- Train for the race. You go all out for 20 minutes or more. If you're not used to that, it becomes a very painful experience.
- Line up near the front of the group. If you don't, when you start you end up sucking down everyone's dust. I spent the next 12 hours post-race hacking and coughing like and asthmatic COPD'er with black lung.
- Realize that you will get passed. I got passed by everyone, including the 7 year old it seemed like. I even think some passed me twice.
- Have Fun!
I ain't racing if you ain't bleeding. Nice farmer's tan, huh?No fooling. My desktop widget shows 91 degrees outside. I moved from Arizona a year ago and I still think this sucks. Yesterday we hit over 100 and it isn't even August yet. And they say global warming ain't real...
I'm just glad I'm off. I've been biking and using public transit to get to work and not pay $3+ a gallon for gas. Only problem is that I get hot, sweaty, sticky and stinky on the way, so when I get to work I smell just like many of my patients. Shadowfax over at Movin' Meat had this post about cycling. I feel his pain. Thinking about moving to the Midwest to get away from them. Ok, not really.
Funny though, since I've started this bicycle commuting thing in April, I've only driven to work twice. Not that I've lost any weight though. But my blood pressure is better. At least until I hit the floor...
A while ago GruntDoc had a great post about "The End of the Code" wherein he describes his actions as a team leader in the midst of a code. IT shows the true meaning of leadership. Luckily on my floor, the codes are usually quick, the patient well on their way to the Unit before most interventions can occur. One of the charge nurses said basically, "get a rhythm, get an airway and get off my floor." We neither equipped nor truly capable of handling complex interventions unless completely necessary. No thoracotomies, invasive monitoring lines, transvenous pacing (all of which have been done...) on our floor, the Unit is much more suitable for this kind of heroics. This is not to say that we won't in the emerging situation, but the reality is that we need them off the floor and down to the Unit quick.
The other night I had my first real code. Not a Rapid Response. A Code. Dude was dead. Wasn't my patient though. Here's how it went down:
We were all hanging around the nurse's station, in that twilight time of 0500, early AM vitals were done, folks were just starting to wake up. The monitor starts the high-pitched binging of a life-threatening alert. Look and see the patient in V-Fib. As we head down the hall, we hear that it's back in sinus rhythm and the pacer had taken back over. So the nurse heads in, starts checking the patient out. I'm almost back to the station when I hear frantic yelling from the end of the hall and that binging again. "I need the cart!" She hollered. I'm closest to the code cart and run for it. Mind you, our unit is big, it's nearly and quarter mile round trip from end to end. I've never made the trip so fast in my life. Hauling ass down the hallway to the very end (yep, it's always the room furtherest away) with the code cart. Into the room, the patient is laying in bed, back arched, mouth agape like a recently caught fish, "oh sit" I said to myself. Then my mind went blank. All that time in ACLS, all that time in previous situations. Nothing. It was like those moments in the Matrix where time s l o w e d to a crawl, my mind was trying to remember what to do next. The arrival of the next nurse behind me shocked me back to reality. He jumped in to start CPR, I went looking for the ambu bag to get an airway. But it wasn't there. I thought, "Isn't it supposed to hanging from the outside? Wait a sec, I checked the cart myself this evening...was it there?" By that time more people were flowing in the room, breaking open the cart (where the bloody ambu bag was...) and getting things going. At this point I got out of the way. Let the pros take over. They shocked twice, after the second the patient came back yelling and cursing. Which all things considered was a good thing. Not soon after, with a rhythm and a patent airway, they went off the floor to the Unit.
After this though, amny realized that we needed more training. In spite of the nature of the floor, we don't do many codes. This was the first I had been in since I started back in December. Sure, we've had them, but not anywhere near me. So we're going to get mock codes and a chance to see inside the cart so we(me) don't freeze trying to figure out where things are. At least I learned one thing: Ambu bags are inside the cart.
Oh yeah, the patient? Was a frequent flyer and this was not the first time they'd coded. Ends up they came back tot eh floor 2 days after the code and went home a week later. Guess it wasn't their time.
