Back in the saddle

It's been a very long time since I posted anything. For a while, I stumbled over one of those roots and fell into the puddle of my own dismay and insecurity. Then, I changed jobs. I am, of course, still working as a nurse, but I now work on a cardiac medical unit at a new hospital. I love my coworkers. I feel - finally - as if I (mostly) know what I'm doing. I can't tell if that's the new situation (well, new as of a year ago), or just having more experience under my belt. I leave you with a brief anecdote, before I run off.

I received report on one of my patients from another nurse (we'll call him Mike), and then we went to meet the patient. I introduced myself to the guy, who seemed like a very nice, elderly man. The patient said, "Oh, yeah. I know you! You're the pretty one." Flattering, right?

Mike says to me, as we walk out of the room, "He's legally blind."

My ego? Bruised. Fortunately, my sense of humor remained quite intact.

Did he really just say that?

A few months ago, I had a patient who had an abdominal aortic aneurysm (AAA) repaired. The poor fellow ended up with multiple complications, but his first night post-op, he had one in particular that was sort of hard to miss. I had, fortunately, been warned about it.

Upon assessing my patient, I found him to be a very nice gentleman who was a very young-looking > 90 year-old. He was alert, oriented, and generally sharp as a tack. I ask him how he's feeling, and his reply?

"Look at my balls!"

Well, it was a valid comment. He had a lot of scrotal swelling and bruising (think plums...), and just... ow! All I could think to reply was, "It's sort of hard to miss them." Pause. "Let's get a little ice and elevate them."

He was a real trooper about it, and very appreciative for the ice, elevation and pain medication. He made a decent recovery minus some bumps in the road.

... no pun intended.

Code Brown

Sensing a theme?

This is just a follow up to the last post. The night after the RRT (Rapid Response Team) & Barbie's question, I received the same patient from one of the girls on evenings. She said that Barbie wasn't able to tell her why there was a RRT on this patient - after I'd gone into excruciating detail about his respiratory status - but that, "At least he had a bowel movement!"

He sure did.

Still can't breathe, a week later, but at least he's pooping.

I need a Dulcolax suppository, stat!

So... last night, I had to call a rapid response team on a patient. This patient had coronary bypass nearly a month ago, and he is just not progressing well. He has had post-op respiratory failure, among other complications.

I heard a call for help and walked into his room to find his oxygen on his cheek. It should be in his nose. While I hear O2 is great for the skin, it really doesn't do much good for the lungs unless it's actually IN his nose! His saturation (sat), as I put the O2 back in his nose, was 66%. This is Decidedly Not Good. I crank the O2 up and encourage lots of deep breathing. His sat only goes up to 86% - better, but still Not Good. Call respiratory therapy, who draws arterial blood gases (ABGs), and we put him on a non-rebreather. His sats come up beautiful - 100%... on 100% O2. I listen to his lungs, and they're just full of fluid (mind you, 3 hours earlier, this wasn't the case).

We call a rapid response team upon seeing the ABGs, and I get on the phone with the surgeon. I get an order for Lasix, the ABGs we'd already gotten and chest x-ray in the morning. I give the Lasix, fluid starts coming off of him and, long story short... his respiratory status improves. We're going to have to do a lot of work today to continue to piece together what else is going on with him, but I'm wondering if I'll come in tonight to find a Lasix drip on him ... hopefully he won't be back in the ICU.

It's 6:45 AM and I'm giving report to one of the day nurses, who really is a lovely person. But, well, she's tall, blonde and gorgeous and occasionally not the brightest bulb in the box (but I adore her regardless). We'll call her Barbie. I'm explaining the patient's post-op course to her, and the respiratory failure after surgery and rapid response team that evening.

Barbie looks at me, and asks, "When was the last time he moved his bowels?"

...

Sigh.

The road goes ever on and on...

"It's a dangerous business, Frodo, going out of your door. You step on to the Road, and if you don't keep your feet, there is no knowing where you might be swept off to. Do you realize that this is the very path that goes through Mirkwood, and that if you let it, it might take you to the Lonely Mountain or even further and to worse places?"

J.R.R. Tolkien

I've been a nurse for about a year now. I work on a cardiovascular surgical unit - a critical care unit. This is my second career, and thank goodness for that. If I were in my early twenties starting out as a nurse, I'm not sure I'd have the tenacity to work through all the crap that happens on a day-to-day basis. I admire those young, new nurses who do. I sometimes wonder if I do.

Patients are often a raw bundle of emotion. We have to accept patients' emotions, respond therapeutically, and somehow manage to walk away unscathed. Sometimes this is easy. Other times, it's nearly impossible. I was speaking with my younger brother on the phone yesterday, on my way home from another long shift. I tried to describe the emotional exhaustion that can accompany a nurse through his or her day (or anyone who works in health care, I imagine).

It's as if you're on a long journey through a very dark forest. There are plenty of scary creatures out there - patients, their families, doctors, other nurses, codes, potential medication errors... and there are occasional places where sunshine bursts through the canopy and reaches the forest floor, illuminating you and your surroundings in one glowing, bright moment that somehow makes the dark, scary path worthwhile.

Sometimes, you find your path is hung thick with spiderwebs - the challenges of working through those scary things. Yet you push through, coming out on the other side covered in the tatters of those clinging webs. If you have good coworkers, they'll help brush those tatters off of you so that you can carry on. If you don't, you may find yourself covered in their spiderwebs as well as your own, and somehow, you have to figure out how to come away from it intact.

Sometimes there's a root across your path that you cannot see, and you stumble over it. If you're lucky, you catch yourself before you fall - or someone else catches you. If you're unlucky, you don't see the root until it's too late, and you tumble to the ground. Sometimes you dust yourself off and get back to your feet. Other times, you lay in that puddle of mud and moan. And sometimes, you get back up and find yourself hurting and covered in leaves, twigs and dirt. Once in a while, someone holds out a hand instead of pushing you back to the ground.

This is my journey. I hope you'll take my hand and join me along my way.