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Monthly Archives: April 2011

The “Ew, gross” Continuum

Apparently, I still have a relatively low threshold for being grossed out. Especially when so-called “gross out factor” is innocently paired with “the element of surprise.” When I walk into the trauma room I know, more or less, what to expect. A rush of adrenaline, perhaps a shocking sight, something to brace myself for. If I scour deep into my heart of hearts I am still stunned to find myself in the profession of nursing. I never saw myself in medicine, and it is not without a degree of disbelief that I find myself in one of the busiest ERs in the most populous city in the country. I am happy to be here, but I still feel like I have to prove that it’s not a wild dream to someone (maybe myself.) So, when I walk into the trauma room, along with my gloves, I also don a mask. It is a figurative shield of pseudo-bravery, utter calmness and serenity. Inside, my heart might be pounding and I may be thinking shitshitshit, but no one wants to see that on the outside.

However, I can’t pull on that protective mask if I don’t have a moment of fair warning.

I tried out my first 12-hour night shift the other day. I was paired with a wonderful preceptor, one who has many years of experience under her belt, and has oriented a plethora of new grad and recent-hires. She was very kind, no-funny-business, and utterly confident in my abilities. I did my best to live up to her expectations. I ignored my typical self-doubt and plowed ahead. The night sped by, hours melting away as I focused on remembering my patients, honing my skills, and keeping the facts straight. I assessed, I gave meds, I started IVs, I charted. Our partner on the team took “lunch,” so we took her patients. All along, my preceptor helped me organize my tasks, but took a background role to my work. Soon I realized that I was functioning more autonomously than I ever had before. Granted, I wasn’t flying completely solo, but I hadn’t crashed and burned either. I glanced at our chart rack and realized that I was caring for 12 patients. Twelve! I knew a little bit about each one, and what they needed from me. I felt pretty darn good.

Of course, my very next patient threw me a total curve-ball. A slimy, puss-laden softball. My preceptor told me to go assess a new patient that we had just picked up. There was a scant note from triage about a foot infection, and that he had left AMA (against medical advice) from another local hospital that very same day. She told me to get a history and help the patient remove his clothing and socks. I went in. I blanched at the smell. I stoically held my breath and put on my gloves. Our patient had already urinated in the bed and soiled his clothing. He was incontinent, but not because he was old, just because he didn’t care. I struggled to help pull his double-layer of sweat pants off; he didn’t help me. Suddenly, the fabric came free and I stumbled back a step, sweats in hand, along with one sock. What I saw made me gasp. No time to pull on the straight face. I’ll spare you the gory details, but the gist of it was a VERY fresh, and VERY infected total metatarsal amputation. I soon found out that the infection was osteomyelitis and the prior hospital had tried its full arsenal of antibiotics to treat it, with no success. Gingerly, I pulled off the second sock. My gift was a big toe amputation, in a stage of healing that looked much better off than the other foot, but certainly not pretty. The patient was not friendly, refused care, and stunk. I am embarrassed to say that I avoided his room whenever possible that night. He wasn’t a fun patient to treat, but he is one I will most certainly remember. It reminded me that I am still quite new, I am not an old hat in this business, and I can still feel shocked and grossed out. In fact, maybe I always will. It’s a spectrum, and my gross-out quotient has already improved dramatically. Maybe one day an infected TMA won’t even make me blink. Maybe, but somehow I doubt it.

 
 

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Dr. Seuss in room 4 needs emergent care, STAT

biggest smile of the day

No…I didn’t take a picture of a patient. But, I did take a picture of what, or whom rather, a patient left behind. Upon our 7am arrival, there was a patient sleeping off her intoxication. Not a rare occurrence in the ED, despite what one may assume is the purpose of the ER (emergencies). My preceptor sent me in to this room to see if I could elicit any information from the patient. Since most of my encounters with drunk people in the ED have been less than pleasant (think: belligerence, lechery, obstinate and loud) I was expecting more of the same, and braced myself. But when I walked in, I saw a middle-aged lady, with hands folded primly above the covers. 1st clue that things would go differently. I asked her about how she arrived here, and if she knew where she was. I was right in assuming that she was oriented times 3. And then she took me for a trip down storybook lane, telling me all about how she had no idea why EMS picked her up, she only drank 3 beers, she was in her own home, alone, not disrupting anyone. To top it all off, someone had stolen her pants and shoes. She was bottomless. Scratching my head in some confusion, I left the room, promising to seek out some clothing for her. I reported back to my preceptor about what I thought was our mistake. My preceptor laughed at me and then very gently pointed out the 28 prior encounters in our EMR that this very same lady had been in for intoxication. I had been hoodwinked. Sober patients are night&day different from their drunk counterparts. After finding this patient a set of bottoms and sending her on her merry way, I noticed the stuffed animal left behind. I guess she didn’t need it anymore. Another nurse set the Dr. Seuss character up in bed, as you see above and closed the curtain. When the 11am shift came on, this same nurse told one of her coworkers, “There’s an emergent case in room 4. Can you go assess, stat?” The nurse agreed and quickly went over to room 4…to find our little friend, all tucked in, with a flat-line for O2 saturation…

Ah, the joys of the ER.

 

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The Emergency Room or a Comedy Club?

Is that man being rolled in on a stretcher by EMS really singing opera? (Also noteworthy: he had a surprisingly good alto soprano.) If you happen to look in his triage record, which I did while puzzling over his diagnosis, you would read that it states simply and accurately, “Loud and singing.” Really?

Is this lady really refusing to remove her diarrhea-saturated panties and jeans because she has money in the pockets?  Upon closer examination, the pockets are actually safety-pinned closed at least 10 times on each side. Maam, do you honestly think I am going to steal your diarrhea-saturated money? Really?

Is that man-struck-down-by-car in the trauma room really arguing with approximately 10 residents and nurses and 3 attendings about the need to lie still while he is being examined because, as he (rightly, as it turns out) states, “I am a physician and I know exactly where I am injured!” He then proceeds to sit up on the bed, ignoring all protest, and removes the C-collar himself. Really?

While I wasn’t present for this, the story is far too good to go unshared. Young drunk lady comes into the ER asking every nurse/resident/doctor that she encounters, “Wanna see my kitty?” Despite stern admonishing, by a nurse that she needs to lie still and keep her gown on, she repeatedly keeps pulling it up while squealing, “Wooooo!” Finally an exasperated nurse says, “Put away your cookies! No one wants to see them.” Too true. But still, really?

Is the nursing student soon-to-be-nurse really still puzzling over the diagnosis of our lovely opera singer? Ah, drunk, yes, that took about 20 seconds too long. Really.

 

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The Crock Pot Saga: Texan Picante Chicken Sandwichitos

I’ve been meaning to post this recipe for quite a while, but kept it on the back burner–so to speak–(pahaha, so punny) since this whole Emergency Room saga began. I figured now is a great time to put it up, though, since it’s been wiggling its way into my food brain lately. Nothing like coming home from a 12-14 hour shift to the tangy and mouthwatering scent of barbecue sauce wafting out into the stairwell, and knowing that it’s coming from my own apartment. The best part about this recipe is that the prep time is next to nothing and it’s great for leftover lunches, too.

Texan Picante Chicken Sandwichitos

Cleverly named by: My fiance 🙂

– 1 medium onions or 1/2 large onions, thinly sliced

– 3 boneless skinless chicken breasts

– 1 cup ketchup

– 2 tablespoons cider vinegar

– 2 tablespoons molasses

– 1 tablespoon yellow mustard

  1. Cut the onion in half and slice. Line the bottom of the crock pot with the onions.
  2. Trim the chicken breasts and place on top of the bed of onions.
  3. Mix all of the sauce ingredients together and pour on top of the chicken covering completely. (I made the sauce the night before so that it’s even easier to prep in the morning.)
  4. Cook for 6 hours on low setting. While cooking, the sauce will thicken and darken and the onions will soften or perhaps dissolve completely depending on how thinly you’ve sliced them.
  5. When the chicken is falling apart tender, take two forks and shred the chicken.
  6. Serve on top of split buns. I like mine toasted and with a few spinach sprigs so they hold up better to the weight of the shredded chicken.

 
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Posted by on April 3, 2011 in Main Dishes

 

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