I wrote this post in mid-March…one year from the date that I first started my stint in the ER as a nursing student. I never published it…I’m not sure why, but here it is now. I am feeling so much better and it is really nice to read this post, just two months later…
I am no longer a student nurse, no longer an orientee. It is unofficially my 1 year anniversary in this ultra-urban level 1 trauma center ER, yet it is actually only my 2nd month off orientation (which was a six-month endeavor), and now here I am, rolling along, sort of wobbly, like a kid on a bike without training wheels for the first time. It’s funny how impatient I am for confidence. I expected after 8 months of being a RN, I would feel better…not fearless per se, but better than this. I like the ER, but I don’t love it. I always take a very deep breath before going in and brace myself for the assault that I know (most nights) is inevitable. I know now that I wasn’t built for the ER long-term. I’m not a huge fan of blood and guts (though I’m pretty proud to say that I have nearly perfected my mask of nonchalance) and I consider it a great night in the ER if we don’t get any terrible traumas or cardiac arrests. Funny, because most ER nurses get their kicks from a “good” trauma. I just pretend to understand that.
I’ve noticed that my moods have been more mercurial these days. Part of this I attribute to the recent passing of my wonderful grandfather. But I also suspect that my newfound capriciousness and random bouts of teary-eyes may stem from sadness and intensities that I haven’t found time or energy to deal with from the ER. Again, why am I not blogging? That always helped me before! But then again, I am a morning person…living on the night shift. I’ve noticed that I have also been cooking less (I crave cereal ALL the time), knitting less, and even exercising less. I really need to fix this lifestyle…it’s gotta be possible to live a normal life on the Night Shift!
One thing I like about nights, though, is that sometimes…sometimes, I get the kind of quality time with my patients that I got in the nursing home. It never felt like there was enough time on the Day shift to ever spend that kind of quality time with a single patient. But on some nights, the really good ones, there are nearly empty hours. I only have 3-4 patient that are “mine” and I really get to take my time.
On one such night, I was working a patient up for chest pain. He knew the drill, he had been to the ER plenty of times for much of the same. An older gentleman, he was a little gruff and curt with his words in the beginning. He was polite, sure, but not exactly a fount of engaging conversation. However, as the night wore on, and more patients were discharged, I had the opportunity to check on him various times. He was asymptomatic and in the wee hours of the morning, our banter developed. Shortly after his second set of labs came back, it was discovered that his potassium was quite elevated. This is the moment most nurses dread for their bed-bound patients. I include myself in “most nurses.” This is the moment of the Kayexalate. And to be quite honest, most patients aren’t exactly jumping up and down for it, either.
The elixir of Kayexalate is an ominous-looking thing, and its looks reflect its purpose. It comes in a small plastic bottle, and pours into one of our styrofoam cups like a long viscous concoction, slightly lighter brown than Hershey’s Chocolate Syrup, but of the same consistency. Most patients get two bottles for a dose, which comes out to be more than a 2-swallow shot. Nurses hate it because it makes their patient have MANY bowel movements, and patients hate it because it tastes bad (or so I’ve heard) and, well, the same other reason — MANY poops.
So, when I introduced the elixir to my new friend, I didn’t exactly expect a warm reception. But there he was, grinning, saying, “Ah yes, I was wondering when I would get this.” Surprised, I asked whether he had tasted it before. “Oh, yes,” he assured me, “My potassium is ALWAYS high. And I just love this cocktail,” he said, grinning some more. Surprised, I proffered the styrofoam cup, and he took it, immediately raising it to his lips for a sip. Yes, a sip! Not a chug and grimace, or the other many expected responses, but instead a small sip with a smile as if it were a fine scotch. “Ah, cinnamon,” he said. And then another sip, “And a touch of vanilla,” another sip, “and dare I say apple pie?” By this point I’m not just smiling back at him, I am actually laughing. Clearly, he is playing with me. But it is such a welcome change from the usual replies. This man reminds me of my residents at the Assisted Living Home. He is graceful in his aging, he is not remotely angry to be awake and drinking Kayexalate at 3am with a nurse in the ER. In fact, he is making it a fun experience for everyone. And this is what my patient taught me. As much as I can, I want to treat this experience in the ER as a chance to make the night better, lighter, less serious, or just more comfortable for my patients and myself.