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Peanut Butter Energy Balls: A Tribute to Nurses Week

Thankfully, I am feeling much better at work lately. It is amazing what 2 months can do. It’s still isn’t perfect, but the fact that I am posting a recipe again means that I am cooking again, which must mean that things are at least a little bit better, and I am a little less stressed. Nurses Week just passed. I was hounded by a couple of the ANCCs to write a story for an “anthology” of stories that was going to be published for the event. Naturally I agreed to do it, but only so long as my story was anonymous, and was only published if plenty of other submissions were received as well. As my luck would have it, my story was the ONLY submission received, and it was published alone, on the back of the nursing newsletter, which was distributed at a very public ice cream social. I didn’t find out until after, and I can tell you, without exaggeration, that my cheeks were as bright as my pink scrubs. Oy! But since the whole world has read my story (it seems) I guess you can read it too. But before that, check out these balls.

I made this recipe because I have been SO hungry at work lately! My coworkers joke that I always seem to be eating something…but I just don’t understand how they aren’t eating something, too! I am training for a half marathon and it is inevitable that some of my runs occur before work, even though that means that they precede a 12-hour cardio endurance event in the ER, which makes me feel that I just created a new Olympic event: the Nursing Duathlon. These energy balls are perfect to pop in my mouth between patients…or on a hike in the Catskills, or a long travel day cross-country to Seattle, the possibilities are endless. And it doesn’t hurt that the “energy” balls kind of taste like cookie dough.

Peanut Butter Energy Balls

Adapted from: The Diva Dish

Ingredients:

1/2 C pecans

1/2 C almonds

1/2 C chopped, pitted dates (I bought pre-pitted)

1/4 C carob/chocolate chips

1/2 C unsweetened finely shredded coconut (plus more for rolling your balls)

1/2 C quick oats

1/4 C pure maple syrup

1 tsp vanilla extract

1/4-1/2 C Peanut/Almond Butter (depends on how extreme you want the PB/AB flavor to be)

First gather your ingredients. In a food processor, first pulse together the pecans and almonds until you see chunky crumbs. Then add the dates and chocolate/carob chips and process some more until your mixture looks pretty crumb-y again. Next, mix in the coconut and oats (one at a time) and pulse until they are integrated. Lastly add the wet ingredients: maple syrup, vanilla and peanut/almond butter and process until they are fully incorporated. Scoop the mixture into a bowl (so the blade isn’t in the way), remove your rings 🙂 it is sticky! Start to roll balls. You can leave them “naked” (which I did for Matt, who has an unfathomable aversion to all things coconut) or roll them in a pretty dusting of coconut flakes (for me, who knows what is better) and then store them in the fridge/freezer as a snack for now/later!

Naked Balls

And now for a little post-cooking story time…

I eye the clock with apprehension. 6:52: my shift starts in less than 10 minutes. I pack my pockets with all manner of nursing paraphernalia; arming myself for the onslaught of patients during the 12 hours that lie ahead. A Carpuject, pulse oximeter, handy notebook of nursing diagnoses and interventions and plenty of saline flushes line my pockets, and my stethoscope is looped around my neck. With a deep breath, heart racing, I set off to receive report, wondering what sort of night lay ahead. It’s impossible not to wonder, but also impossible to control: this is life in the ER.

I thought I knew what to expect. I spent eleven eye-opening weeks as a student in the St Luke’s ER. But “Student Nurse” has a much different ring to it than “Staff Nurse.” As a student, I could apologetically shrug my shoulders and say, “I don’t know” to a patient, and come back with an answer later. As a registered nurse there is a much different expectation. Certainly, I can, and do, ask many questions. But I also feel the weight of responsibility in a different way.

Now, 8-months as a nurse, still green in many ways, I can at least look back on my first few months of being a nurse and see how far I have come. In the beginning, it didn’t take much to throw me off my A-game: a missing piece of equipment that I had to go hunting for or back-to-back “notifications” in the trauma room. Anything could do it, and often did, because the role of the ER nurse is to expect the unexpected and be comfortable feeling perennially behind. Every task is urgent…except for the ones that are emergent. My baseline emotion when chaos erupted was low-grade panic, punctuated by spikes sheer terror.

My confidence was (and admittedly still is) easily shattered. I can start IVs, administer medications and blood products, insert catheters and assist with other invasive procedures. I can competently help stabilize a trauma patient or efficiently do a cardiac work-up. And while I may not yet have the grace of far more seasoned nurses, I can feel satisfaction knowing that as I run around looking harried and crazed, I will get the work done.

It is only recently that I feel a small but perceptible transformation. Gradually, I anticipate what the plan of care will be for my patients, and find that I am correct more often than not. I assist my fellow nurses, like they so often help me. I feel a growing sense of familiarity and comfort with the staff, and realize that in knowing each other well, we work together like cogs in a well-oiled machine. But most significantly, I have started truly hearing my patients for more than their medical histories, and remember the real reason behind why I became a nurse.

One night, as I was busily scurrying around the ER, I picked up patient who had tripped and hit his head. When I went to see the patient, I found a man in his mid-80s, quite confused to find himself in the ER in the middle of the night and with a bloody forehead, to boot. I helped get him settled and explained the purpose of doing a CT of his head. With trepidation, he agreed. He miraculously had nearly no past medical history, and was staggered by the tubes of blood I had to draw for labs and bothered by the incessant beeping that came from the monitor whenever he pulled off his leads. Then, we were called to the trauma room and for 30 minutes I didn’t think about anything else besides the new patient in front of us.

When I eventually made it back to my older gentleman patient, he was agitated and disoriented. While his words came out in a tumble, I gathered that he was afraid, tired, annoyed and that he had soiled the bed. He told me that he had called for someone to help him but wasn’t heard and eventually couldn’t wait any longer. He was embarrassed, and rightfully indignant. I felt terribly that I had been holed up in the trauma room for so long, and apologized profusely. I helped change the linens and his wet gown. Now calmer, clean and settled, we spoke the plan for him to be admitted to the hospital, and I also learned about his wife of 60 years at home with whom he was still head-over-heels in love. In the end, I realized that it wasn’t the subdural hematoma that made my patient feel so scared and upset, but the feeling of being neglected. Everyone deserves dignity in their care and I felt reassured that despite my rush, I am still able to find moments in the ER to provide reassurance, listen to touching anecdotes, and care for my patients during their most vulnerable times. In nursing school, you learn about the progression of competence that every nurse makes in their journey to becoming experienced. It is gratifying to move past a near-exclusive focus on the completion of discrete tasks to the ability to view and implement comprehensive patient care based on individual needs.


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Real ER Nurses Don’t Cry

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.

 

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Craziness and Cookies for Peace

This story does not make me look like an angel. Yesterday, I was severely annoyed by a patient. This patient drove me so crazy that I wanted to pull out my hair, ignore her completely, or worse, make her disappear. It wasn’t that bad from the beginning. While I knew she had a psych history, and had been to multiple ERs with the same complaints, and had same tests done and had been medically cleared any number of times, it’s not in my nature to immediately distrust a patient that I have never met. But with a large load of patients already, and a busy day ahead, it soon became clear to me who was the truly ill and who fell to second (or fifth) priority. And with a steady stream of complaints and demands with seemingly no relief, I soon grew exasperated. Probably more so than I have felt ever before in this setting. It is not a good feeling, and it colored the quality of my care for this patient and tinged my mood for the entire day. I was not at my best. Less than super nurse, to say the least. She was with me all twelve hours, my lovely lesson of the day. She was constantly telling me how sick she was – as if I could forget. She told me again and again that the regular doses of pain and anti-nausea medication that I was giving her had done nothing at all and she would rate her pain as ten out of ten, and later twelve out of ten. When I paid attention to her it was almost worse than when I ignored her. I hate to say it, but I realized that I had to be firm and set limits with her so that I could safely care for my other patients as well. It was a hard lesson, but very necessary. And when she was finally medically cleared (with yet another CT scan, that she demanded) she still wasn’t ready to leave. Multiple physicians tried to use reason, and I did my best as well, but we could not get through to her.

Then suddenly, while I was in the midst of drawing up medications for another patient, an old man appeared at my side. He said he was her father. He looked nearly as tired as me. But with a sweet smile, he asked me if she was medically cleared, and if so, could he take her home? Unanticipated, a huge sigh whooshed out of me. I told him that yes, she had been cleared. Another sad little smile and he said, “If she is clear, then I can take her off your hands.” This small stocky man with the unruly grey Einstein-esque hair and disheveled appearance–sweater pulled taut over a slight paunch–was my knight in shining armor. And after a full day of caring for this patient with no relief or remission of symptoms, arguing with her about her diagnosis (or lack thereof) and just generally sweating over her care, she meekly followed her father out the door. That easy? For me, it was. That was one day for me. One hard day and then I get to wash my hands of it. But guess who doesn’t get to do that? Her kind mother who called earlier in the day to inquire about her status and her sweet father who came to escort her home and ultimately ended the circular game of discharging someone against his/her will, sick or not. Mother and father will never wash their hands of their daughter’s illness and neither will this woman herself, who is clearly sick in a way that the medications in our Pyxis simply cannot treat. I left very sad, and frustrated. Our system isn’t very good at dealing with the mentally ill. In fact, I would even go so far as to say that the system failed this patient, despite our well-intentioned efforts, and that makes it fundamentally flawed. Clearly, I don’t know the whole story. I only saw a small piece of the puzzle. But, I know something different should have occurred to stop the cycle of her using the ER like a revolving door. Should she have received a psych consult even though every complaint she had was physical in nature? The clues of prior visits point to yes, although clearly this is not a means to a permanent end since prior psych consults have not yielded answers or an end to the behavior. And should she have been assessed for an addiction? Perhaps. It is hard to say without knowing more of the story than her singular ER visit.

What I do know is that the very next day, while putting a chart away at the charge nurse’s desk, a little piece of me shriveled up inside when I heard her voice behind me saying, “Oh, Rachel…I’m back. This time I am really sick!” There she was, brought in by EMS…AGAIN…on a stretcher. She told me that she was still feeling terrible, and that “they” had called her back because they had seen something on her CT scan when re-reading it. I have to admit, I held my breath and crossed my fingers that our team wouldn’t be assigned to her care. And it wasn’t. But the Communications nurse later told me that the look on my face was priceless when the patient called out my name, she said she cracked up, and only for that reason was the patient not assigned to our team again Only in blog-land can I admit how grateful I was. After another 12 hours of her in the ER, with so many other patients, I may have quit my job on the spot. Obviously, I need to learn to better outlets to control my frustrations, because not every patient is pleasant or kind. I am working on learning not to let my crazy patients make me crazy as well because then i really can’t help them!

And now, a recipe for peace. Tea and these cookies, combined with a little yoga on the side help me stay externally peaceful in the ER.

simple lemony cookies

Ingredients (I doubled this recipe and kept one log in the freezer for later use at a future tea party date!) From: VodKitchen
  • 9 Tbsp. butter
  • 1/2 cup fine sugar
  • 1 large egg
  • Barely less than 1 cup all-purpose flour
  • 1/4 cup quick cooking oatmeal
  • 1/4 tsp. baking powder
  • 1/2 tsp. salt
  • 2 lemons for zest
Preparation
  1. Put your softened butter into a food processor with the rest of the ingredients (save the lemon zest) and process until smooth.
  2. Finely grate your lemon zest. Stir the zest into the cookie dough and mix together well. Spoon on to a piece of plastic wrap and roll into a sausage shape with a roughly 2 1/2-inch diameter. Chill the dough in the freezer for 30 minutes.
  3. Preheat the oven to 375°. Get your chilled dough out and cut it into 1/4-inch thick slices. Place these on two cookie sheets, making sure you leave a good bit of space between the slices because they’ll spread while cooking. Place the cookie sheets in the middle of your preheated oven and bake for about 10 minutes, until the edges of the cookies are golden brown. Let them cool down slightly before transferring to a wire rack to let cool completely.

Also great made with orange zest instead of lemon, and served with tea, coffee, or hot cocoa!

 

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Comparing myself to overcooked pasta…

Every night leaving work, it’s like the energizer bunny coming to screeching halt after a nonstop day of go-go-go.. On autopilot, I resist collapsing like one big gelatinous noodle. In some recess of my brain I know that my bed is better than train tunnel for sleeping. Thus far, I have always won against my limbs, thank god. Not that I am actually complaining. This is exactly what I wished for: bedside nursing, interacting with people as much as possible, constant learning, and never sitting at a desk in a cubicle. I got all of those things. So far, no matter how tired, frustrated or emotionally drained I am at the end of a hard day in the ER, I am still excited to go back (after a solid night of rest). I can’t say how long this honeymoon phase of our relationship will last (me and the ER, that is) but I am really hoping it’s a not a fleeting feeling.

As a new nurse, I am always running, my brain whirring, trying to anticipate the next step. In the beginning, I had plenty of time to learn my patients and know them fairly well (at least well for a brief ER interaction) but now as I grow more adept with my few patients, I have been taking on more patients, and more. It’s hard to know them as well now, often, just staying on top of their medical case is the best I can manage. Sometimes I yearn to spend more time with just a few patients…respond to all their “real” needs as well as the self-professed “real” needs, instead of triaging their professed needs myself. (For example, bleeding wound=real need. Fix it: clean, gauze, tape, presto-donezo. While, “I’m starving, I haven’t eaten in 18 hours, get me some food now,” is not a real need…I am sorry but it’s not, when the guy in the next bed is bleeding.) I want to respond to all needs equally, which is simply impossible in the ER. I have to make snap decisions, which clearly doesn’t please everyone. The flip side of wishing that I only had a few patients, is that obviously there are some patients that you would much prefer never even crossed the threshold… Luckily, there haven’t been many of those.

Sometimes it’s impossible to miss a special moment though. Yesterday, I had an elderly patient with a laundry list of geriatric problems — Alzheimer’s, Parkinson’s, new onset seizures, the works. Oh yeah, and probable pneumonia on admission. The wife (who looked much better, I might add, and at least 10 well-preserved years younger) claimed that her husband, on a better day (pre-pneumonia, I imagine) walked around the house a little bit, and even spoke occasionally. Pretty incredible to believe from what I saw lying on the stretcher. Nonverbal, limbs contracted inwards, shivering and weakened by illness, he was a full workup waiting to happen. He was in my care all day, while being screened into the ICU and then waiting for a bed to become available. While we drew labs, waited for results, started broad-spectrum antibiotics and gentle fluids, and periodically changed his sweat-soaked sheets, I watched the wife interact with her feeble and febrile husband. He never spoke, but she spoke to him and seemed very certain of what he needed at any given moment. She, dressed in a smart red suit with perfectly arranged hair, sat at his bedside for hours upon hours. And this is no private room either. The ER is full of incessant beeps, whistles and alarms, combined with a cacophony of human-emitted noise – complaints, moans, the works. It can’t be pleasant for a patient or a family member (not that I particularly care for it, either). Yet, she calmly and gracefully sat by his side and thanked us for all the care we provided, not once blaming us for the slow pace of diagnosis and admission to the ICU. At regular intervals when I checked on him, she would be stroking his forehead whispering gently to him, or rearranging his pillows and blankets, or spoon-feeding him miniature bites of applesauce. It nearly brought tears to my eyes, such tender and private interactions that I witnessed as my patient’s nurse. These are the moments that I live for and that I strive to reproduce as a nurse for my patients that have no one at bedside. If this patient had been all alone, I might not have known a single thing about him other than the details of his illness. But with his wife at bedside, I learned that he had someone who loved him dearly, and he probably loved just as tremendously in return. Learning these little tidbits reminds me that my patient is also a person, with a story all his own beyond the hospital stretcher. On a busy day, there isn’t often time to find out the stories of every individual, but it’s important to remember that they all have one.

 
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Posted by on October 13, 2011 in Emergency Room, Healing Spoonful

 

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Holy Hamburger, a Hurricane?!

I got that awesome new catchphrase from a patient today. In short, I was pulled into the trauma room to watch a patient having cardioversion today, a rare occurrence in our hospital, since usually we are shocking dead patients in resuscitation rather than the living. The basis behind cardioversion is that the patient is in an aberrant rhythm and you shock them (in an organized fashion, marking the R waves of the EKG, which is what makes cardioversion different from defibrillation) in hopes that you will be able to startle the heart back into a normal sinus rhythm. They used conscious sedation, which is intended to calm the patient as well as act as a handy amnesic, and it worked well. The patient was calm and chatty leading up to the shock. I was probably more nervous that he was. Upon shocking, his body arched weirdly, like only a 100 joules of electricity can do, and he exclaimed, “HOLY HAMBURGER!” I admit, I laughed. Plus, he didn’t even remember that we had shocked him a few minutes later, and he converted to a normal rhythm, so it all ended happily. The ER can be a very happy place when everything works out as intended.

So, I am starting orientation. I still don’t know quite what to expect. I am stressed, excited and apprehensive. I have only been there a few weeks and haven’t been taking my own patients yet. But apparently, that may change tomorrow, since the hospital just activated its disaster protocol for Hurricane Irene. All nurses on deck, either for the acute phase (storm) or recovery (after the storm). That includes lil ol’ me. I am going in tomorrow afternoon, and depending on the storm’s course, they told me not to expect to leave until MONDAY! Talk about a dramatic entry to the world of nursing. Don’t tell my mother, but I am pretty darn excited. 🙂

Wish me, and all souls that find themselves in Irene’s wrathful path, good luck!

 
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Posted by on August 26, 2011 in Emergency Room, Healing Spoonful

 

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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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