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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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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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Dorothy’s not in Kansas anymore

Here’s a spoonful of something, though I’m not quite sure what category it falls under!

Oblivious to my surroundings, I was paging through my notes on the Subway this afternoon, wishing it was already 24 hours later so I could be done with my finals. All of a sudden, I heard a cacophony of yelps and shrieks ripple down the car, and I looked up sharply. People were lifting their legs and making a ruckus, and it was a few seconds before I could decipher the cause. But the cause soon revealed itself to me as a mottled little rat scurried down the center aisle, clearly confused and hastily contemplating his misfortune. I’ll admit, I yelped a little too and lifted my own legs as the rat scuttled back down the other way again, passing me with mere inches. As the situation escalated, with more and more passengers involved, an off-the-job construction worker picked up one of his tools (a level, I believe), and with catlike reflexes, squashed the little creature. Suddenly, the poor soul looked pathetic, and I was sad. We take a life because we are temporarily afraid? It’s not exactly like smushing an ant, although I know there would be some who disagree with that too. But I momentarily forgot my concerns in favor of a moment of human connection. Everyone was looking around at each other, commenting, making eye contact! Suddenly we weren’t strangers in our own orange and yellow seat bubbles, brushing elbows but never exchanging a word. We had a connection, making us a temporary community. Lots of smiles and comments ensued. An older African-American man (a little rough around the edges, with clothes that have seen better days) who I would never normally connect with, looked at me and said, “Were you scared?” I thought about it and said, “I guess, a little bit. But now I feel a little sad.” He nodded, understanding, then said with wide eyes, “Well, I was scaaaared!” We smiled at each other, but then the spell was broken as the train pulled to a stop; my stop.

The rat and I both got off at the same stop (one with a little more dignity than the other, I have to say). As I exited the train I could swear, but can’t be totally certain, that I heard one of the male passengers comment slyly, “Look, the little kitten’s getting off at the same stop as the rat.”

Oh, New York. What a character you are.

 
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Posted by on December 13, 2010 in Comic Quotes, Miscellaneous, Pondering

 

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Oh so overjoyed to be back with the old folks!

“Maggie and Lynn Buxley*?” I scan the waiting room, and my eyes immediately land on two little old ladies, dressed to the nines, almost identical to one another despite not being twins. They look up simultaneously, smile demurely, and start gathering their luxurious wool coats, mohair berets, and patent leather purses. These are some of the fanciest looking patients I have seen yet. And the story gets better, just weight. I mean, wait… 😉

Time really does fly! I am already finished with my pediatrics rotation and onto the community rotation. This 5 weeks is spent in class, skills lab and one day of clinicals per week. As students, we are scattered all over the city in community clinics, visiting home nursing care, and teen pregnancy clinics to name a few. Since I have been contemplating a specialty in geriatrics, I was fortunate enough to land with one of my didactic instructors at a nurse-practitioner run clinic that serves the elderly as one of its primary populations. What I didn’t realize is that this clinic happens to be in one of the most pish-poshest neighborhoods of Manhattan, which I guess makes it also one of the fanciest in the country. Since I plan on working in a community health clinic for my career, I guess this might the most plush practice that I ever see, but hey, it’s a great learning experience!

So, back to Miss Maggie and Miss Lynn, 85 and 80 years old respectively. These are two sisters who presented to the clinic in all their daytime finery for…drumroll…flu shots. My instructor (the ARNP) warned me in advance that these two little ladies were “real characters” and that this visit would surely be more than “just” flu shots. The trot on in, and sit themselves down, one on the examining table and one in the chair. I perch myself on the windowsill in the corner – there’s not much room for all four of us! And the history-taking begins. It turns out that these ladies come in fairly regularly, but they are both on different doses of different blood pressure medication, as well as many other meds, so there’s lots to discuss. One of the sisters (the older one) speaks for the both of them and she knows everything, and I really mean it, about both of their health statuses. They are cracking me up with their NY-high society-talk (I’m not good enough to even try to imitate it) but my NP doesn’t even bat a lash, so I try hard to keep a straight face. Soon it’s time for me to take their vitals – weight, blood pressure, pulse and respirations. Both ladies start to moan and groan about the weight-taking immediately. I am completely startled because they are teensy-weensy minuscule little things, with not an ounce of extra fat anywhere on their bodies! I weight Lynn first who totals a whopping 86 pounds (but she refuses to face the scale because she is afraid to see it). Then she asks me what the number was anyways, and when I tell her, she grimaces and says, “Ah, I knew I felt my clothes getting tight, didn’t I tell you Maggie?”

And Maggies replies, “Well, Lynn, you know that I make up two of you!” Now this is just plain ridiculous because at most she is 10 pounds heavier, which hardly constitutes fat! She weighs in at an impressive 100 pounds, and sighs dramatically. Now, here’s the thing. Should we worry about them? Clearly they have some form of body dysmorphia but they’re 85 and 80 and healthy as can be, for their age! I guess my NP decided a long time ago that behavior change wasn’t likely to happen now, so I just let it go at that. Both of their blood pressures were also fairly well-controlled, another good sign. When I tried to roll up the sleeve of Maggie’s uber-soft and lovely sweater, I apologized for stretching it a bit. She just tinkled a little laugh and patted me on the shoulder saying, “Oh, this old thing? Don’t even bother worrying!” Now let me tell you, “this old thing” was something that I probably couldn’t afford unless I used 3 months of my food budget on it. It was beautiful and soft and perfectly in fashion, and if it wasn’t a huge HIPAA violation, I would totally look up their home address and go look through their dumpsters for the amazing clothes from last year’s Vogue styles that they are probably throwing away!

Oh, and I also got to give my first flu shot! Maggie gracefully told me I could practice on her (clearly, I didn’t divulge that she was my first victim, though). And so, with my NP watching over me,  I squeezed her miniature deltoid muscle and gave my first attempt at “darting” the needle in, and then injecting the vaccine! It was quick and I was only a wee nervous, maybe a little shaky (I’ll admit) and she told me she barely felt it! Ah, those social graces. Gotta love ’em. 🙂

Upon leaving a few minutes later, they both donned their adorable little French berets, and bid us goodbye in the most proper but sweet way and hobbled out together arm in arm, probably headed home to their Park Place apartment that they share…

This may not be the kind of clinic that I want to end up in, but it sure is a lovely place to be for now. We saw so many patients, they were all so sweet, compliant, friendly – and for the most part – HEALTHY! What a concept! It’s refreshing to remember that not everyone super sick or on the road to recovery. Some people just need preventive care and I look forward to being one of the providers and educators.

*names changed to protect privacy

 
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Posted by on October 11, 2010 in Clinic, Healing Spoonful, Nursing School

 

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Rearranging the Planets

Some days at work it feels like the planets are aligned either 100% for me, or 200% against me. I almost always love working in assisted living, but I have to admit, the rough days are tough. On these days, every resident seems to have some sort of problem that needs solving, I’m up to my ears in dirty laundry, bowel movements are, (ahem), flowing faster than normal…all combined up in a grand mess that makes me wish that it was a few hours later and I could finally just crawl into bed and curl into a little ball. Two days ago, this was the case. To make matters even more interesting, I had decided to take a run before work (bad idea, Rachel) which somehow managed to zap the energy right out of me. In a nutshell, I came in to work ready to go home.

Despite my best intentions, however, the day did not slip away but dragged on through dinner time. And it was at this moment, as I was staring down at my leaden feet while clearing tables, that I overheard a conversation between two residents. One woman, a nearly deaf Midwesterner with a deliciously unique gravely voice, was trying to tell another resident about her observations of a Valentine’s Day ornament that was hanging near the window. The decoration in question is one that I had barely noticed: a two-colored spiral hanging from the ceiling that twists and spins delicately as a breeze catches it, displaying first one side’s color and the other side’s color. She said, “Isn’t it interesting how it twists and turns and when it does, it changes color? Do you notice? It’s so beautiful! I can’t stop looking at it.” (Remember, this lovely woman speaks in a deep gravely voice which made her particular comment all the more delightful.)

At that moment, I stopped feeling sorry for myself. What I realized was this: I had been busy wishing the day away when really, there was still plenty to be grateful for and enraptured by. This old woman, nearly 100 years old, probably has many more reason than I do to feel sorry for herself, and yet, here she was, beaming childish wonder and delight at a silly ornament hanging from the ceiling. Quite suddenly, my entire perspective changed, and so did the day. Nothing seemed as important, and I was able to focus on the funny and cute things my residents were sharing with me. Granted, my feel still felt heavy – but that was my fault for going running before an 8-hour shift!

As I cleared more plates, I noticed another resident staring mournfully down at her dessert plate. I asked her, “Is there something wrong, Sherry?*” She sighed and looked up at me from her plate of icing-drizzled brownie and cornbread muffin. “No, nothing’s wrong but I am just sad that I feel so full. Both of these are just so eat-able!” I laughed and then said, “But Sherry, I think your age has certainly earned you the right to eat dessert if you want it!” She replied, “No, not tonight, but if there is a certain person in the kitchen who is hungry, you can just tell her that I haven’t touched this!” And she winked at me.

Later that night, after spending an hour helping Addie get ready for bed, I was finally close to being able to go home. I could almost taste my bed. It no longer felt as important anymore, but I was still quite tired. Addie called to me as I was turning off the lights in her room and collecting the bags of trash. I sighed, unable to help myself from hoping she didn’t need to use the bathroom again and said, “Yes, Addie?”

She peered up at me from her carefully tucked-in covers and said sweetly, “I can’t wait until I can see you again.” – a pause – “Because you’re kind and gentle and you always do as I want you to do.” She nodded once, resolutely, and then laid her hairnet-covered head back down on her pillow and finished quietly, “And I love you.”

My heart filled up so much in that moment, it felt like it would truly burst, and I replied, “I love you too, Addie. Sweet dreams.”

The bad days really aren’t that bad, after all.

* Names changed

 
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Posted by on February 10, 2010 in Comic Quotes, Healing Spoonful

 

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“That bottle just lost its feet”

The above quote was stated in reference to a tipsy nail polish bottle that almost fell over, and was rescued with these words, deadpan, by possibly the most accidentally-hilarious resident that I take care of.

Addie* is a delightful conundrum. Quite religious, she sometimes takes to praying at random moments. For example, when I offer her a tube of lipstick to freshen up before going out of her room for Social, she looks at me quite seriously and says, “Let me pray to see if God thinks I should put on this lipstick.” She then proceeds to whisper “God, should I let this nice young lady help me put on some lipstick before we go out together?” (Some mumbling follow, a response from God, I imagine…) And then, “Yes. I will put on some lipstick,” she says simply with a peaceful look on her face. And while I usually enjoy being privy to these pleasant interactions with God, Addie is also quite slow at getting ready…for just about anything. Applying lipstick: 2 minutes. Washing & drying her hands = 5 minutes. Brushing her teeth: 15-20 minutes, depending on the circumstances of her last meal. Not only can it be tedious to watch her get ready (she is a fall risk, so we can’t leave her alone) but I also must plan ahead so that I have time to assist Addie, while still being able to help all my other residents in a timely manner. In the beginning, this was frustrating to me. But now, we have established a routine, and I enjoy my time spent with Addie enormously.

I imagine that I will write about Miss Addie quite often, given her propensity for creating fabulous story fodder, so I wanted to start painting a picture for you by giving you this background.

Addie is one of the most well-dressed women of all the residents that I work with. She enjoys looking pretty and well-kept (cleanliness is next to godliness, right?) and her ensembles are always perfectly matched with appropriate earrings, bracelets and necklace. She is quite adorable. When I first met her, she watched an evangelical preacher on TV, but I realized that it was making her want to give all her money to “God” so I helped her find another channel to watch that was a little less demanding on her pocketbook. Soon, we discovered America’s Funniest Home Videos and now there are times when I walk in the door to see a few perfectly formed tears of mirth falling delicately down her cheeks. She reaches out for my hands and says, “Watch this little boy…he’s going to fall down now.” And she cracks up. Hilarious.

I’ll end on one last Addie quote for the day. After I finished polishing Addie’s nails (on the same day that she came up with the fabulous quote that I used for my title) I left her in her big blue cushy chair to admire her shiny fingernails. Before leaving, I carefully tucked in a throw blanket over her legs and feet. I asked, “How does that feel, Addie?” In response, she looked up at me with her big blue eyes and said, “Mo’ better!” (Yes, she is 86-years old and 100% Caucasian. And yes, she said it in the ghetto gangster accent that you are imagining.)

*Names are always changed for privacy protection.

 
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Posted by on February 2, 2010 in Comic Quotes, Healing Spoonful

 

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