Stepping Up

I have always been interested in forensics. Of course, my job consists of gathering evidence every day, evidence of injury or illness, but evidence for criminal investigation is different.

I went to my first meeting yesterday for SANE (Sexual Assault Nurse Examiner) and came out so excited. Now that is how one should feel when going to a meeting on your day off. I was hooked.

Then they started talking about pediatric exams and showed some horible pictures and I wondered if I could do this. This meeting came a day after I took care of a 4 month old who was found to have fractured legs, a skull fracture and was sexually assaulted. I was pretty shook up. I can't avoid seeing this part of ugly life so I might as well be a part of putting some sick ass in jail over it.

Some one must do it and there aren't very many out there doing it. So..... training starts in April.

I'm stepping up.

Harmony in the ER.

When you work with the same people for a long time, you tend to become like family. That includes all the good things and the bad things in family relationships. We love each other, dislike each other sometimes, disagree, clash our personalities, and don't make very good music together when over worked and over stressed.

But sometimes, if you watch and listen for it, there is harmony to be heard.

A 95 year old woman came to my room with abdominal distention and pain. Her bladder was distended and I easily took care of that problem by inserting a foley catheter. The distention was gone but the pain still persisted. On further examination, we found her in need of bowel relief as well.

Another nurse came to me to say she also had a patient in need of an enema and could we keep them in the same room to maybe contain the smell to the end of the hall. I thought that was a good idea.

Dual "do do" duty.

The daughter of my patient was elderly herself and very hard of hearing. She chose to sit in a chair at the end of the bed and offered her assistance if needed. And it was! Mom was not a willing participant in this necessary procedure.

I was well "into" the problem when the lady in the next bed began her ordeal. And, for awhile, there was "harmony" in our department.

"Ow! Stop that! You're killing me!"
"Ow! Stop that! OH, OH, OH!"

And the daughter looked on as her mother began to climb up my right shoulder with her poop smeared left leg while reaching down with her left hand for a grasp at the thing that was causing her so much distress: Me and her poop!

I glanced over at the daughter and asked her come to my rescue, wondering to myself why I had to ask. I had the daughter remove the leg from my shoulder and continued my work.

Now the daughter asked me if there wasn't some other way to do this. I said no while wanting to add "Don't you think I'd be doing it?"

The other nurse was having an easier time of it. Her patient was empty and well into the last stage of this procedure....The Grateful Stage! (Ever been constipated? Really constipated? The kind where it feels so good to get it out you want to cry?)

I wasn't so lucky. Not only was I a failure at disimpacting my patient, but when I decided to call it quits the daughter began fussing at me for "making" her help me.

"Are you short of help around here?"
Aw, yes...The old "short of help" syndrome.
"No mam. You offered to help and I let you"
"Well, I have bad hips and I can't stand for that long."

Well, crap. I thought. But the harmony was nice.

Just Enough.

Just when I think I don't know enough, don't understand the workings of the mind and body, I'm shown that I do know "just enough."

A mother brought her 16 year old son in with a lacerated finger. She was very mad at her son.
She said he was fighting with his brother.

Each time I came into the room to set up for sutures, to check on the Dr's needs and progress, and then to clean and dress the repaired wound, I could see that mom was calming down. As I cleaned and wrapped his finger, we talked about what had happened.

His brother has ADHD and is difficult to get along with. I said to my patient, "So you have to be the strong one a lot don't you." He said, "I never looked at it that way before."

His mom said, "I'm sorry I got angry son. I have a hard time dealing with your brother. How can I expect you to do it any better."

I really felt like I had opened a door for these two to walk through together.

I knew just enough.

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Tonya and I just got back from Cabo San Lucas. A week in the sun always helps me keep my perspective when I go back to work. There is a big world out there. Mine is such a small part of it. And standing on a beach watching the waves come in, the sound, the smells, the ocean breeze, these things stay with me for a long, long time.

When accents matter.

The triage nurse came into the nurses station and said the man she just triaged was delusional.
"He may be a mental case." she said.

"Why do you say that?" We asked her.

"He says the gods dropped him off. He says the gods were after him and then the gods dropped him off at the hospital."

After further evaluation it was found that the man had a New York accent and was talking about the guards from the jail, not the gods.

Cat's Whiskers

Sometimes I wish my older patients had their life stories as part of their medical records. When the mind goes, we have no way of telling who that person was or what they did.

"Cat's whiskers." I heard her say in a high pitched voice.
"Cat's whiskers." She said in a deep toned voice.
"I'm a crazy lady." She said without eye contact or change in facial expression.

As I cared for her, she repeated these phrases over and over.

A daughter in law came in to see her. "How sad it is to see her like this."

Then she told me about this woman.

She was a pilot in WW II. She helped invent and test a zoom lens used to take pictures from the air.

No matter what we do in this life there must be someone who will remember for us. May we all do something worth remembering.

A daughter and a nurse.

I sent this piece to a nursing magazine in the answer to their question "Who was your most unforgettable patient?" They didn't publish it I think because it is as much about me as it is the patient. So I'll share it here.

My most unforgettable patient was my father.
He looked so frail in that hospital bed. A stroke and a fall resulting in a subdural hematoma took him from ER to brain surgery. Now, in ICU, I was told that my mother and I could only visit ten minutes every hour. The word 'visit' really bothered me. I thought, "I'm not a visitor. I'm his daughter and his nurse.

I obeyed this particular rule while sorting through my conflicting thoughts and emotions. Did I stop being a nurse when I clocked out at work?
I heard people tell me to be a daughter now, not a nurse. Confused, I thought, "How do I do that? Forget what I know? Tell my eyes not to notice his skin color? Tell my fingers not to rest on his pulse? Don't check out his blood pressure and O2 Sat?"

I realized there were a lot of things I had to look at differently. I was truly there to be my father's advocate while he was unable to ask for what he needed, unable to call for help, unable to communicate at all. I knew I had to be with him.

My father was moved out of ICU. I was expecting to be at his bedside now. It was getting late and my mother needed to be home before dark. She doesn't see well at night. She was worried about Dad being alone at night and I told her I would stay with him. I never once thought that I wouldn't be allowed to. After Mom left, I went to my father's room and pulled a chair close to the bed. My father was showing signs of brain trauma: agitation, pulling at every tube, trying to sit up although he wasn't strong enough.
It felt so good to be there holding his hand, telling him I was there. I got lotion and gave him foot rubs and did gentle range of motion. These are basic nursing interventions that I usually don't have time for at work. I knew these nurses probably didn't have time for it either.

When visiting hours were over I was asked to leave. I said I would like to stay with him and I was told that family isn't allowed to spend the night. I asked to speak to the charge nurse. As Dad continued to pull and strain against his restraints, I began to strain against my own. The charge nurse gave her scripted answer. "We feel that family members need their rest. We encourage you to go home."

I left the room but only to find a phone. I called the hospital operator and asked her to please page the administrative person on call for that evening. Someone just had to see how wrong this was. I only wanted to be there for my father.

I don't remember who I talked to that night but I remember how well she listened. I spoke quietly from my heart. "I am a daughter of one of the patients in this hospital and I am also a nurse. I want to do for my father what I get paid to do for strangers. I want to do comfort measures for him, keep him safe and help guard his IV and catheter through the night. My father should benefit from my skills and knowledge and my caring. Please let me stay."

She said, "You're right. I believe you are offering us a service and well as being of service to your father. I'll call the charge nurse and tell her you may stay.

She understood the benefits to everyone. She bent the rules and allowed me to be a daughter who is a nurse. Through my father's illness and healing I learned how much I loved caring for him in that special comforting way that nurses have. I try to remember that every patient I care for is someone's father or mother, son or daughter, and I treat them as I would my own.

The thumb.

I was young, a new nurse, scheduled in the ER. I was nervous. I pictured someone running into the ER with a cut off finger or some other body part. What would I do? I felt so unqualified. At around this same time I was going to AlAnon. I was learning a lot about myself..... Just because someone says something about me doesn't make it true, I don't have to be responsible for someone else's behavior and just because someone tries to give me something doesn't mean I have to reach out and take it.

It was a long time before someone actually came into the ER, held out his closed hand to me, and said, "My friend is in the car. He cut off his finger and I have it here." My first reaction a long time ago would have been to reach out with an open palm even before the man had finished talking. I went to a room and got a speciman cup and opened it so the man could drop the finger in it.

I look back at that time and think that it was nothing compared to what I deal with now in that same ER. But the lesson still works. You don't have to take the thumb just because someone tries to hand it to you.

A brighter smile

I Went to the dentist and had my teeth whitened yesterday. It was a little painful but I like the results. Just decided to do something nice for me.
Nursing story: This one left me so sad. In one bed was a man with terminal lung cancer. He had taken a lot of pills, left a well written letter of goodbye, but his family found him and called EMS and they brought him to us.
Across the hall was an elderly woman with non hodgkins lymphoma who could not start treatment because she couldn't pay for it.
One wanted to die, one wanted to live. We failed them both.

Life lessons from Grammy

I picked up my granddaughters, picked up my mother and went to Marsha's house. Jenni and the boys were there. The house was a wreck. Jenni was cleaning out Marsha's pantry. It is cute the way Marsha hangs on to every gift bag she gets. I wonder who gives her so many gifts. Doesn't anyone wrap a present anymore?. We just ripped off the damn paper and threw it away right? The bags are all so cute that they scream to be saved.
All five grandchildren together is always a great thing for me. I couldn't seem to get a picture of them all together though. Jackson was worn out and bringing two more kids into his home to play with his toys was an overload. The boys had a fight. The girls looked on and I saw them draw a little closer to each other. I looked at my mother's face as Jenni dragged the boys out of the room. And I had to talk to the boys.
I told them that their behavior made me cry. It made me sad. And I hope they will remember that. Probably only to think it was weird of me to tell them that. They are still my boys and I love them so much.

I took Emma and Grayce to see the dinasour tracks. We talked on the way. I asked them how they felt when the boys were fighting. They used words like "weird", "sad", "different". I told them how I felt. And we talked about how the way we behave can affect the other people around us.
The girls were about as impressed with the tracks of the big animals as the boys were in August. "Cool" "Grammy, can we play in the water?"
It's a time thing. A million years is meaningless information to them. And, "I thought there would be more". from Emma. The miracle of seeing one print of an extinct creature let alone six or seven all in one spot was lost on her.
The girls wanted to take their shoes off. We were hiking quite a ways. I said sure. Emma said, "What will we do with them?" I said, "Carry them". Then I hear Grayce yelling that she was stuck trying to get over a wet spot a rock away. She was carrying both pairs of shoes. I said, "Emma. Why is Grayce carrying your shoes?" She said, "I asked her to." So I said, "Go get your shoes from Grayce Please." After she did, I said "Now Grayce can you jump to the next rock ?" She happily jumped saying "My shoes are easier to carry when I want to jump over a rock."

I just started laughing and said "Grammy will teach you a lot about life if you let me. You see girls, If everyone carries their own load, everything is easier to do." It sounded great to me. Will they remember this crazy Grammy?

Over the Fence

I forgot how good it feels to get out into the woods. Just over the fence once in awhile. A few great treasures still are there to be found. And a couple of my favorite old trees have come down as if to tell me that even they won't stay here forever. I always think of them as my trees. I look at them in the front lawn so many times and tell them to please hang in there for me.
On our trip this August, mom told us how awful it was in Nebraska in the years of the drought and the dust. She spoke of the pain of seeing all the trees dieing around them. As we drove through Nebraska she pointed out the trees that were lined up or seemed to be placed in rows. She said those were all planted when the rains came back.

A nurse story: I was trying to get a catheterized urine specimen from a woman from a nursing home. She wasn't able to understand or help me. Janice came in and asked it she could help me. As we leaned over the lady and each held a leg, I began to clean her and insert the tube. "Hey" Janice said. "I know this lady. I took care of her last week"

We looked at each other and started to grin. Janice wasn't recognizing her by her face.
You know You've been in nursing too long when you start to recognize patients by looking at their private parts

Home

I have thought often of selling this house and land and moving someplace else. We talked about it yesterday and I totally lost comtrol. Even now I am in tears. This is so much more that a house. The land has held generations of peoples and creatures. The walls have heard my cries and seemed to hold me when there was no one else there to do that.
It is hard to keep up with all that one must do to keep a house upright and healthy. Tonya does most of it. I work and pay the bills. We see things differently. I come home, close the door behind me and relax. Are the days really gone when people had homesteads? I so wanted this place to always be here for my children and theirs. But I know that they would never want it. So I guess now we work on doing things on the house that will make it sell well someday. Why am I so totally attatched to it and why is it breaking my heart to think of someday leaving.
Nothing lasts forever. Nothing should I guess.


Nursing story: EMS brought us a 16yr. old female, hyperventalation complaing of chest pain. She was a member of our juvenile department's boot camp program. She had a diagnosis awhile back of NEUROCARDIOGENIC SYNDROME. After obtaining an EKG and determining that this girl was not dieing, I went to look up this syndrome. "Syncope, hyperventilation symptoms, fainting..." A fancy name for "I need attention."
Then here comes mother......She wanted a blanket, she wanted her daughter to have something for her chest pain. "Don't you know she has a heart condition?"
"That may be so, but what's going on today has nothing to do with her heart." Now you would think this would be good news. Mom wasn't pleased. I brought the pt. an ibuprofen. Mom thought that wasn't strong enough. I said it was the perect medicine for the problem. I told mom that her daughter needed to eat breakfast in the mornings, stop smoking which was by the way against the law, and to get plenty of exercise. Mom thought she should be excused from working out in boot camp. I said, "No, it is probably just what she needs."

I thought as mother and daughter angrily left ER.....I would love to look the Dr. in the eye that gave that girl the fancy diagnosis and call him or her a coward. They I looked at the diagnosis our Dr. had given her: Costrochondritis. No one seems to have thime for the truth anymore.

Giving is sometimes all one can do to help someone else.

Last night at work I gave a friend some money. Her mother is dieing of metastatic cancer and Jennifer has been trying to take care of her all by herself. She finally got a relative from out of state to come and help her. Jennifer has been missing a lot of work because of her mother's illness and she looked so tired. I gave her $100. Not much I know but it may help when she takes a couple of days to rest away from home, maybe in a hotel where she doesn't have to do housework. It really felt right to do that. It felt better giving money directly to a person rather than a group with a purpose.
A nursing story:
A 93 year old male with dementia was brought in by his son. The son stated that his father was fine this morning until an hour ago when he shouted and became irritable. He wouldn't sit still, kept rubbing at his lower back. The son was sure his father's chronic lumbar pain was getting out of hand. He gave him a pain pill which didn't seem to help.
We put the little old man in a room, took off his shirt, examined his back, sent him off to xray, but was not able to find anything wrong. No amount of palpating his back or spine would create any response of pain yet he didn't want to lay down or sit for very long.
The Dr. ordered Demerol 50mg with Phenergan 12.5 IM. I lowered his pants, gave him the injection, and as I pulled the needle out I saw a reddness to his skin lower down his bottom. I pulled his pants down further and discovered that he was having an allergic reaction to his diaper. His lower back, both butt cheeks, and around his groin and lower abdomen was a solid hive.
Even after showing this to the Dr. and the son, we still sent the patient home with a diagnosis of low back pain. The Dr. and son refused to admit they had missed something as simple as this. It would do my heart good to hear a Dr. say "Oops".
This was expensive and dangerous treatment for diaper rash. I just hope he slept through some of the bad itching.

Nice to come home

Tonya and I have been together for a long time. Everyday I am so happy to be coming home knowing she is here. All my stress from being in charge of the ER on weekends seems to melt away. And I can get up and do it again the next day. She has spoiled me though. She was a wonderful department head and a leader in all she did that I get so discouraged at the poor managment we have. I know it can be done better. Tonya in her butch elegance commanded respect and gave it in return. She was a great boss but I'd rather have her right where she is now. Mine!

I was given permission to use this one. Last night we were all so tired at the end of the shift. One of the nurses was giggling behind me. I turned around and she said. "I have a headache and I got a Motrin out of my purse and took it. I then found myself heading for the computer to chart that I gave it.

It took me a minute to see what was funny. "She gave it to herself" Not a patient that she had to chart one. Par for the course of a tired nurse.

New TV
David came to our rescue Thursday night. We got a big ass TV and couldn't hook it up right of course. Why do we always think we can do these things. We are very grateful to David because he has been so busy with his show and I know he is exhausted.
We went to his show Wednesday night and of course were blown away. David, you are the best. And thanks to Marsha and Jackson for sharing their lives with us.
Nurse story: This was a very difficult shift. When I came to work there was an intubated patient that Janice was working on and it went down hill from there. I worked on cardiacs and syncopys, people who were in crisis and needed transfered or admitted. It was good hard work but something was missing. All day long, it was like a piece of my puzzle was gone.
Things slowed down just a bit at one point and I looked at the chart rack and noticed one that hadn't been checked on for awhile. There were orders on the chart that hadn't been done. I remembered seeing this little old lady in a wheelchair being pushed down the hall. I got IV fluids and went to her room. She looked like a skeleton: her lips didn't meet when she spoke. As I explained what I was doing and listened to her answers and questions I realized she was sharp. She cried out often from the pain in her emaciated, cancerous body. I cleaned her, gave her fluids, covered her and went to find the Dr. to get an order for pain medication. I eased her pain and prepared her for admission. It struck me as I ministered to her that the missing feeling was gone. Yes! Here I am!
She had a left radical mastectomy and her chest wall was scarred and red. Her left arm was edematous from poor lymph system function. Her records showed that there was cancer in her colon. I wheeled her stretcher to her room; I felt comfortablle, peaceful, fulfilled. While all the "hearts" were screaming out for attention, this little one suffered alone back in a room where we didn't even walk past to glance in at her. Her cries whent unnoticed.
Up in her room, there was no one to help me get her in bed. Another heart patient was in trouble. Either I stayed to take care of this little one or once again she would be the forgotten, unnoticed one. I stayed and gave her the rest of the morphine I carried in my pocket; a poor substitute for a caring touch. Yet I felt like I had done something far more important than I had all day with all the emergency cardiacs and syncopy patients.