Whatever You Do, Don't Take the Thumb

Unwanted visitors.

2010-12-08T12:11:00.000-08:00

Why do people think just because you have a driveway are allowed to drive up it. And then they think they can come up on your porch, knock on your door, and tell you that you are going to hell if you don't listen to them?

I met those people with a broom in my hand and told them to go away and don't come back.

You would think the days are gone when people would feel safe walking up to a stranger's door.

Next time it might not be a broom I hold.

How would they like it if I knocked on their door and told them they were wrong in everything they thought and believed. Church people have been doing this forever. It is time they stopped. It really isn't safe.

Hospice Angels

2010-05-09T12:37:00.000-07:00

I don't believe in heaven or angels. I believe in the earthly angels. I've met them many times. The best ones work for hospice.

On this mother's day our hearts are heavy. Tonya's mother died April 23. She was in a hospital bed in the middle of our living room. Facing a wall of windows looking out on a yard full of daisies and beautiful green things.

What a lady she was. Always had polished fingernails, always dressed in fine clothes.

She decided it was time to die. She said so. She said she was ready. She talked to the hospice nurse like she was planning a business deal.

We watched her slowly letting go, giving directions to her children, look there for this, look there for that, be sure you check on this.

I saw a slight hesitation as she opened her mouth for her first dose of Ativan and Morphine to ease her pain and difficulty breathing. We kept her comfortable and clean. She left us like a lady.

Wow! If we could all choose to go like that wouldn't we? Shouldn't we?

A family sent a loved one to the ER with respiratory distress. I watched as he struggled to breathe. I watched as he was intubated and put on a respirator. Not good. Traumatic, intrusive, so sad.

Hospice is the way to do this. The angels come to usher us out of this life when we are ready. May we all know when that time is and may we let our families know what we want.

Happy mother's day Arlene. Here's to a strong and brave lady.

The Teddy Award

2010-01-16T16:18:00.000-08:00

No, this isn't about those skimpy nighties. This is about the true Teddy Awards. I will write the original here:

It is not the critic who counts: not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly, who errs and comes up short again and again...who spends himself in a worthy cause; who, at the best, knows, in the end, the triumph of high achievement, and who at the worst, if he fails, at least he fails while daring greatly.

I believe we nurses deserve a Teddy Award. I believe we should be made to feel like what we do for our patients matters. Sometimes it just isn't enough to pat ourselves on the back and feel good inside about what we did that shift, about what happened and how well we handled it all.

Something is just wrong when the CEO brings food down to our break room and then says "Now bring those satisfaction scores up."

We truly spend ourselves in a worthy cause. We go limping home and try to rest and heal our sore spots and get ready to do it all again.

We wash off the blood and the gore and try to get the charcoal out of our clothes, and the thoughts of that homeless person we shuffled from one part of the hospital to another.

There are days it really feels like a strategizing game. Move this one here and that one there and get the admitted patients up to make room for more coming in.

Yesterday I passed the exam and am now a Board Certified Emergency Nurse. I feel great about it. It will get me no raise or promotions. But I did it.

I love what I do. I want to do it better every day. And I want some God damn kudos instead of having things I didn't do pointed out every day.

So everybody on my team gets a TEDDY AWARD, whatever that might look like. I love all of you.

The Power of One

2009-12-01T11:28:00.000-08:00

When there is no one in your life to encourage you and tell you that no matter what, you are good, you matter, there is a reason for your life, and that you are loved at your most unlovable, you will seek out those affirmations anywhere you can find them.

We must seek everyday to build a team of support around us. And we must in turn be there to give others that support.

When we fill our circle, strengthen the walls, and nurture our garden of friends, no one and nothing will be able to make us feel inadequate, unloved, unneeded, unimportant.

And we will not fall for the empty promises of what comes after death. We will not need to give up on this life and this world.

I am looking out my window on a rainy day, feeling melancholy and being okay with that. Rainy days are good for that. I feel loved and happy. I only hope I make other people feel that way too.

Remember When

2009-11-23T08:00:00.000-08:00

We had a few rare moments last night at work to stroll down memory lane.

We remembered when nursing meant something more to us. Evening back rubs with warm lotion for our patients was better than a sleeping pill.

Patients checking in the night before their surgery so we could do pre op teaching and do that dreaded enema and bowel prep under our watchful eye and aide. We taught you to deep breath and cough and told you what to expect when you got out of surgery.

You knew that your primary care Dr. would be there for you in the hospital. You felt safe and secure because your Dr. knew you and your needs. Now you are placed under the care of a stranger, however competent he or she may be.

Remember when you got one bill? I know this is a stretch for some of you younger ones. Now there is confusion over who got paid by the insurance company and who do you owe.

The paper work is overwhelming to say the least. Sign here to say you understand that there is no smoking on this campus. Okay. Sign here to say you understand that you will be responsible for anything your insurance does not cover. Duhhhhh! Sign here to say you understand that you will be receiving a separate bill from radiology and lab. Sign, sign, sign.

I wish for simplicity for us and our patients. I wish for comfort and caring for our patients. I wish for less stressed nurses and an atmosphere of kindness and love. I wish for no more added paperwork. Let's do some take aways for a change.

Remember when we loved what we did?

For the sake of a clean shower door.

2009-11-04T07:12:00.000-08:00

I am always interested in knowing how people hurt themselves. Maybe so I can be more careful in life and avoid those same mistakes.

This one is priceless.

A man wants to have a clear shower door instead of an opaque one. His wife agrees if the husband agrees to squeegee the door after he showers.

The man agrees and the door is installed. The wife discovers his trick. He always showers first leaving her to squeegee the door after her shower.

One day he was headed to the shower and she decided to beat him to it. She fell and broke her ankle.

Now she won't be taking showers for awhile with her cast on so guess who gets to squeegee the shower door?

She smiles when she hears the squeegee sound now I bet.

Are they listening?

2009-11-03T07:36:00.000-08:00

I've been working some overtime lately on purpose. ER has been slower than usual. I have had more time to actually spend at the bedside with my patients. I really enjoy that.

I talked with a German lady and found myself mesmerized by her accent. She told me stories of her travels and compared things with living in Germany.

One thing she talked most about was getting around in the different cities. In Germany, you don't really need a car. You just get on a bus and go anywhere you want.

Freedom means going where you want without having to drive there.

This lady was very sick when she came in. And much better when we had our conversation. I saw her color get healthier and her eyes brighten as she told me stories of her travels. This is my favorite kind of nursing. The human kind.

Listening is cheep medicine.

Flu Season

2009-10-19T03:54:00.000-07:00

We are all being bullied to get the flu shot. If we don't, we have to wear a mask during our shift. How crazy is that. I'm a nurse taking care of sick people and I have to wear a mask. I think we are going to frighten people walking around all masked up.

If we really "care" about our patients, lets keep children under 12 out of the hospital. And make the visitors wear masks too.

Here's the funny part. We ran out of flu shots the second day they were offered. We are so far behind the ball now it makes no sense to even get the shot.

Can you imagine a true Pandemic? We could never make enough vaccine to take care of everyone.

Some more stupid stuff: We have monitors that you can print out your patient's vital signs. We are being told that we have to chart every vital sign because the print outs are being lost. Now that makes sense right? Lets not fix the problem of medical records losing a legal part of a chart. Lets punish the nurses and make them spend time charting five minute vital signs in the computer.

So if you have the flu or anything else wrong with you come on in to the ER. Your nurse will not infect you because she or he will be wearing a mask. But you will be exposed to other patients with viruses galore.

Junk Food Taxing

2009-09-19T03:54:00.000-07:00

While I don't care if they tax junk food, I think the real money is in religion.

We could do a lot with the money we would get taxing churches and religious organizations.
They influence a lot of people regarding who to vote for and what they believe is good and bad in the world.

I think anyone who spreads so much hate and discrimination should have to pay for it.
They push their way into our schools and government facilities, blatantly stand up and pray to Jesus at football games and put the nativity scene on the court house lawn.

The Christians forget what separation of church and state was created to protect us from.
The very thing that Christians are doing now. . . .Proclaiming that their God is the only one and everybody else is going to hell.

Give me freedom from religion. And make the churches pay taxes and turn off all those lights in Andice Texas where the Baptist and the Catholic church across from each other battle to see who can light up the sky more.

And let me introduce you to my God, The Flying Spaghetti Monster. May his pastaness lift you up and carry you through a happy day.

Cleopatra is alive and well.

2009-08-07T08:55:00.000-07:00

While she is known for so much more, Cleopatra is also the Queen of "Denial".

Nurse to elderly man--I see that you are a Diabetic.

Elderly man to nurse--What makes you say that?

Nurse--You are taking Metformin.

Elderly man--Oh, I don't have Diabetes. I just take that to keep my blood sugar down.

Coffin corner

2009-08-01T09:54:00.000-07:00

I read in my time magazine an article on the recent plane crash in the ocean. It was said they were flying in their "coffin corner". Too low, too slow. It sure gave me a creepy feeling and made me think about, what else, my job.

It is very hard for me to think about making money off people who are sick or injured, although I couldn't live without my paycheck. But the pressure is on when my health care organization sees fit to cut "corners" to save money in this bad economy.

This is our "coffin corner"-----

The first to be canceled or cut are the very people who save lives. Nurses.
The next are our clerks, who if they aren't around, the nurses left have to answer phones, put in orders, make calls for DR's. and answer call lights. (One less nurse out there taking care of patients)

We do not have a shortage of nurses in this country yet. We have them knocking on our door to be hired. There are no openings. Productivity, patient numbers, steers the need. What we have are older (45 to 60 year old nurses) however experienced and skillful, who are "flying lower and slower" than we used to.

Expected to do more with less, I struggle as a charge nurse to pick up where others need help and take care of my own patient load while staying prepared for the one coming in who may need all we have available to save their life. And that person deserves nothing less.

May we never be caught flying too slow, too low.

My daughter lost her pregnancy at 10 weeks. We all felt helpless and sad. At least we know she can get pregnant after her cancer battle. It seems the women in this family do best when we have something we can fight against. It is having to accept the things we cannot change that pisses us off.

Tread lightly over the skunk under the porch.

2009-06-25T07:25:00.000-07:00

I was watching the birds out my living room window one morning when something caught my eye coming towards the house.

Oh No!!!! All I could do was sit and watch with horror as a hugh skunk crawled under the porch.

I said, "No. That is not a good place to sleep today buddy. We are very noisy around here. We clomp on that deck all day long. Well maybe we could be a little quieter.

The skunk camped out with us for about a week. Caught a whiff of him once or twice but who doesn't have a guest that smells after a few days.

I am going to be a grammy again. My youngest, Marsha is pregnant. I've been missing having a baby in my arms.

I had an emotional break down recently. I am losing another tree. It has to come down because it is falling down and might do some damage on the way down. It surprises me how much love I feel for my trees.

I saw a dead skunk down the road last night. Skunks come, skunks go. It's all that happens in between that keeps life interesting.

Needing Mom

2009-05-08T12:05:00.000-07:00

"Our achievements are measured by the people who need us."

It will be another mother's day soon.

When I think of my mother, my continued need for her at my age is so strong. She is always there at the end of my phone and she always knows just what I mean no matter what I'm talking about.

May my need for her only bring her a great sense of achievement.

For in being needed we always have something to do, someone to love, and much to look forward to.

I love you Mom

Hand Prints on the Walls

2009-04-28T09:37:00.000-07:00

I am on the other end of nursing right now....A patient.
I had minor surgery on my feet. What is a nurse without good feet right?

The experience was a good one. Except for the pain of course.

There was also a very nice surprise in the OR. A nurse who has been retired and who comes back to work in the OR once in a while was on duty that day. Dee and I worked together when I was a brand new nurse. She taught me how to start IV's.

I barely remember the spinal anesthesia going in. Dee was holding me upright, my head was on her shoulder and we were talking about our grandchildren. It was so good to see her and I felt so safe and well cared for.

This past week has brought back some old memories of all the times we moved as a young family. I can remember cleaning the houses we left behind. The dirty hand prints along the walls where my kids touched them.

Each time we moved the hand prints were higher up of course.

Now I touch the walls as I try to keep my balance walking in these post op shoes. I think my hands are cleaner though. No hand prints to clean off.

I have gained a new respect for walker users. My elbows and wrists are hurting.

Ode to a co worker.

2009-04-11T16:02:00.000-07:00

We met when I was 28 and she was 18. We had decided to start nursing school and we hooked up to do some sharing of rides and soon discovered that we would be sharing so much more.

We studied together almost every night. Let me clarify that. She and my husband drank a lot of beer and laughed a lot about the various anatomy courses while I studied. We both got great grades. I just had to work harder for mine.

Janice made nursing school a great adventure from the beginning to the end. We got a 10 minute break every hour in class and we lived for that 10 minutes. There was on instructor who would try to go over that but Janice fixed that. She hid an alarm clock one day under the teacher's desk. When it went off, the teacher screeched and looked right at Janice frowning. We were all smiling at her though so nothing bad happened to Janice.

They learned not to mess with our ten minute breaks after that.

Things haven't changed too much through the years. Janice is still demanding her breaks and getting them mostly. We have both lost our fathers and are taking care of our mothers and still taking care of our children. I traded my husband in on a wife, which I recommend highly if you have the tendency, and I have the joy of having 5 grandchildren.

We are great nurses, great friends, and still up for any funny business that we can get away with and still get laughs and have fun.

Sometimes I'm a Little up tight because I have a charge position and the director expects more from me than in the old days.

It is hard to find the balance between having fun, being part of my friends and co workers behind the scenes shenanigans, and upholding the trust my director has placed in me.

So I will remember the mustang we drove to clinicals in, the nights she spent on my couch sleeping over after all night "studying", my little ones sitting on her lap when they were so young and cute, waiting for the results after taking the state boards and the partying afterward.

I am happy and so glad we have stayed so close all these years. I will be 57 years old soon but when I think of us I still feel 28.

We are what we remember we are. And we were great!

A SET UP FOR FAILURE

2009-04-05T03:36:00.000-07:00

You would think that after 38 years of washing my hands in a health care setting I would be pretty good at it. Second nature.

I have a pattern that has been endorsed by nursing schools forever. I wash my hands every time I cross a threshold.

However, they had to find a way to document and observe that we are washing our hands so they created a new way... a way that costs lots of money in new product and a way to deliver that product.

Foam in, Foam out. Since my hands are usually full of things going into a room, and full of things going out of a room, this is not conducive to getting me to wash my hands their way. Therefore, when the spies are watching, they say I am not washing my hands. (not true).

I had the humiliating opportunity to get instructed on how to wash my hands the other day. By a sweet young girl who should have been teaching at my grandson's school. There were two of us in the class. Both of us veterans. We could hardly contain our irritation. Let me go back. I definitely did not contain my irritation.

Here we are, mixing up your medications around a dirty sink next to a garbage can in our med room and they want to teach me how to wash my hands.

My bullshit cup runneth over.

The next day I saw that the hand washing inservice had been cancelled. I'll probably be called on the carpet for harassing the poor hygiene lady. Or maybe she caught a clue and went after real issues.
I can only hope.

"They aren't very nice here"

2009-03-15T03:39:00.000-07:00

I heard a wife of a patient bend over her husband and say "they aren't very nice here". It was the end of a very busy 12 hour shift, I was down a staff member and carrying that load plus my own. I had given eye contact to the wife and greeted her when I entered the room which I thought was commendable considering my feet were hurting so bad my teeth were clenched with every step.

I apologized profusely and blamed it on the damn computer I had to chart on. I told them it was a curse that I had to stand there facing the computer instead of them. In my mind I'm screaming at the conglomerate I work for.

"You want patient satisfaction and high scores in that but you cut the nursing staff to the bones. We are the front door to that satisfaction. And the back door, and every door in between."

I also find it interesting and sad that one tired nurse can be the "they" in "they aren't very nice here". My shoulders are strong but I don't want to be responsible for branding the whole place with my inattentiveness in a tired moment.

So I buck up and pledge to be the best "they" I can be today and everyday.

The Universal Sign.

2009-03-12T11:01:00.000-07:00

A car stops in front of the ER entrance, the back door opens and we see feet. The tech jumps in to check the man and we see him start chest compressions. The (feet first syndrome). A stretcher is brought to the car and the patient is pulled out onto it. We work on him until our protocols are exhausted but he dies.

The family will remain in my mind for a long time. I watched them go through the shock into the tears and on through to the planning stage smoothly, quietly, and together. When they were leaving, the wife asked if we were all okay.

In all my years I don't remember family members wondering how the death of their loved one affected us.

This day continued with several more critical patients among the non urgent ones.

And somewhere in between things a registration clerk came out of her office grasping her throat. (The universal sign for choking) A nurse saw her and grabbed her around the waist and did what we are trained to do and then went on about her business taking care of her patients.

The clerk was okay but shaking. Just another day in the life of a nurse.

On the porch with Jackson

2009-02-19T14:00:00.000-08:00

We were waiting for his mom and dad to get home from Washington D.C.

Jackson- Will you tell me when you see them coming?
Me- I will. What are you going to do when they get here?
Jackson- I'm going to run and say "Mommy, Mommy, Mommy!
Me- And Daddy, Daddy, Daddy?
Jackson- Yes, and where's my present?
Me-Jackson, you should tell them you missed them and that you are glad they are home. And ask them if they had a good time.
Jackson-Yes, and where's my present.

When Marsha and David got home, Jackson went running. I watched, confident in my coaching skills.

Jackson- Running, jumping into his daddy's arms. Where's my present?

What a gift this child is to us all.

Team Work

2009-02-09T10:35:00.000-08:00

I was permitted to change my work schedule when Marsha got sick. I was given a charge position in the ER twelve hour shifts on Friday, Saturday, and Sundays. This allowed me to spend Monday through Thursday with Marsha. Her dad came in on Thursday nights and stayed through Friday. David was home on the weekends.

On Chemo days, David's parents took Jackson for a couple of days so I could concentrate my energy on Marsha during those tough days after Chemo.

Tonya came often to play with Jackson. Now Tonya is his, he thinks. Whenever they are together she belongs to him. She sure helped keep the focus off his mom and keep his little life normal and fun.

Jackson is better now but for awhile after Marsha was done with treatments and I would come over he would get cranky and didn't want to look at me. I guess he thought I was going to take his mommy away, which I sometimes did.

We had a great routine going. David's job was to keep working and providing that great insurance. We wanted him to save his vacation days or time off in case he needed to help us.

He sometimes felt like he should be with his wife and that was understandable. Other than a stomach problem, also understandable, David was wonderful and strong.

I recently read in a book a phrase that will forever be in my heart....

"Physical causes are too wrapped up in their emotional results to be disentangled."

David's stomach problems are gone now I think, now that Marsha is well.

It all seems like a bad dream sometimes. But the fear and rage and pain and disrupted life and a loss of direction seem to be my left overs.

But I have not lost a daughter to cancer. I have gained a strong friendship with a kick ass woman who is an inspiration to all who know her.

"Fuck Cancer!"

The day our lives changed.

2009-02-08T03:47:00.000-08:00

It is time for me to write about the patient who most touches my heart and life. My daughter Marsha. Together we traveled through the maze of cancer treatment.

She was 31 years old, a wife and a mother to an almost 2 year old. She had been suffering with a cough, weight loss, fatigue and chest pain for six months. Her Dr. kept treating her for allergies.
I was at her house one day to use the computer and she was talking on her cell phone walking around her living room. She became short of breath and had to lean over the counter in the kitchen to breathe.

I had no idea that she was so sick. I took her to the hospital right then. After a chest xray and a CT we went from peaceful existence into full battle.

The chest xray will be forever imprinted on my mind. The mass filled her right lung. I could no longer feel my body. The noise around me became muffled. Knowing I could not faint in front of my daughter, I focused on moving forward.

We needed a biopsy, a diagnosis. I wanted no gap between this day and treatment. This was July 10th 2007.

I drove Marsha home from the hospital that night; I watched her walk into her house and close the door behind her. I don't know what went on behind her closed doors that night but when I got home, I sure gave in to my own emotions......and then the anger.

How can a Dr. let 6 months go by without blood work or xrays. Again my own profession fails me.

Tonya was there in the kitchen waiting. Those who know me will think this odd that I felt embraced by the kitchen as well as by Tonya. This kitchen has seen me and my family through some amazing and painful times.

It looks different now, light blue floors, and a cool counter waist high that I draped over while I cried and raged and moaned.

July 11th Marsha and I went to see the pulmonologist and scheduled a biopsy for the 12th. More pictures to live in my memory. Oozing pus and necrotic tissue. I think she will lose a lung. But we can live with one lung. We can do this.

David and Marsha came to hide out at our house for a couple of days. Away from people asking them questions they had no answers for.

In 3 days we had a preliminary diagnosis of Non Hodgkins lymphoma. I had an appointment with an oncologist the next day. On the 24th of July Marsha had her first Chemo treatment. Fourteen days from her ER trip to treatment. The battle was on.

Just the beginning. I write this for my own therapy so if it sounds a little me oriented that's why. I'll write more another day. This is hard but I think it will be good for me.

My inauguration story

2009-01-26T11:36:00.001-08:00

There will be many stories from inauguration day this year. I found mine as I watched the older Mr. Bush walking with his wife Barbara. I noticed his cane and then I saw his small steps. The old man shuffle was there.

He reminded me of Dad. Mr. Bush was smiling, looking around and seemed to be really having a good time, but he was having trouble walking for sure. Daddy could walk best when he had nothing else to distract him. But if there was something he was looking at all his body parts came to a halt. Even standing became difficult for him.

I continued to watch Mr. Bush as they came to the stairs they would have to go down and I got a little nervous for him. Barbara was going down the stairs ahead of him and I wanted her to take her husband's arm instead and stay closer to him.

Protective feelings for my Dad were coming out all over poor Mr. Bush. He passed between the two guards who were saluting him and I held my breath until he took hold of the railing going down the steps.

As I let out a breath, Mr. Bush stopped, smiled, let go of the rail, reached back with his right hand.......and patted the butt of the guard at the top of the steps!!!!!

As he continued down the steps, I started crying and laughing. Daddy was at the inauguration!!!! You go George!!

At least George USED his cane.

I miss you so much Dad.

Experience counts.

2009-01-21T11:14:00.000-08:00

I'll take compliments where ever I can get them.

I went into a patient's room to begin care and her husband was sitting at the bedside.

He looked at me as I introduced myself and said, "I like old nurses best. They really know what they are doing."

Also with that "experience" comes some very dark moments.

Moments when I feel like I can't do it another day. I feel too much. Feelings, emotions, coming at me, almost as if thrown at me.

Patients becoming too real to me

A quadriplegic who could look at me, study my every move, but she could not move or talk.
I felt fear.... To be like that, alone, unable to move or cry out.

I feel too much. Make it stop! I fear they may all be me. All the sick, the mangled, the dead.

Only moments. But those will always remind me to treat each one as I would want to be treated, for they are all me.

Thanks Wendy

2009-01-19T10:36:00.000-08:00

A man was having chest pain one day. I was staying by his bed, giving him Nitro and talking to him, trying to calm him and help him relax. His wife was sitting in a chair beside his bed. She told him he had to be okay because his dog would miss him.

I asked him what kind of dog he had. He said, "A Pitt Bull".

Well, I was delighted to hear that. We got to talking about "our" dogs and before we knew it, his blood pressure was down, his chest pain was gone, and I hadn't given him any more nitro.

What helped? The medicine or the dog?

Thankyou, Wendy, where ever you are. You were mine for as long as you were with us and you taught me so much about love and respect.

Who doesn't respect a Pitt Bull? And she gave me a connection to help this man's chest pain go away.

I always knew mothers were magical.

2009-01-18T03:37:00.000-08:00

A mother brought her son in with a painful ankle and foot from an injury playing soccor.

She said, "We put ice packs on and I levitated his foot all night"

Tonya and I have great plans. We are building a new garage soon. She will have a better place to create her masterpieces. We are paying off the house and both our names will be on the deed. It feels like a union to me.

Now if we could just figure out how to hook up our VCR and DVD players we would really rock. We called a Nerd and they wanted $300 to come out and do it for us. They really know when they got you don't they. Screw them. We'll go without.

Up all night.

2009-01-05T10:55:00.000-08:00

What grandparent hasn't kept a grandchild overnight and found that sleeping wasn't going to happen?

Now I expected to be awake a lot and very watchful when I kept my grand"babies", but I had hopes that when they got older, we would have a good time all day and actually go to sleep at night. Well.........

Elijah and Cameron came for a couple of days during the summer. We had a great time until one day I put in the movie I love and wanted to share with them... Lord Of The Rings.

Now these boys grew up watching Star Wars and what I thought were some pretty violent movies. They loved having light saber fights and pretend to cut off each other's arms. I thought Lord Of The Rings at least had some awesome creatures and magical stuff to enchant the boys. I was right and wrong.

We spent the day watching, and the night trying to get them to go to sleep.

Cameron said he was having bad dreams which I couldn't figure out since he wasn't sleeping.

I tried getting in bed with them and that helped, but as soon as I got up to get in my own bed, they woke up and started in again.

I did make it into my own bed at last. Then there stood Eli and Cam, hand and hand. "Grammy, we can't go to sleep. We're scared."

One last try......Worn out, they finally went to sleep.

At 5AM, I hear a few noises. I got up to find the boys in the living room watching------Lord Of The Rings!!!!!!!

"Hair of the dog that bit you" came to mind first. Then I thought they may be innately moving through conquering their fears; or they may be just boys who are drawn to risky behavior and new thrills.

I was kind of proud of them in some sleep deprived way. But I took the movie out and turned on the Disney channel.

And I have a great story to tell their own kids.

I can still be amazed at times.

2009-01-04T03:41:00.000-08:00

Just when I thought there were no more surprises out there, in walked Mr. so and so. He said his wife fell and he was trying to lift her up when he heard something pop and had severe pain in his back. I put him in a gown and helped him onto the stretcher..I asked him if he drove himself here and he had.

He needed pain control but he said he had to drive home so after some Tylenol and no relief from pain we discovered he had a compression fracture in his back.

He began making jokes and telling me if I didn't have that ring on my finger he'd ask me out. Now this kind of talk is not surprising to me... But wait, the surprise is coming.

I was instructed by the Dr. to start an IV and tell the patient that he would be spending the night in the hospital. The patient signed admission consent without comment. No surprise there yet.

As I was getting supplies to start his IV, I noticed that there was another patient with his same last name on the patient board. A female.

Surprise number 1.
Mr so and so's wife is here. She came in by ambulance several hours after Mr so and so arrived. She has a broken hip from her fall.

I went back to Mr so and so and began to start his IV. He talked a lot. "I'm an old sailor and I know all the dirty jokes there are" No surprise there.

When I completed my chore, you see I waited until all the needles were put away before I approached the subject of his wife. He said "Oh, she must have called 911."

I said, "Didn't you know she was hurt when you left her?" He said "Well, yes, I left her on the floor"

Surprise number 2 begins.
Mr so and so told me he layed in his wife's bed awhile after he tried the lifting her off the floor part. Then he took a hot shower thinking that would ease his back pain. Then, when nothing helped, he got in his car and drove himself to the hospital.....Leaving his wife on the floor!!!!

Four hours after his arrival I'm learning these facts. I asked him why he didn't tell us his wife was home still on the floor. He said, "Well, I gave her the phone before I left".

When I left his room, I went to his chart and found an order for IV pain medication. One of the other nurses asked if she could give that for me. I said no. I think I'll wait a couple of hours, I need a nap and maybe a hot shower first!

Stepping Up

2008-12-16T03:40:00.000-08:00

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.

2008-12-01T14:59:00.000-08:00

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.

2008-11-16T12:45:00.000-08:00

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.

-------------

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.

2008-11-04T12:52:00.000-08:00

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

2008-10-30T09:02:00.000-07:00

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.

2008-10-25T14:26:00.000-07:00

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.

2008-10-23T17:50:00.000-07:00

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

2008-10-21T19:17:00.000-07:00

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

2008-10-13T19:25:00.000-07:00

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

2008-10-09T19:29:00.000-07:00

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

2008-10-08T19:32:00.000-07:00

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.

2008-10-06T19:38:00.000-07:00

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

2008-10-05T15:34:00.000-07:00

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.

2008-10-04T19:43:00.000-07:00

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.