Ok, Ok, I Want To Be Popular...

...so please vote for me.

I got sucked in. Fibers.com is hosting a T-shirt design contest for Nurses Week. There are prizes, and of course in exchange, you fork over your intellectual property allowing them to market your T-shirt idea and profit from your creativity. But, it's kind of fun designing them and I highly doubt I'd get rich from the T-shirt business anyway.

Anyway, here's my designs, please go vote for me:


Vote for Nursing Poop Poseurs Here.


Vote for Nurses Saving Butts Here.

And one for the guys here:


Vote for RN-BSN-XY Here.

While you're there, design your own. It really is kind of fun.

Brought To You By The Letter, "Oh $#1T!"

I learned something new last night.

You know what sounds like rain gently thrumming on the soft top of a Jeep?

Well, it turns out that blood spurting and spattering onto acoustic ceiling tiles makes almost exactly the same sound. Eerie really.

And that folks, is what happens when a patient pulls his IABP out of his femoral artery.

I learned something else last night too.

You know what sounds like a dropping a watermelon on concrete?

Well, it turns out that a fainting coworker's head smacking the floor sounds remarkably similar.

And that folks, is what happens when your pod partner faints when she sees blood spurting from her patients femoral artery after he pulls out his IABP.

Lucky for me I was already gloved up about to draw labs on one of my patients when I heard the aforementioned, very liquid sound followed closely by the monitor and IABP machine alarming. The other aforementioned sound rounded out the trio.

On a dead sprint to the other side of the room I managed to scatter the bucket of bed bath supplies for the sake of grabbing a towel, all the while yelling my head off for help.

The patient, all 6'5", 148kg of straight-up-pissed-off was thrashing around in the bed. He was intubated, and supposedly sedated on 60 mcg/kg/min of propofol (which is a 100 ml bottle every 90 minutes!). He apparently took exception to, well, hemostasis I guess.

I clamped the towel down on his fem site, then got control of his right wrist and pinned it to the bed. Next I stuck the elbow of my arm holding pressure deep into his quad and got him to straighten his leg. Lucky for me his other arm got tangled up in his vent circuit and I was able to should block his other knee or there's a good possibility I'd be wearing a black eye today, or worse.

By this time help was arriving, the crash cart got yanked open, the patient is in v-tach (as best we could tell), and was being restrained forcibly by 3 other people. The CRNA on call rolls in (their sleeping rooms are right outside our unit). He takes one look, calls for a vial of vecuronium and paralyzes the patient on the spot. The secretary is running for blood and a rapid infuser from the trauma ICU, there's a saline bolus running in wide open. Somebody shoots an index, it's like 0.9, but the dude somehow still has a pulse. His pressure is in the toilet, and although he converts out of v-tach with some epi, he still has ectopy all over the place. Someone was nice enough to set up a c-clamp because my arms are burning from holding that much pressure on the site (I may or may not have been trying to single handedly push his hip through the bed.)

Meanwhile a code purple has been called for my coworker and she gets C-collared and whisked off to CT on the way to the ED.

There was eleventy-billion people in the room, including family from the other 3 patients in the pod. They couldn't get out because there were so many people attending to the patient and my coworker. It was more chaotic than any code I've been to yet.

Surgeon arrives on unit, and he's pissed. He wants somebody's head on a platter, and since my co-worker cracked hers on the floor, I'm next in line. He literally wants someone fired. My night charge nurse steps up to the plate, and sets the surgeon straight--for which I'm truly, truly grateful.

"That nurse and his quick thinking is the very reason your patient is still alive!"

We did, in fact, get the patient stabilized. He's only slightly more sick than he was before the incident, and that is a very lucky thing. It could have easily been much worse.

I'm sure there will be all kinds of legal shenanigans and ass-covering in the days to come, but it was enough for one night.

In fact, I hope I never see that again!

The Honeymoon is Over

It was nice while it lasted, but the honeymoon is over. The true colors of my coworkers are starting to show through.

Now that I'm no longer new enough for everyone to still be playing nice, all the personalities are starting to emerge. And on a unit like mine, you better believe there's some strong personalities.

To the nurse that found it necessary to inform the night supervisor I didn't get the SCDs on a patient until nearly shift change a few shifts ago, two things:

A.) I was at my other patient's bedside the vast majority of the night taking care of small things like, oh, keeping them alive.

B.) If you had time to keep track of when exactly I got the SCDs on the patient, couldn't you have helped me out and put them on yourself? You know, teamwork? Just sayin.

To my pod partner from last night:

I get that you're the top poodle on the nightshift now having reached the ripe old age of 3 years experience. I am also aware that our collective 4 patients were relatively stable, especially for our unit. However, you spending the entire night out of the pod at the nurses station yammering with your friends and cohorts meant that I was stuck in our pod all night caring for your patients and mine both. Not really that big of a deal, except that if I wanted to wear the soles of my shoes out running from bed to bed, I'd have gotten a med-surg job. And then having to help you get your patients primped and fluffed at 0600 in a frantic rush, while mine have been settled for hours? It should have been my turn to sit down.

To the dayshift nurse who told the night supervisor I didn't bathe my patient because I missed changing 1 of 6 dressings:

You suck. And you lie.

To the RT who didn't believe me when I told her a patient's ETT needed retaping:

I wasn't just playing about, and our patient really, really didn't need the exposure--or the jostling--of a stat portable chest X-ray to reconfirm ETT placement.

Oh, and to the unit in general:

I'm so very tired of hearing, "You have to be careful how you approach so and so about that."

Why can't I openly and clearly communicate my patient's needs to those responsible for assisting me in caring for them? I am so tired of having to slink up to various people from docs to support staff like a helpless, hapless junior high damsel in distress to get what my patient needs. Too many egos to stroke. I demand respectfully request you grow the #@$) up.

And it's only been 3 1/2 months!!!

ICU Psycho

When I came in for my much heralded first solo shift it turned out I was assigned two patients that'd had floor orders since that morning, but no rooms available upstairs. So much for saving the world all on my own.

Pt #1 is a post-op day 1 CABG patient who, aside from being overtly particular, seems pretty chill. He's sitting up in the bedside chair, reading a book and just hanging out. I introduce myself, get report, grab vitals, and head off to meet patient #2.

Pt #2 is a post-op perf'd bowel resection. Brand new colostomy and ileostomy. The only reason he's on our unit at all is he's an old double lung transplant from 2007. He's the picture perfect double lung--10/10 anxiety, twitchy, constant guppy breathing--basically crawling the walls. He has a Dilaudid PCA and knows exactly when he got his last nurse bolus, and when the next one is due. And the last and next Ativan.

From the above brief description, can you pick which patient is going to be the troublemaker?

If you picked like I did, you'd be wrong.

I get Pt #1 assessed and charted, just in time for Pt. #2 to have an anxiety attack, (right on the scheduled Ativan dose time coincidentally), and head to his bedside. I get him settled down, drugs admin'd, assessed and charted. He slowly starts dragging his sats--was at 95% most of the day now consistently at 93-94% on 5L NC. (Cue ominous music.)

By 2100, I've assessed and charted both patients, given 2100 meds, hung about 4 different antibiotic IVPB's on Lung Boy (Hmmm immuno-suppressed and septic much?), and I've gotten Pt #1 into bed (in his Dean & Deluca bathrobe, no less). Lights out; Pt #1 drifts off to sleep and Pt #2...doesn't.

About 2230 Pt #1 awakes suddenly and starts yelling my name, completely freaked out. I dash to his bedside, only to discover...the bedside computer monitor has him freaked out. It's not on, it's just sitting there.

Pt #1 doesn't like this.

Now you're starting to see how this is going to go...

At this point he sits up on the side of the bed and tries to leave the unit. (Post op day 1, mind you.) Through some fancy wordwork I talk him down and avoid having to physically intervene. After 90 minutes of constant reorientation and reassurance, I manage to get him settled back in the chair and reading his book. Where he stays. The. Entire. Night. Hypervigilant. Refuses to sleep. Won't take his antibiotic because he's convinced it's spiked with something to put him to sleep (hmmm...not a bad idea thinking back...).

As the night rolls on, Pt #2 is getting weaker and weaker, it's clear that his physiological reserve is just spent. But he's hanging in.

Meanwhile about 0430 Pt #1 starts nodding off in the chair. He starts complaining how uncomfortable he is so I suggest getting back into bed and surprisingly he agrees. For the briefest of moments he appears to be going to sleep. But alas, the light comes back on and he continues reading.

By 0600, Pt #2 drops his sats to 88-89% and I start him on a non-rebreather, which perks him up to 98% or so. I figure I better notify the pulmonologist since that's a pretty big status change, not to mention it's after 0600 anyway--pager fair game.

It's while I'm on the phone with the pulmonologist getting a lecture about not trying a simple mask first before the non-rebreather (WTF?) that Pt #1's monitor starts alarming. After hanging up on politely excusing myself from the doc on the phone, I dash to Pt #1's bedside to discover he's in V-tach or SVT, and all hell breaks loose. My pod partner runs for some lidocaine, my charge nurse starts paging the on call CT surgeon, and I try and get Pt #1 to valsalva just to see if he's possible in SVT that we can convert.

And he flips out.

Gone.

Bonkers.

Looney.

ICU Psycho.

He's screaming obscenities, misogynistic slurs, anything he can think of. I'm physically holding him in bed after he assaults the RT trying to get an ABG. He tries to attack me, but he's 72, just had major surgery, and I'm probably 6" taller and 100 lbs heavier. He ends up in 4 point restraints struggling with all his might, which although puts him at danger of dehiscing his sternal incision, it's actually bringing his heart rate down because he's in one constant valsalva. Amio bolus on board, Haldol x10 mg, and that's where he was when I left after giving report.

Oh, and Pt #2? During report I coax him into coughing, and he coughs up a nasty black mucus plug and immediately starts satting better. (Guess who's a closet smoker with a double lung transplant.)

When I called in after I got up to check on the two of them, Pt #1 was in 4 point restraints, a posey vest, and mittens after scratching a nurse. Pt #2 had transferred upstairs.

It makes me wonder if Pt #1 would have been alright if he'd made it upstairs to a private room. Kind of sad really.

From the Beginning: Interview

Since my posts here have become a little sparse, I thought this might be a good time to consolidate my nursing school posts from an older blog. Here's a post about my nursing school interview, originally posted September 25, 2008:

My interview went well today. I only managed to tongue tie myself once. My interviewer's office phone went off 3 or 4 times, her personal cell phone went off once, and someone knocked at the door and intruded. Interesting.

The questions were pretty basic:

Why do you want to be a nurse?
What are some qualities of a good nurse?
What are your strengths that you would bring to nursing school?
What are your weaknesses that you would bring to nursing school?
How do you study?
How do you plan to deal with the rigors of the program?
Do you plan to work?
Think of a time when you had a great deal of stress. How did you deal with that stress?

The one that made me think was:

Think of a time that a problem couldn't be solved with your current way of thinking. What did you do to solve the problem?

All in all it was a relatively painless experience. She seemed genuinely attentive, and took notes on my answers. When we were through she all but told me I'd gotten in. Acceptance letters go out towards the end of October, so I'll be glad when it's in my grimy little hand. Orientation is Jan 7 and 8, but classes don't start until after the 20th. Nice little break there to get myself properly immunized.

Oh boy.

Solo, and not the big red plastic cups.

Tonight is my first solo shift.

NurseXY RN-BSN.

No more "Let me ask your nurse...", "Let me ask my preceptor...", "What do I do now..."

Just me and my paper brain. I'm probably making a bigger deal out of this than it really is. My coworkers are really great about helping, and I haven't met any of them that I feel I couldn't ask to help me. I have been essentially on my own for a few weeks now, even with a preceptor. Multiple times my preceptor got called away to take patients of their own, so it's not like it's my first time solo.

Still, it's different.

There is an excellent chance I will get floated tonight, or even left at home on call because coming off orientation puts me right at the top of the "bad list". Both of my fellow ex-interns floated their first night off orientation. They both said that it was simply boring being off our unit. At least I don't have to worry about a step up in acuity, haha. And the nice thing is we can only be floated to other ICUs, no floors.

My first shaky day of clinical (during which I participated in a code, got to put in a flexiseal, put in a foley, and started an IV--we were only supposed to observe, haha!) seems like a long time ago, mostly because it was way back in 2009. Not to mention the hurdles I've crawled over, ducked under, or simply lowered my head and obliterated since then.

I'd wax nostalgic, but I really need to get some lunch and then take a nap before my night shift.

Thanks for reading about my journey and offering bits of advice and encouragement along the way. It means a great deal to me.

Special shout out to Kirsten, Tiffany, and Running Wildly for being with me from the bitter beginning--probably couldn't have made it without you!

From the Beginning: Busy Day Tomorrow

Since my posts here have become a little sparse, I thought this might be a good time to consolidate my nursing school posts from an older blog. Here's a post about prerequisite classes, originally posted September 24, 2008:

I have a busy day tomorrow... Start things off with an Anatomy & Physiology exam at 9:30, but I'll be up at school long before then, studying. I think having a Bachelor's in Human Anatomy is actually spurring me to study harder. I'm deathly afraid that I'm going to slack off, thinking I can coast on my prior knowledge, and I'm going to get smacked. How embarrassing would that be? Failing an undergraduate anatomy exam would just top off my whole chiropractic school experience. I should be fine, there isn't much material covered, and I am comfortable with the material. Still though, when one gets complacent...

Then I have class until 1400. At that point I head home in time for my girls to get home from school.

Then out the door again at 1630, all spiffed up--suit and tie. My nursing school interview is at 1730. It's an exciting step in my journey, and I hope I'll sleep tonight. I am scheduled to interview with the Assistant Dean, the one in charge of admissions--no pressure, haha! The interview is scheduled for 30 minutes, and my classmates that have already interviewed said to expect to be there for every minute of it. As long as I don't fark up my interview, my advisor has all but said I'm a shoo in. I hope that holds true, and I really hope I don't fark up my interview! We'll find out officially by the end of October. Hopefully the mail moves a little more quickly than it did with my interview letter--it took a full week to travel less than 10 miles, within the same city.

I've been thinking about what I'd like to do once I'm through with nursing school. I'm almost certain that I could be just fine working as an RN in a critical care unit somewhere, hopefully a pediatric critical care unit. I've considered the thought of working on a transport team. How fun would that be? Travel, and nursing. Not to mention all the autonomy being in transit affords.

I have also thought about continuing on a bit. I could see myself as a Nurse Practitioner working on a critical care unit. The salary increase isn't very substantial over working as an RN though. Another thought is becoming a CRNA. Big time salary potential there and that's not something to blow off...

I'm sure the path I'm supposed to take will be revealed at some point. Let's hope sooner than later!

From the Beginning: Chest Pains

Since my posts here have become a little sparse, I thought this might be a good time to consolidate my nursing school posts from an older blog. Here's a post about interview letters, originally posted September 13, 2008:

This is the start of a new blog, and I'll update with back story as we get further along. But for now, I'd just like to get a post on the books.

Wednesday in my nursing concepts course, the Dean of the nursing school dropped by. She was there to relay information that the nursing school has changed their application process, and instead of submitting a writing sample, the HESI A2 exam would be used to assess verbal and written communication skills. This wasn't news to me as I'd already taken the HESI as a part of my application process for Spring 2009. The exam did not prove strenuous and thankfully I scored very well. Apparently however, there were 4 applicants for the Spring 2009 class that did not take the exam during the appointed times, and thus their application was incomplete. Since ours is the first applying class to use the HESI, the nursing school has made arrangements to allow those 4 students to take the exam anyway, though the deadlines are past. I'm not sure I agree with that--the nursing school did send two letters and numerous emails about the HESI, but I suppose compassion is the best policy. Especially if I were one of the 4.

Anyway, during her 5 minute spiel, the Dean mentioned that interview letters for the Spring 2009 applying class had been mailed two days earlier, on Monday. Sitting in my seat, I got goosebumps. I knew that this could very well mean that if I were selected for an interview, my letter was probably sitting in our mailbox at that very moment. I had to strongly resist the urge to gather my things and slip out.

Alas, when I arrived home, there was no letter in my mailbox.

Now, for perspective, I live about 10 miles from school, in the same town. Mail usually travels within the city in one day. Mailed on Monday would have a strong possibility of being delivered on Tuesday, and almost positively by Wednesday. Stretching to Thursday was unusual, but not beyond the scope of imagination.

Thursday afternoon the mail arrived. No letter.

At this point I was getting concerned. My conversations with my advisor, and even the Dean, had led me to believe that I had a very strong chance of being accepted to the program, but I was beginning to have doubts.

On Friday, I made a special stop at the house to check the mail between a business lunch and my anatomy lab.

No letter.

Now I was relatively certain that a letter was not mailed to me on Monday, and the panic began to set in. My hands were shaking, my mind was reeling, and I honestly had chest pains. I'm not sure if that's how anxiety attacks feel, but I do know that I was not in a happy place as visions of our carefully laid plans came crashing down around me.

I knew that if I let things ride, I would be a wreck all weekend long. I needed action. I needed answers. As I drove my way to campus, I dialed 411 for the number to the nursing school and called to make an appointment with my advisor. Luckily she had an availability, even late on a Friday afternoon. Meanwhile, I numbly sat through anatomy lab, making small talk to my lab partners, and making all the incisions in our fetal pig for our group. (It's amazing what two trimesters spent dissecting a human cadaver for gross anatomy will give you tolerance for...or callousness to?)

As my advisor walked me back to her office, she asked how she could help. I tried very hard to remain completely calm and affable, and I think I did a pretty good job. I told her I was curious about my application, as I knew that the interview letters had been sent out, and I hadn't yet received one. In fact I was wondering how I might strengthen my application so that next semester I might be selected to move on in the application process.

She frowned at me and said, "But we mailed your letter just yesterday."

It turns out that since I have a professional degree already, I'm in a different applicant group than normal undergraduate applicants. My group's letters hadn't gone out until Thursday.

I'm certain my spontaneous relief was transparently obvious to her, because she apologized for having stressed me out so badly. She then made a copy of the letter from the duplicate in my file so I could bring it home with me.

All's well that ends well, right?

Well, one would hope, but now the system won't accept my login name to schedule my interview...

To Hell & Back

Tonight I accompanied my wife to a yoga class at our gym.

You have no idea how huge this is.

I suck at yoga. When we first got our Wii Fit, the yoga game frustrated me beyond belief. I had very little balance. It had a great deal to do with my being overweight--it's hard to control your body when you're carrying around the equivalent of an extra human being on your back.

Tonight the class was supposed to be hot yoga, but apparently the heat in the room was broken so it was more like luke-warm yoga. Regardless, I was pleasantly surprised at how many of the poses that used to elude me I was able to accomplish in some shape or fashion. I was even able to do the higher level variations a few times. Overall it was a really positive experience.

But this post isn't about yoga.

During the quiet reflection time at the end of the class, I was almost overwhelmed by a rush of emotion. I was nearly brought to tears as I became acutely aware of the grinding, oppressive intensity of my job.

Critical care nursing is a violent, violent beast.

The inhumanity of so many of the "interventions" we implement is staggering. We often do things to our patients where the success or failure of the therapy depends solely on our determination to see the procedure through to the end. Our patients are broken, hacked into pieces and put back together, sometimes not in the right order or composition. We administer vehemently severe drugs that force the body to battle against itself to raise a blood pressure, or increase perfusion, or to be stone still when the entire body aches to thrash about in protest.

This realization caught me by surprise. Actually, the discordant nature of what I do to heal people caught me by surprise.

My compassion for my patients abounds--this isn't the issue. I feel for them; I practice from an empathetic heart.

But this is different.

This is about me. And the horrors I witness on a daily basis in the due course of my job. My career. My livelihood.

Like I'm a computer programmer, or a grocer, or an account customer service representative.

Except that I'm not.

When people ask me what it is that I do, they have no idea the profundity of question they are asking. And I reply like I change oil for a living. Or buy bonds on the stock market.

The reality is my unit is a battlefield. A desolate, bleak, derelict, forsaken, smoking wasteland. Where Death prowls like the inky darkness at the edge of your vision. Where I'll make deals with the Devil to save a soul so they can gasp a few more breaths. Or if we're all lucky, and have muttered the right incantation in the right timbre, to the right lord of medication, the patient pulls back from the brink and returns from the land of nowhere. Where I will attack, wage war, and blatantly injure a patient in the name of healing them.

And so I go, petting the hellhounds, whispering in their ears so that I might escape with one more patient's soul.

No rest for the weary.

But there must be balance.

Namaste.