What Happens A Year Later

Life has a funny way of slipping away from you before your eyes and without you even realizing it. Perhaps for those who have 9-5 jobs and have a certain “rhythm” to life, or routine I should say, time might seem like it’s not going anywhere. With the craziness and furthest from “routine” of a life I have, time seems to fly. I’ve noticed I have no real concept of what time it is, or which day it is–excluding days I work and the time it is while I’m at work. I, like many other people in my profession, have the tendancy to get into work and ask, “Hold on, what’s the date today? And it’s Monday?”

Most of the time, the response is, “I think it’s Monday. You don’t know the date?”

And my (our) response is, “Hun, all I know is I’m supposed to be working tonight.”

Time seems to slip away from you

Your days mesh into one big blob of days (yes, my vocabulary is quite extensive, isn’t it?), weeks into months, and before you know it, it’s the middle of June. Working nights and running on a continuous empty tank does not help. My running on empty first alarmed me last Friday night when I showed upto work and my confused coworkers looked at me saying, “What are you doing here?”

“I’m working.”

“Mol, you’re not on the schedule.”

“Ohh, that sucks. Okay. I’m going. Bye!”

Don’t worry, it’s happened to other people…I think.

Monday, after working two nights in a row, I slept on-off throughout the day. I think the running on empty finally got to me, and the fact work has been insane. It seems I’ve been the one receiving insane assignments and have been the “code/rapid response person” more often than I’ve wanted. (That means, you go to all the code blues and rapid responses throughout the hospital.) Just a FYI, an ICU nurse needs to go to each code, because they are ACLS certified, so they are the only ones allowed to push the medications in a code situation. And, the last few times I’ve been “code/ rapid response person, nights at work have been nuts. I had a code and we coded  a patient– shocked her, gave epi, etc etc, and by the time I brought her to the ICU, she was PEA. Less than ten minutes later, a rapid response was called and the patient I brought up was fine. But, I brought him up at 0630, and still had to do things for the two other patients I had–excluding getting my PEA lady ready for the family to come in and see her. (Another FYI, PEA is pulseless electrical activity, meaning the heart is not actually working, but there is electrical activity that shows up on the monitor).

Insane.

As many are aware, I’m somewhat quiet. And people at work have picked up on that little fact (well, they should after me working there a year). But my inner ICU nurse voice, and frustration at the stupidity of some other nurses, actually made me raise my voice at someone during the code. I did not yell. But I swore, which I never do, except for when riding or running.

The doctor ordered Amiodarone.

“Can someone draw me some Amiodarone?” I was almost yelling. I felt someone put in a syringe and a small vial into my hand. I looked at it.

“This is f-ing Narcan. Is this lady detoxing? No! Give me the Amiodarone. The f-ing brown vial. No. no. Move, let me see.” I pushed the nurse out of the way and looked for the Amiodarone.

Okay, I felt bad, because I think I scared the other nurse. But he was giving me the wrong medications. And, I sounded mean, which I’m really not. It was just an emergent situation. And, I found my inner ICU voice.

When I went back to the floor and told the other nurses, they laughed and said, “Awww, our little Molly is a true ICU nurse when she swears and pushes people away in codes!”

I started this job a year ago in June….Around this time actually. And the things I know now compared to when I first started amazes me. The drips, the diagnoses, the treatments…My knowledge of medicine and nursing has expanded tremendously. I’m not sure it’s what I want to do forever, but it certainly has opened up my opportunities for the future.

 

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What I Love and Hate About my Profession

In attempts to further delay the ride I have planned for today after just seeing that it is eleven degrees outside, and “feels like -1,” I thought I’d write a post about nursing–one of the original reasons for starting this blog (crazy, right? You thought I started the blog to follow only my training).

It’s been almost nine months since I started working at TKH, and the past couple nights at work were bearable. I have no idea how people work five days in a row–a week. Last night I finished my fourth shift in a row, and towards the end of the shift, when you are getting ready to go and give report, your brain just ceases to function. As my colleagues pointed out, I tend to laugh a lot when I am exhausted. Laugh at insignificant things, too, so much that I start tearing up.

Working in an adult intensive care unit is a completely different type of nursing than pediatrics nursing, and I miss working with kids. Yes, there were times working in the PICU where your patients passed away, which was heart wrenching, because they were two years old and in my mind, children should not die. But, on a normal med-surg pediatrics floor, sick children are still children, and there are a lot of nurses who could never work with children, simply because they are kids and not adults. They walk to the playroom lugging an IV pole behind them in one tiny fist, and holding a parents hand in the other. They squirm and wiggle around when you try to listen to breath sounds, and get tangled up in tubing in their crib. Some kids grow up in hospitals, with rare medical conditions that make the top neurologists ask questions. They attempt to color pictures for you, and ask to play games.I miss feeding the infants at night, rocking them to sleep. Yes, something wrong happened and they had to get hospitalized. But, the majority of peds patients get better, and can go home, and continue to be…Kids.

Adults are different. Actually, in some ways, it’s harder working with adults than squirming kids. Adults are needy. They may not complain about not being able to play and have to go to sleep, but they complain. I’m pretty tolerant of needy adults, but after five hours of constant bell ringing of needing another sip of water (when I put two pitchers of water next to your bed) or that the sheet is not covering your toes enough, I get a little fed up.

Life is funny. You enter the world needing to be nurtured and taken care of, and in a lot of cases, leave the world, much older, but needing the same basic things.

Why am I thinking about this? I just had a nineteen year old boy who was in a MVA in October–before then, completely normal. A walking, talking, athletic, teenager who was ready to go to college. I have not taken care of a 19 year old since living in D.C. Now, his pupils are non reactive, different sizes, and fixed in place. He has a PEG tube. Seizures. A tracheostomy. He couldn’t keep his heart rate up on his own–we coded him, twice.

And when the majority of the patients you take care of are sedated and on ventilators and have breathing tubes to help them breath, when you actually get a (friendly) patient to talk with, it’s special. And, that’s a reason I became a nurse, to care and nurture, to listen. To be a presence and help someone during their most vulnerable times. And nursing now a days is not like that.But I had a rare night last night when I could do that. My patient had gone into flash pulmonary edema on the floor and was rapid responsed needing to come up to the ICU. I was the ICU nurse who went to the rapid response, and he ended up being my patient in the ICU. It was amazing how well he did after given the NTG drip, lasix, morphine and beta blockers, as well as Bipap.

The next night when I came back to see he was my patient again, I walked into his doorway and exclaimed, “Well, look at you! Sitting up in bed eating some crackers!”

“I know, hun. Do you have ice cream? I really would like some ice cream?” He said as he scratched his face.

This 78 year old man was cute as a button.

“Sure, let me go find some!”

And then, after his snack, I gave him a bath while we talked about the hospital. And he asked if I could shave him (he had long side burns and a mustache/almost goatee ) and I said, “Ofcourse!” and then I went on to lather up his neck, cheeks, and chin, and shave him. (Might I add, I did a wicked good job shaving that goatee he had). After it was all done, and I was wiping away with a damp washcloth the excess shaving cream from his face, he looked up at me and said, “you know, I never let anyone else shave me, but you seemed special.”

“Well, Mr. X, I hate to brag, but I did do a fantastic job, and you are handsome as ever now.”

That last story was one reason why I love my job. The human to human contact you have with your awake –sane–patients. The stories that make your heart sing.

Another reason I love my job: I love my coworkers to death. They are amazing women and men, with a wealth of knowledge that I can only pray one day I will have. They care about each other. We laugh when we shouldn’t be laughing, occasionally cry when we shouldn’t be crying. We’ve become family. With my parents living overseas, I’ve found my “America Mommy and Daddy” at work (corny, yes.)

I love  when you have the rare, incredible turn of events on a patients stay. They coded three times, could not seem to be weaned off the ventilator, and are in the ICU for weeks. Then after a week of being away from work, you come back and ask, “Where is Ms. X?” And your colleagues say she was discharged from the hospital the day before–walking and talking. Then you get a card with a picture of the patient holding her lap dog again. It’s joyous.

I love some of the comments that come out of patient’s mouths sometimes. They are simply hysterical. For example, the 78 year old man who kept asking for a diet coke, and wanted the hot blond nurse back the next day….Man, I have a million hilarious comments.

I love the action that happens in the ICU–the controlled chaos. I’m a closet adrenalin junky.

What do I dislike?

Residents who do not know what the hell they are talking about, giving you orders and telling you to do things that you know will kill the patient. In the midst of a patient going downhill, the resident on the phone with the true doctor, unsure of what is happening. You feel like slapping the resident and pulling the phone from his/her hand and talking to the doctor yourself. I’m not saying all residents are like this, but some are. Just because you have been to medical school doesn’t mean you need to be a cocky nasty person.

It disturbs me when after years of ignoring a family member as evidenced by the lack of hygiene and medical state they are in-once the family member is admitted to the hospital, the family members are all of a sudden involved in the persons life. How could someone ignore their sick mother for years, and all of a sudden care?

I don’t like yelling. I don’t like screaming. I try to avoid conflict, and am incredibly passive (yes, passive aggressive too). Probably one of my biggest flaws. I hate having to raise my voice when talking to others. I have a very hard time criticizing others, and even harder time when others criticize me (perfectionist? Hell yeah, I admit it. Being a perfectionist and working in intensive care works well. In order to be on top of everything, knowing each detail is required). I’m getting better with age with the criticism, but still have a thing with people yelling at me. Even though it happens often in a hospital setting, where stress levels triple of family members and friends of the patients, I know because I was there when my grandmother was in the same ICU as I work last year, it still bothers me.“Poor thing, got slammed by a family member last night. Could you imagine? Someone screaming at our Molly?”

And there is nothing worse than getting yelled at for something you have no control over what.so.ever.

“Ma’am, I apologize, but I have no control over that, you really need to discuss that with the doctor tomorrow. I’m not a surgeon. I’m not a doctor. The knowledge I have about your husband is what I’ve seen documented, and the report I’ve gotten from the other nurses.”

The above example is another thing I dislike about the job.

Another one: the insane amount of paperwork we have to do. I care. A lot. Too much. But you need that in my profession.However, a warning to new nurses. Nursing now is not what it was twenty years ago. If you do not like to document, don’t become a nurse. At least in the United States of America. I would say, 90% of nursing now is covering your ass for what you did and didn’t do. Not to scare you, but just think– in a country where you will sue your neighbor for falling on their driveway over a branch, imagine now working in a profession where you are legally responsible for caring for a living beings life. If you write in a note that you gave a medication or you called a doctor, you did that. You wrote that down on a medical record. Twenty years from now when you are in court and people are asking you what happened on that “Tuesday at 0215 on so-and-so date” will you remember? No. But the documentation will. There is a reason in nursing school now they drill “DOCUMENT.DOCUMENT.DOCUMENT.” into your brain. What do I remember about nursing school? Those three words. Well, those, and just pure misery.

I don’t like the fact that in the adult ICU, the majority of the patients will never leave the hospital due to their age and medical condition. Unlike kids, they won’t bounce back to perfect health.

Lastly (I could go on and on with this post), it breaks my heart to see grown men cry. I can deal with women crying–it’s what women do. But when a son comes to visit his dying father in tears, I think I can actually feel my heart cracking. And I’ve dealt with a lot of deaths at work.

All in all, I still feel I could not have picked a job that fits my personality better. I know I won’t be staying at TKH forever, but thus far, it’s been a great job.

When was the last crazy post written?

March 2019
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