Ready... Set... DUCK

In my years as a nurse I've seen a lot of vomit. Not one of the perks of my job... but just a part of my job. I handle it with grace, as it generally doesn't really bother me. Not much really bothers a nurse, and if it does, you get over it real quick your first year.

But tonight... I saw something completely different.

I was helping a fellow nurse in her new patients room. He was in an accident after drinking and had broken a few bones. So here he was. He was not allowed to sit up in the bed at all, he had to lay flat in the bed (related to some of his injuries). We were cleaning him up and turning him from side to side. He is an alert and oriented patient. He knew where he was and he had the ability to verbalize with us his thoughts and feelings. However, he was not able to tell us when he decided to projectile vomit across the room. Now I have seen projectile vomiting... but this was amazing. It literally flew across the room, hit the wall with such force that it splattered all 4 walls and the ceiling. It was like a damn firework show! The lucky part of the situation was that the patient chose to turn towards his nurse... not to me. The unfortunate part of the situation was that it was rank old-alcohol-dinner vomit. UGH! So while I don't generally have issue with smell it surprised me when I started to dry heave and had to make my way out of the room. But the kicker of the WHOLE situation was that as I started to make my way to the closest phone to call for housekeeping... I noticed the other nurse in the room. This poor nurse was frozen in her tracks and completely covered in vomit. She had it in her hair... all over her scrubs... she was soaked (remember, we had no warning). I almost died.

As soon as I get out of the patients room I crack up hysterically... it's how I keep from just crying... but I can't even breath at this point. Luckily the other nurse followed me out of the room and laughed as well... think we were both in shock.

But don't worry, we got her new scrubs and a shower. The other nurse was a trooper last night... something tells me that I would have stripped down to my skivvies and gotten in my car and gone straight home to my shower OR I would have begged the ED to let me use the decon shower (and get a high pressure hose down!).

Ah... the Friday night before Halloween. How special. Mental note for next year...

The Crash Cart

So last night was by far one of the most hysterical nights of my life!!! By hysterical I mean, if I didn't start laughing (and stay laughing) I would have ended up in tears. And I hate to cry... for any reason... but especially out of frustration. At the end of my shift one of the tech's told me that I looked tired. Well.... YEAH, but thank you... I look like shit!

I will have many blog postings about last night... but I feel that I must start with the Crash Cart story... because it makes the least amount of sense to me. And it really was the starting point of my night. BTW, for my non-medical readers, the Crash Cart is the cart that they bring into the room when a patient has stopped being alive. It has the shock paddles (you know the medical shows, when they yell "clear") and all the other fun gadgets and drugs that we use to restart a life.

Well, this evening, on my ventures through my nursing unit I noticed that the crash cart was looking a little wonky... so I went to do my check on it and found that it had been opened and not put back together and locked. Which is unusual, but not altogether impossible, sometimes in a pinch we will break into the cart to find a piece of equipment that seems to be eluding us. But generally, we immediately return to the cart and replace the borrowed item with a new one and lock the cart back up. And to add to my dismay, someone had done me the favor of pulling all of the latex gloves OUT of the box and leaving them strewn all over the cart. Helpful... really. So I clean up the situation and put the cart back together. (For those of you who have had to do a cart check... tedious and time-sucking work).

So I walk up to some nurses on the unit and told them about what I found. To which one of the techs told me that he saw some group of ADULT visitors rifling through the cart.

Well... that changes my opinion of a few things... including how my friday night was going to go.

First... WHY the hell would you see something like this and not a) stop them or b) tell someone else so that they could stop them!!

Two... as a visitor, WTF do you want that could possibly be in a crash cart? And... if you were looking for drugs... the only ones that we really have will either stop your beating heart, start your non-beating heart, put you in a coma (which will stop your breathing), and other such non-entertaining medications. And to top it off, the drug section of the cart... which is the visible TOP of the cart, is still sealed and safe. So the visitors were rifling through the drawers for what??

Three... who has the balls to just break into a cart in a nursing unit with people milling around 24/ 7, looking for some unknown medical equipment. (But then again... they did it, witnessed, and got away with it.)

And Four... these visitors were adults. Adults!!! Aren't they supposed to know better?? Another fine example.

So... deep breath... WELCOME FRIDAY NIGHT.

911... what is your emergency?

So when you call 911, they will always ask you "what is your EMERGENCY?"

I'd like to know how a 40-something patient explains that her 'emergency' is that she had a "cough that started yesterday and was bothering her" with a straight face.

She was alert and oriented, ambulatory, and without mental deficiencies. Although I'm prone to not believe the last characteristic to be true.

But she called 911... she was dead serious... she took the ambulance in... and she would not leave when they wanted to discharge her. She made the ED docs life such hell that they finally admitted her.

And as you guessed it... she did not have medical insurance AND her cough was creating her so much pain that she needed some narcotics as soon as possible. LIKE NOW!!!

Mesh panties

So the other day a patients family member came out to the nursing unit and asked if we had underwear for the patients.

The nurse informed this "wife" that we only had one-size-fits-all mesh panties for the female patients on their menstrual cycle (to hold the sanitary napkin in place... duh). Ick... I know. Sorry.

So the "wife" went away for a while. Later she showed up again requesting these mesh panties. Well... we already explained what they were so we handed them over without question. (Although we were all very curious!)

Later in the shift the nurse entered the MALE patients room and found the patient lounging around in these mesh panties.

EEEWWWWW! and Why??

Dressing change hell

So you are covered in abscess's. Where did these abscess's come from?? You are using heroin and meth... and apparently you think the best route is "skin popping."

NOT my issue.

But you want treatment for these abscess's... cause I'm sure the are causing you pain and issues. Fine... welcome to our hospital. The doctors admit you, they treat you with antibiotics, and they even take you to minor surgery and clean some of these abscess's out.

You are a guest in this fine hospital of ours. We are feeding you, we are boarding you, we are giving you medicine's finest antibiotics to rid you of these pests, we are giving you pain medicine for the discomfort you must feel after years of "skin popping" that you applied upon yourself, and we are changing your abscess's dressings so that you might heal. SO PLEASE DO NOT SCREAM BLOODY MURDER TO THE NURSE WHEN THEY ARE DOING THESE THINGS FOR YOU.

And... going AMA so that you can go get your "fix" so that you can "handle" your dressing changes will not be tolerated. We will NOT save your bed for 5 hours, so that when you return we can give you MORE drugs and then try to "treat" your condition.

Cause NOW... I DON'T GIVE A SHIT. If you want those "pesty" abscess's off... I'll just take your arms off completely. Try smoking your meth or shooting up your heroin without arms.

Take a picture, please... I'd like to see it.

Tattoo's and IV's

If there is one thing that I get a lot of experience in, it is starting IV lines. I often get called by nurses on my unit to start an IV, difficult or otherwise. Sometimes we are forced to put and IV in a foot... not our first choice, but if their veins are shot in their arms... we go for the feet. I've done it all.

I actually like putting IV lines in, but I don't just put them in for fun. I really only try if I think I have a good chance at getting the line in.

But a few pet peeves about putting lines into patients...

One... please don't tell me where to put the IV. I will a) think you are an IV drug user, if you know where to put it. and b) I will NOT put the IV where you "like" it best, I will PUT it were my nursing judgment tells me the best place is.

Two... if you are covered in tattoo's, don't tell me you are afraid of needles. Because I won't understand. And yes, I've gotten a tattoo or two. So don't play that card. I won't get it and I really won't try to... suck it up.

Three... If you have a tattoo, don't explain to me that a certain IV line might RUIN your tattoo. Because when we can't get a line in you to give you your Dilaudid and Ativan... guess you got to choose... the IV or the tattoo. Cause you can't have both.

And FOUR... the most obnoxious one on the list. I really don't want to start the IV between your tattoo'd ladies nipple and the snake tongue. So while I like starting IV's, this still seems a little over the line for me.
*In my head... tourniquet, check; gloves, check; IV setup, check; needle, check; alcohol, check; landmark... OMG... nipple and tongue.*

F this.

Many unknown

We admitted an elderly patient last night with a left hip fracture.

Many issues came to light with this particular admit...

First... the patient had been walking around on this fractured hip for over a week. The patient claims that they saw their naturopathic physician after a fall last week. The doc told them that all they needed to do was rest and take Tylenol if absolutely necessary. As you can see, the patient turned back to western medicine and brought themselves to the hospital when the pain was just too much to take.

Second... to get the patients pain under control we had to use Morphine, Valium, and Dilaudid. How the heck did the patient get by at home??

Third... my favorite, the allergy list. One form said "many unknown." WTF does that mean?? Another form said "almost all medications." I think the naturopathic physician filled the patients head with some really good ideas. Honestly... if you tell us you are allergic to almost all medications... guess we can't give them to you. Unless you, as the patient, cannot tell me when you had a certain medication and what your reaction to it was... guess we are going to test the medication out. You just took three narcs... trial and error??

**This is not meant to sway any opinions regarding naturopathic medicice or slander naturopathic medicine in any way. It is just a story. As a healthcare provider I respect all people and their practice and/ or beliefs. It is simply unfortunate that this patient lived in pain for over a week.**

Riddle me this...

Your medical history includes hypertension (high blood pressure) and a brain aneurysm. You deny using recreational drugs, alcohol, or tobacco. You don't have a history of pain, acute or chronic.

So tell me... why do you have METHADONE listed as one of your home medications??

A what??

We admitted a patient who was severely assaulted. Someone really took out some anger on this poor patient.

So what was the patient assaulted with?? A hanger, a shoe, and a peanut butter jar.

WTF? For one, I didn't think a hanger could be so dangerous. Two, a peanut butter jar? Really? And three, why do we know this?? Or care?

People never cease to amaze me.

If you have to ask...

If you have to ask your nurse if it is "too gross" to eat your midnight snack while you are sitting on the bedside commode trying to get nature to move...

THEN YES, IT IS.

And as the nurse, the best response... "well, just don't touch your butt." Cause apparently we feel that if you want to eat while trying to have a BM, then the chances of you doing something of this nature is within the realm of possibilities!

Follow-up to femur-boy

So as a follow up to the pain-medication-refusing-femur-fracture patient that wanted to leave AMA with their leg in two pieces.

He finally admitted to the fact that he did not see the vehicle hurdling at him point blank because he was (drum-roll please)... smoking meth while crossing the street.

Am I surprised?? Not really...

Now I know why he didn't want any pain medication.

A lesson on cleaning your gun

Here is a lesson for you... but a few things first:

1. I don't own a gun.
2. I've never shot a gun.
3. I've never cleaned a gun.
4. I AM A NURSE.

So here is 'Gun Cleaning 101'

1. If you own a gun, know how it works.
2. If you've shot a gun, you should know how amazingly powerful they are.
3. If you are going to clean a gun, you should know how to clean it properly.
4. MAKE SURE THERE ARE NO BULLETS IN THE GUN WHEN YOU CLEAN IT.

And probably more important than that...

If the gun doesn't fire properly when you pull the trigger, do not, I REPEAT DO NOT, look down the barrel of it to find the cause of the miss-fire. (This goes for pellet guns and BB guns too!) Actually... for that matter, NEVER look down the barrel of a gun... for any reason.

I know.

Roller-coaster

Sometimes I wish that doctors communicated with each other a little more when a patient is in the hospital... because generally the mess they leave in their wake is a nightmare for the nurses to clean up.

One doctor entered this patients room today and informed him of the 'good news'. The good news was that the "brain lesion" that was found on the initial CT done in the ED was not a tumor and was not a stroke. I agree that is good news.

The patient was elated with this news. The patient and their spouse were both in pleasant moods, the patient was smiling (for the first time since admission). Things were looking up for them. Can you blame them??

Then the next doctor enters the room. The patient was positive for lymphoma. So the patient just took a wild diagnosis rollercoaster. And now an emotional rollercoaster.

WTF do you do as the nurse now?? How can we compete with this?

Thanks, I know...

So speaking of patients going 'against medical advice' (AMA) it brings back a recent interaction I had with another loser patient.

When a patient decides that they no longer want our care (or our free food and warm bed) and the doctors have not medically cleared the patient from the hospital, the only option for the patient is to leave the hospital AMA. I am not a prison guard, if you want to leave I'm not going to stop you (unless you are psychologically unsafe to yourself or others). Chances are that if you are so unhappy that you want to leave the hospital you are probably going to make my life just as unhappy, or worse. So go... but let me tell you a few things. You don't have to listen... just look at me, and when I ask if you understand, just say yes.

So this loser patient was in the hospital for a few days making all our lives hell. Apparently we couldn't fix him up fast enough (after he got his face broken for being an a**hole while he was drunk) for him to get discharged. I know, I know... my miracle worker was off that week. So I entered the patients room to cover a few legal points of leaving AMA. First, I go over the risks of leaving AMA... which always includes "up to and including death." That rarely gets the patients to bat an eye. Second, I make sure the patient is aware of the fact that their medical insurance 'may OR may not' cover their hospitalization, I tell the patient that they may be held financially responsible for their entire hospitalization. Some patients decide to stay when they hear this... who doesn't know how expensive that can be!!

Well, the impatient loser that was ready to leave AMA heard this last part about the insurance and promptly told me... "I don't have insurance any ways, so it looks like you are going to have to pay for my hospitalization whether I stay or not."

Thanks, I know... my tax dollars at work. Now get...

Do you know what a femur is??

So the other night at work we admitted a trauma patient that was hit by a car. He was crossing the street against a light and got hit by a car traveling approximately 30 mph.

The patient looked like you would expect him to look. Blood, bruises, swollen facial features, dirt... the whole nine yards! The patient's main injury was a femur fracture. You know... the long bone in your thigh. It's connected to the hip bone and the knee bone (a la the children's song). The thing about this bone... it is an essential part of your skeleton and you need it to stand up under your own power.

This brainiac of a patient was ready to leave AMA (Against Medical Advice). This patient was trying his best to climb out of bed, he refused all pain medication (wtf?), and he was going to leave the hospital (for reasons unknown).

Besides being a complete moron, I was in awe at this patients ability to move as much as he did without pain medications (I have a good feeling he had his own brand of meds on board). His freakin' femur bone was in 2 pieces!!!

D-B-D

Douche-Bag Deluxe

Don't be one.

Honestly... I really hope that in the hospital that I work at that I'm not seeing a statistically fair cross-cut (or sampling if you prefer) of the society that I live in.

Because that would just be sad.