Ernesto

SO last night was my first night in the ICU. Had a decent night.... no good stories to tell. Had a day shift nurse come up to get report and said "Who the hell are you?" Excuse me old man?? Don't talk to me like that. I gave some 'tude back and he backed off.


So we are settling in for a long couple of hours here. Mi amigo Ernesto will be here shortly so I've got my water and the essentials (cold beer, leftovers and a charged cell phone) The cop is far far away from all the flood warnings and will be back once the badness is over. I don't get the chance to call in.....we have to be there regardless. Glad the jeep has big 'ole tires!

Will let you know how we do!

Story

I want to share a story that I heard from my friend K last night. Last Thursday I didn't go to work... and she had to pick up the trauma room in my absence. At around 4am they got one of the top 3 calls that trauma centers don't want... Kid Trauma. (TOP 3: staff member, cops/fire/ems, kids) Its not that we aren't trained to handle it, but it always completely sucks.

Mom was driving along in the county somewhere, drunk as shit. Looses control, goes off the road into a tree. The car is pretty deep in the woods so no passing motorist could see her. She calls 911 because she wrecked her car and her ankle hurts. Fire can't find her, so she ends up walking to a house and they pick her up there. Nobody really knows what time the accident happened because she keeps saying it was 11 o'clock when she was on the road. Let me say that the bitch has yet to mention that her 2 year old was in the car as well!!!

Based on where she walked, the fire department found her car in the woods. The two year old was strapped (lapbelt only) in the front seat. The front passenger side is what impacted the tree. She was unconscious, posturing(thats BAD) with deformities to both legs, obvious (multiple) skull fractures and on ct scan she had multile head bleeds that hae progressed down the brain stem. (aka she is now brain dead)

Mom STILL did not remember that she was in the car.

We deal with these situations all the time. People have asked "Oh my god, how do you do it?" Some nights, I don't even know... you just do. The training kicks in and there are 15+ people giving everything they have to save a child who (for all intents and purposes) is already dead. Thats one of the reasons that I love working in a teaching hospital. The med students don't get to do much with trauma (esp kid trauma) but they are there. They are witness to all that we do and they might not remember names, or faces or even whatthe outcome is.... but something will stuck with them. They will see this again and something about this poor child will still be there and they will take better care of the next one because of that.

When we see things like that... this is how I get through.

Moving on...

My last full time night in the ED was last Wednesday. I wriggled my way out of Thursday night... they had staff and I just wasn't feeling like being there. Have been off since then. The educator from the ICU called me on Friday to remind me that my first day will be Wednesday, not Monday. So have been off for 4 days now with nothing at all to do. The cop and I did the grocery shopping/running around town thing on Friday....after we locked ourselves out of the house. Now I LOVE heights, and would have been perfectly happy to climb in the second story window (it was unlocked). There was something pretty damn funny about watching the cop do that.

So he is off to the mountains for the week for some regional gang investigations school. He's actually staying up where my old college is. So I get the house to myself all week. The plan was to clean up these first few days off but have been feeling to BLAAHHHH to do that.

The image above is of an intracranial bleed..... welcome to my new world. I know its not going to be the same as the ED. But its s hoop that must be jumped if I want to be a flight nurse. I'm lucky I got into the best ICU in the hospital. All of my interactions with the staff has been so positive and they all seem very happy with things on the unit. NOT something I could say about the ED. I will still be down there at least 12 hours a week to get my fill of trauma, drama, punks and drunks.

I do have some good news though.... have made a concrete decision about the wedding and booked airfare. Actually, was looking online (as I always do) and found flights to one of the places I was looking for half of what I expected to pay. I had my wedding savings available and booked it. So the decision is made. On the beach in the Keys next spring. At that price my mom may even be able to go.

out with a bang

So I have 2 more nights in the ED as a full time employee. I start in the neuro ICU next Monday. I never really thought about "counting down" until tonight. My friend K brought a Jimmy Buffett theme cake and most of the dept was able to come in a grab some. I was in green and had my ass handed to me. Second night in a row that we didn't get a chance to eat. I ended up with 2 GOMER's (Get Out Of My Emergency Room) who were both old, sick and smelly. These are what we call "total care" patients. They don't do a think unless I do it for them. That gets old. I also had a cardiac ICU patient and a hispanic male (no english) with rocky mountain spotted fever. Loooonnngg night.

As I was getting ready to go one of my buddies came up tp grab me. He was in the trauma room and there was a sick as shitter coming. He has never had a patient get their chest cracked. (google Thorocotomy) This was a girl who coded at an outside hospital, was brought back with emergency drugs and then flown to us. She coded on the flight crew and they were doing CPR when they arrived. She had a right sided injury so the regular thorocotomy wasn't going to work on her. We did a clamshell... which opens from left to right and the sternum is cut from right to left instead of up and down. It allows more visibility of the heart. We gave her all of our emergency blood and used the internal paddles.


The shitty part was that is was Dr Rock who was running this show. UGH. He was the one who crossclamped the aorta. It figures that as we went to go upstairs the clamp came off. What a dildo. He bugs the crap outta me. So she went to the or and is more than likely dead. The success of emergency department thorocotomy is less that one half of 1%. So I left an hour late and played the cops angry rap music the whole way home. It takes a while to unwind from these.

The upside to all of this.... I had a new nurse with me and she got to see it all. Her eyes were HUGE! I hope she enjoyed watching as much as I have loved doing these over the years. I'm going to miss that. I'll be back, I know that..... but this was one hell of a way to finish things up!

Can you shit in a second?

This was the question posed to me by a psychotic middle aged woman the other night. She was tied down after chasing one of the techs with a shoe and wanted to walk to the bathroom. No was in hell was I going to untie this bitch. I told her that she could use the bedpan and it would only take a second. Thats when she screamed "can you shit in a second?" The rest of the patients laughed loudly, and I tried to keep a straight face.

I don't know why I attract this kind of psych patient, but they seem to gravitate to me. It didn't help that I was STILL tired and not sleeping more that 4 hours at a time. I walked in with my bullshit-o-meter already in the red and was not in the mood to deal with people. There is a nurse that we are all soooo very tired of. She weighs almost 400lbs, speaks with a New Jersey accent and has poor grammar. However, she isn't dumb, she has her masters and is a NP (nurse practitioner). She practices as a staff nurse, but none of us know why. The er is fast-paced and almost always busy and she just doesn't keep up. It gets so frustrating to have to pick up her slack. I have never seen her take care of a sick as shit patient, she doesn't do CPR and I have never seen her help move a patient off of a stretcher. (essentially any of the physically demanding parts of this job) I talked to K about all this at the pool today and she agrees. This gal can't do the freaking work.... not sure what we can do about it though.

Off for the weekend for a change, however the cop is working. Our schedule is ass backwards for the next week and a half. I hate that. We always seem to pick at each other when we are on reverse schedules.

Don't have too many good stories to share.... maybe its the chlorine but I need a nap.

Four Hours

For the second day in a row I can't freaking sleep. I have gone to bed exhausted the past two nights and awoken 4 hours later wide slam awake. Unfortunately, that lasts until about the time that I'm supposed to be getting in the shower and then I am zonked again. Is this fate playing a cruel joke?? I'm tempted to call out but we get so much BS from the CC'a that its hardly worth it.

Charge

I've been in the ER for almost 5 years. Its pretty standard for nurses to train in the trauma room after 6 months to a year and then charge and triage at about a year and a half to two years. As a new grad I had a little bit steeper climb. I started the trauma room at about a year and had to do a long ass orientation (because I'm a "new grad). About a year and a half ago I asked about charge and triage... the trauma room gets wearing every night. I was told that I wasn't ready... "you're a new grad". Ummmm.... yeah, about 3 years ago (at the time).

Thats one of the reasons I decided to go up to the ICU. I felt like I wasn't being taken seriously in the ER. So last night I started out in the trauma room, not bad same old same old. The CC walked in at 2200 and said "Kiddo, you're in charge at 2300." What the fuck?!?!?!

Everyone else has had to do several days of supervised orientation. I was BAM, dropped in. Let me tell you, thats some work. I had a great group of nurses thank GOD, and we were all working out asses off. There were several that were sick as shit and one that was trying to code on us. Another had a seizure (defined by the family as "foaming at the mouth and messin' with herself') and then had it coming out of both ends. She never did wake up all the way. But she did a hell of a job of counting from 1-18 over and over and over.... "14" was her favorite, she said that a lot!

Had a drunk, high loser who came in with the po-lice with a towel and hand over his mouth. "He spits like a water fountain" EWWWWWWW! There were a couple of GSW's in the trauma room....one ended up biting the big one. No surprise, he looked BAD when he got here.

Oh, and my favorite asshole of the night. Frequent flyer.... had chronic dry skin and vericose veins. Will pick at the skin over the veins until they bleed and don't stop. He's nasty nasty nasty and mean as hell. He was going to leave AMA until he found out that we wouldn't give him a cab ride.

UGH.... this charge stuff sucks! Went out with the nurses and docs this morning.... I think we needed it. Back tonight.... hope I'm not in charge.

Random

Have been off for a week now. Never get used to being off... sleep/wake schedule is still WAY off. So I woke up at midnight tonight wondering where the hell I was!

Memories are great, but some of these stories are priceless....

Teenager with crack up his ass, refused to give it up at lockup. The doc put KY on a speculum (think Ob/Gyn exam) shoved that bad boy up his butt and cranked it open. Pulled the crack out with a pair of forceps.

Me as a new grad, patient my age, 3am, chief complaint "I wack off too much."

Me (again as a new grad... that was a long year) delivering a baby in the front seat of a Bronco in the ER drive.

Starting CPR on a nursing home patient only to find out that the family had made him a DNR years ago. The nursing home hadn't recorded it correctly.

Hearing the chaplain curse for the first time. (the resident told the family dad was alive, when he was really dead on the side of the road)

Going to the roof when the eye of a hurricaine passed over.

Christmas Eve my second year there doing a blood draw for an older man in a tux and a cute officer. (first time the cop and I met)

Coding a frequent flyer and having the whole ER come watch just to see "if its really her"

Being chased by a psych patient

Taking 30-grand and a loaded .22 off of a 75 year old granny with dementia

Taking care of a dying co-worker (also as a new grad)

Changing scrubs in the trauma room. (covered in blood, too busy to go change...hey I was behind a curtain)

DC

Finally back home. Much more relaxed now. Didn't tailgate the way we had planned in the parking lot. Mom got lost (no big surprise) and showed up at 630. Otherwise it was just too damn hot to drink anything other that the water and gatorade. We ended up with a cooler full of half melted jello shooters and a bunch of beer.

The concert itself was pretty good. A Buffet concert is always fun.... but the lawn is getting to be a little too rough for me. Being run into by drunks, avoiding having beer spilled on me and having to explain to my little sister that the "itchy smell" in her nose is the pot the guy behind us is smoking..not that fun. The high point was a couple of drunks fighting over a folding chair.....they were knocking people down like a bowling ball. V, my littlest sister, loves to do 'Fins' and does so with gusto.... its one of the only songs she knows all the words to.

The cop is pushing the "lets go to the shows in Vegas in October and we can get married while we are out there" not sure how I feel about the Vegas thing. Will have to think about it. I guess I still have the beach thing stuck in my mind.

So we spent a few days in DC after the concert doing the tourist thing. The cop has only been there once before. We saw the National Law Enforcement Memorial, which brought tears to my eyes. The cop has a friend on the wall... and I have taken care of several of them in the trauma room. It is a truly humbling site. I was pretty pissed at the "underprivileged kids group" using the memorial to play tag and climbing all over it.

So we did the museum thing, saw Lance's bike, the flag from the Pentagon and the Star Spangled Banner, the Hope diamond and the Capitol. Let me just say, tourists are assholes. I had families pushing past me to see things and the lines were insane. The cop managed to get into all of the museums with his gun.... every single security office asked "are you armed?" when he stopped and showed his badge and ID. Ummm... if he wasn't why the hell would he stop moron????

We were at the American History Museum and I overheard a child say "Mom, who is Mister Rogers?" God I feel old.

So saw everything we could stomach, but not even close to everything we wanted to see. I think we're going to go back when school is in and its a little cooler. I think the best part of the DC trip was standing in front of the White House watching the hundreds of tourists fighting for space to take pictures. We heard a loud CLICK and then the sprinklers deployed and sprayed all of them!!!

So home again.... off for a couple more days. I might try to put some pictured from the trip on here, but am hopelessly bad at computer stuff. Thats why I don't have links to other blogs or any of that cool stuff here.... I have NO CLUE how to work it. The cop has a degree in computer something or another.... maybe he can figure it out!

I Suck

Apparently, the medics are pissed that I'm not going to be in the department after the end of the month (full time anyway). I have been told that I suck from each and every one. Oh well.. they all understand why.

Last night we had some sick sick peeps. House fire burned a lady up. 3rd degree on 75% of her body. Burns are nasty and the scent lingers forever. You always know when we've had a big burn. There was a GSW that they cracked.... he died. I had a young kid (20) hit a tree and give himself a bleed, skull fx, aortic injury, liver and spleen fractures, kidney lac and femur fracture. He had so much blood in his belly they don't know if he is going to live.

Gonna take a nap and pack up for Buffett. We're going up tonight and playing in DC for a few days after the concert. Am pissed at the fam-damily right now though. I got the tickets, bought all kinds of fun stuff to eat/drink, have decorations etc.... the sister won't chip the $$$$ in, and mom has the only dogsitter that Maddux won't bite (other than my family) coming to her house to take care of her two dogs. Unfortunately, she doesn't want Maddux to be there too... not sure why though. So am desperately trying to find a solution here.

After all of the things that I try to do to help my family I'm starting to feel like they are taking and giving nothing in return. Don't want to ruin the trip, but (as the cop said) I'm about to say 'you guys figure it out your damn self' and just going about my time at the concert. GRRRRR..... I'm going to sleep and hope things work themselves out as I snooze.

Cranky

So I got NO sleep yesterday. I woke to the alarm at 1730 saying "what the fuck?!?!?!" Staggered out of bed, into the shower and dressed with no real issues other than my foul mood. The cop picked up on it right away and was able to stay on the good side. Before he dropped me off at the ER he said he hoped I didn't kill anyone tonight.... not a comment on my nursing care. He was worried I would pummel someone with a chair. Trust me, I would have if given the opportunity. Fortunately, all of my patients were very nice and easy to take care of. I didn't kill a single one!

There was a family that we were all gunning for though. We see all kinds of nationalities around here. Last night one of the nurses had an EXTREMELY large Muslim man with his 2 wives come in C/O being 'Lethargic.' I have seldom seen a family treat the staff so badly. They were both rude and demanding... and irrational to boot. This guy needed a special bed for his big ass, and had MRSA in his butt wound so he had to go to a private room... but had to be on stepdown which is right below ICU level care. Those beds are hard to come by. So we got him a big boy bed, got his as comfy as we could and settled in to wait.

The older wife stated loud and clear that the reason we weren't giving him a bed was that they were black and Muslim and she would have us all fired for discrimination. I found out later that a child (about 7) was with his mom in the waiting room and saw these two women. They were both covered from head to toe with just eyes visible.... so the kid was staring. I bet he had never seen that before. This woman preceded to approach this kid, get in his face and swear at the child in front of the entire waiting room.

Ok, I am all for freedom of religion and civil rights. We take care of ALL people in my department... without exception. So while you play the discrimination card on us I will play my 'Freedom To Kick Your Ass' card.