Super Nurse!

My last few nights in the ER have been interesting. I have started out with a crazy 4-ring sick as shit circus and then settled down to nothing as the 3am hour approaches. The difference has been that I have had ACTUAL sick people, not just people who want to be sick.



Wednesday I walked in to a 53 year old terminal cancer (mets everywhere) patient who had gone to his hospice appointment that morning then went down in respiratory arrest that afternoon. He didn't have a DNR yet so the squad hit him with the full court press. He was tubed, with a pressure of 80 when I showed up. I also had a 63 year old acute renal failure patient with cancer everywhere (notice a trend?) who came in for leg swelling. She was tachy, hypotensive (80's again.... they took turns being the lowest in the dept) and had a K that started at 6.5 and INCREASED after the kayex, D50 etc to 8.9. She refused dialysis before being taken to the ICU. Not gonna be good! My other two patients were a 40-something HIV, MRSA ESRD patient with a pneumonia who was trying to get septic and a 20ish female with non-cardiac chest pain. She got an attitude when I didn't spend enough time in her room. All she wanted was narcotics. Once I got those 4 patients all out (about 6 hours later) life got easy and the rest of the night was cake!



Thursday night started the same. Drug-seeker with the typical manipulative behavior after a MRSA infected spider bite. Sickle cell patient who wanted me in her room. Alcoholic with a hgb of 5.2 and a 91 year old passenger from a slow speed mvc. Her 84 year old husband with a prosthetic leg ("a gift from the Germans") was driving her from her women's meeting and lost control of the car. She was having some chest pain from the airbag being deployed. I had a bad feeling from the start..... her EKG was fucked up... but the doc's wouldn't get in there. When her heart rate dropped to 30's they finally paid attention.



She stayed very stable considering she had a new, trauma related right bundle branch block. We floated transvenous pacer wires at the bedside before she went upstairs. I love little old people (90's) they are hysterical. This one was sharp as a tack. When I told her that her heart rate was slow, her response "well so am I." She met her husband at Walter Reed Army Hospital during WWII. She was in charge of entertainment for the troops. She met all of the 40's movies stars (Will Rodgers was her favorite), knew Gen and Mamie Eisenhower well, and was friends with the socialite who owned the Hope Diamond. She has actually worn the thing!!! She and I hit it off from the moment we met and as sick as she was, we enjoyed just talking.



As her pacer wires were going in, my alcoholic started getting blood.... it was a hell of a start. Later that night we had a police pursuit that ended up in a pretty bad accident. The bad guy and his girlfriend were driving like maniacs and then didn't stop because he had a suspended license and didn't want to go to jail. The two shitheads showed up first. He was pretty much fine, she had two broken arms and kept screaming. I leaned down to her ear and did the best impression of my mom when she was pissed off. Pretty much the evil whisper that told her she wasn't the sickest person in there, she needed to grow up and shut the hell up. It took 45 minutes to cut the officer out of the car. They had the road from the crash scene to the hospital completely shut down for the ambulance. Poor guy will survive, but is sick as shit. Other than the multiple ortho injuries, his CT looked like this.....

Not his actual CT, but close. The heart is in the center, the right lung is on the left (CT's are reversed) and that area on the pt's left (our right) is stomach. No, there is NOT supposed to me stomach in the chest cavity. Poor guy ruptured his diaphragm. The internal pressure to the abdomen causes the weaker side of the diaphragm (the left, due to the heart) to blow out. Its a bad injury.... but being that he was young, he should be ok.

I've gotten calls for 3 flight shifts in the past 24 hours. Too bad I can only do one of them. I did pick up another one New Year's Eve in Md. The cop has to work, so a little double time for 24 hours with a free hotel room won't hurt!!!

TA-DA!!!

I was planning on blogging about my most recent foray on horseback, but was looking through pictures this morning and came across my favorite (flight) picture. I swore that I would not post photos of myself, but figured what the hell. This will be the one and only appearance of 'The Penguin and the Squirrel' live at 1200 ft!

ATLS

This weekend was ATLS. (Advanced Trauma Life Support) I got in through the helicopter and wasn't about to give it up because I'm not flying full time. Most nurses take the ATCN (Advanced Trauma Course for Nurses) its the middle school version of advanced trauma care. I took it about 4 years ago. To get into the ATLS class you have to be cleared through the American College of Surgeons and even then you just get to audit it. It is strictly a MD class. I learned a LOT..... and the great part was that it was taught by surgery docs (attendings and residents) that I know well and have a lot of respect for. There's something about being taught chest tubes, DPL's, pericardio's and cric's by a trauma surgery attending that I truly look up to (and even better that she knows me by name!).

What was scary was the of the MDs that have to either take or re-cert.... some are surgeons (trauma, vascular, general), some are emergency medicine and some have to take it as a part of being a medical director for rescue squads. There was a family practice doc who is from way out in the boonies who had to take the class. He was in my skills group.... scary!!! Poor guy is so far removed from this environment that the primary assessment, ABCDE was lost on him.

Otherwise I have been working like a slave.. this is 7 in a row. I have not heard back from Cardiac Surgery ICU yet, but the Surgery Trauma ICU is more than willing to let me do overtime there, especially after getting a 90 on the ATLS final.

The ER has been crazy as usual. Lurch is back around, making me crazy as usual. Every time we get a sick patient he walks in and takes over. Not sure what the best response other than "get the fuck out" is, but I'm getting close. He has been given the clinical coordinator position in neuroICU so you can bet your ass I won't be going back there! I am still trying to find a full time flight job, but no real availabilities right now. Its hard to hear an inbound aircraft and not get a little sad.

This is one of my favorite quotes... I think it sums up my thoughts on flying.

When once you have tasted flight, you will forever walk the earth with your eyes turned skyward, for there you have been, and there you will always long to return. - Henry Van Dyke

Bug vs Windshield

The phrase is out there.....some days you're the bug, some days the windshield. I have been picking up an insane amount of hours at the hospital and waiting for a full-time offer to come in. I also found that while I am no longer flying full-time, I am the part-time, fill-in-the-gap RN go-to girl. Every overtime or hole (nurse wise) must come to me first and I get first right of refusal. So things are better. We will still have to see what happens. Have some great ER stories, but have to go to work (welcome to my new existence!). Maybe I'll get some sleep tomorrow!

Sad Day

Friends... I am sorry to say that effective Monday both my base and the next closest were shut down. We were given no notice and very few options. I am staying on a strict part time basis, which means no benefits and I will fly 1) when a shift is open 2) if I can sign up for it before the other 4 or 5 peeps in my same position. Its been a dark dark week.

I have been in touch with my nurse manager in neuro (even though I REALLY REALLY don't wanna go back there) and the manager in the ER. Both said they would hire me back. I also applied for an open flight nurse job at our competitor, but there are other out of work flight nurses doing the same, so we will see what happens.

I have never actually been laid off before. I got fired from a job at a hot dog place in college. You are apparently NOT supposed to tell the customers that everything was fried in LARD! (hehe) I've taken it pretty hard, obviously and it hasn't helped that I have to come up to the library to blog, research and try to figure out what to do next! I will try to continue to keep posting as things progress..... the ER has been kind enough to throw every shift they have at me, so while I won't be making what I did at least I'll have an income.

I have faith that I will get through this.... in the meantime I'll put on some Buffett, drink a little Marker's Mark and remember what a kick ass job I had!