Another Day...and back to work

My last day at work (Sunday night) wasn't too bad. Got relieved by a nurse from a sister hospital that had traveled from Arizona as a volunteer to do some relief work. The valley unsually has slow summer season. We don't have extra workers in the summer, but always have travel nurses to help in the winter when we are busy...winter Texans and all. Well since the big OTHER hospital had so many window's blown out...they have almost a whole floor (over 21 rooms) that are out of commission, and they have been on diversion for two weeks now, we have been getting all the overflow. I am not complaining, since that means I'm not getting cancelled and not having to use over-time to tide me over so my pay is level. It just seems like the patient's we've been getting have been really really sick...and "heavy". My "new" nurse was complaining (again) that her patient load was too heavy and I actually should have gotten that assignment...since I was more experienced than her (whine whine whine) I offered to exchange...give her my one day Post-CABG with 3 chest tubes and a PCA, my two day Post-amputee with a PCA, my patient getting two units of blood that night (on my shift), my Confused patient (with no sitter) and my new hemodialysis patient who had a severely low BP.....well after about two heartbeats of thinking about it she realized she actually had gotten the lighter patient load.....very stable patient's with one patient a DNR....what was she really complaining about???? She just has a lot of insecurity and doesn't trust her own judgement. If she would just start relaxing...she knows what she is suppose to do...but she stresses herself and everybody around her because she just has no confidence....too bad it doesn't come in a tonic...I'd give it to her.

Dolly: The aftermath!

Well for us, the damage was moderate...mostly roof. Others' not so lucky. The storm drains overflowed in town and peoples homes have 3-4 feet of water in them. Other places have better drainage than here. Here, there is a levy system for the Rio Grande, but most places have built up small earthen levies around the outsides of their property to hold water in...because it is so dry, when you water you don't want it to run out and into the ditches, well this system has worked against us with the torrent of rain. Water stood in yards for days...allowing the mosquitos to breed and hatch. Hords of mosquitoes..black...clouds of mosquitoes, immune it seems to every spray known to man. Hundreds at the door waiting for a meal to come out. Hundreds swarm into the vehicle when the door opens. Hundreds swarm onto you when you get out. "Off" is our friend...which is only a deterrant!

The adjuster is here...still measuring and computing damage...and we..we were lucky. We didn't lose any food due to being able to use a generator most of the time (and planning, I filled every empty space with water bottles full of frozen water (solid water stays frozen longer than crushed ice) and had 40 pounds of bagged ice in the freezer to keep it cold! The roof and underpinning are our main concerns. The roof...before it rains again...needs to be totally replaced, and the underpinning needs back on to decrease our energy consumption and allow the house to be really cool again. But, we know angels were watching over us. It could have been much worse.

Goodbye Dolly

Thanks to all who were concerned with our well-being during the recent storm. I would like to comment back, but having difficulty with the internet, as well as the satellite since the storm. Today (31/2 days post-dolly) is the 1st day with power. 5pm, and the power came back on....ice...wow! You don't know what you have until it is gone. When you are sitting in Cat II hurricane with the wind blowing the rain sideways at 100 mph, you realize how little and insignificant you are. Walls shaking, wind screaming, you feel so fragile. Human beings are only flesh and blood, and easily injured. I was terrified...almost psycotically so...I've always been afraid of storms. I've survived tornadoes and thunderstorms...but this was something else. Shingles flying, windows flexing...self flushing tolits (something to do with the atmospheric pressure outside being lower than inside or something technical like that...plain weird if you ask me.)

My hospital...being so kind and caring...sent the surgery coordinator out into the hurricane (6 hours after a very slow-moving landfall) to fetch me for work .... so out into the hurricane I wade...with knee boots, and the water was only two inches below the top of the boots. Then I had the scariest , white knuckled ride of my life, creeping along at about 10-15 mph with water up to the doors, trees in the road, power lines down, driving in the ditches...got to the resoaca (small lake) and there was road construction...and the barrels had all washed away, and you couldn't tell which part was the road and which part was going into the water....Got to work...no power except emergency generator. No air-conditioning...just a few box fans...floors sweating (you know how they wax them) within 5 minutes I was soaked to the skin with sweat...not a very pleasant feeling. The first patient began immediately cursing ME because it was HOT and I should FIX it. I sweetly pointed out we were in the middle of a hurricane...and was promptly informed a little wind was nothing...and I was to fetch coffee...of course we didn't have any coffee...because a coffee pot is not considered emergency equipment and does not rate a RED EMERGENCY plug...so there was no coffee. I was then informed by this patient that I was to get my ASS out of his room and GO TO THE CIRCLE K and get him some DAMNED COFFEE!!!!! Hummmmmmmmmmm....and just how was I suppose to accomplish that...on foot...in a hurricane...with objects flying around in the air?????? I made him some instant coffee with hot tap water from my stash in my locker...which he REFUSED to drink after I went to all the trouble. Later a corrections officer who was having to sit with an inmate asked for coffee and I offered him the same thing...and he and his partner were very grateful...and very appreciative. At least somebody thought I was doing something right!. We lost part of the roof on the 4th floor and patients had to be moved to third and second....so we had a mix of med/surg and telemetry/PCCU patients. I kept moving fans around trying to keep my patients as comfortable as possible...but it was really really really miserable.

Today...I have power. The air-c0nditioner is cranking and the humidity is coming down in the house. Life is good.

Well Hello "Dolly"

Looks like we may be in for a hurricane folks. Here the nurses are already getting antsy...reviewing hurricane prepardness charts...logging onto the weather net every hour or so...and the storm hasn't even cleared Cancun yet! Why do you thing we are so anxious. One word "Katrina"! Nurses got racked over the coals for making decisions in crisis situations. Everybody else can flee before the storm, but nurses are required to stay, and report to work. To hell with your family, to hell with your home, to hell with your safety. Even if a mandatory evacuation is called by the mayor, you still must report to your job and be prepared to work without leaving or lose your job. A hospital in Browsville fired a nurse who didn't report for work during a hurricane...came to find out she didn't report because she was killed on the highway trying to get to work ... now that is just wrong! Anyway, when "Rita" was coming in I worked at a LARGE hospital in a South Texas City, and the power's that be decided not NOT evacuate during the mandatory evacuation because the new building was rated for a "hurricane 3". My comment "Yeah, I believe that, remember the building was built by the people who forgot to caulk the window's and it rained inside the first time the wind blew"! Sure, and I really didn't like being their when the wind was whipping up to gusts of 60....it was scary as hell. Add to that the weather channel with hourly Tropical Updates...and the anxiety level is astronomical! So this time, guess I will risk my life in my trailer, because if I evacuate to safety I cannot report to work...and will be fired...then again...if the hospital blows away.....

Anyhow, anticipating being called in if they decide to evacuate to help with patient's. Good think census is low. Hey, maybe they'll send me to San Antonio and I can hang with my brother and nieces!

TGIF!!!!

Last night should have been the easy..breezy, nice and easy. Three patient's and one of those a "medical", non-tele, DNR, no family, NPO, on his way back to the nursing home. Humm...do you think that caring MD...after 4 days NPO and positive for the BIG STOKE...in that...we are surprised he is even alive...will think to drop an NGT and give some nutrient's...or TPN...OR SCHEDULE A FREAKING PEG! Probably not. Poor little guy. Made me think of my Grandpa's last few weeks. Well last night...he got turned every two hours like clockwork...I personally changed him if I couldn't find the aide, I used my stash of baby-powder when we bathed him, I did oral care every time I went into the room...I pretended he was family and that somebody did care. By the end of shift, he wasn't totally comatose anymore...he was saying "water" in Spanish and a little eye opening was happening. His quality of life may not be much...but for the 12 hours I had him it was tolerable (as my grandma used to say).

Had one patient that was on the button all night...knew he was going to be the proverbal pain in the ass when every request was prefaced by "I hate to bother you", "I know you are busy" and "If you can make the time". Yes he was post-op day one, yes he had chest tubes and incisions...but why the hell do I have to fix a "crooked" foot rest (to look at it bothers me", "pull me up exactly 1 inch and I will be comfortable" (no lie..his exact request), 03 am...I want to walk...04 am...I can't sleep and nothings on t.v., 0430 I was sleeping and lab woke me up to stick me, 05 am the ace wrap is too tight. 0530 am the dressing near my neck is bothering me. 06 don't forget my pain med. 0630 Oh, now you're waking me up to take off my dressings (which is what I told him had to be done this morning...last night)...and you are insisting I get back into the chair (you slave driver bitch nurse).

Kodak moment: Unhappy patient, MD throughly pleased that patient is in chair, dressings removed, and he had a "good night"!

TGIF!!!!!!! oH, and what about that 6 am full admit I did....Damn...I rock!

"Brain Damaged"

Yesterday, before I got off shift, I got a late admit, you know...the kind where you really have to rush to get everything done. He came at almost 5 am. I still had a bed-bath to help with (aide is 8 months pregnant and the patient bedbound and way over 200 lbs and needed to be weighted in the sling scale). So, I get this patient who supposedly has practically no history of anything...just hypertension, high cholesterol, non-compliant on meds with vague chest pain, ambulatory, cardiac enzymes neg, everything pointing to a quick admission history and assessment, right? WRONG!

I step in the room and the patient is sitting in the chair, jeans on under the gown, muddy shoes on and the guy is literally shaking....so hard his arms are jerking and I think he must have Parkinson's or something. "Sir, are you cold, would you like to lie on the bed and cover up". "Hell no, I'm not cold, I'm scared!" "Well sir why are you scared? Have you ever been in a hospital before?" I ask, trying to assess the reason for his fear. Eyes darting around the patient yells "You Nurses Killed My Daddy, You gave him too much Medicine and you Killed Him Dead!" .....blink...blink...ok, now I know why the ER was in such a rush to get this guy upstairs...why didn't they give me a heads up??? I keep my voice soft and calm and assure the patient that I won't be giving him any medications unless he begins experiencing chest pain again because the only thing ordered from ER was aspirin which he had alread gotten, and nitro...which he would get if he was having chest pain.
Ok, now he is ready to get in the bed. I relieve him of the muddy shoes (wish I had a broom for the floor) and I put his monitor on him, explaining everything as I go...He informs me that his blood pressure is fine and that he quit taking his blood pressure medicine 2 years ago because he didn't need it anymore...his pressure is just fine. I ask him how often he checks his blood pressure....blank look, blink...blink...blink..."well I don't check it, I don't need too...it's just fine." Yup...and that's why it's called the silent killer. I explain the new BP guidelines 120's over 60's yada yada yada. The guy asks me to call his wife and give her the room number, which I do. Now he's calm enough I can start taking his history. I have one eye on the clock...it's almost 6 and I still need to bath the bedbound patient.

"Sir, other than Hypertension and high cholesterol, do you have any other medical conditions that might affect your care?"

"Well........." he drawled..........."I was born Brain Damaged." (ok, now the corners of my mouth were twiching). "You were?" I ask. ""Yup" he says. Well now I'm looking for a clue that this guy is pulling my leg....he looks normal (except for the shaking). He doesn't act like he has anything wrong with him. "My wife was born brain damaged too, that's how we met". (WHAT???) "She died two years ago." He states. Hummmmmmm maybe I'm confused...I just talked to his Wife on the phone. "Your 1st wife died two years ago?" I ask for clarification (as you can tell this history is going to take the rest of shift to complete). "nope, didn't you just talk to her on the phone? They did CPR". Hummmmmm ok, now moving on..............................

Well 1 hour later....yes I agree...the may is definately brain damaged and a little scary as compared to scared.

Wow was I glad to go home. Yes Big guy did get bathed and weighed but...it was a hurry up rush rush deal. I didn't go home until 9:30...gotta love 14 hour shifts....but today...Vacation. :)

What's Wrong??? WEll doc...he ain't breathing!

Friday, had a code, 2 minutes into taking report. Knew nothing about the patient as yet, just the aides were putting him back in the bed from the chair and she runs out "I think he is having a stroke!" We go in there and like "call a code, get the cart...stroke hell...he ain't breathing"! The nurse I was getting report from was a Winter Worker floated from another floor, so I knew she didn't know where stuff was, I fly outta the room like a bat outta hell and get the crash cart...forgot to unplug it *grin* so the cord just popped outta the wall, I yell at the aides to get the Jerry chair outta the way (no way crash cart, doc's, nurses can all fit with it in the way). They do and I run the cart in shove the board under the dude and start compressions...the float nurse had already checked and he was PEA, they hook up the leads around my hands...and the ER doc arrives. By this time, the float nurse is outta the room in the hallway pretending to be a bystander...and I don't even know this guy! The doc looks and me and asks "Well what's wrong with this guy?"...I'm like...."AAAAA....he's not breathing?!" Did I sound like a dumb-ass or what??? He just gave me the evil eye and asked again...I'm like...well there's the day nurse...I haven't got report yet...but He's got Dobutamine running...so he ain't good!" Sad to say after 45 minutes of good CPR he didn't make it. And the Float nurse....well she was pissed that report was late and she was late going home. I did all the code paperwork, death stuff, called the tissue bank, comforted the family, called the funeral home and did post-mortem care after she left...but SHE was pissed.

Me...I was just sad. Oh and the rest of my patient's didn't get their meds until 11 p.m., and the rest of the night was not much better. By the end of the shift my co-workers were calling me Ninja Nurse...because I was kicking ass to get done!