Death is not always...so neat...

As a nurse, I get very used to seeing death. Death is mostly expected...somebody has been sick a long time, or has a very bad diagnosis. We are not surprised at the outcome, the body wears out, life has taken it's toll, cigarettes....drinking...bad decisions, sometimes cancer and things just totally out of our control. Death is always sad, even when it is the expected outcome. We do post-mortem care...remove IV's, foley's, lines, tubes, and clean and wash the remains, it a very quiet and respectful, meaningful task. It is an honor to perform this necessary task, so the families last view of their loved one at the hospital is in as natural a state as we can achieve.

When death is unexpected...things are not quiet so neat. In the hospital there will be the wreck of the room...tubes, lines, gauze, syringes...you name it, strewn all about the room. The Resuscitation team will work with a frenzy to try to bring the patient back if their code.

This weekend, I got a taste of a different kind of death, the kind that the First Responders and EMT's see on a daily basis. I gotta say, I am glad there are people cut out for that kind of work, because I can tell you I'm NOT one of them.

We were on our way to the beach. The weather was fairly nice, 83 degree's, but it had started misting. We had our cruise control set...after all...we had a vehicle full with my niece, her fiance, her two kids and my grand-daughter...in addition to me and Dave. A jacked-up Ford club-cab passed us just flying. We caught up to him when he got behind a slower vehicle...which he promptly passed. Dave and I agreed that the dude was an accident waiting to happen, as he was passing without adequate space. We remarked to each other that if he didn't wreck, he was gonna cause somebody else to wreck. Unfortunately we were right. He went to pass another vehicle...had to jerk back into his lane, but his truck started rolling. It rolled twice across the opposite lane of traffic, and then hit the ditch and the palm trees. The driver wasn't wearing his seat belt and was ejected out of the driver-side window. He apparently was dead before leaving the truck, since there wasn't much blood....I should know, since I was the first on the scene and was the one who covered him with a bright beach towel. His cousins were with him, and Thank God, wearing seat-belts. The male had already bailed out the broken window, in shock, and told me "don't look at him, he's dead!" I told him I was a nurse and I had to look at him to see if there was anything I could do. It only took one look to see there was nothing I could do for him. He was lying on his stomach, but his head was facing me (in retrospect I realized his neck was totally broken). CPR was not an option as he no longer had a mouth, or even one whole side of his head. The man probably weighed close to 200 lb, but it looked like every bone was broken...like a child's toy...tossed into the ditch. Later, when I was assisting with the woman inside the truck, I found his left mandible lying in front of the truck on the ground...totally bloodless, fleshless, and very clean looking., and probably one of the most horrible things I could have found.

The female passenger was in shock, I had her unlock her door so I could check her out, but instead of staying in the vehicle, she of course bailed out as soon as the door was open (not that I blame her!). I gave her a beach towel to use as a blanket and sat her on the ground. EMS still hadn't arrived and neither had the police...we were out in the middle of no-where's-ville. I asked if they had been drinking...and she said no...and I believed her ...there was no odor of alcohol, or other indication that alcohol was involved. I had given the male passenger a beach towel for a blanket also...but had abandoned him to treat the female because his adrenaline level was so high...he was aggressive (SHOCK!) and I didn't want to agitate him. My sweet husband was busy fetching me towels and trying to get hold of 911.

I know it felt like forever, but EMS and the Constables were there in minutes, then the Laguna Vista Police arrived, although in fact were were a couple of miles outside of the township. A female responder, who was pretty hefty (read: muscled) just picked that lady up like she was a feather and carried her out of the brush. I was very impressed. I was also very glad to relinquish the response effort to somebody better equipped. I had no gloves, no stethoscope, no anything...just beach=towels and my brain.

DPS arrived and took our statements. The children were upset and crying...There had never been quite so close to death before. I promised them new beach towels from Wal-mart on our way to the beach, which pacified them. I, on the other hand, am still thinking about the wreck and what I could have done better or different to help the two survivors. The worse is the dead driver...who will never had that second chance to slow down and wait to pass...to have that chance to get to the beach. In a blink of an eye...his life was over. He was young, healthy and had everything to live for...and that is the saddest part of all.

Coca Cola

Had a patient in ICU, total liver failure, very sad case. Young guy not even 40 yet, probably won't live to see his next birthday, emacipated arms and legs, huge pregnant looking ascites belly. Lot's of co-existing problems, since the liver does so many things besides filter blood. The liver has a lot to do with blood coagulation and so on.

Well the little guy had a Nasal Gastric Tube and was getting feeding via the tube. I had done all the proper things like flushing the tube, checking residule, hanging new tubing and new feeding. I had noticed that the flush was a little sluggish, but nothing really concerning, until I needed to give some medication just before end of shift. I go to check residule and the tubing looks like clabbered milk. Ummmm, cannot aspirate with large barrel syringe, cannot push H20. Ok by now I'm starting to sweat. I have to unplug this sucker. Removing it and placing another is a no go because of esphogeal varcies and the high high high risk of the duke bleeding to death. The best solution is usually to place some soda in the tubing and wait then work it until it clears, the only problem there is the hospital no longer provides cola's for the patient's (budget ya know). Well, it just so happened I had a soda in my fridge stash (my dear hubby had sent it for my lunch two weeks ago, I don't drink soda so I had just saved it) so I put some down and worked and worked and worked. I was finally able to aspirate part of the feeding (which is like baby formula...only like I said clabbered). Dude asks me what I'm doing, he has been without anything to eat or drink by mouth for 20 days, I tell him I'm putting Coke Classic in his tubing to clear it. He gets a big grin and says "Coke...I'm getting Coke...wow!" It was so funny.

So this morning before I leave I go in and flush the tubing, he looks at me, raises his eyebrows hopefully and queries "Coke???". It was just so funny!

Dancing Time in Texas

Tonight, we were gonna go to the Los Fresnos rodeo, however, after two days of rain, the mud deterred me. I don't do mud. Instead I opted for us to go to Wink's Grill and Bar w/attached arena. It is the coolest place. We took Angel to eat and stay (just until 9:30) for a little music. Inside it is very rustic. Rough cut cedar on the walls decorated with deer heads (yup a mans paradise I'm telling ya). It also has a full sized windmill turning by the dance floor. One edge of the dance floor has a mechanical bull with a blow up safety bumper. This place is HUGE! The stage has a full sized wagon on it, and tonight the drummer set his drums up on it. (We did leave before the live music because I was afraid it would get too rowdy for a 10 year old, even though lots of people were coming in with children...just doesn't seem right to have them out late with all the drinking stuff going on). The bathrooms are sooooo cool. The sinks are metal #3 washtubs and the sinks have actual old-time pumps that pump into a wooden bucket, then the water runs out the bottom where you wash your hands. The handles on the sinks are deer antlers. The rest of the bathroom is early sheet-metal decor, but thank-god for state-of-the-art tolits.

I spent a good bit of time teaching Angel to jitter-bug and two step. Then there was a party for a Quincentina (not sure if I spelled that right), which is a Hispanic traditional coming out party when a girl turns 15. The teenagers requested some line dancing and Angel was soooo in her element. Who knew that they teach line-dancing in elementary school as part of their PE? She did very well, and was adequately impressed that her "granny" picked right up and did all the moves right with the teens. Little did she know that I was a hard-core three times a week line dancer in my hay-day!

We had a very good time, then came home and watched an old Jim Carey movie "Liar Liar" and went to bed. Tomorrow we will possibly attempt going to the Cameron County Live-stock show and the rodeo. There is also a carnival and craft show (woo-hoo) so I'm looking forward to it (ok, I hate heights...but I can sacrifice myself to ride the scrambler with the grand-girl child I'm sure!

Did my brain Turn to Mush???

I really had an awesomely crazy night the other night. I arrived at shift and there was no one there to give me report. I was confused. My pod was empty, no patients, no nurse, nada....was there some kinda mistake. Did the House Supervisor have a brain fart, what the hell? Within seconds I realized I was living my worst nightmare..without Vaseline. I was alone because I was "opening" the pod for all the patients that had been holding all day in ER.

I got a direct admit that was being wheeled out of the elevator as I was scratching my head in confusion (over the "empty" pod). One minute later they are wheeling my transfer from ICU, as the phone was ringing for me to take report from Day Patient on "my" patient that has been waiting for a bed for over an hour. Oh, then the aide calmly informs me I have two new admits waiting in ER.

Pause, take a breath here, hummm, usually in ICU, or even PCU, you will only get one and possibly two admits in a night, and one of those is usually a transfer. Transfers are the easiest because they already have their database done and most of the paperwork has been completed. Next easiest is the ER admits, even though they come with a billion orders at least they have a IV access and a rudimentary history and some meds have usually been given, and the patient is relatively stable. Direct admits are the hardest. Not only do you have all the paperwork to do, but you also have to try to twist Pharmacy's arm to get their first dose medications issued, and you have to start an IV.

Well, I get the gal from the elevator. Reception did not bother to put a mask on her, or to inform us that she had a nasty cough, which of course she did not cover. What is it with people? Do they think they sound sicker if they don't cover their cough? I certainly hope she had a benign case of bronchitis or something, because if it was H1N1 or TB, everybody in the lobby, on the elevator or in the hallway were exposed. I immediately introduced myself, fetched myself a mask and put her on isolation.Then I popped into the next room to meet and greet my ICU transfer. Then I popped into the next room to get it ready for the Day Patient.

Two hours later I was transferring my ICU transfer to the Medical Floor and getting that room cleaned. I discharged my Day patient home. I had started an IV on my Direct Admit and I was talking to Pharmacy for the umpteenth time for...you got it...my first dose medications. I then proceeded to get THREE ADMITS FROM ER. Count them...THREE. I was so tired at the end of shift, I was trying to catch up my charting.

This was my charting. Patient received from ER via streacher (scratched that out), via strecher (scratched that out), strechar (scratched that out)....scratched my head...Patient received from ER via gurney.....

Then I went home and slept.

Wide Awake in Texas

I worked Monday and Tuesday nights, and was off yesterday. I came home and caught a few zzz's then had to get up and go the eye doc to get a recheck on the bifocal contacts. If anybody has actually learned how to wear the mono-focal's ....shish, I sure hope they start working for me. My right eye is for far away vision and my left for reading...the only part he didn't tell me is that my already poor depth perception would become practically non-existent. I am working on driving without running into anybody, and walking like one leg is not shorter than the other. Updates to follow.

The Christmas Dress

What we did around Christmas.

Dave unloaded the propane, so we could cook Christmas dinner. It had rained torrents of rain..for days. Note the stylish "hog" boots he is wearing.

Then we cooked out and ate fahita's. It was all good.