August, 2006 Archive

August 8, 2006, 1:38 am

Are You Ready To Submit….to Change of Shift?

psft

I tried to pronounce the name of this drink but I couldn’t stop laughing!

I confess to a dearth of knowledge when it comes to French.

No matter how I say it, it still comes out sounding like commode content.

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Nurses, the deadline approaches for the next Change of Shift, which goes live this Thursday!

Doctors, certainly you have nursing stories to tell!

Patients, I know you have stories to tell!

So tell them to us!

Entries this week go to intelinurse2b at aol dot com or the usual Blog Carnival route.

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And I am proud to say I get to host one of the upcoming Pediatric Grand Rounds!

Yes, I do have a life, thank you for asking!

But every now and then I get an overwhelming urge to empty the cache….

Maybe this ol’ Mac is my life support system….

Now if I can just get it to defibrillate……

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August 6, 2006, 11:20 pm

What Would Florence Nightengale Do?

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Have you ever felt like the nurse in this photo?

No, I don’t mean have you ever felt bigger than a air bus.

I mean feeling that your patient is so fragile, so dependent that you feel their life is in your hands?

Literally?

Or have your patient tell you that you are their angel when you feel it has been an honor to be able to care for them?

I’ve had both experiences.

The one thing I have never had to do as a nurse is deal with patients in a disaster.

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While catching up with my “doctor” links today, I read this post at Dr. Hebert’s Medical Gumbo.

It’s a thought-provoking post on the situation in New Orleans, where a doctor and two nurses have been accused of active euthanasia of four patients during Hurricane Katrina.

I won’t summarize the post here, as it is worth reading in it’s entirety, including the comments.

It did, however, get me thinking.

What would I do when faced with a disaster situation?

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I live in what is essentially Earthquake Central. The land around here does its rock-and-roll thing every now and again.

In 1989 I was home during the Loma Prieta quake. It was quite a ride. It lasted a lot longer than most quakes round these parts.

I was on the phone to Round Table ordering a pizza, as the Oakland A’s-San Francisco Giants World Series was about to start. The woman on the other end screamed at me, “HOLD ON”!!!!!!!

How rude!

Then the shaking started. They say it lasted fifteen seconds. I would have put it at two minutes.

I have distinct memories of my five-year-old son looking like he was surfing in the hallway as he tried to keep his balance and my husband running frantically down the hall to save my daughter’s ceramic mouse collection.

(To this day I have no explanation of why my husband did that. We had Lladro figurines all over the house but he goes to save a collection from the Franklin Mint. Nothin’ like an earthquake to bring out your priorities.)

We had a rather “Oooo, was that an E ticket ride, or what?” sort of attitude. (Disneyland used to “grade” their rides. An E ticket was used for the best ride.)

We did not know of the devastation to the Cypress freeway or the damage in the Marina district or how many had died as we had no power. When I put batteries in a small radio, we heard the Bay Bridge was “down”.

Oh my God…..

We saw there was power in the town below us (we are on a slight hill) so we drove to my parents’ home where the scenes of the disaster blew us away.

And while it was a 7.1 and directly on the San Andreas Fault, we weren’t even the epicenter.

Thank God.

Oh, and by the way, we stopped at a supermarket within three hours of the quake. Every single bit of water, batteries, flashlights, matches and candles were gone. Not looted, it wasn’t like that. They had just sold everything out.

I chose not to go into work.

Primarily because my kids were frightened out of their wits and both were under ten years old.

Secondly, I had been out of ER nursing for two years; Loma Prieta occured during my tenure as a psych nurse. There was no way I was leaving my kids that night.

That was then.

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What were they thinking?

Every single hospital in the San Francisco Bay Area is on a faultline. In fact, if you travel down Freeway 880 from the San Jose Border until it ends at Interstate 80, you will pass a hospital about every ten minutes. On Highway 101, you pass one every five minutes.

I personally know of four medical centers that are rebuilding to meet the “new” earthquake standards, because retro-fitting the existing facilities would actually cost more.

What do you think is going to happen when “The Big One” hits either the San Andreas Fault or the Hayward Fault?

Most of my reading puts the prediction of “The Big One” hitting the Hayward fault by 2030 at 62-80%.

They call “The Big One” 6.7 or greater on the Richter scale (similar to over 5 million tons of TNT).

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Since I spend anywhere from 48 to 64 hours at my hospital, using the 64 hour number there is a 38% chance that I will be at work when “The Big One” hits.

My facility will probably be incapacitated in some way and require the evacuation at least of some of the patients. Not to mention the “walking wounded” or ambulance patients, assuming the roads are passable.

My question, after reading Dr. Hebert’s post was, could I ever leave a patient that could not be evacuated? Even in a damaged hospital, I’d have access to IV fluids, syringes medications, even if only limited to one Pyxis machine, so pain and suffering would probably be relievable.

Abandoning a patient is anathema to every nursing bone in my body.

Could I stay if my own life were in danger? With no water in 110 degree heat and no help on the horizon?

Would I stay? How could I leave?

How do you look a patient in the face and say “I’m sorry, I can’t stay?”.

And if you are 400 pounds and paralyzed, and alert and oriented, isn’t it even more important for someone to stay? Large and immobile doesn’t mean unhuman.

I am so anti-euthanasia that I want to believe I could never, ever kill someone, even if they begged me to do so. I would never want anyone to feel that hopeless or that much in agony and I’d do anything to allieviate their suffering…

….but I won’t do that.

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As much as I hate the televised circus that some trials become, I would want to see this one on Court TV.

And so I will save my opinions and judgements until all the facts are brought out in a court-of-law.

But can we ever, really, know what we would do in a horrific, disaster situation?

Or judge someone else who was actually there?

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5:45 pm

Sunday Morning Comin’ Down…at Starbucks!

UPDATE: THE TTLB ECOSYSTEM IS NOW SAYING I’M A LARGE MAMMAL. THE LAST TIME THEY DID THIS I WAS EXCITED FOR A WHOLE FIFTEEN MINUTES BEFORE THE ERROR WAS DISCOVERED AND I DROPPED TO A CRUNCHY CRUSTACEAN. OH, NZ BEAR, QUIT PLAYIN’ GAMES WITH MY HEART….

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harsh

Oh puh-lease!

Have you ever heard a doctor say that?

I haven’t seen a dumber ad since we weren’t allowed to squeeze the Charmin.

Did the patient rip herself a new one because she used an SOS pad as toilet paper?

Her butt hurts and so the nurse has to support her and walk her into the clinic?

I can hear the talk now.

“That ol’ Mrs. Smith, if she would just wipe her rectal area with something as soft as old linen, she would be pain-free.”

“But doctor, look how much it costs! Three rolls are twenty cents! Why, that’s how much you pay me in a week! How on earth can she afford that much money for high-quality toilet paper?”

“Yes, nurse, it is a sad state of affairs when one has to choose between feeding one’s children and using the correct paper to wipe with.”

Oh…wait…”Soft as Old Linen”…

Yeah, I want my toilet paper to feel like an old sheet.

Is that what they used before toilet paper was invented?

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Starbucks is much better today.

No reggae at 0600. It’s a Sunday afternoon (which is morning to me) and it seems they are having a “deep cuts” 80’s Sunday afternoon. David Bowie, Joe Jackson, Peter Gabriel…and oh man Simple Minds!

{singing} Don’t you forget about me! Hey, hey, hey, hey! {/singing}

I can dig it!

Have to stop singing. I’m attracting attention

(For you young ‘uns out there, my post title, “Sunday Morning Coming Down” is an old hit by Kris Kristofferson. And if you don’t know who he is, well, I’m older than I thought!)

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I hate change.

Did I ever tell you that I hate change?

I’m not talking about the fifty-bazillion new forms I have to fill out.

I’m talking equipment.

We had a perfectly functional needle-less system that meshed with our paramedics’ tubing and was so good that I could stick in a saline lock, get blood from it and never even spill a drop.

Now it looks like a rectal bleed has been through my room every time I try to start an IV.

And the one piece of the puzzle that would solve this problem has not yet arrived.

And the new system doesn’t work with the paramedics’ IV tubing.

And my esteemed colleagues working the floors are not pleased if we don’t take the medic’s IV all the way down to the hub and replace it with our new stuff.

Ummmm…okay….let me see….

  • I have an ambulance patient with chest pain, R/O MI with a field IV, who needs an EKG and I have to take report.
  • I have a migraine patient who needs an additional injection for their pain who has been non-stop vomiting despite the initial anti-emetic.
  • a patient with a dislocated shoulder who will need conscious sedation after he gets back from x-ray for reduction of the dislocation.
  • and an elderly man with diarrhea who I have to get up to his assigned bed before the consult comes in or it will be another two hours.

All in the same room.

Sorry, dear colleagues. I know you run your derrieres off as hard as I do if not harder, but a complete change of IV tubing down to the hub is not going to happen before the patient gets to you.

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Well, it looks like this ol’ dinosaur will be thumping back to the night shift.

Believe it or not, it is actually easier to work from 7p-7a than my present 3p-3a position.

I’m a night person anyway, might as well get paid for being awake!

Plus, I will be working my brains out because both my oldest daughter and my son are getting married within 5 weeks of each other next summer!

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Of course, being the mother-of-the-bride/groom means I must look my best.

I’m down to a single chin, so I’m making progress. Hopefully I can get a waistline showing relatively soon.

My thighs are a hopeless case, but that is why God invented loooong dresses.

Have you noticed that nurses don’t have flabby arms? It’s all the lifting and pulling and gurney pushing we do.

Think of it as a professional perk!

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Speaking of night shifts, they have changed.

Used to be you could clear out the PM shift by 0100 and you never saw another thing until 0530 when the daily Code 3 or hip fracture would come in.

Now it is non-stop almost until 0430 and just as you finish your charting, everyone wakes up and it starts all over again.

We have a good reputation as a great ER to go to, so patients often request us because they don’t have to wait for hours and hours to be seen.

But, the more people who get that impression, the more people will choose to come to us and the busier we are and the more the wait will be.

It doesn’t help when our facility advertises that you will be seen faster than you can finish a sneeze!

But in reality, we are a department of seasoned veterans and we move!

It’s a great ER.

Even with the stupid new tubing…..

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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