September, 2006 Archive

September 22, 2006, 7:18 am

Teeny Little Super Guys in the ER. Part Two.

superguyThis is part two of my ode to pediatric patients in the ER.

If you missed Part One, this is the Teeny Little Super Guy.

He used to be on Sesame Street.

He lives in a cup in a kitchen and all his friends live in utensils and jars.

It’s hard to explain.

But it’s cute!

And it reminds me of my pediatric patients; the Teeny Little Super Guys that make up a special part of my practice as an ER nurse.

******************************

I’m still at Starbucks.

I really do have a life outside of blogging.

Really.

I do.

Starbucks radio report: we went from Motown to Tony Bennett (alright!) and now it’s the Dixie Chicks. I wish they weren’t so good. I really would like to not like them.

******************************

The unit was crazy busy.

Are you detecting a pattern here?

This time I was assigned to the multi-patient room.

Four beds total.

The designated Charge Nurse for the day informed me that a small child had been roomed, chief complaint abdominal pain with vomiting and fever. She had seen her pediatrician two days before and was seen in an ER the previous day.

The pain and fever persisted.

And now she was my patient.

*****

She sat on the edge of the gurney, watching me with apprehension whenever I entered the room. She spoke Spanish.

No problem. So do I.

Sort of.

I thought she was older. She was taller and heavier than most girls her age. I placed her at about seven.

She was five.

I adjusted my approach accordingly.

*****

The ER doctor completed his assessment.

I knew what was coming.

The pain and fever had lasted too long to just pass off as gastroenteritis.

We had to do it.

The dreaded “Pediatric Work Up”.

*****

First, oral contrast as an abdominal CT was pending.

Tears the size of teaspoons ran down her cheeks when she was told she had to drink all 1 and 1/2 cups of the Gastrografin/water mixture.

(Not exactly dehydrated, eh?)

It was slow going at first.

Then we went commando!

Meaning, I sat on a stool in front of my patient and cheered, cajoled, teased her about taking tiny sips and praised her to high heaven when she actually swallowed some.

She laughed at my Spanish.

I made faces when she pretended and did my “happy dance” when she took a gulp of the vile solution.

Do you know how hard it is to do a “happy dance” when you are sitting on a stool? I nearly lost my balance twice, which just made the patient laugh and drink more.

Hey, anything for progress.

I knew all those years as a cheerleader would pay off eventually.

*****

Eventually the contrast was in.

And guess what her reward was for drinking all of the Gastrografin?

An IV. With a bolus.

Tears the size of tablespoons flooded pillow as she verbally assaulted the atmosphere with her protestations.

(Still not thinking this kid is dehydrated; definitely nothing wrong with her lungs.)

In what passes for Spanish in my world, I told her that crying was okay, but she had to hold still. If she held still I could do it in one stick.

(Please God, help me get this the first time….)

She held totally still and the IV was placed, labs were drawn and she managed to deafen me for an hour, something normally reserved for rock concerts and loud iPods.

The bolus was started.

It was time for a teddy bear.

*****

The CT was done and the patient was returned to my care. The bolus ended and she was happy to have the tubing detached.

Good news! The CT was negative for appendicitis!

Yea!

Time to go home!

Except….

We needed a urine specimen.

*****

The patient did not want to pee in a cup.

The doctor told me to do a straight cath.

In my pseudo Spanish, I told the patient she had a choice.

Pee-pee in the cup, or pee-pee with the help of a tube.

You never saw anyone run so fast to the bathroom.

She produced enough urine for ten patients.

I praised her enough for one-hundred.

The urine was clear. No infection.

*****

Now it really was time for discharge.

The saline lock was removed. With tears, of course.

But it was also time for a color book, some crayons and a pretty plastic butterfly.

After all, this young patient has been a trouper. She did so well for someone who was only five. Better than I could have ever expected or hoped.

And after I had given her all her goodies, this tiny Latina, this Spanish-speaking child, this girl to whom I had spoken only (occasionally hilarious) Spanish, turned, looked me straight in the eye and with a smile said:

“May I please have a bear and butterfly for my big sister?”

IN PERFECT ENGLISH!

Of course she got the bear and color book for her big sister (age 7).

And this courageous little girl also got my heart that shift.

I was so relieved that she was okay.

And so sorry that I had to put her through the scary procedures and nasty medicines.

Sometimes you just have to do things for the good of the teeny little super guys in your care.

Because you care.

Read »

5:58 am

Pedi in the ER: Teeny Little Super Guys! Part One

teenylittlesuperguy

Inspiration comes from the most unexpected places.

My oldest daughter sent me a You Tube video of my favorite Sesame Street character.

The Teeny Little Super Guy.

She reminded me that this is what we called my son when he was a toddler.

Unknowingly, she also reminded me of a very special patient from the past.

A pediatric patient.

And you know, sometimes those teeny little super guys remind me why I love my job.

******************************

It’s 0513 and I was the first person at my favorite Starbucks this morning.

I was standing at the door at 0500 when they unlocked it.

Pathetic, isn’t it.

But….I have the whole Starbucks to myself, the cushy chair in the corner and some good ol’ Motown to keep me blogging away. Right now I’m groovin’ to Martha and the Vandellas!

Belinda Carlisle was right.

Heaven really can be a place on earth!

******************************

The unit was crazy busy.

I had the unenviable position of being the shift Charge Nurse.

This meant I manned the triage desk in the small room behind registration.

An adult male presented at the door as I frantically finished charting the initial assessment of the last patient. I looked up, smiled and asked him to please have a seat; I’d be with him in just a moment.

My peripheral vision caught a blur of pink as it passed me and plopped into the other chair. Apparently the adult was not the patient.

As I finished writing the assessment of the previous patient, my new patient began bemoaning the lack of progress she had made on her math homework.

“Oh man, I can’t believe what my teacher gave us today. I can’t even deal with it! I’m just barely through it!”

I looked up from the chart and looked at the new patient in the chair.

She was blond. Blue eyes the size of saucers behind her tiny pink glasses.

Pink was obviously her favorite color.

I handed the now completed chart to the registration clerk.

“What is it you are working on?” I asked.

Rolling her eyes to the ceiling, she recounted her assignment.

“We have to pick the number that is three more than the other number!”

She was seven years old and in the second grade. To hear her talk, you would think she was taking Calculus at the local university.

I fell in love.

*****

Persistent cough interfering with sleep and intermittent fever.

She gave me her previous health history, telling of her surgeries as an infant for two holes in her heart. Seven years old and she gave a better history than half the adults I see.

As my petite mathematician had brought her homework with her, she asked me for a pencil.

Did I mention this was about 11:00 pm?

*****

I kept triaging without a break.

About an hour later, the tiny blond math whiz peeked around the edge of the triage door.

Excusing myself to the patient I was talking to, I asked if she needed something.

She handed me a clipboard with a piece of paper on it.

It was a picture.

“To Nurse Kim” it said.

It was a picture of my patient in pink, her heart prominently drawn in the anatomically appropriate location, standing next to her doctor (labeled). They were connected by a giant heart drawn between them.

She signed it “Love, Dorothy”.

I told her that I was going to take it home and put it on my refrigerator.

And that is where it went.

And where it still hangs to this day.

*****

I ran into Dorothy’s father a few days later as he was walking through the ER.

I told him to tell Dorothy that her picture was hanging in my house like I promised.

And then I thought of something. We were awfully busy that night.

Had Dorothy received her ER teddy bear and special colorbook with crayons?

Why no, she had not!

Inexcusable!

Fortunately, I was able to remedy that right then and there. I sent Dad home with a goodie bag.

From Nurse Kim to one of her favorite patients.

For the picture.

For bringing a tiny bit of pleasure into a hectic day.

And for making it through those two surgeries.

You certainly made my heart feel happier.

Here’s to future all those future math subjects you will study.

Something tells me that you’ll be at the top of the class.

Read »

September 21, 2006, 4:51 am

Change of Shift: Volume One, Number Seven

cooltext19091355.jpg

…is up over at kt living!

Many thanks to kt for hosting this week!

The next Change of Shift will be right here at Emergiblog on October 5th, so be sure to send in your best!

Oh heck, you can send in someone else’s best, just be sure to get their permission first!

So don’t hesitate, head on over to kt’s for some good ol’ nurse blogging!

Read »

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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