December, 2006 Archive

December 19, 2006, 10:42 am

It’s Grand Rounds With…Charlie Brown!


You can never, ever, EVER have too much Charlie Brown at Christmastime and this week’s Grand Rounds proves it!

Mother Jones, RN, proprietor of Nurse Ratched’s Place and blogger extraordinaire dishes up the best of the medical blogosphere with a Charlie Brown theme!

This week I’m savoring the offerings and reading a bit day by day (working five nights in a row really cuts into my blog reading…I hate that!), but always with coffee and always on my comfy couch!



Got a story about a nurse?

Are you a nurse with a story?

Then don’t forget to submit to the next edition of Change of Shift, this time hosted by our musical colleague NeoNurseChic.

Lizz Piano did such a great job of laying out the posting guidelines that all you have to do is click on her link above and all the information is right there!

Many thanks for her generous offer to host during the holiday season!

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December 18, 2006, 5:58 am

Run And Tell All of the Angels, This Could Take All Night

basalBedside metabolism?

This was measurable?

For what purpose?

Seems we are supposed to know.

The ad says we “realize the value of this information.”

The Doctor can carry the test to the bedside.

That looks like a Nurse carrying it to me!


You weren’t supposed to be alive.

You didn’t want to be. You told your family.

You filled out all the papers.

The nursing home couldn’t find them.

The paramedics had no choice, they were obligated to resuscitate you.

Knowing it wasn’t what you wanted.

Not having the papers to prove it.


If you had fudged your age a bit, you could have served in World War I.

I wonder if you served in World War II.

I know you married and had three sons.

I know this because the doctor talked to all three of them.

They weren’t happy you had been resuscitated.

I bet you weren’t either.


You could not express any frustration. You were intubated.

Your ribs were fractured from the CPR and you were showing signs of decerebrate posturing.

Your eyes opened and closed.

You did not follow commands.

Oh, and the papers stating your wishes? The ones the nursing home could not find?

They were found in the stack of papers the nursing home sent with you to the ER.


God bless the emergency room doctor that night.

He spoke to all three of your sons.

They all agreed the endotracheal tube should be pulled and that you should be made as comfortable as possible.

That was very good of them to give us permission to do that.

It would have been even nicer if any of them had shown up to be with you.

If I remember correctly, none of them lived all that far away.


We did it.

You were extubated.

You looked immediately more comfortable.

It was expected that you would not last long once the tube was pulled.

I didn’t want you to die alone.

In an emergency department.


I am a registered nurse.

A health care professional.

I’m not supposed to be judgmental.

I’m not supposed to become emotionally involved.

But dear God, if my dad had lived as long as you did, I would have had him another forty years!

There would be no way in hell that he would be dying alone in any emergency department.

Perhaps when you have your father as long as your sons had you, you tend to take them for granted.

I wouldn’t know about that.


I pushed my thoughts, my anger back into my subconscious.

Where they belonged.

They would do you no good.

They certainly were doing me no good.


You were tough.

You held on. You kept breathing. Your oxygen saturation stayed up with just a bit of oxygen.

I stayed with you as much as possible. So did the doctor.

We talked to you.

Your unseeing eyes would move; your arms would rotate in the classic decerebrate posturing.

Your breathing became labored.

I gave you morphine. You relaxed and so did your pulse.

I wonder if that allieviated some of the pain of your fractured ribs.

I wonder if you could feel them.


Nobody lives as long as you did without being tough.

And nobody your age should have been in the position you found yourself during the wee hours of that morning.

I gave report to the angels by praying you would not continue to suffer.


By the end of the shift, it was obvious your celestial room was not yet ready.

I gave report to different “angels”. The ones residing on the medical/surgical floor.

Time for me to go home.

Seems it wasn’t yet time for you to do the same.


I checked back that night.

And the next.

And the next.

My goodness. I wonder what you were waiting for.

Permission to go?

A chance for your sons and grandchildren to say goodbye?

Did they ever show up?


You should have gone peacefully that night. Your heart had stopped. Your breathing had ceased.

Instead you were physically and chemically wrenched from the arms of God for the lack of a piece of paper. Another celestial tug-of-war.

But….He gave you back.

For three days.

Perhaps you had unfinished business. Perhaps your children had unfinished business.

All I know is that on the fourth day you made the “transfer” to a Higher Level of Care.


I hope your kids appreciate and say a prayer of thanks for the extra three days they had with you.

I would give everything I own for just one more chance to say goodbye to my dad.

Ooops! Better get those thoughts back in their proper place.

I’m a professional, after all.

A rock!

An island in the sea of health care.

And after all,

“….a rock feels no pain.

And an island never cries.”

With all due respect to Simon and Garfunkel…

That’s bull.

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December 16, 2006, 10:24 pm

Christmas With the People in My Neighborhood


Of course I bought this ornament for every nurse in the family.

Except…I forgot to buy one for myself!

Something tells me I’ll get it for Christmas, and probably from one of the people I bought it for!

Okay, I’ll admit it.

I’m one of those people who start looking for Hallmark’s new ornaments in July.

I gotta have the newest ones. I’ve got a million of ’em!

I need more room! So, I packed up all the old ornaments for the kids – a box for each of them. For when they are married.

They wanted to know if I was dying.

I said “Yeah, dying to make room for my new collections!”


All year long, I work with the same people. Day in. Day out. Side by side, we deal with anything and everything the public can dish out. Occasionally we get on each other’s nerves. It passes and our work continues.

December has fallen, another year is history. A year of sharing experiences both personal and professional, humorous and tragic.

An emergency department is best described by the people who work there. The holidays bring out the best in all of us.

Here’s a view of my “neighborhood” during the holidays and an introduction to some of the characters that populate my ER.


There is a beautiful tree in the ER, right by the ambulance entrance. The nurses made sure it was decorated just right. An immediate release of endorphins ensue on sight.

Meet the evening shift RN who stands for hours mixing homemade candy – at least eight different types – and then puts together a sampler for each staff member. I start salivating in anticipation around October! Mrs. See’s has nothing on this nurse!

Stacked in the back of the breakroom you’ll find cases of champagne, specially chosen by the ER doctors as gifts for the department. We’re talking champagne with a capital “C” here, folks. I know. I drank some when I got home from work two days ago. Who says you can’t have champagne at eight am? You can in my neighborhood!


Your sense of smell will lead you to the break-room, laden with baskets generously gifted to the ER by the local doctors. Crackers, salami, cheeses, smoked salmon, coffee, teas, Belgian chocolates, peanut brittle, fruit, nuts, bolts…well, you get the idea.

Every morning a night nurse packs up the pre-made boxed lunches that have reached their due date. She’ll drop them off at a homeless shelter on her way home. Early next year she will embark on her annual mission to a country I can’t even find on a map. There is a package from her under my tree. She made me promise to wait until Christmas. I could open it early, but she’d know. Somehow she would just know.

Amidst the announcements and reminders in our mail boxes you will find tiny morsels and gifts from the staff to each other. Similar to stocking stuffers, they’re box stuffers! Squares of mint chocolate bark, See’s Suckers with a tiny gift tag attached. A goodie a day keeps the doldrums away in my neighborhood. Somehow that reminder to do the medication reconcilliation record seems much nicer with a Hershey’s Kiss attached!


A unit coordinator tried to hide a tiny gift box behind my coffee cup. Luckily I found it immediately, for it contained a gorgeous pair of Christmas-themed earrings. Now I can enjoy them for two weeks before the holiday. That was one gift just begging to be opened early, I just had to do it! And last night I had to wear them!

I’ll introduce you to the nurse who worked a double shift the day after he was sick to cover someone else who was sick. It’s that time of year. We pitch in for each other. He pitches in. Often.

Saturday at six am, one of our orthopedic doctors will drop by a box of warm donuts, fresh from the oven. He does this all year – every weekend. We make sure we have a fresh pot of coffee on for him. Sometimes he’ll stop and have a cup even if they do have Starbucks in the doctors’ lounge!


Oh good! Here’s the co-worker whose enthusiasm for education makes me enthusiastic as I embark on my journey to my BSN. Many factors led to my deciding to pursue my degree but her example is one of the most significant. When I look back on my career, our meeting will have been a turning point.

Let’s say thank you to the RN responsible for giving the nurses’ station its seasonal glow. It doesn’t have to be Christmas; she decorates every month of the year. The candy strewn amongst her decorations always disappears, only to be replaced the next day. Can’t imagine where it goes!

Are you ready for some football?? Well one of our emergency room technicians is, too! Join us in praying that Brady Quinn is a first-round draft pick of the Raiders because if he is, our ER will be become a state in the Raider Nation! One cannot live by ER alone – can you say “season tickets”?


That’s just a sampling of my “neighborhood”.

There’s the doctor who puts life into perspective and keeps me from the brink of burn out. Don’t forget the day shift RN who is truly an angel with the patients and has more energy than the Tasmanian Devil. Then we have unit coordinators who take it from the public, endure the doctors and keep the nurses organzized without missing a beat and always with a smile. Thank goodness we have a nurse with a direct line to all the Mary Kay make up we can ask for – how often can you Christmas shop at work?

All-in-all, it’s a pretty special place.

And if I have to work, I’m happy to be spending Christmas with all these people in my ER neighborhood.

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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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