April, 2007 Archive

April 10, 2007, 7:52 am

Grand Rounds From Down Under: Decidedly Un-Dorky!

Oscar

Meet Oscar.

Oscar is a resident of Roo Gully, a wildlife sanctuary in Australia. Oscar is one of the “gang” I “adopted” over a year ago.

Today, I’m using Oscar as mascot for this week’s Grand Rounds, hosted by our friend, colleague and fellow-blogger Dr. Dork.

And a fine Grand Rounds it is! Some new bloggers (to me) and a bittersweet letter from Dr. Barb with some informative links on why Barbados Butterfly is no longer blogging.

The blogosphere is a huge universe, but today there is a hole where Dr. Barb used to be.

I am definitely missing her.

*****

Change of Shift will be found at Blissful Entropy next week and Erica is looking for the best posts by and about the nursing profession!

Send all submissions to “erica (at sign) letterperfectediting dot com” or via Blog Carnival (see sidebar).

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April 9, 2007, 11:51 am

No One Can Find the Rewind Button Now, So Cradle Your Head in Your Hands…

(This post was first seen last April. Because of the Easter setting and in honor of my patient that night, I am reposting it today.)

What a freakin’ wimpy bedbath!

Gee, we don’t want to overexpose our patient, now do we?

She looks like she’s giving him a manicure!

And I guess we don’t need privacy because nothing is showing! What’s she going to do when she gets past (shock!) the elbow?

Were axilla off limits back then?

Well, at least according to the ad, the patient will experience a “delightful cleanliness”….of his distal phalanges.

I believe in truth in advertising so I’ve never understood how Ivory gets away with saying it is 99 and 44/100% pure.

What’s in the other 56/100%

Ebola?

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It was just supposed to be a quick four-hour shift.I have a co-worker who has trouble with twelve hours shifts, as I do. She was scheduled for one tonight and I offered to do the first four in her place.The unit was down to two patients, the break table full of Easter goodies and a kick-back attitude was to be had by all.All the prerequisites for a Code 3 ringdown.

It came.

Cardiopulmonary arrest. Elderly. Found by spouse. Resuscitated en route. Still unresponsive but with a blood pressure, a pulse and (God bless all medics, every one) intubated with an IV. Technically was a DNR but papers were with the patient’s doctor and not at home.

Lots and lots of activity. Many tubes placed where tubes usually go (foley, ng) and then a few new holes placed for those tubes that don’t have a regular hole to fit it (central line). Many cooks in the broth. Much help to be had.

It did not look good.

The family decided that the ventilator would be removed and oxygen supplied through the ET tube.

Slowly but surely, the other nurses went back to their assignments and somehow I was the one who would be staying with the family until the patient expired, explaining what was happening.

I could insert a joke here, about the Energizer Bunny or the patient being like a Timex that takes a lickin’ and keeps on tickin’.

But they really don’t fit in this narrative.

My patient did not expire for over one hour.

*****

During that hour I heard stories of what it was like to be married to, and now losing, a spouse of 70 years. We laughed over reminiscences the family shared. How one of the grandkids was the spitting image of the patient as a young person.

How one of the last things shared at Easter dinner just a few hours before was the patient saying what a good life they had had with their spouse. How happy they were.

How they had gotten the okay to travel abroad in four weeks. In their nineties.

I sat on one side of the patient holding their hand and the family sat on the other, stroking and holding the other arm. I offered them my place, but it seemed they found strength in leaning on each other.

And then, the resuscitation medications began to wear off and heart began to slow. Gradually, gradually until I documented asystole and turned off the monitor and oxygen.

Pretty technical.

*****

Except that tonight there is a person who will be facing life on their own for the first time in seventy years.

Except that tonight there are adult children who are dealing with the loss of their parent. Grandchildren who will wish they had more time to know their grandparent.

Except for the fact that every time we lose a person who has lived as long as ninety years, we lose a treasure, a link to the past; a wealth of memories and experiences that will soon be relegated to textbooks.

Except for the fact that in ER, patients die quickly before you usually have a chance to get to know them or their families.

I haven’t sat vigil with a patient and their family like that for many years. The opportunity to do so does not present itself often in the ER environment.

*****

The family left.

I went into the bathroom and cried for two minutes……. and then came out and made the requisite calls to the coroner and the donor network, finished my charting, posted my strips, circled my charges and swiped out for the night.

*****

Another death. Another holiday.

Something tells me I will have another “yearly visitor” around Easter next year. And that gives me comfort.

In the meantime, I’ll take the advice in the song written by Anna Nalick from which I took the title of this post and cradle my head in my hands.

And breathe.

Just breathe.

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April 4, 2007, 6:00 pm

Change of Shift: Vol. One, Number 21

changeofshift

Welcome back to Emergiblog for this edition of “Change of Shift”, a nursing blog carnival by and about nurses and the nursing profession!

We have two new bloggers submitting this week, along with patients and pastors and moms and, oh yeah, nurses!

But…before we start, Change of Shift would like to congratulate Marisa, first place winner of the NursingJobs.org nursing scholarship essay contest!

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We’ll start this week with a submission from a blogger well acquainted with nurses from the patient viewpoint. Knitter extraordinaire and author Alison Hyde presents This Is For Every Person Who Has Ever Donated Blood posted at spindyeknit. Alison suffers from Crohn’s and lupus, her daughter has ITP. But Alison, when will you tell us the story of you mooning the Lifeflight chopper?

Hold the coffee! Erica, ER nurse and the next host of “Change of Shift” presents a post guaranteed to crank up a burst of adrenaline! Get ready for Wiped Out, posted at Blissful Entropy. (I’m thankful that all I have to worry about are earthquakes…)

N=1 at Universal Health discusses the unexpected silence of the nursing profession regarding the Walter Reed fiasco in Walter Reed Story Is Being Lost – And So Is American Nursing « Universal Health. Also submitted by “N=1”, a horrific story of apathy in Heroin OD.

*****

When the nurse is the patient, they sometimes act like a patient despite (or perhaps because of) their increased knowledge. Cherry Ames, the nurse details her confrontation with Cherry Ames, the patient in The Danger Zone posted at Sisterhood of the Travelling Scrub Pants.

What do itty bitty, teeny tiny condoms have to do with your vision? Find out as our resident opthalmology nurse Christopher at Deacon Barry takes us through the evolution of intra-ocular pressure measuring devices in On Tonometers.

Oh man! There is nothing I can add to this one. File it under “Just When I Thought I’d Seen Everything” as ERnursey presents Meningitis posted at ERnursey.

*****

An NICU RN and mother of five makes a beautiful discovery in I Wanna Hold Your Hand posted by Laura at Adventures in Juggling (and no, Laura, it doesn’t make you a bad mommy just an appreciative one!).

Mark is a nursing student with a vision of a logical health care system using expanded roles for nurses and increased MD specialists. He articulates this vision in Nurses are not Doctors posted at Mark On The World. What do you think? My bet is that Mark gets the most comments this week!

Max E Nurse presents two supreme examples of “Open Mouth, Insert Foot” syndrome in Say what? « It shouldn’t happen in health care posted at It Shouldn’t Happen in Health Care. Feel free to add your own “foot-in-mouth” experiences in the comments!

*****

Ladies and gentlemen, meet NNP – a nursing colleague new to Change of Shift. I am taking the liberty of including a post, called Little Angel which can be found at the new Developmental Milestones. Welcome to the blogosphere!

Want to know how to end the nursing shortage? Ask volunteer ER pastor Susan Palwick. She explains her solution in How To End The Nursing Shortage, posted at Rickety Contrivances of Doing Good. I give my full and hearty support to her last suggestion!

Public Service Announcement! Nurse Ratched is not perfect! Why, she documents it herself in Shoot Me, I’m Not Perfect at the always entertaining Nurse Ratched’s Place! Would someone tell me how to get one of those Fujitsu robots?

*****

Meet “Wanderer”, a new nurse and the owner and proprietor of “Lost on the Floor: A Nursing Story”. Wanderer tells of learning the hard way in “The ‘Q’ Word”. Another “welcome to the blogosphere” moment!

Checking in with Medscape nurse Beka, she gets a job lead from a colleague in a most unusual place! Find out where in Jeans and Madonna at Medscape Nurses.

I can’t believe it has been an entire year since I first heard about the campaign for a National Nurse. In honor of the anniversary, I will link to my original post from April of 2006. If you haven’t visited the site, please do and consider making a donation to what has developed from a grass-roots organization into a bona fide Political Action Committee! I explain why in “The Office of National Nurse”.

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And that wraps it up for this edition of Change of Shift!

The next CoS will be hosted by Erica at Blissful Entropy on April 19th. Send your submissions to erica at letterperfectediting dot com or use Blog Carnival.

If you are interested in hosting, don’t hesitate to write.

Thanks to all who submitted and to all those who link to and support Change of Shift!

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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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