December, 2008 Archive

August 30, 2016, 10:56 am

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Viagra oral jelly 100mg $175.00 First of all, viagra oral jelly 100mg $175.00 I’m pretty sure that not a single curl on the top of her head is real hair.

Viagra oral jelly 100mg $175.00 She looks like a Tribble took up residence on her head, viagra oral jelly 100mg $175.00 and she is no Nurse Chapel.

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Viagra oral jelly 100mg $175.00 I can’t tell if it’s a deflated ambu bag or a sphygmomanometer!

*****

Viagra oral jelly 100mg $175.00 This is a real photo of an actual nurse. Viagra oral jelly 100mg $175.00 It came from Life magazine and the nurse’s name is Nancy Archie, viagra oral jelly 100mg $175.00 circa 1970. Viagra oral jelly 100mg $175.00 The photographer was Bill Eppridge. Viagra oral jelly 100mg $175.00 Just for fun, viagra oral jelly 100mg $175.00 I looked to see if there was a nurse by that name licensed in Texas. Viagra oral jelly 100mg $175.00 No results found. Viagra oral jelly 100mg $175.00 She must have retired.

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Viagra oral jelly 100mg $175.00 Don’t forget to check out this week’s Grand Rounds, viagra oral jelly 100mg $175.00 a very unique edition “At the Interface of Evolution and Medicine” hosted at Moneduloides.

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Oh no…

That’s what you said.

That was the last thing you said.

After you had told me a joke and

Assured me you were not in pain.

Never knowing you were thisclose to death.

But I knew.

We all knew

And there was nothing I could do to stop it.

*****

Oh no…

That’s what you said as

Everyone rushed to hit their marks on the stage of the drama that is life

And death.

“E.R.” indeed. Viagra oral jelly 100mg $175.00 “The Six-Million Dollar Man.”

“We have the technology. Viagra oral jelly 100mg $175.00 We can make him better, viagra oral jelly 100mg $175.00 stronger.”

We have the technology.

But you needed time.

And time waits for no man.

*****

Oh no…

That’s what you said as

Your eyes flew open wide and your expression…

Surprise? Shock? Fear? Dread?

I had seen that look before on the face of my grandfather who looked me straight in the eyes

As he went into V-tach.

And died.

*****

Oh no…

That’s what you said.

Before the compressions and the defibrillations and the compressions and the intubation and the compressons and

The convergence of decades worth of medical experience surrounding you and the nurses frantically grabbing the equipment for three physicians at once for the insertion of lines into vessels that were useless

And those infernal compressions.

CPR can seem so violent.

So intrusive.

Without hope.

*****

Oh no…

That’s what you said.

Before you died.

I’ve never felt so helpless in the face of death.

I know there was nothing that could have been done even though everything possible had been done and yet

I can’t shake it off, viagra oral jelly 100mg $175.00 even after all this time.

*****

Critical stress debriefing.

We don’t have it at my hospital.

Maybe it’s just another term for “mourning”.

Mourning a man I never knew until that night.

Mourning that began

When you said

Oh no….

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August 30, 2016, 9:09 pm

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August 30, 2016, 1:53 pm

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Lyrica 150mg pills $92.00 Here is another in the series of “IVs and the Nurses Who Love Them”.

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Lyrica 150mg pills $92.00 Then again, lyrica 150mg pills $92.00 this looks like a student so I shall cut her some slack.

Lyrica 150mg pills $92.00 This looks like a classic photo of “goldfish therapy”.

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Many thanks to Laurie Edwards at A Chronic Dose for including Emergiblog in last Tuesday’s Grand Rounds!

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Nurses and doctors do not perceive the emergency department in the same way.

This is not a knock on my medical colleagues, lyrica 150mg pills $92.00 merely an observation.

Actually, lyrica 150mg pills $92.00 it’s more a realization that hit me after a recent shift.

My jaw still hurts from hitting the floor.

*****

In my county, lyrica 150mg pills $92.00 hospitals are able to go on what is called “ambulance diversion”.

This means if the emergency department is overloaded with patients and cannot safely take another at that time, lyrica 150mg pills $92.00 they are allowed to divert non-emergent ambulances to another facility.

It can help somewhat, lyrica 150mg pills $92.00 but it isn’t perfect. Lyrica 150mg pills $92.00 Any cardiopulmonary arrests or life-threatening situation still go to the nearest hospital, lyrica 150mg pills $92.00 even if they are “diverting”. Lyrica 150mg pills $92.00 And of course, lyrica 150mg pills $92.00 there are always the patients who can walk in with a major STEMI (aka: heart attack).

But…it keeps routine ambulance traffic at bay until the department can safely handle another patient.

It’s something the night shift rarely has to invoke.

*****

This particular shift was different.

The department was full, lyrica 150mg pills $92.00 with patients who had been there 3-4 hours and 3-4 triages in the wings.

It was one of those situations. Lyrica 150mg pills $92.00 Everyone who walked in had a serious medical issue. Lyrica 150mg pills $92.00 Abdominal pain was the theme of the day.

Lyrica 150mg pills $92.00 Every patient required a substantial work up. Lyrica 150mg pills $92.00 Tests were coming back positive for everything from appendicitis to ovarian cysts, lyrica 150mg pills $92.00 bowel obstructions to pancreatitis, lyrica 150mg pills $92.00 severe gastroenteritis to Crohn’s flare ups. Lyrica 150mg pills $92.00 Patients were requiring admission, lyrica 150mg pills $92.00 surgery, lyrica 150mg pills $92.00 pelvics, lyrica 150mg pills $92.00 ultrasounds, lyrica 150mg pills $92.00 CT scans, lyrica 150mg pills $92.00 lab work, lyrica 150mg pills $92.00 EKGs, lyrica 150mg pills $92.00 multiple doses of IV narcotics, lyrica 150mg pills $92.00 IV anti-emetics, lyrica 150mg pills $92.00 IV antibiotics, lyrica 150mg pills $92.00 and IV anti-fungals

Lyrica 150mg pills $92.00 Interspersed throughout this scenario were patients whose lungs decided that an oxygen saturation of 80% was a good idea, lyrica 150mg pills $92.00 or who needed multiple sutures to piece them back together after head/knee/arm vs. Lyrica 150mg pills $92.00 cement/table/knife.

Lyrica 150mg pills $92.00 It was busy.

*****

The shift started with three nurses and an ER tech who work hard and work well together.

The doctor on duty was a great guy (and I’m not just saying that because my co-workers know I blog). Lyrica 150mg pills $92.00 He’s calm, lyrica 150mg pills $92.00 friendly, lyrica 150mg pills $92.00 unflappable and a great doc on top of it.

We do not get overwhelmed easily, lyrica 150mg pills $92.00 but we were overwhelmed that night.

We approached the doc and told him we were going on divert unless he had any objections.

He didn’t and we diverted.

*****

One caveat of the diversion policy is a six hour limit in a 24 hour period.

This means we don’t divert unless we have to and we divert sparingly.

We used a considerable chunk diversion time that night.

*****

At 0330, lyrica 150mg pills $92.00 our third nurse was off duty. Lyrica 150mg pills $92.00 Now we were down to two nurses. Lyrica 150mg pills $92.00 No dedicated triage nurse. Lyrica 150mg pills $92.00 No dedicated charge nurse. Lyrica 150mg pills $92.00 No nurses to call in for back up.

We were so out of ratio it was pathetic. Lyrica 150mg pills $92.00 We told the supervisor we were both filling out “Assignment Despite Objection” forms and we never ask for those. Lyrica 150mg pills $92.00 It was that busy and the patients were that sick.

*****

We maintained a full department until around 0530 that morning, lyrica 150mg pills $92.00 when we went off divert.

So we had a solid six hours of non-stop running. Lyrica 150mg pills $92.00 No breaks, lyrica 150mg pills $92.00 no meal, lyrica 150mg pills $92.00 no bathroom, lyrica 150mg pills $92.00 and worse, lyrica 150mg pills $92.00 no coffee!

When we advised that we were going off divert, lyrica 150mg pills $92.00 our doc said something that floored me.

He said, lyrica 150mg pills $92.00 and I’m paraphrasing, lyrica 150mg pills $92.00 that he figured we knew when we were overloaded so he let us (the nurses) decide when we needed to go on divert, lyrica 150mg pills $92.00 but if anyone asked him why we were on divert for five hours he would shrug his shoulders and say he could have taken care of another patient.

Essentially, lyrica 150mg pills $92.00 if there was any question, lyrica 150mg pills $92.00 it had nothing to do with him.

Excuse me?

It’s a good thing I like this guy or I’d have smacked him upside the head.

*****

Let me state this diplomatically.

The nurses do the triaging of the patient and the rooming of the patients. Lyrica 150mg pills $92.00 We place the chart in the to-be-seen pile.

The ER doc examines the patient, lyrica 150mg pills $92.00 decides what tests to order or confirms the tests we have already initiated per protocol, lyrica 150mg pills $92.00 and then walks out of the room and onto the next patient.

All those orders that he writes?

They are carried out by the nurses.

The questions and requests from patients and family members? The continual assessment of the patient’s response, lyrica 150mg pills $92.00 the continual reassessment of vital signs and symptoms? The placement of the IVs, lyrica 150mg pills $92.00 the drawing of the labs, lyrica 150mg pills $92.00 the placing of the foley catheters, lyrica 150mg pills $92.00 the insertion of the NG tubes? The endless documentation of everything that goes on with the patient while they are in the ER? The running for ice chips, lyrica 150mg pills $92.00 warm blankets, lyrica 150mg pills $92.00 more pain medication, lyrica 150mg pills $92.00 more nausea medication? The written report required before admission?

These are all done by the nurses.

*****

So while the nurses (and tech and secretary) were running our butts off trying to meet the needs of multiple sick patients for the entire shift, lyrica 150mg pills $92.00 in the doctor’s eyes, lyrica 150mg pills $92.00 we weren’t that busy and he could have easily done more.

While we shared the same space, lyrica 150mg pills $92.00 we were definitely working in parallel universes.

And that’s when it hit me. Lyrica 150mg pills $92.00 It’s something I fundamentally knew, lyrica 150mg pills $92.00 but had never heard it so clearly stated.

Nurses are from Mars and doctors are from…

…some other galaxy all together.

Either way, lyrica 150mg pills $92.00 we don’t see this world through the same eyes.

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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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