Common Sense Is a Loosely Used Term

It's been a while, but we're back.

There are some bodily things that are common sense to most of us. We regularly brush our teeth; we try to eat healthy; we put on sunscreen. Most responsible adult people care to maintain their body to at least some degree. Or do they?

Mr. Marlboro man got mugged one night and kicked in the groin multiple times. Naturally, he came to the hospital for some much needed assistance and got sent home with a strong painkiller. Several days later, he noticed a growing black spot on his groin. But he waited. And waited. And by the time he came in, he had flesh eating-bateria that had devoured most of his scrotum and leg. Sounds fun huh?

Now let's ask the jury: would you sit on a growing black necrotic spot? OR think to yourself "maybe I should go back and get this checked out?" As much fun as flesh-eating bacteria is, I would opt for the hospital and saving essential body parts. But that's just me.

Mrs. G developed a tumor on her abdomen. But because the thought of having cancer was so horrendous to her, she decided she would ignore it and put it out of her mind. She successfully tricked her consciousness to believe that she didn't have a tumor. So by the time she came in, it was the size of a watermelon and terminal.

As good as I would look in a swimsuit and as much as I would like to give myself a psych disorder, I think I would opt for tumor removal at my earliest convenience. Just sayin.

Let's just call him David. David went to a rap concert and of course had to get high and drunk because apparently it's no fun sober. So he smoked and drank and, surprisingly enough, fell down a flight of very concrete stairs. As a total buzzkill, the paramedics brought him in and we evaluated him for a head injury. He wouldn't let us call his parents and we couldn't legally without his permission. So I was stuck babysitting a drunk kid.

But in walks his visitor. His "girlfriend" fell asleep in a chair in the ER and someone brought her up. It's the middle of the night, she's in high school, and she's wearing no shoes.

Let's stop on the no-shoes thing for a minute. Do you realize how many people have spit, puked, peed, pooped, spilled, rubbed a communicable disease on, or had a baby on those floors? A LOT. AND YOUR FEET ARE TOUCHING THAT. I would not, over my dead body, sit, sleep, or let my child roll around on that floor. Just take yourself down to the ER and ask them to burn the first layer off your skin.

Continuing on. Marcie walks in with no shoes. Her dress is so short I can see way too much on both ends and her makeup is stained down her face from crying and sleeping. In short, she's a hot mess. I sit her down, get her a blanket to cover herself up before a drunk patient tries to hit on her, and try to get the details.

"So is this your boyfriend?"

"Well we've gone out a couple times"

"Why don't you go home, take a shower, and come back later on in the morning?"

"I don't know where my car is."

"You don't know where his house is?"

"No, I don't remember."

"Ok well let's call your mom and get her to come pick you up"

"They don't care. I'll call them in the morning"

"I'm sure they won't mind coming to get you, considering the circumstances."

"It's alright."

So homegirl has no car, no food, no parents who want to pick her up even though she's still in high school and obviously doesn't know the meaning of "high standards". I let her borrow some hospital pants and give her a dollar for the vending machine. And I refrained from saying "don't stay with this loser! Go to college and get a boyfriend who isn't high and clumsy!" And get out of here before someone draws your blood for a tox screen too.

Ms. Collins had some decaying, loose teeth at home. But she didn't have time to get them fixed. So she superglued them in. And she thought that was a good idea at the time. But then she got in a car wreck and they fell out. The daughter wanted to know if she could get free dentures since she was in the hospital! Negative ma'am. This is what your tax dollars go to, people.

I don't even have time to talk about all the people who get an infected tooth, sit on it, and end up with a giant infection over their entire face that has to be cut out with multiple following plastic surgeries. Or the diabetics who one day notice their foot is green or black and get really pissed when you tell them it has to come off. Or my 450 lb patient who sat and ate a bucket of butter popcorn and bossed me around all day. I'm sorry I'm inconveniencing you when I just broke my back trying to pull you up in bed.

I'm not trying to sound insensitive. It's my comic way of showing that not all of the world has the same standards of hygiene or healthcare. I'm not saying you have to floss everyday but let's make a collective effort to prevent blackened body parts. Is that asking too much from the general public?

Thank you to all of your who do actually floss, brush your teeth, see a dentist, see a doctor, take your insulin, eat healthy, work out, avoid dirty needles, get vaccinations, make good life decisions, and don't sleep with shady people. Your contribution to society is duly noted.

Twas the Season to Be Jolly

Twas the season to be jolly. I'm referring to those individuals who ventured out into the chilly weather to attend holiday parties, imbibe excessive amounts of alcohol, and screw that better judgment (yeah!) by proving their ignorance in the form of drunk driving. Or those who chose to stay home this year and smash, crush, and snort various plant or medicinal derivatives leading to a soporific stupor or joining their alcoholic friends in taking the wheel, valiantly ready to conquer the menacing highway 75. Twas the season for smoking, snorting, drinking, shooting, experimenting, fighting, and vomiting. Twas the season for pot, cocaine, cheese, heroin, alcohol, codeine, amphetamines, benzos, and, my personal favorite, all the shit in your crazy aunt's medicine cabinet at once.

A early twenties kid comes in from an MVC. He states he wasn't driving but there was no one else at the scene...that leaves you buddy. We ask him the obligatory "do you do drugs" question or in his case "what do you do?" He proceeds to list off an honestly quite impressive list. Shoots heroin 3-4 X a day. Takes 5 or 6 hydrocodone in a day. Mixes it up by snorting some cheese (heroin plus tylenol pm). I think there were some benzos in the bunch too (ativan, xanax, etc). You always ask a druggie where they shoot up because they know their veins much better than you and can usually point you to a good IV spot. It's a strange kind of role reversal...All in all, he hadn't been fully conscious in 3 years and was flunking out of community college. (The most heartbreaking part about that story was his younger brother, who no doubt looks up to his stoner brother, broke down crying at the bedside. Mom gave me a look that meant she already knew. She didn't even have to ask).

He starts complaining of pain so I give him one hydrocodone (the usual ordered dose). He literally scoffs at it and says he takes 4 or 5. Welp, sorry. You only get one. This isn't your own personal pharmacy. It's your fault you have the tolerance of a 400 pound pro wrestler.

He continues to whine (literally, it sounded like my younger sister when we were little and she was upset) and threatens to throw up. Oh goodness, you're going to puke?? What will I do?? I better give you twelve hydrocodone. Nope. Go ahead, vomit. You don't scare me.

Then he threatens diarrhea. Clearly, he doesn't understand that my JOB is to clean up CRAP. Do your worst. You'll be more uncomfortable than I will.

Finally he passes out and I hand him off. I don't mean to sound insensitive but people who do drugs are generally very manipulative and you have to put your foot down. Otherwise a girl like me gets taken for granted. taken for a ride. used. You get the picture.

My second prime example is a young gentleman who had a brain bleed. He was a chronic drug abuser with Turrets with his crazy boyfriend at the bedside. Talk about a triple threat. He just sat there yelling "ow, ow, ow, ow" over and over and everyone really did feel very bad for him. He took so much morphine at home that nothing we gave him would nullify or improve the pain. You had to feel sorry for him because he was cute but after a while I needed someone to push the off button (again, don't take me for an insensitive jerk).

These cases are not the anomalies. Sometimes our frequent flier drug abusers are well known to everyone in the ER, homeless, and have underlying psych issues. But I'm not stereotyping. Anyone can have a knee replacement, get a little too used to taking their codeine, and end up sneaking around breaking into their neighbors medicine cabinets or having fifteen primary doctors who ALL fill their Ativan prescription. It's all too common and all too frequent. So let's all learn a valuable lesson from this holiday season and say no to drugs! That public service message was useful. in 1984. I think the kids in those commercials are still wearing high tops and neon polyester jackets.

So to quote from a fellow crazie (because we all know it would just be rude to quote David at the Dentist), "hide your kids. Hide your wife. Cause there's a [drug abuser] in the neighborhood. Run and tell that".

Death by Whatever

I went to Six Flags the other day and thought I was going to die. No joke. The history is that I've been there a billion times and have always enjoyed riding roller coasters. This time, as we approached the pinnacle, as my sister and I sat entrapped in this metal container, I thought I was going to see Jesus. I saw the ground so terribly far below me, panicked at how high we actually were, and literally have never been so scared in my life. I've never had that feeling before. The rational part of my brain that is supposed to identify this as "fun" labeled it "imminent doom". Never mind why, in my right mind would I straps myself in willingly, endure a torturous fall where I always black out and leave with a POUNDING headache? I'm assuming this is due mostly to the next statement.

This sounds pretty morbid but let me explain. I imagine scenarios entailing my own death often. I can always identify situations around me that would lead to a horrible demise. I attribute this morbidity to the uncommon circumstances surrounding a majority of our patients injuries. When you see people who got a 2X4 through their neck in a car wreck and are now paralyzed (really happened) or a woman who was in an elevator when it broke and fell 22 feet leaving her with both broken legs (really happened), or a man who got his leg bit off by a random zebra (I wish for his sake that that was false), you see those imaginary situations awaiting for you.

Whenever I'm driving, I never follow behind large trucks with ladders or wood or whatever in the back because that's just asking for one through your windshield, pinning you to the seat as the firemen use the jaws of life to get you out as the gasoline spills out and you are racing the clock.

If I was cooking and my kitchen exploded and my face was horribly burned beyond recognition would I want a face transplant? Who would I want to look like? Would I turn to online dating?

I saw someone in a movie who had gotten their arm cut off in a foreign country and had to get it amputated. It physically caused me agony to think of myself in that situation, more for the horridly unsterile nature of that environment than the actual injury. I would demand a jet from the embassy to take me out, rather than dying of sepsis alone in some godforsaken place.

If I got shot, what part of my body would I most willingly sacrifice? Arm? Leg? Would I get a gang tat after that to legitimize the experience?

If I got kidnapped like the movie Taken and was sold to the European slave trade, would Liam Neilson be there to save me? Or would I have to stab someone with a heroin needle to avoid hallacious STD's and an early death in a brothel?

If I was on a plane and someone emergency surgery and we were in the middle of the Atlantic ocean and there was no help for hours and no one else medical on the plane and the person was asking me to save him on his dying breath, would I perform a tracheotomy to save his life using a straw and a balloon to ventilate him?? Would I???

These are the weird things that go through my mind. I understand if you don't want to be my friend anymore. I can't help it. You could be walking down the street and someone could drop a piano on your head. Unlikely, yes, but somebody once made the mistake of thinking that impossible. But most of the time, I just focus on being alive and thanking the Lord for protecting me thus far.

And if you need help falling asleep at night, I'm not the person to call. Goodnight.

The ICU: PG-13. Only suitable for creepers and crazies.

There’s one word that has been coming up often at work lately: inappropriate.

Example #1: A burly man in his 40’s gets into a single car collision. He insists that he had a “medical episode”, which actually means he’s trying to divert the attention away from his positive tox screen (he’s high as a kite) by making up a fake diagnosis. Unfortunately for him, I did actually pay attention in nursing school and I’m not a complete idiot. He consistently asks me to call his girlfriend but alas, he never memorized the number. He blames it on “those Iphones”, rather than acknowledging the fact that in reality, she’s probably simply his dealer. He asks me to google her. Yeah, let me just google every Jane Doe in Dallas, Texas. That’s simple.

He tells me how to find her… You are a creeper, aren’t you. I’m going to go take my name badge off now just in case your last 5 “girlfriends” are sitting in your freezer right now.

Then it’s bath time and he makes some snide and very offensive “jokes” about slutty nurses….there you have it. Inappropriate. I gave him a piece of my mind that included something about objectifying women and the value of nursing as a noble and selfless profession. Then I told him to shut it. He mocks me, naturally, but then he gets to be bathed by a bunch of guys. Take that.

Example #2: I have an elderly gentleman who wants to chat about anything and everything while I’m doing his assessment.

Pt: “Are you married?”

Me: “Nope”

Pt: “Do you have a boyfriend?”

Me: “Nope”

Pt: “Well don’t you think you should get on it?”

At this point, his daughters are trying not to laugh and they are apologizing. It’s ok ladies, much worse things have been said to me. I go with it.

“Yeah, you and my mother would appreciate that”. I’m attempting to joke with this little old man.

Pt: “Well it’s not like you’re ugly or anything”

Thank you. That’s reassuring. Inappropriate.

Example #3: A young Hispanic girl gets in a car wreck (MVC or motor vehicle collision) and she ends up with us but she’s relatively fine. She’s sitting up in bed, feeding herself, watching tv etc. Her boyfriend comes in, skipping high school no doubt, and he proceeds to lay in the bed with her.

“Sorry buddy you have to stay in the chair. It’s a hazard to the patient because of all those wires”.

“Oh ok, sorry.” And he sits back down.

I come around a few minutes later and he’s halfway sitting on the bed, trying to slowly creep back in. This time I just give him a look. He quits. Then I get a hit (a new admit) so I’m gone for a while.

When I come back, I kid you not, they are full on making out in the bed, him practically on top of her. Inappropriate! Ugh! This is a hospital and you don’t even have a real room, just a curtain! So I threw back the curtain and they both just look at me like deer in headlights (or head lice, if you get that reference…). Anyways, I guess when you’re 16 you don’t care about authority and you just want to make out against the rules so you go for it. Nevermind about rules or germs or a little thing called birth control. That’s probably what you’re both missing in school today. Ironic.

Much worse things have happened but I dare not tell them over the internet. This is a PG-13 blog people… this is all you get for now.

Modern Families

Everyone complains about their family. Everyone has an eccentric aunt or a controlling mother or a passive father. We all know that no one, despite how nice it may look from the outside, has the "perfect" family. But regardless of all the quirks and annoyances and sometimes even deeply rooted hurts, most people would go to bat for their family without question. (Did you catch the Rangers reference....ok we can continue).

We see people at their worst moment; the night they got that phone call they've been dreading all their life. And while my job is to take care of the patient, it would be devastating to ignore the family members who make up a vital part of every patient's life. Family means a connection, something invariably permanent, that supercedes old regrets or arguments. And when something threatens the existence of the family, people completely forget why they have been mad the past 5 years or even that they got divorced 20 years ago.

I've seen ex-wives show up at the bedside for husbands who cheated and left them long ago. I've seen estranged children fly halfway across the country, forsaking even their own families, to hold the hand of a father who never could get it right. The mistakes don't seem to matter when you realize it might be the last time you look upon their living face or say some last words.

I had a patient the other day who had cancer and an extensive surgery to remove tumors. This patient continued to get more and more sick and her sister sat vigilantly at the bedside. Her sister refused to leave, partially because she was so worried, and partially because she had no where to go. She was from out of town and had no car and little money. A dire situation, I think we would all agree.

Because I was hanging blood, giving fluid boluses, and trying to figure out why this patient was declining, I wasn't able to attend to the sister, who sat weeping with her face in her hands. We had someone else come talk to her and try to answer her questions.

After my shift was over, I was walking out and saw the sister, staring at her phone as if she was wishing for a miracle from it. I sat down next to her and we talked for a while. I told her I would be praying for sister because I believe the Lord can heal and do miraculous things. Her sister divulged some of the weighty details of their family situation and I felt so much compassion for her, as she was literally at the end of her rope. She joked that she hadn't even brushed her teeth in a day and I gave her a pack of gum. It was all I had but we laughed that at least it was something.

It was a small encounter but I left that day feeling like I had a connection to this family. This all may sound cheesy but it's vividly true. I care about a family I don't even have yet! I pray for my husband and the little children hopefully I will have. Sometimes I feel like I can see their faces, from a distance. Crazy what you feel, even for an imaginary family :) Or maybe I'm just the crazy one.

I feel like I'm getting a little sappy because I'm having a lonely day so I'll wrap it up. Love on people! Christ gives us no greater calling. Love is the greatest of all the commandments. The End.

Out of the morphine the mouth speaks.

These are actual conversations I've had lately...

Me: "What happened? How did you get stabbed?"

Patient: "Well, I wuz tryin to break up the fight and I got stabbed, caught in da crossfire".

Me: "Hmm. Well this house arrest ankle bracelet does make me wonder whether you're telling me the truth or not"

Pt: "That wuz a mistake too!"

Dad comes in later with the charger for the house arrest bracelet. Because obviously you have accessories for those things.

Me: "Sir you can't use that because it's not an approved device"

Pt's dad:" But see if we don't the police come and get real mad! It mean big trouble!"

Me: "Ok sir. But I'm pretty sure they've figured out by now that he's not at home anymore..."

Me: "Sir do you remember what happened to you? Do you remember how you got hurt?"

Pt (clearly dopped up on morphine and speaking in slurs): " I got bit by an alligator"

Me: "Actually it was a zebra, sir."

Pt (throws his hands up): "Ah, Same difference.."

(He actually did have to have his leg amputated because his friends pet zebra bit it off. ??)

Pt (precious elderly gentleman with a head injury who thought we were still in 1954 and looked exactly like the old guy from Up): "Can I give you a kiss?"

Me: "No silly! This is the hospital and I'm your nurse"

Pt: Look of shock. Clearly does not understand the situation, nonetheless the decade.

Me: "Did you think you were at a bar and you were picking up girls?"

Pt:"Yes!"

Pt (high on who knows what and so drunk he got a facilitated trip to the hospital): expletive you. expletive this whole place. you expletive expletive". Charming.

Me: Don't use that kind of language around here, especially in front of women!"

Pt: "You guys are women?"

Me: "Buddy do you know where you are or what happened to you?"

Pt: "This is the worst drug trip ever!"

Me: "You cannot get out of bed. You are on narcotics and it's very dangerous because you might fall".

Pt: grunts as if he understands.

Later

Me: "Sir you cannot get out of bed! I understand you can't pee laying down but do not put your two feet on the ground".

Pt: grunts, as if he gives a crap what I'm saying

A bit later.

Me: "Ok listen buddy. This is the last time I'm going to tell you. DON'T get out of bed or there will be consequences" (in my best mom voice)

A little more later.

Catch the pt in the act. Standing up beside the bed and looks at me as if daring me to yell at him.

Me: "It is 5 in the morning and I've had it! YOU ARE DISRESPECTING ME, THIS HOSPITAL, AND EVERYONE WHO IS TRYING TO TAKE CARE OF YOU. IF YOU FALL, IT'S GOING TO BE ME THAT GETS SUED AND YOU WHO GETS HURT. NOW GET BACK IN BED RIGHT NOW. GOT IT??"

PT: " yes maam"

Winner. Personal victory for achieving a new level of intimidation.

This is by far the most entertaining aspect of my job. You just never know what you're walking into every morning. That's why it's entertaining.

A Peek Into My World

Here I am...almost midnight. I have a cup of tea in hand and I'm kinda hyper. You've been fair warned.

13 hours. 3o min lunch. 2 15 min breaks (if you get them). 3 assessments. 2 I&O's (intake and output). Q1 vitals (Q means every hour). Maybe Q1 glucose sticks if you get the short end of the stick. 1 CT scan. Countless meds. My life at work is measured in chaotic predictability. An oxymoron you say? Things are not what they seem...

People really have no idea what my day to day looks like. They either believe every minute is a trauma scene from ER where I'm sweaty from doing chest compressions and yelling "Get the crash cart STAT dammit!" Or they think I get paid to babysit deranged and demented neuro patients who throw their sippy cup on the floor a billion times and I have to pick it up. It's somewhere in the middle. So here's a layout for you, a night shift layout since that's what I'm currently entrenched in. Ready, set.....set....go.

I arrive at work between 6:30 pm and 6:40 pm (1830-1840). The charge nurse comes in, reads a synopsis of each patient, and then all hell breaks loose. By this time, I've learned to listen for the most pertinent information. Q1 glucose sticks= a huge pain. Contact isolation= skip that one. Wady (our term for actin a fool, trying to get out of bed and such)= guaranteed frustration by the am. Blood pressure issues= a sick patient (aka fun). At the instant the last syllable rolls off the charge nurses tongue, everyone begins screaming the pair that they want. There is a strategy to this: get there early so you get a seat next to the charge nurse and yell directly into their ear or get there late so you can stand over their shoulder for maximum proximity. Sometimes you get lucky, sometimes you panic from all the pressure and end up taking whatever is last. Sometimes it ends in hurt feelings, bitterness, and cussing. All that fun before your shift starts.

You either skip with glee or drag morosely to your side (depending on the pair you got) and get report from the off-going RN. There's also a system to this and some people get really FREAKED out if you don't follow it but that's for another day. You begin your 8pm (2000) assessments. Then you chart. The goal is to be done by 8:30-8:45. Now if your patient throws up or poops or some other calamity, the course of your night will already be altered. But you go with it. Flexibility, people.

At around 9:30 (2130), you can start doing your 10pm stuff. You go get your meds out of the pyxis, empty the foley bag, clear your pumps, give the meds, and chart. We do I&O's (intake and output, remember it- I don't want to have to define it again young lady) twice on night shift which is fine if you have one pump but sucks if you have to count about 9 JP drains, two chest tubes, an ostomy, a foley, and a flexiseal. If you don't know what some of those things are, there's a little thing called google.

Now at this point your night could go several ways. Your side could be getting a lot of new admissions so you spend all your spare time helping your cohorts. You could have an existing patient crump out of nowhere and end up coding him. You could have a habitual pooper (the worst) and spend every 30 mins cleaning up the same you know what. On a magical night, when the mice and birds sing to you and you're home by midnight with both glass slippers, everyone stays quiet. You spend some time chatting with your friends or reading a book. But sometimes you're bored and want to stay busy. So whether it's good or bad depends on how much sleep you got the day before and if you just want to go home already.

At midnight you reassess your patients, give meds and draw labs. If you patient has a great arterial line, then you can draw the blood from there and it takes two seconds. Piece of friggin cake. But let's say Pedro here doesn't get blood return from his existing peripheral IV's and has crappy veins. You spend about 30 minutes looking and poking at veins until finally you get barely enough and pray that lab doesn't cause a ruckus. I can't even get into the subject that is lab. Probably not ever, if I'm attempting to do this thing called sanctification. If you have a neuro patient, you might have to travel down to CT scan. You have to unhook your patient from all non life-sustaining drip meds, pack them up, and transfer them to a stretcher. That takes anywhere from 5-15 mins. Then you and either the respiratory therapist (if you're patient is vented) or a tech go down the elevator, push the stretcher really fast like this is vitally important (it makes it so much more dramatic and entertaining), get to CT, move your patient onto the CT table, take the CT, and do the whole thing in reverse. Reverse. reverse. Everybody clap your hands.

Everyone usually bathes their patients between 2-3 am because there's not much else you need to do during this time. Granted, if your patient is stable and sleeping, you might want to spare them the early morning embarrassment and let them do it themselves during the day shift. At 0400 you reassess again (last time) and chart.

Now around 0500 an ominous thing occurs. If you're a rookie, you get sucked in but later on you learn how to deal with it... Medical students. They come to your bedside about 0515 and want to anything and everything about your patients. If you don't know any better, you'll waste a good 15 minutes updating them because you believe they actually have some impact on patient care. Now don't get me wrong, I love myself a good med student, especially if he's cute and nice to me, but there's a time and place. When I'm tired at 0515 is not that time.

At 0530 you start again with meds, I&O's, and maybe a serial lab or two if we're gettin crazy. The doctor teams starting rounding and everything starts to wake up (except you, who are on your 3rd cup of coffee). Family members come back in and your replacement nurses make a lap or two before shift starts. Those last 30 mins (0630-7) are the longest of your shift. But they do come to an end, you give report, and assuming nothing happens and you don't have to intubate or code anyone, you clock out and go to breakfast. The sun is rising and the early morning traffic is at its best as you drive home to convince your body that yes, now is the time to sleep.

There you have it. I hope this affords more clarity to those of you who see my job as a nebulous cloud of abbreviations and big words. And if you ever want to go to breakfast when I get off, let me know :).