First off...they call it the ED now. I wonder if they will rename the television show...?
Emergency personnel are my heroes. Hands down. Talk about a group of steely-eyed professionals. I was in a the emergency department big city hospital with a Level 1 shock trauma center and it has been such a great leap for me in terms of advancing my clinical skills. It was also terrifying to realize how on top of everything these nurses need to be and the enormous gap I have yet to traverse to get there. If there was ever a profession that epitomizes multi-tasking, it must be ER nursing.
Every student's experience on a given day will be different -- some of us will hop from patient to patient fairly quickly and see a good number of them during our shift. My first day, I really only saw 2 but that was because I was in the two rooms right next to the trauma bays and we had a couple of patients that needed a lot of care, and took a lot of time.
Codes don't happen in real life like they happen on TV or in the movies. Heck...probably because of this, I didn't even realize I was in one, until my instructor asked me about it later! All I knew, was we had about 15 people in our room for about an hour. Then somehow things turned and poof! -- it was back to just me and my nurse and our very sick patient. During the Code, people were hopping, but somehow it seemed like controlled chaos, this team knew all the dance steps and stayed out of each other's way as they all performed their own tasks. The doctor was so relaxed and no one was shouting, just quietly going about their business. Amazing.
Since I could do hardly anything but just stay out of their way, I had time to notice random things. Since my nurse and I had personally inspected the room and gone through every drawer with an inventory checklist -- I knew we were ready. And I could see why he took this step VERY seriously. As the Code ran it's course...the floor just got filled with debris. All the packaging for every supply was on the ground and they ran through supplies in a shockingly fast clip. I began to think about how, not having one critical item and that crucial moment could just make it or break it for my guy on the table, fighting for his life.
Then there was a whole nurse just standing off to one side documenting everything that happened, every drug given, dose and time. Every order. Procedure. She was like the court reporter. And...its because of today's law-suit happy society that we have her.
All of the "right ways" we learned to do things in class...many fall by the way-side when there is no luxury of time. And that's not a criticism.
Then I saw symptoms occurring in my patient that I wondered if I would ever see. It's called "Decorticate Posturing" and it's sad that I got to see this in real life, because it's never a good sign when the arms go really stiff and flex outward. But I saw it.
I also noticed veteran nurses who have done it a million times struggle with things that I would struggle with now, and that kind of comforted me. After a patient is given an artificial airway, they often need to get a tube down to decompress the stomach. Getting that tube down can be tricky. Even for the pros.
So we got through the Code and after a few hours, our patient was transferred up to the floor and we turned our attention to the next patient. She was thrashing around and confused, so when it came time to give her an IV, I had to wrestle to keep her arm still so my nurse could get a line. After a few failed attempts she had so much blood running down her arm and onto her hand that it looked much worse than it had to be. But she managed to work her arm free at one point and grab my white sleeve with her bloody hand and I looked like I had been finger-painted. It reminded me of old episodes of MASH and how Hawkeye was always awash in gore.
For this lady I got to apply restraints. Something I haven't really had to do before. She was a really sweet little old lady who just needed a little help to keep her safe.
The next day was more excitement and I saw many more patients and got to do more things. Sunk my first IV, a nice big 16 gauge needle, which was awesome. There's this thrill when you see the flash of blood return in the catheter and know you got it I just can't really describe. I'm sure they would discourage cheering, but that's what I wanted to do.
One patient stands out and will likely change how I worry about people who live alone. She had gone down in her home for a week before she was found. She was in a very bad state by the time we got her, and she smelled wretched from having laid in her own filth for that long. Soooooo sad! My eyes would water any time I approached her room. The other nursing students hadn't gone in, but I finally wanted to help and went in and offered. It was just so great to take care of her and make her comfortable. I figured if the whole floor could smell her, surely she could too! We made it better and that's when the nurse I was helping looked up at me, laying across her and holding her arm in position for him to try and get a vein, and said, "Now there's a REAL nurse!" Meaning me! I asked him why he said that and he replied, "You see any other people in here offering to help? We're not that busy..." I floated on that compliment the rest of the day.
I do want to be a REAL nurse.
:)
Sunday, October 14, 2012
Wednesday, September 26, 2012
Exorcisms and Lunatics
A report from this term studying Acute Care nursing, which includes time in the ICU, ER and the Psych unit. We are starting the last half of this term and it has been quite a ride both here at school and in my personal life. Since this blog is about nursing school, I'll focus on that.
First, the med-surg update, wherein I spent the first half of my clinical time taking care of VERY sick and dying patients in the step down critical care floors. I would describe this part of clinical as being thrown right into the deep end of the pool. Where previously I'd have the occasional challenge of more than one IV bag/ pump to deal with, the odd Foley bag or maybe an exciting deep wound dressing to change, usually it was just one of these things at a time to focus on. By contrast, with THESE patients, it was like the Nursing Gods said, "I'll SEE your bag of poop, your purulent wound, your bags of fluids....and I'll RAISE you a feeding tube, PLUS, three more pumps, AND a trach, a vent, heart monitor, an ART line, dialysis, and a couple of amputated limbs!"
The question was more like, "What WASN'T going on with my patient....?"
Like adrenalin? ...Become a critical care nurse.
You might recall my lingering fear of patients who have an artificial airway and the phlegm that is associated with it. Yeah...I'm pretty much over that. Each patient I had this term had this going on...sometimes to an alarming degree. My gag-o-meter did blip a couple times as I initially learned to suction, and I by no means relish this task, but because I did it so often, I became desensitized. I did have my nursing instructor's haunting words running through my mind as I dealt with the holes in the necks of my patients and tried to keep a reasonable distance from that opening. He said, "Make sure you keep your mouth closed when you suction...because a patient coughs and it will shoot straight in your mouth! So no talking!" I pray this never happens, and yet I can see how easy that foul outcome could occur. These folks generate a LOT of goop. Nuff said.
You might be wondering why I refer to exorcism in the title of this post. [Queasy people will want to skip ahead.]
Sadly, I was about to call a priest to fight the demons I thought must be inhabiting my poor patient one day. It was straight out of the movie. She needed just a crazy amount of medications that we needed to give into her feeding tube. It was a staggering number and I just kept thinking, any healthy person would feel sick after all this. [Foreshadowing.] There was also a decompression tube sticking out of her belly that emptied into a bag on the side of the bed filled with both stomach and bowel contents. It was a sick dark forest green / brown and I had to fight from walking in a circle around it just because I feared bumping it and somehow spilling the mess on the floor. The night nurse had changed it and had reported it was the most foul-smelling brew she had ever encountered. That was enough for me...and I was just grateful that the bag was not even close to full, meaning I wouldn't have to change it!
She also had a trach, so she breathed out of a tube in her neck. After a student and I had done our morning care, flipping her this way and that, tidying her bed up, we began raising the head of the bed back up and that became our exorcism nightmare. Suddenly noxious green-brown goop started gushing out of her mouth and down her chin! Terrified it was going to leak right into her trach airway and she would inhale it...I jammed my (gloved) hands under chin and began catching the stuff and my partner quickly tried to suction out her mouth! That's. When. The. SMELL. Came. And my eyes instantly began to water and my own stomach threatened to heave. Nothing could touch this...not a pus-filled necrotic wound, not poop, not vomit. This stuff made me want to run from the room and never return. And just as we would catch up with the suctioning, more would gurgle and froth from her mouth making me wonder just when her head going to start spinning around and she would levitate from the bed!
We eventually got her cleaned up and settled and I sent the trash far FAR from the room so the smell would fade. As much as I hated this, I just kept thinking how bad was it for HER?? This girl had so many things wrong with her I couldn't fit it all on my clinical paperwork, she couldn't talk, felt sick and then something as nasty as that had to happen. And she was MY age!!
Acute care has taught me that when things go wrong...sometimes they go very, very wrong.
So far I got to see and do so many things in the first half of the term, that it was very exciting and terrifying. I am now in my psych rotation and that is like moving from one planet to another. I'll end my term with 2 weeks in the ER, which could get really interesting.
I'm back from my day with the crazies.
Actually, my 2nd day. A few weeks of psych lecture and all of the conditions and their lists of signs and symptoms began to merge together. Depression, bi-polar, schizophrenia, severe anxiety. And we haven't even covered them all. Then I got to go to the floor and saw the real stories and the real people whose lives are utterly destroyed by these conditions. Many of them will never be okay and lead a normal life. But they are not just a list of symptoms to me anymore.
I observed an advanced case of schizophrenia in a relatively young woman. She sat and rocked, carrying on conversations with people who weren't there. I thought to myself how strange to live in this age when if I saw her walking down the street talking out loud like that, I wouldn't even wonder. I'd just think she had a hands-free bluetooth device in her ear and I'd walk on by. In decades past, that behavior would stand right out.
I interviewed another schizophrenic, a pleasant enough guy who was happy to talk to me. I got through a number of questions when he casually mentioned he'd done time for killing a couple of people, like he was commenting on the fine weather we were having.
Another young guy looked like he should have his whole life in front of him is debilitated with bi-polar disorder and completely isolated from society. He was smart and funny, and didn't mind that I whooped his butt in a game of chess. Then I read his file and saw the downward spiral he has been on and I grieve for his future unless medications can help correct his condition.
So many psych patients isolated from society for something they can't help. I'm profoundly sad about this and my experience with these patients has given me a lot more understanding of just how derailed and lost they are. I know for sure I'll never want to be a psych nurse because the hands-on care is part of the job I really like and I'm not sure I have the mental stamina to deal with what psych nursing entails, but I also know that I'm looking at the whole issue in an entirely new light.
First, the med-surg update, wherein I spent the first half of my clinical time taking care of VERY sick and dying patients in the step down critical care floors. I would describe this part of clinical as being thrown right into the deep end of the pool. Where previously I'd have the occasional challenge of more than one IV bag/ pump to deal with, the odd Foley bag or maybe an exciting deep wound dressing to change, usually it was just one of these things at a time to focus on. By contrast, with THESE patients, it was like the Nursing Gods said, "I'll SEE your bag of poop, your purulent wound, your bags of fluids....and I'll RAISE you a feeding tube, PLUS, three more pumps, AND a trach, a vent, heart monitor, an ART line, dialysis, and a couple of amputated limbs!"
The question was more like, "What WASN'T going on with my patient....?"
Like adrenalin? ...Become a critical care nurse.
You might recall my lingering fear of patients who have an artificial airway and the phlegm that is associated with it. Yeah...I'm pretty much over that. Each patient I had this term had this going on...sometimes to an alarming degree. My gag-o-meter did blip a couple times as I initially learned to suction, and I by no means relish this task, but because I did it so often, I became desensitized. I did have my nursing instructor's haunting words running through my mind as I dealt with the holes in the necks of my patients and tried to keep a reasonable distance from that opening. He said, "Make sure you keep your mouth closed when you suction...because a patient coughs and it will shoot straight in your mouth! So no talking!" I pray this never happens, and yet I can see how easy that foul outcome could occur. These folks generate a LOT of goop. Nuff said.
You might be wondering why I refer to exorcism in the title of this post. [Queasy people will want to skip ahead.]
Sadly, I was about to call a priest to fight the demons I thought must be inhabiting my poor patient one day. It was straight out of the movie. She needed just a crazy amount of medications that we needed to give into her feeding tube. It was a staggering number and I just kept thinking, any healthy person would feel sick after all this. [Foreshadowing.] There was also a decompression tube sticking out of her belly that emptied into a bag on the side of the bed filled with both stomach and bowel contents. It was a sick dark forest green / brown and I had to fight from walking in a circle around it just because I feared bumping it and somehow spilling the mess on the floor. The night nurse had changed it and had reported it was the most foul-smelling brew she had ever encountered. That was enough for me...and I was just grateful that the bag was not even close to full, meaning I wouldn't have to change it!
She also had a trach, so she breathed out of a tube in her neck. After a student and I had done our morning care, flipping her this way and that, tidying her bed up, we began raising the head of the bed back up and that became our exorcism nightmare. Suddenly noxious green-brown goop started gushing out of her mouth and down her chin! Terrified it was going to leak right into her trach airway and she would inhale it...I jammed my (gloved) hands under chin and began catching the stuff and my partner quickly tried to suction out her mouth! That's. When. The. SMELL. Came. And my eyes instantly began to water and my own stomach threatened to heave. Nothing could touch this...not a pus-filled necrotic wound, not poop, not vomit. This stuff made me want to run from the room and never return. And just as we would catch up with the suctioning, more would gurgle and froth from her mouth making me wonder just when her head going to start spinning around and she would levitate from the bed!
We eventually got her cleaned up and settled and I sent the trash far FAR from the room so the smell would fade. As much as I hated this, I just kept thinking how bad was it for HER?? This girl had so many things wrong with her I couldn't fit it all on my clinical paperwork, she couldn't talk, felt sick and then something as nasty as that had to happen. And she was MY age!!
Acute care has taught me that when things go wrong...sometimes they go very, very wrong.
So far I got to see and do so many things in the first half of the term, that it was very exciting and terrifying. I am now in my psych rotation and that is like moving from one planet to another. I'll end my term with 2 weeks in the ER, which could get really interesting.
I'm back from my day with the crazies.
Actually, my 2nd day. A few weeks of psych lecture and all of the conditions and their lists of signs and symptoms began to merge together. Depression, bi-polar, schizophrenia, severe anxiety. And we haven't even covered them all. Then I got to go to the floor and saw the real stories and the real people whose lives are utterly destroyed by these conditions. Many of them will never be okay and lead a normal life. But they are not just a list of symptoms to me anymore.
I observed an advanced case of schizophrenia in a relatively young woman. She sat and rocked, carrying on conversations with people who weren't there. I thought to myself how strange to live in this age when if I saw her walking down the street talking out loud like that, I wouldn't even wonder. I'd just think she had a hands-free bluetooth device in her ear and I'd walk on by. In decades past, that behavior would stand right out.
I interviewed another schizophrenic, a pleasant enough guy who was happy to talk to me. I got through a number of questions when he casually mentioned he'd done time for killing a couple of people, like he was commenting on the fine weather we were having.
Another young guy looked like he should have his whole life in front of him is debilitated with bi-polar disorder and completely isolated from society. He was smart and funny, and didn't mind that I whooped his butt in a game of chess. Then I read his file and saw the downward spiral he has been on and I grieve for his future unless medications can help correct his condition.
So many psych patients isolated from society for something they can't help. I'm profoundly sad about this and my experience with these patients has given me a lot more understanding of just how derailed and lost they are. I know for sure I'll never want to be a psych nurse because the hands-on care is part of the job I really like and I'm not sure I have the mental stamina to deal with what psych nursing entails, but I also know that I'm looking at the whole issue in an entirely new light.
Tuesday, July 10, 2012
Old-Timers
Or...Alzheimers.
We spent time studying dementia this term. I have to say, I never really thought much about this patient population before then, which is weird because both grandmothers succumbed to it. And because of it, I have often joked that I'd rather go out in a fiery ball of flames while still in my prime than lose my mind slowly. When I saw on our clinical rotations for the term that we'd be spending time at an Alzheimer's facility, I quietly freaked a little bit.
Old people scared me as a kid. I thought they smelled off. They shook. They pinched my cheeks too hard. They cough and hack up big loogies. (During my childhood, a loogie expelled by an elderly person in our front seat unfortunately stuck to the inside of our windshield during some drive...and I was the only one to notice it there, dangling and suspended for the duration of the trip. This memory has unfortunately stuck with me...and launched my fear of both old people...and phlegm in a single incident.)
I grew out of that, and now I really enjoy the company of our older generation. But I do admit that sick, old people still kind of unsettled me prior to entering this profession. I don't like to see suffering of any kind, but I think seeing older folks sick in bed touches something primal in me which says, "that'll be you someday" -- and I'd spook.
Armed with our new knowledge of the disease process and nursing care associated with Alzheimer's, we began our time at the facility -- no ordinary home, the place is dedicated to this type of patient, and one whose family can afford the six grand a month it costs to live there. It was outside of the city in a very affluent community and I already wondered where they house the ones who can't afford to live there.
I don't know what I was worried about...because I can now say I enjoyed my time with these patients so much, I had a hard time leaving them. The place was as homey as it was possible to make it, the staff were loving and very skilled at communicating with patients in various stages of the disease. Our biggest objective wasn't to provide nursing care to these folks -- it was to learn how to communicate with them effectively. So we went there primarily just to observe and interact.
What did I do?
I fed a lady who was becoming too advanced, she was close to needing to be moved into a full-time nursing facility, because she was entering the final stage. She was non verbal, unable even to eat by herself, and wandered around vacantly the rest of the time. I would occasionally redirect her, or bring her to meal times. She also fell (so common) and I was first to her side, trying to keep her from attempting to get up until a staff member could be sure she was un-hurt. Other than a nasty goose-egg, she was okay. Still, during those minutes trying to keep her still, I saw shear terror and pain in her eyes, and it was all I could do to keep her from panicking. She nearly wrenched my arm off trying to rise -- which reminds me that caring for these folks can be very physical.
I danced. When the singer came to entertain everyone, we were encouraged to act as a pep-squad; handing out tambourines, bells and other instruments for audience participation. We clapped and sang along and I was amazed how even some of the more advanced patients could recall every word to the oldies! There were a few gentlemen who were willing to get up and once they did, still remembered how to lead me in a fox-trot. It's true that long-term memory can linger when short term memory is completely shot.
I took orders. Some of these patients are quite un-patient-like. They could be mistaken for staff. One younger lady was so convincing, she started ordering us around to tidy up. "Get these chairs put away!" "This place is a mess!" Thinking she worked there...I helped stack some chairs! Doh!...she was a resident. [This was amusing to the staff, and to my instructor.] Patients wear clothing, not gowns -- and because of "white coat syndrome" (a fear of medical professionals), the staff also wear street clothes. So, for a newcomer, it can be tough to tell them apart!
I rocked a baby. Another very advanced lady carried around a doll who had a name, and who was very real to her. (This is actually quite common...to bond with a favorite item.) In any case, during the music session, I watched her point to the singer and whisper things in her baby's ear. She would rock and mother her, and bring her everywhere. When it was time to get this lady into the bathroom, she was very unwilling to put the baby down in order to go do her business. The staff member saw me nearby and offered my help to "hold the baby" while she went. I swear this patient pinned me with her eye contact as if to silently warn me that this was a Big Deal, and handed the doll over. I effusively reassured her that I took this task seriously, as any mother would, and reflexively began bouncing and rocking the baby! Then...since toileting can take a while, the staff member went to a nearby counter and began folding laundry and asked if I'd like to help. I nervously glanced back and forth between her and the bathroom door -- what was I supposed to do with the baby?! I'd made this promise to look after her! I laid the baby down on the counter, kept one eye on the door, and helped out. The SECOND I saw that door handle jiggling, I swooped up the baby, resumed my stance and surrendered the it to my nervous mother when she emerged. She snatched her back and all was again right in her world.
I passed out snacks. We all rolled a cart around and became very popular as we handed out ice cream, asking vanilla or chocolate, and serving it up. Many times when we returned to our customers...they had forgotten what they ordered, but were still happy to see us. Then, when we had made one pass around the place, we still had many ice cream cups left -- as many patients had declined. One student asked me..."Shoot, what do we do now that we have so much left?" I said, "Let's go around again, they won't remember us being there the first time!" And it was true. Many that had declined before, took us up on it the second time around. And it is so important for these patients to keep weight on, or even to gain weight, that we didn't want to waste an opportunity.
I took a walk. One lady appeared quite standoffish, and was even referred to as snobby. She had this old-world, old-money feeling to her. Considering the zip-code, she very likely was! She kind of glared down her nose at everyone, and mostly wandered the hallways, looking at the driveway, as if expecting her chauffeur to arrive at any moment. None of the students had engaged her yet, so finally I mustered up courage to ignore her glares and offered to take her for a walk. One of the things we learned is that in those patients who were raised in higher social circles where manners and "social graces" were expected -- they can cover the onset of their disease in the early stages with meaningless pleasantries. In fact, on our walk, I relied on that and she graciously answered my remarks about our fine weather, these lovely roses, and other generally acceptable social ice-breakers with the expected replies. Anyone listening in on our conversation wouldn't really guess she had Alzheimers. This is because I didn't ask her any questions that required recall. However the answers were robotic, and yet allowed her some feeling of normalcy as we strolled.
When it was time to go, I had bonded with so many of these folks, and with the amazing people who cared for them, that I was a little sad to leave. On my way out, I approached the lady that I had fed, the one who was non-verbal. I said good-bye expecting no response and instead she reached out and hugged me and then, plain as day said, "Thank you. Good to see you." And all of the nursing students, and our instructor just stood amazed, grinning. They were the only words we ever heard her say!
Okay, I got a lump in my throat after that.
I have a whole new outlook on the subject of Alzheimer's now...and consider my time with these folks a gift. So many of them will end up in my hospital, and because they will be out of their environment, in crisis, and away from the caregivers who know them and their particular needs so well -- they will be frightened.
I'm so glad I got to practice how to reach them.
We spent time studying dementia this term. I have to say, I never really thought much about this patient population before then, which is weird because both grandmothers succumbed to it. And because of it, I have often joked that I'd rather go out in a fiery ball of flames while still in my prime than lose my mind slowly. When I saw on our clinical rotations for the term that we'd be spending time at an Alzheimer's facility, I quietly freaked a little bit.
Old people scared me as a kid. I thought they smelled off. They shook. They pinched my cheeks too hard. They cough and hack up big loogies. (During my childhood, a loogie expelled by an elderly person in our front seat unfortunately stuck to the inside of our windshield during some drive...and I was the only one to notice it there, dangling and suspended for the duration of the trip. This memory has unfortunately stuck with me...and launched my fear of both old people...and phlegm in a single incident.)
I grew out of that, and now I really enjoy the company of our older generation. But I do admit that sick, old people still kind of unsettled me prior to entering this profession. I don't like to see suffering of any kind, but I think seeing older folks sick in bed touches something primal in me which says, "that'll be you someday" -- and I'd spook.
Armed with our new knowledge of the disease process and nursing care associated with Alzheimer's, we began our time at the facility -- no ordinary home, the place is dedicated to this type of patient, and one whose family can afford the six grand a month it costs to live there. It was outside of the city in a very affluent community and I already wondered where they house the ones who can't afford to live there.
I don't know what I was worried about...because I can now say I enjoyed my time with these patients so much, I had a hard time leaving them. The place was as homey as it was possible to make it, the staff were loving and very skilled at communicating with patients in various stages of the disease. Our biggest objective wasn't to provide nursing care to these folks -- it was to learn how to communicate with them effectively. So we went there primarily just to observe and interact.
What did I do?
I fed a lady who was becoming too advanced, she was close to needing to be moved into a full-time nursing facility, because she was entering the final stage. She was non verbal, unable even to eat by herself, and wandered around vacantly the rest of the time. I would occasionally redirect her, or bring her to meal times. She also fell (so common) and I was first to her side, trying to keep her from attempting to get up until a staff member could be sure she was un-hurt. Other than a nasty goose-egg, she was okay. Still, during those minutes trying to keep her still, I saw shear terror and pain in her eyes, and it was all I could do to keep her from panicking. She nearly wrenched my arm off trying to rise -- which reminds me that caring for these folks can be very physical.
I danced. When the singer came to entertain everyone, we were encouraged to act as a pep-squad; handing out tambourines, bells and other instruments for audience participation. We clapped and sang along and I was amazed how even some of the more advanced patients could recall every word to the oldies! There were a few gentlemen who were willing to get up and once they did, still remembered how to lead me in a fox-trot. It's true that long-term memory can linger when short term memory is completely shot.
I took orders. Some of these patients are quite un-patient-like. They could be mistaken for staff. One younger lady was so convincing, she started ordering us around to tidy up. "Get these chairs put away!" "This place is a mess!" Thinking she worked there...I helped stack some chairs! Doh!...she was a resident. [This was amusing to the staff, and to my instructor.] Patients wear clothing, not gowns -- and because of "white coat syndrome" (a fear of medical professionals), the staff also wear street clothes. So, for a newcomer, it can be tough to tell them apart!
I rocked a baby. Another very advanced lady carried around a doll who had a name, and who was very real to her. (This is actually quite common...to bond with a favorite item.) In any case, during the music session, I watched her point to the singer and whisper things in her baby's ear. She would rock and mother her, and bring her everywhere. When it was time to get this lady into the bathroom, she was very unwilling to put the baby down in order to go do her business. The staff member saw me nearby and offered my help to "hold the baby" while she went. I swear this patient pinned me with her eye contact as if to silently warn me that this was a Big Deal, and handed the doll over. I effusively reassured her that I took this task seriously, as any mother would, and reflexively began bouncing and rocking the baby! Then...since toileting can take a while, the staff member went to a nearby counter and began folding laundry and asked if I'd like to help. I nervously glanced back and forth between her and the bathroom door -- what was I supposed to do with the baby?! I'd made this promise to look after her! I laid the baby down on the counter, kept one eye on the door, and helped out. The SECOND I saw that door handle jiggling, I swooped up the baby, resumed my stance and surrendered the it to my nervous mother when she emerged. She snatched her back and all was again right in her world.
I passed out snacks. We all rolled a cart around and became very popular as we handed out ice cream, asking vanilla or chocolate, and serving it up. Many times when we returned to our customers...they had forgotten what they ordered, but were still happy to see us. Then, when we had made one pass around the place, we still had many ice cream cups left -- as many patients had declined. One student asked me..."Shoot, what do we do now that we have so much left?" I said, "Let's go around again, they won't remember us being there the first time!" And it was true. Many that had declined before, took us up on it the second time around. And it is so important for these patients to keep weight on, or even to gain weight, that we didn't want to waste an opportunity.
I took a walk. One lady appeared quite standoffish, and was even referred to as snobby. She had this old-world, old-money feeling to her. Considering the zip-code, she very likely was! She kind of glared down her nose at everyone, and mostly wandered the hallways, looking at the driveway, as if expecting her chauffeur to arrive at any moment. None of the students had engaged her yet, so finally I mustered up courage to ignore her glares and offered to take her for a walk. One of the things we learned is that in those patients who were raised in higher social circles where manners and "social graces" were expected -- they can cover the onset of their disease in the early stages with meaningless pleasantries. In fact, on our walk, I relied on that and she graciously answered my remarks about our fine weather, these lovely roses, and other generally acceptable social ice-breakers with the expected replies. Anyone listening in on our conversation wouldn't really guess she had Alzheimers. This is because I didn't ask her any questions that required recall. However the answers were robotic, and yet allowed her some feeling of normalcy as we strolled.
When it was time to go, I had bonded with so many of these folks, and with the amazing people who cared for them, that I was a little sad to leave. On my way out, I approached the lady that I had fed, the one who was non-verbal. I said good-bye expecting no response and instead she reached out and hugged me and then, plain as day said, "Thank you. Good to see you." And all of the nursing students, and our instructor just stood amazed, grinning. They were the only words we ever heard her say!
Okay, I got a lump in my throat after that.
I have a whole new outlook on the subject of Alzheimer's now...and consider my time with these folks a gift. So many of them will end up in my hospital, and because they will be out of their environment, in crisis, and away from the caregivers who know them and their particular needs so well -- they will be frightened.
I'm so glad I got to practice how to reach them.
Friday, July 6, 2012
Shock of Re-Entry -- Summer Break
I've been so busy, I neglected to blog the whole last term! And now I've been home for three days. Time to catch up.
It would be too much to try to cover all of my impressions and experiences I had during this term in one blog post. I'll make it a summer project to reflect on all of that. Tonight I'll focus on current events.
Friday, on 48 hours with little to no sleep I wrote my final. My study group and I had to literally pull each other across the finish line because individually we had all hit our respective walls. Among us we had chain-smoking, endless fits of crying, incoherent babbling and fits of rage. Pure adrenalin pulled me through and then I clenched for the "rest of the story" -- because as much as we all wanted to celebrate in our usual fashion (corner bar at 11:00 am over beers), we knew we'd be saying goodbye to students who found out they failed out of the program. So far I know of 7 good people who won't be with us in the fall. It makes me profoundly sad to see some of them go. So the last day of any term is bittersweet.
On top of that we said goodbye to our graduating seniors that night. So after a couple of beers, I went back to the dorm for two hours of precious sleep, before rousing to attend the graduation ceremony. So...more tears, albeit happy ones. Still-- I'll be missing some of the good friends I made this year. The seniors did provide some great insights and encouragement in terms of getting through this first year. I can't wait to hear how they all do writing their boards this summer and landing their first jobs. They must know They Are Being Watched!
During finals week, students were succumbing to illness all around me, and I smugly boarded the plane home thinking I had avoided it for once. Don't know what I was thinking. I got sick my first day back and I may be getting sicker by the day. Bronchitis, rhinitis, laryngitis and otitis. You know another -itis? -- I probably have that too! This may be the universe's idea of a joke, because I was going to be without health insurance for only about a week and a half before I start back at work next Tuesday. So, of course, I'll probably get pneumonia the way this is going.
I feel out of sorts being back home.
At school, we literally have bars around us when we go out on the porches (to keep us from jumping off??) Of course, it feels like prison. Many jokes are made about this, and...like prisoners, we fondly start off many conversations during middle of the night with, "When I get outta here, I'm gonna...." (Fill in the blank.)
So now I'm out. I'm free!! At least for about 6 weeks. Maybe its the time zone change, maybe its illness, or...more likely, its Post Traumatic Stress Disorder -- but being on the outside feels very strange. Like I've forgotten something. Or I should be doing something. I just don't know quite what to do with myself. Reconnecting with friends and family is lovely, and I'd be enjoying that more if I wasn't coughing up a lung and without a voice. But, there's this nagging feeling, it's almost surreal. I walked down the steps to my home, for the first time since I left for nursing school last summer, and I thought..."Did I just wake up from a bad dream?" It all felt quasi-normal: heading back down to the cabin on the beach, walking the same steps, trailing behind my son who was carrying all the heavy stuff as usual. But this is only a brief interlude at the mid-point of this journey called nursing school. The friends and family here can't really know what it's like doing this...and my "fellow prisoners" are all enjoying their brief parole back east.
I think it's time for self-care just now. I better bite the bullet and go in for a throat culture before this pestilence in my throat turns into full-blown pneumonia -- which will waste too much of my precious time. In a few more days, and with the help of some really good drugs, I'll finally ease into my summer and enjoy it!
It would be too much to try to cover all of my impressions and experiences I had during this term in one blog post. I'll make it a summer project to reflect on all of that. Tonight I'll focus on current events.
Friday, on 48 hours with little to no sleep I wrote my final. My study group and I had to literally pull each other across the finish line because individually we had all hit our respective walls. Among us we had chain-smoking, endless fits of crying, incoherent babbling and fits of rage. Pure adrenalin pulled me through and then I clenched for the "rest of the story" -- because as much as we all wanted to celebrate in our usual fashion (corner bar at 11:00 am over beers), we knew we'd be saying goodbye to students who found out they failed out of the program. So far I know of 7 good people who won't be with us in the fall. It makes me profoundly sad to see some of them go. So the last day of any term is bittersweet.
On top of that we said goodbye to our graduating seniors that night. So after a couple of beers, I went back to the dorm for two hours of precious sleep, before rousing to attend the graduation ceremony. So...more tears, albeit happy ones. Still-- I'll be missing some of the good friends I made this year. The seniors did provide some great insights and encouragement in terms of getting through this first year. I can't wait to hear how they all do writing their boards this summer and landing their first jobs. They must know They Are Being Watched!
During finals week, students were succumbing to illness all around me, and I smugly boarded the plane home thinking I had avoided it for once. Don't know what I was thinking. I got sick my first day back and I may be getting sicker by the day. Bronchitis, rhinitis, laryngitis and otitis. You know another -itis? -- I probably have that too! This may be the universe's idea of a joke, because I was going to be without health insurance for only about a week and a half before I start back at work next Tuesday. So, of course, I'll probably get pneumonia the way this is going.
I feel out of sorts being back home.
At school, we literally have bars around us when we go out on the porches (to keep us from jumping off??) Of course, it feels like prison. Many jokes are made about this, and...like prisoners, we fondly start off many conversations during middle of the night with, "When I get outta here, I'm gonna...." (Fill in the blank.)
So now I'm out. I'm free!! At least for about 6 weeks. Maybe its the time zone change, maybe its illness, or...more likely, its Post Traumatic Stress Disorder -- but being on the outside feels very strange. Like I've forgotten something. Or I should be doing something. I just don't know quite what to do with myself. Reconnecting with friends and family is lovely, and I'd be enjoying that more if I wasn't coughing up a lung and without a voice. But, there's this nagging feeling, it's almost surreal. I walked down the steps to my home, for the first time since I left for nursing school last summer, and I thought..."Did I just wake up from a bad dream?" It all felt quasi-normal: heading back down to the cabin on the beach, walking the same steps, trailing behind my son who was carrying all the heavy stuff as usual. But this is only a brief interlude at the mid-point of this journey called nursing school. The friends and family here can't really know what it's like doing this...and my "fellow prisoners" are all enjoying their brief parole back east.
I think it's time for self-care just now. I better bite the bullet and go in for a throat culture before this pestilence in my throat turns into full-blown pneumonia -- which will waste too much of my precious time. In a few more days, and with the help of some really good drugs, I'll finally ease into my summer and enjoy it!
Tuesday, April 10, 2012
I'm Pretty Sure the O.R. Made Me Shorter
I loved my two OR experiences. LOVED them! I know for sure I don't want to work in one...at least, not right now. But the experience was so rewarding.
Last week I got to see a surgeon hunting for a bullet that had been lodged for 2 years in the guts of my dear, sweet patient. The doc hunted for that thing like an easter egg before giving up and repairing the damage it had done to his parts so he could look forward to a "normal life." I met the patient before the surgery, watched his insides get rebuilt for several hours, and then stayed with him in the PACU for a couple more hours since he had nobody there to hold his hand, except his two prison guards. We had a good talk about his hopes and dreams and I didn't leave his side until I was made to go.
Did I mention he was a prisoner?
I wish I could share how much this case touched my heart and reminded me of why I wanted to be a nurse in the first place, but...there are privacy laws. Let me just say that I hope I never forget him. The other students watched as I fed him his ice chips and stayed close so he wouldn't be afraid and declared that if they are ever in the hospital, they want ME as their nurse!
Aw...shucks.
Today was my final day in the O.R. rotation and I faced another fear. The fear of watching the gore that is an orthopedic joint surgery. Why is this my fear? Because I had four surgeries to rebuild my humpty-dumpty left arm not so long ago, and have some titanium in there to prove it. Since I'll be facing more of such surgeries in the future (for maintenance) -- I just wasn't sure I was up to seeing up and bloody close just what goes on in there!
Meh. No big deal. I was glued to the procedure the whole time. I orbited all around the table to make sure I saw every drill, wire and bolt. It was disgusting and fascinating. I loved it.
What I do NOT love about the O.R....
The fashion. Really, the only way to express oneself is by way of eye makeup. (Designers like to express themselves.) It's kind of like a Burka-Situation. The puffy blue hats are as far away from sexy as possible. And you can think some guy could be good looking under all the layers of blue...and yet be disappointed when the patient is rolled away and the guy lowers his mask.... I'm just saying.
It's a meat locker. If you are perpetually cold, like me, this environment is unacepptably frigid. Good for patients because bacteria like warm places to grow. Bad for me. The menopausal ones around me LOVE it.
The lead. If you are going to work in an orthopedic OR, they will ask you if you are wearing lead. You may think about the uncomfortable underwire bra for a second, and then say no. And then they will wrap you in an apron of lead down to your knees and you'll stagger away under its weight. They take lots of x-rays while they drill holes in bones. You will consider your pre-osteoporotic bones, and of the discs of your spine crushing in on themselves under the weight of this new torture device. You will wonder why you didn't drink more milk and if you will be two inches shorter by the end of the day. Bad enough that you will be standing on your feet for four hours in a meat locker, but now you are also shrinking.
And then the surgery will be over and you will take off the lead...
And you will float away!!!
Last week I got to see a surgeon hunting for a bullet that had been lodged for 2 years in the guts of my dear, sweet patient. The doc hunted for that thing like an easter egg before giving up and repairing the damage it had done to his parts so he could look forward to a "normal life." I met the patient before the surgery, watched his insides get rebuilt for several hours, and then stayed with him in the PACU for a couple more hours since he had nobody there to hold his hand, except his two prison guards. We had a good talk about his hopes and dreams and I didn't leave his side until I was made to go.
Did I mention he was a prisoner?
I wish I could share how much this case touched my heart and reminded me of why I wanted to be a nurse in the first place, but...there are privacy laws. Let me just say that I hope I never forget him. The other students watched as I fed him his ice chips and stayed close so he wouldn't be afraid and declared that if they are ever in the hospital, they want ME as their nurse!
Aw...shucks.
Today was my final day in the O.R. rotation and I faced another fear. The fear of watching the gore that is an orthopedic joint surgery. Why is this my fear? Because I had four surgeries to rebuild my humpty-dumpty left arm not so long ago, and have some titanium in there to prove it. Since I'll be facing more of such surgeries in the future (for maintenance) -- I just wasn't sure I was up to seeing up and bloody close just what goes on in there!
Meh. No big deal. I was glued to the procedure the whole time. I orbited all around the table to make sure I saw every drill, wire and bolt. It was disgusting and fascinating. I loved it.
What I do NOT love about the O.R....
The fashion. Really, the only way to express oneself is by way of eye makeup. (Designers like to express themselves.) It's kind of like a Burka-Situation. The puffy blue hats are as far away from sexy as possible. And you can think some guy could be good looking under all the layers of blue...and yet be disappointed when the patient is rolled away and the guy lowers his mask.... I'm just saying.
It's a meat locker. If you are perpetually cold, like me, this environment is unacepptably frigid. Good for patients because bacteria like warm places to grow. Bad for me. The menopausal ones around me LOVE it.
The lead. If you are going to work in an orthopedic OR, they will ask you if you are wearing lead. You may think about the uncomfortable underwire bra for a second, and then say no. And then they will wrap you in an apron of lead down to your knees and you'll stagger away under its weight. They take lots of x-rays while they drill holes in bones. You will consider your pre-osteoporotic bones, and of the discs of your spine crushing in on themselves under the weight of this new torture device. You will wonder why you didn't drink more milk and if you will be two inches shorter by the end of the day. Bad enough that you will be standing on your feet for four hours in a meat locker, but now you are also shrinking.
And then the surgery will be over and you will take off the lead...
And you will float away!!!
Friday, March 30, 2012
Friday...Glorious Friday
It isn't uncommon for me to feel like I "crash land" into Friday at the end of every week while in nursing school - however this week is more like a meteor plummeting from space. This is because last night marked the first night that I (among a small group of hearty souls) pulled an all-nighter before our exam this morning.
Now I remember why I don't do that anymore.
The grades aren't where I'd like them to be this term. I had anticipated this coming into it because of the heavier class load, however, I'm not thrilled that I was proven right. I don't mind the grades dipping, since I never started out with the idea of being an A student. I want to be a balanced student. However I'm especially displeased that I'm missing points this term simply due to Operator Error! I failed my first exam in my life this term -- which was extremely puzzling since I knew I had prepared at LEAST enough to PASS. Well in the post-mortem, it turns out I marked an answer on the answer sheet on the wrong line, and that made the subsequent five (correct) answers, also wrong! Doh! I don't mind missing points for answers I had no clue about, but it does chap my hide to miss them because I didn't bother to go back and check that I'd filled them out correctly!
Still, the poor grade is a black mark on this term's grade-book for me, and is in part why I decided to cram all night for today's exam, on which I did admirably - but still not up to my usual standard.
I think I've just identified the theme for this term: Not Up To My Usual Standard.
How very underwhelming.
We are two weeks away from finishing term 3 and yes, that theme just about sums it up. As promised, the term was incredibly hard academically (and the beatings are far from over). I found myself hitting new lows in every area: emotionally, academically, endurance, nutrition, exercise...and personal hygiene.
An older gentleman stopped me as I was leaving my favorite diner/study spot this weekend, put his hand on my arm and said, "good luck in nursing school -- it's the hardest thing you'll ever do." (I was wearing my school sweatshirt.) I said, "You a nurse?" He smiled and said yes. I wanted to throw myself into his arms and cry, but instead I gave him a wobbly smile and said, "It IS hard, in fact...it's kicking my ass!" And we both laughed.
It has been kicking my ass, I'm not going to lie.
And in the middle of the "fog of war" -- I'm amazed at the things that can occupy my mind and interrupt my thoughts. All of them seem oriented around the bottom of Maslow's Hierarchy of Needs. The following list are random thoughts I have had during lectures about gangrene, osteoporosis, amputations, etc:
[I am estimating I will fall a few points in terms of your respect for me now...]
"I wonder when I last washed my hair?"
"Did I wear these clothes yesterday?"
"When did I last eat?"
"I wonder if I have any money."
"I wonder if the cafeteria has pie."
"Mmm...I put clean sheets on my bed. Man, I want to be in my bed right now." {I actually yearn for my bed like a lover on most days.}
"How can I write this Care Map and still watch Idol tonight?"
"Did I go pee yet?"
"OMG -- am I out of BUTTER? How can I make popcorn and study all night without BUTTER?!"
Yes -- lofty thoughts, those. Oh sure, other stuff breaks through now and then. Things like world peace and the fallen state of man, n' such. But don't be surprised if you call me one day and say...what about those elections? And I say...what elections?
It's that bad.
Now I remember why I don't do that anymore.
The grades aren't where I'd like them to be this term. I had anticipated this coming into it because of the heavier class load, however, I'm not thrilled that I was proven right. I don't mind the grades dipping, since I never started out with the idea of being an A student. I want to be a balanced student. However I'm especially displeased that I'm missing points this term simply due to Operator Error! I failed my first exam in my life this term -- which was extremely puzzling since I knew I had prepared at LEAST enough to PASS. Well in the post-mortem, it turns out I marked an answer on the answer sheet on the wrong line, and that made the subsequent five (correct) answers, also wrong! Doh! I don't mind missing points for answers I had no clue about, but it does chap my hide to miss them because I didn't bother to go back and check that I'd filled them out correctly!
Still, the poor grade is a black mark on this term's grade-book for me, and is in part why I decided to cram all night for today's exam, on which I did admirably - but still not up to my usual standard.
I think I've just identified the theme for this term: Not Up To My Usual Standard.
How very underwhelming.
We are two weeks away from finishing term 3 and yes, that theme just about sums it up. As promised, the term was incredibly hard academically (and the beatings are far from over). I found myself hitting new lows in every area: emotionally, academically, endurance, nutrition, exercise...and personal hygiene.
An older gentleman stopped me as I was leaving my favorite diner/study spot this weekend, put his hand on my arm and said, "good luck in nursing school -- it's the hardest thing you'll ever do." (I was wearing my school sweatshirt.) I said, "You a nurse?" He smiled and said yes. I wanted to throw myself into his arms and cry, but instead I gave him a wobbly smile and said, "It IS hard, in fact...it's kicking my ass!" And we both laughed.
It has been kicking my ass, I'm not going to lie.
And in the middle of the "fog of war" -- I'm amazed at the things that can occupy my mind and interrupt my thoughts. All of them seem oriented around the bottom of Maslow's Hierarchy of Needs. The following list are random thoughts I have had during lectures about gangrene, osteoporosis, amputations, etc:
[I am estimating I will fall a few points in terms of your respect for me now...]
"I wonder when I last washed my hair?"
"Did I wear these clothes yesterday?"
"When did I last eat?"
"I wonder if I have any money."
"I wonder if the cafeteria has pie."
"Mmm...I put clean sheets on my bed. Man, I want to be in my bed right now." {I actually yearn for my bed like a lover on most days.}
"How can I write this Care Map and still watch Idol tonight?"
"Did I go pee yet?"
"OMG -- am I out of BUTTER? How can I make popcorn and study all night without BUTTER?!"
Yes -- lofty thoughts, those. Oh sure, other stuff breaks through now and then. Things like world peace and the fallen state of man, n' such. But don't be surprised if you call me one day and say...what about those elections? And I say...what elections?
It's that bad.
Tuesday, March 13, 2012
Gag-O-Meter
I have rejoined the living after the busy day at clinicals, thanks to my three hour power nap. I still have much to do and its already rounding on midnight, so instead of getting started on all that...of course I'll blog.
First of all, I kind of smirk when I type: "busy day at clinicals." At this point, I really think the words "busy day at" should just be implied. I think I have a really high tolerance for change on the fly. Heck, I ran a design studio for years, full of creative and brilliant lunatics. There existed no linear process of A to B. I honestly don't know how folks could enter the medical profession if they were wired to expect to make a "plan" and then "follow it" to the letter. Still, even I am constantly adjusting to the whole new world of crazy that is the hospital floor. As we are learning in school, there is the "ideal outcome" for any given situation, and then...there's what really happens. Reconciling how far apart those two things really are is always surprising for me. And I'm a Type B! Lord help all those Type A nurses out there!
One incident today (among several less interesting things) shot my best laid plans all to hell. It also makes for an interesting story, although those of you with a delicate constitution may like to skip it and go back to whatever it was you were doing.
THE HEMOVAC.
Sometimes when you have surgery you'll wake up attached to a circular accordion-like vessel which is about the size of a saucer. The surgeon will squish down this plastic device, which is attached to a tube inside your surgical site, and which will then provide a bit of suction and a place for that nasty stuff to collect outside your body. This is a Hemovac, and today my knee-surgery patient had that snaking out of his tidy full-leg bandages on his first morning post-op. Of course I was excited to see it, since it would be something new for me to experience. He also had a couple of wires sticking out of his tush, a nerve block that kept his whole leg blessedly numb. In other words, he had a lot of lines which could potentially detach from him and ruin both of our days.
Of course that's exactly what happened...and how I discovered the presence of my Gag-O-Meter.
Man, we were SO close to the end of my time with him and everything before that had gone swimmingly well. I even got to give him his mid-day IV push medication. Afterwards my instructor had gone over how I would empty his drain, as it was now expanded about two inches full of blood, and courtesy suggests we don't leave these messy tasks for the next shift...we take care of them before we go. She trustingly left me to do this solo and went to deal with another patient. However, for moral support, I snagged another student who had just completed this task and was willing to talk me through it. Since it was essentially a bag of blood, I figured a mistake could easily ruin both my stark white outfit, AND my reputation!
So my patient was tucked neatly into the freshly made bed (which I had just finished making up while he was at PT) and was starting on his lunch of rubber turkey and powdered mashed potatoes when we approached to deal with the Hemovac. I flipped back the crisp white covers and instead of the cleanly bandaged leg resting on clean white sheets -- he was laying in a bed of gore! Bright red blood was leaking through his thick bandages, beneath him on the bed pad and all over the covers! (My bed!) His drain, and its now detached tube were lying impotently beside him. Since his leg was fully numb, he couldn't even sense the wetness he was lying on.
Rather calmly, the other student and I began to deal with the situation. She went to get a nurse, while I remained with the patient. The male nurse came in, glanced at the bed full of gore and diagnosed blandly, "Drain's out." (Clearly this was a "no-DUH" moment, but I repressed it.) The patient stated that he felt a little tug about 30 minutes ago, and we deduced that shifting around in bed had pulled the tube out. (I realize this isn't exactly rocket science.)
The nurse and I then emptied the drain out of the patient's line of sight, thankfully. I held the measuring cup and he squeezed. The thing is, it's blood. It doesn't just drain right out when you open the valve (say, like urine would.) I hadn't really thought about that fact ahead of time and I was already somewhat steeled to participate in this gross task. (You just never know what event is going to cause you to toss your cookies.)
If you can picture me on a television screen this whole time, down at the bottom of my screen would pop an animated meter - my Gag-O-Meter, which goes from zero to ten.
It was at zero when I entered the room. And I am proud to report that it didn't really twitch when we flipped back the covers to see the bloody mess. When I held the cup and felt the warmth of the blood filling it, the meter moved up to a 1. No big deal. But it wasn't until the nurse began to squeeze the drain, and this long, dark clot just hung there suspended, and then slowly began to snake, quiver and coil its way into my warm cup that the Gag-O-Meter moved up a couple more points. I realized that if I had been: pregnant, hungover, or was just getting a stomach flu, I probably would have hurled. I couldn't tear my eyes off of the seemingly endless clot, and kept worrying that the nurse would squeeze a bit too hard to force it through and maybe spray us both, thereby soiling my outfit -- (at which point, I very well may have soiled the floor.)
I think the Gag-O-Meter got to about a 3 today. I'm betting at a 5, I would actually gag. At a 10, that's when somebody would be holding back my hair. I periodically wonder when/if these events will happen for me personally. Perhaps it will be in a couple of weeks during my OR rotation. If not, I have a sneaking suspicion that another body fluid may send me over the edge when I start to suction tracheal tubes in the ICU...
Phlegm.
First of all, I kind of smirk when I type: "busy day at clinicals." At this point, I really think the words "busy day at" should just be implied. I think I have a really high tolerance for change on the fly. Heck, I ran a design studio for years, full of creative and brilliant lunatics. There existed no linear process of A to B. I honestly don't know how folks could enter the medical profession if they were wired to expect to make a "plan" and then "follow it" to the letter. Still, even I am constantly adjusting to the whole new world of crazy that is the hospital floor. As we are learning in school, there is the "ideal outcome" for any given situation, and then...there's what really happens. Reconciling how far apart those two things really are is always surprising for me. And I'm a Type B! Lord help all those Type A nurses out there!
One incident today (among several less interesting things) shot my best laid plans all to hell. It also makes for an interesting story, although those of you with a delicate constitution may like to skip it and go back to whatever it was you were doing.
THE HEMOVAC.
Sometimes when you have surgery you'll wake up attached to a circular accordion-like vessel which is about the size of a saucer. The surgeon will squish down this plastic device, which is attached to a tube inside your surgical site, and which will then provide a bit of suction and a place for that nasty stuff to collect outside your body. This is a Hemovac, and today my knee-surgery patient had that snaking out of his tidy full-leg bandages on his first morning post-op. Of course I was excited to see it, since it would be something new for me to experience. He also had a couple of wires sticking out of his tush, a nerve block that kept his whole leg blessedly numb. In other words, he had a lot of lines which could potentially detach from him and ruin both of our days.
Of course that's exactly what happened...and how I discovered the presence of my Gag-O-Meter.
Man, we were SO close to the end of my time with him and everything before that had gone swimmingly well. I even got to give him his mid-day IV push medication. Afterwards my instructor had gone over how I would empty his drain, as it was now expanded about two inches full of blood, and courtesy suggests we don't leave these messy tasks for the next shift...we take care of them before we go. She trustingly left me to do this solo and went to deal with another patient. However, for moral support, I snagged another student who had just completed this task and was willing to talk me through it. Since it was essentially a bag of blood, I figured a mistake could easily ruin both my stark white outfit, AND my reputation!
So my patient was tucked neatly into the freshly made bed (which I had just finished making up while he was at PT) and was starting on his lunch of rubber turkey and powdered mashed potatoes when we approached to deal with the Hemovac. I flipped back the crisp white covers and instead of the cleanly bandaged leg resting on clean white sheets -- he was laying in a bed of gore! Bright red blood was leaking through his thick bandages, beneath him on the bed pad and all over the covers! (My bed!) His drain, and its now detached tube were lying impotently beside him. Since his leg was fully numb, he couldn't even sense the wetness he was lying on.
Rather calmly, the other student and I began to deal with the situation. She went to get a nurse, while I remained with the patient. The male nurse came in, glanced at the bed full of gore and diagnosed blandly, "Drain's out." (Clearly this was a "no-DUH" moment, but I repressed it.) The patient stated that he felt a little tug about 30 minutes ago, and we deduced that shifting around in bed had pulled the tube out. (I realize this isn't exactly rocket science.)
The nurse and I then emptied the drain out of the patient's line of sight, thankfully. I held the measuring cup and he squeezed. The thing is, it's blood. It doesn't just drain right out when you open the valve (say, like urine would.) I hadn't really thought about that fact ahead of time and I was already somewhat steeled to participate in this gross task. (You just never know what event is going to cause you to toss your cookies.)
If you can picture me on a television screen this whole time, down at the bottom of my screen would pop an animated meter - my Gag-O-Meter, which goes from zero to ten.
It was at zero when I entered the room. And I am proud to report that it didn't really twitch when we flipped back the covers to see the bloody mess. When I held the cup and felt the warmth of the blood filling it, the meter moved up to a 1. No big deal. But it wasn't until the nurse began to squeeze the drain, and this long, dark clot just hung there suspended, and then slowly began to snake, quiver and coil its way into my warm cup that the Gag-O-Meter moved up a couple more points. I realized that if I had been: pregnant, hungover, or was just getting a stomach flu, I probably would have hurled. I couldn't tear my eyes off of the seemingly endless clot, and kept worrying that the nurse would squeeze a bit too hard to force it through and maybe spray us both, thereby soiling my outfit -- (at which point, I very well may have soiled the floor.)
I think the Gag-O-Meter got to about a 3 today. I'm betting at a 5, I would actually gag. At a 10, that's when somebody would be holding back my hair. I periodically wonder when/if these events will happen for me personally. Perhaps it will be in a couple of weeks during my OR rotation. If not, I have a sneaking suspicion that another body fluid may send me over the edge when I start to suction tracheal tubes in the ICU...
Phlegm.
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