Dust Bowl

This is Lake Overholser in 1935 or my living room. Take your pick. I don't know what my mom did that angered God but she certainly didn't get the daughter she asked for. I believe she wanted one that would clean the house, bake, raise flowers, did I mention clean the house???? *also please note I inherited her house*

Dust is one of those things that overall just doesn't bother me. I figure, I don't bother it, it won't bother me. Then again, if I go and dust it, more just like it appears. Best I can tell there is a never ending supply of dust, but only a limited supply of me (now that's another topic).

But alas, sometimes the dust must be rearranged, today was one of those days. A couple of BOYS my sons age will be here Thursday - Saturday. Note, I said boys, they will not notice (at least none of the ones I've met) however on the off chance their parents enter my home, I have stirred the dust so new dust can appear.

We shall see. I really thought by the time I made the salary I make I could afford to hire someone to come do these tasks for me. Fair trade, I nurse people back to health (or something along that line) and I encourage the economy by getting my house clean. Alas, those people that live in my house demand to be fed, clothed, and have the lifestyle they are accustomed to.

Just another day

Not a bad day, for me that is. Funny thing though, I had to call a family member of my patient that is also an ICU nurse. I guess, maybe, I probably shouldn't have implied that his relative was an "interesting" case. Never a good sign to be told that your loved one is interesting to the nurses.

Cardiogenic shock, temporary pacer, balloon pump, ventalator, and the assorted medications that go along with that. Me, the one with the attention span of a gnat, was interested all day. Intriqued even. Again, not a good sign.

So far, so good. We will watch this one closely. They are very sick, but they have very good doctors. Now all he needs is a good heart.

The Order

You must understand, I rarely defy authority. I understand it's place and my place in the universe. I also understand the delicate role I as a nurse play in the unit compared to the physicians I work with. There are always those that we would not use ourselves and might I add are on the list of those that shan't touch me, but I still respect what they order for their patients. Until......

He's been in the unit for some time, I have never taken care of him but as charge I have kept up with his progress, actually, the lack of progress. We knew in our guts this man would not make it out of the unit, but we still tried to make it so. A week or so ago I began talking to the wife, I saw her daily in there and at some point either as a human or worse as a corporate slave I began to check on her each time I was there. Yet I knew where this was going and I'm not sure she did.

So the man is dying, all systems are shutting down, his body is visibly showing signs of breakdown. The sons had come in the day before at our request because we thought he would die that day. I had been shocked to find him still with us on my return. A doc that is covering for another decides we should get a test that will require us to leave the unit, be off the vent and bag, and jostle him around. When the nurse caring for him tells me about this order I was dumbfounded. I had looked at his labs earlier in the day, and this would blow his kidney function. He had been too unstable for dialysis for days and we were eeking by as it was. I can't defy the order, but in good conscious I couldn't do the order.

I quickly asked God for wisdom, as I didn't know what else to do. We decided to call the kidney doctor to "inform" him of this order. He called the "offending
doc then called us and said it was fine with him for the pt to go for the test as long as the family understood this would knock out the kidneys and he would have to have dialysis at this point. I talked to the family twice, explaining that while I would never defy an order, my concern was that their dad would die in process and I had to live with myself over the benefit of the test verses the consequenses. We were questioning whether or not we could do this but I needed direction from them. In answering questions they came to understand there would be little benefit from the test: we might find out why he was suddenly worse but we couldn't treat him and he would lose the kidney function he had. In the end, they decided not to do the test. The man died during the night.

In explaining to the family why this order was written I tried to protect the physician. They couldn't understand why he would order a test that might kill their father in process and for sure wipe out the kidneys with no real benefit. I explained that for many people they had to understand why. I never made this doctor look bad in my effort (I think) but tried to explain what I really couldn't.

But I was left with the feeling of here's the doctor coming in for 5 minutes ordering something that I will have to do and then I'm left with a grieving family when he dies during the test. I was angry! I support you and at the same time I have to wiggle around to try to be a patient advocate. It is about the patient, not why? Then I have to remember, I can't show the anger, I must comfort the family even when I have little to offer them.

As I left that night, they were each saying goodbye to the husband of 50+ years, the father that was special (they told me this, but I knew from meeting the family the kind of man he was), the grandfather that taught him how to be a man, and a man who endured much from my staff.

I stood up for my patient, I have nothing to hang my head about. I did more than my job, I helped my nurse through this situation, and God gave me wisdom to do all without compromising my self.

Isn't It Interesting....

So I worked ER yesterday, it's been awhile. I find it interesting that two patients I treated had the same thing that I sent my son to a doctors office for. My favorite of the day.... "but I'm allergic to everything but demerol...." to which the doc said he would not give. He asked her where she got that drug, she said her pain doctor. ER doc says, "go to him then."" She promised to complain when she got the patient satisfaction survery. I took her information to the director of the ER, he will be aware that she was seeking drugs. Oh, don't worry about her pain, she asked me for water, took a prescription bottle out of her purse and took some meds.

I love ER, the human species never fails to amaze me. You have wonderful patients, then you have the people that demand all while knowing they will never pay the bill. And they want it all fast!! The ones that won't pay, they know the buttons to push "chest pain" for sniffles, kidney stone for drugs, I even had a drug seeker try to fake an MI for the morphine. But then comes the sweet family that will never put you out even for a blanket as they are shivering.

No great stories from yesterday, I don't get many of those cases. But it's okay, it makes me appreciate those I see in the unit, that really need to be in the hospital and have something I can treat. Maybe some days I need to see that.

I Wonder

Some things have happened at my work, but I see them everywhere that have had me thinking. Do you believe what goes around comes around? Do you think when your boss, or their boss, or whoever, does wrong to a co-worker that it will come back to them?

I personally do. Sadly, many times I suspect they don't recognize what they are doing nor see when it happens to them. Of one I've heard the remark "she isn't happy unless she is beating on someone."

What a horrible way to live your life. I can't imagine being so unhappy that you have to treat your fellow man so. Makes me wonder....... The sad part is, most of these people claim to be Christians, yet you find no fruit in them.

Am I any better? I hope so, but then, I've come to realize I've treated one physician badly and must find a way to apologize that he would accept and in a way that would glorify my creator. I want to do it quietly, but I write this just to say that we need to be aware of our ownselves so that we don't become like these others. I don't want to be a bitter person that must belittle those around me. I really do want to be kind, gentle, exhibiting love and peace to all. What a calling.

I have devised a method of dividing people into classes that is slightly different based on an incident at work. There was a physician that I'm less than fond of. He walked into someone's office as I was sitting there and grabbed a piece of candy. Unfortunately he began choking on it (he survived, don't worry). The interesting thing here is that a) I didn't move, b) neither did the person sitting in the office with me.

Please note, I am a kind and gentle person. Known for my caring and loving attitude. I'm sure that had he not recoved BOTH of us would have saved him. However it was quite thought provoking.

The three types of people in the world:
1. The ones you would save
2. The ones you would save with enthusiasm
3. The ones you shut the door on.

Me and My Boss

Yeah, didn't do so good in friendly class, or kindgergarden.

Oops

I Can't Help It

I'm just stupid this way. I love the cartoon and they are better shared.

Cheers!!

(double click to read text)

I can't help it, just reminds me of people I know. I need a laugh, here's to you!!

Tired

I worked four days in a row, normally only three. I don't know what it is about me being charge that seems to bring out the forces of chaos that it does. The image I would like to project is one of quite harmony in the midst of madness... I'm not there yet.

Strange things happen when I'm charge, let me cite a few cases..... end of shift (18 bed unit) young woman comes in on a balloon pump as two other pts arrive that we had been waiting hours one. Balloon pump pt then needs to be turned completely over (pronation) to help her lungs. Madness!!!

Both my pts transferred out. I wait and wait on the two pts coming to me. First one: heart rate in 20's, being externally paced. No big deal. Which is good, #2 pt is young, the dreaded words "flu like symptoms", brought down to one of the units to prevent coding, now intubated but they decide to put in a balloon pump, after that he comes to me, after I get him they decide to do emergency surgery. This amounts to 40 minutes of hell while we get him, family, docs, lab, chaplain, paperwork ready. Oh, they brought #1 pt in right before this one hit my door, and oops, he's intubated but not sedated yet so there are a few issues that we need to deal with RIGHT NOW. Funny aside: one of the nurses that was tripled up kept saying as bad as his day was, at least he wasn't me!!

Anyway, that was fun. I shall work on my auora and see if that can improve things in the atmosphere. If not, maybe pray over a bag of NS and squirt it around the unit. :)

Irony

I had coffee the other day with the associate Pastor of our church. He's a nice guy, we rescued he and his family from the northern US to the south. I had some kind of response I was going to send him from work so I whipped out an email to his address at the church. His name is Chris..... I made a typo...... this is the response my server gave back......

christ@yourlocalchurch.org> no such user here

Another quickie: one of the docs I work with told me they had a guy helping them part time, he wasn't working out. One of the partners sent out an email telling about the problems and wrote "what a bozo." Unfortunately he sent it to the guy... needless to say they are looking for a new parttimer.

PETA

(to see in full size double click)

I love animals, I have many running around the inside of my house. However, I was moved to write today when I read the Pearls Before Swine cartoon for the day. It is not the one above, but I couldn't find it.

PETA, we all know the group.... People that Eat Tasty Animals..... they prowl around my house and wear down my resolve.

ENOUGH I say!!!! Okay, I can't even type this with a straight face...... I love to eat the animals, cows are my favorites, chickens are high up there.... I only wish I knew the creator of this strip, he is truly twisted.

Cats In Sinks

Found this site, after the last post, you probably need it.

catsinsinks.com

The Patient

Funny, he came in today, I don't know these people, but for some reason when the wife was giving the history to the doc something clicked in my brain. Now I've been doing this for several years and there's always some level that you connect with folks, but this was different.

Prior to the doc going in the room he told me there was only one thing more they could really do for this man. That would be to place a pacemaker in his heart. But basically that was it. The wife began telling the doc that only the top part of his heart worked, the back and the bottom were damaged severly in an earlier heart attack. He was being admitted because he was having V-tach (not a good sign for those that have no clue what I'm talking about - the pacer can shock him out of it).

So what, this happens all the time. I guess that's my point. It was almost like I could see me or my spouse or someone I love standing there matter of factly stating the facts. And the doc replied in kind. He was quite and gentle, but responded as she had with the facts. The facts in this case were basically "this is it, all we can do."

Why does it bother me? I don't know. Maybe it's two young ones that died, maybe it's the ones that "almost came to the unit" (a pediactric code today, a young mother - about a week after having her baby - that died, the ones I read about), maybe it's years of death, I don't know. Am I over the recent deaths, I would have to say no. What can make it better....... I don't know. I've talked until I'm sick of talking. I'm frustrated. Why did they die? Or maybe it was that I thought the one was going to make it and she didn't. Or maybe it's the fear that this man will code on me before we get the pacer and I will be inadequate to stop it. I think that may be it..... fear of being inadequate. I know I'm not in control, as I often say, these forces were in play long before we come onto the scence. Just as I am setting myself up for my health in 20 years, so were they. IT's that element of surprise - boom!! you're dead, hope I can save you! that is beginning to get to me now and then. Will I give the right drug, do the compressions right, etc that I wonder about. Will I see the signs before they code???? So much to do.

Sorry, this is way too long. This may be too much truth.

Working on the Photo Thang

Kid shot this the day we went on the field trip. He made one of the small local papers in the process.

More working on Photo's

Again working on the photo's...... son shot these as well.

Duh!!

Okay, I like the picture..... it's from Photobucket, I don't know the kid. I will one day figure out how to get more of my pictures on here so I don't feel like I'm robbing strangers.

I've had a headache, one of the nasty ones this morning. I wrote a couple of emails...... Those things should not happen together. Fortunately I didn't talk on the phone, no telling what I would have said. Just thought I would share........

My poor associate pastor, he should one day change his email address. Seems like when I have a headache I am more "truthful" or shall we say, less tactful, than other times. I checked the email, I think it was okay, but I did share more honestly in this request than I normally would have. What you say, shut up and go to the zoo....... take more drugs??? Good idea, later.

Babies

Some days things make sense, most days it doesn't. My work is so important to me, in some ways I've found that yes, it does define who I am. But some days I find that it leaves me without answers.

In the last two weeks there have been several young mothers die in our hospital. Two were in our unit, one as I was taking care of her. Then another died in another area. There were also several that got into trouble with their pregnancies but were able to resolve those issues.

Our hospital is large, and we are one of the best in the area. These deaths are not because they weren't getting good care, but because situationally these women were probably the "one in x number" that stuff happens to. This sentence sounds so flat though when you see it.

We are left with families that now have a baby with no momma. I didn't know all the dynamics to all the cases for the families and from my standpoint that's probablly a good thing. My imagination can fill in the blanks on that. I'm just dumbfounded that so much has happened.

Yes, I'm used to patients dying, it happens often. But they are usually people that have lived into their 60's or more. Now that I'm in my late 40's that doesn't sound old, but it's older than these women. It's different, and I'm not the only one that is having trouble with this. I find myself thinking about it a lot, what could we have done? Why did such normal illness go so bad in the pregnancy? Why ...fill in the blank? So what about the rest of the staff, is it just me? But I know it's not. We still talk about it. They feel the same thing.

Yesterday I skipped church, went to the nursery. I just wanted to be with babies. There were only two there, and I didn't get to fill my need totally, but I did have some relief. I need to cry. I recognize that need, but I have trained myself to not cry easily. One small tear ecked out with the baby, but someone came in and that stopped it. My fear, it will happen and I won't be able to control it. I will go off when I'm tired or mad and then it will come out and not be healing.

I was in nursing school when my dad died. One day in peds I was assigned a baby that was intolerate of food and his mother had returned to their home to care for other kids. The instructor wanted someone who would just hold and rock the baby. It was for both of us a good day. The only time I sat that baby down was for diaper changes. My instructor was a wise woman, she had clued me in before the others so I could get that assignment. Thanks!!

Babies are healing..... God gave them to us for hope. Hope for ourselves, hope for man, hope for the future. They smell good, and they respond to us. They are cute, cuddly and they need us. Touching them makes people smile. Holding them filles our hearts. And where is one when I need it.......

Dodge Ball

I've never seen the movie, but real life is interesting. Yesterday the males in the youth at church challenged the young married males to a round (or two) of dodge ball. I went to take pictures.

Males are interesting, yes I've known that for a long time but they still continue to fascinate me. Give them a ball and a challenge and they totally change. At work the day before one of the guys was explaining la crosse to me, I've never really seen a game but he used to play. It was interesting, the history of the game more than anything.

Dodge ball as I remembered was nothing like this. There was not only skill, but they set up traps. The youth were pretty well slaughtered, I think they anticipated an easy knock off, but it was not to be. Several of the guys were quite into it, I saw a lot of diving, jumping, etc. Oh, yes, I got hit. It was close several times, but one of the youth threw and I never saw that one. Seems the laws of physics don't bend because I'm female and not playing.

My son, oh my son. He is sooooooo one of them. If only he could move like that when he's here. I was quite impressed. I always knew he could smell like them, but seems he can blend with them well.

Of course what would be a gathering of males without the proverbial stuffing of one of them into the trash can. Actually they used some brotherly love because they didn't get this one too far in. However, sweat was applied to his face. At our church they call this bonding of males "NGL" or "non-gay love". The term was started by my #2 son at some male bonding experience. Actually this group is really good, and even though some of the guys have left the church they still maintain their relationships. All in all, it was great fun.

Time Out

As I said in my last post, I took the kid and we went to a local "mountain" and shot some photo's. This is a huge field filled with daffodils, about 3-4 acres I think. It was great fun, we both had cameras, both ended up on the ground shooting different angles. His photo's (and camera) are much better than mine, but the sunshine and just being free were great.

We then went to a boat dock and shot pictures of boats, water reflections and spider webs. Actually I just watched, my job was more to hold the lenses and make sure he didn't fall in.

It was peaceful....... okay except for the music. My general tendancy is to let him play his music when we are out. Christian rap isn't too bad, and I've almost stopped twitching......

Tomorrow is back to work, I love my job but we will be understaffed again. I went in to help for a few hours today and it was wild. The next three will be tough, but then again, I'm not the patient. I'll try Fat Doctors trick, see if pretending they are Jesus will help, but I suspect that will have it's own trauma.

Planning

Isn't planning a wonderful thing? The 2nd graders this week in my Sunday School class will learn how God planned the world. I made some plans this week..... they were good plans. I was going to take Patient X and Y so that I could work with my preceptee and spend quality time with her. Patient X was very sick, and with stuff we don't usually deal with. Pt Y was boring and no problem.

Any guesses what happened? Pt X resolved overnight many of the issues that would have made that case great. Pt Y on the other hand developed new and frantic issues. We had to go to CT, emergency surgery and another test. Guess which Pt the preceptee had...... guess how much time I got to spend with her...... guess how frustrated I was.

I probably should have changed her assignment, but Pt X was still interesting and there was no time to really teach on Pt Y. Besides, the surgeon was, well, how can I say it, "doesn't give warm fuzzies to nurses" and I really didn't want to run off my preceptee. Actually for him he was pretty nice, either he was still half asleep or feeling good about the case (as he should, perforated bowel got caught early, no real mess).

As bad of a time as we are having being short staffed and beat over the head about budget, and as sick as our pts are, we are actually doing pretty good. Our chaplain (chaplain the kid) is very close to us and usually picks up on who needs some extra support. I'm glad that the hospital has allowed us the support that we get from them, I can't imagine doing this without it.

That being said, the kid that I torture at home and I are going on a field trip today. Where? I don't care, I need a day away to renew my soul.

Too Young

She died today, early twenties, just had her first baby. She got to hold it, but doesn't know it. The baby will see pictures of her with the mom, but never know her. The family wasn't even functional enough to be classified dysfuntional. Live for today must have been the lifestyle, but I can't stand in judgement of her because she has paid for it. And now the baby will.

My unit is not a area where we see much of this, but as she died another rolled in, pregnant and on the vent. We pray for a better outcome. There's always hope, but always reality is too close.

****the baby in this picture is NOT the real baby...... this baby is from photobucket.com.....

Beam Me Up Scottie

So today at work one of the nurses walked around all day talking about how she just needed two weeks away at the beach. ALL DAY...... At times she didn't seem like she was even aware of us.

The boss handled it well. Took her a cup of water with a packet of salt in it and a picture of a family at the beach.

I gave her a candy bar.... Milky Way...... so she could dream of being on the beach at night and looking up at the stars...... We help each other that way.....

Myself, I've always wanted a holideck like they had in Star Trek. I'm not sure what I would want the most, this way I could use it often. Today would have been a nice day to use it. My top choices: riding horses through the day; fishing in a quiet area; the beach is good, like that one. So many choices, so little funds.