Last week I went on a Sams run. Sams is a wholesale/bulk store. I like it because my family drinks a lot of milk and we eat a lot of fruit. It just saves me multiple trips to food stores. But when I am there, I always have a background noise in my head humming about how wasteful and excessive that place is. But then I try to rationalize it by thinking I am only getting healthy things and I don’t count as one of “them.” I know I am a hypocrite. But I recycle every single thing  I can from that store. I really do buy only the essentials, bread, milk, eggs, OJ, apples(my daughter eats three a day) I really need an apple tree.

By one of “them,” I mean the obese person (s) I so often see pushing a cart filled with Cheetos, Fritos, and Doritos. Usually these tasty treats are joined by the 5lb log of ground beef.  I just shake my head. I wonder when they will be on a cart in my ER with an MI or worse and how much of my tax dollars will be going to pay for their care. Or maybe they have already had their MI and just don’t care. You know what? I don’t care anymore. I am sick of trying to get a vein on these supple people, as they complain about my  IV skills.  You know what? I am done with you, go find someone else to help you. Oh and by the way, I know you are diabetic and we aren’t feeding you because I can put money on the fact that your glucose is over normal value.

Not only are these people driving their Suburbans to Sams filled with their entire family, each person complete with their own bulbous rear-end, they are also bringing home cases and cases of bottled drinks. I ask myself, what if they don’t recycle? And just think of the amount of gas they waste in that truck loaded with diabetics and future diabetic family members. With every moment, step and breath comes a resource wasted.

Sometimes I wished I lived somewhere else. Maybe a place that didn’t have to always build bigger roads,malls, and houses to accommodate the growing “size” of the population. I know I live in the greatest country on the planet. But can’t we all try to cut down a little? Can’t we all just drink from the tap? Bring our own grocery bags to the store? Eat a normal portion size?

I met a 10 year old boy at the park today. I could tell he hasn’t learned about portion sizes yet. He was well on his way to a lifetime of morbid obesity. He was the nicest kid. But he couldn’t keep up with his 4 year old cousin. I was more active with the kids than he was. He actually told me to stand in one spot as I was a monster chasing them. He said they were taking the same route around the playground, so why would I keep running around? True, I am all for efficiency, but this kid is totally missing the point of playing outside. I think it was amazing he was physically outside.

When is everything going to catch up with us? I guess the price of gas already is.  In 30 years, when I am eligible for Medicare, what will our heath care system be like? Who is going to take care of me if I need care? What will the state of the environment be for my children?

I wish more people would ask themselves these questions. Maybe they would do a little better to take care of themselves. The only way to solve some of these issues is to delay or reject Medicare benefits to people who won’t quit smoking,  won’t stop eating and abusing substances. There has to be a consequence for irresponsible actions at some point. What is there now?

For the three of you that read this, I realize I have not been into blog town for a few weeks. It’s not because I don’t want to, it’s because I haven’t been at work as much lately because I am (it’s so cool to type this) preggers! Therefore, I don’t have any new stories to bore you.

And the road to me being preggers isn’t the same easy type of road that 9 out of 10 couples are so fortunate to take.  Let’s just say it took a medical team to get me to this state.

I initially found out I was having twins, but now probably not, I have to wait until Monday for the official  word on if baby#2 is going on like it should. But baby #1 looked just like it was supposed to–a seahorse with a heartbeat! Exciting!

So life is good. I have the icky taste in my mouth, some nausea and I want to take a nap all the time. Good times all around.

I swear I will be back with some more stories from the ER. To tell you the truth, my ER has been pretty slow for the past few weeks (rich suburban people who can afford to go on spring break, I guess makes us slow)  My last few shifts have been… ahem…nice? It’s so weird to type that.

On nursesean.com’s blog, he writes about technology and it’s role in the nursing practice. He states,

“I simply do not see being fascinated by technology and science as mutually exclusive to nursing practice–even in the case of a dying patient. In fact, my fascination with human biology and medicine is what began my interest in nursing, and it’s what keeps me interested in nursing as I dive into my career.”

So true. I wholeheartedly agree with you. I remember starting out and feeling the exact same way. Because I was so focused on the patient in relation to the technology that surrounded him/her, I also didn’t have that touchy-feely vibe that other nurses had. I looked up every single medication, researched every disease and went with patients to procedures as much as I could to understand what was going on. I almost felt devoid of feeling because I separated myself emotionally from my patients in order to care for them. I was also 24 and no debilitating illness had ever swooped in on me or my immediate family.

But I have gotten older. Illness has crept into my immediate family. I have seen how something tragic can affect the entire family of the patient. (I have been one of those family members)

I guess after the technology/science aspect of nursing wasn’t new to me anymore, I grew up a bit. Life experiences will shape your nursing practice. Ask any nurse. Patients dying tug my heart now. Family members with a billion unanswered questions about their critically ill loved one also get to me. This never used to happen to me. I feel relieved that I can be a “touchy-feely” nurse and one that is still interested in the science of nursing.

Touchy- feely doesn’t only mean holding hands and being all mushy. It can be just sitting down next to someone and talking. Just letting them know you are there and you deeply sympathize with them. Explaining things and treating them the way you would like to be treated go a long way. I found that I don’t have to say too much. There are no right words.

I think Sean is on the right path. Technology is innate in health care, especially in the ICU. I really liked what he wrote because it described me as a new RN. Being a woman, I struggled with my lack of emotion/feeling when I first started out. I thought I shouldn’t be a nurse at times. Now I am confident that I can provide emotional support and be great at hands-on skills and critical thinking. And hopefully I’ll get better at both. And I think Sean will too.

Please read his entire post. It’s a good one. I love reading about his adventures as a new ICU nurse.

Not sure on which blog I found this first. If you click on the blogs I have listed, you can find their brain scans too.  I think it’s cute. When I put my real name in, it isn’t so pretty.

It’s Sunday morning and I have been assigned to be the Worldwide Triage Charge Nurse Center(actual title name changed). With my cape and scepter,  I will show the sick and needy the way into the depths of the ER.

I basically shunt people where they need to go. That’s it.

Because our department is so big, this position was created to better communicate with the charge nurse about which beds are open, who’s the sickest and who’s going to wait.  It’s a down and dirty triage.  Because the triage desk is so un-user friendly, I stand at the outside of the desk with a computer, get their complaint and maybe their name and send them on their merry way to a assessment nurse or wherever. What we hope to avoid is patients not waiting to see a triage nurse. They can wait after we do our assessment.

There is nothing separating me from the waiting room. It’s an icky feeling at first, but you get used to it.

Maybe that’s why I had a dream I was naked in front of an audience last night.

Anyhoo, the breakdown of my shift:

1. pt with cough/flu like symptoms–34 male (you know he wants a work note, it is a Sunday)

2. pt with diarrhea-flu like symptoms, drinking a bottled water–25 female (are you serious?)

3, 4, 5, 6, 7, all flu like symptoms of varying ages

8. 20ish male needing a work note to get back to work from last week when he was here. (no can do, sorry, no workie for you) He almost signed in for it too. I didn’t let that happen. He had an appt for his primary on Monday.

9, 10, 11, 12,  all flu like symptoms. One  young woman came in leaning over in  a wheelchair, hyperventilating (obviously with boyfriend in tow) wouldn’t let anyone take a look at her. No blood pressure or anything. WTF? Don’t you want to get out of here at some point? Cooperate please. We are trying to help. We get that you crave some attention. Now kindly slip your arm out of the jacket. You put it on today, didn’t you? Don’t make my job harder than it already is. Sheesh.

13  pt with URIsymptoms–40ish male

14  5 year old, vomiting/diarrhea

15 GSW to the left chest 30ish female brought in a wheelchair–

It looked like she was gone. I ran to get her, then ran back to the ER, yelled to everyone what I had. I couldn’t believe “GSW to the left chest,”  was coming out of my mouth.  As I was running her back to the flu infested ER, she gasped a few times–we kicked an old lady with diarrhea out of the trauma room and she was intubated with a chest tube in minutes. BTW, it’s REALLY hard to check a pulse when you are running.

Crazy. The bullet missed her heart, too.

I felt kind of vindicated going back to my guard post out there in the trenches filled with the flu-like victims.  They all had seen what had just happened.  I hope it put things into perspective for them.  The flu is NOT an emergency.

I think yesterday was a good snapshot of what the ER is really like. You can be treating narcissistic suburban flu patients who think they are dying all day long.  You start to hate your job and can’t wait until your day is over. Then there’s  the one true emergency and you realize you never want to stop working in the ER and this is why you do what you do. Doesn’t happen often where I work. But just enough to keep me in emergency nursing.

To clarify a little further, it’s not that I don’t think the real flu warrants a trip to the ER.  I think the people with flu symptoms that are sipping their Starbucks, complaining about how tight the blood pressure cuffs are and talking to me with speech like they have already ingested enough benzos to kill a small animal need to call their primary doctors or lay down on the couch and take some Tylenol.

I found this story first on nurse-ratched’s blog 

Love that blog, by the way. If you haven’t read it, please scroll down and read her posts.

It ’s about a nurse, Adrienne Zurub who was fired for self-publishing a book, Notes From the Mothership The Naked Invisibles about her experience working as a cardiothoracic OR nurse. Working with misogynistic docs and being treated like crap by hospital administration are some of the excerpts I read. Then I went to amazon to buy it and it’s sold out! Way to go Adrienne, you are an inspiration.

I couldn’t help but think, I have witnessed the same sh*$ from  doctors and hospitals over the past 10 years. What nurse hasn’t? I remember doing CPR and having a lard-ass ER doctor chanting sexually “and lift and press and lift and press, work those pecs.” He made my skin crawl. I wanted to stop chest compressions, walk around the gurney, slap him and continue compressions. Sigh….I was too chicken. And I was raised not to do such things. Damn.

It’s no surprise hospitals and doctors treat us like second-class citizens. We get reminded of that every May during the red-carpet affair that is nursing week. Free ice-cream, t-shirts and little bags of Hershey kisses are doled out every year to “thank” us. Nothing makes me feel more degraded than nurse’s week. I dread it every year. I always felt if they treated us properly, there wouldn’t be the need for a nurse’s week. Just a nurses day like everyone else.

You know what I really want? I want you to pay for my mandatory  Ceu’s UP FRONT! I want to be paid per hour while I am sitting in that class to maintain my certifications that YOU say I should have. Oh and some new freaking’ trauma scissors. We are Magnet, after all. It’s only fair. What other profession doesn’t get paid for doing something required for their job? It’s this lack of professionalism on the administration’s part that keeps us “under their thumb.”

I also think as a whole, nurses should stand up for themselves more.  We really do need some assertiveness training in school. I know I have a hard time asserting myself when an infantile doctor’s poor attitude is just accepted and never challenged. I go from 0 to pissed in a minute.  I don’t say anything because I don’t want to regret anything that flies from my mouth in anger. It’s the Italian genes I guess.

Maybe this nurse’s week we should take a page out of Adrienne’s book (if you can get your hands on it) and sound off to stop some of unnecessary crap we deal with. Not angrily, but assertively. Something to the tone of, “I thought that was inappropriate, doctor windbag, when you are ready to speak to me professionally, you know where to find me.”

After all, people come to the hospital mainly for nursing care.

I have been down in blog town for a while because of a few minor medical reasons but mostly because I have been thinking about leaving the ER.I have finally come to a conclusion:

I had a horrible thing happen at work 2 weeks ago that kind of messed me up. As you may know, ER nurses don’t like pregnant patients that are cramping no matter what the gestational age. We think it’s not right for them to miscarry in the ER less than 20 weeks, but we know there’s nothing that can be done to save the fetus under 20 weeks. An ER is not the place to deliver, we trip over ourselves, instruments fly through the air, it’s really like a Three Stooges episode when it happens. We can do everything else with ease and a smile, but we don’t want to be birthin’ no babies up in here.

I had a woman 17 weeks pregnant and having lower abd cramping. I knew it wasn’t going to turn out well for her and her husband. but I tried to maintain a level of calmness as I checked the fetal heart tones, which were 200 (normal is 120-160). I said,”Listen, here is the heartbeat,” and I said nothing else because I knew that was the last time they would hear it. I have never had a woman miscarry that far in gestational age before. I have had patients at that gestational age that were going to miscarry but never in front of me.

30 minutes later after I was talking to the MD about where she should be admitted. I was called to her room and out came the fetus right before my eyes. I am welling up right now thinking about it. The father said,”Is it moving?” And it was, for about 2 seconds, just small crude attempts to breathe. I called the MD in and we cut the cord (I ran around looking for an OB kit like a tool, see? Three Stooges) I cried with the mom and hugged her as hard as I could. That’s all I did.  It was a boy. They named him. We had a priest come and a wonderful OB RN came to take pictures and she even had little clothes for it. I was so impressed with all the resources we could give to this mother and father. I can’t say enough good about my hospital.  I took the fetus down to the pathologist (he was there on a Saturday) to take a skin sample for genetic testing. He told me the fetus probably had trisomy or downs, which are the two highest probabilities for miscarrying.

After she went upstairs (to a medical floor, we did not think she should be hearing babies cry on the mother baby unit.) I was  down for the count.  I took a 15 minute breather in the lounge. It is such a surreal feeling going back to your regular work after being part of something so tragic. Everything else seems so small in importance.  I feel so humbled by the wonder of life and death occurring in literally an instant. I will never forget it.

This has stuck with me for a week or so now. I have contemplated leaving the ER. I even had an interview in a different department.

But I know that my place and heart is in the ER.  I can honestly say we gave her tremendous care in a place that’s sometimes called uncaring.  I think ER nurses may think of themselves as walking callouses. I know I do. This kind of thing has helped me in so many ways that probably aren’t clear to me yet. This may sound weird, but I feel lucky that I was allowed to witness something on such a grand scale of contemplation. You really never know what you are walking into everyday when working in the ER. I am lucky that I get to do what I do.

If you’ve worked in the ER you definitely know what I am talking about with this:

Triage nurse: Hi , what brings you in today?

BP(brilliant patient) My doctor called, didn’t you get the message?

TN: I didn’t, but we can still get the information from you. Did you see your doc today?

BP: No, I called him, he says I need a Cat scan.

TN: OK, so what’s hurting you ?

BP: My belly

TN: Where does it hurt?

BP: (points to her obese abdomen)

TN: When did it start?

BP:Last night. Oh and I have these sores on my mouth and on my ear too. Could you check it out too?

TN: Let’s stick with the belly for now, What type of pain are you having?

BP: I don’t know it’s just pain

TN: How bad is it on a 1-10 scale?

BP: I don’t know, now it’s zero but last night it was a 10. Are you guys going to do a pregnancy test?

TN: Yes. (tries hard not to roll eyes)

BP: I also want to let the doctor know that I fell in the shower 2 weeks ago and hit my head

TN: Did you lose consciousness?

BP: Yes

TN: Why didn’t you come in then?

BP: I don’t know, I was busy.

TN: (WTF?) I will let the doctor know (who will also roll his eyes). I am going to give you pain medication through your IV now, it may make you sleepy. Were you ever nauseated for the past 24 hours?

BP: Yes

TN: (Why did I ask?I feel like I am putting words into my patient’s mouth because she obviously has nothing better to do than to suck the life out of my cells not to mention tax money on bogus work-ups for NOTHING.Oh, she did get a pregnancy test. Negative, with a collective sigh of relief. My god this chick sucks.)

3 hours, 0.9NS 1 liter bolus, 2 mg Dilaudid, 4 of zofran, and a GI cocktail later:

BP: My neck hurts and I have a headache

TN (I am not the triage nurse anymore, I was moved to the ER and got stuck with BP) I am thinking “Oh no you don’t, not now after 3 hours of your whining and not getting your lard-ass up to the bathroom, you have to use a bedpan.” Did I mention she was 21? She must have walked in here. So I say, “I will let the doctor know, by the way how’s your BELLY pain?”

BP: (in her most “I am going to die breathless voice”) It’s…like…a…three now.

TN: Good, then she informes me that the doctor just came in and ordered a CT scan of her abdomen. D’OH! I am going to bang my head against the wall 100 times, as that would feel better than taking care of this succubus. At least he’s not scanning her head and doing an LP. Thank god for small victories.

Unable to finish her oral contrast for her belly scan she says breathlessly,” I..can’t…drink…anymore.” I say “Fine, you wouldn’t want to make yourself more nauseated” At which point she tells me she’s still nauseated.

Hear that? It’s the banging of my head upon the wall….

It’s like every symptom I end or begin a sentence with, she tells me she has it. This type of patient is not sick. It’s like she’s bored with her life… at 21. I wanted to tell her to go to a coffee shop and read. Go to the mall or take a road trip if you are bored. Hang out with friends. How about go to school? Maybe study once in a while. Learn something and become productive instead of a burden.

2 and 1/2 hours later, she’s discharged with a script for Protonix and Zofran. The total time spent sucking resources? 5 1/2 hours. More than half of my shift. I said here’s a doctor to follow up with, I suggested 3 separate times that she follows up with this on-call MD that I circled a few dozen times on the discharge paper.

Me: Any questions?

BP: Can I get a work note?

I am currently hosting NurseOnWheels on Wordpress’ servers. And, since this is a free service, I am a bit limited by what Wordpress.com will and will not let me do.

I currently own RollerNurse.com, but I’m not sure if I like that as much as I like my current site (nurseonwheels.wordpress.com).

So do I change the name as it will allow me more freedom for creativity or do I stick with my current (free) one?

I like Rollernurse, it reminds me of Rollerpig from the Simpson’s movie. I could make up a theme song.Any of you blog veterans have some input?