Highs and Lows

It's the highs and the lows and the joys and the pains and they call the damn thing...

not the rodeo; but trauma. I think I'm becoming a trauma junkie. Dead one night in the Minor Care, so I went up to watch/try to help with a patient who came in unresponsive. The medics brought him in on dopamine and yet his BP was still only 50/30. When the seasoned RT comes in after pulling the results from an ABG, shaking his head, I had a feeling this might be interesting. "Goddamned pH is 6.5...I can't believe it. Not compatible with life..." The MD didn't think he'd make it out of the room alive, and the other nurses are putting on defib pads, preparing for the worst. Several hours later he's still holding on, but now intubated, a Foley put in, IVs started, several amps of bicarb and other meds given, an NG put in, etc and escorted up to the ICU nurses to let them take over his vigil. Three days later, and he's still in ICU, but being weaned off the vent. I don't enjoy seeing people that ill, but when they do get that way, I love the process and the way people come together to put them back on track and return them to their lives.

The next day I'm slammed in Minor Care, and I feel myself getting more apathetic with each low-income person who comes in, appearing in distress and telling me the only thing that will help them is a shot of morphine, of Dilaudid. They're allergic to Toradol, to Tylenol, to Motrin. They are unemployed, on disability for one thing or the other, and they don't care they're siphoning my tax dollars for a temporary high. One lady stubbed her toe (not even her big toe...) three nights earlier, and the only thing she felt would help was some Percocet. The provider, under the ever increasing DEA surveillance, firmly tells her she won't get anything more than ibuprofen or Tylenol. I don't want to be a jaded, judgmental nurse. I need to figure out a way to look past their situations/habits and see them as people. But only to a point...we can only do so much to try to help them get pointed in the right direction; the rest is up to them.

On the other side...

I don't know if I should have been more intuitive, but Dillon didn't eat anything today. He's 2. Sometimes he just doesn't eat. He was acting like his normal self, getting into everything. He felt a little warm this morning, so I took his temp: 99.1. Hardly anything to get excited about. He's passing gas, and it smells as awful as the dog's, if not worse. Maybe he just ate something and it's messing with his system. I take him to TCU with me, so I can help out with Marci's MDSs while she's swamped and so I can earn a little extra cash. He's cuddly, but he hasn't taken a nap.

Nate comes to get him and they go home. I carry on with my MDSs, and then I get a frantic phone call from Nate telling me he's taking Dillon in. I think he's overreacting; it's just a little throwing up. I don't want to be one of those parents that take their kid in for every little thing...He was fine just a few hours ago; unless he had some fall or some other injury, he doesn't need to go to the ER! I clock out, and meet them in the waiting room at the ER. Dillon is lethargic, and his eyes are glazed over. Maybe Nate knows what he's doing after all. So he's a little tachy, and Deb wants to give him IV fluids. Wait a minute; how did he get so bad so fast?...a small tremor of fear goes through me, and I know it's for the best, but how really, how did he get so dehydrated so fast? Teresa pops the IV in, and with each drop of saline he becomes more animated, more like his usual outgoing into everything self Dillon.

It's hard being on that side of the emergency room. I forget too easily the fear, the anxiety, everything that goes with having a sick loved one waiting to be taken care of. But my co-workers are amazing, and if I can have half as much knowledge and finesse as Teresa someday, I'll be satisfied. Dillon tells her, "Good job buddy" as we leave.

I kissed Nate good-night tonight, and thanked him for being such a good father. He has some good instincts, and maybe I should listen instead of automatically thinking he's wrong...

Pushing Propofol

"You never push Propofol..."
"Patient is waking up, give her some succinocholine and some Diprivan!" The moment where the patient is intubated and starting to pull at lines, what do you do? There isn't a doc in the room so what do you do now?
Maybe I need to get in touch with my ER training person. 

Remember

I remember Delores, and Chris, and why it didn't work out. I remember the max setting for a pediatric IV infusion is 100 cc/hour. I remember until I don't sleep, and it's 4 in the morning, and I'm sitting in the living room, in the dark, about to have a cup of coffee, and there's a tear threatening to leak. I'm slightly hungover from my Presidente Margarita and glass of wine last night, and I'm dreading today and tomorrow. It's only appropriate her funeral would be Easter weekend. Easter was always her holiday. The spread of food laid out in her garage, the games of Poker that would follow. I'm not sure why I thought that would ever end. I want to know what will happen to her house. Just another house in Shelby that will become a symbol of "remember when" like Grandma Norma's and our old house on 10th Ave. Will our poker games be the same? I don't know how they can be. Will Grandma be okay? I'm so afraid of her losing her will, and giving up. I'm not sure I can stand losing her. Delores is the herald sign; we're not all going to be around forever...things don't stay the same. The petty squabbling and minor grievances aren't worth it. Delores was the first one to forgive, the first one there when someone needed help. Holiday get togethers just won't be the same without her. I'm going to miss her smile. Good-bye Delores...thank you for being such a wonderful woman. 

“I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
― Maya Angelou

Lessons Learned Vicariously

I've learned so ridiculously much since I've started in the ER. Lessons learned vicariously through the poor patients who are enduring them first hand. Some are their own faults, others is just bad luck, karma, whatever.

Most mind blowing moment this week? Getting ready to start an IV on a grandpa type patient and having him roll up his sleeve and point to his right AC and tell me, "I used this one to shoot up Friday...seems like a good one". Yes, he was talking about meth. I would walk past this man in Walmart 50 times and never suspect he was shooting up meth.

Most disgusting moment this week...tonight. Had a man on oxygen via nasal cannula try to smoke a doobie and ended up lighting his nose, upper lip, and beard on fire. Nothing like soaking eschar and slough (black and yellow dead skin) with saline and then trying to scrape it off with a toothbrush and Q-tips. At least the poor man didn't complain. Just said he'd never smoke again. At least not with oxygen on. Good thing. Lucky he's still with us.

I will never approach a wild animal. Rabies prophylaxis is not fun. Say you get bit on the hand. You get to have this thick immunoglobulin injected just beneath your skin all around the bite site, then the rest injected into a muscle. Then you get the actual vaccine injected into your arm. And THEN you get to come back every few days for more shots. Just stay away from the damn animals. Don't break up the cat fights. Leave the feral animal in heat alone. Ugh.

I'm loving this job as an ER nurse. It makes me feel like I'm doing something, actually making a difference instead of plucking away at a computer, filling in assessments for Uncle Sam to know how much Medicare $$ to throw our way and watching my nursing education slowly slip away from me until I don't even know how to start an IV anymore.

Montana is such a small state. Having patients, then finding out they are so and so's boss, and my heart aches because their prognosis isn't all that great, and just saying a prayer that everything turns out okay.

I see patients come in, Dillon's age, with things that could so easily happen to Dillon. Standing up in a grocery cart and falling to the floor, fracturing his skull. Getting into some medicine/chemical/Pine-sol. It makes me a little more careful when it comes to some things...

I can't believe how big a difference it makes when I'm happy in my job. I come home, and I'm happy. I spend time with Nate and Dillon, and I'm happy. I look forward to going to work. It's insanely busy at times, and overwhelming, and stressful, but in the midst of chaos, I know I wouldn't trade it for anything in the world.

Irony

I'm sitting here with a glass of wine after trying to calm my thoughts enough to fall asleep. Eventually I realized there was too much on my mind and gave up...so I'm typing out my thoughts as they tumble out. Another 12 hour shift in the ER. I love it as much as I did last week, if not more. It's challenging, and I'm learning something new every day. I am a "newbie". I may have been a nurse longer than some of the other nurses, but this is different world. I feel silly asking some of my questions, but I'd rather appear silly than be the one to make a fatal mistake. I've never hung IV fluids without a pump. What do you mean I can just let it hang and it'll infuse? I don't have to worry about the air? I don't say these out loud, but the other nurses understand where I'm coming from and are quick to answer my unspoken questions.

I like helping people, and making them feel better. I like watching the kids bounce down the hall, headed towards the Exit, feeling better now with whatever we did for them. My biggest fear is that I will become one of those jaded ER nurses that doesn't care...just going through the motions.

It seemed like there was a lot of tragedy in the ER today; people falling, coming in unresponsive, crying family members spilling into the halls, consoling each other. It's morbid, but each time I can't help but wonder, when is it my turn? Why haven't I lost anyone close to me? The only experience I really have with death of a loved one is my cat, when I was seven. Losing a parent, a spouse, or God forbid, a child...I can't really imagine. So I just make a mental note to myself to not take those simple moments for granted. Crochet in the backyard. Football games on Sundays. Poker games on holidays. You really never know when tragedy is around the corner.

I had a patient who came in, drunk and in pain. He tried marijuana, and alcohol, and finally four ibuprofen but that darned pain from his recent SDH and back injury just wasn't going away. He had just been discharged from us a few days ago, to the homeless shelter. He admitted he was an alcoholic, and his sadness saddened me. I never felt judgmental; I just wished that he would realize he does have the power to make better choices for himself, to get some help for the drinking, and that he does have the power to turn his life around. He was weighing on my mind so heavily tonight, and I realize that I'm sitting here drinking wine, thinking about this guy with an alcohol problem, and it's ironic.

Ten year class reunion is coming up. I dreamed about it last night. Kinda like going through graduation again, only not knowing hardly anyone. At the party afterwards, and there's gigantic pie slices that are too big to eat and huge machines falling from the sky, squashing people who don't watch out. I made it one of my New Year's resolutions to go, and as apprehensive as I am, I guess I'll go. I hate feeling like I never really fit in, but if Nate is willing to go with me, why not. The whole thing just makes me feel old.

I am proud of where I'm at with my life. I'm married to a good guy, who takes care of my son and loves me. I have a job that I'm excited to go to in the morning. I think I'm doing okay.

Changes

Dillon is headed straight for the terrible twos...he's curious, into everything, and doesn't like to take no for an answer. He isn't afraid to stand up for himself, including at daycare. Yes, he's bitten others, and doesn't always play nice with others. I've only been there a handful of times, but most of the time it seems like Dillon is frustrated when it happens. We took him to see a pediatrician, who watched Dillon interact with us and looked him over, and said he was perfectly normal. I've looked up countless things on the Internet, all of which state it is just a phase, and we need to correct him. Which we have been doing.

I did some research online, found a great website, and in my excitement shared it with his daycare. Now I see why that wasn't such a bright idea; I think I frustrated her. I received an email back that they were giving us 2 weeks' notice. Completely blindsided me; per the contract I had to sign with them there was a whole process before getting to this point, but maybe this is for the best. Maybe Dillon needs a smaller setting, with more supervision. Nate describes the daycare as "chaos" and sometimes I wonder if the kids are being watched as closely as they should be. Nate and I toured a different daycare a few weeks ago, so maybe we should have seen this coming. Either way, it's no one's fault and everybody's fault. It is what it is, and all those trite sayings.

I'm surprised at how much this upsets me. I tossed and turned last night, after watching the first half of Breakfast at Tiffany's, trying to think about other things besides that email that created such a mixed bag of emotions for me: relief that there was finally a decision made; sorrow because I appreciated them and Dillon really seemed to like Bear, fear that I'm doing something wrong with Dillon as a parent, and not knowing what the future holds for his daycare while Nate and I work, and hope because maybe this is a sign that we really don't need to be paying for full time daycare when we only need 6-8 hours a week. There's really nothing I can do but say a prayer to God to show us the way and then to let it go.

Getting ready for PALS tomorrow. I'm afraid I'll fail and they'll wonder if they made the right choice, hiring me for the ER. I've been studying ECGs (pretty much teaching myself each one) and reading the PALS book cover to cover. Of which I still have 100+ pages left to go...I'll do my best and go from there.