The Hardest Part

The family. We were a strange little band of characters trudging through life sharing diseases and toothpaste, coveting one another's desserts, hiding shampoo, borrowing money, locking each other out of our rooms, inflicting pain and kissing to heal it in the same instant, loving, laughing, defending, and trying to figure out the common thread that bound us all together. ~Erma Bombeck

“Parents can only give good advice or put them on the right paths, but the final forming of a person's character lies in their own hands.” ~Anne Frank

I knew couples who’d been married almost forever – forty, fifty, sixty years.
Seventy-two, in one case. They’d be tending each other’s illnesses, filling
in each other’s faulty memories, dealing with the money troubles or the
daughter’s suicide, or the grandson’s drug addiction. And I was beginning
to suspect that it made no difference whether they’d married the right person.
Finally, you’re just with who you’re with. You’ve signed on with her, put in a half
century with her, grown to know her as well as you know yourself or even better,
and she’s become the right person. Or the only person, might be more to the point.
I wish someone had told me that earlier. I’d have hung on then; I swear I would.”
Anne Tyler, "A Patchwork Planet"

"A successful marriage requires falling in love many times, always
with the same person."
Mignon McLaughlin

I'm not advocating for loveless marriages. But it's also the case that marriage
doesn't make us happy every day. No marriage does, but your marriage serves
as so much more than just a vehicle for immediate individual adult needs. It makes
one world for your child, and children will tell you that means everything to them.
Elizabeth Marquardt, Between Two Worlds

A baby is God's opinion that the world should go on.
Carl Sandburg

Making the decision to have a child - it's momentous. It is to decide forever to have your heart go walking outside your body.
Elizabeth Stone

They're the ones dying...

Recording a trauma...motorcycle accident, no helmet. His injuries severe, prognosis bleak. Recording blood transfusions, medications, injuries. Hardware sticking out of his arm from previous surgeries, swollen left eye, the doctors looking at him, shaking their heads. Just another patient.

Until I hear he is related to so-and-so, and with a sinking heart I hear he's related to people I know, and my dad even knows him, and so on, and he's not another patient; he raised so and so, and these broken arms cradled her, and those eyes looked down on her as he gave her away, and suddenly it's so much harder to leave him behind as I walk out the ambulance doors. He stays with me, days later, as I watch her Facebook updates, and my heart is heavy with sorrow and prayers.

I don't want to know relationships. I don't like knowing the details of who they know. Montana is way too small. It's so much easier when there is no relationships, when they are an unknown person.

My heart aches, and my prayers go out to him. God knows what is best for him; the x-rays stick with me. If he makes it, he has a hard, long road ahead of him. Part of me wants him to go in peace, but then I think of her, and God, what would I do if that was my dad? I would want him to fight with everything he has, because I can't picture life without him.

I hate that life is so fragile. I hate that it changes in a split second. I hate that we can't control it.

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.