Thank You Sister Sheila

Nursing has served me well! For all it's ...trials & tribulations, schedules that look like a strip of Atrial Fib, exhausting documentation, impossible personalities , untold pathogens and fluids, mornings when I can still feel my pulse in my feet from yesterdays shift, yes nursing...has served me well. It has provide life experiences and rewards that most people will never have.

When I realized I was entering my 30th yr of nursing in 2006 I decided to track down Sr Sheila and thank her. In the fall of 1973 Sr Sheila called each gal into her office to ask our plans for college. I had to tell her that I didn't know what I was going to do. You see, my father had just recently been hit by a "down-sizing" in his corporate world and was let go. There would be no money for college.

Sr Sheila didn't miss a beat. She picked up my transcripts and said "Your very good in sciences. Why don't you get a diploma in nursing, go to work and then decide what you want to do." And that started the ball rolling. In 1976 a diploma in nursing cost $2400 dollars and 2 yrs study with no time off. I did it and over the next 12 yrs had my children, went through some life changes, and finished my degree. Regardless of changing economic climates I never once worried about finding a job.

I tried to find Sr Sheila using a classmate web networking site without success. I called High School acquaintances, without success. I tried contacting the order of Nuns she belonged to, again without success. I tried a few more ideas and then gave up. I said "OK God, I tried. If you want me to do this then give me the way"

A year later I happened to be at work one day when a favorite ER volunteer was sharing how she had helped each of her four adopted children find their birth mothers using the web. Bingo? I explained to her my quest. She requested the name of my high school, the year I graduated and how old I thought Sr Sheila was in 1973. One week later she walked in and handed me...Sr Sheila's phone number!

I couldn't wait to make the call. When she answered I explained "I don't expect you to remember me but you were my high school guidance counselor in 1973. I continued my story and finished by saying... You steered me onto a path that gave me a sense of purpose, supported me and kept me challenged for 30 years. I want to say thank you. You made a huge difference in my life". Her voice cracked, she said "You will never know how much I needed this call today! "

You see, God didn't give me her phone number when I wanted it, he gave it to me when she needed my call. I love how that works.

FROM THEIR SHOES

I answered the EMS incoming call. They were bringing a transfer from a small hospital 30 minutes away. The story: 33 yr old female patient with a history of Paranoid Schizophrenia involved in a vehicle-tree accident. Evaluated and treated for abrasions at the smaller hospital. During this time the patient was actively combative and hallucinating. Arrangements were made for the admission to our Psychiatric Unit and the patient was given an injection of Geodon prior to leaving. Enroute the patient stopped being combative, no longer required restraints and was cooperative.

When I entered the room she was sitting on the stretcher sobbing. Obviously fearful and overwhelmed she was telling her husband "You don't understand!! God hung up on me!! Now they can get me! I have no protection, he hung up on me!" She was shaking and praying. "I tried calling him over and over but he wouldn't answer!"

It dawned on me. We in healthcare experienced the successful effect of medication intervening and curbing hallucinations, voices, and combativeness. But the patient? She experienced this same scenario as God abandoning her when the voices left. Now, in her "unprotectedness" she was terrified. Vulnerable to the demons that had been chasing her,
a sitting duck.

I went in and calmly said to her "I know your scared but we will take care of you. We will keep you safe." True, we would. She stopped crying, looked up at me and said "Will you pray with me"? I said "Yes"... held her hand and we said the Our Father together. She remained cooperative the rest of her time with us until she went to the psych ward. In nursing we take care of people where they are at, not where we think they should be.

Holiday Hearts

For some of us the term "Holiday Hearts" may bring visions of Salvation Army bell ringers, Toys for Tots and Community Meals for the homeless. For the ER nurse it means a crowded waiting room of upper respiratory infections peppered with the flurry of new onset Atrial Fibrillation.

Ahhh, "Holiday Heart." The susceptible heart carried by the 50ish age group of heavy drinkers gets pushed into an AFib rhythm by a week of drinking "holiday" quantities of booze and chain smoking. They show up in the already crammed full ER waiting room with family in tow or are brought in by EMS complaining of "feeling weak, poorly, not myself", or "my hearts just not right". Poor Souls" as my Irish Mother would say. It may be their first brush with their mortality. The first tangible message that they have been "rode hard and put away wet" one too many times.

They'll be OK, but are now the proud owner of a Coumadin regime including lab draws for bleeding times over and over, safety considerations for falls and accidents, and a lifestyle that requires following strict instructions...... here on out. Not every Atrial Fib patient is the result of hard living, just the ones who spent years standing naked in the snow singing Ted Nugent.
You know who you are...........

Halo Man

It was an hour before departure. The cruise ship was full to capacity. I was on my way down to the Infirmary to meet the medical crew I would be sailing with for 3 weeks through the Panama Canal.

I was flabbergasted when I saw him, a 6'3" skinny old gentleman in a metal Halo walking toward the elevators with his wife. I walked into the infirmary, introduced myself to the physicians and lead nurse, and said "Were in trouble. I just saw an old man in a Halo walking the halls. Who in the hell let him on this ship?" The passenger physician said "No way!". The crew physician said "What's a Halo"? The lead nurse got on the phone to the ship Captain. After a lot of talking the nurse got off the phone and said "he's staying". You don't argue with the Captain.

That evening I was "on-call" for any medical situations. The ship entertainment hadn't even begun when I was paged "Man fell in the showroom". I grabbed my medical bag and went. Sure enough there was "Halo Man" as we endearingly began to refer to him. He was sitting in his seat with trickles of blood running down his forehead from two Halo screws. His wife said "He's OK now. The ship swayed and he fell over". I can see it. This tall, skinny, wobbly old gentleman with

12 pounds of metal on his head gets tipped off balance by a wave and down he goes. Yep, were in trouble. He looked at me with a blank stare and smiled. I cleaned him up, put a little triple antibiotic cream around the screws, checked his pupils, gave him some commands to follow and called the Doc to fill him in. All was uneventful the rest of the night.

Next day, same scenario only out on the deck this time. The passengers watching were pretty freaked out at the site but again...all checked out. We asked his wife to stop by the infirmary daily to let us keep an eye on him. She was more than happy too. A few more days went by and when she brought him to the infirmary the areas around the screws looked red and somewhat swollen. Antibiotics were now in order. While in the Infirmary she shared with me "He has Sundown Syndrome and at night he fights with his Halo and tries to wrestle it off his head" I couldn't stop myself "Why would you bring him on a cruise for 3 weeks?" Leave it to the nurse to finally address the obvious. Her response..."Oh he's a tough one. This is not the first time he's been all broken up. Do you know what he did for his 80th birthday? He went dirt bike racing and broke C-2!! I'm so sick of this I could just kill him. He thinks he's that Evil Kinevil guy. He's broken everything in his body twice over". I was in shock. Poor lady! She's been a 24 hour personal nurse for too many years! "I decided I needed a vacation and he couldn't be any worse than he is at home so I signed up for the cruise".

Halo Man's cellulitis used up all our IVPB Levaquin. And with all his wrestling at night it wasn't improving like we wanted it to. The physician called it....he needed to disembark and go home. Great! This poor wife is the one who deserved a halo! Granted, all the travel arrangements were made for them but now this little old couple was getting off in Nicaragua of all places to catch a northbound plane.

But before she left I had a chance to sit with her and talk about putting hubby in assisted care. They were in their 80's and SHE needed a break. She gave me a hug before they left the boat, and I gave her an old Irish travel blessing.

TOYS: Christmas Hazards

Working the holidays has it's pros and cons.

On the positive side all the "extra" people are gone (administration, students, JCAHO prep teams, extra visitors). The overhead announcements have quieted. The team that is working seems more relaxed. Family members treat you as those "Angels of Mercy" who sacrifice to take care of their loved one on Christmas and there is always too much food.

On the negative side.... you have to be away from home when it feels like everyone else in the world gets to be with their children, the staffing is pretty thin and if your in the ER...nobody told the public to stay home, not drive drunk and not to get in fist fights with relatives.

And then there are the toys. The least of the recognized holiday dangers. A young Dad limped into the ER holding his side. His story: "I came down stairs and the kids had their toys everywhere. All over the living room, the hallway, the kitchen..everywhere. I told them to pick them up then went back up stairs. When I came down again my son hadn't picked up any of his stuff. I tripped over something and fell onto the coffee table. I think I broke a rib."

An hour later we admitted him to ICU with 3 fx ribs and a torn spleen. He was hemo-dynamically stable but he was in shock at what we had found. He kept shaking his head saying "What were the odds?". In no time at all his children had arrived to be at his bedside with Mom. I felt really bad for the 7 yr old boy hiding in the corner. I knew it was his toys.

CALL A CODE.. For real this time

" I need some help.... I need some help" I heard in a concerned voice down the hall. I exited the room I was in and followed the voice in distress. Upon entering the room the nurse said " he just started saying he was feeling really bad!" The man was sitting upright in his bed, his upper body shaking, eyes half open, and he was not responding to us. We checked for a pulse and he had one and was he breathing as well. I looked out on the monitor and he was in VT Ventricular Tachycardia. We yelled to call a code and grab the code cart. As another nurse arrived with the code cart his face turned purple and he fell back. I said " I'll bag him" , they got me to equipment and I began to breath for him. They hooked him up to the monitor as the code team arrived. The few minutes it took them to arrive felt like an eternity. Soon there were about 20 people in the room eager to help. The doctor ordered 150mg bolus of Amiodarone. They gave it. The man eventually lost his pulse and we shocked him. All of a sudden he was responding and the doctor asked him to hold up 2 fingers. He did. OH MY GOSH! He made it. I was so shocked at how fast he came around. The only codes I had ever seen were in the ER and the mostly got intubated and sent off to the intensive care unit after stabilizing. We sent him off to the coronary care unit as he now qualified for and internal defibrillator. I checked on him on my way out that night and he was doing great. Amazing!
So what happened? The nurse told me she was preparing to pull out his epicardial pacing wires and he started saying " I really don't feel good" and then started looking really bad. The surgeon said when he got the page he thought the man may have been going into cardiac tamponade and was preparing to open up his sternum at the bedside. I am so glad that was not the case. The whole thing ended well and I can say it was quite exciting.

BLACK MAGIC MARKER MISPLACED?

The patient was finely dressed with a southern gentleman's flair about him. Not a hair out of place,...pants perfectly creased. Our ER physician walked into the room and said "How can we help you today"? Without blinking an eye the patient responded straight faced in a long drawn out southern drawl "I hav ah magic mahker in mah rectum and I cahe NOT to answer any moh questions". OK.... the magic marker was removed, no further conversation. The gentleman brushed the wrinkles out of his shirt sleeves and walked out. He left his discharge instructions on the stretcher. Guess those aren't something a man of his stature leaves around.

104 and GOING STRONG

I walked into the room of my 104 year old patient who had sprained her ankle. She was bright eyed and chipper explaining her injury and very "with it". I asked "What does it feel like to be 104"? She looked up with a grin and said "There's not much peer pressure". I want to be just like her when I grow up.

NOT THE SMARTEST DRUNK IN THE BAR

It was a sub-zero February morning. The car slid, more than drove to work. I inherited a drunk left over from nights. The story was he was drinking heavy at the bar...OK...he was afraid he was sooo drunk he would fall off his bike, so he tied himself to it with a rope. OK... He's drunk in a bar at 3am on a sub-zero February night and riding a bike? Obviously he has no license and figured this would work. UNFORTUNATELY while riding home on the icy streets he hit a curb and wiped out onto the road. EMS received a disatch for "Man down in the middle of 8th Street tied to a bicycle".

Medically he was unscathed. But we needed to let him sleep off his BAL until he proved safe to be discharge out into the public again. I took report on a few more patients then went to check him out.

He was not in his room! The siderails on his stretcher were still up and his clothes were still on the chair. Hmmmm a drunk Houdini? I reported the findings and security went to look for him, albeit unsuccesfully. 30 minutes later we received a call from a very angry Mother. "How in the hell could you just let him leave in his pajamas in the snow?!! He could of froze to death! She went on and on and on...

I exlained to her that all had checked out well medically and we were just letting him sleep off his drunk. (This was before HIPPA invaded our world) I finished with "He decided to climb the rails and slip out without telling us". "Well the least you could of done is fed him breakfast". Hmmmm it was way too early to give her the "accountability lecture" so I said "If you would like to bring him back I'm sure we could find him a tray" Sometimes it doesn't bother me at all to have the other person hang upon me.

The worst walk of his life...

I was taking care of a young CAB patient (coronary artery bypass)who was
Post-Operative day 5. Other than high cholesterol he had no prior cardiac history. He should have been off oxygen, walking around, and ready to go home. This guy just didnt look good. "Puney" is what we call them, they just look puney. His skin was yellowish pale, he was a bit anxious, still required a little oxygen and had been in and out of Atrial Fibrillation for days(not uncommon after this surgery).

What we tell many patients is " Once your up and walking around the whole hall you can go home". This guy really wanted to go, although I dont think he had a good understanding about his progress or lack there of. So I attempted to wean him off the oxygen and I got him off. He rested all day and we talked about him walking in the afternoon. He was ready, so we went. He was short of breath (SOB)as many of our patients are when they really begin to get up and move. I asked him to turn around about 1/4th of the way down the hall, I could tell he was pushing it. He said " NO, NO I'm going all the way around , I want to go home."

We made it back to his room and he was out of breath. I sat him down and got a pulse-ox to check his oxygen saturations. He was low (81%). Following protocol I put the oxygen on him by nasal cannula and let him sit for a few minutes. He was still low (84-86%). Suddenly he started saying " my leg is numb, I cant feel my foot!".
I asked him to flex and extend his foot but he couldn't. I grabbed a fellow nurse and we got him into his bed. We checked for a pulse. No pulse in that foot. He had a great pulse in the other foot. His oxygen was still low. I knew this was serious, his foot was looking bad. I requested the physicians assistant to examine him and he said we needed to call the doctor. I paged the doctor.
My patient was getting worse. He was anxious and breathing really hard. I placed a nonrebreather on him but and his saturations were still in the 80'S. We tried for a doppler pulse while his leg grew bluish and mottled. He was starting to grimace as the doctor came in. Then he started grunting and sweating in pain. The doctor examined him and decided he probably threw a clot that lodged in his leg
(blessed it wasn't his brain). He needed an emergency embolectomy and was rushed to surgery. The team really pulled in for me that day. I had four senior nurses at my side helping me do everything. They were awesome and I love them for it. I felt safe and on top of things. He left for surgery and I finally sat to chart the event and ponder the outcome.
A week later I inquired about him to one of the doctors. He said he was positive for HIT (Heparin Induced Thrombocytopenia)and threw clots to his heart and leg. Heparin is utilized during these surgeries and some people develop HIT. The fact that he was also in and out of atrial fibrillation didnt help. Basically he showered clots. He is blessed to be alive! A venous clot in his leg, an arterial clot to the right atrium . The leg was saved by the embolectomy. In addition, the patient qualified for an Argatroban drip and spent an additional week in the cardiovascular ICU. He is so blessed he didnt stroke , throw a PE ...die. I felt so blessed that I picked up on his condition and the team took great care of him.

WOW, I helped to save a life. This is what nursing is all about. I became a little less intimidated to call a doctor about an issue knowing it may save a life, and in this case it did. He recovered and told me later that he remembered me turning to his believing wife and saying " pray!" as we rolled out to the OR. The nurses helped, the doctors helped, medicine helped, and the prayers definately helped. THE ROOKIE-

WWII Vets

Every nurse has her favorites. My all time favorite patients without question are...WWII Veterans. I could quickly answer that it is because my father was in the Air Force during the war, but it's so much more than that.

When I walk into a room with an 80+ gentleman on the stretcher I slow down and my heart softens. While looking for a good vein, I ask "Where were you during WWII"? Regardless if dementia has taken parts of their life away from them today, it doesn't seem to touch those years. Without missing a beat they tell me how old they were when it started, which arm of the service they joined, how they told their families and where they were stationed.

I stop what I'm in the middle of, take his hand, look straight into his eyes and say "Thank you. Thank you for what you gave. It's because of men like you that I'm living the good life". They look back with such heart I can feel my own in my throat. They pat my hand with tears in their eyes then look off into a memory.

Once the heart of it has settled I look back up while taping the IV and say... "But you know...they just don't make men like you anymore. "It's true" I continue. "You put aside everything and gave yourself to a higher cause. You came home and somehow moved on past broken bodies, lost brothers and postponed dreams. Your family came first and you seemed driven by a sense of honor. It showed. That's how this daughter saw it anyway, I had one of the best".

By now even the little wife has tears rolling down her cheeks. But I'm Irish and on a roll, I'm not done. "Then we have to pick from a self-centered generation that believes a Porsche is the measure of a man and his inner-child comes first". Now he's laughing and starts telling stories.

I took care of a Norwegian WWII vet who was really joker. He told me "You know we helped the Allies out too. And when I came home I had to ride a train for two hours into the mountains. Then I had to put my ski's on and cross-country into my village"
I said to him "Wow, what was the first thing you did when you got home"? He answered "I made love to my wife of course" I was roaring. Imagine this little white haired man saying that. But then he got me...."Do you want to know what the second thing I did was"? Of course. He looked at me with his twinkling blue eyes and said "Took off my skiis"

The VET

A LOAF OF BREAD AND A COKE.

I had a flashback of nursing school clinicals... Flashbacks like this can be scary, and I am sooo glad that it is over. I did have some memorable moments though. Like a summer of critical care and psych in 10 weeks. I think they were actually trying to kill us, no joke. At one point we endured clinical every day for 2 weeks.

On our Critical Care rotation 8 nursing students were assigned to various areas of the hospital and our instructor floated around all day checking on us. There was this gal in my class who was sort of an "outsider". She was very strange and acted uncomfortable around everyone. I felt bad for her the whole time but a lot of her problems were self inflicted.

I started my ER rotation, scared to death. I don't know if I was more nervous about the clinicals or that this was the ER I had quit working at by calling in the last two days with explosive diarrhea. Hey, no one is going to force you to show up for work when you tell them you have explosive diarrhea! Half of my fear came from knowing that I could be asked to perform a random task at any moment, the other half of my fear was that the manager I had quit on was going to recognize me. I spent the day ducking behind corners, avoiding eye contact and praying nothing bad would happen.

Most of the fear was really about the dreaded IV STICK (which I sucked at). But the Mother who raised me was an ER nurse. And the first thing she did when she found out I was going to face this challenge was let me practice on her. You know your mom loves you when she lets you start your first IV on her. She was lucky I had worked out all my childhood aggression years prior. My first attempts failed and my mom returned to work the next day with a hematoma and a funny story.

The clinical instructors were always watching over our shoulders. Checking us off on our skills list and passing out "ED's" which stood for " experiencing difficulty" when we made mistakes. That day in the ER I was relieved that my teacher was floating because chances were she would not be around to critique me starting IV's, hanging fluids, and dropping NG tubes. But, as my luck has it, just as I was about to start an IV she came walking around the corner.

She followed me into my patient's room, explaining that she was going to watch and I was a student and blah blah blah. I was sure my patient was freaking out hearing about my inexperience. I prayed to God that he would miraculously anoint my hands and this poor woman would live through this with as little trauma as possible. IT WORKED! Somehow I did it , I don't know how, but it worked! I think I was as shocked as my teacher to see it! Glad that it was over, I went on with my day.

I had it easy compared to my strange classmate. This gal ran with some bad luck!
I watched her preceptor ask her if she wants to start an IV and walk with her into a room. A short while later I watched the student walk out into the middle of the ER nurses station, look at me, get woozy and pass out. BAM down she goes right there in the middle of the floor. I couldn't help but laugh to myself. I felt so bad for her, everyone standing around staring. It must have been the worst feeling.

The next week I was sitting at the nurses station and heard a woman screaming "Shit! ahhhh, Damn it!" I ran down the hall and found the strange gals preceptor on the floor holding her Achilles Tendon and she was behind her with a patient in a wheelchair. Those poor preceptors had no idea what they were getting into. I'm sure this preceptor thought all was safe. Then she was assigned the student from hell who wheeled a pt. around a corner and took her out from behind. Oh it was bad!.

She just had no common sense. Another day we found her sitting in the middle of the hallway on a bedside commode drinking coffee. She drank so much coffee she would shake all morning. It was not unusual for her to carry around a 64 oz giant mug. She once told me it held a whole pot of coffee. She smoked like a chimney too. Her graduation cap must have been in her car all semester because at graduation it was yellow, seriously. Her whole outfit was white and she had this yellow hat. She was crazy!. She would never relax and she was always, disappearing and doing bizarre things. Like turning the heat up to 90 degrees in our little conference room so our teacher would become so uncomfortable she'd let us go early. Or the day she just left clinical.
I guess she decided she was done, left and went home. It goes on. There was the day we all sat down to eat lunch and she had bought an entire loaf of bread from the cafeteria . That was what she was eating, a coke and a loaf of bread. It made for an interesting 2 years. - THE ROOKIE

ALLERGIC TO INCARCERATION

The uniformed and armed guards walked on either side of the patient. The patient, a felon, was handcuffed and ankle shackled. He had long white hair past his shoulders and a dramatically weathered face, wrinkled and mapped by the sun. The paperwork said chief complaint: Body rash, no improvement despite 4 days of Benadryl and Prednisone.

The ER physician was a sharp young guy not soured by burnout or tainted by the older Docs cynicism (yet). Refreshing actually. He came with me into the room, the guards removed a handcuff and the patient peeled off his shirt.

Now any ER nurse will tell you, even the ones with 12 years of Catholic school... you "gots to admire the prison body". You know the one. Nothing else to do for 12yrs but lift weights and do
sit-ups. The Doc and I met eyes. It's a special ER glance. No facial expression. It means "get a load of this". Used in a multitude of situations involving patient assessments.

The Doc asked the typical questions including "Has this ever happened before"? Sometimes the answers catch you off guard, sometimes in a funny way. The prisoner answered "Yep it happened two other times but they were at different penitentiaries. Obviously I didn't have that filter on....the one my father told me should be between my brain and my mouth. Because
I burst out laughing and said "Ha...your allergic to incarceration"! If looks could kill...maybe I should say that differently. The prisoner shot a glare at me, the Doc looked at his shoes.

Continuing with the assessment the Doc asks "and how long have you been this facility"? The prisoner answers "16 years and a lot more to go". I guess the Doc didn't have his filter on either because it rolls right off his tongue "Jeez, what did you do"? The prisoner gave us a serious "you've got to be kidding" look and answered "I guess enough".

Now the game was on. I was given the assignment..find out what he did. I tried to be slick and pass it on to the summer ER tech. He said "No way! I'm not getting killed, I have to finish college". Come on. I pushed. Practice your H&P skills. It may help you some day. He was quick to point out "Being dead is not going to help me some day".

While starting the IV a registration clerk came in to verify information. He gave her his birth date. I was stunned. As old and beaten as he looked, I was 3 yrs older. Again, no filter. I said "Wow, your younger than me! Catching myself I scrambled with "but I mean that in a good way. You've been outside a lot" It didn't fly. The guards were now howling and the prisoner was just shaking his head but he had a little smirk on his face.

The IV meds brought him relief. He was re-shackled and escorted out. But before he left he stopped, turned around and said "You have a nice day mam and thank you kindly. Please thank the physician for me". We never did get the answer.

VIAGRA MAN

Once both children were off to college I added "Cruise Nursing" to my resume. I signed on as a part-time cruise nurse and agreed to sail 3-4 times/year. My husband Rick was familiar with cruising and steered me towards a higher-end line that catered to the senior crowd. After all, this groups chief complaints were more than familiar to me. "CHF, Kidney Stones, Skin Avulsions, Falls, Chest Pain and let us not forget the Prostate "I can't get my stream going". I did not want one of those "Kmart of the Caribbean" cruise lines dealing with drunks who dove in the shallow end by mistake. No climbing walls on the high seas for me.

I sailed off to the Baltic, Europe, Alaska, Caribbean and more. On my days off I wandered Spain, Norway, Russia and Portugal. I toured ruins in Rome, museums in France, history in the Panama Canal. I was awed by glaciers in Alaska and found my Grandmother's green eyes in Copenhagen. While walking in the Palace's Amber Room in
St Petersburg Russia I found myself thinking "It's nursing that made today possible" I may not be able to afford to be a paying passenger, but as a nurse I can always barter my passage. There are so many cruise stories to tell. One of my most memorable was a 3 week cruise through the Panama Canal.

Meet "Viagra Man" as the medical staff lovingly nick named him. This gentleman was 85 yrs old and took the 3 week cruise with his 83yr old fiance. The ship stopped for a day in Nicaragua. That evening after pulling out of port the 85yr old was wheeled into the infirmary. I was on duty. His German wife-to-be complained that he was "Veak and vouldn't stand up". Well, that happens with a blood pressure of 76/32. He was a tiny man with no history of CHF so we pumped him full of fluids. Rick (frequently in the infirmary helping) wheeled him back to his cabin for us and we checked on him for the next few hours. All seemed well. Probably just another little old guy over doing it.

So we thought... until the next morning when a cabin boy wheeled him back to the infirmary. B/P still unstable. He was still "veak" and dizzy. Another liter of fluids and more questions. As I sat with him he turned and looked up at me with desperation in his eyes. "Tell her no more. Tell her I can't do this." The story unfolds. Turns out that a few months ago his fiance talked him into using Viagra. He developed chest pains and earned himself a trip to the ER. "My Doctor told me never again. But she won't give up".

What??? While in Nicaragua they visited a local street market where medicinal herbs were sold along with fruits and vegetables. His fiance asked about "performance enhancing herbs" and was sold a bag of something. Ingesting this herb had resulted in his first visit to the infirmary. As usual, and as every ER nurse knows "they never tell you the whole story".

I gave Viagra Man 1000cc of NS and for his fiance, some much needed education. I explained to her, at his age when all the blood went to the "pleasure zone" there was not enough left to keep him standing. If his Doctor said to lay off it...it's because it's not safe and he could die. Rule #1 in ER patient education "blunt works".

What I wanted to say was... "Are you trying to kill the poor guy. For God's sake woman buy a battery operated device and leave him alone!" My mind wandered to the young gold diggers who marry the old farts for their money. This would be a good detective novel. Viagra Man visited us again for another liter of fluids that evening. It took 5 liters of fluids over 3 days to get him functioning. I can only imagine the bill for Infirmary Services.

When visiting Nicaragua don't buy Nicaraguan Viagra!!!

THEN HE SAWED OPEN HIS CHEST!

I was in the surgery changing room digging through a rack of scrubs to find my size. Nervous and excited I quickly changed and met the RN who would escort me to operating room 18. It was my day in the OR. I had wondered all night how it would go. What surgery would I be watching? Who would be the surgeon? Was he going to ask me questions I didn't have an answer to, leaving me feeling inadequate? What if the worst happened...I'd see the blood and guts, get dizzy , throw up and pass out. They would probably just drag me outside the room and carry on. And I would be the inspiration of all their jokes for the next few months, blushing every time I saw them in the halls.
"Oh, I'll put you in the OR with Dr.P, he's doing a coronary bypass , you'll love him." I was listening to the nurse while trying to put on my surgical mask like I had done it a thousand times. The OR room was bright and clean. Several sterilized staff members were busy filling basins, opening sterile instrument trays and dropping sutures onto their work fields. They were very kind and explained that the Physicians Assistant was harvesting the vein and I could stand by and watch. But if I broke their sterile field they would have to kill me and if I felt flush or dizzy to "back up to the wall and sit down". I took it all in as I watched him by video digging through yellow fat and tissue, finding just the right place to remove this vein. Once the vein was out, it was way smaller than I had imagined in my head. Smaller than the diameter of a pencil, pink, and rubbery. Glad I made it through that part, not so bad. The surgeon was paged and we began.

Anesthesia let me stand on a stool at the head of the bed, overlooking this 200+ pound white man with a freshly shaved chest. As the surgeon grabbed the scalpel and cut strait down the center of his chest I could feel my heart pounding. That part wasn't bad at all, then he asked for "the saw". I tried to mentally prepare myself for what I was about to witness but that's really hard when you've never seen a human body sawed open before. How else are they supposed to get through the sternum? I guess I hadn't ever really thought about it. Next he sawed through the sternum and applied a sort of crank to hold open the chest. I detached from the reality of it,and it became strictly medical.
Now this chest was open and there it was, A BEATING HUMAN HEART. Right in front of my eyes! I couldn't believe what I was watching. It was truly amazing! In order to quiet the heart down to a "quivering" organ they could work on...they poured a bucket of ice over it, they also hooked him up to the bypass machine and then began looking for bypass sites. I watched in awe. Inspired by the fact that this kind of thing is possible, I contemplated if I was capable of becoming a surgeon. Then the thought of 10+ more years of school flashed across my brain and my surgical aspirations quickly disappeared.
Magnifying goggles were required to utilize sutures so small that I could barely see them. Once it was all over , the two sides of the sternum were wired back together. It took a ton of strength to jam a needle through the bone on both sides,and run wire through to tie it up tight.4 chest tubes were placed, 1 on either side of the heart and 1 by each lung, and some pacing wires were attatched to the heart and threaded through the front of his chest. Now, it was basically over.

I made it without embarrassing myself! I wanted so bad to take a photo with my phone of my view, looking over the drape at an open chest, a beating human heart and the surgeon performing a potentially life saving procedure.

My life was changed by my experience that day in the OR. I love my role as caretaker of these people even more and can truly understand why they hurt so bad afterwards. Lesson learned: eat your veggies and exercise so you wont have to get your chest sawed open, and that is one lesson I'm saving for my kids. - THE ROOKIE

The Power of a Little Man

I became an Aunt for the first time this year. I am in my mid twenties and it's a great time to practice my baby skills and prepare for the great challenge that lies ahead. On my first day of babysitting I was ready to handle it all . My first poopy diaper...I put him in the crib on his changing cloth and began to wipe away. As I was wiping he started to go some more, and more and more and more. I was wiping as fast as he was going. I thought it would stop but apparently he wasn't finished. I used up a whole box of wipes and then got hosed when he decided to pee and I didn't have his little man covered up. Wow what a job!

So then day two of babysitting comes along. This time I had learned to let him finish. He's a man and men need time to do their thing. Why didn't I know this?
I grew up with an older brother in a house with one bathroom. I spent hours banging on the door, pleading with him that I HAD to shower and he could finish his novel somewhere else. That is why I let little "Caleb" go and go and go.

I set him in his swing and left him alone. When I was sure he was done we went into the baby room. As I removed his little pants I saw it! His little stink bomb had been squished all up his side, out of his onesey and up his back. Great! I stripped him down and started wiping. It was everywhere! The crib sheet, my hands, his arms, back, legs, clothes! The whole time I'm thinking "I need gloves. Where are the gloves? This cant be sanitary. He's going to get Ecoli, I'm going to get Ecoli! No sink, no cavi-wipes no gloves, this is bad." His mom is going to kill me when she gets home and finds some little spot I've missed on his neck or something. I zip lock bagged everything and gave the boy a bath! When my sister-in- law asked how he was, I gave her the full report. She laughed and said " he's been working on that one all day".

The next day I pondered my experience as I cleaned up an explosion from a man I had just given an enema to. I thought, how can I come in here and clean up adult butts everyday with out a problem. Give laxatives, deal with antibiotic induced diarrhea, enemas and fecal management systems and this tiny 3 month old and his bottom the size of my hand can drop a bomb I can barely handle? I leave the nursery a defeated soldier. And yet I conquer the bowel mountain at work everyday.

The great lesson I've learned is this: My nursery will be stainless steel, equipped with sanitary wipes, gloves, towels, sink and a decontamination shower........

The Rookie

We're not God...thank God

Nursing reminds me who I am, who I'm not, and what is better left in God's hands.

Level I Medical has arrived. EMS is coding a pencil thin, naked old man who is covered in dried feces and hypothermic. It took a while for the police to locate his 75 yr old brother. His brother walked into the room, confirmed the mans identity, then walked out shaking his head. I stepped out in the hall to talk with him. According to the brother "He used to be a drinker but his last wife had the rope on him. Made him go to church, fed him good and drove him everywhere. Didn't leave him alone for a minute. She died 11 yrs ago and the family really hasn't seen him since". The EMS run sheet said the patient lived in a one room cabin in the woods. The grounds keeper found him outside the cabin on the ground. He was unresponsive, covered in urine and s____. The groundskeeper figured him for dead. EMS arrives on scene and damn..he had a heart rate of 175. So the fun begins... Intubated and vented, 7 bags of fluids over 2 hours, still ZERO urine output from foley. The ER Doc says to us "That's the highest Na, K and Cr and the lowest Ph I've ever seen". The hot-line"s running saline at top speed, bear hugger in play going strong but I still didn't see a core temp above 92. His racing heart wins him a bed in ICU. I wanted to just hurry and get him up there knowing it was just a waiting game now and he could continue his passing over up there. I had work to do.

But wait, the Doc says "on the way to ICU take him to radiology so we can put a dialysis catheter in him". I guess we will run his kidney through the cleaner and make him better? I start thinking "There is just no dignity for this guy. He's going to wake up covered in s___ in the ICU with 1/2 a brain and lots of debt". There are moments in nursing when the most I can do is return a little dignity. The other nurse and I are literally washing his feet when I start saying "Why are we doing all this. for what reason? CT showed his brain is now the size of a walnut, he's on his way out for God's sake! Why do we get in the way of people dying just to keep them here in their messy lives"? The other nurse speaks up and reminds me "We don't get to choose. He has a heart rate, he gets it all". OK, I'll work on that. The next day I came in curious to look him up on the computer and see what happened. "I'll be damned" I said as I read the ICU nurses charting.

He woke up, started pulling tubes, seizured and by morning all his lab values were normal and he was taking oral fluids and following simple directions. Granted he won't be functioning independently for a while but I remind myself that this had more to do with God's plan than any of us. Maybe now he'll be able to reconnect with his family and leave this earth in a more dignified, loving way. Maybe holding his brother's hand..... I learn again.

GRAB THE CODE CART!!!!

I work on a post cardiovascular and thoracic step down unit so I had to get my Advanced Cardiac Life Support certification 6 months after beginning work. The class was amazing. We were in a university simulation lab running codes on computerized dummies. The instructors sat outside the room and control them, made them stop breathing,go into change rhythms and even talk to us. We ran code scenarios until we were blue in the face. I felt sooooo much better about the whole thing when I left. I was pumped. Up until then I was really scared that someone would code and I would not handle it well because I really didn't have a clear picture of what to do. I had pumped chests and bagged people while working as a tech in an emergency department but never functioned as the nurse. The next week after my class I told my managers how much I enjoyed it and how great I felt. Shortly after that the monitor room called me and said "go look at room....... He just had 4 beats of V-Tach" as I rounded the corner I glanced at the monitor and saw sustained V-Tach. My charge nurse was right there and I yelled " grab the code cart" . Mean while I'm thinking " this is it.. okay, V-Tach, think, think,, check a pulse.." and BAM.. 5 of us go bursting into his room, blazing glory, code cart and all. The man's eyes were as big as baseballs , sitting there asymptomatic as could be, watching t.v. looking at us like " what the hell?". We asked him if he felt okay, he said yes, we told him we had to check his vital signs and hook him up to the monitor. As we are doing all this he starts asking what is happening,gets really scared, and starts to cry. We look at the monitor and its reading sinus rhythm. " Sir I say, your heart looked like it was having some irregular beats which can be dangerous and we had to hook you up for your safety, it looks like everything is okay but I'm going to review your rhythm strips and see what happened. Turned out to be really wierd artifact that from a distance on the monitor looked like V-Tach. My manager looked at me and said "I know you liked the ACLS class, but don't be bringing it back with you." We all laughed. Finally my patient laughed. I told him " well at least you know if something did go wrong we would be all over it!" Glad it was a false alarm.......that time....
-THE ROOKIE

JUST THE BEGINNING.....

Nine months into this gig and I am just beginning to come to work without butterflies in my stomach, although they do come and go as they day passes by. The first 6 months were hard to say the least. I rethought my decision to choose such a demanding and challenging career many times. I thought I may not be cut out for this and I definitely thought nursing school was hard, but nothing like the real thing. NURSING.... what was a dream of mine for so long had now become my life. It was real now, the long hours, the heartfelt moments, the fear,the joy and the satisfaction of going home at night knowing I made a difference. I can say I came into this green, scared and questioning myself. I pushed on , learned my stuff , became part of this amazing team and I have been earning my "battle scars" ever since. TO ALL THE NURSES OUT THERE, WE ARE A TEAM, WE ARE AMAZING AND WE ARE MAKING LIVES BETTER EVERY SINGLE DAY....... JOIN WITH ME ON MY JOURNEY..... ITS ONLY JUST BEGUN....
-THE ROOKIE

33 Years, Still Going Strong

Little did I know 33 years ago that I would now proudly refer to my nursing career as "Life in the Trenches" It's not for the weak of stomach, heart, or spiritually maladjusted. Well, you may enter spiritually maladjusted but dealing with the tragedy, humor, miracles, frustrations and stupidity of humans will change all that. The names and places are forgotten. The stories stay with me.

Like the very prim and proper, perfectly coiffed middle aged mother who anxiously answered the "why did you come in" question with this: When my college age daughters came home for Thanksgiving I was absolutely appalled at dinner when I realized they had both pierced their nose. I was furious. They looked like...I can't even go there. Today i was walking through the mall and I saw these things for sale. It's a small magnet that you put on the inside of a nare then a diamond looking stone that you put on the outside out here (she's got her finger in her nose demonstrating). I was going to wear it to Christmas dinner just to show them how ridiculous they looked. It tickled and I sniffed in. I think the magnet is in my lungs". .

I'm not sure how the billing department coded this one, or what her final out-of-pocket cost was. But an ER room charge, MD evaluation and chin to pelvis x-rays can't be cheap. The end result was she was OK and would just poop the magnet. During discharge I said "You must tell this story to your girls". She threw her nose up in the air and indignantly proclaimed "I WILL NOT!" I hope she changed her mind as her ruffled feathers settled. It would make for a great family story at Christmas dinner.

Day 1 of a Great Adventure in Nursing Stories

This post won't last as it is the girls blog, but I wanted all the world to know how proud of these two I am.

They make me laugh, they frustrate me to tears, but I love them both very much.

This is their journal. The chronicle of their careers. One as a rookie. One as a veteran.

Good luck girls.