Dysfunction Junction

Today I had to explain to a worker from Jamaica what "Dysfunctional Vaginal Syndrome" was. Actually she just keeps bleeding. I was cracking up, what will they come up with next? I finally said to her "Well, you've heard of dysfunctional families? You have a dysfunctional vagina. She LOST it.

I couldn't get her to stop laughing long enough to sign out. She stopped by the desk, still laughing and said "I can't wait to tell them at home about Dysfunctional American vagina's"!
The charge nurse overheard this, stopped what she was doing and just stared. As she left us this giggling patient gave me a big hug and said "I never forget you" As she walked away I said to the charge nurse "You had to be there" Of course what I didn't share was that I told her in America we tell our girls that a vagina is called a musn't-touch-it

CIRCUS LADY

I walked in the room to assess an 81yr old woman who resented with a possible hip fracture. She was in a lot of pain. As I started her IV to give her meds her 80yr old friend piped u. "This lady. This lady is an amazing woman. Just ask her. Ask her about riding the elephants." So I did, "You rode elephants? Where? In the circus?" She nodded her head. I said "I just finished reading the book Water for Elephants. Was the Circus really like that? Were most of the Carnies fugitives of some sort? She said "Yes, I lived that book. That was my life." Her friend jumped in again. "She is a strong lady. She's a survivor, she is! This little thing ran to the circus to hide from a husband who beat her within an inch of her life". I looked at my patient and said "True?" She responded "You do what you have to do. There were n0 Safe Houses back then." I drew up her Dilaudid as her friend continued. "She ended up finding comfort in the arms of the Mayor. Her husband found out and beat her worse than ever and put in the hospital. The Mayor bought her a car, delivered $500 to her and said "Take your 5 kids and run. He'll kill you the next time" So she did. She went all the way to Florida and joined the circus with her 5 children. He looked for her but never found her." I asked my patient "True?". She nodded her head and said "You do what you have to do." Well what ever happened to your relationship with the Mayor? I asked. Her reply "He kept in touch with letters and let me know if my husband was getting any closer to finding me, but I couldn't write him back. He sent me money for the kids now and then." She continued with her story while the pain medicine did it's magic. "I really was a looker so I got to ride the elephants for a long time. When I passed that point I asked them if I could cook for the Carnies so I could stay. They said yes. That man (name withheld, think of a well known Circus) was a crook and a pickpocket. He even picked the pockets of his own Carnies. I didn't like him. He had an island out in the everglades of Florida where all his New York mafia friends would come play poker and drink. I had to cook for them and I hated it. But all I had to do was cook. The younger gals...well, he would send them out there on one of those boats with the big fan and tell them to keep his friends happy". She looked up and said "You do what you have to do." I asked did you ever fall in love there? "Nooooo" she said. "The circus is no place to find a man" (smarter than a lot of us) It was hard to take breaks from her story and go take care of my other patients. How entertaining are UTI's, COPD and A-Fib after this? As the story ended she finally did leave the Circus once her children were grown. Met a good man, married and moved north to years of kindness. The last question I asked was how her kids were after this adventure. Her friend piped in "They don't even talk to her, not one of them. Their all mad because she made them grow up in a Circus" True? I asked. She looked up at me with tears and shame in her eyes and said "It wasn't only the pretty women who they forced sex with". You never know the story behind these eyes until they share it. The ER at times delivers life in it's most raw form.

I had that instinct they always talk about....

A cute 60 something woman came over from the CV/ICU mid-afternoon. She looked good, post operative day 2 . . No major issues to be reported. I settled her in, did a thorough assessment, oriented her and her sister and then continued my afternoon as usual. A few hours later I was in her room talking with them and she just seemed a tad different. I couldn't put my finger on it but it was her eyes that told the story. They had this glazed look to them and were not focusing quite right. I did a rapid neuro assessment and she checked out fine. I just didn't feel right about her so I called my charge nurse in to do a neuro assessment herself. The woman checked out but seemed a little drowsy and the family agreed that this was abnormal for her. We thought about her being a dialysis patient and having received Percocet prior to coming to us. Was this influencing her metabolism of the pain medicine and maybe contributing to her drowsiness?

About 5-10 minutes later the monitor room called to tell me her heart rate had dropped from the 70's Sinus Rhythm to 49 and was now riding in the 60's. I had just left the room and she was unchanged. I checked it out on our monitor and she was Sinus Brady. She had had no rhythm issues prior to this. I reviewed the past rhythm strips and they looked good, so I concluded this was abnormal for her and something was changing. I told my charge nurse and asked if she wanted to put the monitor and pacing pads in the room. She said " let me call the ICU nurse who previously took care of her and ask some questions and we'll watch her close".

I walked back into the room and found she was not arousable, her eyes were wide open and she was barely breathing. I called for a rapid response while the other nurses grabbed the code cart. Her respirations were agonal at this point so we started bagging her. We hooked her up to the monitor and put the pacing pads on her. She was in Sinus Bradycardia. We tried to get a blood pressure and couldn't , they called it "Code Blue". We accessed a strong femoral pulse as people started pouring in to help. The code team , ICU nurses, medical residents, anesthesia and their students , respiratory, the AOD and chaplain. We had plenty of hands, as always in a code.

Still couldn't get a pressure as I tried to explain to her attending physician what was going on. Of course he was frustrated and demanding more information than I had at the time. Eventually he got the picture. I think part of it is that he knows I'm a new nurse and thinks I am incapable in some way. At least that's how I feel when they get all stressed out with me on the phone. Oh well that really wasn't important, my patient was. He ordered her be intubated and taken back to the ICU. Eventually, we got a pressure, a really crappy one and she was headed for the ventilator and some pressors. Days later I talked to one of the nurses about it and it turns out the patient had Sick Sinus Syndrome and needed a pacemaker. So... It was a good assessment on my part and we had done nothing wrong. She received the right treatment in time and is doing quite well now. Another learning experience on my part. TRUST YOUR GUT!