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