OUR SOULS ARE NOT HUNGARY FOR FAME, COMFORT, WEALTH OR POWER. THOSE REWARDS CREATE ALMOST AS MANY PROBLEMS AS THEY SOLVE. OUR SOULS ARE HUNGARY FOR MEANING, FOR THE SENSE THAT WE HAVE FIGURED OUT HOW TO LIVE SO THAT OUR LIVES MATTER, SO THAT THE WORLD WILL BE AT LEAST A LITTLE BIT DIFFERENT FOR OUR HAVING PASSED THROUGH IT.

I take the 5th on that

Some things I'll never confess to. I don't know who snuck the 4-H goat into radiology at 5am to have it x-rayed for a bowel obstruction. I did hear that whoever it was was smart enough to make it wear a diaper

My Spanish...not so good

I felt I would be a better nurse to the Hispanic population I was serving if.....
I knew how to speak Spanish. The hospital had the capability of producing discharge instructions in Spanish, but what if the patient, or the parents of the patient, couldn't read? I decided to sign up for a class. The only class available was "Conversational Travel Spanish" and after about 3 weeks the only thing I could say was "I'm looking for my luggage" and "how much is a room"? Then a friend of mine from Argentina gave me a Spanish/English Medical Dictionary for Christmas and I went to work on a self-study craze. Thinking I was doing pretty well I decided to try it with a Hispanic MVA patient I was discharging. He had a mild Head Injury so I thought it was important that I stress no drinking alcohol for the next 24 hours. I meant to say "No cervesa (beer) for you". But instead I said "No cabeza (head) for you". I knew I had goofed when he and his friend BURST out laughing. They just couldn't pull it together and I stood there stunned by what I had just said and watched them roaring with laughter. As they walked out of the ER the friend kept pointing to the patient teasing "No cabeza for you".

EEEZ NO PROBLEM

It was 6:00am. My hubby was driving me to work. I just happened to look out my window to the right and saw, mostly hidden in brush, the "underside" of a car. I said to Hubby "Pull over, drop me off and call 911. Tell them to dispatch to a MVA. We have no idea if there are injuries." (once an ER nurse always an ER nurse). Hubby drove off and I started climbing through brush. So much for the clean uniform. I was just figuring out how to maneuver around the vehicle when I thought. "I hope there's not a madman back here in the swamps of South Carolina". What I found instead was a dazed tall man standing in the woods just starring. I started talking to him and he walked right past me out to the road. I said "Stop" I just want to make sure your OK" He responded "Eeez OK. Eeez OK". I said "Sit down". He did. The smell of booze was powerful. I let him know "I'm going to touch you and you tell me if it hurts". "Eeez O.K.,
Eeez O.K. Eeez O.K." was his only response to my TNCC process. It was all I could do to get him to sit and not walk away as he kept attempting to get up. I told him I was going to keep holding his head straight but he kept fussing. Then I heard the Sirens. The first to show up was the Sheriff Department. I gave them a quick report and stepped back to watch the show. The look on their faces told me they knew this was an intoxicated driver. The man kept repeating "Eeez O.K." Finally one of the Sheriffs stepped up to him and said "Eeez not OK bud. Turn around and put your hands behind your back" Nuff said...he was leaving with Johnny Law. My husband had called the ER, told them I'd be late but I was coming. As I got off the elevator I looked down at my muddy uniform and shoes. The other staff said "Where the hell were you" I responded "Climbing around the swamp with a Sheriff Deputy".

Can't always trust the Interpreter

One chapter in my nursing career involved visiting local plants and providing Flu shots to the line workers. Many at this plant were Hispanic. After setting everything up I told the Line Supervisor (also Hispanic) " Ask them to line up and pull up the sleeve of their shirts so I can easily get to the (Deltoid) muscle". He announced something very loud. The next thing I knew all the line workers were laughing, undoing their belts and pulling their pants down! I said to the line Boss "Whoa, whoa...arm! Not butt!" He burst out laughing and said "I know. I just wanted to mess with them".

Times May Have Changed but Addiction Hasn't

When I was 19 yrs old I was a student nurse and experienced my first awakenning to the power of the addiction to cigarettes. It was back when patients were still allowed to smoke in the hall outside their rooms. Yes folks that really was allowed! My patient was standing there, inhaling his non-filtered Camel through his trach!! I can remember thinking "that shit has an
in-humane hold on him". The same year I went out with a group of people getting together to celebrate someone's one year anniversary of kicking Heroin. He slapped his pack of smokes down on the table and said "I quit junk! But I can't stop these". That was over 30 yrs ago. Hosital rules have changed. 5 years ago I would walk out of the hospital and pass patients standing outside holding their IV poles...smoking. When hospitals became "No Smoking" environments there were many staff sneaking outside during their shifts, standing by a dumpster to catch a smoke. Rain or snow didn't matter. Now we have Nicotine Patches on standing admit orders, "No Smoking Campuses" and healthcare workers have to be pretty skilled, or slick, to pull off a smoke. But what has always shocked me the most? Watching the Respiratory Therapists head out for theirs.

God was the backseat driver

20 yr old walks in to the ER. In triage he told the nurse "I was rear ended yesterday downstate. I felt OK and the car was fine so I just drove the 5 hours home. Then this morning I woke up and my neck and head really hurt. I told my Mom it was just whiplash but she made me come in to get checked out"



His cervical films revealed a C-2 (hangman's). Good luck? I don't think so. I believe God was in the back seat applying cervical traction the whole way. If any of you have driven these northern rural roads.....then you know the likes of the potholes he went through, over, and around. Reminds me of a country song "Jesus Take the Wheel".



This boy had NO deficits! And would be fine, with story and a song in his step.

You can pierce damn near anything

I walked around the corner just in time to see our newest ER physician walk out of the GYN room pale and shaking his head. He looked up at me and with all sincerity said "I didn't know you could pierce those things" I replied "Oh, it only gets better".

The Hat

One of the best interventions I witnessed over the years.

A creative physician assessing an actively psychotic, hallucinating and escalating pt brought in by EMS would successfully stop the process by asking "Did you have the hat on"? It always seemed to cause the pt to tune in and say "What hat"? The physician would calmly explain "The tin foil hat. If you make a hat out of tin foil and wear it when they start to communicate, they can't get through to you and your safe". Escalating psychotic patients would stop, look up and say "I didn't know that". No more problem, they had a plan now. They settled down, were admitted to the psych unit without the whole explosion, restraints fiasco. As they left for the floor one of us would always say "Good luck. Next time, remember the hat".

No Room in the Cooler

Cruise nursing had some strange moments. This said by an ER nurse who thrives on adrenalin and strange moments. This was a cruise line that catered to a senior crowd. That meant that a huge percentage of the 1200 passengers were obese, Diabetic and had started smoking non-filtered Camels and Luck Strikes at the age of 14. Now, they were spending 10 days eating 5 desserts a day, drinking heavily and doing the "pursed lips" breathing after dancing. I can't tell you how many would wander down to the infirmary 4 days into the sail and say "I left my medicines (all nine) at home by mistake". The infirmary stocked only a very small selection of medications but would provide prescriptions so the individual could wander off the ship and find a pharmacy at the next port. Pre-existing CHF took it's toll.

On this particular cruise #4 seniors went into full blown CHF and "passed over". The standard procedure was to put them in the cooler down below until the next port, then ship them off to home with their family member. I guess the "cooler" didn't have enough room for all #4. So I was told to "call the flower girl and tell her it was now housing a body and not to freak when she went down in the morning to gather her plants. Can't say I've ever had to make a call like that from the ER.

Glow in the Dark Condoms

I walked into the GYN room to greet my latest patient. She spoke no English but was able to get across the idea that something wasn't right "down there". I pantomimed a Gyn exam and she seemed to understand. The boy with her stood in the corner looking at his shoes. Every now and then the gal would say something to him in Spanish but he never spoke. The Doctor came in, legs put in the stirrups and the next thing I see being removed with ring forceps in a bright green with red, yellow and orange designs glow-in-the-dark condom. Apparently "one size fits all" was not the case here. Because it was not "snug" enough, the condom got left behind. My patient was smiling and happily discharged. Her "guy" never looked up from his shoes.

I left the room and went to my heart patient who had been having runs of tachycardia. Her Doctor was in the hall looking flustered. He turned to me and said "Just once I want a normal patient. She's got cocaine in her urine but keeps denying she has used any drugs. Even when I show her the urine results she says 'It must be a mistake. They must have used someone else's pee'. I just once want a patient who doesn't try to BS me". I looked at him inquisitively and asked "Are you flustered because you didn't think an addict should lie?" He apologized and said he was just frustrated today. I told him "Well you could always tag along with Dr ____. He just pulled a glow-in-the-dark condom out of a gal". He burst out laughing and said "Thanks. I needed that. You always seem to give perspective." I'll take that as a compliment.

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!

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.