A day in the life of a nurse

Where the heck have I been?

2007-08-03T01:25:00.001-07:00

Well, the answer to that question is ALL the freakin over the place....and I've enjoyed it too! For those of you who don't know that I have more than one blog- you will be surprised to learn that after the ankle sprain that I went all over Europe with that sprained ankle. I have lots of not so sexy photos of me with a very large brace on the lower half of my right leg. In general- all of my photos from Europe are less than sexy- it was hot, humid and we walked our sweaty selves all over the place. However, I did have lots of fun. I should post a new photo of my ankle, but to everyone but me and my doctor- it looks like a regular old ankle. To me, I can tell (and feel) that it remains swollen and is 1.5 inches larger than the left ankle. I decided to stop going to physical therapy after I got a bill for $45.00 for them putting ice packs on my ankle. Are the smoking crack? $45.00 for ice packs and I didn't even get to take them home with me! Seriously.

Lets see here, where else have I been...
Florida, yep. Nobody here is shocked about that. Nope. Gotta go see my boy Mickey.

School-
I've lost that loving feeling. I enjoy school and learning, but I don't enjoy the studying part, especially for exams. I would much rather spend time planning my next trip, then I would memorizing stuff. Memorization isn't really learning, it's just reputation. I understand why I have to memorize it, when I can look the information up and things that I really need to know, will automatically be memorized. May as well stop bitching, it isn't going to get me anywhere. I threatened to stop grad school and my husband just laughed at me, literally. I was told under no circumstances was I stopping grad school. I reminded him he wasn't my father. He then threatened to call my father....I backed off. I knew my father would not support me in this situation. I guess I know my limits.

Family-
Noah is as sweet, awesome, and handsome as ever. His love for Star Wars grows. He and his father went down to Florida for Star Wars weekends, where Noah dressed in full costume. He wanted his costume to look like the black Jedi outfit from episode three when Anikin went to the dark side. He also grew his hair out for three months to achieve this look. He looked absolutely awesome and Robb said he got lots of extra attention. Noah also continues to get tall and looks nothing like a child. I see pictures of him from last year or the year before and I really appreciate how mature he is getting. It is wonderful and sad to see my son grow.

Me, myself, and I-My life continues to be busy and I am increasingly involved with work and family both those who live immediately with me and my parents. It is frightening to see my mother continue to battle breast cancer, despite the the minimal impact it has had on her physically. I guess I would say that I almost feel as if I am waiting for the other shoe to drop and I feel emotionally terrorized. Terrorized by her potential future. I don't feel nearly grown up enough to have my parents leave and not around to guide me. Don't they know that I only appear to be ready?

A picture is worth 15 days off work and counting...

2007-05-17T14:56:00.001-07:00

OUCH!!!

2007-05-17T14:42:00.001-07:00

This is the result of rolling my ankle. I know that doesn't sound impressive- but it is different than twisting your ankle. It is when your ankle bone is what you are standing on and your foot is perpendicular to it. Medically, it is a grade III sprain- which is the worst sprain you can get with torn ligaments. I get to see the Ortho-surgeion on Monday. Lucky, lucky me.

Living upside down

2007-03-09T00:54:00.000-08:00

Ahhh, one of the joys of nursing is the fact that we work in shifts. Traditionally, nurses in intensive care units work a 12.5 hour shift. It is better for the patient to interact with fewer people. Health care can become like the game telephone and if too many people are in the line the initial phrase becomes twisted. Things get missed and patient care is not optimal- I know it sounds trivial, but you need to know how many liters of fluid ahead your patients is and when their last bowel movement was. Lovely, isn't it- but these are some of the little details that make it so you can provide the best service possible. Yes, health care is REALLY a service industry. Anyways, back to my original point- so we work these long shifts traditionally from 7am to 7:30pm or 7pm to 7:30AM. One of the joys of working these shifts, is that unless you really like working nights and want to do it permanently- you have to rotate. Currently, I am on the night rotation and am almost through the worst part, which is the first three weeks. As this is my third time doing this rotation- I am beginning to know how to do things, so that I feel some what normal. The first time I "flipped" was when I was on orientation- I felt like shit. Literally, it was horrible. I cried everyday and those who know me, know I'm not the type to cry. I had made the mistake of trying to work the way do I when I am on days- three days in a row. Nope, it wasn't happening. With the increased traffic faced on both directions of the commute and the distance I live from my hospital- it made it so I was getting four or five hours of sleep. You can't be effective working for someone else, when you are so tired that you can hardly function. It leads to mistakes and mistakes lead to death. No thank you.

The second time I did it, I mainly worked one day on and one day off. This is much better and I stayed on the night schedule even if I wasn't working. This worked better for me and I wasn't crying everyday- but I got sick. I usually don't get very sick, so it wasn't any big deal. Just the way your body tells you it is angry with you and it doesn't like what you are doing to it.

Ahh, the third time is supposed to be the charm- right? Hmm, I'm not so sure- but to be fair there were some unexpected challenges. REAL sickness. One of my fine coworkers decided to come into work while he was experiencing some respiratory and GI issues. Needless to say- every single nurse in our unit called into sick one day or the other the first week I was on nights. It was great fun to drive home while vomiting....you drive, you pull over to throw up and then sleep for a little while and the cycle repeats. My normal commute took five hours with my husband finally retrieving me. Bless his soul. A week after that, I then got the flu like cold going around the unit. Aches, chills, cough, and feeling like your hair hurts. Surprisingly, I know this wasn't the real flu. Why, because as a nurse you know these things. I get to consistently requalify what the flu is for my parents and siblings- who call any respiratory infection the flu. Anyways, this is the middle of week three and I'm actually beginning to feel seminormal. My body is getting used to doing all of the things it normally does during the day- at night. I have started living out of our family room, while my family is upstairs sleeping. Currently, I am doing laundry and the fire is going. Not half bad. Oh and I am getting ready for my finals- which are Tuesday.

I have to say that seeing the sun come up and go down is kind of weird. When I work days, I see one or the other depending on the season- but not usually both. Sunrise is cooler. I also enjoy my little boy coming downstairs to me, where I get to see him with his hair messed up and his eyes still full of sleep. I like kissing my husband good night and good morning and wondering upstairs to watching him sleep and wonder where he is. I also like the quiet it affords at work. The unit is dark and full of the reassuring noises of heart monitors and breathing machines. The whirl, hum, and beep. There is also the strange beauty that can only be appreciated by an ICU nurse. If your patient is critically ill, the ones we really like, their room is filled with the beautiful glow of machines. The green LCD display of the IV pumps. The green, blue, red, white, and yellow waveforms of the heart, lungs, and brain. The train of four machine in red and the vent in green. The many lights, machines, and medications working together to keep someone alive. It is all beautiful to me.

I don't know where to begin

2007-01-29T18:38:00.000-08:00

I think my title basically says how I have felt about life lately. There are so many things going on that I often feel challenged as to where I should start. I had to look at my last posting to see where I left off. After October, thing have gotten pretty crazy in my "nurse" life and well as my real life. I found out a few days before Christmas that my mother was diagnosed with breast cancer and she would be having surgery right after Christmas. I have always heard that families of nurses appear to be cursed with weird or difficult health problems. I felt that with my mother, sister, and myself all having holes in our hearts and newly diagnosed clotting disorder that we might have made the quota. Then my sister was diagnosed with a neurological condition, which looks the multiple sclerosis on MRI films- but doesn't act like it, that we really had it. Did I mention my father has sarcoids in his lungs....so, to have my mother diagnosed with breast cancer- without an existing family history, kind of threw me for a loop. I was basically a basket case over Christmas, living day to day- trying to survive. I know and understand that people have to get sick and die- I make my living off of it. But, I never contemplated that breast cancer would enter the equation.

Post diagnosis, I spent many hours on the phone with my parents and siblings discussing breast cancer and treatment. My father would call me at odd hours, asking me what I knew and thought about experimental treatment. I did not have answers for many of his questions, as I am not well versed in current oncology therapies. I am able to answer basic questions, but I REALLY don't know enough to tell my father which band of radiation machine is able to provide highest form of radiation, with the smallest amount of damage to the surrounding tissue. At times like this, I got to remind him that I am really helpful to have in the family should someone be trying to actively die- that is what I do and know. That is my playground and I am THE bully.

Being transplanted to a new school, I had to take some lessons. I spent lots of time talking to my parents regarding what to expect before, during, and after surgery. What should they do and what was not acceptable. I also spent lots and lots of time doing what nurses do best-teaching. "No, Mom you can't ever garden again without gloves" "Yes, you must take the permanent marker and write NOT THIS ONE on her other breast." "Dad, I don't care, take a photo of her breast on the camera phone and send it to me- or I'll make your nurse do it." Needless to say, I spent lots of time looking at little poorly taken photos of my mother- trying to figure out what was really happening. You see, the patient and their family are always the last to know what is really going on.

On that note, I am going to go to bed- I will follow up on that last line tomorrow.

I should be flogged

2007-01-23T09:02:00.000-08:00

Despite nice people asking me to update my blog and me telling nice people I will do so- I have failed. I suck.

Right now I am putting off studying for an exam, so I could add this little love note. Tomorrow, while I am searching for hotels in Paris, I PROMISE there will be an update. I have seen some crazy shit over the past few months. I saw something that was so horrid- it was almost beautiful. Anyways, I need to get back to my books.

I have no discipline.

The room facing the city

2006-10-09T14:19:00.000-07:00

I used to know the count of the number of individuals that I have seen die. Before I was a nurse the only dead people I had seen were my grandparents in their caskets and despite my parents prodding, I had never actually touched a dead person. Don't get me wrong, there are worse things than death, but few Americans have actually been with another individual while they are dying. It's interesting to see what happens to the body as it shuts down. Horrid to say- but it is really fascinating to see what happens when it is an emergent situation. You can watch the electrical activity of the heart with those green lines and monitors are blaring at you because the algorithm has determined that you are in deep shit. Lungs collapsing, tubes being inserted, veins being probed and pumped full of fluids. Blood pressure dropping, orders being given, medications being mixed and pushed violently in catheters. "Stand clear," electricity pulses through the body, as the chest heaves into the air. Epi, atropine, ABGs, Fluids wide open, "when was the last epi given?" "Turn the paddles to 360." "All clear?" The heart is always the last thing to give up...

In my new unit I do not participate in as many code situations. People in a neurosurgical intensive care unit are relatively healthy. Those who are not, don't live through the assault to their brain. They just die. However, I still see the struggle of the heart in my unit. There is a patient in one of our rooms, who has been here for 97 days. She lies in her bed with perfectly straight sheets, facing the Chicago skyline. Her position is adjusted hourly. The white tube from her right nostril provides nutrition. There is a drain coming from the left side of her brain and a dressing on the right, where the other drain had been last week. Her heart rate, breathing, body fluids, and mental status are monitored hourly. Occasionally she will move her arms, but never to command and I have never seen her eyes open. Her condition is deteriorating daily and new tubes and gadgets are frequently added to her care.

Daily, an older gentleman comes to her bedside. They almost have the same color of gray hair, except most of hers has been shaved off for surgery. He strokes the small patch of hair left at the nape of her neck, when she is positioned on her right side. Frequently, I walk pass the room and his chin is resting on his arm, which perched on the upper side rail of the bed- at a 30 degree angle to prevent his wife from choking on her own secretions. His other hand is always placed in hers.

I wish I was able to photograph this couple, as it is difficult to describe the expression on his face. He looks at her longingly, knowing she is dying. You can see the adoration in his eyes and know he aches to have one last look into her eyes. To tell her thank you and that he has appreciated their time together. He desires to tell her that he loves her and that she should go, but he is horrified at how life will be without her. I look at them knowing that when she goes, he will follow. You can walk past the room and see that their love is deep, true, and strong. They had the love that is told of in stories and is dreamt about by little girls. The electrodes continue to monitor brainwaves, the urine drips into the catheter, and he sits for hours, silently holding her hand. Like I said, the heart is always last to give up.

Al Gore or Me?

2006-10-06T11:39:00.000-07:00

I received a message titled ping today and this term is now pinging around in my head. I was trying to remember what computers do back when you ping them- I believe they ping you back, but it's been a while since I have used a program that involved that. Probably a year ago and it was a file sharing program. One that is not so user friendly, until you learn how to use it. Wouldn't be a problem for some you, but for those of us who briefly used DOS in the sixth grade and were quickly weaned to windows- it tries me to tell my computer what to do. c://run...ring any bells? Al Gore may claim that he invented the internet, but I might try and claim that I invented cyber sex....or at least "had" it with my long distance college boyfriend before there was a term for it. Go way, way back to summer of 1992 and put me in the University of Utah library typing away to said boyfriend in the land of Lambda Moo. At the start of my lunch break I actually googled this term- believing I might see some historical info and was totally surprised and SHOCKED to see that this MUD program actually still exists. HOLY COW! 14 years later- I wish I could remember what my screen name was. All I remember is that I was one of the few girls on this site and I had lots of cool weapons and stuff. The fact that I had XY chromosomes afforded me many favors from my fellow MOOers. This virtual word is text base- no pictures, yet you get lots of descriptions of the things and people around you. You are able to tell the computer what you want to do or where you want to go with prompt commands. However, I basically used the site as a chat room with my boyfriend rather than running up the telephone bill. There were lots of, "Hey what are you wearing/doing/thinking" comments flung between Utah and Massachusetts. I fondly remember many, many hours spent in the library.(My parents and husband are going to love this story.) Hence my prior claim. I can promise you that sometime this weekend you will find me sniffing around the site trying to find my old user name....

Busy, busy, busy

2006-09-05T10:24:00.000-07:00

As per the title, I have been busy working. I have been working or on call for the past six days. I'm beginning to be really, really tired and I don't feel like playing any longer. It's not the tired that you feel when you haven't slept, it's the my bones hurt and I want to take care of myself and not you- tired. Nothing that can't be fixed by spending most or all of tomorrow in my bed writing papers and/or watching television. All I can say is that without my DVR and my bed, I would be forever lost. My husband used to be perplexed when I would spend all day in bed, now he has grown to accept and embrace it. I need one day of down time, where I can mend, so I can carry on and care for my family and patients again. If I don't get these days, it isn't pretty. I find that my compassion for others is very thin and that is not an attractive or acceptable response from a nurse.

Nothing overly exciting patient wise over the past six days. One of my patient's got to graduate from the ICU to the step-down unit and I have been watching the progression of the really sick patient progress. If you have never cared for a really sick person, it's kind of interesting to know all of the little things that have to be done and checked to make sure that optimal healing and progression is allowed. It's kind of tedious at times, but the outcomes can be devastating and cause further harm.

The best thing that happened over the weekend, was this:
My walkie-talkie patient asked me the following question, " You guys don't tie people down to the beds anymore do you." I looked at her, laughed and slyly responded, "Well, we try not to." Knowing her next door neighbor- the really sick one was presently restrained.

Don't make me put a hole there...

2006-08-31T11:24:00.000-07:00

I'm hiding in the conference room on my unit. Unit is the hospital term for the floor or section of the hospital that a nurse works in. I work in a neurosurgical intensive care unit. While this sounds scary, it isn't. Well, most of the time it isn't. Natural selection plays a big hand in those who make it to our unit. Those with comorbidities tend not to do well and don't make it here in the first place or don't live very long. Your body has to be in decent shape to make it through an assault on the brain. The majority of our patients have blood in their brains- in various spots. Many of our patients have drains placed into their brain to drain extra cerebral spinal fluid or blood. These tubes are called external ventricular drains, or EVD for short. The first time I saw one of these drains placed, I about died. They do this at the bedside and it's kind of strange to see. We open a little kit that has a tool that looks roughly like a hand drill. We shave the person's head, clean it with betadine, make a small stab wound- and then crank this drill (yes, I said drill) until you go through their skull. After the hole has been established, we thread this long, thin plastic tube into one of the ventricles in their brain. This drain also allows us to monitor the pressure in their head, at this site. (Not the entire brain) http://intermountainhealthcare.org/xp/public/documents/pcmc/evd.pdf#search=%22external%20ventricular%20drain%22 This site shows a rough picture of what we use, except it is on a child.

Today I am taking care of one person, who had a subarachnoid hemorrhage. This person was actually lucky because they were able to identify that her bleed came from an aneurysm and they were able to go in through a vein in her groin and clip it- rather than having to do the open method, which means have to remove part of their skull. Don't worry, I won't go into more detail than that. My patient has a total of five tubes in her body: one in her brain, a chest tube, a nasal feeding tube, a endotracheal tube for breathing, and a catheter for urine. The chest tube and EVD are placed through man made holes. Her lung collapsed, so the chest tube is placed in the space around the lung, removing air and/or fluid- which allows the lung to inflate. I used to be really nervous when I had patients with chest tubes. Now, not so much.

I pray that I never have to be hospitalized in an intensive care unit. Trying to keep people alive, when their body would rather be dead- can be very painful. All the tubes, monitors, medications, and tests- not so much fun. All I pray it that if I had to be a patient, that I have someone who will keep me so sedated that I never, ever remember any of it. Or I have a physician that knows when to stop. Sometimes being alive can be worse than death.

Onto a different subject-
My husband and I saw "Little Miss Sunshine" yesterday at the movies. It was very, very funny. Very dark humor. I would love to talk about it but I fear that if I do so, that it will ruin it for you. http://www2.foxsearchlight.com/littlemisssunshine/ All I can say is that I highly enjoyed the hospital scene. Spend your eight dollars and go see it, it's worth it.

Run Forest Run

2006-08-29T15:30:00.000-07:00

Okay, so I only ran part of it- but I did do 10 miles today. Why you ask. Well, I am the ultimate procrastinator. Really, I am. I have found that I perform best under pressure. What is the connection between running 10 miles & procrastination? That would be the Chicago Marathon. http://www.chicagomarathon.com/ I was a foolish, foolish girl with apple pie in the sky hopes. I thought after I completed the Disney World Half Marathon in January- that hey, it might be fun to do the local event. LOL. I must have been smoking crack on the day I signed up. Or at least you'd think if I was going to sign up for such events that I might train or something like that- right because that is what sensible people do. Well, I've never claimed to be sensible.

I hate running. I don't like training. I don't like sweating. However, I do like the sense of accomplishment and the awesome medals you get. I'm going to have to take some pictures of those babies and post them. It's all about the jewelry- and the looks I get when people look at me and wonder how on God's green earth I do such events. I may not be fast and I may not be skinny, but I do have the determination to push through the pain.

So I haven't trained, but I'm going to push myself over the next few weeks and I'll give the marathon the old college try. I don't think I will finish, but hey I paid for my entry, so I'll see what happens.

As runners say-
Dead F*&^ing last > Did not finish> Did not start

I love my bed.

2006-08-28T08:41:00.001-07:00

Earlier this morning I was laying in bed pondering what my most prized possession would be, I decided it was my bed. I am very fond on my king size bed, especially since I must share it with my spouse. It is a pillow top mattress with an additional feather bed on top of that. I always have high thread count sheets because they are so, so very soft. I have two different blankets which I use- one is a feather comforter and the other is a faux fir fleece blanket. See the soft and warm theme?

On days after working three days in a row at the hospital, I have been known to not get out of bed. (except to scavenge for food) Today I don't want to get out of bed because doing so means I have to run. I want to run, I just don't want to do so yet. It's raining outside and I'm warm and happy in bed.

I was really tempted

2006-08-27T16:41:00.000-07:00

I like the idea of a blogg. Especially due to the culture I was brought up in. Being raised in Utah and being Mormon- you are instilled with the importance of capturing your life and being able to pass on information, perhaps wisdom, to future generations. What I really wonder is how many people really write what they feel or do- because they do know there is the chance that future generations will read it. Do I really want my friends, family, and children knowing what I REALLY think about or do?

Not that I lead this exciting life or have interesting secrets- but it would be liberating to really write the inner thoughts that you don't tell others- anonymously. So you don't have to worry what you friends will think. In a position where you can receive input from strangers and still live safely in your little world.

Today I am at work. Nothing really exciting happened, nope nothing at all. I spent lots of time on the internet looking at stuff, getting myself a g-mail account, starting this blogg, talking to Disers* about diabetes, checking my own blood sugar (it was low), and talking about my upcoming cruise with my fellow cruisemates.

It's currently 6:45pm and I should be out of here in 45 minutes- I wonder if I will have the courage to run when I get home?

*Disers are people who share a common interest in all things Disney. There are many different types of discussion boards on this website: http://www.disboards.com/ You can find just about anything about Disney (or anything else for that fact) on this website. There are many kind people there. Many of the individuals who are going on our upcoming cruise have actually sponsored me for my upcoming adventure: http://www.goverticalchicago.org/ On November 12, 2006 I am going to climb the stairs of the Sears Tower Building, while raising funds for cancer research. (I love them geeky scientists.) If you want to see my personal fundraising page you can look here: http://drcrf.convio.net/site/TR?px=1081061&pg=personal&fr_id=1080 Feel free to donate ;-) I have also noticed that I have not been supported financially by any of my family or friends and only strangers, I wonder what this says about me?

It's time to give report- which in nurse speak means I get to go home.