Oh man. Awkward.

My patient was a very old man with difficult, rolly veins. He was awesome in general and we Joked about a lot through the night, but he got pissed at me when both of his IVs burned when I flushed them, and that meant he needed at least one new one. He told me all about how awful his veins were. So when I started his IV on the first try, he asked me if he could marry me.

No known drug allergies

Me: And are you allergic to any medications?
Patient: Just penicillin.
Me: What happens when you take penicillin?
Patient: I see Superman.

Damn. I have to work on this.

Me: "ma'am, you have to keep your gown on, you can't be showing all your goodies to everyone".

Patient: "well, YOU can't be showing all your goodies to everyone either!"

Twofer!

So last night I got punched in the face. Tonight, I got told by one of my patients that I was mean and he wanted to see my manager. He proceeded to tell the charge nurse that I am a NASTY BITCH (his words) and he needs a different nurse. A nasty bitch!

That's the best thing I've been called at work since... Maybe ever.

Fuck, neither do I...

Me: "ma'am, what year is it?"
Patient: "I don't care!"

And this was after this lady "accidentally" punched me in the face.

One of my favorite things

... That crazy people say - besides that we're trying to KILL them - is when they accuse us of withholding their antipsychotic medications.

"You still haven't given me my seroquel!" (he got it right on time, what does he think I am, stupid???)

Attention crazy people: contrary to popular belief, your nurses want you to have those meds just as badly as you do. Maybe even more so...

Finally figured out who this guy sounds like

... And I want to post a video or something but that would be awful.

My patient sounds exactly like cookie monster. Exactly. Dead ringer.

How am I going to keep a straight face for the rest of the night?

Signs of last night

... A stack of masks outside my patient's room... Because he kept spitting on the bed, the floor, anything, you name it.

... A million dead IV flushes (in my other patient's room) and not one, but two transport monitors (when we take an icu patient somewhere like cat scan or MRI we have to use a portable monitor so we can see their vital signs during their trip. The two monitors means we went so many places I forgot I already had one in my room from before).

... Wrappers from new restraints littering both my rooms

... Me getting to my bed at ten in the morning

Man, this chick says "bitches" more than I do.

I love this. I've never had this much fun floating.

Wow, how did he find that out?

"Sir, are you allergic to anything?"
"Well, just herpes."

Just what you want to hear...

... From the er nurse who is sending you your patient:

"I really don't understand why they [the ambulance] took so long to get her, she is so awful if it were up to me I'd have driven her over there myself".

orientation

I'm precepting tonight. Wow. This is horrible. Time management fail. I haven't been this overwhelmed since I was a new grad - it's like it's contagious. Sigh.

Ladies, don't fall for this.

(call light goes off)

"Excuse me, ma'am, I need someone to hold my penis while I use this urinal."

Ohhhh man.

My patient is completely with it. First things first. In our icu that means he knows his name and date of birth, and he knows where he is, and he knows what the month and year are right now. He can pee in his own urinal. I know this because when I came in he had a condom catheter (look it up) and it came off (as they tend to do) so he picked up his urinal and peed in it, no problem. He then proceeded to ask me to put another one on him. Wha? So is this extreme laziness or a not so subtle attempt to get me to have to put a condom like thing on him?

The things I do at work. Why on earth would you want something like that on you when you aren't incontinent?

Get your mind out of the gutter

True story, an order from my patient's chart: "start pleasure feeds diet".

Toys in the attic he is crazy...

But holy shit, I am shaken up by it. I had this guy all night. I feel for the guy, I really do. He's been in the hospital for over half a year. Half. A. Year. I can't even imagine that. Anyway, I kept trying to convince this guy to let me give him a bath. He kept saying no, and I finally reached an agreement with him that I'd give him pain meds beforehand so it would be easier, and he said yes. So I have his bath drawn up (it was absolutely worth negotiations, he was disgusting and needed a bath so, so badly).

I took off his blanket. He sat up in the bed, one hand fervently swinging at me, the other pointing at me. He's so agitated veins are popping out of his forehead.

"you LIE! YOU LIE! YOU LIE!". Ad nauseum. And I'm sitting there floored, because until then this guy has barely even bothered to wake up. I said something like, "Ok, it's going to be all right. I'm sorry you think that". That set him off. "I don't think so, I KNOW SO!" I said, "Ok, fair enough. No bath". And he instantly settled down, laying back on the bed and going back to sleep, like a switch was flipped.

Shit, it shakes me up when people are so freaking fervent, though. I'm as agnostic as they come, and I had the fleeting thought, "oh my god, this must be what people believe the devil looks like" (and maybe this just means I'm a more superstitious agnostic than most). I am not shaken up by deranged patients very often. But this guy has made the hairs on the back of my neck stand on end. Maybe the sudden superhuman strength, the demonic fervor in his eyes, maybe the blood vessels standing out on his forehead?  I don't know what freaked me out, but I am shocked he didn't spin his head around and start spewing pea soup.  I'd have had to get a change of clothes at work.  Ugh.

Happy Halloween! Oh, wait...

Love at first sight

An adorable little old man on lots of pain meds just told me I look and act just like Tina Fey. <3 too bad he's someone else's patient.

running gross interference

So, something (a mass of dried blood and tissue, NOT gross by my standards, but whatever) fell off my friend's patient's foot (follow?).

What does she do?

Yep, she comes and gets me. "can you please, please, please put this in a bag to show the docs later in case they want to see it?". Sigh.
So, I put it in the bag and went back to eating my lunch.

Slow night here. I wish I had more hilarity to Blog...

Double take

One of my patients is a 78 year old woman. We needed to contact her next of kin. There's a form we use to keep that info handy. When I found it, here's what it said:

Relative name: [redacted]
Relationship: Mother


There's the double take. I guess someone filled it out in a hurry, further down on the page in a different color pen and different handwriting, it said:

(the PATIENT is their mother)

Good thing that was on there, I wonder who made the awkward phone call to necessitate that footnote.

My night (or: vacation karma edition 8000)

Every 15 minutes or so:

(call light goes off)
Me: what do you need?
My patient: Am I going to die? I feel like I'm going to die...
Me: No, you're not going to die. (insert various reassuring things and reasons he's not in fact at death's door).
My patient: well, at least don't leave me here in this place... Please?
Me: I can't stay here all night. I have other patients I have to take care of, too. It wouldn't be fair to them.

Ad nauseum all night. Finally the guy's wife calls to find out how he's doing. When I told her all this, you know what she said?

She said, "oh, HE'S THE SAME WAY AT HOME."

Wow, so I guess that's why she wasn't visiting.

Off until next Friday, bitches!

I had to ask.

Coworker: I went in your patient's room. He was freaking out and kept asking if he was going to die, saying "Tell me if I'm going to die or not!".

Me: "...well? What did you tell him?"

Thankfully she told him "no", which makes my night comparatively easier...

Toss up

I'm not completely sure what's odder, when a more-psychotic icu patient wants to kill me, or when (like tonight) they're obsessed with me and LOVE me. It's honestly a bit creepy. Every time I go in there she talks about how cool I am and how good I look in purple, and about how she was worried it was one of THEM before she realized it was me.

Oh, and she asked if I was married. Hmm. (raised eyebrow)

(updated way later in the night) - OK, this went from kind of cute in an eccentric way, to odd, to OMG I'M GOING TO KILL SOMEONE NOW AND SOMEONE WILL HAVE TO COME BAIL ME OUT OF PRISON.   Kidding.  Sort of...

Why do I get the really horribly annoying people before going on vacation?

I wonder if he really is

Me: ma'am, we're trying to get in touch with your husband. What's his name again?

My patient: (states her last name)

Me: what's his first name?

My patient: J.... J....

Me: ok, it starts with a J? What's the rest of his name?

My patient: Jackass.

Me: ok, that's his name? Jackass?

My patient (looks at me like I've lost my mind): Honey, I just TOLD you that.

Quick quiz!

This is a hard one.

You get up in the morning and your wife is on the floor and not waking up. She shit herself. Do you:

A. Call 911
B. Put her in the car and go to the emergency room
C. Call a doctor (I mean, at the very least, right?)

Or...
D. Put her back to bed, and try and wake her up again at 4 PM the following afternoon. THEN when she doesn't wake up, call 911.

Guess which my patient's family did?

Sendoff to the Other Side

So, I really didn't want to come to work today. I was having a nervous breakdown over a missing/broken tooth. I had no sleep, practically. I requested to be canceled and (read this dramatically) my request was denied. I'd had a gross assignment for a few days already and was tired of feeling coated in crap (both literally and figuratively) when I came home. My patients were both kind of emotionally exhausting - both were on all kinds of life support while the families insisted there was still a point zero one chance of full recovery so, keep going!

Today, I came in to find out that in both cases, the families decided to withdraw care. This means - remove the breathing tube, stop life support, keep them comfortable, maybe send them home on hospice care if they do well enough off life support. Not immediately - one of them, the family wasn't sure when and is still talking about it (in those cases we will be gracious and give the family time). The other family - the parents of a very young woman - wanted to come later in the week and take pictures with her, so they can say goodbye before withdrawing care.

This woman was hard to make "look nice" from the moment I had her. She had continuous E.E.G. Monitoring for 4 days, which is where they paste electrodes to her scalp to monitor for seizures. When the parents decided to withdraw care, they discontinued this. She had to have her tube re-taped multiple times daily because of secretions, etc, etc (trying to not make this too gross for some of you!).  Sidebar here:  In the ICU, making your patients look nice is often secondary only to keeping them alive.  My preceptor used to always say, "it doesn't matter what happens, make them look nice anyway" and I'd roll my eyes.  It's funny how I am now totally converted to that viewpoint.  I've learned all kinds of tricks, but it's totally true - in the ICU, as long as you're not having a very hard time keeping the patient alive, they'd better look good.  You end up kind of judgy of people who are not brand-new and learning the ropes but their patients always look like crap.

We bathe patients at night here. I just spent over an hour combing through her hair to get that EEG glue out with nothing more than an icu comb and hospital soap, and my hands. It was oddly soothing, even she calmed down while I was doing her hair. I wanted her hair to look nice for her pictures for her family. I still need respiratory to re-tape her tube again so that looks nice, too, but her hair looks a million times better than when it came in, and I feel such a sense of pride for that.

I got time to process shit. I really no longer care about my tooth or any number of other crises I have going on. This afternoon, a mother and father will come to our icu to take their last pictures while their daughter is still alive. I hope I made that experience just a little easier for them. And this reminded me that I love helping families through loss. I used to want to do hospice. I don't want to now, but sometimes it's good to have a really satisfying night. It's kind of an emotionally powerful experience giving someone their possible last good bath.

I'm really glad I came to work, and even glad I didn't get canceled.  I am so stoked with the way my workweek unexpectedly ended. 

(now back to your regularly scheduled funny shit)

Love being this person... Sometimes.

Charge nurse comes into the break room. "You're missing it! You're
missing it! Mr. So and so (a patient) is telling us all to suck his
dick!"
She wasn't even coming to get anything, just to tell me. And it
wasn't my patient either. What on earth does this say about me?

Who asks that?

"No, I'm sorry, ma'am, we don't have a way of finding out what race or nationality the donor was for the blood your daughter will be receiving."

Yeah, it happens

I've read a thousand medical oriented blogs and I know a lot of people, so I generally know this happens.  It doesn't make it any less bizarre when it happens to me.

I had a patient that told the next shift's nurse, the next shift's charge, and my unit manager that I was "cold" and "Uncaring" and "didn't show empathy".  The kicker - this was my "easy" patient that night, and I did not have an ounce of trouble with her.  My other patient was insanely needy and constantly testing my nerves (is that OK to say? ).

I seriously have no idea what I said or what I did, because I feel like I had a great rapport with this lady.  We talked about how hard it is to be stuck in the ICU especially for someone who's young and active (this lady was a runner, and it sucked that she was going to be stuck there for almost another week for intense monitoring, but was not going to "feel" sick or deserving of an ICU bed, and I always feel horrible when that happens).  I talked her into accepting pain meds numerous times because it was helping her rest to do so, and she was otherwise lying awake whimpering in pain. 

I am not taking it personally or anything, but I feel like I can't figure out what I did or didn't do.  I keep replaying my interactions with this person and I can't make anything out.  I know this is common, but it kind of sucks when it happens anyway.

The night after, though (but before I was told about this patient's complaint) I cared for a young guy who had had an excruciatingly painful surgery.  Several times that night we kept needing to change his pain medications around to give him some semblance of control.  I felt awful because apparently pain service hadn't been able to come see him after his surgery and at the hospital, pain service is 9 to 5, so the pain control was left up to us bumbling nurses and neurosurgery residents (not that we're not good at it, but this was a complex case and this guy had been seen at the pain clinic on an outpatient basis before his surgery).  I apologized to him lots of times about the pain service issue and the fact that he wasn't getting decent pain control.  He told me at the end of the night I was the best nurse he had had ever in all his hospital experiences.  Which was awesome to hear, considering I was about to get ambushed for being a bitchy nurse to my other patient before.  So. weird.

The corollary to having nine days off in a row....

Is apparently nine or so days of utter and complete hell. 

Friday: work night shift 7p-7a

Saturday: work night shift 7p-7a

Sunday: Day "off" but weird one because I got home at 9 am

Monday: go to training for new job, 8a-4:30p

Tuesday: go to training for new job, 8a-4:30p

Wednesday: go to training for new job, 8a-4:30p

Thursday: go to training for new job, 8a-4:30p AND work night shift 7p-7a

Friday: work night shift 7p-7a

Saturday: work night shift 7p-7a

That's 92 hours of work in ... 8 days? 9 days?  Do I give a fuck anymore? 

Whatever.  Anyway, I have six hours left to go (whispering, so as not to tempt fate) and all I have to say to this week* is: Fuck you.  Don't let the door hit you on the way out.  Suck my left nut.  Got that? 

One other thing: Shout the fuck OUT to all of my family and friends. I fucking LOVE you people. I feel like every time I was about to lose my shit completely, I would get an awesome text from someone or someone would make me laugh really hard, which was so much needed. You all rock and you absolutely collectively saved my sanity this week. I owe you guys.

I've been completely climbing the walls.  I went from posting on facebook every 3.1 days to posting 8 times about dumb shit no one cares about - and what did you guys do?  You were awesome.  You kept liking and commenting on shit.  I texted all day incessantly about dumb shit no one cares about.  You not only replied, but totally put a smile on my face every time. 

For that, I think you're all awesome.  You know who you are.

Peace out, bitches, I'm going to bed.

*(And yes, I'm aware that I set this up myself. Completely, horribly stupidly aware of that)...

Hits from last night

I had a post op guy who was just awesome. after I got him settled, and I walked in his room again, he said, "Hey, thanks for coming to my party". I laughed and said, "your party?" - because this guy was thus far not confused at all. He said, "yeah - all you guys keep coming up in here asking me my name, and asking me what my birthday is, it's kind of like people asking what your sign is, you know? And then they all ask what I'm doing here and why I came in today, and some of y'all want the whole life story."

The funny shit about that is, he's kind of right. We are so routinized and always ask people for name, date of birth, and things like that. It's funny sometimes having patients who make awesome observations.

He needed a lot of cups of ice chips. He kept saying, "you rock" every time I brought him another one. Randomly in the middle of the night after he had gotten Dilaudid, he said "you rock it better than any other white girl". I'm totally flattered!

So, I don't know whether it was that guy's Dilaudid or that guy's awesome, but I loved being his nurse. After we did his CT scan and left the room, he said, "I don't think that guy was all about our party". And he was right, the dude wasn't.

If you go someplace faking a stroke

And get admitted to the ICU, be sure you don't suddenly have PERFECTLY CLEAR speech when requesting the name of a narcotic medication. That makes you look like an idiot.

You know it's bad when you're too gross for work.

I forgot to blog about this one!

So last week, I was drinking ice water out of a plastic container. These things are used for everything in my unit, from holding supplies on tables/organization to carrying around urine. So... as noted before, it was new grad week. One of them paused in mid sentence and looked at me with huge eyes and asked, "Are you drinking out of a PEE thing?". I laughed - a pee thing? And I said yeah, although it's obviously not a used one.

The following conversation ensued:

New grad: You should go get an actual specimen cup and fill it with apple juice or something, now that would REALLY freak someone out.

Me, laughing: Yeah, like during report in the morning?

New grad: Totally!

Some of the other nurses thought this was funny, too and they were all laughing.

Me: I could also add some sugar so it looks all sedimented and cloudy.

Everyone else: silent, then EWWWW!

Me: Wow. I just grossed out a pack of ICU nurses. I don't know whether to be ashamed or really proud.

ZOMBIES!

So, yesterday I had to go to the hospital where I'm getting my second job, for more paperwork/bullshit. (this is the 7th time I've been up there for stuff like this, for those keeping track). I had my kids with me, since they can sometimes act decent enough for me to stick them in a hospital coffee shop for a few minutes while I run to the paperwork office and get stuff done. Anyway, we're walking along and run into a sign like this. While I'm asking where there is an ATM (since of COURSE when I'm going with both unruly-ass kids, they can't POSSIBLY have any spaces open in the designated HR use parking spaces, which are free for 2 hours - so I ultimately had to park in the expensive patient lot on level LXZ in row 888).

I noticed the kids were pretty fixated on this sign and were laughing and pointing. Obviously I see stuff like this every day at work, so it doesn't even occur to me that it would be funny under any circumstance. So I stepped closer to listen to their conversation.

Older kid: "That lady looks like a zombie with her hands like that!"

Younger kid: "That guy looks like a zombie, too. What is this poster about? Do you have zombies in the hospital, Mommy?"

Me, laughing: "No, that's a poster about strokes. It's when someone walks funny and has slurred speech, and their arms droop, it means something happened to their brain. It's called a stroke."

Older kid: "No, that sounds like they're turning into a zombie, too. Come on mom, 'something's happening to their brain?' that sounds like code for ZOMBIES!".

Me: "It does."

Younger kid: "You DO have zombies in the hospital, Mommy! Is THAT what you mean by taking care of sick people?"

Older kid: "Oh, and you're supposed to call 911 when this happens. So I'll have to remember that. If you see Zombies, tell them there's someone having a stroke."

I didn't even tell them that people ALSO can drool a lot when they have a stroke. That would have just added to their incredulity. I might have to tell them that later...

Best.compliment.ever

There was a telltale group of nervous looking younger ladies in clean, pressed scrubs. It didn't occur to me, but a friend of mine and silly night shift buddy went up and asked if they were the new grads. I said "Ohhh, new grads! Makes so much sense". She turned to me and said "This is Nurse Geek. She's up to no good" (sidebar: incriminating details removed, the same reason I don't put pictures on this site). Without missing a beat, I replied, "If all you people even knew the half of it...". Sometimes I have some really good one liners after, say, 4 am or so. I wish I kept that talent throughout the day, because most of the rest of the day I feel completely unlively and positively boring in comparison.

When I first started in the ICU, (probably a week kind of like this one, when I had about zero sleep on board) I said something kind of stupid to one of the PAs (Physician Assistants) that works with us. She was talking about how she was at a party with a lot of the nurses, and she brought a boyfriend. About halfway through the party he remarked that there are a lot of nurses here, do they hate you because you're a PA? At that point, sleep deprived and lacking caution and any kind of filter, I piped up, "You should have been like, 'no, they hate me because I'm a bitch!'". Because I really do make little quips like that all the time, and anyone who knows me would just say "I know, you all hate my bitchiness, I don't even belong here with the rest of you bitches" or something and it would be something we'd all laugh at. Well, not this one. She just stared at me, clearly not seeing the humor. I said something like how that sounded much funnier in my head than in real life.

Funniest thing? This lady and I are really good friends now at work and she has NEVER mentioned it. Ha. Did she forget, or did she later realize that saying stuff like that is just what I do? No idea.

(enjoying my first of nine days off, catching up on my lack of...bloggage? bloggery?)

My locomotion is discombobulated!

Definitely the quote of my night. Admitted an older gentleman, a southerner, who said that when asked why he ended up in the hospital. He was freaking ADORABLE. Somehow I love the old men. Husband jokes that I am going to up and leave him one day for a guy who's 90 with the gross yellow toenails and good arm veins. Clearly he just doesn't understand.

So this guy kept ringing the call bell and I went in there. He said "I need to get back to bed". WTF? it's six am, you are totally in bed. Where I work, that'll earn you a roll belt. My other guy ALREADY had a roll belt. So last night I was just running from room to room putting little old men back in bed. In between doing stuff like running to CT and giving platelets and doing entire volumes of paperwork. The guy I didn't talk much about? Good lord. Whenever he wanted anything he would SHAKE HIS EVD POLE. Which is kind of as useful as poking a sharp stick around in your eye a bunch of times.

I really have no idea how the ICU karma knows when you're about to have a long sequence of days off. But somehow my last shift before vacation is ALWAYS full of crazy shit. It's like an ICU prophecy.

OFF FOR NINE - count 'em, nine! - DAYS!

Weekly update? Yearly? Oh well...

So I've made it two years. Someone apparently thinks I'm good enough at this job that I should be allowed to teach the new grads. I hope it's someone who is familiar enough with my irreverant sense of humor that they don't get upset when I laugh at things I'm not supposed to laugh at.

I start a new job soon, but only PRN (defined as working at least 2 nights per month or so). It's in a unit that is VERY different and uses technologies and such that we never use on my ICU. I'm terrified because they only give us three nights of orientation. THREE nights.

I've transitioned to nights only. For a long time it was weekends only, (Friday, Saturday, Sunday nights) because I was homeschooling my kids for the year. Next month they go back to public school, and they are all excited and so am I. So now I'm sticking with nights only, but I get to be off more weekends! Hells yeah.

Part of this is because I can't stand the people who work day shift in my ICU. Part of it is that I do better at night - less people around, less management, more independence. So, a number of things.

I'm looking at starting a program next year for grad school if I can put away enough money from my PRN job. I'm planning to have them deposit my checks into an account I don't use that's not connected to my regular checking account. I really hope that works out for me and it's not just a stupid bullshit strategy. I feel like whenever I work overtime I just spend the extra money away as quickly as possible. The idea of never going to grad school in this is really scary and sad for me - but the idea of not having enough money to, you know, live on and send my kids to school - that freaks me out too. My oldest is going to be 14 next month, so it's not a faroff concern either.

Offering to give friends IV fluids when they are hung over

Well, it kind of changes your relationship. I got this horrified, aghast look.

I have been desperate enough to pop in an IV and give myself IV fluids, though, and it was completely hands-down awesome. As in, I was SHOCKED at how much better I felt after the fluids. I kept marveling at it all day.

One handed IV starts on yourself? Well, they kind of suck, though. I've gotten them 2 or 3 times total. Damn family members who are afraid of blood (what's it going to do? chase you down?). The only one who isn't afraid of blood is my buddy the six year old, but he's not exactly at the stage where I can enlist him for help with the IV starting process.