My first day back to work was halloween, and thank goodness it was slow. I'm still not 100%, but I got my sense of humor back yesterday (didn't really realize it was gone until one of the doctors looked at me and said, "you're feeling better, arent you?") It's nice to work in a hospital; I take patient admits to the floor and then turn on the portable oxygen tank on the way back down to the ER, suck some O's until I have to go back to work again. The nurses laugh at me, but they're also very careful to make sure I'm not pushing myself. Awww, isn't that sweet?
Meth Central Med Center is now a fully operational cardiac hospital. We've had our emergency cath lab open for a couple of months, and we've had a few emergency caths in that time, but my first one was last week. It was the night I was wearing new shoes, which you may not give a hoot about, but it's an important part of the story. Those of you in EMS already know what that means.
So it's about 15 minutes before my break, and we all know what happens when firefighter girl gets hungry. Well, we don't all know, but RevMedic, you can fill them in. It's not pretty. Medics call in with code 3 traffic. Their patient is a 69 year old male who crumped and did a face plant at the dinner table right into his pasta salad. Heart rate initially 20, they have him externally paced at a rate of 70, on a non-rebreather mask and an assload of versed. All other vital signs are within normal limits.
We get the guy on our table, I get him on the monitor, move the oxygen to our wall outlet, etc. etc. One of the nurses grabs me by the shoulder and hisses in my ear, "I can't get our defibrillator to pace him! Make it work!" so I sigh, and connect the our zoll to the pads already on the patient. I look up, see one of the medics watching the exchange. We try not to laugh, because this is a serious situation.
The 12-lead EKG shows some stellar ST elevation; highest I've ever seen. Dr. Twitchy is in rare form tonight, and his 3 espressos and 4 diet cokes were obviously not enough caffeine. He's going by the cath alert check list instead of his normally well-working brain, and the nurses and I wait impatiently for his orders. He ticks off the cath alert sheet-- nitro drip dopamine drip heparin drip oxygen-- and asks if the patient has had aspirin since entering the hospital. We all stare at him in disbelief, then stare at our mostly non-responsive patient, who still has pasta salad stuck in his ear, and moans occasionally with the jolt of the pacer. There is no way that man is chewing up and swallowing anything.
I try to draw blood with the third IV I start. You can tell the patient smokes- the blood is dark and thick and hard to draw, even through an 18g catheter. Lab tries drawing on the other side. We finally end up with maybe 20 mL, and as I'm pushing it into the tubes, I notice the floaties in it- little chunks of what look like butter.
I am not kidding you.
Let's remember, this is a cath alert, and the man is having a heart attack. Lest we forget, a heart attack happens when the vessels in the heart become clogged with blood clots or plaque-- stuff very similar to the chunkies sitting in the test tube in front of me. This guy is maybe 5' 10" and weighs approximately 165 lbs. He is not a large man. Although his oxygen saturation is 99%, his skin is still grayish. This concerns us until his wife walks in. She looks a lot like him, down to the gray skin. She also reeks like cigarette smoke. We're starting to have a really good feeling about the success of our impending heart catheter placement.
We get the guy onto the cath lab table. The cath nurse asks my charge nurse if I can stay to help, and that's pretty cool because I've only ever seen one of these from the outside. We get him all hooked up and they're swabbing him with iodine in his nether regions and he starts shivering a little so we cover him with a blanket and I've got all the lines and pumps untangled and running and the oxygen is ready to transfer from the gurney to the wall and I reach to hand the tubing to the cath nurse and the guy hangs his head over the side of the table and starts puking into his mask which I yank off his face so he doesn't aspirate and they're grabbing suction and he pukes again
all over my new work shoes. And my scrub pants. And the floor, and the cords and tubing and everything else. There is a moment of silence, when all you can hear is the plop plop of the puke dripping off the table. And then the guy's top dentures slip out of his mouth and clatter on the floor, and the tech behind the glass- the only member of the room not currently coated in regurgitated rotini pasta salad- tries very hard not to laugh.
on a completely different note: remember John, from the last post? We got a letter letting us know that much of his bone and tissue was used in transplants. And I wish I could tell the people who got his stuff about John's last three hours.
Sunday, November 11, 2007
Thursday, November 1, 2007
levaquin dreams
Got called into the director of Human Resources office yesterday to discuss the traveler nurse and his traveling hands. I made the mistake of telling the assistant manager of the ER two weeks ago, and he was actually really cool about it. But then he told the manager, who called me into his office for another meeting. I came away from that one feeling like shit. He kept insisting that I must be suffering some ill effects from the incident. I just stared at him, told him I wasn't sleeping, but I'd get over it if everyone would just leave me alone about it. I work in the ER, for chrissakes. You have to be able to let go of things, or you'll go crazy. He finally threw up his hands and told me to talk to HR, which I put off until yesterday.
We do that more often than we think, at least those of us who are emotionally and mentally healthy. Letting go, I mean. There is a resiliency in the human spirit that we don't think of very often, but I see it almost every day. I watch patients and their families adjust to news they never thought they'd have to face. . .the smart ones, the ones who will make it, take it in stride; they let go of the whole life they had planned and open themselves to whatever it is that's been thrown at them. Sure, there's some shock involved-- "yes, ma'am, you've just been diagnosed with a very large tumor in your liver" takes some getting used to--but you can almost see the shift in their minds as they adjust and move on, and face whatever it is they need to face.
I see it in the dying, too, although resiliency becomes grace at that stage. I know that certain things take on almost mystical properties when my emotional armor gets left at home, when I'm over-tired or under stress, like I have been because of the traveler nurse issue. But we had a code a couple of weeks ago that shook me, and everyone else in the room, in the three hours the patient was there.
I'll call him John. He was 46 years old, found down by his sister and mother. No history of drug use, this guy was clean. Medics almost tubed him but he came around, and was conscious by the time he came into the ER. I sat with him, started his IV, drew his blood, cleaned the vomit from his face and neck, smiled at him, talked to him, reassured him. He looked so scared, and I told him everything was going to be okay. He nodded, and smiled, and I squeezed his hand before I left the room. His mom waited outside the room to hear the prognosis of her only son.
Next time I passed the room, they were pulling out the defibrillation pads, and John was seizing. As I was wrapping my brain around that, one of the nurses in the room screamed for me, the doctor started shouting for an NG tube and suction, and all hell broke loose. John's heart rate was over 200 bpm. We cracked the crash cart and the nurse went to push drugs, and we realized that John had sweated his IV right out. I started another on the left arm, then another on the right. And then his heart stopped.
The doctor ordered CPR started, and one of the nurses began. I shoved him aside and started compressions, screaming for a stool to stand on. Once I could get leverage, I discovered something: the chest of a 46 year old man is much different than the chest of an 80 year old man. And ribs break a lot harder and a lot louder. I could feel them pop with every compression.
We got pulses back, and then a pressure. John's left pupil was blown. We all sighed, and looked at each other, and stepped back from the bedside, shaking. The doc shook his head and ordered for the air ambulance to take John to OHSU in Portland for definitive neuro care. I left the room and headed to start a couple more IVs.
Ten minutes later, he flatlined again. His mother still sat stoically outside the room. Turns out she'd lost one of her two daughters two weeks before; her other daughter, the one who had been closest to John, was racing to the hospital from out of town. John's mom just sat, and waited. We explained what we were doing, the care John was receiving, the fact that his prognosis wasn't good. She nodded, said she'd just wait for her daughter to come.
I did CPR on John two more times before he finally died for good. The doctor called the code twice-- the first time, we had a spontaneous return of pulses before the monitor was turned off. But this is where grace in the dying comes in:
John laid there, tubes in every orifice, vomit in the creases of his neck, bedding soaked with sweat, ribs broken, wires everywhere, brain dead but heart still beating. He waited there, until his sister came, and that was truly one of the most beautiful things I've ever experienced-- watching that woman kiss her brother's face, rub his shaved head, tell him how much she loved him, told him he could go. And then he did, and nothing we did could bring him back that third and final time.
By the end of the three hour code, even the doctor was crying. Say what you will, but the human spirit is resilient. And some people who haven't amounted to much in life leave that life with an enormous amount of grace. And I am honored to be part of a leaving that is so graceful, even when I fight so hard against it.
We do that more often than we think, at least those of us who are emotionally and mentally healthy. Letting go, I mean. There is a resiliency in the human spirit that we don't think of very often, but I see it almost every day. I watch patients and their families adjust to news they never thought they'd have to face. . .the smart ones, the ones who will make it, take it in stride; they let go of the whole life they had planned and open themselves to whatever it is that's been thrown at them. Sure, there's some shock involved-- "yes, ma'am, you've just been diagnosed with a very large tumor in your liver" takes some getting used to--but you can almost see the shift in their minds as they adjust and move on, and face whatever it is they need to face.
I see it in the dying, too, although resiliency becomes grace at that stage. I know that certain things take on almost mystical properties when my emotional armor gets left at home, when I'm over-tired or under stress, like I have been because of the traveler nurse issue. But we had a code a couple of weeks ago that shook me, and everyone else in the room, in the three hours the patient was there.
I'll call him John. He was 46 years old, found down by his sister and mother. No history of drug use, this guy was clean. Medics almost tubed him but he came around, and was conscious by the time he came into the ER. I sat with him, started his IV, drew his blood, cleaned the vomit from his face and neck, smiled at him, talked to him, reassured him. He looked so scared, and I told him everything was going to be okay. He nodded, and smiled, and I squeezed his hand before I left the room. His mom waited outside the room to hear the prognosis of her only son.
Next time I passed the room, they were pulling out the defibrillation pads, and John was seizing. As I was wrapping my brain around that, one of the nurses in the room screamed for me, the doctor started shouting for an NG tube and suction, and all hell broke loose. John's heart rate was over 200 bpm. We cracked the crash cart and the nurse went to push drugs, and we realized that John had sweated his IV right out. I started another on the left arm, then another on the right. And then his heart stopped.
The doctor ordered CPR started, and one of the nurses began. I shoved him aside and started compressions, screaming for a stool to stand on. Once I could get leverage, I discovered something: the chest of a 46 year old man is much different than the chest of an 80 year old man. And ribs break a lot harder and a lot louder. I could feel them pop with every compression.
We got pulses back, and then a pressure. John's left pupil was blown. We all sighed, and looked at each other, and stepped back from the bedside, shaking. The doc shook his head and ordered for the air ambulance to take John to OHSU in Portland for definitive neuro care. I left the room and headed to start a couple more IVs.
Ten minutes later, he flatlined again. His mother still sat stoically outside the room. Turns out she'd lost one of her two daughters two weeks before; her other daughter, the one who had been closest to John, was racing to the hospital from out of town. John's mom just sat, and waited. We explained what we were doing, the care John was receiving, the fact that his prognosis wasn't good. She nodded, said she'd just wait for her daughter to come.
I did CPR on John two more times before he finally died for good. The doctor called the code twice-- the first time, we had a spontaneous return of pulses before the monitor was turned off. But this is where grace in the dying comes in:
John laid there, tubes in every orifice, vomit in the creases of his neck, bedding soaked with sweat, ribs broken, wires everywhere, brain dead but heart still beating. He waited there, until his sister came, and that was truly one of the most beautiful things I've ever experienced-- watching that woman kiss her brother's face, rub his shaved head, tell him how much she loved him, told him he could go. And then he did, and nothing we did could bring him back that third and final time.
By the end of the three hour code, even the doctor was crying. Say what you will, but the human spirit is resilient. And some people who haven't amounted to much in life leave that life with an enormous amount of grace. And I am honored to be part of a leaving that is so graceful, even when I fight so hard against it.
new moan ya
yep. some little tiny bug in my right lung. And today is the first day I've been able to hold my head up for longer than 2 minutes at a time. I don't really feel sick at all, just incredibly weak. I've been in bed pretty much since I got off work a week ago Tuesday morning, although I have attempted the bedroom to bathroom route once or twice, and I did manage a 24 hour change of scenery by exchanging my walls for someone else's this past weekend.
On Friday, after giving me a 2cc shot in the ass and a bag full of Levaquin, the doctor informed me that I'll be 100% in six fucking weeks.
Okay, he didn't say fucking.
On Friday, after giving me a 2cc shot in the ass and a bag full of Levaquin, the doctor informed me that I'll be 100% in six fucking weeks.
Okay, he didn't say fucking.
another lesson or two
If you're looking for levity, you probably shouldn't read this post. I've been trying to write this for a week, now, and make it funny or sarcastic or witty. . .but I start it, and everything that comes out sounds so unlike my usual self that I get disgusted and cancel the whole thing. And even now, I've taken it down, and put it back up, and changed it and messed with it and I start to think that maybe I shouldn't leave it up here for all my friends to read. . .like I have something to be ashamed of. And that's just wrong. I need to be able to tell this. The thing is. . .I can't sleep lately. And yeah, I could blame it on my funky work schedule (even though I've been on a crazy schedule for the past 4 years. . .), or loneliness (umm. . .doubtful. . .I love sleeping alone--or used to. . .) or all my injuries or too much coffee or dry air or noisy neighbors or insert other excuse here. But I know that none of those are the reasons why.
I've worked really, really hard to become the person that I am, and I've lost a lot along the way, but I'm generally happy and content, even if my life isn't so-called normal. I'm a very private person, I like being alone, and it takes a lot to get to know me. I don't let many people get close to me, and the people I've dated in the past would be hard pressed to tell you much about me, and honestly, I'm skittish about relationships. But. . .I like my life, and I love my home and my kids and my art and poetry and writing and plants and books.
A month ago, a traveler nurse I considered a friend developed traveling hands and a traveling tongue a couple of nights before transferring to his next assignment. He's married, and has a bunch of kids, and he trapped me in the stock room and seemed a little shocked when I shoved him away. And two nights later, on the last night he worked, at the end of my shift, when I told him that he creeped me out with the kissing and the groping, he apologized, asked if he could make it up to me, and tried to do the same thing again. Which is when I ran out the back door of the break room and called for the friend who was waiting outside. There is more to this story, of course--how this brought up feelings for me from an incident last summer; how I blew it off when I was telling friends about the nurse because I didn't want them to think I wasn't strong, or that I'd somehow asked for it; how afraid I was the full twelve hour shift I worked with him that last night, and how nothing got stocked in the ER because I didn't want to chance getting cornered again, all the things he said to me the first time in the stock room and then on the last night before I ran away.
You wouldn't think that one person could take away something so integral to who you are. But that's exactly what happened: someone took away a piece of the person that I am. It is amazing that something so simple can strip so much away from somebody-- although of course I've still got my self-respect, and my independence--I've worked too hard to let anyone take those away from me. But I can't sleep. And I haven't written or painted or read a book in the last two weeks. I stay awake and restless until my eyes can't stay open anymore and then I fall into bed.
We are all so very fragile, with so many walls we think are solid and indestructable. I've built a few myself, and maintained them carefully, not letting anyone get too close. I'm not sure what the lesson is in all of this, but I'm finding something cathartic in the telling of it. . .and I guess I'm realizing that right now, I could let this experience and the fear it caused close me off again, just when my heart is starting to open up for the first time in a long while. Or I can use that energy to tear down the remaining walls I have built around me. . .because as much as it hurts, I would rather feel too much than nothing at all.
I've worked really, really hard to become the person that I am, and I've lost a lot along the way, but I'm generally happy and content, even if my life isn't so-called normal. I'm a very private person, I like being alone, and it takes a lot to get to know me. I don't let many people get close to me, and the people I've dated in the past would be hard pressed to tell you much about me, and honestly, I'm skittish about relationships. But. . .I like my life, and I love my home and my kids and my art and poetry and writing and plants and books.
A month ago, a traveler nurse I considered a friend developed traveling hands and a traveling tongue a couple of nights before transferring to his next assignment. He's married, and has a bunch of kids, and he trapped me in the stock room and seemed a little shocked when I shoved him away. And two nights later, on the last night he worked, at the end of my shift, when I told him that he creeped me out with the kissing and the groping, he apologized, asked if he could make it up to me, and tried to do the same thing again. Which is when I ran out the back door of the break room and called for the friend who was waiting outside. There is more to this story, of course--how this brought up feelings for me from an incident last summer; how I blew it off when I was telling friends about the nurse because I didn't want them to think I wasn't strong, or that I'd somehow asked for it; how afraid I was the full twelve hour shift I worked with him that last night, and how nothing got stocked in the ER because I didn't want to chance getting cornered again, all the things he said to me the first time in the stock room and then on the last night before I ran away.
You wouldn't think that one person could take away something so integral to who you are. But that's exactly what happened: someone took away a piece of the person that I am. It is amazing that something so simple can strip so much away from somebody-- although of course I've still got my self-respect, and my independence--I've worked too hard to let anyone take those away from me. But I can't sleep. And I haven't written or painted or read a book in the last two weeks. I stay awake and restless until my eyes can't stay open anymore and then I fall into bed.
We are all so very fragile, with so many walls we think are solid and indestructable. I've built a few myself, and maintained them carefully, not letting anyone get too close. I'm not sure what the lesson is in all of this, but I'm finding something cathartic in the telling of it. . .and I guess I'm realizing that right now, I could let this experience and the fear it caused close me off again, just when my heart is starting to open up for the first time in a long while. Or I can use that energy to tear down the remaining walls I have built around me. . .because as much as it hurts, I would rather feel too much than nothing at all.
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