Month: January 2021

Categories
intensivecare

ICU RN Breakdown

This week’s meme from inside my brain… If you’re old enough to remember the movie Gladiator, you’re welcome lol

Well, I think this week finally broke me. The state of California is removing the stay at home orders in the Bay Area, as they project 25% ICU bed availability in the coming weeks. I just want to know WHAT ICUS HAVE BEDS???? Because its not us. We don’t have any. Any time a patient leave, we replace them immediately with another patient from the emergency department, from another unit on our hospital, from another hospital in our system. Our nurses are getting pulled to go take care of ICU patients in random places all throughout the hospital as we wait for the ICU rooms to be available, but we’re already short staffed. So, we’re basically screwed. Plus, the patients are sick. We’re talking multiple code blue events in the ICU per shift, multiple deaths, overtime in the high single digits. And that’s not great, because research shows that shift workers in the 12th through 16th hours of their shifts have the mental capacities of someone who is legally drunk.

So, the nurses are the equivalent of crabby, sleep deprived, hangry drunks. It is a nasty atmosphere sometimes. A lot depends on the mood of the head doctor (the Intensivist) and the Charge Nurses. The nurses need a lot of emotional support. That leaves a charge nurse like me–who seeks to be supportive emotionally and intellectually as well as an upbeat and positive force in the unit but also suffers from being an empath (as well as her own depression)–in a really hard spot. I can get drained. I have the support of wonderful friends and a great therapist, and it takes me a long time, but I get drained.

And last night, I found myself outside the hospital, sitting on the ground a homeless person has probably slept on, letting the cement cool my legs, crying and smoking a cigarette at 4:45 in the morning. This was not my most glorious nursing moment. It was dark and painful. But those tears needed to come out so I could finish report on well over 30 patients and prepare for what I expected to be the oncoming shift’s foul mood leftover from yesterday’s day shift.

So here I am, after a not-sufficient amount of sleep, trying to process some of last night’s feelings. Being a nurse is exquisitely difficult some days. In addition to all the pressures I’ve already mentioned above, we had a traumatic patient admit that ended after what was essentially a five hour code blue. Another nurse and I pushed ACLS (advanced cardiac life support) drugs regularly, gave units and units of blood products in a massive transfusion, started the patient on CRRT (continuous renal replacement therapy, ie dialysis), maxed him out on ALL the cardiac meds you can imagine. After doing everything we could at least twice, more likely four times, a discussion with the family led us to make the patient comfortable with some morphine. The previous five hours had been filled with such pain and chaos–blinding lights and shouting. I put on some soul music. Don’t ask how I choose what music to pick for patients, but the second “Sitting on the Dock of the Bay” started playing, our patient just seemed more alert but relaxed. I sang to him, held his hand, and told him it was ok now and that we’d take care of his pain. He died while “Ain’t No Sunshine” by Bill Withers played. And that’s not what that song is about at all, but maybe it should be. Maybe its a better song that way.

Here’s a Spotify playlist I started for end of life music. I’ll keep adding to it, but I put this two songs on it for a start, in case you need a listen…

Trauma is something that nurses just accumulate, and its hard to release it. Moments like last night’s sidewalk meltdown are bound to happen for me, as I absorb and process all the emotions of the ICU. Would I change my life if it could be less traumatic? Would I change jobs? I’m not sure. I’m starting to consider the idea that I can’t just continue to accumulate trauma and other people’s emotions. I’m just not sure I would love my job as much if I couldn’t help patients at the end of their lives.

Categories
Quick Notes

2 observations from the week from hell, maybe 3 ok???

  1. Covid. Still everywhere & people are dying. It is going to take MONTHS, maybe the entire YEAR of 2021 to roll out the vaccines. Keep wearing your masks, stay home & stay distant.
  2. There are some heart attacks that should kill you, in my opinion. Maybe I’m just traumatized by my job, but when your heart is so damaged that you need A NEW ONE, it seems like life just wasn’t meant to be.
  3. People always talk about nurses not being able to pee for their whole shift. But when you extend that metaphor, having a job where you can’t sneak away to take a poop is also horrible. Gas pains hurt really bad!
Categories
intensivecare

Real Orders from a Patient Chart

WTF?!? Once again, I’d like to remind you that I work in an adult ICU.

Lol, so can the patient watch tv or not? And why is that my job???

Categories
intensivecare

When patients’ families get TOO involved

We have a patient here in the ICU whose been admitted to the hospital for two months. That is a long time to be anywhere that’s not home, especially when you’re sick. She has been in the ICU for more than a month.

During the course of her hospitalization, her mother has become her rock—as you would expect. But what the mother has become to the health care providers cannot be described so nicely.

Is she controlling? Yes. Is she demanding? Yes. Is this understandable? Yes.

But has she turned her adult child into a will-less person who can’t speak for herself? Also yes. Does she coddle her and tell the nurses she won’t get out of bed because she’s tired when getting out of bed is literally the only thing that will help her get better at this point?

Does she ask the doctors for opiates and benzodiazepines on behalf of her daughter’s severe pain and anxiety? Does the daughter as a result always looked totally out of it and unable to participate in her own care?

I can actually feel myself getting angry as I write this. Then why am I even doing it, you may wonder? Because today, we were presented with a list of unacceptable and acceptable nurses to care for this patient. And we were gifted with a daily schedule from her mom, in coordination with our supervisor.

Really? Taking directions from a non-nurse.

So, apparently the mom has caught on that the incentive spirometer is important. But she doesn’t seem to realize how important anything else is, nor does she seem to care that nurses may be off schedule due to their other patient’s medical condition or unavoidable delays in pharmacy or dietary.

Also, giving a critical care nurse a schedule like this insults the years they spent an education and training in order to become skilled enough to take care of patients who are trying to die all day every day. Not to mention that each critical care nurse usually has their own internal clock, rhythm and way of doing things. It follows the same trajectory as all the other nurses but also has individuality.

This is a DOCTOR’S ORDER that mother requests no tv watching. WTF?

In the end, do you know what’s really happening here? This mother, who can’t come and be with her daughter right now, and who feels very lost because she cannot control the diabolical illness affecting her child, has chosen to lash out at the only thing she feels she can control. The nurses.

But we are not her employees, nor her slaves. We do our best to accommodate the families of our patients but in the end, WE DO WHAT’S BEST FOR OUR PATIENTS.

And in this case, it might be forcing her to get out of bed, go longer in between doses of Ativan and the big D Dilaudid so she can wipe her own face and FaceTime her own mother. Because, just to remind you, I work in an adult ICU.

Categories
pandemic

The nurses are restless

Happy New Year. I’m writing to you from the ICU where the nurses have all gotten their first vaccine, have the date for their second, and buoyed by the fresh spirit of 2021, have decided to make travel plans.

I’m the fly on the wall, hearing that 2 weeks after her second dose of vaccine, one nurse is going to India. Another nurse already has plans for Mexico City.

They are also chattering about throwing a party once the second vaccine happens. As they stand next to each other with masks down around their chins, eating potluck food in the hallway near the nurses station.

I’m starting to realize that even my colleagues are no longer with me in the fight against covid. I know people are tired of masks and lonely and burned out, but I also know that the vaccines are NOT 100% effective, nor does everyone have access to or want the vaccine.

Also there are more specific issues at hand— such as the obvious fact that most people won’t take the time to learn how the vaccine works, so they won’t understand in what ways they’re protected and what ways they’re not protected…

For instance, did you realize that you will still “get” the covid virus but the vaccine will have pre-prepared your body’s immune system to fight it so you don’t get ill (or get less seriously ill)? So as long as virus still exists in your community, all of the reasons to wear a mask and social distance still apply after vaccination.

Also, vaccines in general take a few weeks to reach peak effectiveness. In this case, you need to think of all the steps the body has to take to build an immune response:

  1. Get first & second vaccines
  2. receive vaccine mRNA into cells
  3. Start making protein spikes in cells, per the instructions in the mRNA
  4. Release protein spikes from cells
  5. Immune system recognizes these protein spikes as foreign invaders
  6. Immune system begins making b-lymphocytes and t-lymphocytes
  7. These lymphocytes and other immune cells such as macrophages “fight” the vaccine, eradicating it—and it’s important to note that this is really the phase where you’ll feel “side effects” from your body fighting the vaccine.
  8. After this is finished, your custom made t and b lymphocytes are put into storage to be used agsin later if you get the virus

Most vaccines take about two weeks for this process, but these vaccines work a little differently. The literature for the Pfizer-BioNtech vaccine says that peak effectiveness is reached 7days (1week) after the second shot.

But as I’ve discussed above, you will still need to wear a mask to protect yourself AND others as well as continue practicing social distancing.

I’m only saying these things because I’ve already been asked a lot of questions here at work by many of the nurses, and they seem to not fully understand the situation. I’ll also add some links to site that explain the vaccines. I’m sure this will be an ongoing topic, though, as the vaccines continue to receive FDA approval and wider distribution…

Understanding How Covid 19 Vaccines Work (CDC)

Frequently Asked Questions about COVID-19 Vaccination (CDC)

Facts about COVID-19 Vaccines (CDC)

Covid 19 vaccines: get the facts (Mayo Clinic)

Please, be safe for yourself and for the rest of us!

Wear a mask. Social Distance. Don’t travel unnecessarily.