Tag: nursing

Categories
pandemic

In Canada, doctors do nursing

“And starting this weekend, at least one Toronto-area hospital will begin training physician volunteers so they can help critical care nurses in the ICU, as a way to immediately add more staff to keep up with a flood of severely ill COVID-19 patients.”

I had to laugh about this one. The medical residents, aka “baby doctors,” barely know how to do anything. I’ve had to teach doctors how to place an IV line, how to reduce a prolapsed rectum, how to talk to patients about death. And there’s no way they’ve ever considered giving IV antibiotics or other medications. Talk about chaos in the ICU.

I couldn’t find the original news article. See video report on Global News

Categories
intensivecare

I dreamt I died

Work has been shit lately. Covid is still surging in my ICU, and we’re busy with other things too.

Last week was an especially difficult week for our heart failure service, as every patient on service was deemed “not a candidate” for advanced heart failure treatment. Bottom line: this is end-stage heart failure and hospice is the next step. For many patients, this means removing a piece of equipment that’s been helping their heart do it’s job (like an intra-aortic balloon pump, or an Impella). This can mean almost immediate death, but many patients do go home from the ICU to die there. It’s emotionally exhausting but incredibly important work.

And it’s so important to spend some quality time with these patients. Last week, I helped a gentleman who was just days away from getting his Impella out to go home on hospice. He was itchy from laying in bed. I washed his back with real soap and water and washcloths. The put on lotion with a little massage. 20 minutes including gathering supplies. And it made his day! We chatted about traveling and life’s simple pleasures. These are the important moments at the end of life, and I was so happy to be there for him.

But despite that part of my job being so meaningful, there are other parts that are nearly unbearable. There is a day shift charge nurse who is mad at me no matter what I do, and who demands a ridiculous amount of report on our patients. She wants a full head to toe but the 90 second version. Do you know how long it takes me to prepare a cohesive and comprehensive 90 second head to toe report that also includes the plan and updates from when she was last on shift??? It takes about 5 hours to do it for 30-36 patients. And when I don’t give her all the info she wants, she asks for it in aggressive tones. If I don’t know the answers, she will eye roll, sigh and slam turn the pages of her printout. Actually, she does that sometimes anyways if she’s annoyed by something, anything.

I find this to create a workplace so toxic that it gives me panic attacks. I dread giving her report. I get short of breath talking to her. I often cry after interactions with her.

So what do I do when I tell my managers about this and nothing changes? That is the million dollar question facing me right now.

Oh, I almost forgot my dream. I had a left ventricular assist device (LVAD) in my dream, but it became dislodged internally. FYI, I’ve never ever seen this happen in real life… I was bleeding to death, surrounded by work mates. They could do nothing. And finally, as I was about to die, one of the help pressure on the bleeding spot as the warm feeling spread through my chest and I lost consciousness.

Whoa. Is that symbolic? I hope not.

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

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
intensivecare

You have not lived until you have

  1. Pondered your own mortality while rubbing the arm of a man who speaks a different language than you, who is tied to the bed with 2 different kind of restraints and is still trying to hit you, who has survived a brutal car accident that deformed his skull and has now lost more of his brain to cancer, who is on a medicine to make him sleepy and comfortable but still flops restlessly in bed, who somehow manages to fart right in your face as tears come to your eyes, thinking about how you’ll probably die alone.
  2. Received the most vitriolic dressing down from an entitled white woman who no longer wants to be in the ICU but has unfortunately just had her 2nd brain surgery to remove a metastatic tumor. You try to set boundaries by saying “this is not a hotel; it is a hospital” to no avail.
  3. Bonded with your colleagues about all the shitty stuff that’s happened in your night—assignments changed, 2 admits, charge nurse yelled at you, expecting to get yelled at by cardiac surgeon because you didn’t extubate your patient, massive transfusion, and so on. It’s true that working in an an ICU is like going to war. The trauma bonds you.
Categories
personalstories poetry

And the poet finally speaks

I haven’t mentioned it before, at least I don’t remember mentioning it–but in addition to nursing, I have a masters degree in creative writing. Poetry to be specific. As might be expected, my initial bachelors degree was a throw-away English degree with a minor in philosophy. And as I was graduating in exactly 4 years–a record for my friend group, who all stayed at least 5 years!– I decided the best course of action, even though I knew (I KNEW!) it would be a waste of money, was to spend two years in grad school for creative writing. I called it a vacation. Like traveling abroad before starting a real job, except I would have no real job waiting because I had trained for nothing!

But never mind the specifics, I dove headfirst into poetry because that was where my love was. It was how I processed the world, emotions and ideas. Poetry felt necessary to being alive. In those years of school, I learned more about language, and I read and wrote more than I can even imagine now. I was immersed. I was drowned but happily so in words.

And I even managed to score jobs working in teaching, writing, and editing after leaving grad school–first at the university where I had gone to school, then at a textbook publisher and then even in the exciting dot-com world and as I’ve mentioned here at prestigious tech publishers like Wired Magazine. But within a few years, it was all falling apart. September 11, 2001 destroyed not only my budding career but really drained my spirit and left me in what we’ve now come to call the quarter-life crisis.

After a few years spent blowing in the breeze, traveling the US in a Volkswagon GTI, camping for free wherever I could and couch surfing the rest of the way, I found the inspiration to go to nursing school. I’ve often felt like my life was just split in two, with a before & after nursing school– each side clearly delineated by roles and responsibilities, by the presence or lack of poetry, by my involvement in the blogging community or not.

But here I am, 16 years after deciding on my 30th birthday (which I spent camping in Death Valley, for those of you who like metaphor), and I am doing both. I am nursing full time in the ICU of a busy teaching hospital, learning every day, and I have started this blog, this little website where I can write about important issues related to nursing, health, and tell stories from nursing.

Its not so surprising then that in the last month or so, I’ve written my first poem in which I’ve ever referred to my job as a nurse. I’m going to take a chance today and share it here with you. I realize that no one really reads this site, so it doesn’t matter, but I want anyone there to know that this is important to me. These two parts of my life have needed to come together for a very long time, and here I will mark this transition. It is not exactly a celebration because this poem is not happy, because we cannot exactly say that nursing or life or 2020 is happy right now either. But no more justification. Here.

Can we pretend that this is not my eulogy?

This resume I’m writing
            My curriculum vitae
Graduated summa cum honore
      One more tiny Latin word better than
                                  Your laude

And for what?
       A bachelors and 2 masters
But still mostly a slave,

A nurse not much removed
        From the handmaid
               Apologizing for everything that’s   not her fault

So what if my mother didn’t love me?

                           And so what if my husband left me?

Then I say out loud
            “Can you help turn side to side
To get on the bedpan or should I get someone to help us?”