Hot and Bothered…

Well, I haven’t worked a 20+ hour shift on only 4 hours of sleep for about 8 years and found that I really LOVE it!!! I must be somewhat of an adrenaline junkie, after all! But a lot happened to pique my interest and challenge me. I worked with deaf Nurse who can’t hear alarms or ANYTHING. I love her to pieces, but we really need to work on our communication! She can’t hear me with my high pitched voice; and I often can’t hear her as I am listening for Tele alarms with diligence. She asked me to input orders and I couldn’t hear every parameter, so I had to ask her the same question umpteen times (yes, I am probably a little deaf, too).

Furthermore, HOTNESS was there. I didn’t expect that my 20 hour shift would include him because I thought he was off for the Holiday’s…but he was there…it is a smiley moment and an adrenaline rush in and of itself to see his face lit up when he smiles or  laughs. I melt a little inside whenever he and I engage in polite conversation…(a rareity because even though I would probably stop crushing on him  if we were friends, I just can’t win him over enough to be anything more than “ancillary staff,” so the awe I have for his beatific countenance has to suffice). The BIG adrenaline rush came when he and I had a brief discussion about how divorce makes too many adults egocentric and the kids, who should come first don’t. THEN it got better!!! He needed someone to brace a patient who had been admitted for a drug overdose…the patient was having seizures and tremors and an ART line needed to be placed.

Hotness can usually get his ART lines in lickety split…this one was a bit more challenging because the patient would twitch immediately after the line was threaded and a flash occurred. So after four attempts at this I devised a better way for my 4″11″ frame and child sized hands to hold the arm of the trembling patient…I sat cross legged on the floor under the arm of the patient. I was able to get a good angle, hold the arm down and the muscles taut…and we had success!

Part of the adrenaline rush I felt came from the fact that I have never seen an ART line placement up close and personal. I got to see how the RT places sutures in the line; the appropriate technique to palpate for the artery then the method used to thread and tie the suture. In addition to the rush from the learning process. I got to be near my idol and admire his work, handsome face, lovely abductor longus pollicus, and chat with him about anything, nothing, and everything. Although I had butterflies in my stomach the whole time (worried I would say or do something wrong) I realized the pricelessness of the moment…I will never have an opportunity to engage idol in this carefree (yet serious) manner again.

Some of the other interesting happenings from this eventful shift…I got to work with one of my favorite Doctor’s — he is thorough and brilliant, he admitted three other patients to our ICU…I was able to complete all of the orders, run labs and their results, and help with patient care. I think this Doc appreciates my work (I am diligent and have a strong work ethic) so he kept asking me to reprint results and do a few things for him as I was running from patient to patient to ensure all cares were completed.

The only moment we had differing opinions about was a peaked T wave. I felt the elevated measurement was high enough to indicate it as a peaked T wave (a sign of electrolyte imbalance) and he felt it was normal…so I was humbled and taught another valuable EKG lesson….

It was a hot night in terms of  all I learned, witnessed, and attempted to do…such an amazing night of learning and figuring out better ways of doing things; with an amazing EKG strip to boot…and although I completed all of my required work, I didn’t get the extra “AnnieC” touches finished..and that is why I am a little bothered…

SVT…Whaaaaat?

The  patient was a 50 year old male admitted for  bilateral pneumonia. He was originally just placed on O2 mons. His oxygen dropped to 83%…and then whammy…his heart rate more than tripled!!! He went from 67 beats per minute to 203. A manual count of the patients heart rate confirmed that he was experiencing an elevated rate that was over 200 beats! The Doctor ordered that the patient be placed on portable Tele monitors in addition to his pulse oximetry monitoring. Furthermore, a 12 lead EKG was ordered. Both my monitors and the EKG confirmed that the paitent was in true Supraventricular Tachycardia. The Doctor ordered adinosine….heart rate dropped to 200, then a HUGE pause with small T waves present…then the patient converted to Sinus Tachycardia with a heart rate of 113 per minute. Slowly….the patient moved from Sinus Tach into Normal Sinus Rhythm with a heart rate of 87.  One surprising component of this monitor (for me) was that the patient didn’t pause, manifest a 3rd degree block THEN convert to NSR…instead it was pause, Sinus Tach, then Sinus Rhythm. More surprising…after 40 minutes sans adinosine, the patient bradied down to a heart rate of 53 beats per minute. I’ve never seen a cardioversion with adinosine take on the precise characteristics that I experienced…I was slammed with other critical patients, so did not have an opportunity to discuss the situation with the Doctor or Nurse’s….but I wonder why the patient bradied so low in such a relatively fast time-frame?– especially since he was given only 6 mg of the drug……When I have more answers, I will share my findings…but overall,what an interesting strip to witness…

Death….

A 94 year old patient of mine was struggling to breathe. He had aspirated earlier in the day. He was full code. Prior to intubation, both the Doctor and the Respiratory Therapist described the procedure to him and asked if he wanted to be placed on a ventilator to help him breathe with more ease. He finally came to the decison to declare himself DNR/DNI  and decided against intubation.  At about 3am, he was had wheezing and was gasping for air. His O2 sats remained 95% but he was definitely in distress. He was placed on bi-pap with a full face mask. This comfort measure didn’t help and made the patient more agitated. So, the bi-pap was discontinued. Shortly thereafter, the patient’s skin became clammy and was starting to mottle. The Nurse’s were trying to predict time of death. The patient was not experienceing Cheynne-stokes breathing; nor were agonal breaths apparent…..just the wheezy, watery sounding breath that is often associated with aspiration pneumonia. I really didn’t think the patient would die. Although there were significant signs that he would pass, I thought it would be later in the morning after shift change; and, I didn’t agree with any of the Nurse’s time parameters. In my 15 years as a C.N.A. I have seen hundreds of patients with the same symptoms live from days longer to weeks longer…so I was surprised that this patient died — especially since the family present expected more family from out of State to arrive later in the moring to say their good-byes to him. I guess the signifant lesson for me is that a prediciton of death is a 50-50 statistic…ultimately, a patient will die when he or she is ready. I am grateful that we didn’t prolong his life and cause any further stress or pain in an attempt to do so. He was able to pass peacefully with his wife and a few of those he loved holding his hand.

A Christmas Miracle?

I was “on vacation”  from December 1st until the 17th. When I returned on the 18th THE NURSE actually engaged me in a delightful conversation. She asked for my help knowing I would complete the tasks at hand; and, she didn’t say in the morning “What did you do all night?” THEN the oncoming shift came in and said: “We are so glad you are back, a lot of things didn’t get done while you were out, we didn’t realize how much you do to organize the unit!” I felt vindicated!!!!

Ugly Tree x Infinity…

A Christmas Meme…

1. Wrapping Paper or Gift Bags? It depends on the time I have allotted to wrap gifts. If I have time to add extras, like ribbon or something artistic, I like to wrap. Otherwise, gift bags can be a beautiful way to enclose a present and is a great time saver.
2. Real Tree or Artificial?I prefer real trees. Like Trauma Junkie, my favorite is the Douglas fir. However, we’ve had a fake one for a few years. We got it mostly because we bought a home and the fire hazards associated with a real tree (especially when our cats climb it) were scary. The smell of a real tree is one of the most memorable ever – I daydream of Christmases past and recount the wonderful traditions we have. I’m not really religious, and consider myself more of a mystic, but when it is dark and the tree is lit up there is a reverence that falls over one that is pure magic and goodness itself.
3. When do you put up the tree? When we purchase real trees we always put it up on the 10th of December. With the artificial tree we put it up on Thanksgiving, or a few days thereafter.
4. When do you take the tree down? If we are going with a live tree it is taken down the day after Christmas. We leave the artificial tree up until January 2^nd.
5. Do you like eggnog? Some years I crave it and others it is just too rich for my taste-buds or stomach. This year I had one glass and it was enough.
6. Favorite gift received as a child? A bible that had a multitude of artwork in it. It is not a standard King James version bible, yet the cover is striking…blue in color with a depiction of Jesus surrounded by children. I still have it. I think it is one of my favorite gifts because it was given to me by my dad before my parents divorced.
7. Hardest person to buy for? My mother. She is simply a prima donna. This year I took the coward’s way out because it hurts my feelings when I get what I think is a great gift and she indicates she is returning it. I got her a gift card and she can spend it on what she chooses. That way we will both be happy! LOL.
8. Easiest person to buy for? My grand-baby. She is 3 and I started a tradition whereby I give her a star and a box. The star is because she radiates beauty and light – she is our little “Star.” The box because she represents hope for my little non-traditional family (she is half Asian and there were issues with my step-daughters growing up, her entrance into the world brought hope and happiness to our complicated family and brought us together in many positive ways). And at 3, although her “traditional items” are a little odd, she carries around her box and her star as if they were precious treasures.
9. Do you have a nativity scene? Yes. It is beautiful and the first expensive item I bought in my marriage. It is a Lennox all white nativity scene. It is beautiful.
10. Mail or email Christmas cards? Even though e-mail is a great time-saver, I think it is poor etiquette to send e-mail Christmas cards (or even birthday cards for that matter). But I guess I need to get used to the trend…I just got a wedding invitation via e-mail! However, I do prefer to mail Christmas cards…I love to write and so when I send cards, I spend countless hours on each card writing the most beautiful and positive thoughts for the recipient. Unfortunately, I used to send hundreds of cards and now it is down to a mere 20 because of time issues.
11. Worst Christmas gift you ever received? I got a thong with the $2.99 price tag still on it, not from my Spouse, but from his Sister who is loaded. I thought it was a really tacky gift. It was a clear message due to the dynamics at the time..”I was not welcome as a part of the family, nor was I worthy of her presence.” Now it is a memory my husband and I laugh over. He couldn’t beleive his Sister did that…even if she had meant it as a joke, it wasn’t funny.
12. Favorite for Christmas dinner? Ham. We do Turkey for our Thanksgiving dinner and then ham for Christmas.
13. When do you start shopping for Christmas? I used to get all of my shopping done in October and everything wrapped by the end of November. The last two years, however, I didn’t start shopping until after finals…so usually around the 14^th of December. Luckily I found a boutique where I can find just about everything. And, I shop on-line now. I feel the cost of the shipping fees are well worth it as I am not standing in lines or fighting over wanted items. I have less stress when I shop via the net.
14. Have you ever recycled a Christmas present? Yes. I do believe in re-gifting if you don’t particularly like something but know someone who would love it. And, since tastes vary, I always tell everyone I know that I don’t mind if they re-gift anything I’ve given.
15. Favorite thing to eat at Christmas? Anything that is home-cooked and not fast-food or from the hospital cafeteria.
16. Lights on the tree? I love the lights on a tree. My husband used to wrap them around the traditional way and then take two additional strands and zig-zag them up and down the tree vertically. I always had the best lights. This year, he didn’t add lights to our tree (ugliest tree x infinity) because he thought the l.e.d lights would be sufficient. They aren’t – they don’t even FLASH!!! Oh, and the lights MUST be colored…white is beautiful for some trees, but I describe my tree as a country Victorian-esque tree with many beautiful homemade items and lots of red and green. This year I was so disappointed by the tree and had so many stressors, we didn’t pull out all of the ornaments. I just decorated with ribbon and the new ornaments we get annually.
17. Favorite Christmas song? Like Trauma Junkie, my favorite is Carol of the Bells by Transiberian Orchestra (featuring Metallica); I also like this version as sung in the film “The Santa Clause.”
18. Travel at Christmas or stay home? Being home for the Holiday’s and recreating traditions, as well as, beautiful memories, warms my heart. I love to travel, but prefer to do it during other times during the year.
19. Angel on the tree top or a star? I have an angel made of white twine. It works with my tree, but I think stars on trees are beautiful, too.
20. Open the presents Christmas Eve or morning? As a child, my Sister and I used to open up one present on Christmas Eve and it was always pajamas. Now as an adult my husband and I open gifts Christmas morning as I am coming off of a graveyard shift. Since it is just us, our service commitment is to work so those that have children home can enjoy the Holiday’s with their family.  My step-daughters and their children live in another state and so they open their presents either a week before or a week after Christmas.

Darkness Falls….

Even though the resolution in my school matter was such that my life is not completely ruined, I am experiencing so much self-loathing for my lack of wisdom. Even worse is the fact that I broke a huge facet of my own moral code. I don’t know why I thought it was the right thing to help out this girl…I guess I got pulled into the horrors of her life (her mother is dying, she is in a relationship whereby she is experiencing abuse, she wants to be a student but is having tremendous financial problems and needs to work three jobs just to get by). I felt that all she needed was a helping hand, but my life was such that I couldn’t help her in the right way (i.e. help her figure out her topic, teach her how to research, show her how to cite sources, help her build and develop an outline)..instead, I gave her my paper to use as a resource and she plagerized it.

The result for her was bad…she was expelled. I was merely given a warning. But, once I realized  how much my naivety could have cost me…I feel hate  for being the kind of person that is easily lead astray…I have much darkness inside for not knowing that what I was doing was a wrong course of action.

Because I feel so much disgust over my participation in this type of cheating, I guess I feel that I should not be forgiven, so when I received this letter from my Professor, I was overwhelmed with tears…tears for my remorse and tears for my gratitude. I am grateful that I still have a chance at a future I’ve been working on for some time; and to know tha someone understands the depths of despair I am feeling — well, that is remarkable.

This is an excerpt from my letter: “Missteps don’t mean the end. They just mean you have to make amends and try again. We all go through dark times, and I know you are experiencing some dark things. I just want you to know that you will come out on the other side stronger and with greater resolve. “

I have a long way to go, a lot of work to do to get myself back…to become the person I admire and most want to be. I hope I am able to continually do the right things to be a person of integrity again.

I’VE RUINED MY LIFE….

“Yet I am not more sure that my soul lives, than I am that perverseness is one of the primitive impulses of the human heart–one of the indivisible primary faculties, or sentiments, which give direction to the character of Man. Who has not, a hundred times, found himself committing a vile or a stupid action, for no other reason than because he knows he should NOT? Have we not a perpetual inclination, in the teeth of our best judgement, to violate that which is LAW, merely because we understand it to be such?” -Edgar Allan Poe

Although, I know right from wrong, and often choose what is morally right, I don’t always  have a gauge to stop me from choosing what is wrong. When I choose wrong, it is always to my detriment and ruin and despair…so why do I still get myself in the kind of situations where I choose wrong? In my need to connect with people, and make friends at school, I loaned a class-mate a paper I wrote last semseter (buts like 3 content from three semesters ag). I naively thought she would look at it to get ideas, perhaps see how I incorporated APA into my paper, and perhaps use a few quotes (citing them appropriately)…well, she turned in MY paper as her own original work. In my institution, all papers get electronically scanned for review…this paper was reviewed and we both got summoned to the Dean’s office. The Honor Code in our school considers my lending and her using my paper the equivalent of cheating…and we are both under review with the likely outcome of  expulsion. Worst case scenario for me because I go to two Universities is that I will be expelled with no return provisions from both institutions; additionally,  I could possibly have the three degrees I currently hold remanded…so, all the years of work, all the money…well I am ruined. This 18 year old will progress and go on…she will probably get a Real Estate license and have a life and a career…for me I am out of money; and I, feel out of time…the rest of the days of my life will be working as a lackey,  and living in survival mode…always working two jobs, perpetual tiredness, no challenge…..every worst nightmare I’ve ever envisioned for myself. But even harder is the self loathing I have for my self for not having good moral fortitude. The worst part is it is all of my own doing. How did I get to the point where I made a choice to so blatantly  sabatoge myself? I think the worst thing for me is that I have become the person I despise most…one who cheats the system to get ahead in life (my mother).  I am numb and I am lost….

My Manager…the Epitome of the Idiots…

I am irritated by the following e-mail I received from my manager. Instead of discussing these issues in a recent staff meeting he sent updates that affect everyone’s life via the net. I do not think this man knows how to communicate unless it relates to stuffing things under the carpet…

“We held department manager meeting today and there are a few things I need to remind you all about:
1. There will be a mock JCAHO survey some time in the next two weeks. I asked all of you to come bring your binders into me so we could go over them, so far I have only spoken with a couple employees. Please try to talk to me sometime this week. Please do not ignore alarms either the surveryor will want to see that all staff. tele tech and med surg staff are responding to the patient tele alarms.

**This irritates me for a few reasons…he never asked us to bring our certification/inservice binders to him he left a note on a POST IT with instructions that we had until the end of December to see him…now with plans for a mock JCAHO he wants it sooner? Furthermore, we the Tele’s, watch those alarms and per corporate aren’t allowed to ever silence or turn them off…even when the computer mistakenly calls an irregular heart beat A-Fib or when the patient is dying and has a DNR/DNI status… Also, I HATE JCAHO protocols…it seems to me that it is just a bunch of extra paperwork and protocols to follow (that never have much to do with the patient, but more to do with cya and liability issues) which convolutes methodologies for caring for a patient while at the same time ensuring a rating that the public could care less about….

“2..I will be re-working the staffing matrix. We will try to add to the support staff at night and balance it out elsewhere. Please keep in mind not everyone will be happy and someone will have to give something up in order for it to work. Initially you told us that the most important thing to you was that you were never here alone. We gave that to you and now it is apparent that lack of support staff is a bigger issue. Feel free to offer any suggestions and we will try to incorporate them into our new plan.

**The newest matrix, released about a month ago, caused everyone to rebel. Nurses allowed support staff  (i.e. the Unit Secretaries and the Aides) to work entire shifts when the census didn’t call for it according to the staffing protocol. They did this because we would be down to 2 patients and then get slammed with 4 admits right at shift change…the nurses couldn’t do vitals, total patient care, assessments, med passes, med mixes, AND input orders…Hmmm ya’d think you would have a clue as to why new matrix didn’t work. DUH! Not that I expect the new one to be much better, but maybe management will rethink the 6 patients 1 nurse – 1 aide; send aide home upon 7th admit, bringing another nurse in and thus, placing aide on call until there are 11 patients….RIDICULOUS!!!!
“3.. Our rapid response team is in place and ready. To initiate their involvement page overhead anytime of day “Rapid Response Team to Med surg” two times do not review by the team. This is a team that responds to any worsening change in the patient’s condition. They are the pre-code team and their involvement is
strictly informational.

**What friggin’ legit  hospital has a PRE CODE team? This was implemented because in Med-Surg, the new nurses, right out of nursing school only get 3 days of orientation instead of two weeks and have been calling code blue status on patients when they should have just notified respiratory because the patient was having labored breathing. WHAT THE HELL???? I really am annoyed by this one above all because isn’t it the manager’s responsibility job to engage the employee when mistakes are made? Perhaps give advice when one’s newness doesn’t dictate the correct protocol?
“4. Please don’t become so frustrated of the difficult things at our work that wedon’t appreciate the things that are going well. Please see the article in our med room regarding recent changes at other hospitals and be appreciative that we are not there (yet) The economy will continue to bring changes to everyones work
environment. The trick will be in finding happiness in the things we can do well.”

**This last one is because my manager does not know how conflict negotiation works. He just removed our best Tele and relegated her to work Med-Surg as a full time C.N.A. He did this because his regular C.N.A had many patient complaints and wasn’t working with two of the day-shift nurse’s well. Instead of suspending the aide for bad behavior,  and conduct; and,  enforcing a customer service training or dealing with the toxicity between the employees…he rewarded the aide that was acting up and punished our wonderful Tele. It is an egregious action and so many are fed up and complaining…so much so that corporate has made all of us watch a “disruptive behavior” video. Comment 4…another insult to my intelligence…”let’s just cause chaos and pretend we didn’t by wrapping it in a nice fluffy Christmas bow.”

So…admist all of the dumb shiz going on we are told it is all because we are over budget. Then a week later we receive a brand new copy machine and the hospital gets signage… WHATEVER!!!

But the thing that probably irks me the most about this e-mail to me is that the guy didn’t even bother to capitalize things that should have been capitalized. I know my grammar and punctuation is not stellar but it is because I choose to be a creative writer…I am not in a Professional, Technical position..this guy IS and fails (in my mind anyway) to even have a Professional Presence in his writing. I AM SOOOOO BUGGED!!!!! And I know it is really petty to be bugged, I just can’t help myself….

Whew…I was Worried…

Are You Narcissistic?

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YOUR RESULT: A Healthy Dose of Self-Love

“No worries for you. Your score shows no narcissistic qualities at all. You make sure to look out for yourself without going over the top – a healthy amount of narcissism.“
I feel I have been very self-absorbed lately. That, combined with my discovery of the facebook phenomenon ( which has gotten me in touch with some people I totally adore whom I lost contact with) I have not been present in my life…I have been contemplating many things; and, unfortunately, ignoring the people I care about the most. I was concerned that being focused mostly on myself meant that I was narcissistic (a quality that my mother possesses, that I abhor and truly don’t want to develop). So, I took the test above and was relieved to find out that my egocentric moments have been normal and healthy. Now, I just need to work on my love and concern for others, and let my obsessions lie idle (facbook and idol).