I think I'm going to like working here...

I'm orienting for a new per diem job at a large local family practice clinic, and the first thing I noticed in my MANAGER'S OFFICE was the following:

I think I'll fit right in. :D

Nursing Protip

When you're in a patient's bathroom at the end of your shift, emptying the graduated cylinder of its contents, it's a really, really bad idea to exclaim,


"OH, MY GOD!"


even if you glanced in the mirror and got a good look at your end-of-night-shift, slept-on-wet hair, which resembles a coiffure Medusa would envy.

You're likely to hear panicked shouts of "What? WHAT?" coming from both your patient and her sister, and only if you're really lucky will you get laughter in response to your meek, "Oh, sorry. It's just my hair..."

Haiku

your pain is over
I fear mine has just begun
rest in peace, dear Ray

Every breath you take...

I'll be watching you.

To see whether you're actually dead, that is.

I had the honor and privilege of holding a patient's hand while he passed. His family was with him and were bawling. Finally his wife asks, "Is he...dead?"

Um...

Eyes open. Pupils fixed. No visible breaths. Palpating his wrist...is that a pulse?! Shit! Is he or isn't he?!

Where's my stethoscope?! Where it always is, around my neck. Duh. Listening...listening...listening...

You don't know how long a minute really is. You really just don't know...

I hear nothing. Yes, he really is most sincerely dead. I page the doctor and go back to my computer, mentally going over the next steps in this whole process.

About an hour or so later, the charge nurse and I are performing post-mortem care.
P. is trying to grow a pair, because she's always been reluctant to do this very important task on our unit.

As we are carefully washing our deceased patient (and I have it on good authority that I'm NOT WEIRD for talking to the ones who have passed, so there!) I notice a flicker of movement...

P. jumps back with a squawk and I admit, a tiny noise might have escaped my throat.

*ahem*

I belatedly realize that the fancy-schmancy pressure-redistributing mattress doesn't give a flying fuck whether the body that's lying on it is alive or dead, it keeps on with its task of preventing pressure ulcers...by systematically deflating and inflating sections of itself, causing a rippling movement not unlike that of a water bed...incidentally and quite freakishly causing movement to our patient.

P., once she's come down off the ceiling and caught her breath, states, "That's the freakiest thing I've ever seen in my LIFE!"

Oh, Honey...you may have more experience as a nurse than I, but you ain't seen nuthin' yet!

Putting me on the spot!

As I was bustling around my patient last night, hooking her up to various IVs, etc., she looked me in the eye and asked," Am I gonna die?"

I fumbled for a moment and then spouted these words of wisdom," Well, we're ALL gonna die, eventually..."

I'm surprised she didn't punch me in the face.

I knew exactly what she meant to say.

I have a patient with expressive aphasia. When I walked into her room this morning, the very first thing she said, while looking into my face with a huge smile, was

"Happy Birthday!"

I replied,

"Happy Mother's Day to you, too, Iris!"

What a wonderful way to start a shift!

It was very satisfying...

as long as I held my breath!

I disimpacted a patient for the first time, w00t!

I don't think I needed a bachelor's degree for this, though.

Why can't I just get paid to hang out with my friends, chat, and stuff my face?!

Enough to make a sailor blush...

Oh, the things one overhears at Phlegmfest!

Out of context, they are by turns disturbing and/or raunchy.

"I love restraints!"

"Just the tip is in the mouth, you know it's not all the way in."

"I'm sorry I put my fingers on your wiggly bacon!"

It's one of those gatherings where several fascinating conversations are going on simultaneously, and you just wish you could listen to and participate in every one.

Quotes are being tossed around and people break out into song spontaneously, and nobody bats an eye.

And the food? Scrumptious!!!

I'm having a blast!

And I'm very thankful that despite dozing off every evening among the crowd, I have yet to wake up with a dick drawn on my face in sharpie. True friendship.  Thanks, Y'all!

Leaving on a jet plane...

Heading to TEXAS for Phlegmfest!

Dunno what kind of shenanigans might ensue, but with THIS crew, anything is possible!
I might or might not keep you posted, depends on many factors, one of which is my disdain of typing large amounts of text on my phone. Ugh.

I'm so excited to see so many of my friends who live so far away. I missed Blogorado last year, which made me sad, but I'm hoping I'll make it this fall. I already put in for the vacation time. ;)

Here's hoping my trip out is uneventful...car, bus, plane, car...we'll see!

Ugh.

I had the worst day ever today. I thought yesterday was bad, but today was several orders of magnitude worse.

At the end of my shift, after giving report, when I FINALLY started documenting, a long-time unit secretary/CNA (yes, she does BOTH) came up to me and asked, only half-jokingly,

"Whose oatmeal did you piss in to get THIS shitty assignment?!"

I dunno...God's?!

It wasn't supposed to be a bad day, but my patients had other ideas.

One died. One crashed. One was discharged (yay!). One's anxiety made him a huge PITA. And throw in an admission right at the end, and I was completely wrecked.

But, I work on an awesome unit where everyone pitches in to help, so that made a tremendous difference. Everything got done. All meds were given. All my patients were safe (yes, even the lady who died). Documentation is a nurse's bane, however.

I finally clocked out at 2107, picked up Tally, and headed to a local Irish pub. Good food, good music, and now I'm for bed. Luckily I don't go back to work until tomorrow night, so I can sleep in.

I just hope that the feeling that I don't know wtf I'm doing wears off soon...*sigh*.

I'm a REAL nurse now!

Clocked in at 0640 and didn't pee until 1905.

Why I became a nurse.

I admitted an elderly gentleman early yesterday morning, about half-way through my overnight shift. He came from the ED, extremely cachectic, with a diagnosis of "Failure to Thrive", which I thought only applied to newborns and infants.

He was withdrawn and monosyllabic, and I felt bad to be poking and prodding him with my admission assessment and placing of pressure ulcer preventatives, etc., when it was obvious he just wanted to be left alone.

When I came on last night, my third overnight in a row, after receiving report I walked into his room and reintroduced myself,

"Hi, Mr. Top! Do you remember me? I'm Christina, and I was the nurse who took care of you when you arrived on our unit last night."

He smiled slightly and said,

"You're the lady who got me all that apple juice!"

That he remembered me for THAT of all things, something nice I did for him, rather than the various indignities I subjected him to, absolutely made my day. Nothing got me down for the rest of my shift, not even when a patient's ileostomy bag exploded.

These moments are totally why I became a nurse. It makes everything worth it.

Merry Christmas!

So, all my children are here for the holidays, yay! (Actually, TallyAngel, my older twin, moved in with me the day after Thanksgiving, so she was already here...).

Unfortunately, Silver (my oldest) has had a wicked sore throat and can only talk in whispers (99% sure it's NOT strep throat, so I'm not dragging her unnecessarily into an urgent care, even though she wants me to).

Work is going well. I've been working a lot of nights lately, and except for the sleep deprivation, I like it. It's more peaceful. So to speak.

I had my first patient die. It was expected and welcome (he was on Comfort Measures Only), but I wasn't expecting him to die on my shift, nor was I anticipating that I would be the one to discover him, moments after he passed. He was still very warm. It was a good experience, though, and he died at peace and pain-free. My charge nurse said I did a great job, so there's that.

In other news, if you're friends with me IRL/on Facebook, you know that Tucker, one of my pups, has been very sick and almost died. As a matter of fact, he's definitely still not out of the woods, though he's holding his own right now. He has idiopathic autoimmune hemolytic anemia. That's a mouthful! (That's what SHE said!)
His own body has been attacking and destroying his red blood cells, for no known reason, leading to extreme anemia and all that goes with it. I'm taking him in this coming Monday for more bloodwork, so hopefully the labs will reflect what I see in him, namely that he is improving! He's eating again (and pooping!), and he wants to go on walks, even though he's very slow. He still gets fatigued really easily. And the steroids he's on make him drink and pee excessively, but that's just how it goes.

And that's about all I've got right now! My life is pretty boring. ;)

Have a very Merry Christmas! If you're Jewish, I hope your Hanukkah was awesome! Ditto with Festivus and Kwanzaa! (Have I covered everyone? Oh, wait! Wiccans, happy Winter Solstice!)

And for EVERYONE: I hope 2016 brings good health, happiness, and prosperity to you and your families!

And dear GOD, please don't let Trump or Hillary or Bernie be president!

I'm a BIG girl now!

The training wheels have come off! I just completed my first full week off of orientation!

No preceptor anymore, just me...all by myself...trying not to kill any of my patients.

*gulp*

So far, so good. We'll see how it goes later this week, when I work three days in a row.

I just had my first overnight shift (by myself), it was excellent, actually. Though  now I feel like a zombie. I think I'll watch the last episode of "Jessica Jones" and go back to bed.

Nighty-night!

Nope, not tea.

Then there was the elderly patient who asked me politely to dump the contents of his cup down the drain before he could accidentally drink it. When I asked him why he was worried about drinking his iced tea, and that I could get him some more ice, he told me he thought he had mistaken his empty cup for a urinal in the middle of the night and peed in it.

I carefully set the cup back down and said, "Let me get some gloves..."

And I made sure to document the dark amber color of his urine.

BTW, he had THREE urinals at his bedside!

Winning!

Mission: To make a jaded, seen-and-done-it-all male nurse blush.

We're transferring an elderly patient from a crappy foam bed (thanks, ED!) to a fancy-schmancy Envision bed.

I'm on the opposite side, so I have to lean across the Envision bed to slide the patient towards me. Right before we begin the transfer, aforementioned male nurse says to me:

You need to spread your legs.

My reply:

Yeah, I hear that a lot...

Totally inappropriate, I know, BUT I made my colleague blush and the other two nurses laugh their butts off, so I'm calling it a WIN!

There's somebody behind the curtain!!!!

I'm giving a patient an extended-release potassium pill, which is gigantic and extremely foul-tasting. The patient is having a procedure, so can't eat or drink anything (except for her meds), so she can't chug a giant glass of water to get the pill down. You can't dissolve it, crush it, or chew it, either...unfortunately, the instant it comes into contact with moisture, it starts dissolving...and tastes incredibly disgusting.

Me (watching the patient shove the pill all the way to the back of her throat with her finger): Oh, it's like giving a cat a pill!

The patient's twenty-something daughter: It's like giving a blow job...

Me (inside my head): Only if you have a gag reflex...
 
The patient reaches out with her free hand and smacks her daughter's arm: I can't take you anywhere!

Me (to the daughter): Maybe that's not the best thing to say in a semi-private room!!!

*sigh*

Things to consider when you're in the hospital:
-NO PRIVACY
-even if you're in a private room: NO PRIVACY
-but definitely worse when you have a roommate: you can hear EVERYTHING, including when the other patient is shitting into the bedside commode.

Potpourri

Let's see...well, the job is going well, according to my preceptor! According to ME, I'm a failure, because I'm not handling everything by myself, all the time. I know I'm new, and I know that I truly don't know very much (still), but I want to be the best damn nurse out there. Now.

I don't want to be the person nobody wants to work with. You know, THAT person. The one who always needs help and never gets her shit done. As it is, I already feel like I don't get to spend enough time with my patients, that I'm charting all the time. I've been told that as I get more familiar with the (electronic) paperwork, I'll have all that done much faster, and more time will be freed up for actual face-time with the patients. Heh, "patients"...I have patients but no patience (for myself)!

So, skills. I'm getting there. I had to give a patient six different medications via IV yesterday, and I rocked it! I was slow getting everything together, because I'm CAREFUL. All of these meds were clear liquids, you gotta be careful and organized (pretty much OCD) with that shit!

All syringes were labeled, I knew which meds were compatible with the (continuously) running IV fluids and which weren't, which meant I knew which meds could be administered via the implanted mediport, and which had to be given IV push through a peripheral IV site. I knew exactly how long I had to push the meds (generally over two-three minutes, which is a LONG time when you have fifty other things to do and the patient is getting IMpatient, even though you've explained it to him five MILLION times...).

I've done discharges and admissions. I helped administer a unit of platelets, and I'm learning to tactfully and diplomatically DELEGATE TO THE LNA. A very necessary skill, because I don't have time for all that (sometimes literal) shit.

I've given shots subcutaneously (lovenox and insulin) and intramuscularly (flu shot, that's a honking BIG needle!).

I've given patients little cups brimming with colorful pills and capsules, scary the polypharmacy, but necessary. And I've been able to tell them what they all are and what they're for.

I've done lots of patient education, about many different things. Like nutrition and portion control. Why they might be retaining water, and what the docs might do about it. And what they, the patients, might have to do at home to deal with it.

I've done dressing changes and linen changes. I've wiped people's bums. I've catheterized one poor soul. Successfully. On the third try. Hey, it's way harder to do females! Have you looked for a female's urethra lately?!

I've gotten my first, and hopefully last, needlestick. Don't worry, the "source" came back clean, so I'm ok.

I've dealt with doctors, interns, residents, and medical students. I've spoken with PTs, OTs, case managers, social workers, and pharmacists, among many others. It's all good, nobody's has ever accused me of not being a talker!

I've discovered that patients misunderstand or mishear a lot of what you say, and that they also forget a lot you've said. And sometimes they even forget that you were the one they talked to!

Along the way, I've learned that pancreatic cancer is a fucking bitch. And that Graft versus Host Disease is a VERY SERIOUS MATTER. Ugh, what a nightmare!

I've also found out that with age truly comes more tolerance. I've had to caution some younger folk, to A: talk more quietly at the nurses' station, and B: that they never know the whole story, so stop JUDGING.

Regarding my move, I love the area. New Hampshire is glorious in the autumn, truly. And I need to move as soon as my lease is up, because you never make as much (take-home) money as you thought you would, and convenience and proximity to the hospital makes my apartment too expensive for me. I have student loans to pay back!

And I finally am in a position to make my private massage business a reality. And it's perfectly legal to do so here out of my home, which makes it a lot easier for me. I have my spare bedroom set up as a treatment room, and it's wonderful! Hopefully that will ramp up as time goes on and word of mouth spreads. We'll see.

So, that's the update. I'll try to be better about posting more frequently, I see that it's been over a month! YIKES!

Yeah, I have a blog post dying in the drafts folder, since I lost the fire to finish it as the immediate urgency waned. It was about the Day of the Needlestick. It was a Very Bad Day. I had a discharge followed immediately by an admission (like, the minute the room was cleaned), and the discharged patient was the one I got the needlestick from. I was deaccessing her mediport, and the honking big Huber needle whipsawed back and jabbed me in the thumb. Right through the glove and I started bleeding like a stuck pig. Hurt like a motherfucker. Turns out there's a safety mechanism on said needle and I didn't engage it. Whoops. Now I know.

Oh, and that day was super-busy. Only my third day on unit, I never got lunch, but I did get my period. Yeah, one of those days. I had to fill out an incident report about the needlestick. And as it was a weekend, I had to wait until Monday to go to Occupational Health for an exam and blood draw.

See, this was pretty much the blogpost I had planned, so you didn't miss out at all! Except for maybe some Atomic Level Whining, so you're better off this way.

Anyhow, I'll try to post more often, but understand: When I get home after my shift, I usually just walk the dogs, eat, and go to sleep.

This weekend I'm headed back to Mass to visit and do Fun Things. Including going to my first rave. With my twins. God help me! So maybe I'll even have something to blog about!

Take care and see you on the other side!

I love living in the future

As I was walking the pups about an hour ago, I realized I had left the apartment without my trusty maglite. Dammit!

Now I literally couldn't see shit.

While Tucker was completing his patented PoopWalk in a spot under a shrub, I was wondering whether I should be a dick and ditch the poo, or head back to the apartment to get my flashlight. Then the figurative lightbulb went off above my head, and I remembered I had been wanting to get a flashlight app on my phone for awhile. A few seconds later, smartphone in one hand and plastic bag in the other, I was able to do my duty.

Living in the future ROCKS!