Found on Facebook . . .

You might be a nurse if . . .

You believe that all bleeding stops … eventually.

You find humor in other people’s stupidity.

You believe that 90% of people are a poor excuse for protoplasm.

Discussing dismemberment over a gourmet meal seems perfectly normal to you.

Your idea of fine dining is anywhere you can sit down to eat.

You get an almost irresistible urge to stand and wolf your food even in the nicest restaurants.

You plan your dinner break whilst lavaging an overdose patient.

Your diet consists of food that has gone through more processing than most computers.

You believe chocolate is a food group.

You refer to vegetables and are not talking about a food group.

You have the bladder capacity of five people.

Your idea of a good time is a cardiac arrest at shift change.

You believe in aerial spraying of Prozac.

You disbelieve 90% of what you are told and 75% of what you see.

You have your weekends off planned for a year in advance.

You encourage an obnoxious patient to sign a self discharge form so you don’t have to deal with them any longer.

You believe that “shallow gene pool” should be a recognized diagnosis.

You believe that the government should require a permit to reproduce.

You believe that unspeakable evils will befall anyone who utters the phrase “Wow, it’s really quiet isn’t it”.

You threaten to strangle anyone who even starts to say the “q” word when it is even remotely calm.

You say to yourself “great veins” when looking at complete strangers at the grocery store.

You have ever referred to someone’s death as a transfer to the “Eternal Care Unit”.

You have ever wanted to hold a seminar entitled “Suicide … Doing It Right”.

You feel that most suicide attempts should be given a free subscription to “Guns and Ammo” magazine.

You have ever had a patient look you straight in the eye and say “I have no idea how that got stuck in there”.

You have ever had to leave a patient’s room before you begin to laugh uncontrollably.

Your favorite hallucinogen is exhaustion.

You think that caffeine should be available in I/V form.

You have ever restrained someone and it was not a sexual experience.

You believe the waiting room should be equipped with a Valium fountain.

You play poker by betting ectopics on ECG strips.

You want the lab to perform a “dumb shit profile”.

You have been exposed to so many X-rays that you consider radiation a form of birth control.

You believe that waiting room time should be proportional to length of time from symptom onset.

Your most common assessment question is “what changed tonight to make it an emergency after 6 hours / days / weeks / months / years)?”.

You have ever had a patient control his seizures when offered some food.

Your idea of gambling is an blood alcohol level pool instead of a football pool.

You shock someone with an unrecognizable rhythm … until you get one you DO recognize.

You believe a book entitled ‘Suicide: Getting it Right the First Time’ will be your next project.

You have ever referred to someone’s death as a ‘transfer to part 3 accomodation’.

You can identify what kind of diarrhea it is just by the smell.

You will never name a daughter “Melena” or anything along those lines.. and laugh to yourself every time you hear someone by that name

You call subcutaneous emphysema “Rice Krispies”.

Your immune system is so well developed that it has been known to attack squirrels in the backyard.

I’ve been a nurse long enough now that I am starting to feel like an old-timer.

I worked in the cath lab today and there are a lot of staff now who weren’t there when I used to work in the lab a couple of years ago. Few of them realize that I am a “real nurse.” They’ve only known me to sit behind a desk and spout terms like “risk-adjusted mortality” and “data elements.”

I tagged along with a friend today to become re-oriented. When we set up for a TEE (transesophogeal echocardiogram) and cardioversion (deliver a shock of electricity across the chest to normalize the heart rhythm), I bounced into the room and asked the circulating nurse, “Tony, do you want me to sedate for the TEE?” He said, “Sure,” and then explained very slowly, “First, you ask the patient to gargle with viscous lidocaine. Then . . .” It took me a second to realize he was attempting to teach me how to do the TEE.

“Tony.”

“Yes?”

“I know how to do a TEE.”

“Oh, you do? Really?”

What Tony doesn’t know is that once I was one of only three nurses in the hospital who was responsible for doing every TEE. For some reason, it bothers me that someone tried to teach me how to do a job that I’ve taught many other nurses to do.

Oh, well.

There’s a doctor who works in the cath lab who is notoriously difficult. He has no tact. He is impatient. Except with me. He loves me, of course. I worked closely with him for several years.

The funny thing about some of the staff not knowing that I am a seasoned veteran is that they also don’t know that, to this one certain doctor, I am a princess.

Yesterday, I was called to the EP lab to troubleshoot why the 12 lead EKG wasn’t working. I quietly inspected the leads, located the problem, and then called out, “Okay! It should be working now!” The doctor heard my voice, looked up and said, “It’s Heather!” and embraced me in a hug. As I pranced out of the lab, one of the new nurses stopped me and said, “None of the rest of us got a hug just for showing up.” I winked at him as I left the room.

Today, it was the same doctor who was performing the TEE and cardioversion. After the procedure, as we recovered the patient, I started teasing him:

“Dr. —, Brenda and I were going to let you take us to lunch for your birthday but it was just a busy time.”

“My birthday was in October.”

“Yes, I know. And I am sorry you were unable to take us out to lunch to celebrate. But we will let you take us to lunch for the new year.”

The anesthesiologist and nurse in the room were looking at us like we were crazy, so I explained:

“We always take Dr. — to lunch for his birthday but we make him pay.”

I teased and flirted (innocently, the man is practically my father) and talked with the doctor as the (male) anesthesiologist and the (male) nurse looked on in astoundment at the difference in the doc’s manner. As the doctor reached the door of the lab with a smile stretched across his face, he waved back saying, “Thank you, girls!”

I couldn’t help but giggle at the look on the (male) nurse’s face.

Sometimes it’s fun to be me.

today

Apparently the males who live in this household all experienced some weird form of mental regression last night and this morning. My theory is that their brains atrophy when there is no estrogen-based life form marching about the house issuing directives.

I had to work late last night, unexpectedly. I got home at 9:30 after the kids were already asleep to find that Brad had checked Bump’s homework but somehow forgot to even check and see if Crash had homework. The clothes I had folded in the family room were not put away but instead were stuffed unceremoniously in a basket and were waiting to be folded again. The same clothes that I had placed in the washer and dryer that morning were still there. Sci-Fi was on the television and Brad sat transfixed.

(I have to admit that I understand him wanting to kick back and relax since he just finished up two of his courses for his MBA Sunday night and he worked all day. But still.)

I was too tired to argue last night. But this morning? Not so much.

My day got off to a shaky start when I rolled over in bed, rubbed my soft, silky legs against Brad’s warm fuzzy ones, and he? Well, he laid there and yawned.

I ask you.

I woke the kids up and laid their clothes out while I fixed breakfast. I heard a squeaky, frustrated sound coming from Bump’s room and checked on him only to find him throwing a hissy fit because he couldn’t get his new jeans buttoned; he is used to snaps. I rolled my eyes, buttoned his jeans, and walked past Crash’s room to see him lying on the bed, looking at the ceiling. I stood over him and he pouted, “I don’t want to wear my new clothes!”

I walked back into the kitchen making a mental note to let the ungrateful little twerps go naked the next time their school jeans begin to disintegrate.

While the kids ate breakfast, I sat about the task of making lunches. Except, I couldn’t find Crash’s lunchbox. Matter of fact, I couldn’t find Crash’s backpack. Reason why? He left it in the babysitter’s car the day before. At this point, I feel compelled to point out the obvious: If Brad had tried to locate Crash’s homework folder last night, it would have become apparent that the backpack was missing. It would also have been possible to retrieve the backpack from the babysitter’s.

To make matters worse, when I walked into the family room, I was confronted with the sight of Bump’s brand new shoes sitting in the middle of the floor just waiting to become a chew toy for the dogs. The whole reason he had new shoes is because the dogs chewed up his last pair.

I couldn’t take anymore. I declared that both boys were grounded. And I gave Brad the stink-eye at every conceivable opportunity. And then I kissed them, sent them out the door to school and work, and laid across my bed, trying my best to take deep, cleansing breaths.

That didn’t help much. So, I called Sharon. I was laughing within five minutes. I want to say, here and now, that my friends save my life just a little bit nearly every single day.

I went to work happily anticipating a day working in the EP lab. The cath lab nurses sometimes complain that they “have to” do electrophysiology cases. Me? I am beside myself with happiness when I “get to” do electrophysiology cases.

When I walked in the lab and greeted the EP doctor, he asked, “What’s been going on?” I answered, “I sit chained to a desk for several hours a day and emerge periodically looking pale and pasty.” He replied sarcastically, “Well, so long as you are doing something you love . . .”

I cheerily spent my day moving patients from EP table to stretcher and vice versa, hooking up ECGs, blood pressure cuffs, O2 sat monitors, and defibrillator patches. I paced hearts and closely watched intracardiac electrocardiograms, calling out to the doctor when the paced beats exactly matched the ectopic beats.

Oh, it may sound tedious and tiresome to you. But I was happier than any nurse has a right to be.

My primary job now is to manage databases so positive change can be affected for our cardiac patients. I have a fancy title and I am well-respected by a lot of people who are far more powerful than I am.  I am certain I have saved more lives through the multiple Performance Improvement projects I have implemented and/or participated in than I have through direct patient care.

But deep, deep down, I am an electrophysiology nurse and I was immensely fulfilled by my work in the lab today.

The day didn’t turn out so bad after all.

Life is what happens while you’re making plans

What is it they say? Oh yes, I remember. Life is what happens while you’re making plans.

All week I have been going about the very time consuming business of getting the kids ready to head to New Mexico for a week and for Brad and me to head to Florida. I’ve been checking a mental to-do list:

• Insurance card to send with the kids. Check.
• Laundry washed and folded and ready to pack. Check.
• Ask neighbors to watch the house. Check.
• Ask my mother to babysit the dog. Check.
• Healthy children.
• *ahem* I said, healthy children.
• HEALTHY CHILDREN? Um, not so much.

It would seem that Crash has hand, foot, and mouth disease. He’s on his third day and it usually lasts 2-7 days. His mouth and throat are broken out in sores and he cries every time he tries to eat. It is likely that he will break out in sores on his hands and feet by tomorrow. And he’s supposed to be going to stay with his grandparents for the week starting, um, tomorrow. His doctor says he is fine and that he will be feeling great by Monday which is when he will be leaving to go to the New Mexico mountains for a week. He even said it is okay to send him to his grandparents tomorrow as planned. But lawd Jesus, it is hard to think of leaving my baby when he is sick.

We’ve hit upon a sensible plan. Instead of spending Saturday and Sunday night at Brad’s parent’s house where he would be running around playing with his brother and his two cousins and not only wearing himself out and making it harder to get well but also potentially spreading the virus to the other children, he is going to stay those two nights at my mother’s house where he will be the only child and thus will be more likely to stay still and get enough rest. Brad’s parents will pick him up on their way out of town Monday morning when, according to the pediatrician, he will be feeling perky and bright.

The doctor recommended mixing up a cocktail of Maalox, Benadryl, and Orajel to apply to Crash’s mouth to relieve the pain caused by the sores. I stood at my kitchen counter tonight preparing the mixture and then leaned over to swab his oral mucosa as he opened his mouth wide saying, “Ahhhhhhh.” It suddenly put me in mind of the last time, nay, the only other time I’ve ever swabbed the same cocktail inside someone’s mouth.

It was when I was in nursing school. We had two weekends where we had clinicals in a much bigger town with a much bigger hospital. I was assigned to the oncology floor. Oncology was not my choice. I have never, ever entertained the notion of becoming an oncology nurse. I don’t like watching people suffer as I look on helplessly. But I digress. The point is, oncology was my assignment.

Both weekends I took care of the same patient. She was a middle aged woman who had non-Hodgkin’s lymphoma and was receiving inpatient care and chemotherapy because she had been so weakened by her treatment. She had no hair but her daughter kept beautiful scarves tied in a turban-like fashion on her head. Her skin was so pale it was almost translucent with blue veins showing through. She was thin and weak and stayed in bed most of the time. She had a potty chair at her bedside but it sometimes required more energy than she had to get to it, even with assistance. Despite being sick and weak as a kitten, she was cheerful and smiled through her pain. I remember her smiling up at me as my instructor watched me hang an IV piggyback medication. My hands shook and I tried very hard to remember exactly how I had been taught to do it at school. It seemed very different when I knew it wasn’t just practice but someone’s medication that I was administering. The patient said, “You’re going to be a good little nurse. I just know it.”

Between the first weekend and the second weekend that I took care of her, she was given a dose of chemotherapy. I was alarmed to see how weakened she had become when I returned to her. But she was still smiling. Chemotherapy often causes the skin inside the mouth to peel off and it causes excruciatingly painful sores, much like Crash is experiencing right now. When she asked me for something to help with the pain in her mouth, it was obvious that it hurt her to even try to speak.

I fetched the cocktail from the med cart and remember thinking how child-like she looked when I asked her to open her mouth so I could swab the medicine inside. She smiled and said, “Ahhhhhh.” just as Crash did earlier tonight and I leaned over her and ever so carefully, so as not to cause her more pain than necessary, coated over the sores in her mouth. What I remember most is that, when the lidocaine in the medication took effect and her pain abated, she looked up at me with tears pooling in her eyes and whispered, “Thank you.”

That was when I knew I would never make an oncology nurse. When a patient is so miserable that simply swabbing her mouth inspires such gratitude, well, let’s just say that is too much misery for me to stand. It may sound selfish. Maybe it is. I just know that I am far too tender-hearted and empathetic to surround myself with humans who are so desperate for healing and in so much pain. I also know that I wouldn’t be able to look at myself in the mirror if I ever became hardened to such pain and suffering. And so I work on people with sick hearts. They are very much in need of my nursing skills and worthy recipients of my tender-heartedness.

I guess they are right. Life is what happens while we are making plans. And sometimes, Life is about recalling memories we had buried deep in our hearts. Swabbing my son’s mouth reminded me of a woman I met long ago who had a beautiful spirit and, in turn, reminded me of the rewards that small kindnesses can bring.

Life is in the interactions we share with the people we meet along the way. Life is in the kindness we show to others and the kindnesses we receive. Life is what happens when we aren’t expecting anything wonderful. Life is in the routine tasks we perform every day.

Life is a precious gift.

Nursing

I went to work early this morning because I knew I needed to be home by one o’clock so the babysitter could take her mother to the doctor. I had just sat down to start reading charts, which is a never-ending, tedious and sometimes boring job but is necessary in order to affect positive change, when my phone rang and the cath lab supervisor said, “I have a small crisis. There is an electrophysiology study on the schedule and our EP nurse is off today.” I said, “I’ll come do it. No problem.” He was so grateful. “Oh, thank you, Heather, for saving the day!” I am always a little incredulous when the cath lab staff thanks me for coming over and doing procedures when they are short-handed. I am incredulous because I think it is great fun to do procedures; especially EP procedures. They are used to having to do procedures all day. I live for the days when I get to lay hands on a patient. I guess it’s all about perspective.

I love being an EP nurse. I never really willingly gave up being an EP nurse. I started out working on databases and Performance Improvement projects because a) I had the time b) I had the aptitude, and c) there was no one else to do it. Our hospital administration was so impressed with the results that Brenda and I achieved with our cardiac performance improvement initiatives that they gave us fancy titles and we were gradually fazed out of procedural nursing just for the sake of time and workload. There are perks. Our CEO refers to us as “the brain trust.” He recently lauded our accomplishments at a meeting with our board members and told them that we needed to duplicate the cardiac PI successes in every other department in the hospital. I have a very flexible schedule. I am well-known throughout the hospital. No one ever doubts that I have the talent to back up my assertions that I can make things happen. I have connections in high places. In fact, when my grandfather had his heart attack, our CEO walked into the cafeteria as my family and I ate lunch and asked what was going on. After I told him the story of my grandpa’s heart attack and impending bypass surgery, he winked and said, “Well, let me know if there is anything I can do . . . though I think you can probably facilitate more in the cardiac department than I can.”

So yes, there are lots of perks to doing my job. But I miss the excitement. I miss the opportunity to utilize the years and years of knowledge and experience I have acquired. I miss the teamwork. I miss the banter!

It all comes back so easily whether it be the serious or the not so serious parts of the job. Brenda and I were training two new nurses today and one of them is a young man who was taking everything so seriously. At one point, I looked very seriously at our patient and asked, “Darlin’, did this young man tell you his first name?” The young nurse looked at his shoes and said, “No, I didn’t. I just forgot. I’m sorry.” I inquired, “Do you really think he should be seeing you half-naked without being on a first name basis?” The student and the patient both burst into laughter. The patient admitted to being very nervous and I quipped, “Lucky for you that I am a great bartender. I already have a cocktail mixed for you right over there in that IV bag.” She shot back, “Well, you’d better make it a double.” At the end of the procedure, while the patient was still groggy, she began wiggling on the table which very much resembles an ironing board because it is so narrow. I asked her to not move too much because I didn’t want her to fall in the floor. She responded that she didn’t want that either and I mused, “Yeah, do you know how much paperwork I’ll have to fill out if you fall in the floor? It’d really be inconvenient.” She just grinned.

My nursing skills always come back so much more easily than I expect too. Today, we induced ventricular tachycardia in our patient which, believe it or not, is what we wanted. But we also got a side dish of extreme bradycardia and that wasn’t expected. Before I could think twice, I was in the room tearing a crash cart open and preparing to administer advanced cardiac life support. It turned out not to be necessary but I was prepared nonetheless. In the midst of all the drama and excitement, Brenda and I never once stopped teaching the two new nurses. We’ve been in such situations so many times before and work so well together that we are able to simply go with the flow, do what needs doing, and keep teaching along the way.

Yes, I miss the days when I did ALL of the EP procedures for our hospital. I miss scrubbing into surgery. I miss doing pacing protocols and interpreting intracardiac electrograms. I miss connecting with the patients and their families. More than anything, I miss the well-oiled machine that was mine and Brenda’s teamwork.

But I don’t miss working until 8:00 or 9:00 at night because there is no one who knows how to do EP except me. I don’t miss scrubbing into six hour cases and the backaches caused by wearing twenty pounds of lead all day. I don’t miss the phone calls from the OR and the cath lab asking me questions that really should be posed to the electrophysiologist. And I certainly don’t miss having my schedule set by someone else.

Days like today are nice because I get to do what I love without all of the extraneous baggage that used to go along with it. I went to work this morning and played in the EP lab. Then I ate lunch with Brenda and came home. I spent the afternoon with my two boys. First we went to see a movie and then we went swimming.

Adrenaline-pumping electrophysiology nursing in the morning and napping under the sun on an inflatable mattress in the blue waters of my best friend’s pool in the afternoon. That’s a pretty good life.

Pay Attention!

Last night, Brenda and I attended an event called “Head to Toe.” It was a women’s event and there were booths with jewelry, perfume, clothing, massage, manicures and pedicures, and there was even a live makeover performed onstage. Our specialty is women’s cardiac health so we attended in order to educate the attendees as to their risk of cardiovascular disease. The only screening we provided was to check blood pressures but we offered lots of literature and a few goodies for the women to take home.

I checked many blood pressures. I am guessing we checked 75-100 blood pressures over a four hour time period. You want to know how many normal, healthy blood pressures I saw? About six. Yes, you read that correctly. Six. You want to know the average age of the women attending the event? I’m guessing the majority of the women were between 30 and 50 years old. These were not old women. These were not women who were already sick and in the hospital. These were the same women you see shopping at the grocery store and the mall. These were the same women you see attending their children’s Little League games and dance recitals. These are women just like me and you.

Can you guess what many of the women’s responses were when told their blood pressure was too high?

Oh, it has been high every time I checked it but it is because I am stressed out. Or because I have been walking around. Or because the sun rose in the East this morning.

Here’s the news, ladies. Are you paying attention?

Your blood pressure should never be above 120/80 on three consecutive tests. If it is, GO TO YOUR DOCTOR.

Did you know that, for every ten mm/Hg that your systolic blood pressure (the top number) is above 110, your risk of stroke doubles?

If your blood pressure is high, don’t make excuses. Don’t tell yourself you are too young to have hypertension. Don’t talk yourself into believing that you will never have a heart attack or stroke.

Because I am here to tell you that Brenda and I read every chart for every patient who comes into our hospital with a heart attack. Guess how old all of the heart attack patients were in the charts I reviewed today? They were in their 40’s and 50’s, people! When I started reading charts five years ago, most of our heart patients were 60 years old or older. Not anymore. Our sedentary lifestyles are catching up with us. We are dropping like flies from hypertension, heart attack, and diabetes related diseases.

If you go to your doctor and he or she tells you it is okay to have a blood pressure higher than 130/80, become assertive. Be an educated healthcare consumer. Read the literature. Don’t let your doctor leave the room until all of your questions are answered. Doctors are very busy people. No matter how wonderful and intelligent and kind your doctor may be, he or she is only completely focused on you for the fifteen minutes or so that they are sitting before you. It is up to you to make sure your questions are answered. Be an active participant in your healthcare.

Note: Blog, Blah, Blah’s regularly scheduled programming will continue if and when I decide to climb down off of my soapbox.

Tilt

I was thinking today about tilt table tests, mostly because Sharon had one yesterday. Tilts have always been one of the procedures I dread administering the most. You wouldn’t think that would be true considering I personally am not responsible for any pain except for the IV stick. I am usually complimented on how little my IV sticks hurt, come to think of it.

No, I don’t dread them because of any role I play. Rather it is the role I am not allowed to play. The whole purpose of a tilt test is to induce fainting. That means I have to sit and watch as my patient turns pale and sweaty just before fainting. I have to listen to the primal moan of agony that comes with the sense of impending doom experienced just prior to passing out. I didn’t become a nurse in order to watch people suffer. I became a nurse because I can’t stand to see suffering. Tilts go against all that is in me. In fact, during the first tilt I ever administered, I applied a cool washcloth to the face of my patient when she started feeling sick. I was chastised. Heather, what are you doing? You are going to keep her from fainting! Cut that out!

What bothers me most about the tilts is not necessarily the physical discomfort the patient experiences. No, it is more disturbing to me to know that most of those patients would rather no one ever see them at their weakest when they are whimpering or moaning aloud from the dread feeling of an impending blackout.

Because I would really rather no one ever see me during my moments of weakness. I am an actress extraordinare, if the truth must be known.

The day of my wedding, I was so very anxious that I refused to walk down the aisle until I had seen Brad and been able to hold his hand and be reassured that he would be waiting for me at the altar. I was so adamant in my request to see him despite the age old superstitious tradition of the bride and groom not seeing one another before the wedding that I told his aunt that she could either move aside or I would walk over her in order to see Brad.

A few moments later, as the ceremony began, a friend remarked to my mother, “Heather is so calm!” Mom replied, “Nah. She is acting.” I was acting because I knew I was a nervous wreck but I would be damned if I let everyone else know.

Last month, when my stepfather had his emergency surgery, he had what was probably a severe bronchospasm immediately post-op. He turned blue and was placed on a high flow oxygen mask. My mother told me about it over the phone. I assured her that bronchospasms are a complication anticipated by anesthesiologists and they knew how to treat it and he was going to be fine. Then I called Sharon and choked, “He’s turning blue. Oh my God, he’s turning blue and there is nothing I can do about it.” Later, when I saw with my own two eyes that he was okay, I admitted to my mother, “I was so worried when you told me he was blue.” She commented that she hadn’t worried after talking to me because I had been so calm and reassuring. Like I said, I am an actress.

Which brings me back to the reason I dislike tilts. I think I would rather be seen naked by strangers than to let anyone see me moan in pain. I would rather have an invasive procedure under sedation than a test that only requires me to stand for 20 minutes but that brings my defenses down so far that I might whimper even once.

And really? That attitude is not so much noble as it is foolish. I have had to train myself to let go enough to let a few select friends actually hear me cry when I am hurt. I am so reluctant to admit when I have been hurt by someone I love that I often bury the hurt deep inside my heart where it only festers and creates a deep, open wound.

But I am learning. I recently had to admit to a friend that she hurt me deeply several months ago. She didn’t mean to hurt me and she didn’t even know she hurt me because of me and my stupid tendency to project an attitude of: Who me? Hurt? Impossible!

It is never good to be such a good actress that my pain can be covered so completely from view from those who love me. I find myself thinking that no one cares or else they wouldn’t have done this or done that or not done such and such when I needed something extra to get through the day. But guess what? If I don’t admit I’m hurt, the only bad guy in the situation is me. Because no matter how egocentric and arrogant I may be, the only person who thinks the universe revolves around me is me. No one else is going to take the time to analyze every exchange they’ve ever had with me in order to understand what is going on in my mind. Which brings me to another point: No one, no matter how close they are to me, can read my mind. Even when I want them to; it is simply not possible.

So even though I dread the tilt table tests, I was always respectful when I administered them. I provided my patients with cool cloths for their neck and forehead immediately after the procedure and pumped them full of IV fluids so they would rehydrate and feel better. And then? I pretended I had never noticed that they cried out or moaned as their blood pressure and heart rate dropped. I didn’t baby them or act like I pitied them. I talked about the weather, I talked about my children, I bantered with the people in the room. I made sure my patients did not have to remember that only moments ago they had been frightened and sick.

I think they appreciated that.

Medical Mystery

It’s not Heather, and I’m sure at this point she’s pretty much convinced that I won’t post anything, but here I (Brenda) am.
I spent today at a medical conference here in town. Our hospital had a booth, so I had to be there, but it was very good despite my work-mandated attendance.

Yes, I’m the one that Heather took to lunch because I’m overwhelmed at work and my blood pressure is high. Now everybody knows that high blood pressure is not something to be trifled with–or if you don’t know, you should. In the past, we’ve been pretty relaxed about blood pressure, but elevated blood pressure can increase your risk of heart attack, heart failure and stroke.

When my blood pressure went up, I wasn’t too worried about the heart attack (I consider it a good way to die), but heart failure is debilitating, and having a stroke terrifies me. My blood pressure was at it’s lowest 130/80 and at the highest, 147/93. I wasted no time in seeing the doctor and getting on blood pressure medication, then titrating until my blood pressure is less than 120 systolic (the top number). In fact, it’s running about 114/63, which is great. Despite my willingness to take medicine to get my blood pressure down, I have been ignoring one little thing that we all know about hypertension–I should be on a low salt diet. Now, I love salt. Especially sea salt, or kosher salt–the really salty kind. Imagine my relief in listening to lectures today and finding out that I had sought help at exactly the right time, gotten my blood pressure to the desired level, and that a low salt diet is not mandated until you have Stage C heart failure. I’m a happy camper!

I was impressed that the physician who did the talk really emphasized how important it is to treat blood pressure starting with lifestyle modifications at 130 systolic and medication at 140 systolic. Too often that type of mildy elevated blood pressure is ignored. Would you ignore it if you realized that high blood pressure doubles your risk of stroke? That is a fact that we all need to keep in mind.

Heather will feel lonely if she gets no comments, so I’ve got a comment generator ready. I put together a hospital slide show for the conference today, and while I was wandering around, I took a medical mystery photo. Take your best guess…

I’m here! I’m here!

I must apologize for my unexpected absence. What? You didn’t notice I was gone? Again?

*sigh*

My stepfather had an emergency appendectomy yesterday. The appendix ruptured as they were removing it which made him much at higher risk for infection. And since I am the mighty alpha nurse, I rode into town on a white steed to save the day.

Actually, I showed up and did what any non-medical person would do: I worried over him and sat at his bedside to provide entertainment during his wakeful moments. Well, that and I pulled him up higher in bed, fluffed his pillows, felt his forehead, fetched his water, and made him a splint to hold against his side when he coughed. I also helped his nurse get him up out of bed and walking around the unit, changed the sheets on his bed and brought him warm, soapy water so he could wash his face and hands. I also shooed everyone out of his room around 9:00 last night and intercepted phone calls from well-wishers so he could get some rest.

My mother likened me to Nurse Ratched.

Seriously, his nurse came in the room a few minutes after I arrived and asked, “Are you the one who’s a nurse?” I nodded my head in response. He proceeded to detail my stepfather’s plan of care and ask me anxiously, “You are going to stay, right? You will keep an eye on him, right?”

“Right,” I said, nodding my head solemnly.

The nurses were very, very nice and I felt comfortable entrusting his care to them. But I was more than mildly amused that they rationalized every nursing intervention to me and waited for my approval before proceeding.

Did I think he should have Vicodin or Demerol IV for his pain? Because he was pretty weak and loopy on the Demerol earlier. Demerol, of course. Take care of his pain. If he wants the shot, give him the shot.

I really think he shouldn’t be walked without his oxygen. Naturally. His O2 sats are only 90% without the oxygen.

I think he should have a sponge bath so he doesn’t desaturate while in the shower. What do you think? Well, I think he might be fine in the shower but I certainly don’t think it would hurt to be cautious.

This was a new experience for me. As a rule, nurses eat their young. They also eat nurses who are not native to their territory. This has always disturbed me. Nursing is a caring profession. We should be as kind to our peers as we are to our patients.

Alas, this is rarely the case. Usually, when a loved one is hospitalized and lets it be known that I am a nurse, I get irritated glances aimed in my direction and the nurses adopt an arrogant manner as if to say, “Who does she think she is? Coming in here and judging me. Hmmmph.”

Honestly, I am not judging! Naturally, I will not tolerate ill treatment of my loved ones but I would only presume to question a nursing intervention if I considered it to be unsafe.

So, it was nice to be deferred to in the care of my stepfather. I found it so much easier to relax and let the nurses do their jobs because of their friendly attitude.

The day nurse, Jeff, was a very nice guy who was probably a few years younger than me. He’s been a nurse for four years. He was a nervous little fellow, I can tell you that. He was very, very, very cautious in his care of my stepdad. Myself, I would have stuck my stepdad in the shower and trusted that he would breathe deep enough to bring up his oxygen level once he was up and around. But I also had no problem with Jeff being cautious and offering a sponge bath instead. Myself, I would have written off the event where my stepfather’s legs buckled during his first time standing after surgery to orthostatic hypotension. But I also had no problem with Jeff being more cautious about getting him up just after giving him pain medicine. Myself, I would have had my stepfather up and walking much sooner than he did but stayed quiet and let Jeff keep him in bed in the interest of not causing any further pain. Which actually resulted in more discomfort considering that gas built up in my stepdad’s belly as a result of not walking soon enough after surgery.

But I digress . . .

My point, and I do have one, is that the nurses caring for my stepdad made me feel proud to be in the nursing profession. Yes, Jeff was a nervous fellow. Yes, the night nurse asked me before she administered pain medicine. But they cared. That’s what counts. It was so obvious that they wanted to take the best care possible of my loved one.

I am happy to be associated with nurses of such high caliber. I can hold my head high knowing these lovely people are caring for those who need kindness the most.

Proctor

Tomorrow morning, I have to go to work and proctor a Basic Arrhythmia test for a group of nurses who are taking a critical care course in order to become ICU and CCU nurses. Really, all I have to do is sit there and take all of the tests to the nurse educator when everyone is finished.

It struck me, though, that I am going to be proctoring a test that I took seven years ago. I didn’t really sweat it too much because I have always been a whiz kid with heart rhythms, but it was considered to be one of the most difficult tests in our critical care course. I studied rhythm strips until I was seeing atrial fibrillation in my dreams.

And now I have enough experience and knowledge under my belt that I could probably teach the arrhythmia course. As a matter of fact, as one of only a couple of electrophysiology nurses at our hospital, I am regarded to be an expert on the topic. A few weeks ago, I was walking down the hall on our telemetry unit and happened upon a young nurse trying to explain sick sinus syndrome to a family. When I walked past, the young nurse sighed, “Thank God! Heather, will you please explain it to these people?” The nurse sat and listened as intently as the family members did. And then I gave the family directions to a great mexican food restaurant. I felt it was far more impressive that I knew where to eat good food than it was that I could talk about arrhythmias but that is neither here nor there.

I don’t say any of these things to brag. The most dangerous nurse is one who thinks she has nothing to learn. I learn new things every day and actively seek out the latest evidence-based guidelines for patient care.

Instead, I say these things because it seems so unreal to me that I am an authority on anything. In my heart, I still feel like the twenty-four year old nurse who walked into the ICU feeling intimidated and impressed by the critical care nursing gods and goddesses who walked about the unit. They were all so smart and intuitive! Would I ever be so smart and confident?

The answer was, yes, I would be smart and confident. I would develop a nurse’s intuition. I can still look at a patient who, to all outward appearances, appears to be stable and say, “I don’t have a good feeling about this one” and not be surprised at all when they code an hour later. I don’t know how I know. Ask any nurse and they will tell you the same thing. Sometimes you just know.

It just feels crazy, utterly crazy, that I will sit in front of a room tomorrow adminstering a test to new nurses who want to excel in critical care. It feels even crazier to have a nurse stop me in the hall and ask me to explain an arrhythmia. It feels crazy to have hospital employees knock on my office door and hand me a blood pressure or EKG strip and say, “What do you think of this?” Why is it crazy? It just is! I know that I have tucked a lot of knowledge and experience into my brain. I know I am good at what I do. I know that I know more about heart rhythms than many doctors. Cardiac is what I do. It is what I am good at. But still.

It’s crazy. It just is. I must be getting old.