Tales of an ER Nurse

Through the Looking Glass....or Bong

2011-06-21T21:20:00.000-07:00

It's been over a year since I posted anything, and not for lack of material. Stories pile themselves in my head, and it's time to type some of them out.

"Laverne" was brought back to my open room, and right from the get-go, a strong crazy vibe was palpable. I always say that there are a few trademarks of the insane:
1. Untamed female facial hair
2. Wearing a puffy coat (especially old-school Seahawks or Raiders) on a hot day
3. Insisting on representing oneself in court
4. There are more, but I can't remember right now

Laverne met #1 and #2. Probably #3, too, but I was not privy to that information.

Her chief complaint was that her husband was trying to kill her. She thought he was putting Drano in her cereal in the mornings. "Why not just stop eating food he gives you?" one might ask. And one might ask to no avail. Please see aforementioned list.

I introduced myself as usual, and started asking her why she came in today. "He scratched a death threat in my bong," Laverne answered, with intensity in her eyes.

"What did it say?" I asked.

"I'M GONNA KILL YOU, YOU MOTHER FUCKING BITCH WHORE," she replied.

"Laverne, I'm concerned that you may be thinking things or seeing things that aren't reality."

"Here. Let me show ya." Laverne grabbed her ratty, stained backpack, rummaged through it for a minute, and then sure enough, pulled out her bong. And a magnifying glass.

She said, "Jenny, you look right here, and use the magnifying glass, and tell me what you see."

Peering carefully through the glass, I inspected all aspects of the bong, praying that no one would enter the room during such an investigation.

"Laverne, it doesn't say anything. It's just some random scratches in the glue. There are no letters or words. From your urine, I know that you've had marijuana and meth. I think someone has probably laced one of those drugs with acid or something else that's making you see and think things that aren't real."

"Jenny, thank you for telling me that," she said. She hugged me hard, and then went on to tell me a bit about her life. She lived with constant nausea, for which she smoked pot. Marijuana is cheaper and easier to come by than prescribed anti-nausea medication for many people, so that was her preferred drug.

We talked a little more, and she told me that she knew Jesus died for her, but that she was pretty bad. I told her that's why He died--for bad people like us--so we could be free. She said, "Yes, I know," and gathered up her belongings, and shuffled out the door.

Walking the Line

2010-05-28T20:53:00.000-07:00

Today I took care of a patient who used to be an ER nurse. She's married to a man who used to be an ER nurse. After years of diverting and shooting up Dilaudid and other drugs, both she and her husband lost their nursing licenses, their jobs, and their health. She checked in today because she's detoxing off of methadone and alcohol. In order to function, she has to drink alcohol every half hour. Even during the night, she wakes up every 30 minutes to take a drink.

This woman brought her 10 year old son to the ER with her. He sat in the corner and drowned out reality by playing his hand-held video game. She has other children, too.

Her veins are scars, and her limbs are pock-marked with scars from shooting up for so many years. She laughs at everything, but the smile didn't reach her eyes.

She terrified me.

In nursing school, I remember learning about a shocking percentage of nurses that end up abusing drugs and stealing medications from work, or even using at work. It seems like such a huge line to cross. And yet she crossed it.

Because of God's grace, I'm the one wearing scrubs. Hopefully I'll never be the one without a license, detoxing in an ER. But the reality of such things scares me.

Opportunities for Regret

2010-03-10T17:11:00.000-08:00

During this last work rotation, I met a few people that have not left my mind. I've actually prayed for them each, several times. This is unusual since often, I have forgotten yesterday's work entirely as I rush into today's workload.

The first was Margaret, a woman who had had multiple miscarriages. She was angry, and crying in a wheelchair in the ER waiting room, and I apologized for the wait (about 2 hours) as I rolled her back to one of my rooms. Hallway, actually. As soon as I could, I got her into a room, and heard her story. She was about 10 weeks along, had just stopped taking Prometrium, and had had a sudden onset of bleeding while at work. She was scared, panicked, anxious, and upset. Instead of telling her "we won't really be able to do anything except an ultrasound since you're so early in this pregnancy," I just listened. Blood work was sent off, a pelvic exam was done, and off she went to ultrasound. Her husband waited in the room. Hours later, I saw her leaving, and I asked what had happened. Her entire face was glowing, and the anger and fear had been replaced with gratitude and hope. "The baby is still alive, and that's all I could ask for. Now we'll keep praying." I've been praying, too, Margaret.

Next on the list of patients who made an impression was a young lady, 18, who had just found out she was pregnant. She was sobbing, but for a different reason than Margaret. This patient wanted us to refer her somewhere for an abortion since "I want this out of me." My heart felt heavy. I wished I could somehow say something to give her hope, or help her realize another option, but she was hysterical. I had the social worker go in and talk with her and give her whatever information she wanted. I just pray she'll think about this decision and how it will impact not only the baby's existence, but her own life for years to come.

And finally on the list, a 60-year old man who came to the ER simply because he was afraid of dying. Recently diagnosed with cancer, he'd had a few radiation treatments and thought he was handling everything well. But over the past few days, he'd been overwhelmed with feelings of worry about dying alone from cancer. I asked him if he had any kind of faith in anything. He said, "No. I'm not spiritual at all." I wanted to tell him that yes, he was. And that was why he was worried--because he is a spiritual being and there is a spiritual reality. But it didn't feel like the right time to say that, so the doctor saw the patient, and we referred him to some counseling. Maybe somewhere along the line, after the antidepressants, and the antianxiety meds, and the counseling, God will shine into His life with His truth.

So anyway, I felt like I was of absolutely no help to these three people in the long run. I can only pray that God will help them through other people they meet further along in their journeys. And this makes me wonder if the ER is really where I should be. But it's where I am, so there you have it.

Unsure

2010-03-09T17:17:00.000-08:00

Although I started this blog with the intention of MUCH more frequent postings, it's turned out that I'm not a diligent blogger. Big surprise. It's just an electronic version of my pile of half -empty journals that intermittently chronicle three decades of life.

Part of it is that I don't want to be a chronic whiner. Especially about work, which is so difficult even with a positive attitude. I'm also unsure at this point what I really want to share publicly about my life.

Another aspect is the fake Hollywoodish stuff where Meg Ryan sends out her emails "into the void" or Julie writes to the scores of "servantless American cooks" or Sarah Jessica Parker sums it all up in one question. I don't necessarily want to be like them.

Deep down, I'm just insecure enough to want validation from friends, or even strangers online. But my pride keeps me from writing from the real depths of myself.

One of my life goals is to write a book. Whether fiction or nonfiction, I'm not sure. And I don't know how to approach this goal. Perhaps this blog, if I were to be diligent about it, could serve as fodder for a book about work. Or I could broaden the blog's scope to be about my life in general. Either way, it requires a commitment and dedication that may be beyond me.

Also, I have no idea how to even put pictures on this blog thingy, make it look chic or artsy, or organize it to be more attractive. So....those are my thoughts right now.

Totally Unnatural

2009-11-17T14:57:00.000-08:00

My friend and fellow nurse, Elise, asked me to come into one of the patient rooms with her to help prepare her patient's eyes for cornea donation (actually, the word used is "harvesting" but that just seems too grotesque and industrial).

"She died from thyroid cancer with mets," Elise explained as we entered the dimly lit room. The family had said their goodbyes and gone home. Unthinkingly, my hand flitted to my own thyroid. Although her body was already cold, the woman didn't really look dead. I kept waiting for her chest to rise. It didn't.

I asked what the woman's name was, and Elise told me. Even though we knew somewhere deep down that she couldn't hear us, we still explained what we were about to do. Holding her eyelids open gently, I watched as Elise instilled saline in the woman's already cloudy eyes, and then I taped the eyelids closed. I fought the temptation to wipe what looked like salty tears from her cheeks.

"Should we put another blanket on her?" Elise asked.
"No. She's gone," I said.

We left her with her knitted hat on her head, her hands folded. Chest unmoving.

Death is not natural.

Surprise

2009-08-06T17:37:00.001-07:00

During my last shift, I checked in an ambulance that brought in an 87-year old man. Chief complaint: decreased LOC. His eyes were almost gunked shut, his skin and mucous membranes were dry, and he answered questions with barely understandable words. His body was weak and limp.

I did the usual nursing things....started an IV, drew blood, got blood cultures, took a rectal temp, got vital signs and an EKG, and ordered the typical gamut of stuff. I left the room to chart and check on my other patients.

A little bit later, after the patient returned from x-ray and CT, I looked over to the room and saw, below the curtain, two feet encased in navy blue socks, standing by the bed. Racing to the room, I threw the curtain aside to find my 87-year old man, IV yanked out, blood dripping down his arm, oxygen tubing off, all EKG leads off, gown off, standing completely naked except for the aforementioned socks, peeing on the floor.

He had removed all the wires and tubes that beset him, and climbed over the rails of the bed. Apparently his level of consciousness was not so low after all.

Good Question

2009-06-02T12:29:00.000-07:00

The other day, a patient asked me, "Do you have any pets?" Immediately, I pictured Spike and his cute little mustached face and hilarious personality. I replied, "Yes, a little Cairn Terrier. How about you?"

She told me about her three Italian Greyhounds, and showed me pictures on her phone.

It struck me suddenly that this is a fabulous question to ask people. It's not invasive, it won't make the childless people hurt, and there may be some fascinating stories behind the answers.

Usually, patients and other strangers ask me if I have children. I say, "No, not yet" and leave it at that, quickly getting back into my therapeutic nursing communication mode to get the focus off me and back onto the patient. But I always feel the ache of having to say "No, not yet" over and over again. It just felt so good to be able to say, "Yes!" to the pet question.

Quite Possibly, the World's Largest Vagina

2009-03-24T22:31:00.000-07:00

Yesterday, I got report on my rooms, including Room 5. Room 5 was a female, in her late 40's, and weighed somewhere between 250 - 300 lbs. She had come to the ER because her chronic back pain had gotten too intense to handle at home. She was unable to lie on a bed because of her severe pain and had been sleeping sitting up in a chair at home for a few weeks. When offered pain medication, the pt. declined. She also complained of abdominal pain and diarrhea, but since she couldn't lie flat, we weren't able to do a CT scan or MRI or pelvic ultrasound.

We tested her stool and it was positive for blood. She gave a urine sample, and there was also blood in her urine. I told the doctor about these results, and he said that "we" needed to get a sterile urine sample by catheter. "We" in these situations means ME.

About every 10 minutes, the patient had to go into the bathroom to have bloody diarrhea. Her sheer girth made it impossible for her to clean herself thoroughly. She couldn't lie down on the hospital gurney. All these details equaled me wanting to quit my job on the spot.

Usually, a catheter is easily inserted with a patient lying supine on the bed. ER nursing is all about ingenuity. So I had the pt. stand on the floor, leaning over with her hands resting on the gurney, legs spread apart, with one leg hiked up on a chair.... underwear off.... gown pulled up around her shoulders. It was me, on my knees, face to face with The Vagina. I attempted to spread the labia with one hand, used betadine to clean the area, and then with my sterile hand, to insert the catheter tube. My head was basically in her crotch. Trying to find the urethral opening was like searching for a particular crevice in the Grand Canyon. After fruitless poking and prodding, I gave up, threw away my soiled supplies, and got back to my feet. The pt. went to the toilet again.

Totally frustrated and irritated and grossed out, I found the nurse who had given me report earlier that morning to elicit her help. I described the problem. She agreed to assist. It was definitely a two-nurse job.

I told my fellow nurse that I would hold the folds of flesh apart so that she could find the hole and insert the tube to get the urine sample. We steeled ourselves outside the pt. room. Before we went in, I whispered, "If she shits on my head while I'm under there, I'm going home for the day."

The pt. again assumed the position, and we got on our knees beneath The Vagina. Using both hands, I pulled the skin apart to expose the perineal area. It went on and on, seemingly forever. The other nurse looked at me, we both stifled gags and giggles, and we proceeded. My arms were aching already from the strength required to hold her flesh apart, and my knees burned from kneeling on the floor. My friend cleaned the extensive area, and then inserted the tube into what looked like the appropriate opening. The pt. shrieked in discomfort, and we realized she had tried to penetrate too high. I motioned for her to try lower, and then, at the moment I felt I could not maintain my position for a second longer, urine flowed out of the tube. We were in! We left the room with urine cup in hand, and the other nurse looked at me, shook her head, and said, "That must be the world's largest vagina."

A true story of survival and success. I'd like to take this opportunity to thank God for giving me a mouth to breathe through instead of just my nose. I'd also like to thank my fellow nurse for being willing to go in with me, where I'm sure few have gone before. Now, if only I could forget the images burned into my mind.

Panties

2008-11-18T11:08:00.000-08:00

The other day, a 50-something year old male came into the ER, guarding his abdomen, hunched over due to pain. I introduced myself and started an IV, and told him I needed him to give a urine sample. I offered to put a robe on him so he wouldn't be flashing his backside. He commented, "Oh, that's okay. I have panties on."

I waited for a second, then looked at his wife and smiled, and she smiled back. I asked, "Did you just say you were wearing panties?"

He said, "Um, yeah." We all started laughing.

A few hours later, when I was discharging him, he asked, "You're not going to tell anyone that I called my underwear 'panties,' are you?"

I replied, "Oh, you bet I'm going to tell people!"

Death

2008-11-12T20:25:00.000-08:00

The movie that came to me from Netflix this week happened to be "Beaches." A poor choice to watch tonight, as it turns out, given the timing of events this week.

Yesterday, we received a medic call to alert us that in less than 10 minutes, they would be bringing a 50 year old male who was pulseless; CPR in progress. This is never a happy prognosis. Upon arrival, the pt. was a big, strapping, overweight black man with cornrows, still wearing his waterproof construction pants. He had been on the job site, and had collapsed, vomited, and was unresponsive. When the medics arrived, apparently he had no pulse, so they commenced with CPR and then got a pulse back, and a shockable rhythm. They shocked him and followed the ACLS logarithm with the appropriate drugs and electricity. Twice, they were able to "get him back," as we call it. Probably his soul was gone, but his heart responded with a normal rhythm for a few seconds, and a palpable pulse. That's plenty to give us hope to keep working on a pt.

Our team got the pt. transferred to our gurney, and kept doing CPR and using the bag-valve mask to oxygenate the intubated patient while we got him hooked up to our monitor and defibrillator. He was in V-fib, so we shocked him at the maximum amount of electricity. No response. He was still pulseless, with an agonal rhythm. We pushed amniodarone, and epi, and atropine, to no avail. Finally, the Dr. called us to hold compressions and ventilations, and he used the ultrasound machine to detect any cardiac activity/movement, and there was none. So he called it. Family had not yet arrived. I listened with my stethoscope over the heart for 60 seconds and heard only silence.

Since I was the primary nurse, I was charting furiously the entire time. I prayed for his soul and his body. I was the one that had to write the words, "Time of death 1339." About 5-10 minutes after we ceased our efforts, his significant other arrived alone, not knowing what was going on. I don't know who let her into the ER and directed her to the room, but the Dr. was not in the room at this time. Only I was there. So I was the one who had to let her into the pt. room and try to explain what had happened. She was hysterical, weeping, shouting, throwing herself on him. She cried, "How could this happen? He was fine this morning! He promised he wasn't going to leave me! What am I going to do?" Then in her anguish, she started vomiting.

I could not hold back the tears. It was strange--I could NOT bring myself to say the words, "He is dead." I just told her that we and the medics had worked on him for a long time, had given him every medication we could think of, had shocked him, and that we could not save him. The chaplain showed up then--thank God--and began to comfort the woman. I ran and got the Dr. to come into the room, which he did, and he explained everything that had been done and how sorry we were. By now, the significant other was able to compose herself and she thanked us for trying, in the midst of her tears.

She was able to spend about 10 minutes with the body, and then other friends and family started arriving. Probably 50-60 people flowed in and out of that room all afternoon. Their pastor came and prayed a beautiful, comforting, eloquent prayer in the style that only an African-American pastor can voice for the family for peace and hope. Thankfully, it was decided that it was not a coroner case, so I was allowed to pull out the IV's, the endotracheal tube, and the nasogastric tube that had been inserted by the medic. I washed his face with a cloth and invited the family back into the room, now being able to see his face clearly--no tubes.

After a few hours, it was obvious that no one would leave any time soon. I had to tell the family that the funeral home had been called, and that they had 20 more minutes with him for goodbyes. Everyone was respectful, and quietly crying.

Finally, the time came, and I told them we had to prepare the body. They all left, and I and another nurse and a tech put him into a bag, tagged his toe with his name tag, and zipped him up. His body was still a little warm.

At this moment, a friend came by and said that one of the man's sons had not been able to see him yet--could they please come into the room? I felt awful. So we unzipped the bag, and tried to cover up the bag and zipper with blankets, and let them back into the room for a few minutes. He really looked like he was simply asleep and could wake up at any moment.

There is no moral to this story. I felt incredibly sad for the family. I wondered if I should have spoken up to continue working on him until the significant other arrived, just so she could talk to him while we breathed for him, and so she could see how hard we worked. They had a three-month old baby together.

I pray God will give them peace and comfort. I came home, kissed Nate, and went to run on the treadmill for a while.

Oct. 14, 2008

2008-10-14T19:40:00.000-07:00

Today is the birthday of one of my first big childhood crushes--Ben Lee. He was tall, older, dark, handsome. And ever since I was 9 years old, I've remembered his birthday. I wonder what he's up to today. I hope he's happy:)

And hopefully not visiting an ER. Like one of several interesting patients that came through triage today, where I was assigned. One was a 50 year old male with a dildo stuck up his rectum. Obviously, he was unable to retrieve this accessory on his own, and after 10 hours of trying and straining away (talk about an urge to go), he showed up, shamefacedly, at my ER. Embarrassing....but not an automatic surgical case like the guy from a while ago who came in with that long, flat-ended vacuum cleaner attachment stuck up his rectum into his intestines which were necrotic by the time he checked into the ER, with poop coming out of the vacuum end.

Another patient after being discharged immediately checked in again. Hoping for a better outcome, I guess. Or, more likely, a doctor who would give her Dilaudid. She's morbidly obese, stinky, "dead behind the eyes," and shows up at the ER in spurts of several times a week, then a month will go by, and then she'll be there all week again. Today, she had her usual complaint of flank pain caused by her nonexistent kidney stones. 16 CT scans prove it. Multiple US confirm no problems. Bloodwork and urinalysis are WNL every time. I've watched her fake passing out twice. Apparently, while I was at lunch, she did it again in the waiting room, and my fellow nurse told her to get off the floor. Which she did. Maybe got MRSA in her mouth in the process. We can always hope. So after she checked in for the second time today, I eventually took her back to a hallway, where she proceeded to tell me that her IV was not taken out from her previous discharge. Nice. So the doctor comes to see her and blatantly tells her he will not be giving her any pain meds. She cries, she yells, and finally decides "I'm getting the hell out of here." She rips out her IV, starts bleeding onto her shirt, and when I try to put gauze on it, she grabs the gauze and blows her nose in it and refuses to let me dress the site.

And of course there were bright spots--the Irish priest with a lovely lilting voice, with gallstones.

The depressed, suicidal young man finally coming in to get some help.

The ridiculous girl complaining of rib pain, nausea, vomiting. She ate a doughnut while I was triaging her.