I hate losing...

I have come to the conclusion that I hate losing.

I know we can't save them all, and some probably are suffering far less once they are gone, but it still pisses me off..

Younger patient this weekend (well, too young to be as sick as they were). Once everything was calmed down, and I could talk with the family, I found out they had started drinking heavily in their teens, and continued on most of their life, until their body started falling apart...

Had just signed on to a hospice service that morning! Had signed DNR paperwork literally less than 12 hours prior to coming in. Patient had end stage liver disease from cirrhosis.

Patient started vomiting bright red blood, and the family called 911. EMS found the patient with a very low blood pressure (like 70's/30's). Got an IV in and started a bolus as they headed in to us...

In rolls a patient the color of a banana, with eyes that glowed yellow. Opened their eyes when you spoke to them, but never really answered any questions. One of those patients you look at, and go, "It's going to be a long, busy night..."

Family didn't come in with the patient. I think they felt guilty for calling 911 (since hospice had told them to call them for any problems) but, obviously, if someone I cared about started spewing blood everywhere, I would have, too...

Long story short, labs showed we were in for a fight, if we were going to fight... Hemoglobin less than 5. Crit less than 17. Bilirubin more than 15. Ammonia over 300, INR over 8...

And, of course, the patient is circling... The doc's call the family and do a great job of explaining the choices... keep them pain-free and provide supportive care, or do the whole shebang. Either way, life expectancy isn't very long...

Family wants everything except surgical intervention and CPR/shocks... So, off to the races we go. Blood up, boluses up, platelets up, lots of IV's... Patient has obvious esophageal bleeding, and we can't keep up... I have dopamine up maxed out, vasopressin up... and I'm still not catching up...

Finally the doctor called the family and said, "If you want to be here when they pass, you need to come now... we're talking minutes, not hours..."

I'm still working, but the pressure is still dropping... Patient still opens their eyes to voice at 50/30, but no pain apparent thank goodness. At 40/20, they are unresponsive... At 30 systolic, I can see an arterial waveform, but can't hear a heartbeat, and they go into agonal breathing... I wonder where the family is... I'm watching the Art line...28..25..20... The ECG becomes erratic, into an escape rhythm, and finally stops... I record the time of death, and let the doc know. He verifies... 4 minutes after time of death, the family comes running in...

I spent quite a while with them, answering questions, telling them there was no pain... After a while, they thank me, and slowly leave, and I get the patient cleaned up and off to the mortuary...

I know the patient is finally free from pain. I know their death was rather peaceful, as far as dying goes...

But I still hate losing...

Received in an Email...

I don't have anything exciting, or even interesting to post... I've been reading the world's dryest textbook all day for school...

But, this made me smile...

A first-grade teacher, Ms. Brooks, was having trouble with one of her students. The teacher asked, "Harry, what's your problem?" Harry answered, "I'm too smart for the 1st grade. My sister is in the 3rd grade and I'm smarter than she is! I think I should be in the 3rd grade too!"

Ms. Brooks had had enough. She took Harry to the principal's office. While Harry waited in the outer office, the teacher explained to the principal what the situation was. The principal told Ms. Brooks he would give the boy a test. If he failed to answer any of his questions he was to go back to the 1st grade and behave. She agreed.

Harry was brought in and the conditions were explained to him and he agreed to take the test.

Principal: "What is 3 x 3?"
Harry: "9."

Principal: "What is 6 x 6? "
Harry: "36."

And so it went with every question the principal thought a 3rd grader should know. The principal looks at Ms. Brooks and tells her, "I think Harry can go to the 3rd grade."

Ms. Brooks says to the principal, "Let me ask him some questions." The principal and Harry both agreed.

Ms. Brooks asks, "What does a cow have four of that I have only two of?"
Harry, after a moment: "Legs."

Ms Brooks: "What is in your pants that you have but I do not have?" The principal wondered why would she ask such a question!
Harry replied: "Pockets."

Ms. Brooks: "What does a dog do that a man steps into?"
Harry: "Pants."

Ms. Brooks: "What goes in hard and pink then comes out soft and sticky?"
The principal's eyes opened really wide and before he could stop the answer, Harry replied, "Bubble gum."

Ms. Brooks: "What does a man do standing up, a woman does sitting down and a dog does on three legs?"
Harry: "Shake hands."

The principal was trembling. Ms. Brooks: "What word starts with an 'F' and ends in 'K' that means a lot of heat and excitement?"
Harry: "Firetruck."

The principal breathed a sigh of relief and told the teacher, "Put Harry in the fifth-grade, I got the last six questions wrong....."

Could this night get any longer???

Oh, what a night!!!

Busy as all get out, but no really sick people...

Were getting them in, working them up, and sending them home... but then it hits a snag...

We have a few doctors that are, for lack of a better word... methodical... They do full workups, horde the charts, take their time making decisions... I try not to say they are purposefully slowing down the care, perhaps they are being careful to make sure they aren't missing anything..

All is well and good on an average evening, when we are thinning out, and enough people are still moving...

Last night we had a methodical doctor working with a mover and shaker... a doc that gets things done... We were crazy busy, like I said, but no really sick people...'

Then our mover and shaker started getting fed up... He was seeing a substantial portion of the patients, and it was becoming obvious... so the mover and shaker stopped picking up charts... When the methodical doc picked up a chart, the mover would pick up a chart...

The rapid result was gridlock... at one point, we had 11 charts waiting to be seen by a doc... The mover looked briefly at each chart, and made sure they weren't "seriously sick". In his defense, he did pick up and see a patient that probably needed to be seen quickly... but I also had another patient, who needed a workup for abdominal pain, that I had drawn and sent labs on a full 90 minutes before a doc (in this case, the methodical one) finally saw the patient and ordered the labs I had drawn way earlier...

Our doc's change shift at 7am just like we do, and to top things off, the "do not see zone" started at 5:45 am... Every chart that hit the rack after that time was left for the day shift docs...

They weren't happy walking in to a overflowing "to be seen" pile... I'm sure the patients weren't too happy, either...

The happy ones were us, for surviving one of the longest nights on record!

Wow... A depressing look at my future...

I am hard at work on my first class leading towards my Master's degree..

It is your basic entry class into a masters program, basically having us all look at the different roles a masters-prepared nurse can take, and getting us to further define our desires for our education.

I am in a learning track leading to a emphasis on Nursing Education. I have felt a desire to get into nursing education in some form as I continue in my career. I have always loved training and education. Probably the job I loved the most in my previous careers was as a "Development Advisor" for a convenience store company, where I was in essence a corporate trainer. I taught classes at a regional training center, developed curriculum for the management training program, and loved every moment. (sadly, the position was eliminated in a "cost-cutting" move)

Combine that with the love I have for nursing, and an overwhelming desire to "give back" to the profession that in a few short years has given so much to me, and the desire for a career in nursing education seems a natural.

As I was doing research for a paper on the history and current challenges in nursing education, I came upon the following statistic:

"In 2003, the average pay rate for a master's-prepared nurse practitioner was $94,213. The same year, the average pay rate for a master's-prepared nursing instructor was $63,916."

I want to get into nursing education for a lot of personal reasons. I have preached many times about money not being important to being happy (I have had many jobs that paid well... I hated most of them.) Ultimately, I do not want to spend a lot of time and money on an education to take a huge step back in pay, however...

While I still have a huge desire in my heart to get into nursing education, it pains me to see how much "dis-incentive" (is that a word?) there is to get into that field. No wonder there is such a shortage of nursing instructors... The same time spent in getting a degree can be so much more lucrative in other fields of nursing...

It's Nurse's Week Again!

Happy Nurses Week!!!

Yeah, its that time again! Time for the hospital to show they appreciate us nurses...

Let's see... This week we have:
a "Native American Flute player" playing in the chapel for our relaxation pleasure...
Popcorn popping in the Nursing Resources office...
Drawings once an hour foor door prizes...
The hospital Chaplain performing "Blessing of the Hands" several times a day...
Cake for all in the Cafeteria on Wednesday afternoon
Every nurse got a card!

We also got the neatest little "thank-you" present. It looks for wall the world like a small fabric lunck box (Oh, Lord, not another one!!!)...
But you open it up, and it unfolds a little. You open it up again, and it unforlds more... Keep going, and it opens up to be a 6x4 foot "event blanket", perfect for the park, picnic, beach, whatever...

Yesterday was actually "Nursing Leadership Day", where a select few "nurse leaders" were invited to attend the "leadership conference" which was actually quite good. We had several speakers, including Patty Wooten.

If you've never heard her speak, she is fantastic. She is a nurse who, after several personal setbacks went to clown school. She lectures on using humor in the healthcare setting, and is simply fabulous.

We had other lecturers, including the Dean of the College of Nursing I am attending, who spoke on moving "beyond excellence".

There was another presenter who spoke on "Working together to improve nursing's image". She spent a long time talking about how we as nurses need to rise up to write and complain about the unrealistic way we as nurses are portrayed on television. Gave a bunch of statistics about recent episodes of House, Grey's Anatomy and so on... I made the mistake of saying that I really think that since we are a "huge group..2.8 million strong" (her words) we should "pick our battles" and work toward promoting nursing as a career, rather than waste our time complaining about TV shows that rarely show anything remotely acurately. (Forget medical dramas for a minute. Does the President complain about being unrealistically portrayed on 24? Is there a street in your neighboorhood like Wysteria Lane? Do you hear all the Crime Scene Investigators complaining because they don't get to solve all the cases in 48 minutes, and always get their man?)

It was a good workshop, and an interesting day.

Happy Nurses Week everyone!

An overheard exchange...

I don't know why this tickled me to death so much last night, but it really did...

We have a lot of new ED doc's, and it is hard to remember a lot of new names. It can be even harder on the ancillary service people, like X-Ray, lab, and respiratory...

We have a respiratory therapist who is incredibly smooth at not letting the doc's know they have no clue who they are. Tonight the super-smooth approach didn't quite fly...

"I'm sorry, Doctor; how do you spell your name again?"... said, while looking over paperwork...

(with a confused look)"Um, S.M.I.T.H.... "

I looked at the respiratory therapist and couldn't stop laughing... Then again, maybe I was tired, but it struck me as funny....

So glad I went...

It has been an incredible few days...

I went to my college graduation.

Originally, I hadn't planned on going. I didn't "walk" for my ADN graduation; I did go to my ADN "pinning", but the graduation was a few months in the future, and when it rolled around I was working, and busy, and it didn't seem "important" at the time...

Something clicked in my head a few months ago when I had to make a go/no-go decision, and I decided, "I want to do this"...

It was three days of pomp and circumstance. Thursday was a ceremony just for the College of Nursing. A "pinning" ceremony for their traditional students, and a "hooding" ceremony for the Master's candidates, for us RN-BSN students it was "re-pinning". It was very nice, formal and elegant. Very informative, too. They talked about the different regalias and the history behind them. We each had a card with our future plans, and the name of the person we had chosen to pin us, that was read as we walked across the stage to be pinned. There was also one student who had been an ROTC cadet, and was officially commissioned into the Army at the service. It was a very moving ceremony to watch, as she received her first "official" salute from a veteran Master Sergeant, and took the oath of office.

Only my wife could attend that ceremony, but it still was a great experience. It made me even more determined to get my Master's Degree. I want to experience "being hooded"...

Friday was a special service for those who achieved their bachelor's degrees. The school I go to bills itself as a "Christian University"; while I consider myself a Christian, my faith is not quite the same as my school's, so I chose to miss that event. Deep down, I sort of wish I hadn't missed it....

Saturday was incredible. The whole family was together; everyone looked so sharp all decked out! It is rare my wife and I get together with all three kids at the same time, getting them all together and dressed up was a special treat.

Off we go to a local sports arena. I kiss them goodbye, and head downstairs. Get my name card, which tells me where to line up (in numerical order)... Would you believe, I'm number 666??? Yep, only me... At least its at a Christian University!!! Maybe that balances it out? (It's sort of like hospital room number 13... Don't you think they would have just left that number out?)

The ceremony was three hours long. The first 90 minutes were the whole "processional" and some speakers. The keynote speaker was a businessman and author who had a great message. His speech was just the right length, and then, we were told that after leaving the stage for our graduation, that he would be at the base of the stairs and personally hand each of us a copy of his #1 best-seller book!

Finally, the time came.... Row by row we went up. We handed our card to the poor guy who had to say 1000 names.... Walk across stage. First person, the University President, who greeted me by saying. "Congratulations, John..." (He remembered my name from the announcement a few seconds before... but it still felt incredible to hear it!). And on it went. Shook 6 people's hands, was given a Bible, a diploma cover, and a school pin. Walked down the stairs, and there was the speaker, shaking my hand, and congratulating me as he handed me a copy of his book...

Then, walk back to my seat and listen to everyone else's name...

As we got back to our seats, they had placed large tubes filled with confetti on our chairs, and as we all stood at the end, the place filled with huge amounts of confetti. There were lasers, fireworks, everything.

And then the recessional, and it was done...

I walked outside, found my family. My wife grabbed me, said, "I'm so proud of you!!! I know your parents are, too"... And, I almost lost it... My parents both passed away in their 40's, and I know my dropping out of college at 18 was probably the biggest disappointment in their lives. I really wish they were still here to enjoy the moment with me...

Off to a nice, delicious dinner we went, and then home to relax.

It has been the most incredible weekend!!! I'm glad I decided to go...