Appreciating the Moments

Wow...So I don't even know where to start. I know I haven't written in awhile and that bothers me, in more ways than one. I haven't written on here in awhile and I haven't written written, like on my novel and that makes me sad. I remember awhile ago (like in the summer maybe?) I remember saying how busy I was, and I couldn't wait for the fall when things would calm down some....well, things are busier than ever and life is moving faster than I can even watch it.

This is going to be a long blog, I think. So 1) I apologize, and 2) like I always say, go get some popcorn and make yourself comfortable.


Let's start with life updates and then I'll focus on the title of this blog. Maybe they will relate to each other, maybe not. Then again I'm running on 5 hours of sleep right now and earlier tonight I was thinking maybe I was having a stroke because I was delusional and words were coming out of my mouth before I could catch them. I do that a lot when I'm really tired. Its remarkable how much the brain changes on a lack of sleep, and quite scary come to think of it, considering I'm a nightshift nurse. Hmm....

Anyway, life updates. So I'm buying a house! I know, crazy, right? It's absolutely insane. I'm 24 and if you told me when I was 14 "In ten years you're going to be a successful college graduate with a good job and buying a house by yourself", I can guarantee I would have laughed at you. And then probably would have gone to burger king or written some teenagery post on my xanga.

But yeah! Everything in my life so far has been.....like right place/right time kinda thing. Everything bad thats happened to me has opened up a brighter door, even if that door didn't open for a long time. So this sort of falls under the same circumstances. The entire situation started from something I didn't know how I was going to get through, to now I'm buying a house because of it. The same push that knocked me down to the ground is the exact same push that gave me the courage to actually get a realtor and now I'm closing on a house. I honestly didn't think I'd be buying a house until I was in my forties. I thought thats how it worked. I guess I'm still a kid because I don't consider myself an adult that can buy a house. Ah!

So thats my big update. It's amazing and all but holey moley crapbeans, buying a house is stressful. I'm probably an idiot for buying a house and starting a new job all in the time span of about 3 months. Smart, I know.


As for the new job....thats been....interesting. Like my old job, there's been some shifts where I leave and I'm like "I know I chose the right profession". It's those shifts where you do everything right, go above and beyond  and feel awesome about it, your patients tell you they love you, you help your coworkers, your boss is like "Yeah good job!" and everything is just awesome. And maybe throw in a really nursy emotional moment you have with a little old lady or something and its icing on the cake.

But then there are those shifts where you SERIOUSLY question why you ever would have wanted to not only put yourself through four years of tormenting nursing school just to deal with crabbypants doctors, deal with patients (or family members) that call the police because they pooped in their bed and couldn't find their call bell (that happened), or tell you you just aren't good enough despite doing the best you can, having 7 patients every night, dealing with a lot of WTF is going on situations, etc. And there's been more of those shifts than the good ones lately. And like the typical human condition, we always remember the bad memories which totally override any good memories.

I've been realizing lately that I have some serious issues I need to get over, and STAT. I am a perfectionist when it comes to my job. I care about my job. I care about my patients, deeply. I'm a hypochondriac with my own body and this translates to extreme anxiety when it comes to my patients. They complain of new pain and I'm automatically thinking OMG they're gonna end up in the OR by the end of the night. Thank goodness after a 1.5 years of being an RN, I'm finally beginning to know the differences between serious symptoms and symptoms that may appear to be serious but aren't. But back to my serious flaws, I am the type of nurse where I hate leaving shit behind for other nurses, I hateeeeeee giving medications late or letting a patient down when I said I'd be there at a certain time but end up not being able to. I hate when the computer yells at me for giving something late and it's all like "WHY ARE YOU GIVING THIS LATE?" and there's no option to write in, "because my other patient couldn't breathe and I was swallowed in another room and I HAD MORE IMPORTANT THINGS TO DO". It sucks. So I try and finish everything and be everywhere at once and solve every problem. I don't ask and I hate asking when I have to, for help. I hate admitting weaknessess in myself and asking for help. I try and do everything on my own and its going to be the end of me one day.

I also have a problem with appreciating the good times, hence my blog title. I always thought that I related to President Obama in a way that I heard once from someone that he finds it hard to feel extreme emotions. He's always calm and cool, he's neutral. He doesn't feel extreme sadness, anger, but also doesn't feel extreme happiness either. And that's how I am and I hate that. Hate it.

I cannot tell you how many times I've been in the middle of a shift, and thought;
"man I cannot wait to be in my bed later, it is gonna be so amazing" or
"I can't wait to blast my favorite song on the way home and wind down from all this" or
I see a patients tv and its a good show and my patient is enjoying it and I'm just like, "how much do I seriously want to be at home just chilling watching tv? THe next time I chill and watch tv, I'm gonna think of how lucky I am."   But then.....when I finally get to my bed, when I'm finally done with my shift and blasting my music on the way home, when I'm finally just chillin watching tv, I don't think of how much better it is, because I carry home the sorrow and anxiety from my job. I drive home like a super zombie, my mind reeling from what I did wrong or right at work. When I watch tv, I just get lost in the show and watch it like a zombie. When I have a day off, I let myself get stressed of the shit-ton amount of things I have to do that day, that I don't even enjoy it, because hey- I'm not at work at least. So I have to work on that this year coming.

I started noticing this in myself when I first saw a baby being born. This was a moment I dreamed about for a long time, one of the BIGGEST reasons I went into nursing in the FIRST place. All I wanted was to see a baby be born. But about 3 years ago when I finally got the opportunity, it was happening right in front of me- I was all decked out in the scrubby gear, I saw the whole thing happening and I just stood there watching. There was no euphoric moment in my head. Sure It was a lovely thing happening, but in my mind I wasn't freaking out like "Oh my god this is actually happening".  Nope.

Ever since then I've noticed this a lot on multiple examples.

The only way I can seem to find enlightenment or euphoria, is when I surprise myself. It can't be something I've been looking forward to. It has to be something I decide to do last minute, something that surprises myself and everyone else. It usually involves a journey of some kind, like when I was driving home from Long Island one time and just decided (literally last minute before the exit) to just go to the beach. Being on the beach that day by myself, walking along the ocean waters, one of my most enlightened moments ever.

I'm not perfect, I get that so much. But I try so hard. Too hard, And I have to learn to let that go. Because humans aren't perfect. But somehow I've got it stuck in my head that I have to surpass normal humanity and be a superwoman.

Which is funny, I actually just giggled to myself just then, (that could be because I'm really tired), because if you saw my room right now you would NEVER EVER peg me for a perfectionist. My room is literally not sustainable to most forms of human life except me. I would normally try and blame it on the fact that I'm back in my parents house while I wait to close on the new house, and all of my belongings are shoved into this little room with me along with the stuff my parents moved into here as an extra storage room since I moved into my own apartment, BUT I really can't because my rooms normally a mess anyway. *deep breath that was a really long sentence*.

Back to the point, I'm a perfectionist when it comes to my performance, in all areas of my life. In my relationship. In my job. In my friendships. I always try and prove to the people that love me that I am a worthy friend, I am a good girlfriend (I usually fail miserably on my face on that one just ask my boyfriend), or I try and prove that I am a good nurse. I am usually very generous, and this past Christmas I could only get people very limited gifts because of money and that killed me. It seriously hurt my heart and I'm still feeling bad over it. My boyfriend hates how I can never remember stuff he told me already and I hate that I can't be perfect, the model girlfriend. In nursing there will always be moments where no matter how hard you try, something will always fall through the cracks. You give extra attention to one friend one day and then the next day another friend chews you out for not spending enough time with them.


I know I said above that I don't let myself feel extreme emotions usually. But there have been so many instances in the past month and a half where I felt like I was seriously in over my head and I was about to lose it. And I usually, usually can contain myself, keep my cool even if my plate is overfull, but its when something really small goes wrong on top of everything else is what tips over the edge.



*sigh* . Sorry for the sad ish post. It wasn't all sad, was it? OK yeah it mostly was. Sorry. I say sorry way too much too. I have to work on that as well.

Don't get me wrong, I have an amazing life. Like I said, everything in my life has happened for a reason. I have a great job, good pay that's stable, I am like 92% healthy (lol), I have the most amazing boyfriend that makes me so happy, I have the most supporting, nurturing nuclear and extended family, I have some of the best friends a girl could ever ask for. I have a good life.

I just saw the movie "This is 40" tonight, and despite its comedic nature, it really hit on a serious topic. Or maybe I just thought too much into it. It showed really well that everyone is under their own ridiculous amounts of stress, and we all try and hide it, we are all about to blow up but we all try and keep our cool. No one knows what another person is struggling with, and we all try and put so much crap for other people to deal with, not realizing how much they already have to deal with. People accuse others of "not understanding" or "you don't know what its like!" or "you do nothing all day" but they really could be struggling with anything, you just don't know it. So have patience with everyone. Be nice to everyone. Try and see the best in people, I try to (Sometimes its hard, I know). Trust people even when you know you shouldn't. Have a little faith and go with it.


So I'm going to leave with you with one of the most famous and most helpful prayers that got me through one of the shittiest shifts last night (that ended in tears- there's real emotion for ya),

"God, Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference."

That prayer is perfect and applies to so many aspects of my life. Nursing, relationships, and just life.


If you've made it this far, you get.....a gummy worm..........ok well you would if I had some. It was really just the first yummy thing I thought of. But you get my love, that's for free. Gummy worms are expensive.


With so much love,


~ WNB


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Close, but no cigar.

So I have two random funnies for you, direct from my new hospital!

The patients are the exact same type as my old hospital, I'm just in a newer nicer setting. The patients have the same diagnoses, same problems, same families, and same funny things to say- which makes for good stories for you!


Funny #1!

So I get in report that my patient is confused at times, but it's questionable. Sometimes patients just don't feel like answering the question or don't understand. So I go in to see this patient, and it turns out she answers all her questions correctly. She knows who she is, where she is, and what day it is. So I'm just about ready to leave the room after I finish my assessment, and im taking off my gloves- literally stepping out of the room when I hear- from my patient- "what's that giraffe doing outside?"

And I froze. What? Giraffe?

So I wasn't sure what to say, really. I kindly looked out the window from where I was standing, and due to the fact that my hospital is not in Africa and its not next to a zoo, I did not see a giraffe.

So I'm all like, "I don't see a giraffe."
And I'm thinking, should I recheck her orientation? Is she hallucinating?

And she's all like, "it's right there! It's a giraffe! Its right outside my window and I'm scared at how close it is."

So I'm like, shit. Shes hallucinating...giraffes. Like, why giraffes? Why not turtles? Or koala bears?

So then I'm like, "I still don't see a giraffe....but you let me know if it comes in the room."

So then she's like, "come to the window and see it!"

So to amuse her and I guess myself too, I go over to the window....


....And low and behold.....


...there wasn't a giraffe. There was a crane. My hospital is under construction, just so happens a construction crane was right outside her window.

I couldn't contain my giggles as I explained to her the differences in our construction vehicle naming misunderstanding.

It was a nursing giggle funny, my patient was not hallucinating after all, and we both giggled about it all day.


Nursing funny #2!!

Okay so I'm admitting this elderly male last night with heart failure. I figured out pretty quickly into the admission that he was *extremely* hard of hearing, and oh- he left his hearing aids at home, of course.


So I couldn't get much out of him from his admission, because he couldn't hear me. But I'm all like, I can't not try. I have to at least try and communicate, that's my job. So I struggle through all the questions, one by one.

Well I get to this one, what religion is the patient? And at first I'm all like- is this really an important question to ask when I'm struggling with all the rest? No. But then I remembered that I'm a bit biased one the religion side of things, and what if this guy is like an ex- priest or something and he's actually super religious and it means a lot to him that someone come to see him when he's here (even if he couldn't hear them- that's beside the point).

So I ask my patient, "do you have a religious preference?"

"what?"

"do you have a religion?"

"a what?"

"a religion? Like catholic, or presbyterian or something?"

"oh..a religion...a religion.....hmmm..."

So he literally took a moment to think, and I was just about to give up, when he shouts out, "yes! I'm American!"


I had to try so hard to not laugh. I smiled and I thanked him and clicked "no preference/other" on the religion choice.


Well that's It for the funnies this week! It's been an adventure so far, that's for sure. But I'm slowly starting to fit in and learn the ropes. :)


Thanks for reading everyone!


With love,

WNB


Hope I made ya giggle :)

Settling in and Grateful

Hey all!

It's been a rocky couple of weeks, and the months ahead will be up and down! Welcome to the adult world, I guess.

But regardless, my favorite holiday of the entire year and I get to spend it with some of my favorite people. Like I did last year, I'd like to dedicate a post to what I am most thankful this year. I don't mean to sound cliche, but I think everyone (including me!) forgets what blessings we truly do have and we tend to focus on the negatives in our lives. I've had a lot of negatives lately and today I am making it a point to focus on the positive, not just today but for the months to come.

I am most thankful for the following, in no particular order:

- My health. I have all four limbs, I can walk, talk, hear, see and smell. I have all my organs. Nothing hurts every day. I can breathe.  I am blessed.
- My family. My parents have supported me so much and are always there when I need to fall back on them. I couldn't ask for a better set of parents, ever.
- My sister, she's growing up to be a pretty cool grown-up :)
- The most amazing, loving, nurturing and caring boyfriend I could have ever asked for. I definitely don't deserve him and yet he sticks around anyway. He is always there when I need him and he can read my mind and always knows when I need a hug. His smile brings a smile to my face every day and I am grateful for that.
- My grandma and grandpa. I am with them both this holiday today and they are both able to walk, talk, hear, see, remember everything, and laugh. I am thankful they are still present in my life and I will cherish that.
- I'm thankful for a nursing job that recently changed into one of the most amazing deals I can think of, working less and getting paid more. I am grateful that this leads me to have more time to finally finish my book.
- I'm thankful for my gym, its one of the most amazing gyms and has introduced me to racquetball, one of the hardest and fastest sports I've ever played and I love it.
- I'm still thankful for my car. It's still, so so so awesome.
- I'm thankful for the United States troops- Marines, Army, Navy, Air Force, Coast Guard and all the reserves that are away from their families today, fighting for their families, fighting for our freedom so that we can enjoy our day today in peace. Thank you.
- I'm thankful for all my fellow nurses out there, we are our own breed and we can communicate with each other so well, also thankful for all the police officers, firefighters, EMS workers, mechanics, grocery store workers, and everyone else that is stuck working today instead of with their family.
- ARTSQUEST!! I'm thankful for Artsquest, my escape, my place to smile in.
- And Barnes & Noble. ^^
- I'm thankful for a roof over my head and a warm place to live in. I have the most amazing apartment in the BEST little city and I couldn't ask for anything better.
- I am thankful for the BEST friends a girl could ever ask for. My friends this year, new and old, have taught me that its okay to open up to them and not keep everything inside. They truly care about me and I will love them forever in return. They know who they are.



I guess thats about it.

It's 2012 and this country is in a severe economic crisis, and by all means not every 24 year old in America has their own apartment, car, and an income to support themselves. Not every person, regardless of age, has what I have said above, and every single human deserves it all. THe human race amazes me every day, despite all of our flaws. I know I am very blessed and I have so many people to thank for that. I truly do.


So, I'm settling into my new job and its going somewhat well, I'll dedicate a new post soon all about that. Anyway, I hope whoever is reading this enjoys the holiday today with their loved ones, friends and family and takes a moment to think about what they  are most thankful for this season. It's okay if its what you've been thankful for last year, because all that matters is that you remind yourself of your blessings.



With love,



WNB.


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What This Election Means

So now that all the political aftermath has seemed to maybe calm down a bit, let me take a minute to talk about my favorite part about the American Democracy.  Let me remind you I am not passionate about politics in any way. I voted, sure. It's the basic American right. What I felt most passionate about when I was following this election, was which candidate was going to take care of the country's healthcare system better? Thats basically what made my vote for me.

But thats not the point of this blog.


The day of voting, I went after a long day in class/work/orientation. I stood in line like many across the country did that day, and in front of me was an elderly gentleman. I noticed this man was on supplemental oxygen and was alone. He managed to either drive or get dropped off, but regardless made the effort to participate in the election. He then walked all the way into the polling center, and waited in line like the rest of us. What I was pleased to see was that other people in line in front of him, all let him go before them. They also went and got a chair for him to sit in not only while he waited but during the process of actually casting his vote. Other people helped him carry his oxygen machine. The poll director helped him back down the stairs and to his car.

Now I was pleased to see that not only people in my country but people in my community, still have human souls and would go out of their way to make this gentleman comfortable. But what really made me so happy was that this gentleman bothered to come out and vote.

It made me angry to think of how many young and able people don't vote because they're lazy, think their vote won't count, or they don't "believe in politics"....and yet this 90+ gentleman citizen believed enough to make it out to vote.

I don't even care a single ounce if he voted different than me. I don't care whose side he is on. He is on my side because he lives in America, and that is the point. To just participate. To make your voice matter, no matter what you believe in. Thats what election day is all about.


Thats all, simple post today. :)


~WNB


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EKGing it up!

So, a lot has happened lately!

FIRST OFF, I got the job! Woot! I officially start there on Monday, it is a med/surg position still, which is great because I need my two years and I like the constant variety... However it will be a weekend night position. What's that? You basically strike a deal with the devil and agree you will be there 2 nights, every single weekend except TWO per the entire year...but that's it. You get off 5 days per week, work the weekends and get paid more. I see it as a win!

But anyway, at this new hospital I will be responsible for my own EKG readings. For my non-medical readers, an EKG is a test involving 12 little stickers or "leads" that are placed on your chest, legs and arms to monitor the amount of electricity through your body conducted by your heart, which is displayed on a strip piece of paper and we can see the type of rhythm your heart is making. By knowing this rhythm, we know what's wrong with your heart and what part of your heart isn't working.

So! Here I am, a one-year RN going from a med/surg unit where I never had to worry (much) about heart rhythms to a unit where I will be responsible for my own. Yikes! I skip completely over the unit where they have techs to watch the monitors and tell you what they mean. *sigh*

The first time I floated down to that unit, my cardiology unit in my hospital here, I first asked my old preceptor, "do you have any really important advice to give that I should know about cardiology?"

She looked at me very seriously as she nodded, got a piece of paper out and drew this:



As she drew that line she said, "if you see this, it's not good."

Of course she was kidding. Well, sort of kidding. Partially kidding. Only in the aspect where every nurse (or really anyone every that's watched a medical show on tv in general) knows that a flat line is never good. So that pro founding bit of advice wasn't exactly that helpful.

But I learned quickly. And whatever you don't know in nursing, you quickly get someone that does know.

But being that I have the type of brain that loves to do math, figure out mysteries, do busiwork, etc., I found that I fell in love with trying to figure out each rhythm. It was like a puzzle.

I finally finished the class and all of the sudden I feel 200% more competent as an RN. No more constant dread that I can't competently take care of cardiac patients. I can look at the tele monitor now and understand who is in critical condition, when to call the doctor, what to do about certain rhythms. It feels amazing to connect those synapses in your brain when things coming together, applying knowledge you gathered in nursing school to knowledge you learned on the field to knowledge you regain after like this, on top of the clinical knowledge.

For example when I came on shift recently, I looked at my patient on the monitor. I had asked the nurse taking care of him prior what rhythm was his normal, and they had trouble reading it so they had to move his room to better wireless area. So I was the first to read his rhythm. I looked at it and right away thought, "that's a.fib". My heart threw a PVC (haha), and I thought "shit! My patients in a. Fib!" but then I remembered the basics. 1) assess my patient. 2) assess the heart rate (is the heart able to accommodate or control the a fib? 3) does the patient have a known history of the a.fib? 4) does be doctor know about the a.fib happening on this hospital stay?

Luckily, they were all in my favor. My patient was not symptomatic. His heart rate was under control. He had a history of the a.fib, and the doctor already knew because they saw it during surgery earlier that hospital stay. So all I had to do was continue to monitor my patient, monitor the heart rate, make sure it doesn't enter an uncontrolled rhythm. The reason I bore you with this story is to show you (or myself ) that before this class, I would have freaked out if my patient was in a. Fib because that's a scary term and I wouldn't know the difference of good or bad a.fib....but now, I am competent enough to understand the heart enough to see that rhythm on the monitor and not have to 1) initially freak out 2) enter a bout of colitis because I would be stressed all shift about it until my patient went normal sinus (the normal heart rhythm).

With every bout of learning I learn, I love nursing more and more. The days I hate nursing are the days I feel incompetent. Those are the days I feel stressed. I don't mind having a completely shitty, busy as all hell day, whatever bring it on. But the minute I feel like I aren't good enough to care for my patient, that's when I feel that I hate nursing and can't wait for my shift to end. But when I feel like I can take care of my patients no matter what and can help other nurses even, I love my job. I love being able to feel confident. It's empowering and it makes me want to learn more, more, more. Soon I will be taking an ACLS class, which would further my certification to enable me to take care of more critical patients. During code-blue situations I would be able to push life-saving drugs into patients. I can work in the ICU or the ER with this certification. So, that's pretty cool and up and coming.

I finally have fully functioning power back and at least 134,342,114 posts ready to write, so look forward to that! Hopefully I still have readers =)

Love you all, thanks for reading.


~WNB.

Not cool

Hey folks! Sorry I haven't been able to update, I'm in those pa/nj statistics you're hearing about on the news that still don't have power because of sandy. I have tons of blogs to write but finding power isn't easy. One public outlet actually has a waiting line. Gas is hard to find, it's scary. No heat in our homes and my house is currently 54 degrees. Hopefully well be restored and back to normal soon! :-/


-WNB

C-Ch-Cha-Changes!

Hey everyone! I am so sorry, It has been forever since I last posted, it has caused me so much anguish. I feel like a lot of my posts lately start with this apology. It *kills* me that my 2012 post count is like four times less than 2009-2011, what I usually write. Don't get me wrong, I've had plenty to write about, PLENTY, all these thoughts every day race through my head and some formulate themselves into blog posts, some don't. And in my haste of constantly being busy, I just store it in the back of my head and think, "Make that into a blog post one day". But it never happens because I am busy all-the-time.

Here's an example of how busy I am. This week, starting around Sunday, I was so stressed that I gave myself one of those stupid mouth sores, like inside your mouth after you bite your cheek or sometimes stress literally does cause them (my dentist told me that!). Anyway, it hurt so bad to eat, (I had one on both sides), so I kept telling myself, "I should stop at the store and get Oragel or something", and so my counterpart subconscious was like, "Yeah thats a really good idea, do it." So then my other part subconscious in return was like, "Okay I'll put it on the to-do list." ( I have conversations in my head a lot like this, don't be concerned, or do be, its your prerogative). Regardless, I put it on my to-do list. Now stopping at the grocery store to get Oragel might take what, 10 minutes? Tops? Yeah. So from like Monday to today, I have not had *ten spare minutes* to stop at the store. Tonight I finally had *ten extra minutes* because I was *cancelled from work* (otherwise I wouldn't have had time)....and there I am in CVS, about to pick it up, when I thought to myself, "I waited so long to get it, now it doesn't even hurt anymore." So I stood there like an idiot in CVS, alone in the store, staring at the mouth care products. My other part subconscious was all like, "put it back, then. Don't just stand here." But my other part in return was like, "But we might as well get it for the next time you get a canker sore." and then I was like, "Yeah, true." So I got it. Now I just applied it anyway, (can't hurt, right?) but it did hurt because I accidentally swallowed some and now it feels like I'm dying except I can't feel it.....because its numb........



Yeah. Anyway. I'm not dying. Or delusional. Or crazy. I swear. Well maybe a little crazy, thats argumentable. << Is that a word?

And thats just the past WEEK. The past MONTH has been INSANE. Literally, I envy people that say they are bored. I forget what that's like. I forget what its like to READ, to WRITE, to just have nothing to do. I crave a day, an empty day to just do whatever I *want* to do. The problem is that I'm so busy, that when I get like three spare hours somewhere in my day, I'm just like "Oh thank god, NAP TIME", Instead something that makes me happy like reading or writing....or drawing. Even reading nowadays feels like a chore because I have a stack of books that my friends are like "Read this!" And I want to read those, I do! Except I have "homework" for two classes I'm taking for work this fall. So when I sit down and "read", Its about EKGs and ACLS. Super.



But I truly have been meaning to update my blog community for a long time now, the last thing I want to do is lose my amazing readers. The only reason I am writing right now is because I have twenty spare minutes, because my computer is so slow, and its trying to upload photos to my website that are from 1 of 2 photoshoots I did this past weekend. Phew! Also, because I got cancelled from work.

A lot has been happening....Like, a lot.

First of all, I think I mentioned this in a post in August or September, but the nursing unit I was hired to work on as a starting RN (surgical oncology women's health unit) closed down due to lack of patients. It closed down in August and we all thought it would be temporary, a week or two perhaps, a month tops. Just until we could keep the patient census up again. Meanwhile we had been made an unofficial float team, floating around the entire hospital. Not having a home got real old real fast, so they gave us a permanent home on the Medical/Surgical unit, putting a bigger number of people at "risk" for being floated (not many people like to be floated). But due to patient census not improving and one floor adding on a whole other units worth of staff, a lot of people were getting cancelled or floated still. Now, I am financially stable, enough so that I don't mind getting cancelled at all, I enjoy the surprise night off! But some of the older nurses with families, kids in college, etc., they need every last penny and don't enjoy getting cancelled, especially when its all the time. So they had too many complaints. Well, a month later, in Mid-September, they announced we were officially closed down (my old unit). In result, to improve the surplus of nurses and lack of patients which leads to cancellations and floatation's, they asked ten nurses to leave the hospital and transfer to another hospital in our network.

Now I saw this as a BIG open window. The hospital they want us to move to is not only gorgeous (practically a hotel), but its brand new, with *amazing* technology. I saw it being built from the ground up and daydreamed about transferring there, but never thought it could actually happen. I figured they'd have nurses at the front door begging to work there. So, I applied, I interviewed, and I'm waiting for a call back this week!!! I would still be on a Med/Surg floor, so it's not going to be glorious. It will be the same stuff I do now, just different setting. But that's okay, because as *hard* as my job can be sometimes on Med/Surg, I cannot even begin to explain how much I learn, due to the extreme variety we see. I can have 6 patients and not only can they range from 18- 105 year olds, but they can range from meningitis to cellulitis, to pneumonia, to COPD, to respiratory failure, to Acute Renal Failure, just to name a few. Med/Surg nurses see it all, all body systems. As much as I know I am destined to one day change the entire nursing healthcare field, I know I need to build my roots first. I need to stack my building blocks of knowledge first.

So thats exciting! I'll post again about whether or not I actually get the job.

The other exciting big change in my life is that I applied to graduate school! I'm waiting to hear back from them as well. If I get the new job, it will be a weekends nights position (I would work all weekends, but get mon-Fri off), allowing me to go to school during the week. Win! So I'm deciding between which to major in, Nursing Administration or Nursing Leadership.... I know in the past I've talked about Nursing Epidemiology or Nursing Informatics, and I still want to do that in the future. However those specializations I can get as certifications, after I make the building block of my MSN. So super exciting!


Being that School wouldn't therefore start until January, I would have until then to work on/ maybe finish? my novel, finally!


I'm working on not being as busy, that is key. Part of me likes being busy, it gives me purpose and drive....but I hate letting my friends down when they ask when can I hang out next, and I say......Hmmmmm....in three Tuesdays?? I feel like I'm already doing so much and then someone says I'm not doing enough. So I'm working on it. I'm excited that If I start this weekend position, that opens up a lot of time for me and I can write, which makes me happy.


Lately I've been doing a lot of questioning if I'm in the right field or not...it usually comes to me when I'm in the middle of a crazy shift and I think, "Am I meant to really be doing this?" "Is this making me happy?" But then I have a patient that tells me such high compliments that it makes me wonder how I could have thought I wasn't in the right field. In the past week I've received three compliments from patients. On the first one, I was just hanging an IV bag and making sure all her IV lines were where they were supposed to be. I had just spent awhile with her making her comfortable. She was a 40 something woman with very advanced cancer. And in the middle of the silence she said, "I can't tell you how much everything you've done tonight means to me." I looked at her kind of like, what? And she continued, "You are a great nurse but there are a lot of great nurses here, but you have that extra touch. Like that extra sense of knowing what I need. I just want to say thank you and that it means so much to me." Another patient, I was helping to feel better after she was crying due to a long day of testing she had had in the hospital. Later, when she was feeling a bit better, she told me out of the blue, "You know, you're in the right profession." It made me smile.


So, I've got a lot to work on coming up. A lot of change happening this year. But I have faith. I just have to breathe.



Thanks for reading,


~WNB

That Defining Moment

As your nurse, there are a lot of things we know about you that you may not even realize we know about you. But we do. And that's just your history.

Sometimes (actually a lot of times) we also know your future.

We're just not legally allowed to tell you.

For example, last night at work I had admitted this really nice guy. Middle aged guy. No significant past medical history. Admitted for a UTI (Urinary Tract infection). In the ER he was complaining of some constant pain in the abdomen, they ran a CT scan to find out why, pretty common practice when someone complains of pain.

So I got to know this guy when he came to my floor. Nice, retired, family at home, typical.

Then in the midst of running around at my nurses station, I saw his CT scan report come up.

Now, 92% of the time, I'd say thE CT reports I see are all normal with minor anatomical differences. Doctors just order the scan to cover their license, pretty much. So I wasn't expecting much from the report.

But I found the worst, what we hate to find. Bad, bad news. Not definite bit probable malignant cancer, aggressive. I stood there reading the report, just steps away from this patients room, processing this information. The patient doesn't even know yet, that kept running through my head.

How could I go back in the room and keep my same happy face? I thought back to what I had said earlier, he told me about his abdominal pain and I said "well hopefully the CT scan will give us some answers".... I guess there's just no way to prepare patients for the worst answers.

He never asked me what the CT scan said, and even If he did, we're supposed to play dumb and act like we haven't seen any results yet.


The ridiculous part is that this guys admitting diagnosis is a urinary tract infection, something we can easily fix with an antibiotic, and he will be leaving with cancer. What if we had never run the CT? What if he never came to the hospital?

The sad part is, I have off for a couple days and most likely won't get to see the clinical progression of this patients journey, emotionally and physically, but we as nurses, know what's in store for you depending on what road you choose and its never a pretty road with cancer.

So, it's hard. It's hard to pretend like you don't know information that will soon change your patients life. I think that has got to be one of the hardest parts of being a doctor, telling people they have cancer. I can't even imagine.

:-(


Anyway, sorry for the extreme lack of posts. I have a lot stored in my head, life has just been over the top busy...


I'll write soon, with love---


-WNB




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Funny Thought for the Day

So, to check orientation of all of our patients when doing our assessments, we have to ask each patient three main questions: Their name, where they are, and what time/date it is. Well, with my younger middle aged patient with something simple like Cellulitis or an earache, I usually skip over this and assume, from my normal conversational interactions with that patient, that they know who they are, where they are and what day it is. Just a hunch.


So it then becomes a matter of where do you draw the line? Is there an AGE where I should assess or not assess for orientation? Is there a diagnosis?

I really think it just depends, its different for every patient. Granted, the older the patient, the more likely I am to check for orientation right off the bat. Some people fool you pretty easily, they are having a full fledged normal conversation with you and you think they are oriented, until you ask them what month it is and they say its February when really its August. And its 1982.

So the other night, I got a new patient under my care. She was elderly, but with her husband. She seemed to be pretty with it but on the verge pretty forgetful. So I decided to definitely check for assessment. This is how it went down:


Me: "This is going to sound pretty silly, but I have to ask, Can you tell me your name?"

Patient: " Mrs. IKnow MyName"

Me: "Okay good, Can you tell me what day it is?"

Patient: "It was just Thursday, but now its Friday."

Me: Okay good. Can you tell me where you are?


Patient:   "Yes."


Me:  ...........


Patients Husband:  "Dearest, I think she wants you to tell her where you are."

Patient: Oh! I thought you just wanted to know if I knew where I was. I know where I am.

Me:    ...........


Patient: ....... I'm in ThisLovely Hospital........ *looks around at everyone*, Right?




*sigh*


~ WNB

Ho Hey

I. Am. Totally. Completely. Madly. in. Love. With. this. SONG.


Repeatrepeatrepeatrepeat. LOVE IT. Can we say just adorable!

Vegetables at Home

The other night at work, I was taking care of an elderly man in his 80s. Like it so often happens, I often end up having heartfelt conversations with patients around 3-4 AM. Some people may think that just because I work nightshift, I never see my patients, because they sleep the whole time. Not true. They sleep 25% of the time, lol. In reality, I spend a lot of time with them before they go to bed, from when I come on at 7pm to 11pm (about). I get to put them to bed, which can be quite a personal thing- I am involved in their routine on a nightly basis. Then, once they go to bed, I see the average patient even 3-4 times after that. Either they need pain medication, need...anything, they need their vitals attended to because they are out of whack, or they need assistance to the bathroom.

So this patient was having a lot of gastrointestinal problems, so I was in with him a lot helping him to the bathroom. After one of his trips, he was feeling sentimental and we got to talking. He got to telling me his life profession, about his wife whom he's still happily married to, his friends, what he does per daily basis in his retirement. He was telling me how upset he was that he's never been sick his entire life, and then now in his retirement- the time he's always envisioned being able to enjoy- he's sick now. But then he got to telling me something, something that he probably didn't even realize made me think so much.

I've heard this a lot from patients, especially my elderly crew. They are worried more about their home life, more so than the fact that they are sick at the moment and in the hospital. They are usually worried about their dog, cat, etc., or worried about their spouse, or the mail, etc. But for some reason, this guys stressor made me so sad.

He was so worried about his vegetables. He was telling me he has been working on a full garden at home for years now, and how his wife was now alone at home. He said she wouldn't be able to drive his truck down to the garden and pick his vegetables, and they would go to waste- Even though she told him she would try. He didn't even want her to try, because he didn't want her to hurt herself.

Now you may think, why is this such a big deal? But the look on his face, the sorrow....he was so incredibly upset, to the point of almost tears, as he said "those tomatoes were just about grown too, they were going to be perfect....and now I'm in here. You know, I try to feed all my friends? Some of my neighbors and friends, I give them my vegetables because I have so many, and they are so poor that they rely on my garden. And now I'm here and can't be in my garden."

These kinds of things are hard for me to hear because as a nurse, I can't help them on these problems, whats making them so sad. I can treat pain, I can treat upset stomachs, I can treat mental conditions, I can treat infections, I can treat electrolyte imbalances, I can treat chemotherapy side effects, etc. But I can't go to my patients home and pick their vegetables or feed their pet, or make sure their spouse is OK. It breaks my heart. I am the type of personality where I want to fix everything, not just in nursing. When I'm in a relationship, I want to make that person completely happy. I can't  stand for my boyfriend to ever be upset- I do everything possible to turn the frown upside down, if I can't help it. And it kills me if I am ever the cause of someone else's sorrow.

I had a patient tell me a story a couple of weeks ago. There was a time where my patient that I was taking care of at that moment, her husband was in a nursing home while she was still at home, by herself. I guess conditions warranted that either family wasn't close by, didn't care, or family didn't exist, so it was the two of them. Well she went and visited her husband every day in the nursing home. Well one day she didn't come visit. The husband knew something was wrong, he told a nurse. The nurse shrugged it off, figured he was getting confused or the wife was just busy at home that day. The next day, she didn't come again, he told another nurse. She did the same thing. He began telling some of the other residents, and they backed him up- telling the nurses that the wife does exist and she hadn't been there in a couple of days. Eventually, one nurse decided to go above and beyond her call of duty. She remembered seeing the wife at one point. She found the patients home phone number and called the house, there was no answer. She called again later in the day and there was still no answer. She decided to call the police, and asked if they could please go check it out. Turns out they found the wife in the basement on the floor, she had went to get something and tripped. She was alive but had spent 3 days on the basement floor with a broken hip...Obviously the police saved her and sent her to the hospital, but ultimately, that nurse saved her. That nurse went above and beyond her call of duty to help her patient, the husband that she was taking care of. She saw the whole holistic picture, what was making him so upset. She fixed it and I think that's amazing.

So my patient was that wife, a couple years later and she was telling me that story. She told me how she survived by crawling to where she knew she had saved food down there, and fought through the pain, and some other....unpleasant survival techniques- being that humans have body systems that need to be relieved. It was so sad, but inspiring.


Well that's it for today folks. To all my other nurses, just remember- there will be things you can't fix sometimes. But what you can do is be there to listen. Sometimes that's all that your patient needs. So often does the nurse treat the body system that needs attention, and then they leave. Sometimes we have to leave because another patient is critically ill....but other times....not so much. Just always remember the psychosocial aspect of your care plans. See the whole picture. It will make you so much better of a nurse...



- A Writer in a Nurse's Body



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Well Alrighty Then

So I had this very elderly lady last night. She was having some difficulty urinating, but yet wasn't showing much on the bladder scanner and didn't give out much when we straight cath'd her (put in a very temporary catheter just to extract urine). She then felt it necessary to also remember she hasn't had a bowel movement in a week. Problem solved. Sometimes if you're anatomy is slightly strange and you're constipated and you're laying in bed a lot, your bowels can sort of impinge on your bladder, to make it easy. So new goal was to get her to poop. I knew I wasn't going to accomplish much medication wise with a closed pharmacy at 400 AM and an attending doctor that most definitely wouldn't want to be woken up at 400 AM with a request for a laxative.

So I decided to go with the good ol' fashioned.......prune juice! YAY!

I've heard the old age tale that it works best when you heat it up first. But It was 4 am and my brain wasn't working at full capacity, and when I was staring at the microwave and staring at my choice of cups, my brain couldn't remember which ones were OK to put in the microwave so I just decided to give it to her cold and call it a day.

So down goes the prune juice.

About an hour later, she presses the call bell. This is our conversation:


Patient:  "That prune juice you gave me...."

Me: ".....Yeah?"

Patient:  " It was cold."

Me:  "Oh. Yeah. I'm sorry."  *makes weird face*

Patient: "My husband heats it up at home and always gives it to me that way."

Me: "Oh...well next time we can heat it up for you."

Patient: "Actually,  I've always hated it warmed but never had the heart to tell him because he was sweet enough to make it."

Me: "Oh.......so you liked the cold prune juice?"

Patient: "Yeah."

Me: "Okay........"

*Awkward moment*


Me: "Um, is that all you had to tell me?"

Patient: Yep.




As I was charting a little bit later into day shift outside her room, I overheard her telling the day nurse how glorious the prune juice was and I had to work really hard at stifling my laughter in the hallway. Thank you to the confusing microwave!  o_O Win!


~ Another special nursing moment from WNB



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Just Answer the Question

These can be the most aggravating types of assessments:

Me: "have you ever had an ulcer before?"

Patient: "well my grandmother did, on my maternal side. She died from that ulcer, then my uncles step-son lives near her in Alaska and had to take care of her cat because it had no where else to go and then that cat turned out to have diabetes and my brother had to give it insulin- you know what insulin is, right?- and then the cat ate this flower once so then my uncle couldn't buy flowers anymore."

"okay. But have you ever had an ulcer?"

Patient: "oh uh, no. My stomach is great. My friends aunt had stomach cancer though."


-_____-


Very nice people indeed, but when I have 110 questions to ask when admitting someone and they answer every question with a story that always circles back to a friend/aunt/uncle or CAT, you kind of just want to stick yourself with 100 units of insulin and call it a day.



Am I already jaded??!


:/

WNB



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A Satan kind of Business

Yesterday I went to a hospital-sponsored "Birthday" breakfast, where employees get to sit at a breakfast table with the hospital CEO/CFO and some other important big-wigs. I have been employed at this hospital for what will be 6 years this August, and this is the first birthday that I've actually went.

We just hired a new CEO, and there have been mixed feelings about him. Normal, I suppose,when a new big wig comes to play, as this instantly makes people fear they will lose their job. A CEO has to really work in order to gain the trust from its employees.

So I wasn't sure what to expect from this "birthday breakfast" with the CEO....how many people would go? Would it be 1:1 time with the CEO? What would we talk about? Cupcakes? Breakfast? The weather? Monkeys? History? Rules? Africa? Eggs? Pancakes? Opinions?

We started off the breakfast with one of those "icebreakers" where we all had to share our name, how long we've been employed, what we do.....squishsquash like that.

Then we got into the real mishmosh, the nittygritty of things we've been wanting to hear about. When are we getting our raises back? Whats going to happen to the hospital? Are we going to remodel? Are our jobs secure? Everyone sits tensely in their seats, politely yet rebellious as a lion inside, ready to pounce, yet trying to behave. People get very tense when it comes to money and their jobs.


Lately our hospital census has been in the toilet, meaning we have not very many patients. This raises a lot of concern, being that without enough patients , we won't have enough money to sustain the business or pay our employees. So everyone has been nervous, so of course this issue was brought up with the CEO. His response is what really got me thinking.

He jokingly said, "I guess we gave out too many flu shots this year." People laughed quietly.


But what he said.....it's absolutely true, and yet it isn't true. True, we did give out a lot and they were effective. But we didn't give out "too many". We prevented a lot of people from getting sick this year, and it may have impacted our census, maybe it didn't.

But it got me thinking....running a hospital is like running a Satan business. We thrive, we depend on people getting sick or injured. When less people get sick or injured, our business suffers. We market our business just like any other type of business out there- We billboard and advertise on TV to get people to think of and choose us when they are sick or injured and need to choose an ER.

I guess the point I'm trying to make here is that, an ideal world would be if a hospital could support itself and its employees without depending on others suffering. It can't happen, I suppose, considering money doesn't just magically appear and fund organizations.

In my schooling, we learned about the growing concept that hospital patients were changing. In this present day and in the coming future, a typical hospital patient is a lot sicker than in the past. More and more illnesses and conditions are treated in the outpatient, long term care, clinic or home care setting. This is great for public health care but it could be why we are seeing a lower census as of late. Some of these sicker, long term hospital required care patients don't have insurance or insurance that is going to pay. Also, these patients aren't turning over the beds and are taking up space, draining the staff, etc. So its like the hospital administrations depend on the misfortune of the community to sustain itself, but we need you to get better quickly, so you can be a patient of ours, pay us and then leave so we can give your bed to the next paying patient.  Like I said, its a Satan Kind of Business....


It's similar to the concept of warfare health care. Back in the days of surviving WWI and WWII, we learned and advanced so much in health care because of all the emergent practice we had on suffering soldiers. Suddenly we had patients that were going to die anyway if we didn't try something, so it gave surgeons and doctors of the age to experiment and practice....and sometimes save lives resultingly, sometimes not. But it taught and revolutionized health care. It's the concept of trial and error.  It's yet another example of how health care thrives off the mass suffering off its population.

Yet this concept turns on itself. The more people that suffer and come in to the hospital, the more money the hospital makes. For non-profit organizations, such as mine- this allows us to then put the money back into the hospital, better machines, more nurses, better doctors, new units, more services, which all lead to safer, and better patient outcomes and satisfaction, which then leads to word of mouth in the community to others, which therefore leads to more money back into the hospital from others that are suffering. It's a cycle. A Satan cycle. A necessary cycle in the health care industry. A sad cycle.


I've had this post, this thought, stemming in my head for a long time, since June. I even had half of it written out but decided to halt the writing on it because I felt it was getting too political. I really know nothing about politics or finances. Nothing. I know that. All I know is nursing, nothing administration. All I know is what nurses see and how nurses are affected. So what prompted me to finally go through with this post? My unit, the smallest unit in the hospital, recently shut down last Friday along with the second smallest unit. At first we all thought it would just be the weekend. Tomorrow we will hit one week. All of us are on our toes. This is where a low hospital census hits home. My entire staff team is now orphaned, being sent out around the whole hospital, floated. It's miserable. We all want to be back on the unit we were hired too, the unit we have raised and grown to love throughout the past year.

The only, and I mean only, good thing about this sad misfortune, is that I am at least gaining experience on other units in my hospital. But I miss the familiarity.



Thats all for now folks,

~WNB.




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Another WIN for Therapeutic Modalities

Hello everyone! Sorry I haven't posted in approximately ten years. I have either been out of town, nothing to say/write, or just trying to find seconds to spare just to breathe. But there's no excuse! So look for a lot of upcoming posts. Many weeks of no posts= a lot of pent up thoughts waiting to escape into blog posts! Yay!


So this post stemmed from last night at work. Here's the situation:

My patient had a total abdominal hysterectomy approximately 2 days before she was under my care.  Under report I learned that she had not had a bowel movement since surgery (but this is common with recent abdominal surgery), and that she has having a lot of bloating and pent up gas cramps/pain.  When I first saw her, she was having some intense nausea. However she had just received a one time dose of morphine, which can very often cause some intense nausea, especially depending on how its given. She also received a PO (by mouth) dose of percocet (she was in a lot of pain). Percocet can also cause nausea. So I decided to give it a little while and told her I would come back.

Well, not ten minutes later is she throwing up, but not much. I still attributed it to the recent doses of narcotics and helped her clean up and decided just to keep an eye on it. However about thirty minutes later she was in intense nausea again, so much so that she couldn't stand up, and was vomiting. My mind started reeling....is there an obstruction? As with any abdominal tampering, its possible to get an unfortunate bowel obstruction. If severe enough, this would then cause anything that's in your intestines above the blockage to come out upwards because it has no where else to go. Keep in mind that she was promoted to a regular diet, just as of the previous day.

So keeping in mind the very real possibility that we were facing an obstruction and may be putting in an NG tube (this would drain out the contents from your intestines above the obstruction), I didn't want to scare her so I didn't even mention it yet. She was already having enough anxiety from her pain and nausea.


Then a thought occurred to me....I always try and put myself in patients shoes. I have had my own very extensive share of gastrointestinal problems and have a lot of experience with different therapeutic techniques, both with western and alternative therapy. 

So despite the fact that I've been blessed enough to have never had abdominal surgery, I have had my fair share of "gas issues", especially thanks to my ever so lovely lactose intolerance. So I thought, what do I do for gas cramps/pain?

I went in the room and asked if anyone had taught her the "Left side trick". She looked at me strange because I pretty much made up that phrase on my own, but what else do you really call it in a quick bundle?  She obviously said no and I then proceeded to have her lay on her left side and massage her entire abdominal wall in a clockwise motion, slowly and rather firmly (but not enough that it hurts). This follows the natural pathway of your intestines and helps guide the gas out the exit door, so to speak.  If you're super lucky, it may even promote the probability of having a bowel movement, in addition to the gas passage increasing the then probability of a bowel movement.

So I had her concentrate on this technique, as I so often do when I'm in gas pain. I also encouraged her to take some deep breaths, and to remain on left side, while also in the fetal position. I find that in the fetal position, the pressure of your knees against your abdomen also helps guide things out the exit door, and....well, it "opens up" the exit door completely, making it that much easier to pass gas.

Now for the epic result?? I checked back in about thirty minutes after that education time, and I honestly didn't have much faith in my alternative non-medication therapies. I came  in offering a powerful anti-emetic that she was now eligible to receive, but turns out? She was feeling much better already. Her nausea had receded slightly and the gas cramps were improving. Win!

Even more win, when I went to go to check on her in the middle of the night, I heard some unexpected news that she actually passed gas! Woot! She even managed to pass a very tiny (but one all the same!) bowel movement. Woo hoo! A + for non-medication therapies, for the win!


I couldn't believe it worked. I mean, I thought everyone knew that trick. I thought it was an old age wive's tale, or whatever they call it. I learned the trick in a mother-baby class in college, when we were taught how to alleviate gas in babies. I assumed it would work for adults, and its always worked for me and now for my patients too! :)


So, thanks for reading through a rather gaseous post.....it can be helpful if you also suffer at times! Who the heck doesn't??!  Admit it. You probably just farted.  Yeah, I just said fart.



Anyway, like I said, I'll try to post more upcoming! Stay tuned....

With Love, WNB




.

Not the Sense I Wanted

So, for anyone thats ever gone to nursing school, chances are you've heard of Patricia Benner's "Novice to Expert" model. The five stages depict what stage of nursing you are in based on your experience and performance. THe stages range from being a:

-  "novice", which means you are by-the-book, no experience, new grad.
-  "Advanced Beginner", meaning you have enough experience to help formulate future guided actions, you start developing your "nursing spidey sense"
-  "Competent", meaning you usually have 2-3 years experience, you start thinking about your patients long term goals and health, rather than just the textbook here-and-now.
-  "Proficient"- Meaning you have learned from enough experiences to modify plans, change others perspectives, teach others your skills, and your nursing spidey sense is pretty strong.
-  "Expert"- Well, here is where you're just awesome. You've been a nurse for a looooooooong time and your Nursing spidey sense is just out of this world.


Now, what exactly do I mean by 'Nursing Spidey Sense'? Simple. Let me explain.

At the stage of a Novice, which I was not too long ago, I was so scared with my patients. I saw the more experienced nurses (I work with a lot of 'Competents and Proficients') and I would witness them catch a patient going downhill pretty early. I thought, how did you know? What if My patient is suffering and going downhill and I missed something in my assessment? My assessment skills aren't good enough, what if I am missing something simple, or something huge that could save their life? The more experienced nurses on my floor assured me that it was important that I just keep learning and always doing my best, always being on guard. I listened.

Now, almost hitting my one year anniversary in nursing, I feel like I have graduated to "Advanced beginner", and suddenly, I don't have that constant fear. I know I have a LOT to learn, but I feel comfortable in my assessments. I can feel my nursing spidey sense definitely getting stronger.

Point being, At the stage of a Novice, you have no nursing spidey sense. None. Zip. You go by facts, whats presented to you, lab values, evidence. There is no "intuition" developing just yet that something is wrong without any evidence.

Although I cannot speak from personal experience, from what I understand, "Expert" is when that same intuition of the nursing spidey sense is at its peak. You can enter a room and look at a patient and you just KNOW that something is very wrong with that patient before you even lay a stethoscope on them.

So, my nursing spidey sense is helping me in a lot of ways. I like having that "gut feeling" developing...it comes in handy when its time to make a decision. However, there are ways that it can be a huge bummer.

For instance, lately I seem to have developed the skill/spidey sense (I'm not sure which you could call it), of being able to predict if someone is dying or not. Not necessarily on my shift (in fact I do almost anything to NOT let you die on my shift!), but I've learned enough in nursing to know when someone just simply isn't going to pull through whatever they are going through.

I had a very kind patient not too long ago. He touched my heart with his generosity and patience, he was a very sweet elderly gentleman and was going through a lot of hard times. He had advanced stage lung cancer and frequent bouts of pneumonia, due to frequent aspirations related to the lung cancer and intubations. Well, one day I heard he was discharged and doing a little bit better. Well, a couple weeks later, I was doing a small rotation in my ICU, and I saw a man in one of the beds, intubated and hooked up to every possible wire and tube you can think of. Drips, tube feedings, multiple IV pumps, vital signs, you name it. I thought, "Wow, poor guy." But something made me look further, I saw his name and realized it was my guy. My heart dropped to the floor, along with my jaw. I couldn't believe the last I heard he was home and doing better and now he was in the ICU, unconscious. I walked closer to his room and watched him, watched the ventilator breathing air into his lungs methodically for him. I couldn't believe it. And I knew, at that point, regardless of all evidence, even though I knew nothing about his current medical status, I knew- that he was facing death any day now. I could feel it in the room, it was as if he wasn't even there any more. His lively and kindred spirit wasn't there and that deadweight feeling was left in the room, daunting.


As for on my floor, I work on an oncology unit. That being said, I've had multiple patients in the past that simply couldn't pull through the advanced cancer. This knowledge has helped me develop pretty early on in a patients diagnosis on whether or not I think they will make it, and sadly......I have been right, lately. And that makes it so hard, staying with these patients for weeks, months, prolonging the inevitable. Watching them suffer slowly. When you know they probably won't pull through and yet the family has no idea. Sometimes even the patient doesn't have an idea....but most of the time they do, too.

 This same sense has proved to be intact with patients outside of oncology as well. Recently I had an 83 year old with advanced end stage COPD. I knew he wasn't going to make it til the end of the week. In fact, (and this was the first patient I ever did this for), I prepped him for a code blue on my shift. I made sure my IV was definitely intact, made sure the room had a lot of spce, made sure the code cart was handy, because I was that sure he was looking at the light.  He died that week.


I was just blessed enough to have about 8 days off from work, I went on vacation and had some free brain time, away from all the nursing and death and living. The only medicine I had to think about was my own, and I gave my cousin a bandaid and some neosporin. 

However, when I got home, the very first night I had to sleep, I had this awful- frighteningly lifelike dream. I was at work, and in the dream I was standing over a patient's bed. She was a young female, in her 40s. She was a mom, I knew that in my head in the dream. I also knew she had advanced cancer and she was going to die, soon. In the dream I was faced with the ultimate daunting task, the husband asked me, "Is she going to die? What do you think? I've heard what the doctors have said, but what do you say? When will it happen?"  No nurse ever wants to answer that question, ever. In the dream we were in an absolute white room, white floors,white walls, no furniture. I sat there in the dream checking her foley output, knowing how much it decreases before death. I held her hand and told him nonverbally what I thought, what he already knew.

What kind of dream is that? What happened to dreams about princes and frogs and fairytales? Seriously, but it just goes to show that a nurses mind never shuts out the world of medicine. Once you start developing that nursing spidey sense, it never shuts off, even if its in your dreams as well.

I love my nursing spidey sense. Like I said, its been handy when deciding what to do next with my patients and helps guiding long term thinking for your patient. But sometimes, I'd like to not be right about the death sense. :-\ Its a strange conundrum.



~WNB



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You've Got a Point

So I have this 93 year old gentleman, who is 100% "with it", aka he's still got it all up there. These are the patients I truly cherish as they are fascinating to talk to. The stories they can tell can blow you away and sometimes you feel like you're working with a truly honorable person, even for just making it this far in life. Anyone that climbs past 90 gets a special medal in my book.

Anyway, this poor gentleman had an NG tube in his nose, which travels down to the stomach. Patients may get these for different reasons, but in this case its purpose was to drain out contents that was impeding a potential small bowel obstruction.

Patients generally hate these tubes, as it is a tube that goes into a nose nostril, travels down the back of your throat. Patients hate it. I would, too. Everytime you swallow, a tube is there and you have to walk around with a tube coming out of nose, on top of totally feeling like crap.

So this one patients tube was giving me a little trouble and I was resultingly in there more working with it, which unfortunately causes him more discomfort. So this is how our conversation went during this whole ordeal:

Patient: "I don't like this tube, it's stuck in my throat."

Me: " mr patient I can imagine this is very uncomfortable and I am very sorry for that. I'm going to do the best I can to make it a little more comfortable for you."

Patient: "what you CAN do is take it out! That will make it all better."

Me: "I know that would make you feel less discomfort but Right now your doctor thinks its best to leave it in, at least for tonight."

Patient: "yeah, he's not the one with a tube down his nose!"


Me, thinking: "touché."



WNB.

Facepalm.

The past....couple days...week....month...have just been the type of days where I just want to be like......*facepalm*. Complete and utter failures, some on my part and some on other peoples parts.

It's hard to explain. It just seems that lately, no matter what direction I turn in, there is somebody there to point me in the other direction (in a not friendly way), or someone that is telling me I'm doing whatever I'm doing, wrong.

I hate confrontation. I'm beginning to really learn this about myself. I've always known growing up that I hate confrontation, but I'm just seeing now as I age into my mid twenties how much of a big problem it is. In high school and college, It was easier to let things go, let things slide. It was OK to get pushed over because the people that were primarily doing the pushing was my own parents, getting me to better myself more and more. But what else was there really to worry about? I had a part time job and that money went to funding things I enjoyed. No adult problems, I was well taken care of. So why strengthen the need to defend myself?

Until now. Hitting mid-twenties and living away from the parents, working a full time job. My friends are getting older with me, all with their own serious problems as well. They are getting married, having babies, being parents....life is rapidly changing around me. I am dating and this leads to really learning a LOT about the human race and how screwed up some people are out there.

All of those above unique scenarios lead to the inevitable set of confrontations. Two people are bound to come to a problem, and there needs to be a solution. Only two things can happen:  1) The two people can compromise.  2) One person has to completely back down.


Lately, I feel like I am doing nothing but continuously backing down. Not just for the same person, either- but in my job, in my living quarters, in my family, in my friendships, in the dating world. And its making me jaded. The more and more I witness the human race behaving like this the more I revert back to my original dream of wanting to live in a tiny cottage at the top of a mountain, alone.

I am the type of person that will do your side of your work for you, without being asked. Just because. I will go out of my way to help you and expect nothing in return. If I owe you money I will do my absolute best to pay you back as soon as I can. If you owe me money, I will never say anything. If I ask how your day is and you don't return the question, I'm still just as nice to you. I will pay for my friends/dates to eat or do whatever we are doing. I let my friends/dates pick whatever they want to do, what they want to eat.


Why, do you ask? Because I don't know how to be anything else. I literally don't know how to tell someone "you're being a JERK, and you are SO WRONG, why can't you SEE THAT?" Instead I keep it all bottled up. I guess part of it stems from being a nurse. We are trained to be able to keep a poker face when being in very awkward or difficult situations and to never talk back to a patient. So I guess I take that nature home with me.

A lot of me has always believed strongly in Karma. I think, "Okay- If I can handle this wrongdoing to me now, karma will bite them in the ass." Or, "maybe this person doesn't realize they are doing something wrong. Maybe next time they will realize and be extra sorry."

But it never happens that way. Karma never comes through. At least not in ways I can visibly see. People around me- acquaintances and people I consider friends, continuously make the same patterns and do it over and over.

And I get it. I do. If I never say something, then how are they supposed to know they are doing anything wrong? I guess I'm naive and immature in thinking that "Oh, eventually they will grow up and look back and realize they were wrong." But will they? Do people ever really change? No.

And lately I've been working on balancing out the wrongdoings. I make baby steps and confront people on the smaller issues but I have this inferiority complex and I instantly feel like a mouse asking for a cookie. A cookie that was never that persons cookie in the first place. Somehow I've either managed to surround myself with very dominant personalities or maybe I am just that introverted on the scale.

The only confrontation I know how to do is avoidance. And by avoidance, that means I won't seek you out for anything, even if you are the only person I know that can do me a particular favor. I will build my own damn house by myself before asking you for a hammer if I'm trying to avoid you. But I'm not even strong enough to tell you off or to even TELL you I'm upset once you do seek me out for whatever you need.

I let people walk all over me because I'd so much rather be the one thats hurt than worry about you being hurt, and I'm the one that hurt you. Is that so wrong? I know I can't let everyone walk all over me. I have to find a balance. But even when I attempt to fight back, it retaliates so much and backfires so drastically in my face, and things end up even worse than they were before. So I stop trying.


Lately it just seems like I've been dancing with the devil in many forms. You can't beat the devil. You have to get the F out of hell before he knows you are down there. And again, I leave hell thinking "boy, I really hope the devil meets his karma". But he won't. He's the devil. There is evil in this world and good. And I grew up thinking the good will always win. If you always do good for other people, people will do good to you. We always learned in elementary school to "treat others how you would like to be treated" and that motto always stuck in my head. But the devil will always be there, and he doesn't seem to give a flying shitwad if you treat him well, he's still going to screw you over.

Humanity makes me sad. Lately strangers make me happy because I don't expect them to be decent. Strangers can go either way, and it makes your day when a total stranger does something really nice for you. We live in a strange dark world and it brightens your day when a stranger smiles at you from across the room. Suddenly you don't feel as alone.


 I hope my faith in humanity comes back soon. I miss it.

I get that I am wrong here too in a lot of ways. I have disabled and very disorganized coping mechanisms. I get that. I need help with that. But part of me just wants to go build an igloo in Alaska, live there, and call it a day.



Sorry for the depressing mombojumbo post. I guess this is one of my few places I can let myself vent, even just a little bit.


~WNB.



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Well, that is true...

So when we do an admission assessment, we always have to ask the same questions for everyone. So much so in fact that it's easy to memorize. Regardless, there is one question that is in the beginning of the admission assessment that prompts the RN to ask the patient to describe in their own words why they feel they came to the hospital or why they got admitted. This is done to highlight the patients understanding of the plan of care and to document the initial symptoms the patient is experiencing so the admission story is easily referenced by all RNs taking care of that patient. So this is how it went down this morning:

NURSE coworker: "can you tell me what brought you into the hospital today?"


Patient: "umm........an ambulance...."


I almost died from holding the "kudos!!!" in. She WAS right...



:-) WNB

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I Just Can't Agree

Alright so back in Mid-Winter I had to spend 3 days in the hospital for a general GI workup. Long story, doesn't have to be retold.


Well, ever since then I've felt a lot better. However ever since then I've been getting claims from my insurance company. None of them have been bills, but they've simply been telling me "We spent this much money on you-I hope you're happy!"

Well, I just got the total one for claims, that basically clumped everything together that I had previously known about. All together, my 3 day hospital stay- which included the following:

-ER services (medications, lab workup)
- CT Scan (1 view)
- daily lab workups
- blood cultures
- EGD (includes anesthesia)
- GI consult



Keep in mind this is a Community, non-profit hospital. Its the hospital I work in.


Whats the total bill?  $21,117.



WHAT.


Alright so thankfully I work there and so far all I've been asked to pay is $20 for the initial ER visit. So far benefits are awesome.


But still. What if I didn't have insurance? How in flipping monkey bean kingdom do people, so many of MY daily patients, pay for the extraordinary amount of care we provide? If my stay was 3 days, what does a 2 week stay look like? What does an ICU stay look like? How do the people pay that get 6 MD consults? Multiple unnecessary tests run?


So I thought about it. $21,000. That's like a year, A YEAR, at college. At my college I went to, that would cover my room and board and tuition combined for one year. Then I thought, whats the most expensive college I can think of, offhand? Harvard?  Its probably not the most expensive in the country but Its the one I chose to look up.

Tuition for Harvard for one year, for a student of my/my parents income, would be $20,600. So my THREE DAY hospital stay for a GENERAL work up on a MED/SURG unit at a NONPROFIT community hospital, cost $500 MORE than a YEAR at an IVY LEAGUE school.


How do we live in this kind of country? What is wrong with this picture? What is wrong with this health care system when a year's worth of education at one of our countries best schools is less expensive than a 3 day hospital stay when you're really sick?

Granted, I could go buy a corvette right now and spend more than a year's worth of tuition in just one signature, in one hour. Yes. But that would be my choice. I would save up for that, plan for that, work that into my budget. But people don't plan to get sick. They get slammed in the face with it.

I understand that I was seen in my ER after a two hour wait and I got a CT scan within 3 hours of being seen. In a country where healthcare is free, I might have had to wait weeks for that CT scan. I get that. But right now- If I hadn't had insurance, I damn well would have waited weeks for that CT scan if it meant I didn't have to pay. Then again they were ruling out appendicitis, so...


It just bothers me. I don't have enough research or political drive to slam against the entire system. I'm just pointing out a small flaw.



~WNB


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Observation Skills WIN

So last night at work we emptied out for the holiday weekend, but-as always- emptying out can only mean one thing....Admissions. And lots of them.

Well, every nurse has their "thing" that they really prefer not to do if they can avoid it. My "thing" is admitting people. It makes me anxious, the unpredictability. From the first moment we get their information called up to the floor, nurses try to predict what their patient will be like. Based off their diagnosis, what problems will we encounter with them when they get to the floor? What will we be doing for them? Based off their age, what do we need in the room to accommodate their needs? Based off the Doctor, is it an attending and we won't have any orders all night? Or is it a hospitalist and getting orders won't be a problem?


However, admitting/ER sometimes ***forgets*** to tell us certain things about the patients because they don't want us as floor nurses to freak out and try and "divert" the admissions. So, usually the common result is we get patients admitted for one thing and turn out to be a complete psycho. Or they come up screaming, when the diagnosis is something not scream-worthy like cellulitis. Or, sometimes, they totally come up handcuffed to the bed with a police officer with them, because they live in....the jail. And they are violent and loud and not cooperative in any way. And the admitting department just *forgot* to give you a heads up.


Well, last night I get an admission called up. Pneumonia, older gentleman. I figured it would be pretty routine. Patient feels like total crap after multiple days of failed attempts working cold medicines at homes. We get them situated, start some antibiotics, nebulizers, get them to sleep, etc.

Well my "pneumonia" guy comes up on the stretcher, with nothing less but a city cop- hand gun, their little walkie talkie scanner thing, badge, uniform, the whole get up. Legit.

So I'm like, oh- fabulous. I mean a nurse cares for her patients regardless of their status. Regardless of race, age, gender or poor life choices. But still, I wasn't thrilled about the idea of listening to a prisoners bowel sounds that might spit in my face.

Before entering the room, I so badly wanted to pull the cop over in the hallway (ha-ha, no pun intended) and ask what the patient *did*. But I didn't. I decided it didn't matter and I didn't want to know anyway. I was going to care for him the same no matter what.

So I start my admission assessment, composed of a whole bunch of questions about the patients history. The patient is elderly, a little scruffy, tall, lanky. Not your typical prisoner type, but then again who am I to know what a typical prisoner looks like besides whats on TV?  So as we discussed his medical background, the cop kept chiming in, "Oh, you had that ulcer right? And that lung cancer, you had the chemotherapy for 30 weeks, right?"

So I'm like, Wow- This cop really knows a lot about his inmates. He must have been in this jail for...a long time. Wouldn't that be the state jail? I don't know much about our criminal justice system. Clearly.

So I go about my clinical hands on assessment, trying to keep my guard up for any *sudden* movements from my patient, noting that for some reason he wasn't handcuffed to the bed as all prisoners usually are. And why is he in penguin sweatpants?

So then comes a question that we have to ask. Who do you live with? Do you have a support system? If so, who? I always think it's an awkward question, prying into personal lives as such.

So this is how this short lived conversation went down that made me look like a total idiot, which- I am.

Me: "So...........You live with.....I mean, In.............the....jail?"  I make awkward eye shifting contact between my patient and this cop. The patients facial expression was pure confusion and therefore I felt the need to verify my statement with looking at the cop. Awkwardly. Long pause.

Cop: "Oh! OH! NO! noooooo. Oh! I'm his son! I'm on shift, they just called and said he was over here."

Me: "Oh....I was wondering why he wasn't handcuffed to the bed."

Patient: "Do I really look that bad?!"

Me: "No! No of course not!"


Thank goodness we all had a good laugh over it but I was seriously kicking myself. I should have known when I saw the penguin sweatpants.


I went and told my coworker the story, thinking it would be totally suspenseful and she wouldn't guess that the cop that came up with my patient was actually the son in the end. Instead she's all like, "Didn't you see the cops badge? It was totally the same as the patients last name."


I win the super award for naivety because she was with this patient for like 2 minutes and I was with him for 45 minutes and I didn't notice the nametag. Super observations skills WIN.



-A Writer in an (unobservant) Nurse's Body


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Epiphany of the Month

Hey all,

So lately my brain has been in a major blank status. Each day I rise and I think, what can I blog about today? And I come up with nothing. Reasons being lately all I have been able to do is:

1) Work

2) Sleep (you don't really want to hear about my dreams, do you?)

3) Eat ( I actually almost did blog about my dinner the other night, I was desperate)

4) Photography job (this is not interesting to blog about, I tried)

5) See friends (I don't usually blog about people I know)

6) Play Racquetball (I'm failing miserably- not blog worthy)



And thats it. Yup.


This entire month of May has not only been very hectic but as my friend put it, "I am a very lucky girl and have many blessings, but sometimes life just keeps slapping you in the face." Thats how I feel. Like I'm swimming in the ocean, enjoying myself one minute- then I get hit by an enormous wave, it knocks me down. I think- OK- I am strong, I can get back up. Big setback but I can handle it. Then I stand back up and there's another wave waiting for me, knocks me down harder. I sit on the ground a little longer this time, wallowing- but get back up more slowly this time. And you guessed- another wave. At this point you're at the bottom of the ocean, sand between your fingers and you're just thinking REALLY?! You remain at the bottom (figuratively speaking- otherwise you'd drown) and try and think of a gameplan. The waves can't keep knocking you down if you just stay down, right?

So within the past couple days, I've been sitting down on the bottom of the ocean, so to speak. I've just recently "learned" that I can swim to shore and just get out of the water. I know success comes to those who go back out and surf (stay with my metaphor here), but sometimes you just need a moment to reflect and sit on the damn sand, dry.

I'm starting to learn that the waves will always be there. But if I want to get out to the peaceful ocean beyond those incoming shore waves, I have to get knocked down first. A lot. And as much as that sucks, I'm okay with that. My defense mechanisms start to turn on and say, "Hey, this is starting to just be comical. Keep it coming! It can't get any worse and eventually it has to get better."

I had a really good April. And so far my June is looking pretty darn awesome....So I just have to sit on the sand for a little and play in the shallow end for a little and remember how lucky I am to have all four limbs, to be alive, to be able to walk, to see, to hear, to have family and friends that love me, a full time job with opportunities ahead, a home to live in, etc......the shallow end isn't so bad.

 Just gotta lay low and roll with the punches.
And laugh about it every once in awhile.
Tell the devil, I really don't give a flying shitwad. Then wiggle.  :-)



~ WNB



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Total Movie Moment

The male cashier at my local Barnes & Noble cafe just knew my complete order-down to my size, type of tea and even my weird preference for only one tea bag in a large cup.

I have never seen him before.


I feel like he's waited for a long time for his moment to do that.

I feel like an unobservant jerk!


But it was one of those total movie moments, very sweet. Blown away!

Then again.....I DO Go there like 3 X a week..... Not sure whose case that helps.


Good story.

Thank You Dr. Improv....

So the other day I go into see my patient. I'm assessing him, being that it's the beginning of my shift. I noticed the surgeon had just left the room but I was tied up with another patient and didn't get to talk to him.

So I notice on my patients bed sheet above his leg area, it's bright red.

Obviously, being that we're in a hospital, I'm a nurse- this is my patient ...my first thought is somehow my patient is bleeding profusely...from his....thigh area...

Noticing my sudden concern regarding the bright red marks on the sheet, the patient laughs.


I have a raised, expectant eyebrow expression- like this- ^_^ (sort of).

Patient: "oh don't worry. Dr. Improv did that."

Me: (again) ^_^....... "um....can I...see what happened...?"

Patient: "what do you mean?"

Me: "the blood? On your sheet."

Patient: "oh! No. That's marker. Dr. Improv was drawing pictures for me about the surgery hes doing on me tomorrow. See, this is my stomach, those are...the intestines...I think...that's the duodenum there..."


Me: "well, this is a first."



Reason # 37291 why I don't advise using red markers to draw pictures on your patients bed sheets.



*sigh*

-WNB




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Happy Nurse's Week!

Ah my profession has a week! This is cool!

I've always known about nurses week....well, for the past six years that I've worked in a hospital I've known- that is. But this is my first year that I actually get to celebrate it, as an official nurse. Way cool.

And this is the first year that I'm noticing society celebrating it, too! Which shocks me. I mean, Its one thing for hospitals to celebrate it.....but society? Non-medical people? For example, in the mall today I did a total double glance- I was walking past "Cinnabon" (food) and I noticed a sign that said "Nurses week! Bring in your hospital ID badge, all nurses get a free cinnabon roll!"

I was shocked! Fo realz?

And then my local radio station is having this huge luncheon for just nurses. Cordial invite and everything..... They have been advertising it for about a month now. Thats super nice! Unfortunately, I can't go. Because I work. Nurses don't get off work for nurses week, lol.



Anyway, being that a lot of my friends on facebook are also nurses, I have been seeing quite the medley of hilarious "memes" as they call them nowadays. So I want to share the funniest ones I've seen. Please keep in mind, I did not make these, I do not know where they originated from nor who the maker is.

This is definitely my favorite. I see it in a hugely sarcastic tone and I love it.

I want to tell this to the cops that pull me over (ever so rarely, of course).

Sad, but exceedingly true.

If only our patients were actually this considerate.....

As for good news on my end, my hospital is starting this new thing to prompt......eh...competition? Hard work? Good customer service? About a month or so ago they announced they would be giving out awards based off nominations from peers to nurses and supporting staff that excelled in that particular award denomination.  So, somehow- I'm not sure how- (other than the fact that my nominating peer wrote a killer essay to nominate me)- how I won. But I won! I got an award for being a "rising star nurse", qualifications being a nurse under two years, and shows exceeding potential for future excellence. So, that kinda made my day week month year?! "  :-) I'm super stoked and honored.


On other happier notes, I seem to have a super duper outlook on my future job prospects...I've been interested in getting my MSN in nursing informatics, and today the head of the informatics team at my hospital told me herself she is retiring and her along with our Vice President of Nursing  said that they are looking into me to come into the department and maybe eventually fulfill her duties. Which is totally terrific!! Lots of door openings today!!!!!

So I have to super speed up my MSN. Must start applying now, ahh!

Lots of good news today. I am super blessed to be living this wonderful life. I have my own place, I have a full time job in my college major study, I have a lot of doors opening for my future, I am healthy, I have phenomenal friends, I have exceedingly phenomenal coworkers (those two overlap), I have the best most supporting family...what more could I really ask for?!



I hope all nurses weeks to come are this wonderful! :D

Happy Nurses Week Everyone! Try not to get peed or pooped on this week, you owe that to yourself ;) Duck the punches!


With love,

A Writer in a Nurse's Body


PS- Please remember the memes are not mine! I do not own a copyright to them. Google them. Re-post them, I dont care!



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