Old Man-crush

This is not some sicko post so please don't get your knickers in a knot.

Have you ever had an elderly patient for whom your rapport was so great that you have a soft spot in your heart for them? I definitely have. Usually it's the stubborn old coot who talks about his wife as if he still is in wonderment, and the sly one who, when on transport and asked where he is, states "the elevator" instead of the typical "hospital". It melts my heart.

It's not gender based either. Sometimes the little old ladies crack you up. Like when an 89 year old talks about her sex life (ew), or when she tells you a story of her youth and how she got into trouble through her escapades.

I'm not a fan of geriatric nursing, but sometimes I do develop a little old man-crush.

U.S. vs Canada?

I had a patient the other day who came in with pleuritic Lt sided chest pain, with a coughx2 weeks. We were able to get her into the department within a half hour of her arrival, and did all the chest paineur type things like bloodwork, ECG, ASA for the slightest chance that this cough-induced pain could actually be a heart attack.

Her ECG looked great (confirmed by MD), Troponins were negative, and although she was still in pain on deep inspiration/expiration and cough, she was doing just fine.

We were having an incredibly busy night with people needing internal pacing, intubation, ICU-bound-type patients. Thus the doc's were behind on seeing the urgents and less urgents. They were getting to them, and we were letting people know there would be a wait, this particular patient was infuriated.

"Why haven't you done anything yet?" she states, 'Where is the doctor?" This is, of course, after we have placed an IV, drawn blood, did O2 therapy, gotten an ECG, and given her ASA. The only thing we haven't done is done a chest xray (which nurses can't order on their own through the medical directive). After explaining that the doctors were tied up with very sick patients, the lady then states these words: "If we were still in the States we wouldn't be waiting." When I explained the severity of the sick people in the department, and that people DO have to wait for a doctor in the States, she stated "If you have insurance, you do not wait".

I kept my mouth shut, knowing full well that even people with insurance in the States, especially at a busy Emerg, would be waiting just as long as she was. She left AMA, which was fine with me... If she wanted to complain about the 'service' here, she can go back where she came from.

Wow

A year goes by so quickly.

It was around this time last year that I was hobbling myself (because of a broken patella) to citywide ED orientation. I was so excited about getting into the ED and learning so much.

Today, I wouldn't call it excited- more settled but still glad to be there- and feeling much more confident.

I still don't know a lot, and I'm learning everyday. However I now can look after all my patients on my own and help out my teammates. I have seen chests cracked open, people go into Afib right in front of my eyes, and septic patients tank as I work desperately to help them get better.

I have learned about more medical conditions that I have never heard about before. Who know what labyrinthitis was when they were in nursing school?

I'm starting to feel more part of the team, versus that 'new grad'. To those just graduating, I'm no longer the new grad. People are actually going to go to ME for help and for advice. Scary.

Thank you so far for your support. In the last few months I have been so swamped at work, and feeling fairly overwhelmed that I didn't feel I had anything to contribute to this blog. I just wanted to get away from work. Now I'm starting to get back into it (I guess vacation can do that!).

Yours at the bedside,
Elaine

Pain control

In nursing school they teach you that pain is a subjective experience and that we as nurses are to do our best to help our patients in pain.

I wonder if they were prepared for a case like this:

30 year old person comes into the ED with 'epigastric' pain. They have been worked up extensively for this pain and have diabetes, but no medical condition that affects the abdomen specifically. Already referred to a pain specialist, the patient was on 500mcg of fentenyl patches changed every 2 days, 10 oxycodone controlled release BID PO, as well as a PCA pump with hydromorphone which gives 10mg/hr as well as potentially 2 patient initiated boluses of 5mg/hr prn. This patient, because of the investigations and interventions, also had a J tube and was on dialysis for renal failure.

We had nothing in the ED that would really touch her additional pain. Giving 5 of hydromorph every hour (per MD order) seemed pointless, the patient would settle for 5 minutes and then act up by slamming their body against the side rail and screaming. THe patient had no problem getting out of bed to get to the commode. Some of this I'm sure is behavioural and some of it could be actual pain, but this seems to be an extreme form of drug seeking.

At what point should we be treating the behaviour versus the 'pain'?

Long time no see

I know the last few posts have been rather bitter and angry. Generally, I'm not a bitter person, and I find that sometimes my voice here has been an outlet of sorts.

I'm not terribly busy on my days off, and although the last few months have been really bad in terms of acuity and volume, I have been able to recover enough that I don't dread going to work. I just haven't been motivated to write much. I read my favorite blogs everyday, so to those that return the favor- I haven't forgotten about you!

Updates on the life factor- Mr E proposed! :) We'll get married in 2010 but already my family has been pushing me to set a date and plan! I'm hardly a girly girl so getting into flowers is not my thing.

I have some ideas for posts so you'll hear from me again soon!

now THAT's entitlement

Go to a 2nd world foreign country. Get into a car accident. Don't have insurance.

Be unconscious for a few days. Get better enough that they can kick you out for lack of money.

Fly back to Canada on a 20+ hour flight with no medical care. Go to the nearest hospital once you arrive. You have only 1 working appendage.. the rest are scarred from surgery from the foreign country and you have a severe infection.

Demand treatment- state to the doctor upon your arrival that if you don't get what you want, you'll go to another hospital 10 hours away- in a threatening voice as if the doctor really cares that you go to another place. Demand to those same docs they fix you TODAY. State to the nurses that the care was better at the other country because they let you smoke in your room and have something to eat. Conveniently forget that you were told not to eat or drink, or to use your cell phone while in your room.

Yell at your mom and grandma because they are hovering and wanting you to listen to the staff at the hospital. Yell at the nurses because they 'lose' your chart. Meanwhile your chart is with your mother and she has already told you this.

You are really the most important person in the world.... better let everyone know it, ya know?

You get what you ask for.

You know when you get so busy that you have no desire to do anything but laze around and sleep? That has been my life lately. I feel like I'm drowning a bit, and although I like my work I don't want to go back. I need a vacation.

As you can see it’s been a while since my previous posts. Work has been insane lately. Slowly but surely I have become a ‘shit magnet’, with STEMI’s and Aortic tears and sepsis patients arriving and end up being taken care of by yours truly. I enjoy the heavy stuff so that’s not the problem. The problem is that we’re short nurses lately and it seems as though all the sick people are coming in all at the same time… literally.

One night in our 3 bed resuscitation room we had one person actively seizing, one septic patient needing intubation, pressors and transfer across town to the other hospital’s ICU (no beds in ours… seriously), one patient who was unresponsive, and one who was having crushing chest pain. Yes, that’s right, 4 patients. Not to mention that the rest of the emerg was clogged with admitted patients, and there was only 1 RN assigned to the whole room. I wasn’t even supposed to be helping, but after I did my initial assessments on my patients at change of shift, I went in to help out. Chaos, I tell you, chaos.

Our shifts start around 7pm, and we didn’t’ get any form of break or relief until after 2am. It was THAT busy.

That’s just a start of the insanity. More to follow.