girl in greenwood

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thankful

2009-11-25T22:25:00.000-08:00

Thankful 2008
Thankful 2007
Thankful 2006
Thankful 2005
Thankful 2004

It has been a very busy year, with lots of good things and lots of bad things too - and yet I have a great deal to be thankful for.

As always, I am beyond thankful for my smart, funny, creative, thoughtful, strong husband. We have held each other up this year in countless ways and I can't fathom life without him.

And equally important, I am thankful for my fun, loving, generous parents who provide unconditional love, handyperson advice and labor, and more laughs than anyone else's parents I know.

I am super-duper thankful for our new house! Moving, painting, and the millions of other projects we've taken on have been hard work and lots of money, but I think it's all been worth it - every day I look around and think that I can't believe I live in such a nice home.

I am thankful for the chances I've had to reconnect with old friends this year - between Facebook, Google, and some fortuitous travel plans, I've gotten in touch with quite a few people who were important to me in the past and that makes me happy. (Keith, I'm looking at you as one example! And Emilie, you & Derek are another!)

I am thankful for the friends I've stayed in touch with after nursing school, and for the new friends I've made at work, because both groups are available for nurse talk whenever I need them.

I'm thankful for all our excellent friends from various other backgrounds who are fun and loving and help us see the world from different angles.

I am thankful for my continued employment in this lousy economic time - and I am even more thankful that my coworkers are so excellent and fun and loving, and that I am proud of the work I do at Big County Hospital.

This may sound strange, but I am thankful that I have had the experience of helping several people pass from life into death this year - because it has strengthened my belief that hospice nursing is the right path for me.

Finally, I am very thankful for the good health that my family and I have. I care for people who are sick and broken in thousands of different ways and I am profoundly grateful that my loved ones are not fighting those battles.

Now I have a request for you, my dear readers. In honor of our beloved friend who died this year, please do one small thing - think of a friend or relative or someone who you've been meaning to call but have been putting off for no good reason, and call them just to say you love them and are thinking of them. You'll both feel good afterwards.

Happy Thanksgiving, everyone.

book report: The House of Hope and Fear

2009-11-13T00:14:00.000-08:00

The House of Hope and Fear: Life in a Big City Hospital
by Audrey Young

I loved this book and read it in a few hours becuase I was so fascinated. I work at the hospital that Dr. Young describes with honesty and affection. In her stories about patients, doctors, families, and aspects of society, the reader gets a view inside a public hospital and the people who work and are treated there.

There are two reasons why I would recommended you read this book: First, it would help you understand why I choose to work at the county hospital and why I am so proud of the work I do. The other reason is more political: reading about the patients who end up at the county hospital seeking primary care - the homeless, the addicted, the mentally ill, the underinsured, the unemployed, the desparate - is the best argument I can think of for universal health care.

Just one fact pulled from the book: the United States spends more than twice as much on health care than any other country, and yet our health outcome and life expectancy statistics are nowhere near the best in the world.

realized

2009-10-07T21:28:00.000-07:00

I was just thinking that when I was a kid, I read several books about patients in hospitals, and always thought "Wow, what a foreign area medical care is, and how fascinating." While reading a review of a new book about the hospital where I work, I realized that now I work inside one of the books I used to read and marvel at. That's pretty neat.

(I know I haven't been blogging much. It's been a busy summer. R* and I bought a new house and have been working on fixing it up. I've been working hard, and am being rewarded for my hard work by being asked to be one of the charge nurses on my shift. R* changed jobs and while that's a good thing, it's another source of stress. If you want to get more frequent updates from me, find me on Facebook or Twitter!)

really, don't

2009-07-21T18:14:00.000-07:00

Conditions I've witnessed and am glad I don't have:

Calciphylaxis in end-stage kidney disease.

A colostomy resulting from a rectal foreign body and subsequent intestinal perforation.

A collection of problems that were all making each other worse: congestive heart failure, acute renal failure, necrotizing pneumonia, and protein deficiency due to lack of interest in eating. Also, did you know that when part of your lung tissue dies, you pretty much have to cough out the dead stuff to clear your lungs?! Gross.

endings

2009-07-16T22:15:00.000-07:00

Today was a difficult day.

My patient was 20.
He'd had a drug overdose.
His family had made the difficult decision to put him on comfort care.
Today was the first day I'd cared for him.
Today was the day he died.

Normally this kind of thing doesn't get to me that much.
But he was so, so young, and the family was so, so heartbroken.
It was tough to watch.
I cried.
More than once.

But you know what?
I did a f*cking outstanding job as their nurse.

The patient died peacefully without signs of pain.
The family was all gathered at the bedside singing and praying.
I reassured the family that the patient's signs & symptoms were normal, that he was very near the end, that their feelings of guilt/anxiety/relief were all nomral, that they didn't need to worry about any logistics, that they were doing the right thing by holding the patient's hands and touching him.
My excellent coworkers took over care for my other patients for a while so I could devote my time to this family.
I got the chaplain, the palliative care doc, and the medicine attending doc to stop by before the patient died.
I did postmortem care to get the body ready for friends and family to see.
I paged a couple other doctors who had cared for the patient so they could visit the family.

The nightshift nurse who had asked for me to be assigned to the patient came in at the end of my shift and we hugged and told each other what a terrific nurse the other was.

I called another of my coworkers on my way home to give her some positive feedback the family had shared with me.

Now I am drinking a large alcoholic beverage.
And wishing there was some way to tell people not to use heroin and aprazolam together.

surreal

2009-06-11T22:32:00.000-07:00

One year ago I was a brand-new nurse scared out of my mind about starting work.

Today I precepted a brand-new nurse (a graduate from the same school I attended) who was scared out of her mind about starting work.

One year ago I could barely handle taking care of two patients.

Today I had a total of six patients with admits and discharges.

One year ago I had successfully drawn blood once.

Today I helped my preceptee try to draw blood for the second time. She didn't succeed. I stuck the patient once and while I had to dig around a bit for the vein, I got the blood sample.

One year ago I had no idea how to put a tele monitor on a patient, much less how to read an EKG.

Today I admitted a tele patient, stuck on the monitor and assessed his rhythm, then called the doctor to report on the weirdness I was seeing without breaking a sweat.

One year ago I was nervous every time I went into a patient's room because I felt awkward and incompetent.

Today I breezed into a patient's room and was greeted by the patient's daughter, who informed me that I was her mom's favorite nurse.

One year ago I was not sure how I would like working in a hospital with lots of people I didn't know.

Today I got hugs and kisses from most of my coworkers, including a doctor.

This job has worked out brilliantly.

hug

2009-06-11T22:29:00.000-07:00

People I hugged today:

-a patient
-a patient's daughter
-a jail guard
-an MD
-a nursing assistant
-5 of my coworkers

I kissed my husband but I didn't hug him because he was still lying in bed when I left for work, and lying down on the couch when I got home from work.

still don't

2009-04-19T11:42:00.000-07:00

More conditions my patients have had that I'm glad I don't:

Huntington's disease. And a big honkin' meningioma as a "bonus".

Multiple enterocutaneous fistulas secondary to surgeries to treat colon cancer.

Diffuse large B-cell lymphoma - this was actually a patient who had undergone chemo in the past, and when it was discovered that the cancer was back, she declined further treatment and went on comfort care. She died on my shift.

therapeutic

2009-04-15T19:23:00.000-07:00

In nursing school, we spent a great deal of time discussing therapeutic communication. We were taught to validate feelings, express respect for the other person, and try to steer the conversation in a productive direction.

Yesterday I heard the following interaction while out with a group of coworkers:

Nurse 1: "You know that guy G*** with the possible mad cow disease, and how he's totally crazy?"

Nurse 2: "Sure, yeah, he calls everyone "f*cking b*tch," right?"

Nurse 1: "Yeah, that guy. The other day I gave him his meds and then asked him if there was anything else I could do for him, and he looked me straight in the eye and said, "Yes. You can suck my dick."

Nurse 2: "HAHAHAHA! What did you say - "It sounds like you're feeling horny right now. Would you like to discuss those feelings?" "

Nurse 1: "No, I just covered my mouth and ran out of the room because I couldn't stop laughing!"

I love my coworkers.

don't

2009-04-07T22:01:00.000-07:00

Recent diseases that my patients have had lately that I am glad I don't have myself:

-Full blown AIDS with Kaposi's sarcoma and C.diff diarrhea as a bonus.
-TTP and resultant amputations of both hands & both feet
-completely out-of-touch with any kind of reality schizophrenia (and a foot infection)
-Median arcuate ligament syndrome. (No, I'd never heard of it before, either.)
-spontaneous pulmonary embolism for no apparent reason.

I think this may become a recurring topic on my blog, since I find new conditions that I really don't want to have on a regular basis.

paging Z in Richmond

2009-03-11T17:07:00.000-07:00

Hey, I'm thinking of you and wondering how your nursing school journey is playing out! Update me when you have a chance. Hope you & yours are well.

eyeball

2009-03-11T16:35:00.001-07:00

Okay, okay, I've been promising this post forever. Consider it a cautionary tale. (If you don't like gross stories, don't read this one, ok?)

I took care of a patient a while ago who was a young woman who had decided to leave her boring suburban life and plans for college to hang out with the wrong crowd. She was using heroin and while her claim was that the massive necrotizing infection in her face started when she just picked at a scab on her forehead... it seems more likely to me that she had either injected or dripped a solution of heroin into her eye. That's right, her eye was the center of the infection. And man was it gross. The eye was swollen shut and continually oozed bloody drainage... when we cleaned it, it drained more, so that it looked like she was was weeping blood. Amazingly, she didn't lose the eye, although she is blind on that side now.

The good news is that she stopped using heroin and got into a methadone maintenance program. The bad news is that she came back to us a couple monthes later with abcesses in her thighs... apparently she decided to change things up by injecting cocaine into her femorals. I didn't ask her this, but I wanted to ask why she would risk infection by injecting when she had a perfectly good cocaine nozzle right on the front of her face... I suppose that would be a less-than-therapeutic message?

So, the takeaway lessons here are:
1. If you use heroin, keep it the hell away from your face and eyes.
2. If you want to use cocaine instead, I really can't recommend injecting it.
3. Srsly, college is not that bad. At least give it a try before you turn to drugs & whoring yourself out. Kthx.

And finally, heroin factoid of the day: dealers apparently cut black tar heroin with many things including fecal matter. Yes, poop. Which then users inject. And get nasty infected abcesses, big surprise. Could it get any grosser?

not the newest

2009-02-25T11:45:00.000-08:00

I started this entry back in October... but it's still relevant to me so I'm posting it anyway.

****************************
You know what's funny? I precepted a newer-than-me nurse this weekend. And it went really well. I think that was partly because the new nurse is EXCELLENT. She was a nurse tech at Big County Hospital for the last year, so she is already very familiar with the work environment. Partly it was because I am so recently finished with orientation that I remember it keenly, and have lots of opinions about what makes for good vs. bad experiences. At the end of the first day together, she thanked me for helping her have a good day... which made me feel great.

Otherwise, I'm doing all right. I've been in kind of a funk at work lately - I think I'm reaching the point where I need to shake up my expectations for myself. Right now, I feel like I do a decent job with basic nursing care like making sure that my patients get their meds, have good pain control, get fed appropriately, get blood sugar checks if necessary, get their braces cleaned and adjusted if they have 'em (we have quite a few patients in spinal braces of various shapes & sizes)... which is all good. I'm pleased with that. But! Remember how I was talking about how I feel like there is so much more I could be doing? I have quantified some of that for myself. (I apologize that this is going to be boring for non-nurses, but I've got to get this stuff in writing before it gets away from me!)

In a perfect day, I would go into each patient's room and do the following:
-introduce myself
-update the whiteboard (we use these to write the nurse's name, the patient's name, the date, and any other assorted information like questions or goals)
-check vitals, assess for pain
-listen to lungs/heart/abdomen
-ask the silly orientation questions (do you know who/where/when/why you are?)
-check their name band
-if they're someone who needs to be turned every two hours, go ahead & turn them unless the night nurse told me they were just turned.

It doesn't sound that hard. But I don't think I EVER actually get all of that done in one visit.

Later on in a perfect day, all my patients would get:
-a bath
-teeth brushed or oral care; frequent oral care for unconscious or trached patients
-lotion applied to dry skin, especially feet
-room tidied & organized
-turned/repositioned every two hours like clockwork
-education packets on pertinent health conditions
-a chart review that included not just med checks, but tracking down details like the location of their belongings and starting discharge paperwork
-new IVs if the old one(s) was due to expire
-their freaking disgusting nails trimmed (if applicable)
-whatever sort of wound care they may need
-an offer to help fill out their menu requests (if applicable)

I'm sure there is more that will come to mind over time.

vancouver

2009-02-24T19:01:00.000-08:00

We visited Vancouver, BC over the past weekend and had a marvelous time! I want to make some notes for future reference, and for anyone who happens to be looking for information online.

We took the train from Seattle to Vancouver - it was cheap and easy. Actually, we got on in Edmonds, which was a good choice because only a few other people got on at the same stop, so there was not much waiting in line. We did have to wait for a quite a while to get through customs at the Vancouver train station, but oh well. It was nowhere near the 2-hour wait at customs at Blaine that some of my work friends described recently.

Wedgewood Hotel - Absolutely marvelous. The room was spotless and comfortable, the service was excellent and cheerful, and the massages we had the spa were lovely.

Bacchus Restaurant and Lounge - the lounge is intimite and cozy, with lots of dark wood, cushy chairs, heavy drapes, and soft lighting. The drinks are expensive but delicious, the lounge menu is tasty, and the breakfast & afternoon tea are quite good. However - the main dining room is overpriced and underimpressive. It's not that the food is BAD - it's just that it's uninspired and costs much more than it should.

Diva at the Metropolitan Hotel - we had lunch this trip, and had a prix fixe dinner on a previous trip. I remember being wowed by dinner, but that was years ago and I'm sure my tastes have gotten snootier. We had a prix fixe lunch this time, and it was quite good. There were three courses - the appetizer & dessert were quite excellent, but we felt the main course was somewhat off the mark. Not that it was bad, it just didn't work as a cohesive dish. However! I would go back just for cocktails. I had one they called a "Poire Belle" and it was AMAZING, like the essence of pears distilled with vanilla and a hint of spice, incredibly smooth.

Cioppino's - don't let the generic-sounding name turn you off - we had a really terrific dinner here. The chef is considered one of the best in the city, and I can see why. We had a mushroom & chestnut soup that was to do die for. I had a bowl of cioppino for dinner which was hands down the best I've ever eaten, and R* had duck which came in 3 different preparations on one plate and was outstanding. At dessert, R* had the house tiramisu which put all other tiramisu to shame - like we may consider driving back to Vancouver just for dessert, it was that good.

Vancouver Symphony - Put Seattle's symphony to shame. The hall is run-down and chilly, the bathrooms are a little yucky, but the orchestra is terrific. Louis Lortie was the guest pianist, playing two Lizst pieces (not for the faint of heart or small of hand!) and he was stunning. I'm so pleased we went to this performance.

Kirin Seafood Restaurant - we went here for dim sum and discovered that we've only eaten cheap crappy dim sum in Seattle! The food was excellent, the staff steered us through the experience since we obviously didn't know what we were doing, and the restaurant was full of Chinese people chowing down. I would love to go back with a bigger group so we could try more dishes. (Note, the dim sum is of the order off the menu variety, not the wheeled around on carts variety.)

Vancouver Art Gallery - we visited this art museum the last time we were in Vancouver and had the same reaction: the building is lovely, the collection is nothing special, and the museum store is the best we've ever seen - and that includes MOMA and the various Smithsonian/National Gallery stores. Good news: you can shop at the museum store without paying admission to the gallery.

Bill Reid Gallery - Bill Reid was a half-Haida (Native or First Nations group) artist who put a phenomenal amount of effort into reviving and publicizing his people's native art forms, as well as bringing many of the native motifs into modern media. The collection is really lovely and features lots of multimedia stations such as videos, interactive displays, and audio recordings that help place the art in context.

Chambar - Amazing Belgian restaurant. The menu features crazy cocktails, a nice variety of Belgian beers, moules et frites in multiple preparations (yes, I am in love with mussels!), gorgeous entrees, and artistic & tasty desserts. I wish we could have gone back at least twice more.

We also bought some nice stuff at Danier Leather (R* got a coat, I got a purse) for ridiculously good prices, and I stocked up on tea at Murchie's.

All in all, a terrific vacation. Wish we could go back every couple of months.

smell

2009-01-20T18:26:00.000-08:00

Spotted on the fridge in the break room at work. My coworkers are sooooo mature.

go cordless

2008-12-18T18:40:00.000-08:00

Hack Attack: The Cordless Workspace (sort of)

Wow, this is genius! We have that exact desk in our home office. I'm thinking we should do this the next time we have to deassemble and reassemble it.

eyeball

2008-12-17T22:45:00.001-08:00

I can't believe I didn't mention Eyeball Girl before! In the vaguest possible privacy-protecting description, she was a young woman with a heroin problem who got a necrotizing infection of her face.

Okay, now keep voting.

year end

2008-12-17T11:12:00.000-08:00

This year has really flown by. My workmate E* recently pointed out that we've been employed at Big County Hospital for 6 months, which is astonishing. It's turning out better than I could have hoped - I work with a fantastic bunch of people.

I'm somehow surprised to find R* & I still in our rental house - intellectually I know that we planned to spend about two years here, but it's already been an entire year? Wow. This little house has been treating us well - it is completely free of poo in the bathtub and the furnace is working like a dream. Not to mention the guest quarters for anyone who needs to stay with us and the garage storage for bikes and such. We're still contemplating our next move - R* believes the housing market will continue to fall for some time, so the longer we wait, the better deal we'll get & the bigger our down payment will be.

I started this entry wanting to write about work, but I still struggle with knowing what to say about it. Here, I'll give my readers a choice of patient stories, and I'll write first about the one you vote for.

*my comfort care patient who died on my shift (this is the first time a patient of mine has died under my care)

*the reappearance of Eyeball Girl

*the flasher guy who wouldn't go home

Vote in the comments, please!

compensation

2008-12-06T11:00:00.000-08:00

UroStream: Harley riders: beware!

I wonder if us trauma nurses could use this as an additional demotivator for motorcylce-riding patients? We see so many accident victims who were on motorcycles... maybe they'd stop riding if they knew it could break their penises.

thankful

2008-11-27T20:41:00.000-08:00

Thankful 2007
Thankful 2006
Thankful 2005
Thankful 2004

I am thankful for a lot of things this year.

I love my husband and my mom and dad a whole lot.

I graduated from nursing school!

I passed the NCLEX!

I got a job at a terrific hospital, and it turned out that I love it.

And I also seriously love my coworkers!

R* and I are in a financially sound place even as the whole world's economy goes down the crapper.

Time for having a baby is any time now. (No, I don't have an announcement at this time.)

None of my loved ones have any of the horrible problems that I see at work: head injuries, diabetes, addiction problems, colostomies...

In just a few more weeks, Barack Obama will be our president!

Happy Thanksgiving, everyone. I hope you're all happy & healthy.

infectious

2008-11-21T17:10:00.000-08:00

There has been a great deal of outrage at work based on this series in the Seattle Times:

Culture of Resistance

I work at the Big County Hospital prominently featured in the articles. I can tell you that our MRSA infection rate for last month (October) was the lowest that it has been in the last 10 years. This is due to aggressive detection & isolation practices as well as strict hygiene and cleaning measures. The casual statements made in the article about how the hospital doesn't screen or isolate patients is WRONG. All ICU patients are screened at admission and routinely thereafter. MRSA patients are very rarely roomed with non-MRSA patients - and when this happens, it's because the county hospital cannot just close its doors because it's too full. We have to continue to provide care. In these rare instances, the MRSA patient is paired with a low-risk roommate, someone who doesn't have open wounds or a compromised immune system, to try to avoid communicating the infection.

I am appalled at some of the "facts" people are spouting - both in this series and in the comments. For example:

Hospitals don't thoroughly clean rooms between patients.
That would be wrong. Not only do rooms get cleaned in between patients, when the patient has been isolated due to infection, a "terminal clean" is done, which takes about an hour and is very thorough. Every bed is disinfected between occupants.

MRSA, C. diff, and other superbugs are viruses.
No no no. They are bacteria. This means, unlike viruses, they can be treated with antibiotics. This distinction is really important!

Patients with MRSA acquired it in the hospital.
There was a time when this was likely to be true - but these days LOTS of people are carrying MRSA out in the community. So they bring it in to the hospital in their noses or on their skin, then it may flare up into a full-blown infection after trauma, surgery, or some other insult to the immune system. Yes, these carriers need to be isolated, but it's certainly not a given that the hospital made them sick.

What it boils down to is that everyone needs to participate in preventing infections. This means hospital employees, patients, visitors, everyone. So patients, quit refusing your baths. Visitors, wash your damn hands, and don't let your kids sit on the floor. Doctors, take off your white coats and put on the gowns when you go in an isolation room. Everyone, clean your stethescopes between patients.

Now, I would be interested in getting a nasal swab for MRSA because I'm sure it would come back positive!

spit

2008-10-30T22:24:00.000-07:00

I learned a random fascinating fact today: Byetta (a drug used to help treat type II diabetes) was derived from the saliva of the Gila monster. The coworker & I who were looking up the drug agreed that we couldn't make this stuff up!

I also did a good thing for a patient today - the patient had a painful wound that needed to be cleaned and have the dressing changed twice a day. The night nurse told me that it was so painful the patient was literally crying loudly... so before I did his wound care, I paged the doc and asked for an order for topical lidocaine. Which he stopped by and wrote for me almost immediately. So I was able to blast a bunch of numbing medication into this guy's wound - and it made a huge difference in his comfort level for the rest of my shift. That felt really, really good.

Of course, I also forgot to label a syringe of Reglan that subsequently got thrown away, and forgot to hang an antibiotic in a timely manner. This is why I will not be getting too big for my britches anytime soon.

undecided?

2008-10-23T11:01:00.000-07:00

Undecided

I haven't really bought into the whole David Sedaris thing, probably just because everyone in my age group thinks he's the best writer that ever existed, but I have to say this made me laugh out loud. Especially this bit about the undecided voters who keep showing up on the evening news:

"I look at these people and can’t quite believe that they exist. Are they professional actors? I wonder. Or are they simply laymen who want a lot of attention?

To put them in perspective, I think of being on an airplane. The flight attendant comes down the aisle with her food cart and, eventually, parks it beside my seat. “Can I interest you in the chicken?” she asks. “Or would you prefer the platter of shit with bits of broken glass in it?”

To be undecided in this election is to pause for a moment and then ask how the chicken is cooked."

adjustment

2008-10-05T21:34:00.000-07:00

I noticed this week that I'm feeling like I'm getting the hang of being a nurse. I go to work, I get my assignment, I go about my day, and I generally don't freak out about any of the regular stuff that occurs in my shift. I still leave the hospital each day thinking that I could have done better/more/in depth/smarter... but I suppose that's always the case.

I continue to get good feedback from my patients, which is pretty reassuring. And I am really growing to like my coworkers. I already knew I liked the 4 others I went to school with, but I like the ones I didn't know in advance, too.

I did post-mortem care for the first time this past week. The patient wasn't assigned to me, but the nurse who was assigned to him was busy with a semi-emergency and the deceased patient was, well, deceased. So I helped. And I was surprisingly okay with it. I suppose it helped that the patient was elderly and had a do-not-resuscitate order and died peacefully.

On a personal note, I'm finally getting some time off. I didn't work last weekend, but my in-laws were here so I didn't exactly have down time. This weekend, however, I have been lazy as hell, and I have two more days off before I go back to work. Sometimes working 12 hour shifts is so worth it!

Two of the best patient quotes this week:

(little old lady to male nurse) "Don't you touch me, or I will KICK YOU IN THE BALLS!"

(head-injured young patient to the same nurse, on the same day) "Dude, do you think you could get me some weed?"