Clinical Decisions

I tried to do my nursing duties.
I tried to wipe your bottom.
I tried to bathe away the stink.
I tried to brush your nasty teeth.
I tried to turn you q2h, like a good little nurse.

But thanks to your heroine/meth/alcohol/opiate addiction you went bat-shit crazy.
And I had to recruit not one, not two, not even three, but seven of my coworkers to literally sit on you to keep you from hitting the ceiling like the scared cat in cartoons.
I got a nice kick to the gut. So did work BFF.

So today you got a flexi-seal placed in your rear.
And a big bottle of room deodorizer.
And your nice ICU specialty bed got set to rotation mode.
And you got a beautiful pair of ankle restraints.

Then I took that thirty minutes or so I had leftover from NOT doing my duties to explain to your family member on the phone that...
1. No, you aren't actually smoking and drinking while in the hospital
2. While we are essentially "drying" you out, we can't actually keep you from going back to your lifestyle once you leave.

Then he was nice enough to clarify that you don't actually drink or smoke or do drugs because you like it. Silly me. You only do it "for you heart to be healthy".

The Lazarus Expectation

Mr. A has sadly passed as expected by we who have been treating him. The ventilator is still connected and pumping. But their is no HR, rhythm, pulse, BP, O2 sat, or any other sign of life other than the vent pumping air into his chest.

But I guess that's enough for a little hope.

The family informs us that they are ready for us to "let him go". Thanks for the permission but Elvis left the building about thirty minutes ago. No encore, sorry.

"But we would like to pray over him first." I am informed. Fine by me. "Could you tell my Sister's-husband's-baby's-niece to come in and pray with us?"

Umm ok. Which of the sixty of you is she? Or he?  What?

I find Sister's-husband's-baby's-niece who is on the phone with Brother's-wife's-mother's-nephew.

"Uh uh. No. I can't be a part of this!" she yells. "I got too much faith! Too much faith I tell ya."

Sister's-husband's-baby's-niece looks to me for answers of course. "What his vital signs?"

"He doesn't have any." I say for the fourteenth time since obscure great nephew tried to punch the doc for trying to turn of the ventilator after Mr. A made his exit.

"Mmm. I just got too much faith."

Every problem has a solution...even if it's dangerous.

How do you get over your recent suicide attempt leading to respiratory and renal failure?
How do you cope with the fact that your versed drip just got cut off so you could be extubated?
How do you get your nurse to give you more drugs to "make you sleep"?

Stick a few fingers down your throat and throw up while your airway is still delicate from extubation.
Then push really really hard. I'm talking laboring-a-baby hard in order to release the biggest GI bleed stool ever seen.
Then when you are rolled over to be cleaned, throw up again. And this time inhale all the nasty shit that just came up.

Your heart rate will slow down effectively throwing you into what we medical folks like to call PEA.
We will pounce up and down on your obese chest.
And you will get that tube back down your throat.
And the good juice. Good ole Propofol.
And CRRT.

Way to go Princess. If at first you don't succeed, try try again.

In which I'm personally victimized by a chronic pain drug-seeker.

A little background info: I live in a major medical district. I'm talking five hospitals within a 20 mile radius. No need for me or the fiance to travel out of our little bubble for anything but maybe some freak ass disease. 

Several months ago, fiance went to a popular theme park in The Big City about two hours away from home. He used to be a little punk-ass rocker dude, but all that's left of that now is his wallet-on-a-chain habit. And of course, since he could be a terrorist who could cause mass  chaos with a wallet chain, he had to leave said chain at the front gate. Thank God for security (sarcasm). 

Now since he is a skinny ass and has no wallet chain to bind him to his belongings, his wallet flies out of his butt pocket on a roller coaster.  Panic ensues and we call all card companies and banks and cancel everything yada yada yada. All better right?

Wrong.

A few months later, we get an ER bill from a hospital in The Big City. Then we get a bill from a Radiology group in the The Big City related to ER visit xrays. Someone is using Fiance's ID to visit multiple ERs.

"Someone is using your ID to get pain meds." I say when the fourth bill comes. 

"Why would they do that? Why wouldn't someone use their own ID?" he asks, confused.

"Because they did it too much with their own name and have probably been tagged as a frequent flyer by the ER staff."

"That's sounds like a lot of work." he says, still skeptical that someone would go through so much work and risk getting in trouble for a high/relief. 

Fast forward about five months, 50 ER bills, and one private investigator later. 

"They arrested the guy."he informs me. 

"Good! What did he have to say?"

"I guess the guy was a marine or something and had gotten injured and was just trying to get pain meds."

I just call it like I see it!!

Hope you got some momentary relief out of our year long hassle, asshole. I'm not saying to guy didn't have legitimate pain issues, but there is a right way to do things. And on another note, how badly are we treating our retired military personnel that they feel the need to steal to get medical treatment?

It's a zoo in here.

ICU does things to people.

Whether it's all the beeps, bells, and whistles. Or being tied down to a bed in an unfamiliar place with tubes sticking out of every orifice. Or the fact that you are not getting your normal dosage of [insert abused substance here]. Or a combination of all three.

One thing is for sure: if you're in intensive care for more than a few days, you will at some point lose your head.

Now, I'm used to the obscenity-screaming and boogie-spitting and bed-thrashing. As long as four point restraints are involved the insanity is quite funny.  But the simultaneous outbreak I experienced recently was particularly hilarious!

Four out of fifteen patients went bonkers at 1845. We are all sitting around, waiting for night shift to roll through the door rubbing their sleepy eyes, and we hear a call from one end of the unit.

"MOOOOO!!!!  MMMOOOOOOOO!!!"
Mr. DKA is moo-ing.

Then from the other end.

"Baaa. Baaaa. Baaa. Baaa. HHHeellLLLp MMmee!!" (just imagine a goat screaming for help)
That's Mrs. Schizo whose been off her meds.

"Meow wink wink meow wink wink."
MS Contin addict whose was alert and oriented five minutes ago thinks he a cat.

So, the unit turned into Old MacDonald's Farm. Then I ran home as soon as report was finished.

Sorry about that.

Ring Ring.


"Floor nurse, how can I help you?"

"Hey floor nurse, it's ICU nurse. I have a lady here that says she is Mr. ETOH DTs estranged wife. I'm just going to send her on up ok?"

"That's fine ICU nurse. But could you do something first?"

"Sure."

"Stall her for about 10 minutes. He just shit on the floor. And now he's rolling in it."

"Uh yeh. No problem. But something tells me she's probably seen worse."

Sense of Entitlement

I'm going to be very vague, just in case the HIPAA monsters are trying to find me.

-You may not abuse rules and policies of your hospital simply because you work there.

-You may not stalk the nurses and question everything they do when your job title puts you as far from bedside care as possible and does not allow you to do anything patient care related.

-You may not be a bitch to the nurse who calls your bullshit-rule-breaking. You also may not try to report her to her supervisor. Didn't know I already report YOU to YOUR supervisor did you?

- After all this, you may not expect all the other nurse to be extra nice to you. Bitch nurse has already activated the Crazy-Family-Alert.

Thank you and I promise your family member lying in that bed is my first priority. You, however, are not.