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.

Challenge Accepted

I've developed a sick pleasure working in the ICU. Nothing kinky or anything like that. Get your mind out of the gutter. It defies all instincts developed in nursing school.

When I was a naive little student, I dreaded the bed bath. Even more so than the poop clean. So we'll just say I learned to face my fears after I landed my job in total care nursing.

Now I pride myself in my ICU "admission bath" skills. In my unit, everyone gets a chlorhexidine admission scrub down. EVERYONE. Alert & oriented X 3 will not get you out of it, sorry.

Most people aren't gross at all. Maybe there's a little yeasty goodness down yonder, or dry skin. No big deal. But every so often, we get a good one. One that gives us the deer-in-headlights look after we strip the covers off.

Teeth are blackened and missing. Breath smells like a rotting corpse. Beards to the navel with God-knows-what living inside. Skin dry and scaly and falling off all over the sheets and drifting into air. Sweaty armpits and dirt (or what we hope is only dirt) caked fingernails. Blackheads in places that shouldn't have blackheads. Slimy pudding like substances caked in the reproductive orifices. Smears of fecal matter on the rear. And toenails like gnarled dead tree branches.

CHALLENGE ACCEPTED

For seemingly hopeless cases such as this, we break out the triple threat. Chlorhexidine, Aloe Vesta Shampoo/Soap (or what ever daily wash we are carrying in the Pyxis at the time), and a nice bar of Dial Soap. Lots and lots and lots of soap, little bit of water. And basically I pour the whole concoction all over. Forget saving the linens that were already on the bed, they were ruined the second they hit the sheets.

So there's my secret. The triple threat can turn the nastiest patient into an ad for personal hygiene. Don't forget the hit the teeth with a chlorhexidine mouthwash of some sort.

Happy Bathing!

I hate that feeling...

When I go home and go to bed with a feeling in the pit of my stomach. I want to call the unit up and ask how my patient is doing since I left. But I don't.

Then in the morning, the already bad feeling completely drops to the bottom of my stomach when I look at the assignment board, and that name is gone.

Then I go about my day wondering if I could have done anything different.

Some days are hard.

Excuse me, your ascites is leaking.

Typical ICU day, LOL with a nasty PEG tube is septic from the site. Serious ascites going on. Stinks to high heaven. GI doc comes in and removes old nasty PEG. No big deal right?

Wrong.

From the second he walked out of the unit (because, let's face it, weird shit never happens with doc standing at the bedside) she starts spewing from the site. A nice greenish smelly fluid. No big deal. We'll just put a nice big dressing on it. Right?

Wrong.

The dressing is soaked in seconds. Remove dressings. Hold wads of towels over site until we figure out what the heck to do. Our ICU brains get to work on a ghetto way to fix this. Hmm, a colostomy bag? Sounds like it would work right?

Wrong. 

We put the bag over the site and quickly turn and toss the patient to change her green soaked bedding. Then I hear something. Drip. Drip. Drip.

 The wafer has pulled away from the skin and that lovely greenish liquid is flowing over the edge of the bed. Onto my shoes. 

Great day in the ICU. 

In which I ponder spelunking. And I don't mean in caves.

I mean spelunking as in "Hey, KLynnRN! Wanna go spelunking with me on this new patient?"
I mean foley catheter insertion on obese people. Ladies in particular (but I've donea good cave diving on a male).

It's really an art. Almost a recreational sport, like the real thing. The similarities are eery.

1. You need to train for such ordeals. You can't just go traipsing through the deepest, darkest cave if you've never done it before. You might not recognize landmarks. And you could get lost. Spelunking is not for newbies. You should attempt smaller caves to hone your skills first.

2. Equipment is vital. You can't just grab some rope and a backpack and trek into unknown territory. You need to set up your tools. You need to know what all your tools are for. And grab a flashlight. You will always need a flashlight.

3. Don't go solo. You know that movie where the guys hand gets stuck under a rock, and he didn't tell anyone where he was going? Same thing. Don't assume it will be a typical experience. Let your coworkers know where you'll be. If fact, recruit a few helpers. You'll probably need it.

4. Be prepared mentally. Spelunking is not for the faint-hearted. You may see things that will haunt your dreams. You make smell odors that will ruin your lunch. You could have a cave-in rendering you trapped and claustrophobia may set it. Consider these things before beginning. Prepare yourself.

5. The finale. When all is said and done, and the legs are propped and the belly flop is held back, and XXL lady parts are parted like the Red Sea, you peer into the unknown. You see a little wink. Like the light at the end of the tunnel. You head for it. Liquid gold bursts forth and you've made it out of the cave to daylight!

Don't forget to wash your hands :)

No you did not just do that!

The other day, a coworker and I were helping another coworker get caught up so we could all eat lunch at some point that day. We decided to double team her intubated and sedated patient so we could get it done faster.

We blew into the room like tornados, checking blood sugar, scanning meds, scanning patients armband. All of a sudden the patients daughter appears out of nowhere. We quickly introduce ourselves and let her know we are helping the nurse. By that time we are actually finish and go to excuse ourselves.

"Wait! Wait!"she says "I need to ask him a question with you two in here."

Odd request, but whatever, families are usually weird like that. We stand by and listen.

"Daddy?! Daddy??" the patient opens his eyes "Do you want treatment. Like that chemotherapy and radiation like before?"

Pt nods enthusiastically.

"Daddy?! Daddy?!" he opens his eyes again. "God forbid something should happen, but if it does..."

At this point of course we are thinking she's asking about DNR status.

"...can I have your camper?!"

Seriously, I'd like to think he comes back to haunt her. Or better yet, rip her ass to pieces when he gets extubated!

Letters to the floor.

Dear Floor Nurse #1,

I do realize I did not check Mrs. Smith's blood sugar at 12 noon today. Per protocol we check blood sugars q6h on every ICU pt. However, Mrs. Smith has no past medical history of diabetes and no abnormal sugars since admission. Not that I feel the need to explain, but... I did not check her noon blood sugar because my other patient, Mr. Bi-pap, wasn't doing so well. What's that now? You say her blood sugar is in the fifties now? Well, sorry to hear that, but I transfered Mrs. Smith to your floor almost four hours ago. And we are now in the middle of shift report. Sounds to me like to should either go grab an amp of D50 or call the doc. Not call me. 

Thanks.

Dear Floor Nurse #2,

Yes I do realize Mrs. Postpartum was admitted for preeclampsia. No her BP was not high before I discharged her to your floor. What was it for me exactly? 120s/80s. For six hours for me and several hours for night shift before I got here. You say her BP was elevated when you took her vitals right after you recieved her? Well you do remember she ambulated to the bathroom when we got down there (first ambulation in two days) and had a nice poop (first poop since admission). She also knew she was going to see her brand new baby for the first time, in NICU. My BP would probably be high too. If you're that concerned, call the doc, not me.

Why I put up with it.

Some days make it all worth it.

Long story short, I have a patient who we are having trouble weaning from the vent because he flips the hell out when the propofol is turned down.We have orders to extubate per protocol if weaning tolerated because the only thing holding up the process is the damned propofol. So RT and I decide to go for it.

I go tell my charge nurse I'm going to be MIA for a while and to please keep an eye on my other non-critical patient whose awaiting transfer orders and I drag a chair into the room and pull the curtain.

I dial down the propofol. He opens his eyes and two seconds later that familiar reaction ensues. I gently take his hand and calmly talk him down. He mouths around the tube "I can't breath!" and "What happened?" I remind him of his surgery and the fact that he's on the ventilator and assure him I will be right there so everything will be OK. He calms little by little, closes his eyes and drifts back off to sleep.

This process lasts an hour with be turning the propofol down and calming him down; propofol down, calm him down; propofol down, calm him down. Finally he is mostly awake and trying his hardest to stay calm.

"Ok go." I tell RT who has been in and out of the room the entire time. She is already set up to extubate.

I turn off the remaining amount of propofol  and RT pulls the tube a few minutes later. After the usually coughing and gagging has subsided, he takes my hand and squeezes tightly as he begins to cry.

"You are my angel." are the first words out of is mouth. "Thank you."

"You're welcome." I say.

"Really, you are an angel. Are you married?"

"Not yet, but I will be soon." I say, showing him my ring.

"Good. Tell that boy he better be good to you. Or he's going to have me to deal with!"

Sometimes I just love my patients!!

Find the humor...

You know what makes a shitty day better?

Watching your new admit via helicopter landing while listening to the MASH theme song with your work BFF.

This kind of day...

...can only be described as a cluster-f*ck. A huge one. Starting at 0700.

Census looks a little something like this in my little 15 bed unit:
-Two patients are royally dubbed 1:1 since once is on CRRT and the other is GI-bleeding-out faster than we can get blood in her.
-I have three patients, one of which is old as dirt and demented who is a post-op hip in Afib-RVR. Who is also trying to get up.
-ANM/Charge has two patients from the get-go meaning no help for  me or anyone else.
-We have no admitting power and five open beds.

Ring. Ring. (house sup. is on the phone) "We've got another one coming for you."

All of us simultaneously, "Who the F*CK is going to take her?!"

ANM drops what she's doing and gets on the phone. She looks small and has a squeaky voice but a feral look in her eyes.

"I don't care who you send. Send Resource. Send the director. But don't you DARE send that patient until you send help first." Click.


Relief that was supposedly non-existent five minutes ago is walking through the door.

Nurses take care of their patients. Managers take care of their nurses. Kudos ANM, we are lucky to have you!

I hate PCAs

Especially in the hands of a chronic pain family who feels the need to push the little red button for Daddy.

Pt post-op thoracotomy/lobectomy. Pt recieved, assessed, settled, resting quietly, denies breakthrough pain. Family invited back to visit.

"What is he getting for pain?" asks Mrs. Pt.

"He has morphine through the epidural pump. He gets a set dose per hour but also has the button here for breakthrough pain."

"Oh good!" she says, snatching up the little red button and pushing repeatedly. And by repeatedly, I mean she may have agitated her carpal tunnel syndrome. When I checked the pump to chart my epidural assessment two mintutes later ... delivered doses=5, attempted doses=35.

Great. Pt. dropped BP in PACU because of that shit. Awesome.

A few more minutes later I hear that oh-so-familiar monitor alarm. "DING DING DING. Bitch get in here, art. line pressure low. DING DING DING."80's/40's.


Freaking awesome. It's 1845. I would like to get home at a decent time tonight.

Mr. Pt. gets a little bolus and Mrs. Pt gets a little education and a swift kick in the ass back out to the waiting room til after I'm far far away.

Just because there's a bowl of M&M's that say "Free, eat me." Doesn't mean you go and eat them all. Just sayin.

Family-centered Care

I know I'm still a newbie. But I'm still shock at how much focus on families of patients take away from care of the patients themselves.

Would you rather me bring you a cup of water, or oh I don't know, find RT because Grandma is desatting on pressure control? Oh you don't know what that means? Because no docs have explained anything to you? And you only come to visit once a week and I need to call the doc NOW so he can tell you what's going on? Ok, Grandma, hold on and suffocate for a few minutes while I fulfill your families every request.

Yes Mrs. Wife, I am your husbands nurse today. What's that? You want to speak to the supervisor? Because no one notified you of your husbands Code Blue until after  he got transfered to ICU? Supervisor said next time we'll call you first before we call the code.

Hi Mrs Obese. Yes you're hubby is doing to same today. Yes we're doing our jobs. OH, you got your bill today. And you think we aren't caring for your husband properly because you're self pay. And he's got a decubitus I could fit my head it. Well that might be because he's 500 lbs and almost died everytime we moved him for the first two months he was here. No were are not neglecting him. Yes, I promise. *Meanwhile Mr. Obese is A&O lying in the bed behind her nodding and waving tryng to get her to shut up. But since he's trached with no passy-muir yet, she's ignoring his attempts at defending us.)


I'm a little too new to be this jaded.

The time I gagged.

Poop does not bother me. I live for poop. I can clean other people asses faster than I clean my own.
Occasionally and particularly bad smelling batch of shit will make my breath catch in my throat but I have never gagged over poop. Ever.

Enter Mr. Hard-to-Extubate. We'll refer to him as HTE for now. HTE was of the grungy variety. You ICU nurses know the type. Always stinky. No matter how many baths or what soaps you use. More teeth missing than present. In fact, we taped the tube in one of his gaps so he couldn't gnaw on it anymore. The wife was a piece of work too.

But I digress.

It was a typical day. Report, rounds, meds, wash, rinse, repeat. Nothing terrible exciting going on. Until HTE decides to move his bowels. We roll him, clean him, clean him, clean him some more. Then stand back and wonder why the hell he's not getting clean.

Upon a closer look, we see a little black things encircling his exit point. Tons of them. In the skin. Like watermelon seeds.

"C!! Come look at this!" I called out to my bump-popping precepted-me-as-a-new-nurse coworker.

"What?!" she yelled, bright-eyed and bushy-tailed like were about to call a code or something.

"Look at these blackheads!"

Her eyes lit up like a kid at Christmas, reaching for a pair of gloves.

Then she gets to popping.

Every watermelon-seed-black-head she squeezed out had me retching and thanking the nursing gods that the toilet was only two feet away.

Thank goodness poor stinky Mr. HTE was still pretty sedated because I was rather close to vomitting in his face.

I don't know if it was just the nasty concept of having ass-hole blackheads, the size of them, or a combination. But my stomach still turns everytime I think about it.

And now I have trouble eating watermelon.

From the mouths of babes...

...come some funny as shit words.

By babes, I mean newbie nurse, like myself.

I new to the world of nursing, new to the ICU, but not to blogging. Everyday I work I'm still amazed at the things I see and do. Grown men shake in their boots when I tell my tales.

Here I will start my effed up collection of stories (falsified of course) of my first six months. The good, the bad, and the dirty. The real shit storm days and not-so bad.

Fasten your seatbelts and grab your stethoscope. It's gonna be a bumpy ride.