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.