When I was in the peds cardiac ICU, there was a surgeon who seemed to
have particular joy in making nurses tense and everyone jump when he
came storming into to room. Even when everything was fine he was really
aggressive at getting answers met. When things were bad, he was far
worse. Imagine already having really high adrenaline levels and
sweating to do everything you can to save this child's life and then
this tall man walks in yelling at you and everyone else in the room! I
remember him standing over me literally so close that I had to crane my
neck up to maintain eye contact while he fed me 20 questions and
feeling my heart in my throat. I tried to leave the room and he
followed right behind me continuing to talk at me.
Only one nurse seemed to know how to deal with him and that was because she was
much older than him, had many more years of experience and was very, very New
York - Brooklyn even. She talked right back to him as if he was being
ridiculous, while showing she was obviously on top of the situation, "so
why was he so stressed out?" He liked it. I took notes. I was not any of
the three things she was, but I could display confidence around him and
let him know I was on top of the situation he was emoting about.
Things changed after one of my patients coded and we saved him. The infant had only
a single ventricle and had had his chest open for several days after
his heart surgery - because the pressure would have been too much to
close right away (there is a sterile dressing covering it all, but
still weird to see). They had just closed his chest earlier that day
and the surgeon went home. He went asystolic (ie flat line) and we
rushed to revive him. These children are very tenuous and when they do
code, they typically have to be placed on a mini heart and lung bypass
machine of sorts (called a ventricular assist device) to support them
for a few days. But this baby did so well after our resuscitative
efforts, that was not needed. The surgeon came in long after it was all
over and seemed amazed. He still tried to bark orders by having me
increase the dosages on some of the inotropes (medications to support
the various heart functions and blood pressure) and I would call back
"So you want this much? That means X per min." As I dialed it on the IV
pumps, he tried to be condescending by asking How do you know that?!
And I looked back at him and smirked, saying "I calculated it." He's
been nice to me ever since. Even now when I run into him in the
cafeteria, he asks why I'm not still there and tells me his patients
need me.
Friday, June 22, 2007
Feb 2005 The Morgue
Some how I've lucked out and have always had someone
else take the body away after I've done post mortem
care. No one to do it last night. I carried my infant
patient in my arms, covered by a blanket, down to
security to get the key and then down to the basement
morgue where I placed her in a bag. There's something
so weird and final about zipping up that bag over the
face. I placed her next to another tiny body in a
refrigerated room.
I keep playing the moment of her death over and
over.... her parents holding her, crying out her name.
Wondering if I was supportive enough for them......
Not an easy aspect of my job.
else take the body away after I've done post mortem
care. No one to do it last night. I carried my infant
patient in my arms, covered by a blanket, down to
security to get the key and then down to the basement
morgue where I placed her in a bag. There's something
so weird and final about zipping up that bag over the
face. I placed her next to another tiny body in a
refrigerated room.
I keep playing the moment of her death over and
over.... her parents holding her, crying out her name.
Wondering if I was supportive enough for them......
Not an easy aspect of my job.
Sept 2004 offer
This morning, driving Mike to Cal train, I get a phone
call from my boss. I think she's tryin to get me to
work extra this weekend and right away I'm forming
excuses in my mind, when she asks me..... if I'd be
interested in training in the Peds heart cath lab.
Didnt see that one coming!
The cath lab is a place where cardiac diagnostic and
other proceedures take place (angio grams,
angioplasty, Rashkind, stent placement, ect). Some of
these procedures are done to allow a newborn to grow a
bit and maybe get to go home for a few months until
their open heart surgery. Some fix the problem all
together and prevent a baby from having to go through
surgery.
It's temporary..... to fill in for nurses on maternity
leave. But it'll be really great experience!
Something new and different to learn! It'll be an
amazing adition to my resume! And it may mean a better
work schedual (not 100% sure on this one) But I do
know that most heart caths happen during normal
business hours mid week. ie, I may get a break from
the night shift and working weekends for a while!
call from my boss. I think she's tryin to get me to
work extra this weekend and right away I'm forming
excuses in my mind, when she asks me..... if I'd be
interested in training in the Peds heart cath lab.
Didnt see that one coming!
The cath lab is a place where cardiac diagnostic and
other proceedures take place (angio grams,
angioplasty, Rashkind, stent placement, ect). Some of
these procedures are done to allow a newborn to grow a
bit and maybe get to go home for a few months until
their open heart surgery. Some fix the problem all
together and prevent a baby from having to go through
surgery.
It's temporary..... to fill in for nurses on maternity
leave. But it'll be really great experience!
Something new and different to learn! It'll be an
amazing adition to my resume! And it may mean a better
work schedual (not 100% sure on this one) But I do
know that most heart caths happen during normal
business hours mid week. ie, I may get a break from
the night shift and working weekends for a while!
Coping with Death
My boyfriend is the largest part of my
support network and I feel guilty for having to use
his sholder to cry on so often because of my work.
Thats why I've always focused on getting out of town
whenever possible. Roadtrips, camping, snowboarding,
etc helps keep me sane. But sometimes even thats not
enough.
When a child was expected to die, the situation is hard but a bit easier to deal with. The hard ones are the ones that surprise you; when they plummet and you fight hard for their life coding for hours and still dont get
them back. And the older the kid is, the harder it is
for everyone to accept.
2 infants died the week of October 17, 2004 . A little girl,
after caring for her for over a month post op, and a
little boy we cared for over 6 months of multiple
surgeries. Both deaths were hitting me very hard.
Especially after the numerous deaths we've had the
past 2 months in the ICU. Including an 18 yo we tried
to save through 2 hours of chest compressions and code
drugs. It pains me to watch the families mourn. I was
doing a lot of crying with them, and couldn't seem to stop once I go home.
No one ever said nursing was glamorous.
support network and I feel guilty for having to use
his sholder to cry on so often because of my work.
Thats why I've always focused on getting out of town
whenever possible. Roadtrips, camping, snowboarding,
etc helps keep me sane. But sometimes even thats not
enough.
When a child was expected to die, the situation is hard but a bit easier to deal with. The hard ones are the ones that surprise you; when they plummet and you fight hard for their life coding for hours and still dont get
them back. And the older the kid is, the harder it is
for everyone to accept.
2 infants died the week of October 17, 2004 . A little girl,
after caring for her for over a month post op, and a
little boy we cared for over 6 months of multiple
surgeries. Both deaths were hitting me very hard.
Especially after the numerous deaths we've had the
past 2 months in the ICU. Including an 18 yo we tried
to save through 2 hours of chest compressions and code
drugs. It pains me to watch the families mourn. I was
doing a lot of crying with them, and couldn't seem to stop once I go home.
No one ever said nursing was glamorous.
Thursday, June 21, 2007
Emotional Wound Analogy
Let me tell ya what I know about wounds. The deeper
they are, the more problematic a bandaid becomes.
Sure, it seems like its protecting the wound, allowing
it to heal, protecting it from infection. But what if
the infection is already in there, and now its trapped
with a covering to keep things moist and warm for
further breeding. The sking starts to scar and heal
as skin does, but the wound still lies benieth, not
having the chance to properly heal from the inside
out. Sometimes it continues to grow deeper and deeper
in the tissue, while looking ok from the outside and
confusing the person who cant figure out where the
pain is comming from.
To really heal a deep wound, you have to get in there,
behind the bandages and clean it, regularly, to
prevent infection and keep the tissue healthy as it
heals. Sometimes a temporary bandage is useful. but
it cant stay on and the wound may need some debreeding
there after to get rid of the scar tissue and get back
to the healthy tissue needed for really good healing
from the inside out.
they are, the more problematic a bandaid becomes.
Sure, it seems like its protecting the wound, allowing
it to heal, protecting it from infection. But what if
the infection is already in there, and now its trapped
with a covering to keep things moist and warm for
further breeding. The sking starts to scar and heal
as skin does, but the wound still lies benieth, not
having the chance to properly heal from the inside
out. Sometimes it continues to grow deeper and deeper
in the tissue, while looking ok from the outside and
confusing the person who cant figure out where the
pain is comming from.
To really heal a deep wound, you have to get in there,
behind the bandages and clean it, regularly, to
prevent infection and keep the tissue healthy as it
heals. Sometimes a temporary bandage is useful. but
it cant stay on and the wound may need some debreeding
there after to get rid of the scar tissue and get back
to the healthy tissue needed for really good healing
from the inside out.
ICU Cookies Aug 2004
Working in a busy ICU, thats often understaffed, there
are days where I feel like I'm putting out fires right
and left. But this month, I'm on night shift.
Typically no fires. The pace is often slower. Slow
enough to bring in cookie dough to bake in the toaster
oven in the staff lounge.
It seemed like a good idea at the time.
The toaster oven, while used, seems to have been in
decent shape. We set the temp to the recommended 350
degrees and discovered with our first batch that in
less than 5 min, the top cooked much faster than the
middle and got a bit dark. Still tasty, just a bit
doughy in the middle. The second batch, we decided to
flatten and cook at a lower temp and watch closely.
These came out great! Only six more to go and it's
time to serve hot chocolate chip cookies to all my
co-workers at 5 am. Who wouldn't love that? With the
last batch in the toaster oven, I asked another nurse
Sarah (yeah there's 2 of us here) to watch them while
I take care of my patient.
Next thing I know Sarah and Jamie are yelling from the
lounge "Oh my god there's a fire! I'm not even
kidding you Sara!" I ran, grabbed a towel and soaked
it ran in to the lounge to find flames leaping out of
the toaster oven and licking the shelf above. I start
batting it with the wet towel with one hand while
removing items next to it with my left and yelling at
the other two (who are totally freaking out) to get
the extinguisher. But they only run around saying "I
don't know where it is! Arn't we supposed to call
someone? Who do we call?!!"
Take in to perspective that these are ICU nurses here.
We're used to high stress situations with patients
who drop their heart rate and blood pressure with in
seconds. This requires a personality who can hold it
together in times of crisis. We've been trained for
such. Except in cases of fire. Drills we've had.
Inservices on who to call and how to use and
extinguisher. All the info is even printed on the
back of our badges. But the situation has really
never come up.
So my two cohorts are running circles around each
other while I'm battling flames and trying to figure
out how I'm going to reach around the flames quick
enough to unplug the toaster. Finally someone got our
charge nurse from her break and she came in and
immediately closed the door of the toaster. Fire was
out. (Now why didn't I think of that?) But the smoke
thereafter was really incredible! The charge nurse and
I soaked the burnt cookies and threw all the
incriminating evidence in the trash. By now alarms
went off and several service men showed up to
investigate, followed by the sound of fire trucks
outside. As the front of our ICU was filled with
Firemen in full gear, my cohorts and I stood by,
giggling from embarrassment and competing for reddest
face (Tough competition! They're both redheads and
really good at such shades!)
So the toaster is, well, toast. The electrician
checked out the scene and came back to tell us the
good news: that the coffee maker was on a separate
circuit, so everything will be ok.
My throat feels like I just had a cigarette. My scrubs
and hair really stink. And my charge nurse has
nicknamed me "Pyro"
I think I'll leave the baking to conventional ovens
from now on.
are days where I feel like I'm putting out fires right
and left. But this month, I'm on night shift.
Typically no fires. The pace is often slower. Slow
enough to bring in cookie dough to bake in the toaster
oven in the staff lounge.
It seemed like a good idea at the time.
The toaster oven, while used, seems to have been in
decent shape. We set the temp to the recommended 350
degrees and discovered with our first batch that in
less than 5 min, the top cooked much faster than the
middle and got a bit dark. Still tasty, just a bit
doughy in the middle. The second batch, we decided to
flatten and cook at a lower temp and watch closely.
These came out great! Only six more to go and it's
time to serve hot chocolate chip cookies to all my
co-workers at 5 am. Who wouldn't love that? With the
last batch in the toaster oven, I asked another nurse
Sarah (yeah there's 2 of us here) to watch them while
I take care of my patient.
Next thing I know Sarah and Jamie are yelling from the
lounge "Oh my god there's a fire! I'm not even
kidding you Sara!" I ran, grabbed a towel and soaked
it ran in to the lounge to find flames leaping out of
the toaster oven and licking the shelf above. I start
batting it with the wet towel with one hand while
removing items next to it with my left and yelling at
the other two (who are totally freaking out) to get
the extinguisher. But they only run around saying "I
don't know where it is! Arn't we supposed to call
someone? Who do we call?!!"
Take in to perspective that these are ICU nurses here.
We're used to high stress situations with patients
who drop their heart rate and blood pressure with in
seconds. This requires a personality who can hold it
together in times of crisis. We've been trained for
such. Except in cases of fire. Drills we've had.
Inservices on who to call and how to use and
extinguisher. All the info is even printed on the
back of our badges. But the situation has really
never come up.
So my two cohorts are running circles around each
other while I'm battling flames and trying to figure
out how I'm going to reach around the flames quick
enough to unplug the toaster. Finally someone got our
charge nurse from her break and she came in and
immediately closed the door of the toaster. Fire was
out. (Now why didn't I think of that?) But the smoke
thereafter was really incredible! The charge nurse and
I soaked the burnt cookies and threw all the
incriminating evidence in the trash. By now alarms
went off and several service men showed up to
investigate, followed by the sound of fire trucks
outside. As the front of our ICU was filled with
Firemen in full gear, my cohorts and I stood by,
giggling from embarrassment and competing for reddest
face (Tough competition! They're both redheads and
really good at such shades!)
So the toaster is, well, toast. The electrician
checked out the scene and came back to tell us the
good news: that the coffee maker was on a separate
circuit, so everything will be ok.
My throat feels like I just had a cigarette. My scrubs
and hair really stink. And my charge nurse has
nicknamed me "Pyro"
I think I'll leave the baking to conventional ovens
from now on.
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