Gone in 60 seconds

Life is so fleeting and fragile. Cherish it.

Have you ever seen a person pass away in front of your very eyes?

It wasn’t a violent death nor an accidental one but still, it was unexpected because of the very fact that he was talking to you and moving about in bed and the next thing you knew, a couple of hours later when you walk in and see him unresponsive and gasping for air until eventually his heart stops beating.

As this sweet old semi-confused man lay there with agonal breathing, I tried calling out his name and stood there transfixed and in a daze. I knew he was a DNR (Do Not Resuscitate) but all my nurse’s instincts were telling me to do something, to save him! No, it wasn’t his time yet, not on my watch. I checked his vital signs. They were all normal except for the temperature which wouldn’t register orally. I looked at him, he was the color of death and his feeble lips were still moving, trying to breathe. I knew I was in denial when I still attempted to check his temperature in his axilla while at the same time calling my charge nurse to come quick. His bony fingers were cold and his lips were grey. He was fading away fast. The monitor tech told me he still had a heart rhythm but an irregular one at that. I couldn’t feel a pulse nor hear a heart beat. The charge nurse and supervisor who came up a few minutes later confirmed that too. He literally stopped breathing and died in front of us. He then flatlined on the monitor. A doctor came up to pronounce the time of death.

My hands were as cold as his as I was trying to wrap my head around what just happened. No codes, no heroic measures. At least, we left his thin fragile and disease ravaged body intact and not be on life support. He surely knew what he wanted!

I was so relieved the doctor called the family. This task I really hated doing. How can you ever deliver such news? I never really knew how to say the right words.

As I went about doing other things, I can still hear his soft voice as he was consciously yet weakly talking to me earlier during the night, asking to be covered up because he was too cold or for a sip of water. And he never failed to say thank you every time. He got more and more restless and anxious as the night wore on. As if he knew death was coming, kept telling me “I am dying, call the doctor.”

The only thing I did to comfort him was to give him some mild pain reliever and an anti-emetic that were ordered because he also felt nauseous. I tried to reposition him and put his covers on or off as he requested. He was feeling hot and cold at the same time. He was just restless. He would quiet down and lay still for a few minutes and then he would pick at his hospital gown again.

I wonder if he really knew he was dying. I wonder what his last thoughts were. I wonder if he was afraid. I wonder if he was ready.

As my co-workers were being supportive and empathetic towards me, I kept my calm and held myself together. I was too busy to break down at this time. The more I did other nursing stuff, the more I couldn’t think about it. But at the same time, I wanted to talk about it. I wanted to relieve the pressure and burden. I wanted to cry.

Surprisingly, I didn’t cry. Even when I talked to my husband about it when I got home from work. Even when I had a good long hot shower. Even when I was getting ready to sleep.

Later that day, I still felt full inside and just about ready to burst. So I did yoga. When it was time for Savasana (interestingly enough, this is known as the corpse pose), I mentally let my mind float through the days’ events and at the same time trying to still my thoughts, that was when the flood gate of tears opened and in the silence of my living room, I cried my heart out. I cried for this poor old man who died without his family beside him. I cried because I could have done more to provide comfort to him. I cried because I couldn’t do anything about it. I cried because I can still see his face. I cried because I wasn’t expecting him to die that night. I cried because I just had to.

Nursing is a tough job.

IMG_20130324_073929

Who is Nurse Jackie?

We all know that nothing on TV is real. Even those ubiquitous so-called reality TV shows, game shows,  documentaries, not even the news. *sigh*

Everything is just so easily manipulated and crafted to make you believe what you want to see and hear and feel. What the public wants, the public gets. If you want blood, you get blood and gore. If you want sensational news, you got it! However, sorry, this is not going to be a political or a current events post. My blog is not the platform for that kind of nonsense. You all know me better than that.

For the past couple of days, I have been compelled to write about a TV series I discovered on Netflix that I have recently watched and felt a strong connection to. Let’s get it out in the open first. I rarely watch TV. In fact, I’d rather read or be on my computer than sit in front of that wide screen absent-mindedly flicking channels with the remote control. That is my hubby. He can be mesmerized by a TV ad, stop mid sentence and forget that I am in the same room with him while I am a totally non-TV person at all. Yes, we are complete opposites.

So what is this fascination about a Netflix TV series?

I don’t “Netflix and chill” like most young people do these days. (Errr, or is it just young people?) You have to click on the link if you don’t know what Netflix and chill means!!! I admit I misunderstood its meaning at first until a 15 year old boy corrected me. Oh dear…

Anyway, I got addicted, so to speak, to the TV series Nurse Jackie. I have heard of this show sporadically from nurses and friends, but I didn’t really take a keen interest on it that time. I had it grouped together with the likes of Grey’s Anatomy or House MD, which I watched the first few seasons of and then lost all interest.

518TruhJ+LL

To make this long story short, Jackie is a seasoned ER nurse in New York City who is battling drug addiction. She is a really great nurse but sucks in all other aspects of her life. Her husband, children, co-workers, lovers and friends are all victims to her lies and manipulation. Boy, does she make one really good liar! I am not an expert in addiction so I am leaving out my opinions and just telling it like the TV show does. So I binge watched all seven seasons in just about two weeks. How is that for addiction! Ha!

In several episodes, it shows her caring greatly for the homeless, the drunk and the drug addicts. She bathed a homeless and alcohol-abusing former nun and in the last episode of the final season, she washed the feet of a heroine addict. There’s lots of allegories here but of course, this was not without her gaining anything from doing these things. You can almost say that she was selfless and selfish at the same time. Well, I would say mostly selfish.

But what am I getting at? I have been a nurse for almost ten years. I have seen, heard and done stuff that most of you would not want to see, hear nor do. Blood, sweat, tears, urine, poop, mucus , vomit do not faze me anymore. I will take that than dealing with homeless people, drug addicts and ETOH’ers anytime.

Why do I say that? Aren’t nurses supposed to treat everyone equally with compassion and respect? In a perfect world, yes. The truth is, being in this profession can make you jaded and cynical and tired after seeing and dealing with these kinds of people. They know the system. After being in several different hospitals countless times, they know how to manipulate and make the system work in their favor. They know how to push your buttons (not just the call button). They know how to make your shift hell. And I am ashamed to say, I was becoming that jaded, cynical and tired nurse.

I stopped looking at them like persons. I stopped listening to them. As long as they got their drugs as ordered by the doctor, tried my best to make them happy by giving them food and warm blankets (with patient satisfaction scores in mind), I was okay with that. In the end, I stopped caring.

But Nurse Jackie undid all of that for me. I know it was just a TV show and I told you in the beginning that they aren’t real. Yet, somehow, it stuck in my subconscious. I recently had a patient who was a polysubstance abuser and a “frequent flyer” (one who likes to visit the hospital frequently) and instead of going through my usual motions when dealing with these kinds of patients, I realized I had a breakthrough moment when I was talking to him. I empathized with him, thought about his situation, gently and thoroughly applied ointment to his leg wounds, kindly offered him snacks the way I would with my other patients and actually looked him in the eye! I was so surprised at myself that night! I couldn’t stop and think about what Nurse Jackie would do in this situation. I know, it is just a TV show…

One that actually influenced me to change my behavior to a positive one. One that made me realize how everyone’s story is different and that we have no right to judge. One that unsuspectingly dismantled my cloak of cynicism and refreshed my tired jaded eyes. Yes, I am that much affected over a TV show.

In a good way.

Have you?

 

 

 

A Nurse’s Conundrum

You graduate from nursing school. You pass the board exams. After all those long hard years of toiling away, studying and cramming, sleepless nights and the lack of a proper social life, this is it… you are now officially an RN!!!

You can’t wait to work in a hospital. You get hired and all the paperwork that comes with it. Hospital orientation comes and goes. You start on the floor wearing brand new scrubs, squeaky clean nursing shoes and a Littman around your neck. Fresh from your books, you think you know everything. You are ready to conquer the day!

This is harder than you thought.

But first, a couple of months of floor orientation is required before they let you off by yourself to take care of patients. So you shadow a more experienced nurse for the meantime, learning the tricks of the trade, getting the know-how and the lowdown of the unit and hospital, the ins and outs of dealing with five to six patients and demanding doctors, the feel of not being able to eat lunch on time or holding your pee for six hours. This is different than you first thought. Harder.

Once you are done with orientation, you are good to go. Finally, you are free from your preceptor’s clutches and can now independently take care of patients. That doesn’t mean your nursing life is a breeze though. Three months does not give you enough experience to know the subtle differences between a patient who is in true pain and one who is merely drug seeking. Or if it’s okay to call the doctor at 2 AM for anti fungal powder or wait until the morning. Or who do you attend to first, the patient who is mad because she is hungry and in pain, the family member who has a question, the pharmacy on hold, or that bed alarm ringing from a patient that is trying to get out of bed. That’s why it is good to have a mentor around, one that you can trust and feel comfortable with, for moral and emotional support and back up. And even more better, good teamwork from staff. Much, much harder than you thought. 

On becoming a mature nurse.

As the years pass, your skills grow and your confidence develops. You’re definitely more knowledgeable now than when you first started. Your scrubs are wrinkled and have that distinct hospital smell. Your nursing shoes have all sorts of stains known to man and have probably stepped on various bodily fluids that you wouldn’t even want to know. Your original expensive stethoscope, if it didn’t get lost or stolen, is now replaced by those cheap yellow disposable ones. You have dealt with emergency situations but can never find it easy to let family know that their loved one has passed away. But you are more wiser now. More organized, more efficient.

And so with being a staff nurse comes the numerous meetings and hospital politics. First, you don’t seem to mind. You try to help and get involved as much as you can without sacrificing your precious day off. Of course you want to be a part of the team. More and more changes and policies come. Managers and assistant supervisors come and go. Instead of being beneficial to the staff to make the workload easier, it gets more and more ridiculous and time consuming. They demand more and more from you. They don’t seem to listen to your needs. You get frustrated. You start to get jaded. It’s not about the patient anymore. It’s about scores and reimbursements.

Burnout.

To add to that, the acuity of patients being admitted get more and more severe, the patient to nurse ratios get higher and higher (except in states with mandated nurse-patient ratios like California) and some people just repeatedly abuse the healthcare system with staff receiving little to no support at all from administration leading to increased burnout and high turnover. All these lead to huge nursing shortages in most parts of the country. Nurses are leaving the bedside to either work in clinics or a non-hospital setting or to simply stay away from nursing. With this exodus, the already worn out staff gets stuck with more and more patients. More patients mean sub par care. It’s a vicious cycle.

Travel Nursing.

Some nurses leave their full time jobs to do travel nursing. That seemingly “glamorous” world where nurses work for 13 weeks (more or less) at any state of their choosing, where they play and explore on their days off and then pack up their bags and move on to the next adventure. Free from staff meetings and hospital politics. Free to go wherever you want to go. Sounds easy? NOT!!!

Travel nursing isn’t for the faint at heart. It definitely is not for everyone. There is so much more into it from getting a good recruiter to negotiating for your pay packages to looking for safe and affordable housing close enough to the hospital to packing light (or not) to traveling to your assignment to adjusting to your new environment. At the end of your contract, you have to do it all over again, either extend in same hospital or elsewhere. Or you can take a month long vacation overseas, how cool is that! That my friends is travel nursing in a nutshell.

Conundrum.

So what is a poor tired nurse to do? Stay as hospital staff and just pretend to ignore all the BS involved? Have job security but no freedom to go on longer vacations? Or jump into the exciting but uncertain world of travel nursing where hospital politics are not your concern, and contract cancellations may happen any time? Where everyday is an ongoing adventure?

Dreams or reality?

What would you do?

nurse51.jpg

 

 

 

 

“My 12 Hours as a Night Shift Nurse” ~ Week Twelve: Where is my doctor’s stethoscope?

This post is inspired from the recent controversy regarding certain TV hosts who made “brash” comments regarding a Miss USA candidate’s talent show performance. It so happened that this particular beauty representing Colorado is also nurse. Now, I don’t care much for beauty pageants and such but the context from which this whole post is about is personal to me.

As Miss Colorado stood on that glittering stage sticking out like a sore thumb in her nurse’s scrubs, she delivered a powerful monologue about nursing and how it impacted her life. I am not going to critique her as to her performance because I am no talent judge but her story and her words deeply touched me, maybe, because I am a nurse too.

The following day these talk show host ladies (I’m not even mentioning the show and their names because I think they’ve been overexposed already as a result of this ruckus) bashed this poor nurse’s performance saying she was “reading from her emails” and “what was she doing with that doctor’s stethoscope?”.

I believe that last statement was tactless and ignorant. They claim it was made all in jest and that “we” weren’t listening well – after they made a public “apology” on their show when they got blasted all over social media by at least 3 million nurses in America. I never knew we were that many!

Lesson of the day: Research first before opening your mouth and making opinions or comments about something specially when in the media. But then again, some people just love controversy, don’t they? Any kind of publicity is good publicity, right?

Lastly, don’t get the nurses mad. We decide what size foley catheter or IV catheter to put in you. Seriously speaking, we can help save your life. We don’t ask for much. We work long hours, get beaten up, kicked at, spat on by confused patients, clean up your mess and sometimes rarely get a pee break! We don’t steal doctor’s stethoscopes, we have OURS. In fact, it is the other way around. They steal ours (sometimes).

This is an old post that I am reviving for this week’s travel nursing weekly updates. It is somewhat lengthy but I am proud to show you a little bit of my world.

That Traveling Nurse

I’ve been blogging mostly about my travels and personal life but never really touched much about my work. Well aside from HIPAA* laws that prevent us from revealing and divulging our patients’ private health information, I haven’t really found the urge to write about it (my work, not my patient’s private health information, I don’t want to get fired, thank you!) until now.

Welcome to my boring nurse life!

choose-to-be-anurse

1600 – My alarm goes off. Time to wake up!

1630 – Done showering and changing into half my scrubs.

1630-1700 – Dinner with the hubby.

1700-1730 – Finishing up, getting ready for work. Top scrubs donned, after brushing my teeth (of course I do not want my top to be smeared with food or toothpaste).

1730-1745 – Getting my lunch food/snacks ready, and my hubby’s too, if he is also working. Playing around with Facebook, WordPress and/or emails while waiting.

View original post 1,416 more words

We Cry Sometimes Too

When my patient dies, I try my hardest not to cry. I try to look composed and act all professional as I deal with the paperwork and flurry of phone calls that comes with a patient expiring. Most of the time, a pool of tears threaten to spill down my eyes as I try to swallow that big ball of sadness going up and down my throat. Sometimes, a tear slips down quietly unnoticed. I quickly wipe it away.

I may have been a nurse for more than ten years and you would have thought that dealing with death and dying is all but normal for us. Yes, it comes with the job. It is part of a nurse’s world. We even studied post mortem care in nursing school. And you would have thought that four years in nursing school would prepare me for that too.

No.

If a very sick patient does not get better, death is inevitable, everyone knows that. Heck, death is a part of life itself! Easily said. But not when it is YOUR patient. Not even when that patient is a DNR (Do Not Resuscitate). Not even when hospice care is involved. What will I say to the family members? Is hugging okay? Offering tissues perhaps?

But why do I get affected that way when I do not even know this person, at least, not personally? I do not know their families, what kind of lives they have, their issues and conflicts, their hopes and dreams.

All I know is that that patient expired on my watch. Maybe, there is a feeling of guilt attached. That I was not vigilant enough. That I didn’t take care of him enough. That I didn’t do enough. Be it an expected death or not, I always, always find it hard to do THAT phone call, especially in the middle of the night. I don’t know how surgeons or physicians break bad news to patients and families. They just do it.

Of course, it is harder if it was an unexpected death or say, the patient coded (either from a respiratory or a cardiac arrest) and the code blue team (that amazing team of doctors, nurses and respiratory therapists) is busily resuscitating and has been for several minutes now, the prognosis looks dim as the patient is elderly and has a multitude of medical conditions to begin with, and we do not know for certain if the patient is going to survive being intubated and sedated with a million other IV drips going, or if he does, for how long is he going to be this way. These are ethical questions and dilemmas that we as health care providers face everyday. And when that situation arises, you, as the primary nurse taking care of that patient being coded is responsible to call the next of kin and let them know what is going on. In short, you have to ask them what they want for the patient’s best interests. If they want everything to be done, then so be it. The team will work their hardest to succeed and let the patient live another day. If the family wants enough and no more has to be done (at this point, the patient has suffered maybe more than enough), then the team stops all resuscitation efforts and let nature take its course. However, that call that you make to the family is as close to or almost exactly the same as telling them that their beloved family member has passed away. And it is never easy for me.

More often the public may see us as calloused, hardened people. We talk about the grossest things, especially when eating. We laugh about the silliest medical jokes which others may perceive as offensive. We act like we do not care at all when the truth of the matter is, we are affected deep inside to our very cores that to show emotion would mean having to break down our barriers that we have ever so carefully put up and then not being able to deal with the situation in an objective manner. Everything we do at work has a purpose.

Even crying just a little bit at that patient who just passed away.

Nursing is a tough profession. Not everyone called gets to be chosen. I am blessed to be one of them, as hard as it is.

When my patient dies, I also pray that they journey well to the next world.

IMG_20130324_073929

A Birthday Sunrise Treat

A few days ago, I celebrated the first few hours of my birthday working at the hospital. Midnight came and there I was passing meds and checking on my patients, playing catch up with my charting and at the same time finishing my admission. Hubby texted me at exactly midnight to greet me. Other than that, there was not much fanfare until later during the day.

Like most nurses, I was thankful I made it to the end of my shift without a patient crashing or coding. We all pray for a quiet night although no one would dare say the “Q” word out loud in fear of jinxing oneself. Busy nights are okay as it makes the shift go by faster but anything busier than several successive admissions, a rapid response or a code, is really not welcome.

So I drove home eager and excited for my day ahead, the surprise dinner my hubby planned and for the chance to stay overnight in Orlando again. Well, not really, Orlando is about an hour away from us and we’ve been there so many times that it has lost its magic and charm. Honestly, I’m really not that excited. I was dreaming more like busy airports and plane rides and exotic locations but, this time, we were being pragmatic because we were saving for our future big trip. Hence, Orlando it shall be for the time being. I can’t complain too much.

Since America moved its clocks forward for the Spring season, every time I go home, I get to drive with the sun coming up to greet the day with its soft golden rays touching the Indian River. Always a beautiful sight!

Because it was my birthday, I spontaneously made a decision to stop by one of the parks along the river and enjoy the morning views. I thought I would give myself a visual treat. I remember my birthday last year when I was working in Connecticut, cold and colorless.

Having scenery and moments like this make me think how blessed we are to be living in Florida!

(All photos taken by my phone)

Wound Care 101

most-terrible-moment-in-life_o_1193640

Being a nurse, I have seen my own fair share of wounds, though not as crazy as those that you see in the Trauma units/Emergency Department, they come in many different kinds and sizes as well.

I can deal with wounds, open, bleeding, oozing, even the pustulent kind (no gory photos here). Grab a pair of gloves, clean it with good old saline, apply pressure to stop the bleeding or pack it with whatever the doctor prescribes and then slap some gauze and ABD pads to cover it, secure with tape. Or if it is just a tiny one, bandaid! Easy, right?

Then there is the other kind of wound. The emotional one. The one that you can’t see, measure or quantify. The one that can wreck havoc in your life. I can’t deal with that. And yet, they come in different kinds and sizes too. No matter how much you try to clean them, or dress them or apply pressure to stop the bleeding, it always comes back. Eventually, the wound can become a scab or a scar but in just an instant, a memory, a word, a gesture, a picture, that scab can be picked and ripped apart or the scar can become just as fresh as it was when it first started.

Hurting and painful.

Bandaids please anyone?