Thursday, April 17, 2014

I'm no longer a virgin

I'm shell shocked speechless

I had my virginity taken away from me....

One of my patients died. While I was working.

Sort of anyways.....

Between my first shift and me coming on for the next shift my patient's O2 needs increased ALOT.... as in 2L to requiring 50% O2.

He lasted on 50% for 2 hrs then went up to 60% for an hour then needed 100% via a non rebreather mask in order to simply maintain him at 90% - and I had the vitals machine hooked up to his toe so that if I or any of my colleagues went past his room we would know what his sat was (BTW ALL his other vitals were awesome)

I did my last rounds at 0645hrs - I get off at 0730hrs so that left me enough time in order to complete my documentation.

At 0730 hrs I gave report on 4 of my patients - then was about to go into THAT pt's room when my colleague decided she wanted report on the other patient first - I said alright and we went to the room next door (door ways are not next to each other tho) and gave report.... took about another 5 minutes total.

When we went into Mr. X's room, he was gone. You could tell just by looking at him. Clearly he had just passed because he was still warm. My colleague and I just looked at each other completely shocked. He was NOT expected to pass! At least he was a DNR so we didn't have to do anything to him but man was I shocked. I couldn't believe he had died.

Stats state that people die most often at change of shift - go figure!

I feeel a bit of guilt - maybe had I gone in there another time he wouldn't have died. You coudl tell that he knew he was dying because he took off his oxygen mask. It was sitting in his hand. So maybe if I had gone in there again it would have stayed on his face, helping to keep him breathing.

When I informed his doctor that he had died he was shocked as well. No one expected this guy to die. I mean, 2 days previously he was on the rehab unit!!!! He was on his way to getting better (he was a previous patient on our unit and I had taken care of him when he was with us before - so it was kinda surreal). So because he wasn't expected to die there was no order on his chart that indicated that the nurse could pronounce so we had to wait to pronounce til the doctor made it to us.

I felt bad for his family as well because they didn't get a chance to say their goodbyes. When I called his family I was only able to say that he was doing poorly and that they needed to come now (charge nurse told me not to tell them that he had died). Sucks. His family was shattered that they didn't make it in time to say goodbye. So of course they're going to feel guilty that they didn't get to the hospital faster. UGH. I would seriously be pissed or feel guilty if that sort of thing happened to me let me tell you!

I left my patient's death rites to my colleague but I did all the documentation associated with his death. May he rest in peace!


Monday, April 7, 2014

I passed at least

Unfortunately I missed the top level by 3% - ugh!

Feeling less overwhelmed but at least I have a bit of stuff off my plate. I'm plugging my way through it.

I feel like the little train that could - "I think I can, I think I can, I think I can" - therefore I know I can.



On other news... I've been in talks with the teacher of my next course (clinical that is) about trying to set up placement cause I've had SUCH a hard time getting it arranged myself. I have inquired whether I would be able to do placement in the ER because I work already in a medical unit and if I can't get into a surgical unit then I would love to try out a placement in the ER. We'll see how that goes though, it's doubtful.

Friday, April 4, 2014

Overwhelmed

A feeling I can certainly say I feel at the moment.

Here's what's on my plate...

Sunday previous - MAJOR test - only got 73% on it (boo!)
Tuesday this past - 3 quizzes - not too bad but a TON of reading for it
Tomorrow - MAJOR paper due - still reading resources, got my quotes picked out (mainly) but still have to get it put together

Saturday - working days then coming home and studying immediately BECAUSE....
Sunday - another MAJOR test - can't say I feel prepared for it! Oh and I have to also work days! Plus I have a discussion board post due and my final draft of my paper for my one course (finished that one already at least)

Then Tuesday I have 2 more quizzes - TON of reading for them.
Friday - MAJOR paper due - mostly done - still have to complete the editing though.
Sunday another discussion board - and I work saturday and sunday evenings.

And it just keeps going like that with a few more tests and quizzes thrown in for good measure!

Seriously, I'm only JUST keeping my head above water - it doesn't help that this paper that's due tomorrow is NOT a subject that interests me (so as to try my ADHD!) and the psych course is the bane of my existance (I hate the subject - and hate is a strong word but it so aptly fits!). I just keep telling myself to take one day at a time, it's the only way I'm surviving.

Monday, March 31, 2014

Never thought this would happen

Saw the surgeon today, after my night shift....

And he said that I was healed enough that he cut my fistula string!!!!!! I'm done with it.

I never thought it would happen. It's felt like it's been FOREVER and a day since this all started.

He said I don't need to see him again....

Unless I develop another abcess (good God I sure hope not!!!) or if the fistula doesn't close up properly and I am still getting discharge and pain in a month from now.

He gave me another month of short weeks for work but then I should be back to work regular schedule!

Saturday, March 29, 2014

How did I get myself into this mess?!

I was sleeping away, dreading getting out of bed.... it was after 3:30 when the phone called.... it was my charge nurse asking where I was and why I wasn't working! HOLY SHIT BATMAN, I wasn't SUPPOSED to be working.... Hell I even double checked that since two weeks ago I went into work when I wasn't supposed to be working (OK with that because at least I'm not getting in shit for going in when I'm not supposed to)... so I made for SURE what I working this weekend. So much so that I printed out new schedules last week because I was paranoid about missing a shift or something.

So I told my charge nurse that I didn't have a problem coming in but that I would also bring my schedule to PROVE that the problem wasn't me this time!!!

So I brought my schedule in and even proved myself! What was her response?! Ya, make sure that you go into the scheduling system to ensure that you know your shifts, don't go by the print outs that SHE does!!!!! Grrrrrr...... Lady it's not like I'm available to work many shifts! We also called scheduling people to ask when the shift was accepted... turns out more than a week ago at 10:20 AAAAAAAMMMMMM - let me state this in VERY clear language - I LOVE MY SLEEP!!!! So when I drop my daughter at school, I go straight to bed... I do NOT pass go.... so I sure as hell wasn't answering the phone at that hour to accept a shift more than a week in advance!!!!

Plus, when I accept a shift, I get the scheduling people to send me an email indicating which shift I've accepted on which day so that when this sort of shit happens I can have proof or something.... well I certainly did NOT have an email from them indicating the "supposed" shift I picked up.

So off I went.... late - and it was the shift from HEEEEEEEEEEELLLLLLLLLLLLLLLLLLLL - it was like it was fucking payback for not knowing I was supposed to be working or something.

Pt 1 - CVA, lang barrier - on the call bell ALLLLLLLLLLLLLL the time - which I don't understand half the time what the pt wants... so that was fun - oh and a diabetic so you have all the extra work that goes along with that.... plus she's incontinent.

Pt 2 - non formed but has a security guard - because he's hallucinating - that snakes are crawling all over him - turns out it's actually illusions which still suck majorly but the pt KNOWS that what he's experiencing isn't real but still it traumatized and wants it to end! Plus he's a double amputee who's also a diabetic - and is newly admitted and the chart hasn't been checked yet by a nurse (so that "fun" job lands on my shoulders - which has to be checked BEFORE I can do meds or diabetic stuff) - and he doesn't want to be in his bed (because he thinks that the bedding is snakes (don't blame him for that one) and so he's very anxious and needs a LOT of hand holding and reassurance.... plus psych came and saw him so I got even MORE orders (at least these should stop his illusions - we hope!)

Pt 3 - trached, MORBIDLY obese, basilar stroke (AKA VERY BAD), legally blind and because of the stroke can't talk - but she CAN hear and DOES understand - (man that would suck!) and she's in pain and for some reason thinks she's going to fall out of bed so ANY kind of movement makes her startle and drip the side rails for dear life. She's incontinent so it takes several of us to change her (which causes more work because you have to go FIND the other people to assist). Has a PEG tube which means that you have to crush the meds and dissolve them and THEN administer them.... which means lots of work. Oh the fact that there's a trach insitu means that you have to suction so there's more work for you there - I had to do so 4 times in my shift... and when you suction it has to be sterile so there's more work there. She's on 2 different antibiotics that you have to go into our med room for - so more work for that. And she's diabetic - so more work for that one.... oh and when I came on she was tachycardic at >145 bpm - but BP was JUST FINE - so I had to call the doc about that one - administer that med..... which didn't really bring the pulse down so after about 4 hours I had to call on-call doc and get ANOTHER med ordered.... and that all takes work because you have to transcribe the med, get the med co signed - then go give it..... and an hour later recheck vitals and an hour later recheck again. Good thing was was that she wasn't symptomatic - she wasn't having trouble breathing and her BP was good.... it was just that her heart was racing. The other part of lots of work has to do with her tube feeding - you have to make sure that you only put one can in at a time because this reduces reflux and the risk of aspiration (forget why but as long as it work it's cool with me!) but you have to still take the time to fiddle with the stuff... and when you give meds you have put them through that which can be a pain in the butt..... FYI pantoprazole is NOT a good med for PEGs or G/J tubes - it clogs them regardless of what you do. And I have told our pharmacist to ensure that autosubbing is done for this stupid med but I am ALWAYS the one bringing it to his attention.

Pt 4 - my ONLY independent pt - did NOT know that he had a urostomy until like 2000hrs when the daughter went looking for me because his urostomy was leaking!!! So off I went to find supplies to change it out - which THANKFULLY we actually had on unit! And of course THAT takes more time away that I just don't have.... he had an IV and two antibiotics - quite a bit of work for that one because I had to prime two lines (incompatible with each other) because he's a new patient.... Other than that he was simple! Poor guy got ignored otherwise. Such is the life though!

Ya it was nuts to say the least. I have 2 more night shifts to go for this weekend - I hope they're better than tonites shift! Though I know who'll be working with me tomorrow and when this one gal and I work together it seems like the floor goes crazy - honestly, the last time we worked we had to restrain FOUR patients, and other patient had a grand mal seizure for like 3 minutes! Insanity! So ya, it should be interesting!

Thursday, March 27, 2014

Got me my referrals

Saw my GP today - had an "episode" of anostic aphasia while in his office with him and he didn't take notice - I did but he didn't and neither did hubby for that matter. What happens most often is that I go blank when I can't find a word and sort of stutter or go "uuuuummmmm" til my brain can beat around the bush and somehow come up with the word I was looking for. But the doc was willing to take me at face value (LoVE him for this, usually when I ask for something with him - side note - he knows I'm a nurse in a hospital on neuro - so this helps - that I get what I want) and I got me a referral to my hospital's neuro clinic in which I can basically choose which doc I want - I have two that are great in my books - one looks like he should be on a soap opera (no lie!) and the other treated me when I had the meningitis and was in my hospital. So we'll see how that goes down!

I also got a referral to a gyne - need me a change out of my IUD - which my GP is bummed out for us.... he keeps pushing/encouraging us to expand.... I told him that when I'm done my RN THEN we will. But for now I need my IUD changed out so that that doesn't happen. He asked when I needed it by - which is December but I would really feel more comfortable having it done so before then because the hormones in it are sapped out more quickly when you're over weight and I am - about 60 lbs so and so this makes me a bit nervous. We don't want to be in a predicament that's for sure.

My other referral was for a dermatologist - I have super bad acne. Have since I was about 17, it just sort of snuck up on me and I got a bad case of it. It drives me bonkers. I've tried almost anything to get rid of it. The only thing that SEEEEMS to help is Accutane but let me tell you, it's tough shit! It's no joke. Gets rid of my acne while I'm on it and for a while after I'm off it but for some reason it hasn't been permanent with me - as it most often is with people. This drug is teratogenic (BAAAAAAAAAAAD news for fetuses!) and so you HAVE to sign a contract saying that you will use TWO forms of birth control while on it and do monthly pregnancy tests or else they won't/can't prescribe it for you. It also can do a number on your liver and so you have to have monthly LFTs to make sure that it isn't killing your liver too much.The last time I was on this stuff I burnt sooooooooo badly - even with a caked on layer of 8 million SPF! I burnt so bad that my skin on my HANDS peeled! It was UUUUUUBER grosse!

I also got my prescriptions refilled. This was the funniest part because when I asked for my maxeran and he only ordered 10 mg, I corrected him and said I needed 20mg he was like "what you addicted to it?!" Shit I almost pissed myself.... who was he kidding, it's not like it's addictive! I knew he was joking but still.

Then I got my sick note for work so that I can still work weekends - tho I asked for Thurs to now be included. More days available to work = more money for me!

Oh and I also went and got my criminal record check done - it'll only take 4-6 WEEKS to be returned - FUCK ME! Damn I should have gotten it done sooner cuz my community volunteer hours have to be completed by the end of april! OOOOPS, my bad!

Monday, March 24, 2014

Something's happening to me

I'm a bit in denial. Have been for quite some time. When BFF was here it struck home that it wasn't just me thinking that I was off, she noticed it as well.

For the last year I have noticed that finding the "right" word has become difficult. In the last 3 months it's become a daily struggle. I'm finding my eye sight a bit off, as well as my hearing. Oh my hearing - I feel like I'm going deaf. Hell I feel like a hypochondriac. But are you one when others start to notice these things as well? I don't know. It's been really hard writing my papers for school because I'm struggling to find the word that I want but doesn't sound right in the sentence and having to use the built in thesaurus when I already know that i should know the word but it's not coming to me is frustrating. Writing this blog is frustrating at times as well because of this. How to you relate how you feel when you can't put it into writing (let alone speaking) - let me tell ya, I certainly can empathize with my aphasic patients!

When I "googled" the difficulty finding words thing = anostic aphasia is what they call it. And it turns out that it's not so great. Options open to me are lesion, tumor, or brain injury (AKA actual injury or stroke) - so ya not good options!

I was hoping when I worked this weekend that I would come across one of our neurologists and simply ask their opinion but alas I did not. I don't work until next weekend so it's unlikely that I would come across one then anyways. So I suppose that I have to make an appointment with my GP and see what he thinks. I know something's happening to me, I just have a hard time not expecting the worst (considering what I've been going through for the last 9+ months!).