question of the day

"Do you know how long this is going to take?"

It isn't unusual at all to be asked this question in the ER, and I imagine I probably hear it at least five times a day. That might be a generous guess, come to think about it. If I'm in triage I can pinpoint the moment I'm going to hear it first, and that's when I say, "Okay, I'm going to get all of your information into the computer and then I'm going to have to send you back out to the waiting room for a bit." To my way of thinking I'm giving them a little heads up that we're busy and I don't have any rooms, so that when I don't take them back immediately they aren't surprised. That's usually the point where I hear a small (or large, depending on the level of status dramaticus we're experiencing) sigh, followed by the inevitable

"Do you know how long this is going to take?" 

If I'm the primary nurse, the questioning follows a different course. When will the doctor be in? When will the lab or radiology results be back? How fast can I run and get their pain meds? And how quickly will they kick in once I've given them? If someone is waiting for a "scary" result, their anxiety level over it is understandably higher than someone waiting to find out if they've broken a toe. This is why I make it a practice to never take care of my friends (or kids of friends) when they come in. My empathy level for people's stress and fear is distressing enough on a normal day, and the last thing I need to be doing at work is freaking out over waiting on a loved one's test results. Objectivity. It's the name of the game. It has to be. None of us could get through the day otherwise. But friend or not, emotions run high in the ER and the normal societal pressure to grin and bear it usually doesn't apply.

"Do you know long is this going to take?"

I had a patient recently that was, for lack of a better term, a train wreck when he came in by ambulance.  He had some physical limitations that made him largely dependent on his paid caregivers, and the overwhelming stench of rotting flesh hit us all as soon as he was wheeled into the room. The EMS gal was almost in tears - never a good sign. Several of us actively gagged - also not a great indicator. He came in just this side of a code, but things resolved pretty quickly once we swung into action, and before you knew it he was actually relatively stable. Relatively being, well, relative.

Abuse and neglect are two things that not too many people argue in favor of, but until you see it up close, until you can touch it and see it and smell it, it's hard to understand just how devastating it really is. As with anything, those smaller or older or more dependent are so much more susceptible, but strength and money don't always help you out either. I was still in orientation in my ER when my preceptor and I were assigned an elderly woman who was being "taken care of" by her son. I guess if you define "taken care of" as spending her entire social security check at the bars and the strip joints every weekend, she was living the dream. He had left her in the same recliner for weeks, never getting her up, and some of the fabric was actually almost glued to her skin by old excrement. If you're squeamish stop reading here. When we went to put the foley catheter in, a maggot crawled out of her vagina. The other nurse and I jumped backwards like bats out of hell and then simultaneously burst into tears. The image is seared on my brain, and, I fear, always will be. I can still tell you the color of her bathrobe. I can also tell you that she didn't live out the day.

So I was feeling pretty good about my stinky guy who was responding so well to our care. We had mega fluids and antibiotics running and his blood pressure had actually gotten high enough to read on the monitor. It was a Guinness Book of World Record low, but hell, at that point it was an improvement. He was alert and oriented, although I do not have a clue how. The doctor made some phone calls and found that this guy was a DNR, even though he was only in his very early 50s. Probably would have been a good thing to know an hour ago, but at this point it was beginning to look moot anyway.

Until he told us that he wanted to die. Asked us to stop all the fluids and meds. Keep me comfortable, he said, that's all I want.  Give me something so I'll stop hurting and just let me die. I'm ready, he said, there's not a damned thing left for me here. He had a DNR in place, so we had to abide by his wishes. We stopped the fluids and meds, took him off the monitor, gave him morphine and warm blankets, lowered the lights in the room. I asked him if there was anything else I could do for him. He said no, but he did have a question.

"Do you know long is this going to take?"

take two

Ahem. Let's try this again.

My very first post on my old blog was an explanation of how the RC title came to be, and I'm thinking that it might be a good idea to do the same thing here. Unless you're a medical professional, the term "saline lock" probably doesn't mean a thing to you one way or another, but it has come, in a wacky kind of way, to mean a lot to me. You surely didn't notice that the very first post on this blog was a repeat from a couple of years ago, but that wasn't just something random I pulled out. It was very deliberate, for oh so many reasons.

A saline lock is, simply put, an IV. In true medical fashion,  terms and titles are deliberately designed to be as confusing as possible, and this is no exception. Back in the day they were called heparin locks, which confuses even me, but I'm going to spare you all the Medical Obfuscation 101 class and cut to the chase. Maybe you've never thought about the actual purpose and function of an IV, silently accepting them as a sometimes necessary evil. I've thought about it a lot, and it all boils down to this - they're something that no one looks forward to, they're painful as hell... and they can literally save your life.

From a nursing standpoint they represent even more.

It's about fear - paralyzing, overwhelming, panic inducing. It's about stepping outside of your comfort zone - in every way imaginable. Its about being realistic - because no one bats 100%. It's about tenacity - when you fail you pick yourself up off your butt and do it again. It's about self-esteem - the kind you get when you face something that you thought you simply could not do...and then, miracle of miracles, you did. And you do. It's about survival - the most basic (and necessary) skill of all. It's about pure, unadulterated joy - when you can't even remember why it freaked you out so much in the first place.

It is, of course,  about the last three years of my life. 

You could even interpret it as "quit your boo-hooing and get on with it." You know - saline (tears) and lock (get over it). How I can take a post that I wrote as a self- motivational piece during the darkest days of my divorce, and turn it into a mantra that propels me still is anyone's guess. Some people have good luck charms, some have lucky numbers, some collect inspirational quotes. I bow at the altar of a sharp piece of metal, a syringe full of saline and some plastic tubing.

Haven't I been saying all along that medical people are nuts?

Oye

I guess I wasn't kidding about being out of blogging practice, because I just wrote a post, hit a button and WHAM! It disappeared. Gone somewhere into space and I can't find it anywhere. It was a nice little post too, damn it, and I'm too tired to do it again tonight from memory. This is going to be really interesting..

ten topic teasers...details to follow

1. If you don't miss a man in the first year after he moves out, chances are you never will.

2. Visiting Egypt in September 2010 was a much better time to go than, say, February 2011.

3.  Beware of middle aged men who tell you flat out that they'd "just like to find a hot 21 year old with low self-esteem and father issues." This same man may bring said 21 year old to his ex-wife's ER and stand there helplessly while she is innocently asked - by two different people who don't know him - if she'd like her father back in the exam room with her.

4.  Yes, Virginia, six years in, you can start to burn out on critical care nursing.

5. You can blog virtually every day for close to three years, and still not remember one darn thing about setting up a blog. Don't hold your breath for pictures or anything "fancy". It's all I can do to find the "Publish Post" button.

6. If you're totally hung up on a guy and all your friends who know him tell you that you're way too good for him...believe them.  

7. In the contest between Redemption and Closure, I'll take Redemption. Nine times out of ten anyway.

8. Angry kids can become reasonable, reasonable kids can become angst ridden, and angst ridden kids can bring tears to their Mama's eye with how gracefully they handle themselves under pressure.

9. It sucks ass to finally be brave enough to get back into "the game" and then, in your first real foray out, get dumped for a manipulative control freak who seriously looks like a cross between Olive Oyl and Mr. Ed the talking horse. 

10.  Life ain't perfect, but is sure is darned good. And unless I'm mistaken, it just keeps on getting better...

I'm baaaaaaack...

When I applied for my job in the ER, I wanted it with an intensity that you can only get from fantasizing about something so hard and for so long. And as I sat for my interview, I thought it was going really well, and had (finally) started to think this could actually happen, when my future boss asked me the question I was dreading.



"So, how are your IV skills?" she asked.


Lots of things went through my head. The fact that we almost never started IVs in the ICU, since virtually everyone had a central line. The fact that this woman was a riot and I adored her instantly and wanted desperately to work for her. The fact that any IV I had ever hit in my life thus far had been a matter of sheer luck, done with shaking hands. And that there hadn't been many of those. The fact that I was petrified of IVs and that no matter how hard I chanted my little "face your fears" mantra, I still ran the other way when anyone mentioned them. The fact that I really am a pretty honest person, which led me to admit,


"Not so hot, to tell the truth."


My heart sank. I could feel my dream sliding away. We talked about other things for quite a while and when she offered me the job (on the spot), she said


"Don't worry. We'll teach you IVs. You'll get plenty of practice."


And I have. After a learning curve full of fear and frustrated anger and more than my fair share of anxiety, I've looked the beast in the mouth and realized it isn't so scary after all. Even crazier, I've started to really like doing them, to the point that I sometimes run around at work volunteering to start other people's lines for them. And when my mentor, the nurse whom I followed around like a puppy coveting her IV skills, asked me to try recently when she had missed twice on someone, and I sauntered into the room and nailed it, I had a feeling that was really hard to pin down.


It was an incredible rush. I had faced down something that terrified me and realized it wasn't so bad. I had taken something that in my opinion was one of the worst things I could have to do and seen that it wasn't such a big deal after all. And I had come out of it confident and proud and excited about what might lie ahead. The beast only looked like it roared. All it took was the right mindset to realize that if you never give up, good things will happen.


Not a bad lesson for life in general.