My patient was several days post-op, recovering well, and waiting for a floor bed to become available for him.

I was finding myself rushing around to get all my work done–and accomplishing that feat by 09:00. The remainder of my shifts were spent staring at my patient while he stared back.

On rounds, when presenting my patient, I was sure everyone was ready to fall asleep. Vital signs normal, breathing normal, peeing normal…zzzzzzz.

New goals and orders: none

He was no longer in the ICU yesterday when I worked, so I assumed he had finally been transferred to the surgical unit.

His wife walked into the unit carrying a big box of donuts.

“Hello!” I gleefully shouted. I adored her. “How is your husband enjoying his new room upstairs?”

“He didn’t make it.” She responded sadly.

“Wait, what?!”

“He had a cardiac arrest and died two nights ago. He never made it upstairs.”

I gave her my condolences. After she left, I asked around. He had coded the night after I had cared for him. They had started CPR and brought the crash cart to his bedside, but soon stopped as he had a DNR order.

You just never know…

4. Do not, ever, press me for my opinion on political matters. You won’t like it.

I’m a big ol’ flamin’ feminist socialist. And, since I can actually define “socialist” correctly and use it in a sentence, I get annoyed by those of you who can’t (and who further equate socialism with Communism, Stalinism, Nazism, and Glenn Beck’s Flavor Of The Week). Please don’t ask me what I think of health care reform, universal sufferage, the plight of immigrants (legal or il-), or whether women’s shelters ought to be defunded. I might tell you, and then your aneurysm would grow, and you’d have to go to the ICU and would be deprived of the pleasure of my company.

via Head Nurse: Auntie Jo’s Rules For Decent Behavior, Inside The Hospital Or Out..

I spent the weekend working: twelve hours Friday, Saturday, and Sunday. My patient was several days post-op, recovering well, and waiting for a floor bed to become available for him.

I was finding myself rushing around to get all my work done–and accomplishing that feat by 09:00. The remainder of my shifts were spent staring at my patient while he stared back.

On rounds, when presenting my patient, I was sure everyone was ready to fall asleep. Vital signs normal, breathing normal, peeing normal…zzzzzzz.

New goals and orders: none

The big excitement was when physiotherapy would come around and we would attempt to mobilize my patient. This was always a challenge as he would scream, shout, fight, yell for help, and beg passers by to call 911 because we were hurting him and he would have to go to the hospital.

Ugh! I’ve had three extremely confused and/or agitated patients in a row. I am so incredibly sick of being verbally and physically attacked. I’m tired of spending all day preventing patients from crawling out of bed.

I came to the ICU for ventilated and sedated patients darnit!!!

Unfortunately, the acuity has been ridiculously low throughout the entire unit lately. I’m sure when I come back after the long weekend (of partying, drinking, and car-smashing) that will be fixed.

******

Monday was the most challenging day, in many ways, that I have experienced in my entire life.

I received news first thing in the morning that a very good friend of mine had died in his sleep. He was only in his early forties, healthy, and having a beautiful, fun weekend.

He went to sleep laughing, and never woke up again. His best friends found him cold and long-gone in the morning.

Not many things kill people in their sleep with no warning at all. We won’t know for sure until the autopsy is done, but I’m sure you’re all guessing the same thing that I am. I think it’s a fairly good guess.

I really haven’t processed my thoughts and feelings surrounding his sudden death, so I truly don’t have much more to say right now. But, I do no that I’m devastated.

******

I received the tragic news about my friend while packing up for a long hike. This was a spontaneous challenge that we decided on only a week ago, but we were excited and overflowing with joy at the prospect of pushing our physical boundaries (keep in mind we’re both quite overweight and never exercise).

We contemplated staying home amidst my sadness, but I decided that experiencing the beauty of the mountains was the perfect way to combat the tears.

The path up the mountain (OK, it’s actually a ridge) was HARD! Six-hundred meters of elevation hard! It wound back and forth through the trees getting steeper and steeper until it opened up to a beautiful view. A little bit farther and we reached the summit.

Breathtaking!!!

Here’s some pictures:

My legs were like jello, and struggled to hold my weight on the long walk back down. My lungs were screaming, and I was mentally getting tired.

But we made it! We passed our challenge and are SO proud of ourselves. We just wish it wasn’t then end of the season. We really won’t be able to go hiking again, which is horrible now that we are addicted.

I can barely walk today, and have spent most of the day laying on the couch and taking tylenol for muscle aches.

It was ALL worth it though…

Head Nurse: Sometimes you cry..

I love this part:

We all do our jobs with the belief that we are invincible. That is not true, of course, but being shown our inability to save every life hits hard. Eventually the belief in invincibility comes back, because how on earth could you do this job without it?

As an occasional member of the code blue team, I see this type of situation all the time. You can always tell who the primary nurse is. No matter how hard they try, the sense of panic, fear, and regret always show on their face.

I bawled for hours the first time my patient died suddenly. Even still, I’m usually fighting back tears, and always on the way back to my car.

Great story!

Unfortunately, I have definitely seen glimmers of all these behaviors in other nurses. Thank goodness they don’t seem to be as concentrated and rampant as it would appear in this story. I’m glad he got himself out of that place!

Licensed 2 ILL: To Live and Die in L.A..

On another note, I ask this almost every day, but I never seem to get tired of it: How the hell do you American ICU nurses handle two patients? That’s just crazy!

Thankfully, here in Canadian hospitals, it’s always 1:1, except for the easiest (read: extubated and up for transfer) patients.

My evenings after work often look like this: Get home at 20:15, make my lunch, put together my uniform for the next day, find my bed, and pass out the moment my head hits my pillow. I haven’t figured out how all those young nurses go out after their shift, drink and dance the night away, and show up for their shift the next day, bright and cheery (and often still manage to do a much better job than me).

But I digress, I’m supposed to be talking about the emotional ride bestowed upon us by patients. And I must say, I think this plays an even bigger part of my working life in the ICU than on “the floor.” This is likely because we have only one patient that we are with for every second of the day. That’s twelve hours experiencing every intimate detail of the patient’s current health crisis. There’s never a break while we chart at the front desk, or care for another patient.

Frankly, I’m not that great at the “emotional” stuff that goes along with being a nurse. I struggle to be the warm, friendly type that has a soft, sympathetic touch on the shoulder, or a shared tear in the time of difficulty. No, instead, I tend to get more frustrated and impatient in these times. At best, I’m completely awkward. I am certainly aware of this flaw in myself. And it’s a flaw that spills over into real life; I’ve never been good at communicating emotions, or dealing with them in any capacity.

My patient was Mr. Panicky-anxiety-attack. If you walked near him, he would flail about in his bed, eyes wide open, screaming (around his trach even) shaking the bed, and banging the side rails. All the while I would be desperately holding his head trying to stop him from tearing apart the delicate sutures all along his neck and face. Of course, trying to hold his head still would make him even more ridiculously agitated and he would flail and bang even more–clearly mouthing very distinct swear words. We had to tightly restrain him so that he wouldn’t pull out his tubes, IVs, and airway during his “episodes.”

Pain control was his main issue. He had scheduled tylenol and dilaudid, and a large fentanyl infusion that we could titrate to effect, and bolus him with. Nothing helped, and the pain became more and more of a concern. CTs, x-rays, cultures were done in an attempt to find the source of his inappropriate pain, and when no reason could be found, our hospital’s pain team was consulted to try and help. Nothing would.

I went home completely drained. I was exhausted and nearly in tears with frustration because my patient was so incredibly uncontrollable. I even contemplated asking for a new assignment the next day, but had heard that three other nurses already asked, and I figured somebody had to “bight the bullet.”

The next day really wasn’t all that different. In fact, it was possibly worse. And it all came to a climax when Mr. Panicky-anxiety-attack had his biggest temper tantrum to date. By this time he was writing notes for us, and in a desperate attempt to find out what was wrong, I gave him a pen and paper. He wrote, with me continually prompting him for more details:

Help Me! Help Me!

What are you doing to me!?

Call 911!!! Something’s wrong, I need help!

I don’t trust you! Call 911

Fuck you Fuck You FUCK YOU ASSHOLE!!!

In his frustration, he threw the paper, clipboard and pen at me, one at a time, just missing, and began flailing about and banging his bed, screaming (as loud as he could around his trach).

After two days of dealing with his temper-tantrums, I was MAD. My ability to stay calm had been completely worn out.

“Listen Mr. Panicky-Anxiety-Attack” I yelled, “I’m not going to put up with this kind of shit anymore! You’re acting completely inappropriately, you’re like a two-year old here with your temper-tantrums, so stop all of this shit!”

Yes, I swore and yelled at him much more than I’m proud of. Then I took a deep breath and calmed myself down. I did the whole, “Close your eyes, breath, and count to ten” thing.

When I opened my eyes, I said, “Sir, do you remember where you are?” He shook his head to say no, “Do you remember that you’re in the hospital? You had that big surgery on your neck. I’m your nurse, we’re all nurses and doctors. We’re trying to help you.”

He shook his head no, looking confused. And then after a few moments, you could see the memories rushing back. He remembered everything. He wanted to write something, so I gave him the pad of paper.

I’m sorry, I’m sorry, I’m so sorry!

And then he burst into tears. I sat in a chair beside his bed.

“Sir, you’ve had one of the hardest surgeries to recover from, this is HARD, you’re in pain and have a million tubes going into your body. We get why you’re having trouble. And to top it all off, your wife hasn’t been able to come visit for days.”

He nodded, still crying

“Do you sometimes wake up and not remember where you are? is that why you get panicked and scared.”

He nodded again, crying harder.

“Would it help if I spent more time reminding you where you were and why you’re here”

He nodded and grabbed my hand, mouthing “sorry.”

And I’m almost in tears now, completely ashamed at myself and the way I acted. For the rest of the day, he was a delight. And I kept up my end of the bargain. If he started looking scared, I would reorient him, explain everything that was going on, and make sure he was calm before I continued.

So many lessons could be taken from this, but here are a few that I found for myself. Firstly, I realized that I am only human. I have serious flaws and weaknesses. I am not perfect, I can only tolerate so much emotional stress, and I too have the capacity to behave inappropriately.

Secondly, I learned that I can and do deal well with patient’s emotional issues. Perhaps I was slow on the draw, but I assessed the problem, provided emotional support, and found effective solutions. And, I did so in a caring manner–eventually.

Thirdly, I learned again (and this lesson will smack any nurse in the face over and over again), that you can’t always take a patient’s behavior at face value. When a patient is behaving strangely, look for reason for this behavior. And don’t forget that it isn’t always just an emotional issue. It could be a stroke, hypoxemia, withdrawal symptoms etc. And never EVER be afraid to ask family, “Is this behavior normal for your loved-one?”

After giving report to the oncoming nurse, we were discussing possible causes for his outbursts and confusion. She had a student nurse following here that day. The student theorized that it was the large amounts of narcotics, or perhaps ICU delirium. All valid theories.

The oncoming RN and I looked at each other and made drinky-drinky hand motions. You know, where you mime that you’re taking a drink from an imaginary beer bottle.

“But the chart says he never drinks” Argued the student nurse.

“If it looks like a duck…” I respond.

I really enjoyed this post. However, I had a problem with one aspect of the post, and the general ideologies it represents.

I find that one of the biggest mistakes non-smokers make, as seen in this article, is to accuse smokers of being “ignorant” and “in denial” about the dangers of smoking.

I was a smoker for approximately ten years before successfully quitting after many not-so-successful attempts. So I speak as a former smoker, a health professional, AND someone who successfully quit.

Smokers are fully aware of the dangers of smoking. They absolutely know how it affects their health, and yes, they know that their pesky cough, shortness of breath, and difficulty exercising is because they smoke.

There is this strange belief amongst “health experts” that if only the smoker knew that their habit was bad for them, they would instantly stop.

This is wildly incorrect! It makes the assumption that smokers are completely unintelligent, uneducated, and naive. It also discounts the addictive nature of cigarettes, the social reasons for starting, and even the fact that, yes, smoking feels good and is very pleasurable.

From the moment a person is conscious, they are inundated with anti-smoking campaigns–and it has been that way for decades. I assure you, every smoker is fully aware of the dangers of their habit.

So, I would recommend not looking down on smokers as “ignorant” or “in denial” as it comes off as fairly condescending. People, ALL people, make choices, good and bad. When they become ill and show up at the hospital, it is your YOUR opportunity to discuss their options regarding quitting, and let them make their choice.

Again, thanks for the great post. I enjoy reading your blog.

My response almost says it all. Upon further pondering the topic, I realized something. I think what is happening is that people are confusing the false belief that oneself is invincible with being completely ignorant and uneducated.

For example, if you ask any teenager, “Is it dangerous to get really drunk, smoke crack, and drive really fast?” They will, of course, say, “yes.” However, this certainly does not guarantee that they won’t do it. Teenagers famously have the belief that bad things happen, but definitely not to them.

Being a smoker may be somewhat similar, but the feeling of invincibility fades as time goes on. Especially as youth fades and the negative effects of smoking take over. But, by then, there is of course the chemical addiction, etc. to deal with.

I’m just saying, stop assuming smokers are stupid.

Nurse: He’s failing miserably! He’s desating and is gasping for air despite being on 96% 02 with tusks. Do we need to set up for possible reintubation?”

Doctor: Nah, he’s fine, just get him some water. Walking away. And get him a toothbrush!

Nurse: ???

Two hours later. The same doctor is called to the same bedside stat

Nurse: He’s trying to get out of bed, he’s pulled out his IV and NG tube, and he’s screaming at the top of his lungs, It’s taking three nurses to hold him down and keep him in bed. Can he have some sedation?

Patient: AAAAAAAAAAAAHHHHH!!! I want to die, kill me now! AAAAAAAAAAAAAHHHHHHHHHH!!!

Doctor: Just give him some orange juice, he’ll be fine

Nurse: ???

Today, we went for a couple hikes (more accurately, a couple short walks). One was along road that leads to some caves that I used to frequent as a kid. They have blocked the road, forcing one to walk six kilometers to reach the caves. Apparently they closed all access to the caves due to an excess of injuries.

The rest of the pictures are from a beautiful lake near my home. We hiked a small way along the path. We desperately wanted to keep walking farther, but we weren’t really prepared for anything but a small walk. However, we have decided to go back and do the entire ten kilometer hike in a couple weeks.

I can’t wait! I’m so glad I’m getting out and exercising a bit more. I really need to lose weight. I also need to get in a bit better shape for all the walking I’ll be doing in Europe.

Yay me!

As mentioned by Wanderer over at Lost on the Floor, I deleted my old blog website. Unfortunately, this was completely unintentional and I’m STILL trying to fix it. All I did was overwrite one measly little file and all was lost. In fact, there was a tense moment in which I thought I had permanently lost ALL my blog posts going back eight and a half years (can you believe I’ve been posting that long!!!?!?!?). Fortunately, I was able to restore the posts from backup to my new site.

I’m not totally sure I’ll keep trying to restore nursesean (dot) com. Perhaps it’s the universe’s way of telling me to just move on. I will most likely just put up a redirect page.