Desperately Seeking Dilaudid

Dilaudid, aka hydromorphone, is an oral and IV pain medicine that is about 10 times stronger than morphine. It's a drug I'd never heard of before going into nursing, but one which is asked for by name in hospitals around the country...

Pain is obviously subjective, and everyone has different pain thresholds and manifestations of pain. But giving pain medicine scares me sometimes because it can cause respiratory depression (and nausea, which isn't scary, but still). This is especially true when my patient rates their pain as a 10/10 as their eyeballs are rolling back in their head, and insist I "push" the medication faster through their IV because it "works better". It's hard not to sound condescending when you explain that pushing the medication faster will get you HIGH, but no matter how fast or slow it's pushed it will "work" the same (ie. reduce pain). I feel like a bartender sometimes except I don't have the option of cutting off my customers. The whole interaction can become very manipulative on the part of the drug-seeking patient trying to pull one over on the stupid nurse.

I am by no means saying that my patients don't experience pain, and I have never withheld pain medicine because I personally felt someone didn't need it. The objective with pain management is to bring your pain to a manageable level, and that might mean not alleviating it 100%. We want you to be able to get some sleep while not slipping into a coma, for example. There is a fine line between Dilaudid and Narcan, and it's a road I would prefer not to travel.

I'm Still Here

It's been too too long since I've stopped by here. Is anyone still out there? I started a new job about three months ago and have been overwhelmed, stressed, and adjusting to all the changes that come with a new hospital and a new type of unit. My feet are hurting and I'm tired.

My patient population has changed dramatically and I find most days that 2 to 3 of 4 of my patients have cancer. I'm beginning to feel like there are more people out there who have cancer than don't.

The hospital I work at is reserved for the "sickest of the sick" and ours are the patients that are too complicated to be treated elsewhere or that need fixing from previously complicated or botched surgeries.

I miss my crazy old patients from my last job, but I'm learning a lot about new surgeries and conditions, as well as how to become the most anal retentive nurse on the planet ...because that's how you've got to be on this floor to survive. 

Alone

I had some time last night to spend a few minutes holding one of my patients' hands and I thought of this picture, she was so weak and small. I'm not sure if she understood what was happening or that I was there but I hope she felt something. I did.

Remain Calm

I made it through the first day of work with NO crying!

Newbie

This week marks my one year nurse-aversary and the start of a new position! Just when I was finally getting comfortable and confident in my work... I've been deported from my personal comfort zone.

I was lucky that everyone got along at my last job and that everyone was NICE to each other. I'll remind you that, sadly, this isn't always the case in the world of nursing. Why do nurses eat their young? I don't know. Maybe it's because we're hungry from missing meal breaks. Maybe we're crabby because we haven't had time to pee and have been holding it for 10 hours... Maybe it's because being a nurse is extremely stressful. Whatever the reason, I pray to the patron saint of nurses that I'm able to maintain a blood pressure that is within defined limits and that, above all, I don't cry.

A Lesson in Etiquette

Yo! Could you please get off your cell phone for like 5 minutes so I can assess your ass and/or give you some drugs? (... and by "your ass" I mean the familiar term for "you" not the actual anus, rectum, butt or butt cheeks although those are also possibilities) 

That's how I feel patients who won't get off their cell phones when I enter the room to care for them need be spoken to. This is a hospital for the love of all that's good and holy, not a club, chat room or bus stop. I demand some respect!

Sundowning

There are few things that make me sadder than seeing a confused old man in a pair of these mits. The look of hopelessness and confusion in their eyes as they ask you why you are putting these on them is enough to make you want to cry. We use these to prevent patients from pulling out their IV's, foley's and other bodily tubes.

Patients who sundown can potentially win themselves a pair of these gloves. They remind me of the mittens Micky Mouse wears which makes them even more depressing.

I had never heard of sundowning before becoming a nurse, but as I understand it, it is dementia that kicks in abruptly in the afternoon/evening and then goes away again in the morning. You might recognize this phenomenon when suddenly that elderly patient who you've been having such nice conversations with all day is now calling you a tooth fairy (in the best of cases) or trying to break your fingers (in the worst).

How'd I End up in the Psych Ward?

This somehow manages to summarize my last few days at work in just two simple images.

Cocaine is a hell of a drug.

3 for 3

My last three IV insertion attempts have all been successful! This is a real feat for me as my track record up until these past few weeks has been about 30%. Hooray!

When Your Patient Hates You

I was under the impression while in nursing school that your patients will generally appreciate you to some extent, but I have unfortunately learned the hard way that this is definitely not always the case.

I hate to stereotype people but I have found that there are some patient populations who share certain characteristics: burn patients are often drunks and/or drug addicts, transplant patients are nice but can be very anal, and gun shot victims are usually jerks.

Least Favorite Words

The four words I absolutely dread hearing come from the mouth of a patient are (in this particular order):

It could just be an anxiety attack or pain from an injury (shoulder or rib fractures to name a couple) but it also might be a freakin' heart attack, y'all. It's happened to me a few times already, and what follows that evil utterance is a barrage of tests which include:
1. EKG (which you hook up in a nonchalant manner to give your patient the impression that you do this all the time at 3:00 am)
2. Troponin labs (which will then have to be repeated every few hours, oh and it's fun to draw someone's blood under stressful circumstances when you're a new nurse and not a great phlebotomist so far)
3. Chest x-ray (also totally normal at 3:00 am)
4. You peeing your pants a little because you're afraid they actually are having a heart attack and that they just might code on you (#4 does not require an order from a doctor).

Let Me Help You Help Yourself...

Why do I get the sneaking suspicion that my patients sometimes think I am out to GET THEM? I felt like the mother of three very dysfunctional children today who were all convinced I was being paid mega bucks to inflict pain and suffering upon them (ah HA! ...the sadistic nurse! buuwahahaha!!).

When hospitalized and you are encourage you to do something like... walk, deep breath, remain NPO ... it's generally for a good reason: i.e. to prevent you from getting pneumonia, help you poop, help you not barf all over yourself (and myself, I aint gonna lie).

I hope I'm not crossing the insensitive tough love nurse line here but, I'm not here for my health y'all, I'm here for yours! Smooches.

Top O' the Morning!

Who knew there were bars that opened at 8:30am catering to medical professionals and professional alcoholics? I had my first experience at such an establishment the other morning, and while there were definitely other nurses bellying up to the bar, there were also a few old and not-so-old men coming in for a good ol' shot and a pint to start the day out right. I never thought I could stomach a drink that early in the morning but really, when you're working nights, your world is upside down and inside out and your morning suddenly becomes the right time for a night cap.

"This Side Back"

It's hard enough not accidentally showing your crack when you've got your gown on the right way and you're behaving yourself, let alone when your a large female wearing it backwards, ranting and raving at the top of your lungs at 3 o'clock in the morning outside your hospital room. If you find yourself in this situation, take a 15-second break from abusing the nurses and doctors who are (trying to) take care of you and take a look down your front side (and maybe just say screw it and put a shirt on).

Sensational Week

For the second time in less than a month my patient was shackled to their bed and under 24-hour police guard (awkward!). Meanwhile, several other patients were also headliners and/or awaiting arrest. Watching the local news in the breakroom over lunch, I witnessed each patients' 15 seconds of fame then promptly returned to the floor to wipe their butts. 

What to do, what to do...

Does work, life, the weather, ever make you feel like this?

Well, at least we can say we're not handcuffed to a hospital bed (I hope you're not, reader) or getting slapped by a patient (true story). At least not today. We'll see what tomorrow brings.

Night of the Living Nurse

It's been far too long since I've been awake during the day. Today, coming off almost two weeks of nights I feel like my skin just might set fire from the light of the sun.

Sometimes I can't believe how hard this job is and I catch myself wondering, "Why in the world did I sign up for this?" But the good usually outweighs the bad from day to day. Looking into someone's eyes in the middle of the night, knowing they probably won't be around much longer (not that most of my patients are that acute), and trying to give them a little comfort from their physical pain and the pain and loneliness that comes from being in the hospital is heart wrenching. It's weird to share such intimate moments with "strangers."

Oh S*@$!!!

I had to give my first sternal rub today when I found my patient unresponsive in bed. Seemed she was sleeping so peacefully but, alas... no. A sternal rub is a type of painful stimulus one can apply when trying to wake an unresponsive patient (see green glove below). Try it on yourself and you'll agree it hurts (I just did). Others include pressing down on the nail bed with your fingernail, pinching/twisting the skin below the collar bone, and pressing on the (closed!) eyeball.

This was the first time I've ever gotten close to a code with my own patient and it was pretty intense. I think I heard someone call it a "soft code" which made me think of soft core porn but in life saving terms rather than sex movie ones.