Xmas on Ice (Chips)

 

It's Christmas on Trauma and what does Santy have for you? One size large 3rd degree burn from a scalding pot of grease, one malodorous nasty wound infection, one holiday stabbing at the mall, and a paaaartridge in a pear treeeee...!

It's sad when patients are NPO and can't have anything to eat or drink and they literally beg you for ice chips. "I'm sorry", "I wish I could..." (the worst is when you forget and ask them if they've ordered breakfast yet. Ouch. Sorry!)

Even sadder is being a patient hospitalized on Christmas who holds the holidays in very high regard and is alone with no family or friends in the area to visit them. But possibly saddest of all is dying on Christmas at 7:00am. Good morning and good night, and Merry Christmas.

Dear Diary

It's hard being a (new) nurse. These days I feel like I'm always asking questions or needing help with something --all the time.

The other day I was in the midst of transferring a patient and thought to bladder scan her because she'd been having low urine output, and lo and behold she had over 600 mL of urine hanging out in her bladder (that's over half a 40 oz for all you ghetto fabs out there). That meant I'd have to straight cath her which can be difficult to do on a female patient because the anatomy is not as clear cut as in the picture I just linked up there (I wish). I tried and failed and had to ask for help, and fortunately the nurse who helped me is one of my all time favorites in terms of being available and willing to help. She never seems too busy to lend a hand. An hour or more ended up passing before I was able to transfer the patient to the other floor. I was flustered, didn't take my meal break, lost my assignment sheet and my stethoscope (I thought). This was one of those days that I felt was my time to cry on the job. Luckily it didn't happen. I told myself I'd just have to stay as long as it took me to get the job done. But in the back of my mind I worried that I'd get in trouble for a) missing my break and b) leaving late.

What's a rookie to do?

Stop - Drop - Roll

Lesson #57 in fire safety: alcohol is flammable.

Tell that to the patient who catches themself on fire while engaging in a little recreational drug use and then attempts to extinguish said fire with the cocktail they also happen to be drinking. 

This is a kind of one-up to the traditional smoking-while-on-oxygen style of self immolation but doesn't quite top shooting oneself --although CAREFUL: not as a suicide attempt (per patient's report) which made this other self-inflicted injury quite unique.

The day I work with sane patients suffering from banal ailments is the day I die.

I Love Nursey

Sometimes I feel like the Lucile Ball of nurses... a well meaning, clumsy and comical nurse who accidentally trips on an IV line and rips it out, who steps on a patient's broken foot, or pats someones back which happens to be covered in 3rd degree burns (all done lovingly, of course).

I can picture myself in one of those comedy sketches from the 50's where they're tripping all over some poor injured patient and he's screaming in pain every time they accidentally let his tractioned broken arm come crashing down on his chest full of broken ribs, or let him fall to the ground as they try to help him into a wheelchair. And all the while the patient is getting madder and madder, screaming, "WHY YOU LITTLE...!!"

Hands off the catheter, my friend

I had a patient remove his own foley catheter the other day and it was not a pretty site. It's unclear whether said extraction was intentional or not but the result was a positively bloody mess. As you'll see from the diagram below, the catheter is maintained in place in the bladder via an inflated balloon, so just imagine the damage that can be done when that balloon passes through the urethra and out of the penis without FIRST being deflated.

yowee!

I hear the secrets that you keep...

...when you're delirious and hospitalized.
When asked, "Do you know where you are right now?" of some of my less oriented patients I've heard: "a barn", "a birthday party", "a bus", "a sex lab", and "Serbia" to name a few incorrect responses.

One of the unique aspects of nursing is the intimate moments you sometimes share with your patients. I've heard admissions of hatred of family members, revelations of sexual exploits, and of course there's the usual cleaning of butts, weenies, and va-jay-jays... It's kind of like being the bartender at a pub your patrons never wanted to come to (and often times don't even know they're at).

Compassion Fatigue

"Compassion fatigue (also known as a secondary traumatic stress disorder) is a condition characterised by a gradual lessening of compassion over time. It is common among trauma victims and individuals that work directly with trauma victims. It was first diagnosed in nurses in the 1950s. Sufferers can exhibit several symptoms including hopelessness, a decrease in experiences of pleasure, constant stress and anxiety, and a pervasive negative attitude. This can have detrimental effects on individuals, both professionally and personally, including a decrease in productivity, the inability to focus, and the development of new feelings of incompetency and self doubt."

You hear a lot of talk about compassion fatigue in nursing and I feel like I've seen it. We had a patient from another country who was involved in a serious car accident while on vacation in the US in which a relative of the patient died. The patient was on our unit for several weeks and I would often hear nurses complain about how needy or whiny the patient was. I know I'm new (and I hope this doesn't explain my empathy) but imagine yourself in a hospital in a foreign country where you don't speak the language, you're in a pretty good amount of pain from your injuries, and you've just lost a loved one to boot. I think I'd be pretty needy too.
I wonder why with experience and exposure to patients with acute or chronic pain it seems we become detached from the moment and start to see the patient as a just a complainer. After watching a patient sobbing in pain with tears streaming down their face this week, asking themselves and me why God would do this to a person, it never crossed my mind that this patient was a whiner and I hope it never does.