It's Trichy

Oooooh girrrrrl. I've been working on my FNP clinical rotation this semester at a women's jail and peeped some trichamoniasis through my trusty microscope this week...  you gotta know sh&%# is ROUGH when you got these guys swimmin' around up in your lady parts...

Trich, as it's so fondly referred to, is a sexually transmitted infection that if left untreated can lead to such terrible conditions as Pelvic Inflammatory Disease. It can also increase your chances of acquiring HIV!!! Sheesh.
... And so meanwhile... we sit around gazing lovingly into our iPhones/pads/pods and post pictures of our manicures to Instagram... Hi people! There's a whole other world out there we might want to think about, so put down the phonepadpod. It's a crazy orange jumpsuit world where tons of really really young girls languish in jail with STI's and a lifetime of other disadvantages. In this world about 80-90% of the inhabitants are black. A lot of the time it feels like these ladies never had anyone give a crap about what was going on with them until they walked into the clinic and had someone tell them they were important and that they didn't have to stuff drugs up their vaginas just because some dude told them to.

Coding Mr. S

I've been in a couple of codes during my short nursing career but this week was the first time I coded my own patient. It was incredible to see the amount of teamwork that went into trying to revive him. Doctors and nurses work really hard to get your loved ones back.

Sadly, after nearly 45 minutes of CPR, defibrillation, fluid boluses, and meds, Mr. S didn't make it. He was still breathing when the doctor running the code asked everyone in the room if there were any objections to ending the code and providing the patient with comfort care until he passed. This can be "disturbing" to the family someone in the room noted, "when the code is ended and the patient is still breathing. Respiration is the last thing to go." But Mr. S had no blood pressure, no pulse. His body hadn't been profusing for nearly an hour ...And so there were no objections and the code was ended. Mr. S stopped breathing. We washed his body and "bagged" him, tying a tag to his toe with his name and time of death on it. I had only known him for a couple of hours.

Surgery vs. Medicine

I was stunned the other night when after hours of trying to get orders for a patient on a Medicine service, and finally getting in touch with the MD, he later came to my unit to apologize in person for having taken so long to get back to me. I work on a Surgical floor and mainly deal with surgeons. Medicine patients are tough but the teams of doctors who take care of them at my hospital are pretty much the bomb. I had a surgeon yell at me over the phone for not taking a verbal order once (something we are not allowed to do), and many many times I get no response from our Surgical teams at all. But In the words of a coworker, "Medical docs are like normal people."

Our surgical patients are sick but medicine is a whole other ball of wax. It gets a lot of flack and you'll notice many a nurse will cringe when the idea of working on a medical unit is mentioned. So I have to give props to these doctors for their awesome and caring attitude and their respect for nurses. They've got some very difficult patients but it doesn't seem to be bringing them down.

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!