Another First: CPR

I did CPR for the first time last month.

He was in his 40's.

He died.

Then I had to go on working for the next 12 hours.  It was hard.

It was harder emotionally than I expected.

Then I beat myself up about being sad about it, and that only makes me sadder.

I'm not even sure if sad is the right word for it.  Anxious?  Sure.  Mad?  I guess.  Stressed? Yeah.

I know nothing could have been done differently.  I know we the nurses and the doctors did everything we were supposed to.  I know it was a "good code with a bad outcome."

But sometimes when I close my eyes, I see him gasping for air.  I see his eyes close for the last time.  I smell his body odor on my hands.  I can feel that last pulse in my fingers.  I see asystole in that last second before I fall asleep.

Then I wonder why I do what I do.

Nursing is 85% boring repetitive work, 12% politics, and 3% absolute terror.

To those people who ask me if I like being a nurse, I do most times.  As I said to someone once, "It's not what I expected.  But it's better."

"And the LORD God formed man of the dust of the ground, and breathed into his nostrils the breath of life; and man became a living soul." Genesis 2:7

Flu Shot

Got my first ever in my life flu shot this week.

Basically got forced into it by work and grad school.

Work said if staff did not get the flu shot, then we would have to wear a mask within 4 feet of patients.  I really don't care about that.

But, school said, if we didn't get the flu shot we would be kicked out of class.  And I paid too much money for school to try and fight the system like that.

I have only one word to add to this discussion: Autonomy.

"Pleasant words are as an honeycomb, sweet to the soul, and health to the bones." Proverbs 16:24

I/O cath

So I was helping to in and out cath this lady yesterday.  I mean the nurse didn't want to do it, so I did it and she watched.  I like to get my hands dirty, so I didn't mind helping.

I set up the sterile field, glove up, etc.  You know.  And I go in for the urethra.

The urine starts coming out, and she grabbed my boob.  This old lady who can't pee grabbed my boob.

I thought she did it on accident, but then she said:

I used to have breasts like these.

Laughter ensued.  Then she proceeded to caress my waist and breast until we were done.

"Let her be as the loving hind and pleasant roe; let her breasts satisfy thee at all times; and be thou ravished always with her love." Proverbs 5:19

100%

So I went back to school this semester to get my master's degree to become a nurse practitioner.

I really like it.  But it's hard.

It is fun because in my patho class we learn about things I have seen in my practice but in much more depth.

The first patho exam was not fun.  I failed actually.  So disappointed.

I'm also taking Theory and Research 1.  We are doing a research project that lasts this semester and next semester.

I'm doing mine on alcohol withdrawal and CIWA protocol.

I turned my midterm draft in this week.  100%.

I guess I am smart enough to be in grad school.  I was worried about not being ready, especially after not doing well on that first patho exam.

"And I have filled him with the spirit of God, in wisdom, and in understanding, and in knowledge, and in all manner of workmanship." Exodus 31:3

Is It Raining?

Confused patient: Can I go out for a cigarette?
Me: No.
Confused patient: Oh, is it raining?
Me. Yes. Yes, it is.

It wasn't raining.

Reason #5486 to not smoke: even your confused brain craves it.

"And if it be not so now, who will make me a liar, and make my speech nothing worth?" Job 24:25

Penis Blood

I got penis blood in my face last month.

I'm know, again, that I am immune to Hep B.

The patient didn't have anything bad either.

The other two nurses were not immune to Hep B, so they are getting the vaccination series now.  They thanked me.

It still freaks me out a little.  You know how many sharps I poke into people bodies everyday?

A lot.

"Keep me as the apple of the eye, hide me under the shadow of thy wing." Psalm 17:8

New Nurses

I've been a nurse for over a year now and already I'm shaking my head at "the new nurses."

It's one thing to make a mistake, but it's another to not listen to others when they try to teach you.

"Oh sing unto the Lord a new song: sing unto the Lord, all the earth." Psalm 96:1

Stop Whining

Heard this conversation the other day between a patient and a nurse.

"Time to go to your CT scan."

"Uhhhh, my tummy, don't turn me that way.  It hurts."

"You drank all that contrast already, so really need to go to this CT scan."

"But my tummy, my back."

"Stop whining.  You have to get this CT scan.  Uh, I mean *kiss on the patient's forehead* we're going to move you over to the stretcher, you'll get the CT scan, then you'll be back, and we'll get you all settled for the night."

"And when the people complained, it displeased the LORD: and the LORD heard it; and his anger was kindled; and the fire of the LORD burnt among them, and consumed them that were in the uttermost parts of the camp." Numbers 11:1

Cigarettes

My patient called me a bitch last week.

She was angry because I was keeping her from her cigarettes.

Cigarettes.

Reason #2687 to not smoke.

"And the smoke of the incense, [which came] with the prayers of the saints, ascended up before God out of the angel's hand." Revelation 8:4

Fluid Restriction

On a scale from 1 to 10, do you want to know how much I care about your fluid restriction?  With 10 being the most care I can muster.

Zero. Z. E. R. O. Zero.

You want coffee this early in the morning?  You go right ahead and drink what ever you please, even if it is over your fluid limit for 24 hours, you know the risks of drinking more than your prescribed ml's of fluid a day, but I'm not in the room 24/7 watching what you put in your mouth.  Stop harassing the CNA, she is doing her job by asking you what you drank/ate.  And yes, yogurt is a fluid.  Yes, I had to Google it, but yes, it's a dairy product that melts, similar to popsicles and sorbet and ice cream and coffee creamer.  You, the patient, must care about your body more than anyone else.  I'll educate you, but I am not going to be your mother.

Do you need anything else?  Are you all set?  Is there anything else I can do for you?  *smile*  Okay, you call me if you need anything.  You have your call bell.  Okay good.  Call me if you need anything.  I'll be back to check on you soon.

"Now we exhort you, brethern, warn them that are unruly, comfort the feebleminded, support the weak, be patient toward all men." 1 Thessalonians 5:14

Coping With Patient Deaths

I read an article about how nurses cope with patient's deaths.

It was really good, I teared up a little relating to their stories.  Until I got the the last sentence. "I have never let a patient die alone."

This really frustrates me.  Actually it enrages me.

I have heard/read this exactly thing before two of my patients died two weeks ago, on the same night.  Before two weeks ago, just thinking about letting a patient die alone was a horrible thought.  As if letting a patient die alone would be failure of mine.  Or it would be not caring.  Or some other word that would mean I was a bad nurse.

Where I work, we do a fair amount of comfort care for dying patients.  We were "joking" this week that we should rename our unit to the Hospice unit, instead of GI, because of how much comfort care we do.  I have come face to face with death more often than I expected.  Months ago I remember asking the charge nurse if I was supposed to spend my whole night in a comfort care patient's room because her family wasn't there and I "don't want her to die by herself."  She told me I could, but that it wasn't necessary because I was busy with my other patients.

And who comes first?  The patient who the doctor says has 12 hours to live, or the ones who will be going home tomorrow to fill out satisfaction scores?

My first patient died alone.  I checked on her every 30 minutes.  The CNA checked on her often as well.  I called her family to see if they wanted to come in; they didn't.  I medicated her to keep her comfortable.  But I didn't hold her hand.  Actually, her emaciated, cachectic body freaked me out.

Was I a bad nurse for not holding her hand as she died?  Did I fail?  Could I have done something differently to be in the room so she would go into eternity with someone at her side, with a Christian at her side?  Should I have ignored my other patient to be with her?  No.  Just no.  No to all of it.

There was no emergency contact for my other patient. He opened his eyes for a moment when I first got on duty, and I told him my name, told him not to be afraid, that I was going to take care of him, and he wouldn't be in pain.  He never opened his eyes again.  Late in the night, a family member showed up, and an hour and a half after she got there, he died.  I watched him take his last breath.  If you can even call that last inhale a breath.  And that was it.  He was dead.

At least I don't have to work through administering morphine with a "double effect."  Double effect is where you give someone morphine (or any other medication) to relieve someone of pain and suffering, knowing that the effect of respiratory suppression and lowered blood pressure would directly lead to their death.

Where do these people work where they have time to hold patient's hands as they die?

This is a hard job.  Don't do it if you don't have a strong stomach and a strong constitution. 

"He will swallow up death in victory; and the Lord God will wipe away tears from off all faces." Isaiah 25:8a

Death x2

Two of my patients died tonight.

Both DNR.  Both comfort care.  Both in their fifties.

Today was the first ever day I had a patient die while I was there, and I had two patients die.

It is really intense seeing someone's very last breath.

I did not keep them alive 'til 7:05.

Instead of trying to stay awake and do something productive this morning, I took a shower and went straight to bed.  Then I woke up and went to lunch/dinner with a friend and bought myself flowers.

Just trying to remember the song: "Great is thy faithfulness, great is thy faithfulness.  Morning by morning new mercies I see.  All I have needed thy hands have provided.  Great is thy faithfulness, Lord unto me."

"Oh death, where is thy sting?  Oh grave, where is thy victory?  But thanks be to God, which giveth us the victory through our Lord Jesus Christ." 1 Corinthians 15:55,57

Two Funerals

It's been a long week.  Two funerals in less than 10 days.

I've never seen death like this before.  So fresh.  So painful.  So raw.

I'm glad to be family.

I called off work for the first time yesterday, after working at my job for 8 months, for the funeral.

I don't feel like going back to work today.

I'll get off my butt and get ready soon though.  Pack a lunch.  Wash my face.  Put a smile on.  And get back to life....

"To appoint unto them that mourn in Zion, to give unto them beauty for ashes, the oil of joy for mourning, the garment of praise for the spirit of heaviness; that they might be called trees of righteousness, the planting of the LORD, that he might be glorified." Isaiah 61:3

Hey Nurse!

It's hard to ignore your patients when they scream your name instead of "Hey nurse!"

"Oh give thanks unto the Lord; call upon his name: make known his deeds among the people." Psalm 105:1

Pain Pills But Nausea

Pancreatitis Patient: *questionable dry heaving* I. Need. Pain. Medicine.
Me: I'll get you some Zofran for your nausea, but since your pain meds are pills, I can't give you anything until you stop feeling so nauseous.

15 minutes later.

PP: I'm not nauseous anymore. I want pain medicine.
Me: Okay. How bad is your pain on a scale of 1 to 10, with 10 being the worst pain you can imagine?
PP: 10.
Me: Okay, I'll be back.

"But his flesh upon him shall have pain, and his soul within him shall mourn." Job 14:22

Worried

Sometimes I worry about being sued.

About being stuck with a dirty needle.

Being hit by a crazy drunk.

That's in order of least likely to happen to most likely to happen.

"Casting all your care upon him; for he careth for you." 1 Peter 5:7

Six Months

This morning the manager comes to me during report and tells me she has a paper for me to sign in her office before I go home.

It was my permanent employment papers.  Like what I've been doing for the last six months was provisional employment.

So, yeah, I get to keep my job. =)

Totally didn't realized that until this morning when I signed the paper.

She said I didn't act like a new nurse.

"What does that mean?"
"It's a complement."
"Thanks!"

Six months.  Wow.

"Sing unto him a new song; play skilfully with a loud noise." Psalm 33:3

That Makes Three

I kissed another patient last night.

That makes 3 patient now I think.

I'm going to get a reputation doing things like that.

"Salute one another with an holy kiss." Romans 16:16a

Best Memories of 2012

Best memories of 2012:

• Playing around on an internet dating website, and meeting my boyfriend of almost 10 months now,
• Graduating from nursing school with my friends,
• Visiting my grandma in Ohio,
• Getting a phone call about getting my first job while I was there,
• Going to the West Side Market with my cousins and Grandma,
• Coming out of the NCLEX and not being able to hide my excitement from my Dad because I knew I had just passed the most important test of my life thus far,
• Starting my first real job,
• Getting my first paycheck,
• Recognizing my patient was having a stroke right in front of me,
• Thanksgiving,
• Christmas Eve,
• Christmas,
• New Years Eve.

"For the Lord is great, and greatly to be praised." Psalm 96:4

"Everyday I will bless thee; and I will praise thy name for ever and ever.... They shall abundantly utter the memory of thy great goodness, and shall sing of thy righteousness." Psalm 145:2 and 7