Murder and Mayhem

It’s chaos out there. Utter chaos. But quarantine is not what’s on my mind this week. No, I’m still reeling from the everyday, run-of-the-mill events of this past week at work. Have you ever taken care of a murderer in your line of work? Nope? Not suprising. (Clue…It was the colonel with the candlestick in the library….)

Well, life and death often go hand in hand; after all, nursing is all about the circle of life. Earlier this week, not only did I help code a murder victim, but I also took care of the accused only hours later. It’s a bit of a surreal feeling; we did our very best, but a gunshot wound to the chest is not something that all the king’s horses and all the king’s men can ever put back together again. And as remorseful as a soul can be, there’s no returning anyone back to life after a split-second action gone wrong. I mourned for everyone involved in the scenario. The young children who no longer have someone to call “Mommy”, the mother who lost her adult child, and the poor soul who “accidentally” discharged the weapon mere feet away from his girlfriend’s chest. His life will be over from this point on. He can never close his eyes and forget what happened or the consequences of his actions. He will be reviled and hated for the rest of his imprisoned days. His tears were real, and far from over. And of course, there were extenuating circumstances. (There always are, it seems like, but I can’t speak to that here.) I shudder to think of what the girl’s family is going through. Unimaginable pain and loss, and the day after Mother’s Day, at that. So, so incredibly sad…..

The night after that, I was called in to work due to an emergency c-section for a 27-weeker who was bleeding and in labor. There were tears in that room that night as well. Tears of fear…and pain…and then JOY when the baby responded to care. It is always miraculeous to see a baby that small respond to modern-day emergency medical care. We are a small hospital — to enjoy the benefits of a NICCU team, we have to call ahead of time and arrange their 1+hour drive to our facility. They work alongside our nurses to stabilize the baby for several hours before loading up and driving the 1+hour back to OKC. They are courage under fire, calm under pressure…it is always amazing to see them at work!

I also took care of my first-ever case of mumps this week. Having never seen it before except in textbooks, it was still immediately recognisable. My first question was, “Have you had your immunizations?” Interestingly enough, it was the doc’s exact same first question, so I knew we were both thinking the same thing. I’m telling you, it’s been a weird week, and it’s not even full moon.

All this is going on while the covid virus is still running amok and causing chaos. Or, at least in our area, the covid restrictions are causing chaos. We have been extremely fortunate to not have the virus in our town, other than a handful of cases which have all been resolved. I hope you have been fortunate wherever you are as well.

2020 has not been a stellar year for anyone. For us, it started with the death of an extended family member hours after the ball dropped to bring in the New Year. Then, an unexpected death of a dear friend on January 4th, and it just went downhill from there. A huge house renovation has hit multiple snags and delays for us during all this. We are still fostering the same child we’ve had for three separate placements now. Parental termination hearings have been delayed several times, but are finally happening in two weeks, if all goes according to plan. We anxiously await to see if we will be able to adopt him. We have been “in limbo” for so long, it seems like we will wait forever to find out. Such is the foster care system, and I repeatedly remind myself that patience is a virtue.

That’s my life in a nutshell, how is yours? We are all in this thing called life together. We may not be in the same vicinity, and our covid restrictions may not look the same, but we are all experiencing loss and change at the same time. We are all learning new things about ourselves, as well as our neighbors and coworkers. If you didn’t know before if you’re considered “essential” or not, you know now. If you didn’t know before if you’re an extrovert or introvert, you certainly know now. ūüôā Perhaps you’ve learned a new skill or taken up a new hobby. Maybe you’ve found new favorite TV shows or movies that have helped you get through this. Maybe you are a better cook, or gardener, or family member, etc, after all of this. I hope this finds you well and slowly returning to a more normal lifestyle. May there be peace in the midst of our chaos, and hope amid our covid fears. I have faith that we will come through this stronger than when we started. We have a better understanding of our fellowman, and a stronger sense of identity. We have hopefully gained a better appreciation for what’s truly important in life, and can take that with us into a better future.

“Peace I leave with you, my peace I give you. I do not give to you as the world gives. Do not let your hearts be troubled and do not be afraid. ” John 14:27

                                 Nurse Ames, RN

 

Trying to teach an old dog new tricks (Uh, that would be me)

Have you ever been in that situation in life where circumstances force you out of your comfort zone? Where you have to jump into a new skill set, or learn a new way of doing an old job? Where you get transferred out to a different facility, town, maybe even state? If you’re like me, I’ve had my job down pat for quite some time. It’s comfortable like an old hat. I can do it in my sleep. I do so many things by rote memory, I’d be hard pressed to have to explain to an outsider what it is exactly that I’m doing. But, ahhh, that great dictator Time brings change for everyone. And for me, that change has come in the form of taking on a new department at the hospital. I’ve been asked to join OB land, mother/baby, labor/delivery, whatever you want to call it. Now then, I’ve avoided that department like the plague for the 25+years I’ve been a nurse. But here I am. My patients are no longer only the COPD, pneumonia, heart attack, stroke, postop variety. They now weigh under 10 pounds instead of the 300-400 pounds I’m used to. They’re at the beginning of life, not the end.

If all goes well, it’s great. Cue the pink bows and blue hats. The big smiles and proud parents. If not? Well, it looks a little different. I work in a small rural hospital, so we have no NICU to call on. It’s just us. If babies are bad enough for NICU, we have to neo-flight them over an hour away to OKC.

For that matter, we don’t have an ICU either, so we often fill in as ICU nurses (unofficially) until the patient gets better, or takes that same ticket out of here to an OKC hospital.

That saying about trying to teach an old dog new tricks? It does have a ring of truth to it. We who have honed our skill set for years, who have gotten too comfy in the job we are in, sometimes have a hard time with change. Gotta fire up those brain cells and make some new brain pathways to incorporate all that new knowledge. Gotta get off the couch of life and jump right in there with both feet forward. See the world thru different lenses.

Well, here I am, and I AM learning new things. For instance, did you know that if you work on a bad baby while standing under the warmer for upwards of eternity, you can practically get a sunburn without even going outside? ūüėāūüėā. At the very least, what feels like heatstroke. And the babies born today are just as slippery, tiny, and fragile as they were when I had my babies 15-20 years ago. Then again, they’re just as cute, so that counts for something.

So, here’s to new beginnings. Whatever new venture you might be facing, I hope it’s going well for you. I hope you’re out there killing it every day, turning your world upside down and enjoying every minute of it. Because ultimately, it IS satisfying to change things up a bit, to knock those brain cells around and see what shakes out.

Good luck, my friends! And may your new experiences include great things that don’t involve the eternal sun of a baby warmer. ūüėä

Katie Brack Day

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So… I know we all have them. ¬†If you don’t, you will sooner or later. ¬†(And consider yourself very lucky if you don’t already.) ¬†You know them, those days we all dread…those silent, looming anniversaries of some terror, some horror, perhaps the loss of a loved one. ¬†Maybe it was the day you were told you had cancer, or that your loved one was killed unexpectedly in an accident, or the day you realised you’ve lost everything you’ve ever worked for. ¬†Your spouse was unfaithful, your dog died, another war started and your loved one didn’t make it back alive. ¬†So, so many things in this life can and do go wrong. ¬†And we go through the stages of grieving, and we gradually recover, because we are a resilient people. ¬† But there’s always that day that comes around once a year, that day on the calendar, that marks for you a space in time to stop and remember. ¬†To grieve anew, to honor what was lost, to put into perspective what time and change has wrought. ¬†Everyone deals with that day on the calendar differently.

I have been radio silent the past two weeks for that reason. ¬†(Well, that, and partly because I was on a Carribean cruise soaking up some sun–I really was radio silent and unable to write during that time. )

This past week marked the 21st anniversary of when my beautiful five year-old goddaughter passed away unexpectedly in my home. ¬†A whole person’s drinking age life-time ago. ¬†I have had three great kids of my own, helped care for numerous foster kids, have taken care of oh-so-many kids in the healthcare system as a nurse, and still the ache remains. ¬†Oh, time has greatly helped heal the wound. ¬†Now the anniversary is more of a tug at an old scar vs. ripping my heart open again, like it used to years ago. ¬†The way I remember the day is different now than what it used to be–I don’t fall to pieces anymore, for one thing. ¬†I still cry a few bitter tears each year, and we still plant flowers in her “memory garden”, and my hubby makes sure I know he remembers too. ¬† I message her parents, who are divorced now and live in different states than we do. ¬†We check in on each other, make sure the other is doing okay. ¬†And I look at her scrapbook, and remember all the beautiful, wonderful things about her. ¬†All the things that made her so uniquely “her”, that made her so sweet and loveable, despite her severe level of cerebral palsy.

To this day, I have a hard time talking about the details of that day. ¬†We’ve since moved to another state, where no one knew her, or what happened. ¬†It’s easier to not talk about it at all. ¬†But I made a promise to her and her parents. ¬†That her short little life was not lived in vain, she did have a purpose, and I will always strive to keep her memory alive in whatever way I can. ¬†I tell my friends and coworkers about her. ¬†I tell my kids about her. ¬† When we go “back home” to visit every couple of years, I take them to the cemetery with me to visit her. ¬†(And then I choke up and start crying and I whisper to her I will see her in heaven someday, and I have to leave before I’m a complete wreck.)

I suspect you know what I’m talking about. ¬†Your scenario might not look the same. ¬†You might handle grief totally different than I do. ¬†But we all have those memories, those moments in time that stand out starkly in our minds. ¬†It’s one of the things that bonds us together as humanity. ¬†Just as a smile is universal, so is crying and shaking your fist at the sky.

Whether it’s been two years or ten, or way longer than that, grief and loss never totally go away. ¬†We are grateful that the sharp sting fades away, and the jagged edges smooth away like rocks worn smooth in a stream. ¬†But that takes time, and time means days and weeks and years. ¬†Which, of course, means anniversaries that roll relentlessly by.

If you still struggle with the anniversary part of the grieving process, I encourage you to start something new to carry on as a tradition for years to come. ¬†Something that lets you vent your grief in a positive way, to honor your memories, to help you get through it. ¬†And when it’s come and gone, and you can breathe a sigh of relief again, whisper a prayer of thanks that it won’t roll around again for another year. ¬†And hopefully by then, it will be easier to deal with. ¬†Trust me, I’ve been there.

Rest in Peace,  KatieBug,  I Love You

4-25-93 ¬†— ¬†6-6-98

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                            Nurse Ames, RN

Housekeeping Blues

 

Now I’ll be the first to wholeheartedly agree that without good housekeeping staff, no institution functions properly. They are the backbone of any hospital, Medical Center, nursing home, etc. That being said, they can sometimes offer up humor without trying, just like any of the rest of us.

This past week in the ER, we had an interesting experience. I had a elderly patient that had an unfortunate experience in the bathroom. An enema gone wrong, and diarrhea that somehow ended up covering the walls and also the floor near the toilet.

We called housekeeping and let them know the bathroom would need a thorough cleaning. After the patient left, housekeeping came to clean and we warned them how bad it was and that they would want shoe covers and gowns.

They dressed up like they were going into major surgery. They were covered head to toe in blue throwaway gowns, caps, shoe covers, eye protection… it was like aliens were invading that bathroom. Or so we thought. We saw them from the doorway cleaning the whole room– floors, walls top to bottom, mirrors, equipment–they even took the clock down and cleaned behind it! We were so impressed they were going the extra mile –although we didn’t quite understand their reasoning, we weren’t complaining. They finished and left, and soon another nurse went to put a patient in that room. She took the patient to the bathroom in that room and handed them a specimen cup for a urine sample. Soon the nurse and patient came hustling out of the door and headed for another room. When we asked what was wrong, the nurse said “There’s diarrhea all over that bathroom!”

Completely puzzled, we called housekeeping to come back. What were they possibly thinking, meticulously cleaning the room itself and not the bathroom where the actual mess was?

It wasn’t long before we found out. And when we did, we were rolling on the floor laughing. Tears were coming down our faces– I haven’t laughed that hard in a long time!

(And remember, friends, you can’t make this stuff up. Absolutely priceless.)

When we asked the two ladies who had cleaned so diligently before and yet missed the mess altogether, here is what their response was. ” We thought the mess was in the patient room itself, not the bathroom, and since we didn’t see any mess in the room, we thought it was that kind of diarrhea that is the clear diarrhea!” Huh? Clear diarrhea?? “Yeah, you know, the clear kind!”

Omg, smh, lol. ūüėúūüėāūü§Ēūü§£

                           Nurse Ames, RN

 

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Do nurses ever truly clock out?

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Ahhhh… Vacation. ¬†Gotta love it. ¬†Nurses tend to joke around about never truly being on vacation. ¬†We make t-shirts about it, send each other funny memes, laugh about it at work. ¬†But really, we do tend to try to avert anything that looks like it might turn into an emergency, because hey, everyone needs a mental break sometimes. ¬†Even nurses. That being said, we also jump in and help without hesitating if the need arises. ¬†Even on vacation.

Last weekend I met up with a girlfriend of mine for a weekend away from home.  We met in St. Louis, which makes the most sense for us while trying to meet halfway.  (I live in Oklahoma, she lives in Ohio.)  We had an awesome weekend just catching up, trying some new restaurants, seeing some great sites and places.  We even managed to get in on opening night of Miss Saigon.  I did not manage to get away from being a nurse for the weekend, however.

We were hiking up the concrete steps of the Gateway Arch when it happened. ¬† I was blazing a trail to the bathroom (which seemed a good half mile off in the distance) when I hear my friend call my name. ¬†I turn around and see her. ¬†One of the sweet little elderly ladies we had just talked to is lying on the ground, clutching her head, groaning softly, a grimace on her face. ¬†My friend later told me “her head sounded like a melon cracking open” when she hit the ground. ¬†She has fallen down the concrete steps onto the equally hard concrete pavement below and taken a direct hit to the back of her head. ¬†My friend motions me over, saying “You gotta help”, and I’m doing a split minute decision on whether my bladder will hold out for this emergency, or if it will become the main emergency itself. ¬†I can’t NOT help her though, so I rush back to her side. ¬†I gently address the elderly group surrounding her–¬†“I’m a nurse, may I help you?” ¬†The look of relief is evident on their faces. ¬†I quickly assess her while someone goes for help. ¬†She hasn’t passed out, and she is talking to me without difficulty, so I know she is okay for the moment. ¬†Soon a physical therapist stops and offers help, and bystanders are quick to help with whatever they can–keeping her shaded from the bright sun shining in her eyes, something to put under her head to pillow it from the concrete ground, ¬†etc. ¬† ¬†Her friends are praying out loud, panicky, scared something terrible has happened. ¬†My training kicks in–regardless of what has happened, calm the patient and those around her. ¬†I quickly point out to her and her friends that she is stable for the moment, and that emergency services will be here shortly for further assessment and to take her to the hospital. ¬†I talk directly with the patient then, discussing her condition and telling her what needs further testing and why. ¬†She insists she doesn’t want to slow down her group of friends, which has not yet gone up in the Arch. ¬†I gently remind her that she might have suffered a brain bleed from the fall, which wouldn’t necessarily be obvious in the few minutes that have passed. ¬†At the very least, she might very well have a concussion. ¬†I convince her to keep from moving until Emergency Services get there to take over. ¬†Once they arrive, I step back and let them do their thing. ¬†We leave after they have taken over and have things well in hand. ¬†I still really¬†need to use the restroom, and it’s almost time for our tour to go up the Arch. ¬†For all I know, that elderly group of visitors may have been slated to go up on the same tour as us. ¬†We’ll never know; neither will we ever know how things turned out for her. ¬†We did ask a park ranger after the tour if they had any updates. ¬†Apparently, she was still refusing further medical care and was not taken to the hospital. ¬†I laid awake that night, worried for her. ¬†Was she okay? Did she eventually get worse as time went on? Was she near help if she did worsen? ¬†As I lay there, I thought of all the things I could have done differently to help her. ¬†Did I miss something? Was there anything else I could have done before EMS arrived? And other thoughts I had…Why are the steps and walkway designed like they are at the Arch? How many people fall on them each year? ¬†How much worse are they when it’s actually wet? ¬†How do they respond to emergencies inside the Arch? Or at the top? How far is it to the nearest hospital? ¬†Where DID¬†those emergency workers come from so quick? Why aren’t there better signs posted around the Arch, directing traffic? ¬†Sometimes I have a hard time shutting down the “what if” questions.¬†

Nurses are trained to look at scenarios to find out what’s wrong and to try to fix it. ¬†I guess that’s something you don’t just turn off when you clock out and walk out the door. ¬†I had a great weekend in St. Louis, but I came away with a few golden nuggets of wisdom. ¬†1) Allow plenty of time to reach your destination, in case something unexpected happens. ¬†2) Never turn down a bathroom break when it’s presented to you, as you may really, really wish you would’ve taken it a little while later. ¬†3) Always be prepared to lend a helping hand to those around you…you’ll be so glad you did. ¬†

To the sweet little lady who fell, I hope you are okay. ¬†I hope you and your friends were able to go see the Arch. ¬†I hope your vacation was all you dreamed of. ¬†And… here’s to many, many more adventures for the both of us.¬†

                   Nurse Ames, RN

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Hannah’s uvula’s Big Day.

 

This week my daughter Hannah had an EGD performed to hunt for the source of some ongoing stomach issues. ¬† After hearing her talk about how much her uvula hurt, I told her I’d write a little something funny to remember the incident. ¬†She had been scoped before, and was caught off-guard by how much it hurt this time compared to last time. ¬†I helped her through the experience as best I could, and then I wrote the story from a totally different angle. ¬†I wrote this mainly for her, but I thought it might make you smile this morning so I included it here as well. ¬†Enjoy! ūüôā

Hannah’s uvula’s Big Day

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Today I woke up like I always do, a little dried out from sleeping all night, morning breath in place, because, well, that’s what happens inside a mouth in the morning. ¬†I thought today would be like any other day, but wow! was I wrong.

I got my surroundings brushed up and minty fresh, and assumed I’d be heading off to school with Hannah just like any other day. ¬†Boy, was I in for a surprise! ¬†I started to realise we were at the hospital about the same time the anesthesia hit me like a ton of bricks. ¬†So,¬†I relaxed like any good uvula does under those conditions. ¬†Then I heard a lot of talking by nurses and the doctor. ¬†And then ….Bam!, out of nowhere, the most massive tube ever made just shoved right past me into Hannah’s esophagus. ¬†Quite rudely done, if you ask me. ¬†So I’m trying not to gag, while I’ve got this massive tube pressed up against me, violating me and all of Hannah’s mouth and esophagus all the way to her stomach. ¬†I see a camera come into view at one point, and realize someone is actually taking pictures of this weird and offensive start to my day.

Finally, it’s over and the tube is gone. ¬†Ahhhh, what a blissful feeling. ¬†Until I realize I hurt all over and I’m swollen what seems like ten times my normal size! And her tongue– its swollen too, and we are fighting, pushing and shoving, for who needs more room in the back of her throat.

Several hours later, I’m still totally miffed about the situation. ¬†I’m still sore as can be, swollen up like a dead bloated toad, and nothing is helping. ¬†Finally, Hannah gets some Advil past me, and starts helping me out with some ice chips and cold ice cream. ¬†We can be friends again for that one. ¬† But it might take a few more offerings of the ice cream to make up my mind.

I can tell this day will be one of infamy for me. ¬†I am the biggest, baddest neighbor in town in my neck of the woods today. ¬†I demand everyone’s attention, as my swollen, angry red self asserts itself as the power-to-be for the day. ¬†I get all the attention, all the negative feels. ¬†I longingly wait for my former nice, not-red-and-swollen, self to return. I dream of all my favourite cold popsicle flavors, and think ice is the best invention ever made. ¬†I wonder what I did to deserve this outrageous attack, and vow to fight back the next time.

The next morning I wake up, a little worse for the wear, but feeling a little more like nature intended me to be. ¬†I still long for ice, Advil, and popsicles, but I’m more open to the thought of returning to life as regularly programmed. ¬†However, I have a few thoughts on the subject of EGD’s, scopes, hospitals, and the like….What’s that saying? “History repeats itself”? ¬†There had better not ever, ever be a repeat, that’s all I’ve got to say!

                           Nurse Ames, RN

Peg tubes–good, bad, or ugly?

Life is a balance of holding on and letting go.”–Rumi–

She’s 66 years old, she lives in a group home, she has cerebral palsy and MR. She’s been in and out of the hospital this past year several times, each time declining physically. She doesn’t speak, she just points to what she wants and makes hand gestures. I’m only 5’2″ and when I help her to the bathroom, I tower over her height-wise. She is tiny, but her personality is huge. We nurses know her normal by now–she’s happy, grins ear to ear, wants to give everyone hugs. If only all of our patients could be that way, right? Today she is back in the hospital. They have placed a peg tube because she can no longer pass a swallow study. She is hurting, despondent–not her normal self at all. Her mouth is dry because she can no longer eat or drink. Her stomach is trying to get used to bolus peg tube feedings, which is stretching her stomach more than it’s used to. The canned liquid we give as total nutrition is causing her gas. Not only are these things causing her pain, but also the new peg tube site itself is still quite sore. She’s never been on pain medicine before, but the need for it is there now. So she sleeps a lot more than normal, is much less active. This leaves her wide open to a variety of complications–bed sores, pneumonia, blood clots in her legs, etc. However, at least she is now hydrated, and getting the vital nutrients she needs to stay alive. She doesn’t have to choke on her medicine, food, or drinks anymore. And she no longer needs to worry about aspiration pneumonia every time she takes a swallow.

Making the decision for end-of-life care is never easy. Nurses have the luxury of an objective point of view.  Meanwhile, family members are torn by the possible consequences of their decisions, no matter what that decision might be. Nurses have seen the same scenario enough times to guess the most likely outcome, whereas family members are dealing with uncharted territory. It’s a tough call to make, and I’ve been on both sides of the equation.  As for peg tubes themselves, I have seen some people thrive and regain health with them, while others just sort of wither away regardless. Are we giving loved ones another shot at life? Or delaying the inevitable while their quality of life further declines? I don’t know…there’s definitely no easy answer to that.  Every situation is different, every patient, every family group…All I can do as a nurse is provide information and be as honest as I can be when difficult questions arise.

As for my little peg tube patient, I hope she’s doing well again back at her group home.  I never got the chance to see her smile return before she was discharged.  I do know she was surrounded by love.  Her caretakers and other residents often visited her, and she seemed to have a great support system.  If anyone has a chance at returning to a better quality of life, it would be her.  I hope she gets her smile back.  

                           Nurse Ames, RN