A Nurse With Attitude

Where Dark Cynical Humor, Nursing Issues, and Politics Seem to Merge

Archive for the month “September, 2011”

Hosting my own site now!!

Hey, I’ve decided to host my own site. I have start this site new and I have transfered everything to my new place.  All of the old stuff along with some new cool stuff.  If you like anything that you see here, lease check it out.  You will be very happy to see the new stuff. My new addy is:  ANurseWithAttitude.org

  I will try to keep up this site for a while if I can remember

JTaylor

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Just Craziness

    There’s a lot to be said about mental health issues in America today.  It’s like the mentally ill are just forgotten.  That is,  until someone steals their Uncle Mike’s gun and goes on a killing  spree at the mall because voices in their head told them to. Then, after the media runs with it, everyone wants to do something.  But it’s not something about better mental health care, it’s about doing something about gun control.  “By God, we need to make more restrictive gun laws!”  That’s another story for another day. 

    When I was beginning my career in nursing, the mentally ill were kept in large state hospitals much like the one here in Oregon that was made famous by the movie “One Flew Over the Cuckoo’s Nest”. Due to funding issues the mentally ill of today are integrated into the public and all of the large hospitals are, pretty much, history.  Indefinite involuntary institutional imprisonment was clearly not the answer. However, releasing them all onto the public is not the answer either. Today, the only way a seriously mentally ill person can be separated from the public is if he/ she commits a really serious crime like murder, and go to prison. This completely bypasses the health care loop.  They go to prison, they continue to not get the care they need,  and we all can still pretend that they are not there.  This “all or none” plan doesn’t work and we clearly need to be somewhere in between.  We need a happy medium to get the mentally ill adequate healthcare while giving them as much freedom as possible and still maintain public safety.  Unfortunately, the current “do nothing” system falls to the regular hospitals to fill the gap. This adds a severe burden on the ill prepared traditional hospital … which leads me on to yet another tangent.  (I know, my ADD seems to be on a bender today, but I’ll make a point pretty soon.)

   At work, I really hate to be in charge.  It seems that when someone says “charge nurse”,  it easily translates into “who’s to blame”.  Well, one night I was in charge by default.  I was in an the “Emergency Room” of a large trauma center.  Even though I protested, apparently, I was the only FTE nurse on the unit who was not a new-grad or traveler.  I got there a little early and went over to the O.R.  to have a coffee with my wife, who is also a nurse.  For child care reasons, we worked opposite shifts and the only time I got to see her was at shift change. While going through the PACU, a very skinny, very tall man who looked to be in his mid 60’s ran into the room with the speed and briskness of a 12 year old.  He was completely naked. He was wild eyed and frantic.  As I stood there agape with the PACU nurses, he ran straight to our large sharps container, where we trash old used syringes and needles.  He dumped it onto the floor and began shaking out needles.  Before I could say a word, he picked up a long spinal needle and ran to the corner of the room and stood there with his arms out like he was brandishing a sword. “You bastards better stay away!”  He had horribly cracked chapped lips that bled a little as he yelled his threat.  His hands were trembling as he stood there.  I said calmly, “my name is John. I am in charge here and I won’t hurt you.  I am your friend. How about we just relax, have a cup of coffee and talk while…”  he began to relax just a little.  Then, without notice, four security men large as Green Bay Packer linemen stormed into the room. They didn’t say a word. They grabbed a mattress off of one of the beds, held it up and ran at the man full blast.  They all smashed the poor frail man against the wall with the mattress and then backed away.  He slumped to the floor unconscious.  I snapped awake from this bizarre dream, “what the hell are you doing?” They grabbed the guy and drug him out without even a response to me.  I followed up with the Supervisor, got the brush off, wrote a PSN report for my manager and eventually went on to my work.  The off going nurse was very eager to get away from all of this.  I got report and started my shift. As the hours ticked by, it developed into terrible night with multiple MVA’s, stabbings, and several gunshot wounds. One GSW to the chest actually walked into the triage area and politely asked for help before keeling over.  I told the supervisor that it was a good thing he fell over, because the new grad at the triage desk was going to make him wait.  As I was talking to the triage nurse, a taxi drove up.  Then man got out with a box.  “Here’s the equipment you ordered from St. Vincent’s Hospital”  As I signed the form and the secretary called the transport to deliver the crate to the OR.  That same naked man ran past me and jumped into the cab and sped off with tires squealing.  The cabbie broke down sobbing saying, “today’s my first day on the job and some kook stole my cab…” 

    Morning eventually came and I couldn’t be happier.  I gave report and went home for some much needed sleep. The next night was destined to be more of the same, as I was getting report from the off going nurse, she said that the operator just called with an incoming call… she asked specifically for you.  “What the heck, I just got here.”  I picked up the phone.  It was the Sheriff from Chalmette, Louisiana.  “Hey, you the John in charge there?”  I hesitated a bit,  “uhh yea, I guess I’m the guy”.  In a slightly less gruff voice, “great! … I’ve got a guy here that claims he’s your friend.  He said that you’d pay his bail and pick him up. .. or well at least the hospital responsible for him will pay damages and pick him up”.  Thinking out loud,  I said, “now wait a minute,  I don’t know anyone in Chalmette”   Still insistent, “Well, he came from your hospital and he knows you and said that you’re in charge there.”  I said, “how do you know all this and how can you prove he’s from here?”  the sheriff said, “well, he has an arm band with the medical center name stamped on it and a phone number written  on his arm.  He named you, and said that you were his responsible guardian…  and oh yea, he was caught sitting behind the wheel of an overheated,  wrecked, out of gas yellow cab two states away.”   Did I say that I hated to be in charge?

America Declines

Has America become the land of the special interest group and home of the double standard.  I have ranted of the issues of liberal
politics, the double standard and the decline for years.

If we lie to a Congressional committee, its a felony and if a congressman lies, well, it’s just politics.

If we dislike a black person, we’re a raciest.  If a black person dislikes a white man, then it’s their 1st amendment.

The government spends millions of dollars pampering prisoners, while nothing is done for the victims of those crimes.

It’s just fine to teach the details of homosexuality in our public schools, but you had better not use the word God in the process.

You can kill an unborn child and it’s still wrong to execute a mass murderer.

We cannot secure our border with Mexico, but we have no problem protecting the border between north andSouth Korea.

If you object President Obama’s policies, you’re labeled a Tea-Party “terrorist”,  But if you hang George Bush in effigy, it’s your 1st Amendment rights.

You can have free access to pornography on TV but you can’t put a nativity scene in any public area during Christmas.

We can use a human fetus for medical research, but it is considered wrong to use an animal for any type of medical research.

Where are we going, what have we come to in this once great country. We have eliminated all criminals in America, they are
now called sick people and instead of prisons, we rehabilitate them and release them.   We take money from those who work
hard and give it to those who don’t.  We support the Constitution only if it reflects our political views.  We still have freedom of speech, but only if we are being politically correct.  Parenting has been replaced by a social workers and day care.  We don’t burn books, we rewrite them.  We got rid of the communist and socialist threats in the world by renaming them progressives The land of opportunity is now the land of hand outs and government checks, housing, schools, and oppressive regulations.   How do we handle a crisis today… we can’t.  The majority of America is dependant of a government hand out.  What ever happened to the real America
of our forefathers? What happened to the land of the free and the home of the brave? I fear it’s gone forever.

 

ICU Nursing Revisited

Why do we insist on keeping people alive past the time when they should have passed from this world.  Is it our own ego, or selfishness in not wanting this person to leave us even though we know that they will be going to a much, much better place?   This is an ongoing sore spot with me as an ICU nurse.  Our “modern medicine” along with the ego of some of our star doctors, (who get paid based on the procedures they perform as apposed to the end result), are unable to let people go naturally.  I’m not advocating physician assisted suicide by no means.  I believe all people die eventually, and giving some terrible incurable disease, we’re only piling  additional harm  and debt onto the patient’s family by temporarily holding back the inevitable.  Yes, I am a strong hospice advocate, especially with terminal illness.

(For liability reasons, I’m not naming names).  I first began nursing as a new grad in a Neuro / Trauma ICU, in the only level one trauma center in Alabama.  I was very naive. I remember one of my very first long-term patients. He was a very high cervical spinal injury and we were working to get him off of the ventilator.  He was very sick and had multiple surgeries. I remember how busy he was and how complex it all looked. He was truly the sickest individual I had ever seen.  He was a multiple trauma victim… crashed his Harley into a large truck.  Multiple long bone fracture, spinal injury, closed head injury, cardiac contusion…

Call it blind naive optimism or too many TV medical shows, but …   It never crossed my mind that he would not recover from this injury.

Weeks went by and he remained frail and required multiple pressors. He was swollen, sedated, and still the sickest person I had ever seen. He then followed a course that I was to witness many, many more times over my career: trach, PEG, weeks and weeks in the ICU, and once he finally left ICU he would come back several times before finally dying.

One thing I remember about him was that we would feed him ice chips. Being long term NPO (nothing by mouth), this was one of the greatest pleasures granted to a long term ICU patient.  Our ice was mixed with blue food coloring. In that way we could tell if the stuff he was coughing out of  his tracheotomy  was aspirated ice chips.

It was. Every time. Blue phlegm.

The other thing I remember is that his wife came to see him every single day and would stay for a long time. Maybe she had no other obligations, maybe she did but made him a priority. I don’t know – all I know is that she was there and it was obvious that she really loved him. Through all this, I somehow became close with his family. I talked with his mother and father, his wife, sister and brother.  I encouraged them and prayed with them.

Eventually he got better.  He was doing so well, sitting up, talking, optimistic and happy.  With therapy, he had gotten some use of his hands.  He  and discussed his future and how he had planned to go into business rebuilding starters and alternators.  When I discharged him from the ICU to the floor, it never occurred to me that he could still die.

I also I realized that for the majority of my patients and their family members, their loved one being critically ill is the first time they’ve ever seen anyone so sick before. Through hope and a misguided sense of medical science’s abilities to cure, they have unbridled optimism. They don’t see the same cases day in and day out. Just as when I was first exposed to someone this ill, I didn’t realize that there’s really a pretty good chance that this patient will never recover.

This realization has gone a long way towards clarifying the thought process that goes into making someone who is obviously (to me) terminal a “full code.” With the patient that I described above – I think it would have really shocked me if someone initially, way back in the ER, had suggested stopping treatment and letting him die. I would have protested as sharply as anyone.  But where do you draw the line when you see clearly that this is just too much for the normal human body to recover.

It had been weeks and I had moved on.  One night, out of the blue, there he was back in the ICU.  This time he was blue, unconscious, and on a ventilator at 100% with high PEEP.  I was distraught and shaken.  The off going nurse said that he had infarcted and his entire bowel had died.  Now he was septic.  There was nothing more to do and he was now a DNR.  Although I had a feeling from the beginning that this would not turn out well, I still felt really bad.  This wasn’t just another patient, he had developed into a friend.  Somehow, I not only felt I had let a very nice family down, I had let my new friend die. In twenty years, I’ve never again let a family get that close to my heart.

Another thing that has been on my mind recently is the availability of those making decisions for the patient. We recently had a patient that was in ICU for over 3 months. It was clear to many of us nurses that she would never, ever leave the hospital (and turns out, didn’t leave the ICU for more than a day or so on transfer before she was back). The family was adamant that everything be done for her and she lay in that bed and wasted away day after day. Her labs became increasingly abnormal. She developed bedsores despite frequent turning and skin care. She was trached and was on the ventilator. She was fed through tubes. She closed herself off from almost everyone, even nurses that she used to smile at before. She would barely look at her family… but there’s the thing. The family. That family was there every single day to watch this unfold. Did that make it right? I don’t think so, personally. But it made it a little better in my mind. At least they were there with me… and taking responsibility for their decisions. They were at the bedside every day, watching the patient deteriorate as the months went by. For some strange reason, that really meant something to me. It was like they were going through all of this with me, giving me comfort while I attempted to give their loved one comfort.

Yet a few rooms down, there is another patient in a similar situation. This patient is also trached and is fed through tubes. It was impossible to get him off the ventilator. The times that he has communicated with us through writing, he has told us that he’s ready to die. Ready for this to be over. But his family is making the decisions. They’ve decided that everything is to be done for this patient. If his heart stops, we’re going to pump his chest and try to get it restarted. Yes, the family knows his wishes – they’ve seen what he’s written. They won’t accept it.  The difference? This family very rarely comes to visit. Maybe once or twice a week for a few minutes. They’ve put this patient in hell and now they won’t watch it. They won’t watch what they’re doing to him. They aren’t present for the times he coughs and needs his airway suctioned. They aren’t there to step out of the room so that we can clean up his incontinent bowel movements. They are nowhere  to be seen when we do dressing changes. They just aren’t there. To have a person who is suffering so much, we as nurses seem to be there just to perpetuate it, as this guy is clearly not getting better.  With the progression of his disease he can only maintain.  He has made peace and is ready to move on.  The family is in denial and doesn’t want to even come to the hospital.  I think this situation is one of the saddest things I have ever witnessed.

We are all war victims in some sense.  I know nurses that are all shot out, drink heavily, live a very unhealthy lifestyle, possibly suffering from  PTSD.  It’s not the war on sickness and disease that gets to us,  its the suffering of our very human patients that we invest so much of our lives to help that gets to us.

A New Space Race to Save the Planet

The Liberals say that the space program is a waste of money and as a result the Obama administration is dismantling the Shuttle program and defunding NASA. I think that this is a travesty. They feel that schools, welfare, infrastructure, free healthcare, and enhanced social programs are a better investment… I disagree. I feel that it goes back to that saying, “If you give a man a fish, he will eat for a day and if you teach him to fish, he will never go hungry”. If you give someone a free hand out, you rob him of his incentive or motivation to do anything else. People receiving government assistance will never be motivated to excel and never have a goal to seek something better. Even worse, they will never be satisfied and will even become angry thinking that somehow they were cheated or wronged. This is clearly evident by the civil unrest and rioting in the UK. In Britain, the citizens have free socialized health care, free food subsidies, free mass transit, rent subsidies, and welfare for practically everyone. By the liberal standard, it should be a virtual paradise. Yet there is unhappiness and unrest aplenty. I believe that in our very nature, the human spirit needs a challenge. In history we have overcome our greatest difficulties in times of hardship. We need something to overcome, a goal to succeed, a competition to win, a reason to live. Our forefathers were explorers who came to America on great sailing ships. A generation or two later, they tamed the Wild West.

When I was a kid, America was in a heated race with the Soviet Union to get to the moon. This affected the lives of everyone. The whole world was watching, and the whole nation had a sense of pride and a single focus. Every American kid wanted to be an Astronaut. I never became an Astronaut, but I still drink “Tang”. Instead of sitting at home and watching TV waiting for my government subsidy check (like most young adults continue to do today) I studied science, math, chemistry, physics and eventually became a nurse. I think that the space program of the 70’s had a huge influence on my life and my educational goals. We need to give our youth a goal… something to work for. We need to rejuvenate the space program on a global scale. We need a new space race with some serious competition. We need to send people into space, to explore, to learn, to lay claim to the unlimited resources of our nearest planets and beyond. If we let the space program die a quiet death, as the current Democrats want, I believe we will have continued unrest, stagnation and possibly even a decline in societal evolution.

My youngest son still maintains a keen imagination and a sense of adventure. If this generation is lost, I fear that the next generation won’t have even that. I fear for what would happen in the way human development? It would be just like if everyone in 1490 Europe had said, “why on earth would I want to go to America when the King gives me everything that I need here?”

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