Death

So someone asked me the other day if I ever encounter death of my patients. The last weekend that I had worked I experienced it each night.
Friday night. Mr Smith, age 76, He saw his doctor earlier that day and then worked out at the gym as he does three times a week. His wife heard him "snoring" in bed and went to check on him. She found him hardly breathing and called 911. The paramedics did CPR and shocked his heart. They got his heart beating again. I took care of him for a very long 4 hours in the ED. His heart continued to beat on his own. We breathed for him with a breathing tube and I gave him medication to sustain his blood pressure. His wife was devastated and kept saying that she can't lose him. They had been married for 58 years. In my mind I was torn as to if he would pull through or not. Since he had gone the 4 hours with his heart working on its own, I thought maybe he had a chance. I finally was able to take him to the ICU and about 30 minutes later we heard "code blue ICU." My heart sank and I knew that it was my patient. The ER doc went up and pronounced his death.
Saturday night. Mr. Jones, age 94 comes into the ER after fainting at home. He was talking to the paramedics on the way in and then his heart stopped. I personally did CPR on his chest. After a round of medications, his heart started to beat on its own. Again, I took care of him. We breathed for him with a breathing tube but his heart continued to beat and he maintained a good blood pressure without medication. I updated the family and let them know that it didn't look good for Mr. Jones. I later took him to the ICU. The next day I called the ICU, expecting them to tell me that he hadn't made it. Surprisingly they told me that they had removed the breathing tube and that he was sitting up in bed doing well. Crazy! We had saved a 94 year old's life after performing CPR. That just doesn't happen all that often. All I could do was smile:)
The thing is...I truly believe that God only calls his children home when it is their time and not a minute sooner! We do all that we can to save every patient that comes through the door, but it isn't really up to us if they make it or not.
Believing this is how I cope with loss in the ED. Now with that said, it's not always easy. When it is a child or younger person it is difficult. I just have to remind myself that God needs them more than we do.

Henry

So I will never forget a little boy by the name of Henry. This happened back in 2005 when I was 8 months pregnant. My sister and niece were visiting and we had just gone to Target and were on our way back to our house. We were right outside our subdivision when I saw that an accident had just happened. My sister stayed in the car with the kids and I ran over to the car. A truck that was pulling a stucco machine was traveling one way when the trailer came unattached and hit a car head on traveling the opposite direction. There was a lady in the drivers seat , young boy in the passenger, baby in the back car seat and then Henry in the rear passenger seat. He looked the worse as he was barely breathing. I had some men pull him out and lay him on the ground. I began CPR (along with mouth to mouth which I had never done before) and soon another RN came by and began to help me. It seemed like forever until the firemen/police arrived. They continued to work on Henry and they wanted to stop efforts (it was pretty obvious that he was not going to make it). However, I have seniority over them and I wouldn't let them. I couldn't bare the thought of leaving him dead in the middle of the street. He was flown by chopper to a near by trauma center and pronounced dead upon arrival. Being a mom, I would want everything to be done to save my child's life. Even though flying him to the hospital did not change the outcome, I'm hoping it helped the mom realize that we really did everything possible to save his life. All others in the car survived without life threatening injuries. I found out that Henry died of
1. subdural hematoma (bleeding on the brain)
2. cerebral edema (swelling around the brain)
3. laceration of the spinal cord (spinal cord snapped in half)
4. transection of the spinal aorta (major blood vessel cut in half)
5. massive hemoperitoneam (Bleeding in the abdomen)
6. hypoxia- ischemic injury to the intestines (gut died due to lack of oxygen)
7. rib fractures (possibly caused by CPR, that is very common)
8. partial avulsion of the lt kidney (part of the kidney tore off)

Last I heard they were still deciding if they were going to press charges against the driver of the truck and owner of the company. Two weeks prior to the accident the company had been cited for a faulty emergency trailer brake and lack of safety chains. Every time I pass a truck pulling a trailer I look to see if the safety chain is being used and it's amazing how often there is no safety. I get so mad every time I see that! That safety chain is so important!

Henry was wearing his seat belt but it was only a lap belt. This experience has made me realize how important that shoulder strap really is. The experience was very sad. It reminded me of how fragile life is. How our earthly time can be over in an instant.
I'm glad that I was driving by just at the right time. I'm glad that I was able to do all that I knew how to save Henry's life. I'm sad that I was not able to save him. But it was his time.
I try to remember the importance of this life and the good that each one of us can do.

Not all medical errors end up being bad.

Well my wife has been after me for a long time to post a blog on the internet. So I’ve decided I would hijack her blog and post one of my E.R. stories. When I was 16 I worked at the local hospital in the Lab drawing blood after school. As part of my job I often would draw blood and perform 12 lead EKGs on patients in the E.R. I remember one busy night while working I received a request to come down to the E.R. and perform an EKG. I had been doing this for several months and didn’t think anything of it. As I looked at the request I realized the patient was a girl that I went to school with. For the non medical readers of this blog you have to realize that in order to perform an EKG you have to have the patients remove their shirt and bra. Normally this test is performed on older individuals so it was never a big deal. I had never done this on a younger person especially a female that I knew and went to school with.
Luckily I didn’t work alone I had a supervisor. So I decided I would have him do it. Within a few moments I discovered that he was trying to get some blood from a new born infant that was critically ill. I remember telling myself normally EKG’s aren’t things that have to be done immediately so I decided I would put the procedure off until my supervisor returned from drawing the blood. Just then the phone rang. It was the E.R. They were calling to inform me the patient was going to surgery so we needed to hurry up all of her test. I couldn’t believe it nothing was going right. I knew that if I performed this procedure it would be not only embarrassing and awkward for me but also for her. After a minuet I just told myself, “This is your job, you’re a professional you can do this and it is really no big deal.”
So I grabbed my machine and headed to the E.R., as I walked down the hall I passed the respiratory therapist who asked me who I was going to do an EKG on. I told him, he replied that’s strange that their doing an EKG on someone so young. I told him that she’s going to surgery and maybe it had something to with that.
I then went into the patient’s room. I performed the test. Just like I expected it was very embarrassing and awkward, but I did it. As I walked out of the room I saw the respiratory therapist running towards me yelling stop don’t do the EKG. My heart dropped, I asked what’s wrong. He told me that someone had marked the wrong box on the order sheet. The Dr had ordered an HCG AKA a pregnancy test, a standard test for all women going to surgery and not an EKG. Just then the Patients mother heard the commotion and stepped out of the room to find out what was going on. Luckily the mother was very understanding and actually thought it was a little funny. Actually all of the staff thought it was very funny. Me, I was just pissed off. I wanted to know who would make such a stupid mistake as confusing an HCG for EKG.
I grabbed my machine and headed back to the lab even more embarrassed then when I headed to the E.R. A few moments later a girl in scrubs came to the lab and introduced herself she said that she was the new E.R. tech and came to apologies for making the mistake with the orders. I accepted her apology while thinking to myself how dumb is this person that they can’t even fill out an order sheet correctly
Well ultimately I did truly forgive her, and found out she was pretty smart. A few months later we started dating and a few years after that we got married and now ten years later I have to admit not all medical errors are bad.

Gratuity Included

So here is the deal. Why is it that almost every profession in this world expects to be tipped (okay not every but there is a lot). This is on my mind for two reasons. #1 I just got back from a trip to DC and here is a list of who wanted a tip...

* Curb side check in
* Super Shuttle Driver
* Doorman at the hotel
* Tour bus driver
* Waitress/waiter
* cab driver

#2 Tonight, I was being the kind nurse that I always am :) and I wheeled a patient out to his car as he had a sprained ankle and no one with him to be of assistance. So I get him to the car and he asks if I would accept a "small tip" as he tries to hand me two 20 dollar bills. I graciously decline, telling him I was glad to help him and would not take his money. (As health care providers we are not allowed to take money from the patients.) I've actually been offered money quite a few times and as tempting as it is to take, I know deep down, I would not accept it even if it was allowed. I did have one patient ask for my address (I know what you are thinking but it was an old man in his 80's and I took care of his sweet wife for 2 days while she waited in the ER for inpatient bed) and he sent me a beautiful hand carved roadrunner. I have it sitting on my entertainment center.
Anyways, I really don't want tips...I've just decided that when it comes to the nurses...the gratuity is included!

What brings you to the ER tonight?

Okay, so there are great things about being an ER nurse and I really do enjoy helping those that are in need of medical care...but then there are the 80% of those that I care for that don't need to be in the ER...here are just a few examples!

*I need my toe nails trimmed
*I need the wax cleaned out of my ears
*I have had abdominal pain for the last 3 months
*I have had abdominal pain for the last 5 years
*This mole that I have is changing colors
*I think I may have testicular cancer (this is a female pt)
*"I'm bleeding to death, it's pumping blood"...I unwrapped the dressing she had applied and she had nicked herself shaving her legs...it had already stopped bleeding
*"I have a headache, my husband has placed metal plates in my head...the FBI is tracking this and they are on their way here with pictures."
*I'm pregnant and I feel nauseated
*I need you to check and see if I am pregnant
*My body is burning
*I have had some small bumps on my arms for one month (this pt came in at 3am)
*I have a bad tooth and I don't have money to pay the dentist to fix it
*I have vaginal bleeding (me: when was your last menstrual period, her: I'm on it now)
*I was already seen yesterday but I didn't fill my prescriptions and now I feel worse
*me: sir please have a seat I'll be with you in a moment
him: well I just can't sit down
me: what do you do at home
him: I think I'll go to another hospital cause I just can't sit
(he was there for leg pain...I can only imagine that he stands 24/7)
*I think I'm getting shorter
*I'm having trouble breathing (when we call her name, we find her outside smoking)
*I have this big abscess and my friend that just got out of prison lanced it for me (he was bleeding all over the place)
*My baby has been fussy today (me: well, they do that sometimes)

There are just so many I can't even begin to write them all down. If you can think it...someone has been to the ER for it!

Pink Cowboy Hat

Okay, so a few weekends ago the ambulance brought in the little old lady. I'll never forget her or the pink cowboy hat that she was wearing. It didn't take long for us to figure out that she was a little short upstairs. I can't actually remember her main complaint, maybe abdominal pain of some sort. After only about 30 minutes of waiting for the doctor she called me over to tell me that she had waited too long. She rambled some other crazy things and I explained that she just had to wait. Another ten minutes and she called me over to tell me that she was leaving and that we had better "disinfect" this room due to the contents that were in a paper cup on the counter. She goes out to the lobby and a few minutes later the ambulance company calls us to tell us that a patient in the lobby called 911. Our charge nurse went out and kindly told her that she could not call 911 from OUR lobby to have the ambulance come and get her. About 30 minutes later I walked outside to get warm and this is what I saw....an ambulance by our front door with the lights on and the same lady sitting inside on the stretcher. This is what had happened. She walked outside and borrowed a cell phone...she then dialed 911, told them she was having chest pain and was outside of our ER entrance. Well, now the ambulance has to come and because she is having chest pain, they have to come with lights and sirens. I guess the lady whom she borrowed the cell phone from (and a bunch of others in the lobby) were very concerned about Ms. Cowboy Hat and was pretty upset at us for not taking care of her. So....

#1 Many people think that we are heartless, careless people!

#2 They will never understand that we really tried to care for her but she's just plain crazy!

#3 Ms Cowboy Hat got another ambulance ride, to another ER (I guess she had ER hopped all day with nice ambulance rides in between) just as she wanted.

#4 There was nothing we could do about it!

#5 Any guess to how much tax payers money she wasted on just this one day??

As the ambulance drove away I waved to her. She sat up on the stretcher, smiled and waved back. A few minutes later and truck pulls up and the man is looking for this lady. I explained to him what had happened...he sighed and headed for the next hospital. I told him to hurry. I doubted that she would be there long :)

Feeling queasy

So I had only been working as a tech in the ER for a few months when this happened. At first even watching the doc suture would make me a little queasy....so I knew this incident would be tough. We got the call from the medics that they were bringing in a girl who for her 14th bday was teaching her cousin how to jump on the train that goes through our small town (the train goes pretty slow). Well, she fell and the train cut off her leg. They brought the girl in and then one of the EMT's brought in her leg and he handed it to me. I was sick, I really felt like throwing up but didn't. We took her leg over to the sink and started to clean it up. It was a ragged tear and the leg had dirt, sticks, etc. in it. We got it cleaned the best we could and we sent the girl and her leg to a trauma center. The cut was near the hip and with it being jagged they were unable to attach her leg. I saw her a few more times in the ER over the next few years and she was doing well. She was also not a candidate for a prosthesis so she will use crutches for the rest of her life. I was proud of myself that night for being able to do my job. Every night at work I would get better and the nausea feeling would lighten. Now, nothing upsets my stomach!

Missing Mrs. S

So on Friday night the ambulance brought in Mrs. S that had fallen, she also had Alzheimer's Disease. She kept telling me that her husband was on his way in. I kept looking but couldn't find him. He eventually showed up and said that he had told the ambulance to take her to a different hospital (one closer to their house) and so he had been waiting for her there. He was pretty upset with the ambulance company. Mrs. S ended up being just fine and so I sent her home with her husband. Last night this same lady came in by ambulance again around 3:00 am. (I was at lunch and so I didn't see her arrive). Her husband called on the phone and I immediately recognized his voice. This is what had happened... Mrs S called 911 and met the ambulance out in the driveway. Her complaint that her feet were numb. She told the medics that her husband had a busy day and not to wake him (in her mind she was doing the right thing). So they brought her in. Meanwhile MR. S wakes up and can't find his wife anywhere. He calls the police, they call the local hospitals and we tell them we have her. Mr. S is just frantic, worried sick not knowing where his wife is. He is on the phone just crying to me telling me how worried he had been. He comes down to get her. He is still crying and so upset. This makes Mrs. S upset and very sad. She says just admit me to the asylum because my head is just not right, he of course would not even think of something like that. It was a very sad situation. I recommended putting an alarm on the doors so that she can't get out without the alarm going off. I sent Mr and Mrs S home again and told them as much as I liked them I didn't want to see them again. Mrs. S kissed my cheek as I belted her in the car. I learned two things: One, unconditional love. Mr S is amazing to take care of his wife and love her so much even though her mind is not very clear. Second, I am thankful for my ability to think, act and respond appropriately.
p.s. Mr S is now even more upset with the ambulance. They took his wife without even waking to tell him...honest mistake (I'm sure they did what they thought was best) but for sure a learning experience.

What do you mean I can't smoke in here...

I took care of a 24 year old male that decided to take a bunch of vicodin, soma, and xanax along with marijuana for his sciatic pain. Well his mom found him drowsy and pretty much unconscious and so the wambulance (as called by the ER nurses) brought him to me. He was not very nice, hit his brother, twisted my arm behind my back….you get the picture. I took him up to the ICU and he asked for a sleeping pill. Now remind you that he took enough meds to sleep for a week and so I kind of laughed and explained that he wouldn’t be getting a sleeping pill. Then he decided that he wanted to leave and was just being a pain. Happy for me that he was now in the ICU and I headed back to the ER. So like an hour later security comes running in the ER and says they have my patient from room 2. I was like, what?? Oh yes, my lovely patient had jumped out of the second story ICU window so that he could smoke!!!! And now he had a broken foot! We took some x-rays, applied a splint, I even gave him some pain meds and took him back up to the ICU! I’m guessing they locked the window…:o)
02/2008