Your private doctor does not work down here in the ED. He is probably not going to see you here. He didn't call to "reserve" you a bed. Your doctor can't call here and "order" someone to see you right away.
Also, all the specialists in the world don't work here either. Blowing off your dermatologist appointment to come here and get your weird rash checked out because you "just want to get to the bottom of this" was probably not a great idea, since we're just going to send you to the dermatologist anyway.
Monday, November 9, 2009
Monday, October 19, 2009
In Memoriam
Sheila was born on September 21, 1934 on a small homestead farm on the plains of midwestern Canada. She was the second of seven children. They grew up in a one-room log cabin, farming grain and livestock.
Sheila and her family lived the life of rural homesteaders: no electricity until Sheila was eleven years old ("It'll come down the road soon enough," her father said), and no indoor plumbing until the "big house" was built a year after Sheila had left home for the big city.
She went to the local one-room schoolhouse (by horse-drawn sled in the winter), helped on the farm, and idolized her Auntie Beulah, a nurse for the Red Cross who worked in Korea, helping Eurasian orphans find homes with families in Canada. She left home at 17 to go live with an aunt in the nearest city to attend 12th grade, as their local school didn't have that grade and most kids finished school by correspondence.
She decided to go to nursing school because the only other options for women were working in an office or a grocery, or becoming a teacher. She didn't want to be a teacher because her mother was one--and who wants to do what their mother did?
She attended a diploma school in which the students staffed the hospital and were managed by senior nurses. Sheila found she had an aptitude for nursing (although she hated working the midnight to seven shift she was so often placed on) and graduated with honors in 1956.
Sheila traveled around Europe, learned to ski, made friends--and decided to move to New York "for the adventure" in the 1960s. She intended to stay only for six months and then head on to San Francisco, but ended up staying in New York for the rest of her life.
As the head nurse of the critical care unit of a major metropolitan hospital, Sheila found herself in charge of the nursing students that passed through the unit. She fostered the careers of hundreds of nurses in this way. She also earned a BSN from Columbia University.
In the mid-60s, she was one of a handful of nurses in the United States who specialized in cardiovascular medicine, assisting cardiologists and surgeons at her hospital in open-heart surgery when pacemakers were just becoming routine. She also worked in one of the first cardiac catheterization units in the US, and worked with medical engineers and manufacturers on designing cardiac catheterization equipment.
In 1970 she got married and had her first daughter; in 1974, her second. She worked private duty at night for years when nurses were underpaid and had no benefits so she could be home with her children during the day, and began work on her Masters degree in nursing. When the kids finally went off to school, she decided she needed a career that allowed her to be on the same schedule as her children, so she did what she thought she'd never do.
She taught--nursing.
For thirty years she taught basic and critical care nursing, instructed on nursing units, and developed a "Math for Meds" course that is used in many nursing schools. She pioneered the use of computers in the hospital and for learning, and obtained a post-graduate certificate in Nursing Informatics. She estimated at one point that she had taught over 1,360 students how to be nurses. One of those students was me.
Sheila passed away on October 7, 2009. She was at home, in her own bed, at peace, and in no pain. Both of her daughters were at her bedside. She leaves a large nursing legacy--hundreds of students who will remember every word she taught as they use the information she imparted every day in their careers as nurses. They will remember the contagious and boundless enthusiasm and joy she found in all aspects of nursing: caring, learning, teaching, innovating. They will remember a woman who had an almost unlimited knowledge of nursing, who pushed and encouraged them to succeed at their careers in nursing for years after they left the school.
I'll remember her as Mom.
Sheila and her family lived the life of rural homesteaders: no electricity until Sheila was eleven years old ("It'll come down the road soon enough," her father said), and no indoor plumbing until the "big house" was built a year after Sheila had left home for the big city.
She went to the local one-room schoolhouse (by horse-drawn sled in the winter), helped on the farm, and idolized her Auntie Beulah, a nurse for the Red Cross who worked in Korea, helping Eurasian orphans find homes with families in Canada. She left home at 17 to go live with an aunt in the nearest city to attend 12th grade, as their local school didn't have that grade and most kids finished school by correspondence.
She decided to go to nursing school because the only other options for women were working in an office or a grocery, or becoming a teacher. She didn't want to be a teacher because her mother was one--and who wants to do what their mother did?
She attended a diploma school in which the students staffed the hospital and were managed by senior nurses. Sheila found she had an aptitude for nursing (although she hated working the midnight to seven shift she was so often placed on) and graduated with honors in 1956.
Sheila traveled around Europe, learned to ski, made friends--and decided to move to New York "for the adventure" in the 1960s. She intended to stay only for six months and then head on to San Francisco, but ended up staying in New York for the rest of her life.
As the head nurse of the critical care unit of a major metropolitan hospital, Sheila found herself in charge of the nursing students that passed through the unit. She fostered the careers of hundreds of nurses in this way. She also earned a BSN from Columbia University.
In the mid-60s, she was one of a handful of nurses in the United States who specialized in cardiovascular medicine, assisting cardiologists and surgeons at her hospital in open-heart surgery when pacemakers were just becoming routine. She also worked in one of the first cardiac catheterization units in the US, and worked with medical engineers and manufacturers on designing cardiac catheterization equipment.
In 1970 she got married and had her first daughter; in 1974, her second. She worked private duty at night for years when nurses were underpaid and had no benefits so she could be home with her children during the day, and began work on her Masters degree in nursing. When the kids finally went off to school, she decided she needed a career that allowed her to be on the same schedule as her children, so she did what she thought she'd never do.
She taught--nursing.
For thirty years she taught basic and critical care nursing, instructed on nursing units, and developed a "Math for Meds" course that is used in many nursing schools. She pioneered the use of computers in the hospital and for learning, and obtained a post-graduate certificate in Nursing Informatics. She estimated at one point that she had taught over 1,360 students how to be nurses. One of those students was me.
Sheila passed away on October 7, 2009. She was at home, in her own bed, at peace, and in no pain. Both of her daughters were at her bedside. She leaves a large nursing legacy--hundreds of students who will remember every word she taught as they use the information she imparted every day in their careers as nurses. They will remember the contagious and boundless enthusiasm and joy she found in all aspects of nursing: caring, learning, teaching, innovating. They will remember a woman who had an almost unlimited knowledge of nursing, who pushed and encouraged them to succeed at their careers in nursing for years after they left the school.
I'll remember her as Mom.
Sunday, September 13, 2009
Bleh.
Sorry I've been gone so long. It's likely I'll be gone even longer, because these days I don't have the energy or gumption to post.
I'm in school full-time, scrambling to finish my BSN. Work has been really, really bad lately--so bad that management has had to come in to do patient care because we're so busy and so short staffed--and it's not even cold and flu season yet!
And, on top of that, my mom, who has been fighting stage IV colon cancer with metastases to the liver (and probably lungs at this point) has taken a turn for the worse. She decided to stop chemotherapy after the last round was completed, saying at this point she's more afraid of the chemo than she is of dying. She did OK for a while, but now is deteriorating rapidly. She's got ascites and her legs are swollen; she's not eating much, and has lost so much weight that she looks like a pregnant skeleton wearing Uggs boots. She's not yellow...yet. She's not having trouble breathing...yet. But she's very tired, and sleeps most of the time, and doesn't have the energy to do much.
What's even more awful about this is that, as some of you may remember, my mom is a nurse, too, and is aware of exactly what's going on with her disease and body. She is also a terrible patient. (For a long while she was hiding how bad she was doing from me--my sister came for a visit and told me mom's legs were swollen. She always wore long skirts and dresses in front of me so I couldn't see how bad they were. When I confronted her, she said, "I was hoping you wouldn't notice.") It's pretty unfun. I know she's feeling pretty bad because when I tentatively brought up the topic of hospice ("you know, mom, for later, just so we can have some resources in place eventually") she immediately agreed and wanted it set up right away. She also gave all control of her finances to my sister, which is a HUGE thing for my mom--and she did it without so much as a blink.
So we had a meeting with the home hospice nurse yesterday, and I have to say that MAN is that program fantastic. My mom is going to get everything she needs, right at home--and if there's something she needs that can't be done at home (palliative paracentesis, for example), they get her a bed in an inpatient hospice for a few days and then it's right back home. No ED visit, no fear that she'll be admitted to a regular hospital.
Even with hospice in place, the next month or so is going to be pretty bad. Every time I go to visit her, I'm so afraid that I'll find her in her bed, gone. Part of me, though, hopes for that--that it will all be over, quick. The rest of me knows that this might end up being a long, sad haul for all of us.
I'm just so relieved to have a nurse who is experienced in these matters on the case. She has the knowledge to be able to tell me what's going on and maybe even what to expect, which is something I need--because my sister lives 500 miles away and is pregnant, and requires extra planning to get her here to say goodbye...eventually.
Ugh, this sucks.
I'm in school full-time, scrambling to finish my BSN. Work has been really, really bad lately--so bad that management has had to come in to do patient care because we're so busy and so short staffed--and it's not even cold and flu season yet!
And, on top of that, my mom, who has been fighting stage IV colon cancer with metastases to the liver (and probably lungs at this point) has taken a turn for the worse. She decided to stop chemotherapy after the last round was completed, saying at this point she's more afraid of the chemo than she is of dying. She did OK for a while, but now is deteriorating rapidly. She's got ascites and her legs are swollen; she's not eating much, and has lost so much weight that she looks like a pregnant skeleton wearing Uggs boots. She's not yellow...yet. She's not having trouble breathing...yet. But she's very tired, and sleeps most of the time, and doesn't have the energy to do much.
What's even more awful about this is that, as some of you may remember, my mom is a nurse, too, and is aware of exactly what's going on with her disease and body. She is also a terrible patient. (For a long while she was hiding how bad she was doing from me--my sister came for a visit and told me mom's legs were swollen. She always wore long skirts and dresses in front of me so I couldn't see how bad they were. When I confronted her, she said, "I was hoping you wouldn't notice.") It's pretty unfun. I know she's feeling pretty bad because when I tentatively brought up the topic of hospice ("you know, mom, for later, just so we can have some resources in place eventually") she immediately agreed and wanted it set up right away. She also gave all control of her finances to my sister, which is a HUGE thing for my mom--and she did it without so much as a blink.
So we had a meeting with the home hospice nurse yesterday, and I have to say that MAN is that program fantastic. My mom is going to get everything she needs, right at home--and if there's something she needs that can't be done at home (palliative paracentesis, for example), they get her a bed in an inpatient hospice for a few days and then it's right back home. No ED visit, no fear that she'll be admitted to a regular hospital.
Even with hospice in place, the next month or so is going to be pretty bad. Every time I go to visit her, I'm so afraid that I'll find her in her bed, gone. Part of me, though, hopes for that--that it will all be over, quick. The rest of me knows that this might end up being a long, sad haul for all of us.
I'm just so relieved to have a nurse who is experienced in these matters on the case. She has the knowledge to be able to tell me what's going on and maybe even what to expect, which is something I need--because my sister lives 500 miles away and is pregnant, and requires extra planning to get her here to say goodbye...eventually.
Ugh, this sucks.
Sunday, August 16, 2009
Overheard in Triage
Man: Do you have a CAT scan machine here?
Me: (stares at man)
Man: Seriously. Do you have a CAT scan machine?
Me: Yes, sir, this is a modern urban hospital. We have a CT scanner here.
Man: OK. How do I get one?
Me: A doctor has to order the test.
Man: Oh. So I can't just sign up for one?
Me: No.
Man: Are they expensive?
Me: They're not cheap. Do you have any medical problems that you'd like to discuss?
Man: No. I just wanted to see what my brain looks like. Thanks anyway! (gets up and leaves)
Me: (stares at man)
Man: Seriously. Do you have a CAT scan machine?
Me: Yes, sir, this is a modern urban hospital. We have a CT scanner here.
Man: OK. How do I get one?
Me: A doctor has to order the test.
Man: Oh. So I can't just sign up for one?
Me: No.
Man: Are they expensive?
Me: They're not cheap. Do you have any medical problems that you'd like to discuss?
Man: No. I just wanted to see what my brain looks like. Thanks anyway! (gets up and leaves)
Saturday, August 15, 2009
Thanks, Nurse Jackie
There's been a lot of...well, not "furor," mostly just talk... about Showtime's series Nurse Jackie. Blah blah blah, not a good example of a nurse, blah blah blah detrimental to the public image of nursing...blah blah blah.
I've only seen the first episode (I don't have Showtime, and am waiting to Netflix the whole season to watch all at once), but I can't say anything bad about it.
However, I've become a huge fan of the show because of its effects on patients and their families in the ED.
Yesterday, a very difficult patient was about to go upstairs to her room. For her whole stay, she had been complaining and needy and angry. Just before she was to be transported, she started demanding her Valium. The admitting doc hadn't put in any orders yet. I told her so, adding, "I can't get the pills out of the machine without an order from the doctor."
She smiled. "Oh, I understand. You guys have a Pyxis! Don't worry about it," she said knowingly, "I watch Nurse Jackie!"
I've only seen the first episode (I don't have Showtime, and am waiting to Netflix the whole season to watch all at once), but I can't say anything bad about it.
However, I've become a huge fan of the show because of its effects on patients and their families in the ED.
Yesterday, a very difficult patient was about to go upstairs to her room. For her whole stay, she had been complaining and needy and angry. Just before she was to be transported, she started demanding her Valium. The admitting doc hadn't put in any orders yet. I told her so, adding, "I can't get the pills out of the machine without an order from the doctor."
She smiled. "Oh, I understand. You guys have a Pyxis! Don't worry about it," she said knowingly, "I watch Nurse Jackie!"
Friday, August 14, 2009
Finally, an apology!
(Unfortunately, it was completely unnecessary, but whatever, I'll take it...)
We had a middle-aged guy come in with severe scrotal swelling and pain--it was so bad that he couldn't walk or even close his legs. If anyone even came near him, he would start crying and screaming "please don't touch me! Please!" He was a diabetic and on dialysis. And unfortunately, there was a really specific smell coming from his area--probably Fournier's gangrene.
I gave him a ton of pain meds but nothing was even touching his pain, and we needed to do a CT of his pelvis to see how bad it was--and to examine him. So the docs decided to do a sort of conscious sedation with ketamine. I've used ketamine on kids with no problem, but sometimes adults have an "emergence reaction" when it's wearing off--they can hallucinate and get a little nutso, so they have to be watched very closely.
I got him to the CT scanner on a portable monitor, gave him the meds, and we got the scan. Everything went well (except for the fact that the CT and manual exam pretty much confirmed gangrene).
When he started to wake up, he was relatively calm; a little moaning, a little thrashing, but mostly ok. When he was a little more awake, he kept looking at me and saying, "Miss? I'm so sorry, I'm so sorry!" I would ask him what for and he would say, "I didn't do anything nasty to you did I? I'm so sorry! Tell me if I did! Tell me the truth! I'm sorry, I didn't mean it..." I kept reassuring him that all was well.
Hours later when he was pretty back to normal, I went in to see him and asked how he was feeling. He told me he didn't really like the drugs we gave him. "They gave me weird dreams," he said. "Really?" I said.
"Yes," he replied, blushing and averting his eyes. I wonder what he dreamed?
We had a middle-aged guy come in with severe scrotal swelling and pain--it was so bad that he couldn't walk or even close his legs. If anyone even came near him, he would start crying and screaming "please don't touch me! Please!" He was a diabetic and on dialysis. And unfortunately, there was a really specific smell coming from his area--probably Fournier's gangrene.
I gave him a ton of pain meds but nothing was even touching his pain, and we needed to do a CT of his pelvis to see how bad it was--and to examine him. So the docs decided to do a sort of conscious sedation with ketamine. I've used ketamine on kids with no problem, but sometimes adults have an "emergence reaction" when it's wearing off--they can hallucinate and get a little nutso, so they have to be watched very closely.
I got him to the CT scanner on a portable monitor, gave him the meds, and we got the scan. Everything went well (except for the fact that the CT and manual exam pretty much confirmed gangrene).
When he started to wake up, he was relatively calm; a little moaning, a little thrashing, but mostly ok. When he was a little more awake, he kept looking at me and saying, "Miss? I'm so sorry, I'm so sorry!" I would ask him what for and he would say, "I didn't do anything nasty to you did I? I'm so sorry! Tell me if I did! Tell me the truth! I'm sorry, I didn't mean it..." I kept reassuring him that all was well.
Hours later when he was pretty back to normal, I went in to see him and asked how he was feeling. He told me he didn't really like the drugs we gave him. "They gave me weird dreams," he said. "Really?" I said.
"Yes," he replied, blushing and averting his eyes. I wonder what he dreamed?
Wednesday, August 12, 2009
Conversation of the Night
Man: My grandmother is very sick! She needs antibiotics!
Me: Yes, the doctor just ordered them, and I'm going to go get them right now.
Man: But she's having cardiac arrest over there! (gesturing to his little grandma who is sitting up in the bed, smiling and eating a tuna sandwich)
Me: Do you know what that means?
Man: Uh, no. It just sounded important.
Me: Yes, the doctor just ordered them, and I'm going to go get them right now.
Man: But she's having cardiac arrest over there! (gesturing to his little grandma who is sitting up in the bed, smiling and eating a tuna sandwich)
Me: Do you know what that means?
Man: Uh, no. It just sounded important.
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