A Memorial

Recently I found out that one of my instructors from Nursing school, Jason Kurtz, RN, BSN, CMSRN,  had passed away, losing his fight with cancer.  It really shook me up as he was one of the biggest influences in my nursing life.  He set an example that I still try to live up to.

He was my CNA instructor who pushed his students to be the very best.  He held us to standards and expected us to adhere to those.  He was a guy who wasn’t afraid to ruffle feathers.  On the day before clinicals he said, “And whatever you do, shower.  I say it because people haven’t and came in smelling worse than the patients.”  He used so much of his personal experience to color our thinking about the care we provided.  Having been both a patient and a nurse he reminded us that these were real people we were going to be taking care of, with all the complex issues real people have.  Even though he could be hard, he had a forgiving side, even when I mistakenly called it, “perennial care” versus “perineal care.”  He just joked, “So you only do it once a year?  Glad I’m not your patient!”

Later, he was my boss.  He hired me as an extern on his unit.   I saw him in good times, when the cancer was in remission, and in bad as he was preparing for a bone marrow transplant.  I saw his “O” face after another nurse had given him some demerol to finally knock down the pain he was experiencing.  Not something of your boss’s that you want to see.  And as uncomfortable as it was, I even had to bladder scan him, which he took in a completely professional way.

After school ended, he had offered me a permanent job on his unit.  I knew that he wanted me to be there.  It felt like he felt we were kindred spirits, or that he was trying to mold me in his image.  On my last day as an extern we had conversation where we talked about my future.  I told him I was considering moving back to the Northwest.  To which he told me that he would love to have me on his unit, but understood my need to head home.  It was a professional send-off, which I greatly appreciated.

His was an example that I strove to achieve.  I tired my hardest as an extern both for myself and because he inspired me to do better.  He knew that I would be a great nurse, told me as much,  but expected that I live up to that expectation.  On that last say, he told me that,”You’ve lived up to the expectation of you.  I never regretted picking you.”

Here was a guy who was fighting cancer, running a busy tele unit, living his life, who always told the nurses that if any of their patients received a new diagnosis of cancer, he was more than willing to talk with the patient, even if it was a day off.   He gave himself to the unit, the hospital and community.  He received Nurse of the Year Leadership award at Flagstaff Medical Center and nominated for a March of Dimes Nursing Leadership award.

He was a hero to me.  I know that his guidance, all the way from those first awkward moments of clinicals to graduation day helped forge me into the nurse I am.  He will be missed.

Favorite Recent Admission Diagnosis

Chest Pain, Enlarged Left Testicle

Enlarged?  Yes, it was bigger than my fist.  Painful?  I do believe so, although he didn’t really seem to complain much about it.  Did he have to sit down to pee?  Do you really want to know that answer?  The poor bastard…

 May you all have a wonderful and Happy Thanksgiving!

Me?  I’m going to work.

Peace and love…

Conference Notes and a Meme

Instead of going to work last Thursday and Friday, I got the chance to sit, learn, schmooze, soak up free stuff, eat bad hotel food, reconnect with an old friend, drool over HDTVs and not work. Sure, my boss didn’t pay me to attend the conference but rather paid my way for it – which is almost as good. It was incredibly fascinating. Over my head, but fascinating. The conference was geared towards ICU nurses, but I was able to get a lot out of some of the presentations. Some went completely over my head and had no impact or bearing on my practice.

The highlights:

A presentation about CA-MRSA.

Considering the latest hoopla in the news, this was a welcome bit of science. The speaker differentiated between Community Acquired and Hospital Acquired MRSA, most notably the “Panton-Valentine Leukocidin (PVL)” toxin found predominantly in CA-MRSA. This is a nasty, nasty toxin. He showed slides showing normal rat lungs, rat lungs without PVL and lungs with. While the lungs of non-PVL MRSA were injured, the necrotizing effect of the PVL literally turned the lungs to mush. Not a pretty picture. He also showed histological samples of white blood cells attacked by the bug literally leaking fluid contents out through punctured plasma membranes.The speaker also presented statistics showing the uptick in cases of CA-MRSA and increasing mortality rates especially in MRSA pneumonia. One especially sinister aspect to the PVL+ CA-MRSA is the speed it can progress. One of the case studies presented showed a rapid consolidation in the lungs leading to death approximately 36 hours after presentation due to respiratory failure and septic shock. He also noted in the research notes that approximately 50% of skin infections in the community are due to CA-MRSA.

Another presentation was about unhealthy work environments. While there was a lot of “kum-by-ya” touchy-feely stuff, there were a couple of great take aways. First, was the concept that on a unit, “no one sits until we all sit.” Meaning that everybody pitches in to help and make usre that no one is left behind, struggling or just plain lost. As nurses we’ve all had those nights where 2 or 3 of our co-workers (or aides…) are sitting surfing the web while you’re running around like a maniac trying valiantly to at least keep your head above water. Second was a quote about ratios where basically, “if you have time to sit at the bedside and look you patient in the eye and truly learn their needs your ratio is ok.” One of my biggest issues with my unit has been ratios. I think we’re staffed too short for the acuity of our patients. But when I take that idea into mind, it seems like it might be OK. At least lately.

There were others like a presentation on hypothermia post-cardiac arrest, acute renal failure in ICU settings, spectacular trauma cases (which was waaaay cool!), some stuff on nutrition and one on clots and clot busters. It was a great experience. Perhaps the highlight though was in talking to the Stryker rep, found out that my unit is getting new beds. Very, very, very nice new beds. Evidently our manager had gone to bat for us (as a unit) that we needed beds of a higher caliber than what we had been using. Sound like she really went out of her way and fought hard to get this. These beds are amazing. All have bed alarms, bed weights, will turn your patient for you, convert to a chair and allow one tiny nurse to push a 550lb. patient to Xray. These beds are going to save our backs and make life a little bit easier.

The other take away from the conference was how it made me feel. It made me want to step up my game as a nurse and take a greater interest and active role in the way my unit is run. Maybe instead of bitching about all the things that are going poorly, maybe actually work to try to change those things and make it a better place to work. I came away with a renewed sense of excitement and hope. Of course that will last all of about five minutes when I walk in the door nest night I work and see nothing but geri-chairs and tent beds all down the hallway…

Read the meme after the jump…

Change of Shift

New Change of Shift is up over at Kim’s place.  Go check it out!

Ask your doctor about…

You’ve heard them on TV, ominous sounding symptoms followed by a plea to see your doctor and ask about “brand X” medication.  And sure enough, folks run out to do so.  Consumer Reports has a great video blog about this very thing.  Thanks to Dr. Wes for the link.

Maybe I should do my own…

Cue eerie  music, scenes of people on a busy street:

Announcer:

Are you breathing?  Is your heart beating?  cue heart sounds

Do you have the strange sensation of wind in your hair, the taste of a good meal or the diversion of a great conversation?  video of people riding motorcycles, eating at a nice restaurant, sitting at a coffee shop

Do you get up the morning and sit in your car commuting to a dead-end job?  video of congested freeways, office cubicles

Odds are you have a condition called “life.”  You see life is a sexually transmitted disease with a terminal outcome but researchers are coming up with ways to not make this so worrisome.  cue uplifting music and video of smiling researchers with laboratory equipment  If life has got you down, ask your doctor about Fucidol®.

A once daily dose of Fucidol® can ease your worries.  It soothes your feelings and makes the thought of a terminal outcome, or any coherent thought at all just distant vague memory.

Fucidol® has been shown to cause tiredness, dizziness, heart palpitation, incontinence, anal leakage, munchies, constipation, diarrhea, nausea, vomiting, increased sexual urges, impotence, blindness, altered sense of taste and smell, red eyes, cough, decreased value of your house, anxiety, paranoia and depression.  In some cases people have stopped breathing.  This is a serious side effect and you should notify your health care provider at once.  Certain people should not take Fucidol®.

So ask you doctor if Fucidol® is right for you!  And start living like tomorrow doesn’t matter and you don’t care!

cue empowering music and video of happy shiny people, fade to black.

Hmmm… with the writers on strike now, maybe I’ve got a second job?

Inappropriate ICU Transfer of the Week

When folks need to go to the Unit, whether it is an evolving MI, (non)lethal arrhythmia, hemodynamic instability or they just need that higher level of care, we can’t wait to get them off the floor. Last thing anyone on our floor wants is a truly unstable patient lingering in one of our rooms when they needed to be the Unit 20 minutes ago. Sometimes though, you just can’t seem to convince the docs that they need to go and in the same vein, those that really don’t need to go, get sent.

We had a couple of instances of that lately. First, we called a Code on a guy who vagaled on the toilet. He was down to the Unit in less than 15 minutes, albeit already awake and laughing with the transport nurses as he went. At the decision time though, he needed to go. Now.

On the other hand is the patient who is stable but the docs are convinced they require  the advanced monitoring care of the ICU. This happened just the other night.

Let me remind you, we’re a cardiac unit. We deal with post-PCI patients, pacers, rule out MI’s, pre/post-op open hearts, CHFers, arrhythmias (like atrial fibrillation with rapid ventricular response) among other things – like being the largest unit in the hospital and getting overflow patients. When it comes to all things cardiac, we’re the place to be. Guess that’s why the sign over the entrance to our unit says “Cardiology/Cardiac Surgery”.

Anyway. My colleague’s patient was post-chole or some other laproscopic surgery. Nothing too hot and heavy. She goes in to asses her patient (who’s not on tele) and notices her heart rate is rapid and irregular. Being the good cardiac nurse she is, she grabs a12-lead EKG and voila’ – a-fib with RVR. She calls the surgical resident on call who orders some metoprolol to slow down the rate and eventually a diltiazem drip. No biggie to us. We do this all the time. Heck, with our fresh hearts we have an A-Fib protocol where we don’t even have to call the surgeon if the patient goes into fib, as long as they’re hemodynamically stable. We just follow the protocol.

In this case, after the drip was started, blood pressures were 110’s over 70’s, rate in the 80-90’s, good perfusion (warm, pink and intact), making urine, not even short of breath. Totally manageable on our floor. But the surgical resident still wants to transfer. My colleague tries to suggest that it isn’t needed. She did everything but come out and say, “Y’know what? She’s stable. Her rate’s good. She doesn’t need to go.” Not that it would have done any good. So off she goes at 0630 down to the Unit. Her rate on arrival to the unit was 70’s and it looked like her heart was already trying to convert back into normal sinus.

I looked at the ICU nurse and said, “Ten bucks says she’s back up by the end of the day.”

To which she replied, “End of the day? She’ll be back up by noon!”

“Right,” I retort, “if they haven’t given her room away…”

It’s a Murphy’s Law kind of thing: they go when they don’t need to and stay when they do.

And for all you soda drinkers out there, here’s a little bit of science to enliven your day: “What happens to your body if you drink a Coke right now?” Now, off to the fridge, I’m kind of thirsty…

Ahh…oops, brain fart.

I knew I was missing a link when I posted about helmets..  Now I found it.  You should see these pics and crazy story.  Now I remember why I wear a helmet.  Oh yeah, check the coverage on BikePortland.org about the recent spate of bicycle crashes here in PDX, it’s a bit sobering.

Continuing the digression, I wonder what the true cause for the crashes in PDX is.  Nothing against the folks who have been killed, in fact it’s a damn shame, but I wonder if us cyclists are getting a little full of ourselves.  Yes, we’ve made PDX a great cycling community.  I see tons of bikes even out in the ‘burbs where I live, but sheer numbers do nothing to protect us.  We’re still just meat on a flimsy steel frame waiting to get smeared into road kill by the next idiot distracted by their oh-so-important cell phone conversation as the wonder what that “bump” was  while they were turning into Starbucks.  Aggressive cycling, by that I mean exerting your space on the pavement, which by law is ours, has it’s downsides as it opens us up to the full assault of the motorized public.

Be safe out there, picking gravel out of road rash is not a good way to spend the last sunny day of the year out here…

Men in Nursing

Nurse Sean put up an emotional post related to men in nursing. It’s a sobering look from the other side. Go give him some support, sounds like he needs a”pick-me-up.”

Read: Men in Nursing

I’ve always felt I’ve been lucky in this regard. There were 10 guys (out of 30 people) in my nursing class. My floor has 6 guys on the night shift alone, with more on the day shift. We’re treated like equals on the floor, treated like professionals and trusted with our patients. Sure, I think I push myself to learn more than your average nurse, but that’s just me. I’m a big nerd. My wife describes me as a black hole of “trivial trivia” and never plays Trivial Pursuit or Scene It! with me, unless we’re on the same team. But I digress. I know that there is underlying resentment from some female colleagues about men in nursing, like somehow we’re invading “their” territory”. I know there is a societal aspect to this as well. Men in nursing are either: gay, criminal, sexual predator, or a freak, according to society. I’m none of the above. My colleagues at work are none of the above. Society likes to call me a “murse”. When my friends call me a “murse” I crack a bad joke about their momma’.

We’re professionals. We strive to be the best we can be, in spite of societal and deeply held cultural biases against us. But I think there is hope. It’s becoming more common to see nurses who happen to be male. People are starting to get used to the idea, at least here in the States and accepting us as nurses. Change takes time. Hopefully Sean is willing to give it the time.

WTF?! It’s only November.

That’s what I said as I cruised down auto row this evening on the way home with teriyaki take away.  The big dealership already had Christmas decorations up.  Yes.  Gaudy tinsel scenes hanging from the multitude of light poles, lit up like the Vegas strip.  C’mon folks, it’s only the 5th of November.  Aren’t we supposed to wait until at least Thanksgiving?  That and I saw Christmas commercials this week.  When will the madness stop?  Then my wife tells me they’ve had decorations up at the malls since before Halloween!  It just ain’t right.

I’ve seen a lot of helmet related posts out there lately, but this one here takes the cake.  ‘Tis why I wear a helmet in the first place.

A Revisit to Room #66

As I related in a previous post (here), room #66 and I have a storied history. Some of it good, some of it bad. I finally figured out the mojo that was haunting me: it was the particular charge nurse. Each and every time I have had an issue in room 66 it was one particular charge nurse. Didn’t have a problem with that room when other charge nurses were on. It was her. Not that she is a bad person, or even a bad charge nurse, there is just some weird mojo about it. Superstitious? You better believe it. And I’m not the only one. Nurse Sean has shared his superstitions. Do I have some? Yes. But that’s not the point.

How did I figure all of this out? Stick around, you’ll see.

A couple of months ago, my assignment included room 66. Housed there was one of our frequent flyers. Atypical chest pain, responded only to morphine. Chronic shortness of breath. On top of all of that he was a smoker. Loved to leave the floor to smoke. For two nights I had him with another charge nurse. Yeah, there were a couple of hairy moments. But nothing a little morphine and a neb treatment couldn’t fix. But then the charge nurse rotation happened and you know who was in charge.

At first, the night went like normal. Nightly nursing things done. Meds were passed. Mr. Chest Pain was doing just fine. He had even gone down to smoke twice and never had a problem. I had everyone except him tucked in. I had even charted my first set of nightly charting before midnight – which never happens. The call light rings for room 66. The aide comes up to me and says, “He can’t breathe and is complaining of chest pain.” Down the hall I go. I peek in. He’s tachypneic, distressed but not too bad. I head down to the med room, call RT on the way and grab a touch of morphine to both calm him down and help him breathe until the neb got there.

By the time I got back to to the room however, things had changed. He was bolt upright in bed, using every muscle in his torso to breathe. I swear he was rocking his hips to help him breathe. For a second I sat there, transfixed by what was happening before my eyes. Then I grabbed the phone, “Rapid response to room 66, rapid response to room 66!”

I began hooking him up, grabbing a set of vitals when help began streaming into the room. The doc took charge as I gave him a run down of the situation. Shot a CXR, took a 12 lead, and he got a double strength neb. After a bit of time, he began breathing better, calming down a bit. Of course first thing out of the RT’s mouth was, “When was the last time he went to smoke?” Lucky for me he hadn’t been down since 8pm (and it was 2am). Soon he was breathing better. No longer straining, no longer using every muscle to breathe.

As the crew left, we sat and talked. He had a bit of a wide-eyed look to him. As we talked re told me how scared he had been, especially when all the people began flooding into the room. Of course I couldn’t share how scared I had been. He told me the thought in his mind was, “Please don’t tube me!” He told me he had been tubed before and it had been the worst experience of his life. Then he said, “I think I may go for a smoke…” To which I said, “Y’know, I really don’t think that’s a good idea right now, do you?” Grudgingly he agreed, then settled in and went to bed.

When I walked out my charge nurse met me in the hallway. She said, “They never said which room, but I knew. I knew it had to be 66.” “Yep, ” I replied “it’s my room, but I really think it’s you. Things seem to go well when you’re not charge and I have it, but when you’re charge…”

Since then she’s tried not to give me 66 when she’s charge. At least I learned a lot since then though. I looked back at the situation and know what I should have done differently and if presented with a similar situation, would probably do better and probably wouldn’t have called an RRT. Oh yeah, and Mr. Chest Pain? Yeah, he went down to smoke no less than 3 hours after the commotion. I guess some people never seem to get the point.