My little rant

Everyday we walk through those EMS doors into the ER hoping for a good shift. We put up our walls to protect ourselves from the evil, sadness, shocking emotions and event we witness within our department. However, sometimes our walls that we built to keep us detached are not strong enough. All of us have the patients that we will always remember. For me I remember the ones that I could not help, or the ones that remind me how fragile life really is.
Today, I received a letter in the mail. It was from a child that I had taken care a few years back. Every year, on the same date, he sends me a little gift and note. I keep all of them tuck away where I do not see them and I cannot be reminded of that night I first encountered him. He and his family do not mean any harm. They are just sending their thanks and letting me know that I had made a change in their lives. Now, with that said, I became a nurse because I wanted to be able to make a change people’s lives. I did not know then, that making a helping someone would ever be painful.
So here is the story. Child is on vacation with father and they are driving to the child’s birthday party. It was a very dark, rainy night with thunderstorm warnings and tornados watches out. Drunk driver came across and struck the vehicle that the child and father were in. Father died instantly on impact and his body pinned the child down in the car. It took over 3 hours to get this child out. He then came to me. He had many injuries and his closest family was three states away. I took care of him, and when he would fall asleep, he would wake up in screaming. There was nothing that I could do to comfort him, but sit with him, hold him, and pray he did not ask about his father. His family that was driving in wanted to be the ones to tell, which I understand, but hell the boy already knew. He would tell me over and over what happened and finally, he just asked for the truth, which I was could not tell him. A few of us nurses ended up staying with him for the day while his family was on the way up. I felt guilty leaving him because I would hope that in the same situation someone would try to comfort my child. We had switch from acting as a nurse and now was acting as a protective mothers. As nurses, we tend to band together to protect our patients, especially children. The child had four older brothers, who are the ones that came to get him. For some reason the child had bonded with me and I to him. So every year he now sends me a thank you thinking of you letter.
Many ask why it bothers me so much. Shouldn’t I be happy that I did make a difference in someone’s life? So here is the back-story. I had two children who were killed by a drunk driver at the age of 6months and 3 years on my older son’s birthday. The night this child came in was the anniversary of their death and was the same age my child would have been if he was alive. It also did not help that he had the same name as my older son.
Here’s the point. Many people go through, read our medical blogs, and wonder how we can be so cold and find humor in everything. Our jokes and laughing are a way that we protect ourselves from everything that we see and hear. Moreover, there are times that our patient’s stories and situations break though our protective walls.

Ring Tones

People really should consider what type of ring tone that they have on their phone. I can't count the number of times some one has had their phone ring at the most inappropriate times with some of the funniest ring tones.

Examples:
1. In middle of chest compressions, we hear the song Ex-Girlfriend coming from the patients phone. His cause of death = shot by ex-girlfriend

2. In the middle of retrieving a "lost Tampon" woman's phone rings, Her ring tone "Hello in here, get me out, answer me, help it is dark in here." --- I could not help but laugh

3. My favorite to date, I all the sudden I hear a song, "Dear penis I don't like you anymore, you used to stare at me in the morning while i shave, now all you do is look down at the floor, It use to be me, you, a paper towel and a magazine was all we needed to get by," At this point and time, my tech was putting a Foley in the patient

So please be aware that your phone will ring at the most inopportune time, and I as your nurse, will attempt not to laugh my butt off!!!

Unresponsive----- Why???

Had an interesting patient today. Presented to the Ed responsive only to pain, pupils pinpoint and nonreactive. Was found by friends this AM, last known well time more than 24 hours ago. All BP, HR, RR, AP, Temp are wnl, CBG was normal. CT and EKG was normal. Lungs were diminished and pulse ox 92% on room air. Was vomiting. I pulled the ET tray "just in case," 1st year resident took the hint and we protected his airway. 20 minutes later his BP dropped like a rock and we could only get 43 systolic with a doppler. Since he is well known to us, we had admin narcan upon his arrival, with no response. All lab values were wnl, yet he was unresponsive, and now his BP was in the crapper. Hooked up rapid infuser and 2 boluses had no effect. Pulled out dopamine with the hope 1st year would get that hint. After he did not, I went to the ER doc and got order for dopamine, which in long run did not help, but at-least I got the ED doc to take over the case. We went to levophed, which got pressure up to 80/30. Still a crappy pressure in my book. As it stands right now, he is in ICU and they are still attempting to figure out what the heck is wrong with him.

Ethics of Preforming Codes

Today was a busy day. First client was a hospice client that family decided that they wanted everything done to try and save him. Problem is that he had cancer that had spread to his bones, most importantly it had spread to his ribs. I understand not wanting to watch you family member die, and my heart goes out to them. However, when your father is downing in fluid that is is his lungs, his heart has a tumor in it, he has a GI bleed, and is septic, enough is enough. As the nurse we must go proceeded with all life saving measures, even when we know that there is no hope. So, when he stopped breathing, we place an ET tube . When his heart stopped we did compressions, which ended up breaking every bone in his frail chest. Wehad to placed chest tubes. We went on and on. Every measure we did gave him an addition 30 minutes of suffering it seemed. I feel that he was in pain every time that we brought back, yet we are unable to give pain medication because it would hasten his death. We talked with family, yet they were in denial. Finally, I brought family in for them to witness the last set of compressions. I believe that they needed to see for themselves that by attempting to keep him alive, we were only prolonging his pain. After 3 hours of code after code, he finally past away. Even though we did everything for him, I feel that we were wrong for not letting him die in peace without pain.

Certifications

Every time I turn around, I need another certification. SANE, ACLS, PALS, TNCC, CEN, and now they are coming up with PNCC and GNCC. Yes, it is nice to have a review to work within the ED, but it is getting to the point that we, as nurses, are just paying for our little cards that say we have sat in that class. The last two days, I have sat in class with some very bright people. However, there is always that one person in the class who is a complete idiot. They ask questions that just demonstrate how idiotic they are and you just want to pull your hair out. For example, one woman, who has been a nurse for well over ten years, stated "we just irrigate with normal saline, and that just cleans everything right up." Now, we were talking about needle aspiration for priapism. after questioning what the heck she was talking about, we further learned that she was under the belief that priapism was an eye condition related to dust in the eyes.