chartingnewterritory

[chartingnewterritory]

Coming off night shift with no sleep and my damn fortune cookie is taunting me.

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“You can try to put an IV in her, but NO ONE in the hospital could get one in her, so I really doubt you’ll be able to either.”

My patient’s daughter, right before I placed an 18 gauge on the first go. Those ICU skills come in handy sometimes.

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When people ask me what I do and I tell them I'm a hospice nurse, they inevitably say some variation of, "Wow that must be so hard! I don't know how you do that."

Hospice is hard. But you know what was harder? Unnecessary, pointless interventions and putting people through the ringer when everyone already knew it wouldn't do any good. Having these conversations with families as we were coding their loved one for the third time in as many hours. Doing compressions on an already broken chest. Using all the drugs we have and knowing it won't matter. Intubating someone we knew we would eventually terminally extubate because their family wanted everything done. That is so, so much more traumatic than what I do now.

I get to make people comfortable. No painful interventions. Nothing they don't want to do or feel like doing. Medications as needed with lots of room for adjustment for every symptom. Comfortable positioning. Family and loved ones visiting 24/7. Music. Pets and therapy animals. As peaceful as possible.

I do inpatient hospice. When patients come to us, they are in crisis usually after choosing to discontinue aggressive treatments or after hospice can no longer be managed effectively at home. I get to help ease those symptoms and anxieties and allow for comfort.

I am so glad there are people who love ICU, because it is so necessary. I'm so, so glad people find ways to cope with the downs so they can also save others. I got so burned out by it, and have found so much peace and hope in hospice.

Kudos to my ICU and ED friends. Your job is so, so hard. Take care of yourselves. ❤️

We told her we did everything we could.

We asked her if we could stop.

“If there is nothing else,” she said

“Then let him go peacefully.

Not like this.”

Nobody told her he had been gone

For an hour.

And it was not peaceful.

It was violent,

And bloody,

And chaotic.

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Update

Post-op day 2 now from lap cholecystectomy. Positive things to report:

- I did not fight or curse at anyone in a bout of post-anesthesia delirium this time

- I do not appear to be suffering any sort of post-op hemorrhaging, so that's already a step up from the last surgery at this point

- Mostly just popping the occasional Advil and Norco and watching Netflix

So far, so good y'all. 👌

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Oh, goody!

Late night trip to the ER last night after hours of trying to convince myself that the excruciating and recurring abdominal and back pain and pressure was just terrible indigestion or a stomach bug and not my gallbladder. Seriously, I didn't want to be the person in the ER who's like "my tummy and back hurt give me the drugs plz." After a positive Murphy's sign (which I instructed my husband in testing me for), I finally went in about 2 am. Guess who gets to have surgery next week to have this bastard taken out? You guessed it.

So, some of you may remember the chaos that resulted from my tonsillectomy earlier this year (and followup emergency surgery for post-op hemorrhage...and multiple ER trips for recurring bleeding). I swear the doc last night reassured me about the surgery using the same words the ENT who did my tonsillectomy used: "It's really a pretty routine surgery with few complications." Let's see what happens this time!

P.S. Should I warn them this time that I almost extubated myself last time in my post-anesthesia insanity and that it took 3 nurses to subdue me? Or just let them be surprised? Might as well have some fun with this. Hey, at least I've already met my deductible for the year! 🤦‍♀️

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Reblog if you got vaccinated against influenza this year! Let’s set an example and be proud of our choices to protect those around us!

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I really don't miss this. Inpatient hospice is the best of both worlds, or at least mine is. We almost always are adequately staffed (2-4 patients apiece, which is hilarious compared to the hospital), and it's still bedside nursing, which I love, but without all the problems I found are synonymous with hospital nursing. I think I finally got to a point after routinely being in charge with 2-3 true ICU patients of my own where I was just like... man, fuck this.

Which is really terrible on so many levels, obviously, but especially because it's driving nurses away. What's the best way to address a current or impending nursing shortage? Don't fuck over your staff. Give them support and hire adequately. Pay fairly and create a supportive culture, so retention is higher. Maintain a good mix of well-experienced and newer nurses, recognizing that being too heavy handed on either side of that equation can lead to bullying and/or resentment and a generally unhealthy unit culture.

I really miss ICU sometimes, and I consider maybe doing it PRN just to keep it up, but then I remember all these things that the vast majority of hospitals AREN'T doing, and then I let the desire go.

And at the end of the day, I am so, so thankful for my job and the beauty that is hospice. I feel so at home and like I've finally found the area of nursing that I'm meant to be in. I'll write more about all of that soon, but in the meantime, I'll say this: hang in there, hospital warriors. You're my heroes, and I know how hard it is. You're all amazing.

Okay great

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Love Covers.

Part of my hospital chaplaincy duties is to write a reflection on how it’s going. Identities may be altered for privacy. All the writings are here.

—

I’ve seen love. I mean, pure love. The kind that builds you, that bursts wide open and free, the kind they tell you about, but you were afraid to believe.

A nine-year-old boy comes into the trauma bay with deep, jagged lacerations all over his back. Car accident, roll-over; dad and children nearly ejected, going fifty. His shirt is shredded. His back is really torn up, almost ribbons in several places, blood filling his shorts. He’s fidgeting, squirming, but not from his wounds. He’s trying to sit up, eyes darting, looking for someone. He’s trying to tell something to the paramedics, to the nurses and doctors, to me. 

Medicine, he says in a choked whisper, medicine for my sister. She has a new kidney. Medicine.

A second later, his four year old sister is wheeled in—they had been in the same car accident. She’s in shock. Her brother keeps saying, Medicine, for my sister. She needs her kidney medicine.

A nurse replies, “On it. I’m on it, little man.”

I go to the nine year old, pull up a seat, and tell him, “You’re a good brother.”

“Thanks,” he says, finally resting his head. The nurses move around us, not missing a beat, and there’s just me and the kid, eyes locked, his eyes on fire.

“What happened?” I ask him.

“I heard the car inside make a boom, like a firecracker,” he says. “I knew something was wrong. I knew it! I grabbed my sister … and I put myself around her, because … because I didn’t want glass to get in her face.”

I remember his back. The lacerations. 

Suddenly, I’m crying. I lose all professionalism. I’m just crying.

“You’re a hero,” I tell him. “You saved your sister’s life.”

“But her medicine?” he asks. “You’ll make sure she gets it? She takes it everyday for her kidney. It was the one that I gave her.”

“Yes,” I tell him, trying to smile through flooded eyes. “Yes. You’re a good brother,” I say again. “What’s your name?”

He says, “Angel.”

Of course it is.

I sit with him, quietly, as the medical team begins to work on his back. He makes no noise, except to ask how his sister is doing. 

I hold back tears. I feel angry, that something like this had to happen to Angel and his sister, that we live in such a world where no child is safe from destiny, from fate, from the universe, from God, where kidneys don’t work and cars roll over—but I think about Angel covering his sister, and that on our tiny fractured little spinning rock in the random cold chaos of meaningless collision, where the world can explode in glass, one child didn’t hesitate to die for love. I think it is awful that they have to be here in this hospital, but my heart stretches to this other place, where love is powerful and real, and that within lawless disorder, very beautiful things can still happen, and that perhaps pure love must be born through pain, through the life of another. 

— J.S.

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The best part of family coming to stay with you is the heartwarming, calm, respectful political discussions you can have that really help you to see each other’s viewpoints and generally become a more understanding, kind person.

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Today we finally took my dad home. He always said this is where God lives. I hope he was right. I think he was.

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Endings and Beginnings

Yesterday was my first day actually working on the unit at my new job. I'm working at an inpatient hospice unit that does both adults and pediatrics. By noon, I was basically on own with 2 patients, which was actually fine. Normally I will have a patient load of 3-4, which is awesome for this acuity and care level. There's also a CNA to help with baths and other patient care during each shift (the 3 I've met so far have all been amazing, truly caring people). The other nurses have all been wonderfully helpful, knowledgeable, and kind. I've never felt so comfortable and welcomed on a new unit (in a new specialty too, no less). Three patients on the unit passed during the shift. I wondered how I would handle this the first few times, since my father died in this very unit not 5 months ago. One of the patients yesterday was mine and was in the same room my dad was, with a similar diagnosis and story. During my shift, it was fine. I tended to the patient and the family, comforting both and making arrangements after the death. I feel good about how I did. The rest of the shift went well and I left feeling satisfied with my new job and more hopeful for the future of my nursing career than I've felt since nursing school. I went home and spent time briefly with my daughter before her bedtime and then settled in to relax and talk with my husband. After a while I went upstairs to bed, still feeling pretty good. As I lay in bed thinking about my day, the thought crossed my mind to call my dad and tell him about it. This happens to me a lot still, and I'm always met with the same familiar pang of renewed grief when I realize that I can't. Then, as I've also done many times, I decided I wanted to hear his voice, and I went to my saved voicemails. I listened to a few of his silly or mundane messages from the last couple of years. This is always so predictably bittersweet. I know it will be hard, but often it's worth the pain to hear his voice again. It makes me feel connected to him still. Then, as I sat thinking about him and reliving his last days again, I realized something. I am so, so sad that I can't share my life with him in the same way anymore, and it is so hard not to be able to call him up and tell him about this new job that I feel called to; and then I realized... I would not have chosen this job without him. His death, in hospice, in the very unit I now work in, led me to know that this was where I needed to be in a time where I was full of self-doubt and feelings of inadequacy in my professional life. The added importance of his death there made me pursue this job for two months and to convince my now manager that I could do it even after my loss and to take a chance with me. It drove me to overcome my fear of "starting over" in a new direction and a new speciality. I could not have done this without him. And because of this, and so many other things, he is with me still.

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This is a 90 year-old female patient who has no wrinkles and so I hate her.

Nurse giving report

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I could watch this all day.

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Bunny yawns are both adorable and terrifying.

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May 1-7 is Maternal Mental Health Awareness Week

As if having a new baby isn’t hard enough, 

1 in 7 mothers will experience postpartum depression or anxiety

The good news is -  it is not forever, and you are not alone.

If you or someone you know is experiencing pregnancy or parenting mental health distress, please follow the links below for help:

US: http://www.postpartumstress.com)   AU: http://www.beyondblue.org England: http://apni.org Ireland: http://www.pnd.ie/index.html Canada: http://postpartum.org Internationally: http://www.postpartum.net or call 1-800-944-4PPD

Thank you to POEM Ohio for the resources: http://poemonline.org/

Please share.

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“I didn’t spend six years in soda medical school to be called ‘Mr. Pepper.’” (via manny_bodega / carbine_fox)

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Nurses make the worst patients

So I had my tonsillectomy done Friday. Here's a few highlights for you, and reasons why being both a nurse and a true redhead cursed me from the start: - Woke up from anesthesia fighting, had to be restrained by 3 nurses - Tore out my IV in a fit of post-anesthesia insanity - Followed all directions, still ended up with a severe post-op hemorrhage on POD2 - To the ER twice in one day and then finally back to the OR to have the bleeding fixed - Had to have my stomach pumped because of all the blood I swallowed (you guys it was like a murder scene around here) - Earned myself a night in the hospital - So much pain after surgery #2 cannot open my mouth more than 1/2 inch and am living on Vicodin and Ensure - Having to postpone starting my new job because my recovery period has now lengthened - Have already met my (insanely high) deductible for the year thanks to these events When I complained to my nurse that this was just my luck, she was like, "Well, nurses ARE the worst patients." It's true, y'all.

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Brewing coffee kinda sounds like suctioning a trach.

@rn-erdy

(via

nurseanonymous

)

Coffee is forever ruined now..

(via nurseeyeroll)

NO. no. no. no. Don’t ruin coffee for me. It’s what gets me through things like suctioning trachs…

(via nursegif)

Also banana pudding looks like pus.

(via wayfaringmd)

Funny (and sort of awful) story...when my dad was in hospice, at the very end, he had a very loud "death rattle" for a couple of days. My mom came in the room at one point and said, "It sounds like someone's brewing coffee." From then on, whenever we would call and update each other, we would say, "Well, he's still percolating."