Sisterhood of the Travelling Scrub Pants

Need New Scrub Pants?

2008-11-26T12:24:00.001-04:00

If you are looking for new scrub pants, you've come to the right place... check out the new links in the side bar to see a fabulous selection of uniforms and scrubs!

Alone

2008-01-09T22:57:00.000-04:00

A colleague is dead. By her own hands. I never saw it coming. None of us did.

I hadn’t worked with her very long, but from the very first meeting she impressed me and made me like her.

Her other workplace environment was difficult and distressing, but she stepped up to the challenge. She was kind, compassionate and non-judgmental even while telling the patients that they were full of &#$%. I don't know anyone who didn’t feel cared for when she was around.

Somehow she held her own distress inside so well that no-one knew how sad she was, or how desperate. She cared for everyone except herself. And now she's dead, and we'll never get the chance to try to help, or to tell her that we care.

But we did.

"I walk a lonely road, the only one that I have ever known. Don't know where it goes, but it's home to me and I walk alone." (Boulevard of Broken Dreams ~ Green Day)

Happy Holidays

2008-01-02T23:06:00.000-04:00

Ahhhh Christmas. More specifically, Christmas spent working. Overnight shift.

No folks, it was not fun. We all would have rather been celebrating with friends and family. But of course, the hospital never closes. And the patients that come in have concerns and they would most likely be with thier family and friends too.

I think it was summed up perfectly by one 10 year old in the middle of the night. While I processed his registration he spent most of the time resting his head on his arm on my desk. At one point, he looked up at me with a look of desperation and said "I'm so glad you guys are open". So I smiled at him and said "We never close. Just in case someone really needs us." He breathed a sigh of relief and went back to resting his head.

He came in because of vomiting. Had a short visit with the doctor and then was sent on his way. But at 3:00 am on Christmas day, he didn't want to be at the hospital either. But in the end, he was glad that we were there for him. And that, I suppose, is the only thing that makes a night shift rewarding (whether or not it is Christmas ).

Dear Hospital Administration Staff

2007-11-07T22:48:00.000-04:00

Today I spent a full day at a workshop.

I was interested in the workshop. I thought that it really was going to change my perception about how we care for families in our facility.

To a degree, it did. There was a panel discussion and 4 families shared their stories, their experiences as patients, and families who have come to our hospital in times of need. My complaint, is that these were all families who had positive things to say. One parent commented that she and her family spent nearly 10 months in an intensive care and had only had one not so positive experience. Woo hoo. Except this: I see and hear from disgruntled parents. I know they write letters, send complaints and voice concerns. Why didn't we hear any of their suggestions? Any of their stories? Because, yes the nice pat on the back is great. But how the heck do you think we're going to see change if no one tells us what we're not doing right.
The same issues come up over and over again. We identified areas that we could improve on. Well, parents, families and staff at the hospital have been talking about this in the 7 years I've worked there. So why are we still discussing the ideas. When do we stop talking about them and start implementing them.
And really, what I felt that I walked away with at the end of the day was a bunch of people who were just looking for a pat on the back. A dog and pony show so we could 'voice' our ideas that have fallen on deaf ears for what I'm guessing is decades and feel like we've accomplished something.

I'm not buying it.

Sincerely,
One very disgruntled employee

Communication Medium

2007-10-30T01:10:00.001-03:00

The lab called for the second time to say they were rejecting a specimen. The first one was rejected because it was clotted and unsuitable for testing. The second one was rejected because it was not labeled correctly.

The labeling of this particular specimen has always been a bit tricky. It's a blood screen: a group and cross match. They need to be sure that there are no mistakes made. Understandably so.

When the lab called, the nurses were livid. More so at their own mistake than the lab. They begged me to call the lab and beg and plead with them. We offered to send the nurse to the lab to correct the error. They still told me no.

I turned to the three RNs at the nursing station and I repeated that there was nothing the lab could do. The specimen was void and was being discarded. The nurses argued with me and told me that there was a way around this. They asked me to page someone, but were reluctant to clarify who. So they begged and pleaded that I call the lab and ask if there was a manager or supervisor around.

I attempted to stress the fact that I didn't want to do this. I used phrases such as "I don't understand what you want me to ask when I call, or who you want me to page, or what you want me to say to the lab". What I should have said was, "I don't feel like it is my job to do this. You're the charge nurse (to nurse 1) you're the nurse who made the error (nurse 2) and you're the nurse who thinks you know the loop hole in the policy (nurse 3).

So while all three of you sit there and listen to me repeat word for word what you say, then what the lab says, then what you say in response to that, don't you think it would make a heck of a lot more sense for one of you three to communicate with the lab?!?!? Especially when you're going to whine and pout that you need to explain to the family why we need to do another poke for more blood.
But what do I know. Apparently, I'm just some sort of communication medium. If only I were psychic.....

The Cat Came Back

2007-10-09T02:52:00.000-03:00

The patient arrived from a rural St Elsewhere to see our social worker. He had disclosed to his friends during their weekend getaway that he had been having some vague thoughts of suicide. Thus his friends brought him to the local Emergency Department, and they had in turn referred to his home hospital in the city for a full assessment.

The social worker arrived, did his assessment, arranged for out-patient follow-up, and sent the man on his way. All very routine.

The ward assistant took the chart after discharge and began filing it away. "Umm - does this paper mean anything?" she asked the charge nurse, and presented her with a form from the original hospital indicating that the patient was required to have a psychiatric assessment prior to discharge.

Whoops.

The patient whose suicidal plan was to jump from a moving vehicle had just been sent home by taxi, and without pschiatric clearance!

The taxi company was phoned, the taxi turned around, and the now very annoyed patient was returned to the hospital for a complete exam.

An hour later the patient was cleared by pschiatry to follow the original plan set up by the social worker and was again sent on his way.

This time he made it all the way home.

Let Go

2007-07-24T23:40:00.000-03:00

I just heard the helicopter in the distance. They were faster than expected. It's going to the hospital I just came from.

About half an hour before the end of my shift, there was news of a transfer coming from a community hospital via air. They were dispatching the transfer team ASAP. The phone was ringing off the hook. Calls as physicians far and wide consulted each other.

The ICU doctor on call wanted to speak to our Emerg Physician. Our Emerg Physician needed the Radiologist, CT Tech and Neurosurgeon. Then the trauma team leader.

After everyone was on the phone, the patient was ID'd so we could register them as soon as they arrived. I wrote the info out neatly for the next ward clerk. That way, it would should only take her less than a minute to register the patient and order a stat head CT.

I wanted to be there when the patient came. I wanted to be the one to tend to the family. To direct them where they need to go. To order the stat everythings. To get the right doctors, technicians and specialists on the phone, or better yet, in person.
But I went home. My shift was over.

A few minutes ago, I heard the helicopter. I think I left part of my brain at work. I immeadiatly wanted to get on the phone and start paging people. And then I remembered that some days, you just need to let go.

Junkie

2007-07-10T19:45:00.000-03:00

While driving in the car the other day, my friend mentioned a horrible accident and the outcomes of the victims. As the other friends (who don't work in hospitals) discussed, my friend the RN and me, the ER Ward Clerk had a conversation that went something like this.

"Man, that sucks"
"Yeah, but you can't tell me that you wouldn't have liked to have been there"
"Imagine being in the trauma room with something like that, I mean, that's a real Emergency. I could have totally rocked the trauma room with that."
"I hear you. I would have loved to have seen it. Why doesn't anything like that happen in our hospital?"
"Good point, it sucks that it's happening, but really, if it is going to happen, why not on my shift in my hospital?"

It's not that we're wishing bad things to happen. I think it's that we both feel an overwhelming desire to help when they do happen.

Head case

2007-05-30T23:45:00.000-03:00

I don't like to second guess people. But I do feel that I have a certain amount of responsibility to ensure that the orders I receive are written on the correct chart. Because lets face it, we all make mistakes, especially when it's super busy.

The physician handed me a chart and asked for a chest x-ray. Routine, I thought. No big deal.

"Ummm, are you sure you want a chest x-ray?"
"Yep, Room 7, Chest"
"Okay.... but his chart says he's here for a head injury."
"Yep."
"Okay, I think I'll put 'trouble breathing' as reason for exam. If I put head injury, I'm pretty sure that x-ray will be confused and ask if that's what we really wanted."
"Sure, that sounds good."

For the record, he left the department with the findings reading as: Asthma. That must have been one crazy head injury.

Ratios

2007-04-26T00:00:00.000-03:00

How many people does it take to run an emerg department?

Today, it felt like too many.

It was a busy shift. Staff wise. Patient wise. Not so much. There were always patients to be seen. There was a short (less than an hour) wait. But there wasn't a long, long line up.

If you had stumbled into our Emerg department today and did a head count of staff you would have found:

2 staff physicians
2 house staff
6 nurses
3 nursing students
1 ward clerk
1 unit aid
2 registration clerks
1 senior resident (admitting a patient)
1 junior resident (admitting a patient)
1-3 specialist residents (Ortho, Opthamology and Psych)
1 mental health crisis worker

Maybe, just maybe, we had some patients floating around. But with that many people, it's hard to know. But i guarantee you, at any given moment, there were more staff than patients.

Full Moon.... Full House

2007-04-03T15:34:00.000-03:00

I never believed the full moon theory of chaos until I started working in Emerg. But after one HECTIC shift last night, there isn't even a shadow of doubt.

I had an errand to run early in the day which took me down to Emerg. I could see a crowd of physicians and nurses gathered outside of our Trauma Room. I changed my route slightly to avoid getting in the way. Next stop, the waiting room. Shortly after noon, in the middle of the week, when family doctors and walk-in clinics are open, the waiting room is packed. Families impatiently check their watches and trade stories of symptoms, wait-times and symptoms from waiting for hours. I can't help but think, we're not forcing you to be here, call your family doctor.
I go about my business and think, I'm in for one crazy shift later.

At 3 p.m. I'm on duty. Ward clerk desk. Angry parents approaching the desk. Same story -- how many people in front of me, My child has a high fever, how much longer? I don't know, the department is full, we've got very sick kids back here, we're doing everything we can. I go through the same list of reasons and excuses with families, redirect patients with more symptoms to the Triage nurse and call over the charge nurse as an angry parents bursts into tears and starts yelling at me.

We need another physician. I call absolutely every doc on our roster. No one can come to help out for a bit.

It's almost supper time and we get a call from the parent of a well known patient. I alert the charge nurse and everyone heads down to the trauma room to draw up the protocol meds. Everyone remarks the same thing-- this is the wrong time of day for her. She usually comes in in the mornings. We're ready and able.

Well known patient is stabilized. I sneak away for a quick bite to eat.
When I return I'm bombarded with STAT bloodwork. Teenager, ingestion. I order the usual panel. Five minutes later, I'm asked to do a stat panel for a teen ingestion.

"I just ordered it".
"Nope, this one is on bed 3 you ordered for bed 6. "
10 minutes later... it happened again. 3 teenagers, 3 ingestions.

We're still sinking and fast. No one is moving. Every room is full. A tight wheezer gets aerosol masks in the assessment room.... there is no other room for them.

We call the ICU resident to come and fast track a few patients for us. She helps out for a while, but eventually, has to return to her patients. We were grateful for her help.

I check the clock. My head is pounding. Three hours left of my shift. I pop a couple Tylenol, take a deep breath. "Ward Clerk?" I then turn around, smile and say "How can I help? What do you need me to do?"

The Danger Zone

2007-03-28T12:02:00.000-03:00

"'Cause it’s another overcast day, Like it’s been for weeks, And I would blame feeling down on the weather If I had no other reason to be." (In Perfect Time ~ Jill Barber)

Ever wondered why so many patients stop their own meds? I used to wonder. Actually it used to p*$$ me off...

"What was the point of that? You came to us for help, we provided you with a medication which should only be adjusted with physician input, and you just stopped it?? You know better than a doc how to taper a med and when it truly isn't needed anymore??? Geez!!"

Of course I wouldn't say that to my patient, but that was what I was thinking. Instead I would try to delve more into the reasons behind their decision, to help me when formulating my teaching plan about how this should be handled better in the future.

So that was me, perfect nurse. Then along came February. (Actually, it was January on, but why quibble with details...) I'm faithfully taking my meds, and then I catch myself, every once in a while taking an extra one...

"maybe I just need a little more serotonin, maybe I just have gotten used to this level of med - I know the dosing range and I'm on the low end..."

I smarten up and go back to taking the prescribed dose. I work on other things to try to kick the funk - walking, exercising, eating better, going to bed before 1 am, avoiding alcohol even more than I usually do. Then I realize that I've missed a couple doses. Four, to be exact. In a row. And I'm feeling OK. Better than OK - actually kind of good. For the first time in months. So I start to think...

"Maybe I'm over this - I know the research says that a minimum of 9-10 months of treatment is required for remission and minimizing chance of recurrence - that's how long I've been taking this! maybe I'm ok. Maybe I can stop the meds..."

One would think that with my background I would recognize the red flags waving, but I don't. I do, however, know enough about antidepressants to recognize that they shouldn't be stopped cold turkey, but weaned off over a period of time so I take one, wait two days and take another. Then....

WHAM

I get hit by a 2x4 (or maybe it was an 8x16), and it knocks me off my feet. There are indeed social factors contributing (a close family member is diagnosed with invasive cancer, a trusted child is caught being very untrustworthy, some really awful events at work), but amid the fog, the fatigue and the despair, the truth hits me.

I've just done what so many of my patients before me have done. I'm just like them. No better, no worse. Just a patient.

So every day I learn something new. And some new things are more humbling than others.

Oh My

2007-03-10T00:53:00.000-04:00

Cyanide & Happiness @ Explosm.net

Open to interpretation

2007-02-16T22:08:00.000-04:00

Twice a year, I go through a routine process of bloodwork. Each time it happens, i anxiously await the test results. Please be normal, please be normal.

Usually, I get my blood drawn at work. I can register myself as a patient, and have one of my friends draw my blood for me. It gets sent to our lab in the hospital, and the results are available through our patient information system.

Naturally, 24 hours after the blood was sent to the lab, I was curious. I needed to know that I was okay. So I looked up my own self in the computer and printed off my bloodwork.

I know, it's wrong. But we've all done it. I've seen nurses and doctors check their own bloodwork. The differenece is, they know how to interpret it. Not me. I don't know how to interpret the results.

Faced with my own blood results, I ignored anything that was "normal". But when certain things showed, low or high, i wondered what it meant, and if this was bad. And I began to panic. So I showed it to a friend (thus making said friend an accomplice). Help me, what does this mean? Am I okay? I was panicking.

Cholesterol levels? are they normal? why would my glucose level be so high after a fast? what do those cells do? hey, my iron level is back into normal.... last time it was critically low... this is good.

"It's fine. Your bloodwork is fine. You're fine."

I felt better. I could see my results on paper. She interpreted them. I was fine. I am fine. And next time I know that when the doc tells me to schedule an appointment 10 days after I have the bloodwork done, it's because he wants to tell me what it says. Next time, I might leave the interpretation to him. Maybe, just maybe.

Broken Heart

2007-02-16T17:20:00.000-04:00

Last time it was the newborn baby with the fatal diagnosis.

This time it was the four month old with a 'non-accidental injuries' list longer than my arm.

Memo to self – do not work evenings on Valentine’s Day ever again.

Sometimes this job really hurts.

Stolen Property

2007-02-02T23:53:00.000-04:00

Today I woke up in stolen property. Let me explain. It all started about a month ago.

The rain storm got the best of me. And by the time I arrived for work, my clothes were soaked through and stuck to me. I was shivering from the cool mid-winter rain.

"You can't work like that", said a friend of mine as I huddled myself in a blanket from the warmer. "Why don't you get a set of OR scrubs".

So I did. Okay, someone did for me. I was lucky really. Within ten minutes, I was in a fresh set of scrubs. I was warm and dry.

I wore the scrubs home. I had no other choice because my other clothes were still wet.
But now that they're home, they don't want to go back to the hospital. Okay, maybe they want to go back - maybe it's just me that doesn't want them to.
But they're comfy. Very comfy. Perfect for lounging or sleeping in. Perfect as a warming layer under my jeans on a cold day. They're mine now.

And as the little tag on them reminds me, removing them from hospital property constitutes theft. Just don't tell the authorities, because if I end up in jail, the uniform might not be as comfortable as my OR scrubs. Shhhh, this will be our little secret.

I just want to be Noticed

2007-01-14T23:12:00.000-04:00

It must be some funky moon phase because we've had more people presenting with psychiatric concerns than usual, and most of them have had more drama than the usual Tylenol overdose or suicidal ideation.

Among the many, a few stood out. Those were:

The girl with the hair scissors, nail file and dual pencil sharpener hidden in her underwear. (Prior to knowing the patient's gender the social worker noted that the patient had to be a girl, as a boy would never hide stuff like that in his skivvies!)
The boy who "fell" down the stairs 48 hours ago, received an immunization 8 hours ago, and now, suddenly, cannot walk or move his legs, and his hand grips are weak. Interestingly enough after a full work-up at a referring hospital, a $600 ambulance ride and a late night assessment at the specialty hospital he was given some ibuprofen which dramatically improved his sensation and mobility, to the point that he was able to walk out of the hospital to go home.
The lady who wanted us to believe that she was too ill from her Tylenol overdose and subsequent Mucomyst therapy that she couldn't participate in a mental health assessment yet, so she pretended to fall asleep in her chair, then slid to the floor and refused to respond to people calling her (but magically could prevent her hand hitting her face when it was dropped over her) until someone hit upon the brilliant idea of saying "You must be so tired after all of this. Come on with me and I'll tuck you into bed for a nice nap." She rolled over, moaned and crawled forward, then was assisted to her feet and led to a room where she proceeded to stick her fingers down her throat to make herself vomit (all over herself and her bed while refusing to use a k-basin) for the next 4 hours.

All I can say is: I am so lucky.

Stories

2007-01-11T12:21:00.000-04:00

There is nothing more enjoyable or more educating than a good story. As a child I would read for hours, and short stories were among my favourite (as well as frequent re-reading of my collection of Cherry Ames books, of course!)

As an adult the time available for reading is much less, and good stories are hard to find. So, imagine my delight when Kim, the author of Emergiblog, began a blog carnival just for stories of, by and for Nurses!

Yesterday the current edition of 'Change of Shift' was posted. I have voraciously read every edition, but this is definitely one of the best collections yet (and not just because one of my infrequent posts is there, LOL).

Props to the contributors - you make me happy and proud and sad in an ongoing swirl of emotions. These are great posts. Thank you for representing our profession so well.

Props also to Kim - without your leadership we would not have this excellent forum. Thank you.

Bogus Bolus

2007-01-04T21:12:00.000-04:00

I made small talk with the paramedic hovering above my desk.

As I registered the patient that him and his partner had just brought in, we discussed the usual workplace pleasantries. When we ran out of things to talk about the conversation turned to discuss the holidays.

Because I know his girlfriend, I asked what their plans were for New Years Eve. Not much he told me, he had to work the next morning. He was still planning on going out, and having a big night out on New Years Eve. "I think I'll just ask my girlfriend to bring home the IV supplies so she can give me a bolus."

Interesting, and handy, all at the same time. Not knowing what else to say or do, I laughed and we changed the topic.

Fast Forward:

This weekend, a coworker of mine noticed I was slightly under the weather at work. I laughed as I told her it was self induced and I couldn't justify calling in sick. "I wish you had told me earlier that you were hungover, I would have taken you out back and given you a bolus". It was the end of my shift, I was heading home to take a nap. "I'm fine, but thanks anyway".

Fast Forward to preventative medicine:

I had her put the IV in, and I'll hide it under my dress. That way, when I've had too much to drink, I can give myself a bolus at home. She explained that lately she would vomit after even just 2 or 3 drinks, so this would help. It was a form of preventative medicine.

Oh okay then. That's a great idea. And besides, if using a bolus as a hangover preventer doesn't work you can always have one of your buddies give you one the next day as a cure. I guess it pays to work in healthcare. Although personally, I think I'll just tough it out and suffer the consequences of my actions.

Lines

2007-01-04T12:48:00.000-04:00

Coworkers ... are they your friends or are they friendly acquaintances? Where is the line? How far do you go for the people you work with?

What about the colleague who is clearly depressed and stating suicidal ideation and funeral planning? I've engineered a physician assessment that resulted in subsequent script writing and a mental health assessment and I've made myself available for conversation whenever he feels it necessary. He is taking the meds but is resistant to most of the other steps suggested; has attended the mental health assessment but is not finding it or the meds helpful... Must remember, he is not mine to save. Just because he is a friend it is harder to know where the line is - but in this case he is still just a patient.

What about the colleague whose child is sick and who is receiving substandard (ie wrong) care? How do I let him know where to find the appropriate care and tell him what that care should be? How do I know I am right? I'm just the nurse, and the doc is the doc, but sure isn't following any established standard of care... Must remember, I can provide information and options, but that is all. Just because the parent is a friend, it is harder to know where the line is - but in this case his child is still just a patient.

What about the colleague who is in labour, but whose is having complications and requires care that differs from her requests on her birth plan. I must care for her appropriately despite her stated wishes, but how do I help her to see this need? How many decels can I safely ignore without putting the child (and myself) in jeopardy? Must remember, I have two patients, not just one. Just because the mother is a friend, it is harder to know where the line is - but in this case the mother is still just a patient.

I wish that line would stay still!

Blast from the Past

2006-10-25T05:41:00.000-03:00

I saw the name on the chart I'd just been handed and my heart skipped a beat. It couldn't be - but it was... Suddenly I was transported back to my high school days and I blushed miserably.

I'd tried so hard to make J notice me. I made endless drives past his house in my Dad's car, took his 12 year old sister out shopping, went to church with his grandmother and mother, walked home from school with his younger brother (who was in my grade) even though it took me well out of my way to my own home, and came to every friday night family movie night in his basement for months. Always without success. I was welcome, but was always treated like his kid sister. The whole family tried to encourage his brother to like me, but that never worked either. His brother just wasn't that into me, and vice versa.

In retrospect, this was to J's credit. A 26 year old with a 16 year old would not in any way have been an appropriate pairing.

Back to the present. It's 22 years later and my biggest unrequoited crush is now about to become my patient. I begged a co-worker to take this patient for me, and then made myself scarce while J was placed in the department. Professionalism was absolutely not possible.

Besides, I didn't want my memories of the kind young man he was tainted by whatever he had become..

Red is Blue

2006-10-17T16:01:00.000-03:00

"Everything is changing. You're looking for the cure.
And you feel like you're the loneliest girl in the world.
Trouble in your head now, don't know what to do.
Seems like up is down and red is blue"

(Red is Blue ~ Ben Folds)

What is the deal with health care workers and depression?

Shrinkette quotes a Washington Post article that states "One in 10 American women takes an antidepressant drug."

Well here in Canada far more than 1/10th of my health care colleagues take medications for depression, and a significant number of my patients (especially women of childbearing age and the elderly) are taking mood stabilizers and antidepressants.

I was vaguely aware of this trend, and then as I read more in the blogosphere I've noticed lots of posts about my on-line colleagues (nurses, doctors and paramedics) and their ongoing struggles with depression. Most upsetting to me was Dr Dork who completely disappeared from the blogosphere after admitting that he was dealing with a depression crisis. As I read the comments to his post Dr Dork: Lazarus, arise ! I was struck by how many bloggers echoed his sentiments, including and Kim, whose writings I read every day, and whose writing never gives away the fact that she, too, sometimes needs help.

Why do so many of find ourselves frequently deep in the doldrums? Is it what we do? Are we so sad because we deal with heartbreak and sorrow on a daily basis? Or is it who we are - we are sad so we join others who feel the same well. Hell, misery loves company, right? Or is it that those of us who experience depression are more likely to end up in helping fields, allowing us some small feeling of making things better for someone else, since we can't do the same for ourselves. Is it a chicken and egg story with each of the parts chasing the other?

And why does it matter to me?

Because I think, after years and years of self diagnosed dysthymia, I'm finally ready to ask for help. I am finding it harder and harder to just press on, to put on a good face. At home it is easier and easier to retreat away from my real life into the computer, or instead of being home, to pick up even more shifts and work at a pace that prevents me from thinking about anything other than the patients in my care.

The asking for help is hard. Really hard.

Despite my knowledge that mental illness is just that, an illness, I continue in my reluctance to admit that I am sick. I want to believe that I'm stronger than that. I don't want to think that this could be hereditary. I've worked my butt off for years to prove that I'm not like my other family members whose life challenges have been a frequent and ongoing source of stress and concern. I'm afraid that if it is hereditary, I've passed it on to my kids, like some malignant gene that makes life miserable. I am mortified to have to ask my doctor for meds. My doctor is wonderful, caring, and a friend. Our children used to play together. I don't want her to know that I can't do it. There is no adult emerg doc that I work with who I trust enough to keep my need confidential. My pedi doc friends cannot prescribe an adult drug to an adult without opening them selves up to concerns about improper prescribing practices. It would be easier to ask a stranger, but there is no walk-in clinic doc that will prescribe, since they cannot do follow up. I can't go to a new family doctor as none in my area are accepting new patients. I can't think of any single person I could talk to without feeling embarrased at my weakness. I don't even want my husband to know, although he'd have to be blind not to recognize the problems after all these years. I also have difficulty accepting that I have these feelings despite having such an excellent husband, amazing kids, wonderful family, an terrific group of close friends and fabulous coworkers. There is nothing wrong in my life, so why am I so down?

Update. That was June, this is October. What a difference a couple months can make.

I did it. I worked up the courage (truly one of the hardest things I have ever done in my life!) and asked my Doctor to put me on an antidepressant. She was kind, supportive and prescriptive.

Swallowing the first pill was a real challenge - I wasted six before I managed to choke one down, but now they go down easily and they are working. I feel normal for the first time in more than five years, and probably closer to ten years.

Now my challenge is not to run though the streets with a placard proclaiming the benefits of my new medication. Truly though, this feeling is wonderful and I wish more people could feel it.

"I think I can make it now, the pain is gone. All of the bad feelings have disappeared. Here is the rainbow I've been prayin' for. It's gonna be a bright (bright), bright (bright) sun shiny day."

(I Can See Clearly Now ~ Johnny Nash)

You'll have to excuse me, I'm not at my best....

2006-06-17T20:30:00.000-03:00

What do you get when you place a group of Emergency personel (nurses, paramedics & ancillary staff) in close proximity to large quantities of alcohol and loud music with a beat after a really busy stretch at work and lots and lots of rain?

That's right - a high school dance on steroids. A bunch of giggly, flirty girls and a competing bunch of horny, testosterone filled, strutting boys. A group that have been working hard and now are ready to party hard.

Boys: Just in case you don't remember the answers to those 'important' conversation starting questions you asked me last night:

No, thanks. I'm happy to chat with you but I'm not going to go home with you. Nope. Not now. Nope. Not later either.
No, I'm not a lesbian. These girls are my friends and co-workers, not my lovers. Really.
Yes, I'm married. Yes, happily. Yes. Really.
No, I'm not giving off 'unhappily married and looking for a great new guy' vibes. {Well, perhaps in your dreams, but since they started with you thinking/hoping I was a lesbian, then it is pretty clear that you don't have the best vibe reading skills. Especially since you can't even find my face because your eyes haven't left my chest in 6 minutes.}
No, thanks. I don't want to dance. Really. {Actually I'm not on the dance floor because everyone else out there is dirty dancing. I don't dirty dance. I look like a duck having a seizure. So do you, but you don't seem to care, so feel free to go dance without me.}
Yes, I really am 10 years older than you. Yes, really. {Nice try. I know I don't look like a teenager. I have a mirror, and no illusions about how old I look.}
Yes, I can tell how drunk you are.

Girls: I'd also remind you of a couple things, since you also are likely not to remember.:

Yes, your hair is flat, and you still look great, so stop stressing!
No, I'm really not going to drink that shooter. No, it doesn't matter how often you chant my name or call me party pooper. Yes it is fine with me if you have the shooter.
Yes I'm enjoying myself. No, I'm not drunk, but that doesn't change my last answer. Yes, it is fine with me if you want to get drunk.
Yes, you really look hot, but it would be a bit more appropriate if your top wasn't completely falling open like that.
Yes your husband would be a little upset if he saw how actively you were bumping and grinding with that paramedic.
Yes, I really am heading home. Clearly I'm way too old to be here. Besides, it's 1:30 am and I have to be to work at 7 am. No, I don't mind if you stay. Really. Have fun and play safe!

Now, before you get the wrong idea, I want to point out that the evening was actually quite fun. We had a nice group of people. There were only a couple who really went over the top and the silly stuff was only a small part of the whole picture. None-the-less I was really surprised at how the people who I thought I knew showed themselves in an entirely different light once some alcohol was in the picture.

The evening also had another unexpected result. After watching a group of professionals overindulge despite their knowledge of the down side of excessive alcohol gives me a whole lot more empathy for those people who come to the department for stitches or whatever after a night on the town.

When Does the Nursing Start??

2006-05-31T14:12:00.000-03:00

I had a busy shift in triage recently. Often there was a line-up and I'd be required to move on through ~ ABCD and focused assessment, two-three minutes per patient, no more ~ but every once in a while there was a lull and I could start some nursing care to make the wait to see the doctor more pleasant and to initiate care to reduce wait times once in the department - things like:

* providing ice to injuries and ordering xrays when appropriate
* providing tylenol and ibuprofen for fever & pain and pedialyte for vomiting
* offering blankets, water and popsicles to the people who had been waiting for hours to be seen
* collecting urine specimens and throat swabs and sending them to the lab
* applying freezing cream to the veins of kids who looked like they would need IVs
* reducing a pulled elbow (on the first attempt and only after a thorough assesment and history)
* removing the imbedded rock from the boy's knee and flushing it with saline before applying freezing gel

I acted completely within the scope of my practice, using standing orders, delegated medical acts and shared competencies to facilitate this or discussing with the physician prior to initiating care that fell outside these (such as the facial xray for the guy who accidentally shot his lip with a nail gun).

None-the-less it appears I did more than usual at this facility as no less than three people made comments to me

*"Why are you doing all that out there for? We won't have anything left to do when they get inside!"

*"Stop keeping them so happy - they'll just keep coming back!"

and, the real insult ....

*"What, you think you're a doctor now?"

Nope. I think I am a nurse and I am providing nursing care. I am amazed to think that I should do any less!

Only

2006-05-24T23:02:00.000-03:00

It was only 25 feet long, housed 3 computers and had lots of open space as well as a multitude of shelves and racks for books. We were told it was the 'charting room' - for use equally by the doctors and nurses.

It was only a small corner of this desk, in an area never touched by anyone except to dump their reference materials when they couldn't be bothered to put them away.

It was only a milk crate of small (quiet!) toys and picture books donated by the nurses (or more specifically, by one of us). 20-30% of our patients are between the ages of 2 & 10, so it seemed reasonable that there be some toys available to entertain them during the hours of waiting.

It only took one doctor (small 'd' doctor) to have a hissy fit about the 'toys crowding his charting area!' as they sat inoffensively 10 feet away from him, neat and tidy in their 1 ft by 1 ft milk container.

And now in the corner there is only his crumpled coffee cup, and the toys are gone.

Totem Pole

2006-05-24T22:36:00.000-03:00

<>I am at the bottom of the totem pole. And I’m okay with that. I know my role in the department and how it contributes. I understand that what I do has its function and therefore I strive to do it as best as I can. I have a good job, and for the most part, I feel that I’m respected and treated respectfully by physicians and nurses. Like everyone, I have good days, bad days, hectic days, and slow days. But at the end of the day I love being and Emergency Department Ward Clerk.

A physician was on his way to the photocopier. He stopped by my desk to verify the password. I confirmed that he had it right. A nurse piped up and said, “Tracy can go copy that for you”.

<>
Sympathetically, he looked at the multitude of papers that covered my desk as I attempted to finish the last of the paperwork before the next shift started. I told him not to worry about it and I reached out and took the paper out of his hands. <>I looked at the paper and explained the hesitation I felt towards obliging to the request. He questioned the usual procedure and I explained it to him. He understood. But then, again, a nurse piped up and explained in this case why it was okay. His Dad is a cardiac surgeon. If they want a copy of their EKG they can have one.

The physician looked at me, the nurse looked at me. Both looked at me with looks that said, “We’re not going to ask you again”. It was obvious that I lost my case. Dutifully, I obliged to their request. <>I returned to the nursing station one minute later. Years of Health Records experience, and ER experience told me that handing a patient a copy of their chart is wrong. We can fax it to their family doc, but as to hand a copy over in person, we’re not supposed to. I know that.

But this time, I wasn’t given a choice. And after denying the request and being asked again, or rather told again, I knew I had to oblige. So I handed over the papers and clarified that if anyone asked, they didn’t get them from me. Because I know, it’s me, and I should know better.

<>And it’s not so much the fact that I did what I wasn’t supposed to that bothers me. It’s that I wasn’t given a choice. I made my case according to hospital policies and my experiences and it was ignored. I stated why I was uncomfortable with the request but all that was tossed aside because of who the person making the request was. And at the end of the day, I can’t help but wonder if the person denying the request has any say at all. Because the physician, the nurse and the family all looked at me as if to say “you know your place, how dare you talk back to us”.

Stationed

2006-05-24T00:35:00.000-03:00

She's a Nurse.
I'm a Ward Clerk.

We both watch things happen. We both get involved in what happens. And we'll both be telling our stories here.

Stay tuned, because after these messages, we'll be right back ;)

The Start

2006-05-24T00:02:00.000-03:00

What do you do when your work makes you crazy and you can't share it with anyone? How do you debrief when you can't violate confidentiality? Why, you blog, of course.

Soon my friend and I will share with you some of the fun and frustration of the places we work, but for tonight, it is enough to figure out this blogger program. :)

See you again soon!

Cherry Ames