Do nurses ever truly clock out?

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Ahhhh… Vacation.  Gotta love it.  Nurses tend to joke around about never truly being on vacation.  We make t-shirts about it, send each other funny memes, laugh about it at work.  But really, we do tend to try to avert anything that looks like it might turn into an emergency, because hey, everyone needs a mental break sometimes.  Even nurses. That being said, we also jump in and help without hesitating if the need arises.  Even on vacation.

Last weekend I met up with a girlfriend of mine for a weekend away from home.  We met in St. Louis, which makes the most sense for us while trying to meet halfway.  (I live in Oklahoma, she lives in Ohio.)  We had an awesome weekend just catching up, trying some new restaurants, seeing some great sites and places.  We even managed to get in on opening night of Miss Saigon.  I did not manage to get away from being a nurse for the weekend, however.

We were hiking up the concrete steps of the Gateway Arch when it happened.   I was blazing a trail to the bathroom (which seemed a good half mile off in the distance) when I hear my friend call my name.  I turn around and see her.  One of the sweet little elderly ladies we had just talked to is lying on the ground, clutching her head, groaning softly, a grimace on her face.  My friend later told me “her head sounded like a melon cracking open” when she hit the ground.  She has fallen down the concrete steps onto the equally hard concrete pavement below and taken a direct hit to the back of her head.  My friend motions me over, saying “You gotta help”, and I’m doing a split minute decision on whether my bladder will hold out for this emergency, or if it will become the main emergency itself.  I can’t NOT help her though, so I rush back to her side.  I gently address the elderly group surrounding her– “I’m a nurse, may I help you?”  The look of relief is evident on their faces.  I quickly assess her while someone goes for help.  She hasn’t passed out, and she is talking to me without difficulty, so I know she is okay for the moment.  Soon a physical therapist stops and offers help, and bystanders are quick to help with whatever they can–keeping her shaded from the bright sun shining in her eyes, something to put under her head to pillow it from the concrete ground,  etc.    Her friends are praying out loud, panicky, scared something terrible has happened.  My training kicks in–regardless of what has happened, calm the patient and those around her.  I quickly point out to her and her friends that she is stable for the moment, and that emergency services will be here shortly for further assessment and to take her to the hospital.  I talk directly with the patient then, discussing her condition and telling her what needs further testing and why.  She insists she doesn’t want to slow down her group of friends, which has not yet gone up in the Arch.  I gently remind her that she might have suffered a brain bleed from the fall, which wouldn’t necessarily be obvious in the few minutes that have passed.  At the very least, she might very well have a concussion.  I convince her to keep from moving until Emergency Services get there to take over.  Once they arrive, I step back and let them do their thing.  We leave after they have taken over and have things well in hand.  I still really need to use the restroom, and it’s almost time for our tour to go up the Arch.  For all I know, that elderly group of visitors may have been slated to go up on the same tour as us.  We’ll never know; neither will we ever know how things turned out for her.  We did ask a park ranger after the tour if they had any updates.  Apparently, she was still refusing further medical care and was not taken to the hospital.  I laid awake that night, worried for her.  Was she okay? Did she eventually get worse as time went on? Was she near help if she did worsen?  As I lay there, I thought of all the things I could have done differently to help her.  Did I miss something? Was there anything else I could have done before EMS arrived? And other thoughts I had…Why are the steps and walkway designed like they are at the Arch? How many people fall on them each year?  How much worse are they when it’s actually wet?  How do they respond to emergencies inside the Arch? Or at the top? How far is it to the nearest hospital?  Where DID those emergency workers come from so quick? Why aren’t there better signs posted around the Arch, directing traffic?  Sometimes I have a hard time shutting down the “what if” questions. 

Nurses are trained to look at scenarios to find out what’s wrong and to try to fix it.  I guess that’s something you don’t just turn off when you clock out and walk out the door.  I had a great weekend in St. Louis, but I came away with a few golden nuggets of wisdom.  1) Allow plenty of time to reach your destination, in case something unexpected happens.  2) Never turn down a bathroom break when it’s presented to you, as you may really, really wish you would’ve taken it a little while later.  3) Always be prepared to lend a helping hand to those around you…you’ll be so glad you did.  

To the sweet little lady who fell, I hope you are okay.  I hope you and your friends were able to go see the Arch.  I hope your vacation was all you dreamed of.  And… here’s to many, many more adventures for the both of us. 

                   Nurse Ames, RN

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Hannah’s uvula’s Big Day.

 

This week my daughter Hannah had an EGD performed to hunt for the source of some ongoing stomach issues.   After hearing her talk about how much her uvula hurt, I told her I’d write a little something funny to remember the incident.  She had been scoped before, and was caught off-guard by how much it hurt this time compared to last time.  I helped her through the experience as best I could, and then I wrote the story from a totally different angle.  I wrote this mainly for her, but I thought it might make you smile this morning so I included it here as well.  Enjoy! 🙂

Hannah’s uvula’s Big Day

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Today I woke up like I always do, a little dried out from sleeping all night, morning breath in place, because, well, that’s what happens inside a mouth in the morning.  I thought today would be like any other day, but wow! was I wrong.

I got my surroundings brushed up and minty fresh, and assumed I’d be heading off to school with Hannah just like any other day.  Boy, was I in for a surprise!  I started to realise we were at the hospital about the same time the anesthesia hit me like a ton of bricks.  So, I relaxed like any good uvula does under those conditions.  Then I heard a lot of talking by nurses and the doctor.  And then ….Bam!, out of nowhere, the most massive tube ever made just shoved right past me into Hannah’s esophagus.  Quite rudely done, if you ask me.  So I’m trying not to gag, while I’ve got this massive tube pressed up against me, violating me and all of Hannah’s mouth and esophagus all the way to her stomach.  I see a camera come into view at one point, and realize someone is actually taking pictures of this weird and offensive start to my day.

Finally, it’s over and the tube is gone.  Ahhhh, what a blissful feeling.  Until I realize I hurt all over and I’m swollen what seems like ten times my normal size! And her tongue– its swollen too, and we are fighting, pushing and shoving, for who needs more room in the back of her throat.

Several hours later, I’m still totally miffed about the situation.  I’m still sore as can be, swollen up like a dead bloated toad, and nothing is helping.  Finally, Hannah gets some Advil past me, and starts helping me out with some ice chips and cold ice cream.  We can be friends again for that one.   But it might take a few more offerings of the ice cream to make up my mind.

I can tell this day will be one of infamy for me.  I am the biggest, baddest neighbor in town in my neck of the woods today.  I demand everyone’s attention, as my swollen, angry red self asserts itself as the power-to-be for the day.  I get all the attention, all the negative feels.  I longingly wait for my former nice, not-red-and-swollen, self to return. I dream of all my favourite cold popsicle flavors, and think ice is the best invention ever made.  I wonder what I did to deserve this outrageous attack, and vow to fight back the next time.

The next morning I wake up, a little worse for the wear, but feeling a little more like nature intended me to be.  I still long for ice, Advil, and popsicles, but I’m more open to the thought of returning to life as regularly programmed.  However, I have a few thoughts on the subject of EGD’s, scopes, hospitals, and the like….What’s that saying? “History repeats itself”?  There had better not ever, ever be a repeat, that’s all I’ve got to say!

                           Nurse Ames, RN

Peg tubes–good, bad, or ugly?

Life is a balance of holding on and letting go.”–Rumi–

She’s 66 years old, she lives in a group home, she has cerebral palsy and MR. She’s been in and out of the hospital this past year several times, each time declining physically. She doesn’t speak, she just points to what she wants and makes hand gestures. I’m only 5’2″ and when I help her to the bathroom, I tower over her height-wise. She is tiny, but her personality is huge. We nurses know her normal by now–she’s happy, grins ear to ear, wants to give everyone hugs. If only all of our patients could be that way, right? Today she is back in the hospital. They have placed a peg tube because she can no longer pass a swallow study. She is hurting, despondent–not her normal self at all. Her mouth is dry because she can no longer eat or drink. Her stomach is trying to get used to bolus peg tube feedings, which is stretching her stomach more than it’s used to. The canned liquid we give as total nutrition is causing her gas. Not only are these things causing her pain, but also the new peg tube site itself is still quite sore. She’s never been on pain medicine before, but the need for it is there now. So she sleeps a lot more than normal, is much less active. This leaves her wide open to a variety of complications–bed sores, pneumonia, blood clots in her legs, etc. However, at least she is now hydrated, and getting the vital nutrients she needs to stay alive. She doesn’t have to choke on her medicine, food, or drinks anymore. And she no longer needs to worry about aspiration pneumonia every time she takes a swallow.

Making the decision for end-of-life care is never easy. Nurses have the luxury of an objective point of view.  Meanwhile, family members are torn by the possible consequences of their decisions, no matter what that decision might be. Nurses have seen the same scenario enough times to guess the most likely outcome, whereas family members are dealing with uncharted territory. It’s a tough call to make, and I’ve been on both sides of the equation.  As for peg tubes themselves, I have seen some people thrive and regain health with them, while others just sort of wither away regardless. Are we giving loved ones another shot at life? Or delaying the inevitable while their quality of life further declines? I don’t know…there’s definitely no easy answer to that.  Every situation is different, every patient, every family group…All I can do as a nurse is provide information and be as honest as I can be when difficult questions arise.

As for my little peg tube patient, I hope she’s doing well again back at her group home.  I never got the chance to see her smile return before she was discharged.  I do know she was surrounded by love.  Her caretakers and other residents often visited her, and she seemed to have a great support system.  If anyone has a chance at returning to a better quality of life, it would be her.  I hope she gets her smile back.  

                           Nurse Ames, RN

Quasimodo’s house on fire

“France is crying, and the whole world, too.”– Ruairi Casey

September 11, 2001.  Do you remember where you were?  What you were doing? How you felt as you watched the towers fall? …April 19, 1995, 9:02 A.M.  How about that one?  Does that bring back sharp memories? Do you remember the agony of knowing your fellow Americans lie trapped beneath the rubble?  Think back further…Remember the day the Challenger exploded, the day the Berlin wall came down, the day the Gulf War started? How about the day they finally got Osama Bin Laden? I remember the headlines–that day felt pretty victorious in America, almost like a party.

This past week was to be the week that we as Oklahomans gathered together to remember those lost on April 19, 1995. Each year our collective memories gear up for the anniversary of our loss as a state.  Each year, I try to teach my kids the importance of learning about history from those who can remember it personally, not just by learning it from a history book.  I remind them that as their generation takes its place in history, they will someday have their own events burned on their collective conscience.  History that they will pass on to their own kids as a memory instead of from a history book. History is alive in the hearts and minds of those who’ve lived it–it’s personal.  While I can relate to them what it felt like to sit in school and learn about the Challenger exploding, they can go to their grandparents to hear firsthand stories of when Armstrong walked on the moon, or when Kennedy was shot.  It’s way more interesting to hear about it firsthand than to listen to your history teacher lecture about it while you try to stay awake in class.

So, this past week started with generations worth of historical memories already lying on the back burner of everyone’s mind.  It’s usually good for at least one Evening News recap–April is rife with historical events.  The sinking of the Titanic, Lincoln’s assassination, Boston Marathon Bombings, Oklahoma City bombing, Columbine shootings …Tax Day….the list is long and tedious.

And then I walked into a patient’s room this week and watched in horror as another historical event played out on the TV screen in front of me.  I was discharging a patient when I actually realized what was happening–I literally stopped talking mid-sentence, my mouth agape.  Tears sprang to my eyes as I watched in disbelief.  I could hardly stand to watch as I saw the flames and smoke of Notre Dame shoot higher than the great cathedral ever dreamed of reaching. Friends started texting me-“Did you see the news??”  Coworkers passed the word through the halls while the news spread like wildfire on social media. And as we watched her burn, we began sharing stories.  Reminiscing who had seen her when, and what was our favourite memory of her.   I had witnessed Notre Dame’s great beauty myself less than two years ago.  I was awestruck by her magnificence and had every intention of returning sooner rather than later to see her again.  Now I watched from almost 5,000 miles away as 850+years of history burned to the ground.  What mankind had managed to preserve for centuries was now gone in a matter of hours.

That evening I hugged my kids, and cried a few more tears for the majestic building that was now only a shell of its former self .  I related my memories of my time there, and we mourned her loss together. Then we talked.  “…Kids, remember when I’ve told you that your generation will have events that will go down in history, just like all the generations before? And that you will have your own ‘live’ version of that to pass on to your kids?  Here is one that will be in history books.  Remember what you were doing, where you were at, so that it is easier to bring it back to mind. Just as I can remember the day when Princess Diana died,  I want you to be able to remember the day Notre Dame burned.  Because you are a part of history yourself.  And how you relate to history and the world around you affects your life on a daily basis.”

I hope they can soak up my knowledge–what I’ve learned from my love for history, travel, and the world around me.    I hope what I’ve learned in my lifetime is not in vain, that they can retain it and use it for themselves.  So that they too have a love for life and respect for all mankind.  That they can pass it on and make the world a better place.  And I’m glad for my memories.  And my pictures of myself and that grand beauty.  For she was a building like no other.  I hope she is rebuilt, stronger and better than before.  That her purpose remains the same.  To point others to God as well as continue on as a historical legacy for generations to come.  To be an inspiration, a source of beauty, a place of worship, a safe haven.  She unites not only the people of France, but mankind as a whole.  I am so thankful to have been one of the millions to have passed through her doors and found peace within.

                        Nurse Ames, RN

Proms, perms, and Aqua Net

“Life moves pretty fast. If you don’t stop and look around once in a while, you could miss it.” —Ferris Bueller’s Day Off (1986)

Ahhh, the 80’s.   Do you remember them?  They were glorious.  Permed hair teased as high as Aqua Net would take it, stone-washed jeans, all the great hair bands, neon colored anything, mohawks and mullets , CD’s and walkmans….the world was a happier place.  We listened to Reagan as the wall came down, we cried when the Challenger exploded, and we lived out the last of the cold war.  As a teenager, I can well remember how we rocked “Born in the USA”  along with Springsteen for all the world to hear.

And then there was high school.  Its own little world, its own hierarchy system.  Were you the basket case, the brain, the princess, the criminal, or the athlete? Which clique did you hang out with? Did you love it or hate it?  During my senior year, I was the brainy nerd dating the class clown.  It made for some interesting memories in my small town.   When they announced us Prom King and Queen, I about fell over dead.  And because I was a nerd, I was instantaneously so anxious, I could barely walk to the front to enjoy my moment.  Flash forward 30 years…I’ve already seen my daughter live through her Breakfast Club days.  Now it’s my son who’s a junior in high school, living out his own version of the Wonder Years.  He’s quiet, sticks to a small crowd, just the average kid in FFA and shop class in western Oklahoma.  He drives a dependable car, works after school at a small engine repair shop, and is headed in the right direction in life.  You’ll miss out on his dry wit and sarcastic humor unless you’re privileged enough to be close family or friend.  Then he cuts loose.  And does so in spades. I marvel at him, this son of mine.  He’s so different from me, yet he’s the closest to me personality-wise out of my three kids.

This past weekend was his junior prom.  I was shocked when he announced he was going.  He hates social events, especially the more formal ones.  As prom planning approached, he had told me he was going with a group of friends which would make it easier on him.  Knock me over with a feather.  Fast forward and imagine my surprise when I found out he was taking a date.  This is new.  This is very, very new.  This is a side of my son I’ve never seen before.  Even more surprising, it’s a blind date, set up by a mutual friend.  What just happened?  Did I miss something?  Did he magically grow wings and start to fly?  Did someone kidnap him and replace him with a lookalike?  Don’t get me wrong, I’m ecstatic for him.  But this is so far from his norm, I’m in shock.  We are in uncharted waters here.  But hey, I’m a proud momma, so let’s fancy this boy up and send him to prom! I do have to say, it’s about a million times easier helping a 17 yr old boy get ready for prom then it was my 17 yr old girl. No drama, no fuss.  The only thing you have to decide is if you want the super-expensive slim cut tux, or the just-as-expensive regular cut tux.   And in western Oklahoma, it’s a given you’ll be trading out the formal wear shoes for your best pair of black cowboy boots.  And of course, he’s a boy, so he is tasked with finding the coolest ride possible to deliver his date to the promenade at the beginning of prom.  And does he deliver.  He borrows a bright yellow 1980 Camaro with loud enough exhaust pipes to let you know he’s arrived from two blocks away.  Western Oklahoma kids show up in some outrageous rides to prom–I’ve seen grain trucks, fire trucks, semi trucks, tractors, antique cars, sports cars, the biggest and baddest pickups you can find… This year one of his friends was determined to ride her horse side saddle in her prom gown.  That would’ve been a sight to see.  But good ole’ Okie weather had to have a temper tantrum and ruin everything.  It went from 80 degrees the day before prom to bitterly cold, windy, and raining the evening of prom.  And little does my son Cadon know beforehand, the car he has borrowed doesn’t have a working heater.  (Who needs it in 80 degree weather, right?)  Promenade gets cancelled an hour before it’s supposed to start.  A small group of us decide we will watch them walk in anyway, even though they will no longer be announcing them as they make their grand entrance.  So we huddle under a canopy near the doorway, a small band of cold, wet parents, determined to get that picture of our kids walking the promenade.  In the meantime, the kids wait in the valet line for over an hour in a cold Camaro, getting to know each other, cause, you know, it’s a blind date.  I can only imagine how awkward that was.   Needless to say, Cadon’s friend did not arrive on her horse sidesaddle.  The wind and rain had no sympathy on anyone that night.  I cringed every time I saw a girl in a beautiful long, flowing prom dress step in a puddle of water. Or when I saw the umbrellas flying away in the wind while the girls melted in the rain on their mad dash indoors.  The collective hours of beauticians everywhere that went to waste that day…Wow, I’m crying foul on that one, Okie weather.

I chuckle as I look down memory lane and remember my own junior prom 30 years ago.  My dad insisted I make him a chocolate shake minutes before my date was to pick me up.  As I took the glass canister out of the blender, the bottom fell out, and chocolate shake went all over my dark green dress.  By some miracle, it was a material that repelled liquid and for the most part, ran off and onto the floor.  I was able to wash off what remained without leaving a stain.  I’m sure I smelled of extra-chocolatey goodness that evening.  And then there was my ride to prom.  My date had a 1966 Mustang that was the envy of everyone.  Only it was 80+ degrees that day, and his car had no air conditioning.  I remember sweating buckets by the time we arrived–along with my chocolate catastrophe, I was a certifiable mess.  I was thankful he was a good friend, because my social anxiety was at an all-time high that evening.  I probably never did thank him enough later for helping me get through that first memorable prom experience.

So thirty years later,on my son’s prom night, I stand next to that sweet boy’s parents in the cold, windy rain.  They are here because their “honorary” granddaughter is my son’s blind date.  Doesn’t life have some funny twists and turns?  We reminisce as we wait, laughing about Jason’s old Mustang and escapades lived out a lifetime ago.  Finally, I hear an engine rev, and see a flash of bright yellow.  I’m not sure who’s more happy about it–us or them.  You would have thought we were the paparazzi as our little group of teenagers made their way past us to go inside.  I’m so stinkin’ proud of them.  My momma’s heart swells with pride as I watch my son offer his arm to Natalie, and see him grin as he walks by.  Go have some fun, son!  Tear up the dance floor, take the pretty prom pictures, eat the fancy hors d’oeuvres.  And in thirty years from now, may you too have great memories to look back on as you watch your own teenagers engage in this timeless ritual.  Who knows? Maybe by then they’ll be showing up for promenade in flying cars.  I can only hope I am around to watch the magic one more time.

In Loving Memory 

Jason Miller

1972-2000

Palm Sunday

IMG_2893There’s nothing cuter than all the little kiddos waving their palm branches in church on Palm Sunday.  Clearly, this is way more fun then trying to hold still while sitting in a pew!  And there’s a festive atmosphere in church.  This is the day we celebrate Christ’s triumphant entry into Jerusalem.  It’s also my Sunday off, and I’m thankful to be here with family and friends.  But what tugs at my heart the most is seeing our little foster baby waving his palm branches and grinning ear-to-ear for me. My heart is heavy for him, for his future remains uncertain.  His parents have recently split; meanwhile, termination proceedings have started for dad and mom is back in rehab AGAIN.  This is the second time around we have had him in his short life.  I feel so torn between love for this sweet, innocent child, and anger for the unfairness that life has already dealt him.  And he’s just one of so many kids in this situation.  So, so many families in America are touched personally by this same problem.  And each time I get to know another foster kid and their parents, I realise all over again that these are people just like you and I, who are either down on their luck, or dealing with every-day life issues just like the rest of us.  They usually have a poor support system, poor role models, or both.  They don’t set out to purposefully sabotage themselves, and yet that’s where they end up, regardless.  There’s no quick fix, no easy solutions to these problems in society.

How do I reconcile my faith with the problems of every-day America?  There’s no easy answer to that either, but I do it the best way I know how– I put it into action.  On this Palm Sunday, I’m thankful I can love on this little one, and keep him safe from the big bad wolf, so to speak.  He doesn’t have to worry about going hungry, or being scared or hurt, or crying himself to sleep at night.  He can run and play at our house to his little heart’s content, and not have a care in the world, as all one-year-old’s should.  In the meantime, I pray for his future.  I pray that this happy-go-lucky, carefree toddler gets a chance to grow up as a normal kid in a normal home.  That his smile never goes away, that his cheerful spirit stays intact.  Every kid deserves that chance at happiness.

His future won’t be decided today, however.  That’s somewhere out there in the hazy distance.  But today is here, right now, and we are gonna live it up the best we know how.  Which means we’re gonna swish some palm branches around for fun a few more times, probably chase each other with them a time or two, and laugh out loud while we’re doing it.  I’m going to try to not to fall in my heels while he scampers away from me, and when I catch him and all his greenery, I’ll give him a huge bear hug.  And my heart will be full of thankfulness.  

Grandfather time

1014016fb0324258342cdd5468c05329You’ve seen him. Pictures anyway. Grandfather Time in all his white-haired, long bearded glory. But have you met him?? I took care of him this week.  Or at least his doppelgänger. At 85 years old, he could certainly have claimed the title of Grandfather Time. As soon as I entered the room, I knew this patient was different from the average. He had the weathered, grizzled aura of someone who had seen much during his time on Mother Earth. I decided when I had a moment, I would ask him about his life story. I was not disappointed when I did. Slated to go back to the VA Center that day, he was well enough to sit and chat at the nurses station over a cup of coffee before he left. He said he grew up in Connecticut and had only ended up in Oklahoma due to an accident. When we asked why he chose to stay, he chuckled and said, “Stupidity…”  He had been in the Air Force for 15 years and said he had seen the world over many times. I asked him if he served in wartime or peace. ” Well, girl, you know…the Korean War… that’s where I messed up my head so bad.”  I nod silently. We’ve all heard the stories of the soldiers who never came back the same. He talks more of the places he’s seen, and jobs he undertook while in the service. Then he falls silent as he sips quietly on his coffee while reflecting on the past. I thank him for his service, although that doesn’t seem to count for much, compared to what he has done for me and my fellow countrymen. I make sure his next cup of coffee is exactly to his liking( lots of sugar) and carry on with my work.

Personnel from the VA Center soon show up to take my patient home. And just like that, my brief encounter with him is over. I reflect on what he’s told me. Have I spent my life making a difference like he did? Does what I do matter?  I hope so.  I can’t imagine getting to the end of my life and not knowing if I made a difference in the world around me.  Time waits for no one.  We either use it or waste it.  I hope when I am as old as Grandfather Time, I too can say I have seen the world over and come to it’s aid.  Make today count. 

                                  Nurse Ames, RN