Trying to teach an old dog new tricks (Uh, that would be me)

Have you ever been in that situation in life where circumstances force you out of your comfort zone? Where you have to jump into a new skill set, or learn a new way of doing an old job? Where you get transferred out to a different facility, town, maybe even state? If you’re like me, I’ve had my job down pat for quite some time. It’s comfortable like an old hat. I can do it in my sleep. I do so many things by rote memory, I’d be hard pressed to have to explain to an outsider what it is exactly that I’m doing. But, ahhh, that great dictator Time brings change for everyone. And for me, that change has come in the form of taking on a new department at the hospital. I’ve been asked to join OB land, mother/baby, labor/delivery, whatever you want to call it. Now then, I’ve avoided that department like the plague for the 25+years I’ve been a nurse. But here I am. My patients are no longer only the COPD, pneumonia, heart attack, stroke, postop variety. They now weigh under 10 pounds instead of the 300-400 pounds I’m used to. They’re at the beginning of life, not the end.

If all goes well, it’s great. Cue the pink bows and blue hats. The big smiles and proud parents. If not? Well, it looks a little different. I work in a small rural hospital, so we have no NICU to call on. It’s just us. If babies are bad enough for NICU, we have to neo-flight them over an hour away to OKC.

For that matter, we don’t have an ICU either, so we often fill in as ICU nurses (unofficially) until the patient gets better, or takes that same ticket out of here to an OKC hospital.

That saying about trying to teach an old dog new tricks? It does have a ring of truth to it. We who have honed our skill set for years, who have gotten too comfy in the job we are in, sometimes have a hard time with change. Gotta fire up those brain cells and make some new brain pathways to incorporate all that new knowledge. Gotta get off the couch of life and jump right in there with both feet forward. See the world thru different lenses.

Well, here I am, and I AM learning new things. For instance, did you know that if you work on a bad baby while standing under the warmer for upwards of eternity, you can practically get a sunburn without even going outside? 😂😂. At the very least, what feels like heatstroke. And the babies born today are just as slippery, tiny, and fragile as they were when I had my babies 15-20 years ago. Then again, they’re just as cute, so that counts for something.

So, here’s to new beginnings. Whatever new venture you might be facing, I hope it’s going well for you. I hope you’re out there killing it every day, turning your world upside down and enjoying every minute of it. Because ultimately, it IS satisfying to change things up a bit, to knock those brain cells around and see what shakes out.

Good luck, my friends! And may your new experiences include great things that don’t involve the eternal sun of a baby warmer. 😊

Housekeeping Blues

 

Now I’ll be the first to wholeheartedly agree that without good housekeeping staff, no institution functions properly. They are the backbone of any hospital, Medical Center, nursing home, etc. That being said, they can sometimes offer up humor without trying, just like any of the rest of us.

This past week in the ER, we had an interesting experience. I had a elderly patient that had an unfortunate experience in the bathroom. An enema gone wrong, and diarrhea that somehow ended up covering the walls and also the floor near the toilet.

We called housekeeping and let them know the bathroom would need a thorough cleaning. After the patient left, housekeeping came to clean and we warned them how bad it was and that they would want shoe covers and gowns.

They dressed up like they were going into major surgery. They were covered head to toe in blue throwaway gowns, caps, shoe covers, eye protection… it was like aliens were invading that bathroom. Or so we thought. We saw them from the doorway cleaning the whole room– floors, walls top to bottom, mirrors, equipment–they even took the clock down and cleaned behind it! We were so impressed they were going the extra mile –although we didn’t quite understand their reasoning, we weren’t complaining. They finished and left, and soon another nurse went to put a patient in that room. She took the patient to the bathroom in that room and handed them a specimen cup for a urine sample. Soon the nurse and patient came hustling out of the door and headed for another room. When we asked what was wrong, the nurse said “There’s diarrhea all over that bathroom!”

Completely puzzled, we called housekeeping to come back. What were they possibly thinking, meticulously cleaning the room itself and not the bathroom where the actual mess was?

It wasn’t long before we found out. And when we did, we were rolling on the floor laughing. Tears were coming down our faces– I haven’t laughed that hard in a long time!

(And remember, friends, you can’t make this stuff up. Absolutely priceless.)

When we asked the two ladies who had cleaned so diligently before and yet missed the mess altogether, here is what their response was. ” We thought the mess was in the patient room itself, not the bathroom, and since we didn’t see any mess in the room, we thought it was that kind of diarrhea that is the clear diarrhea!” Huh? Clear diarrhea?? “Yeah, you know, the clear kind!”

Omg, smh, lol. 😜😂🤔🤣

                           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

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

“I’m 91..I’m too young to die.”

She’s 91 years young, she drives a Mustang convertible with an epic sound system, she cooks, cleans, goes to the beauty parlour every week, and keeps her nails a beautiful deep red.  She’s hell on wheels, this patient of mine.   This morning her husband wakes up at 4am and finds her “different”.  He waits until 7:45am to bring her to the ER.  Too much time has passed for any life-saving clot buster agents to reverse the massive ischemic stroke she has suffered. So, we hang an IV drip for her sky-high blood pressure and give palliative care otherwise.  Family members sit at her bedside, willing her to come back from the brink of death, to start moving all her limbs, to open her eyes and talk to them, to take a sip of water to relieve her dry mouth.  Instead, she thrashes restlessly in bed, not responding to any questions, never opening her eyes, occasionally mumbling “help me”.  She has lost the use of the right side of her body, although she does not appear aware of this.  We tell the family as kindly as possible to expect the worst, but that only God knows what lies ahead for her.

Life has a way of kicking you in the seat of your pants.  Strokes are one of the final ways it does so for the elderly.  It’s particularly unkind–robbing you of quality of life, and then of life itself.  As for my little powerhouse of a patient, her days of driving her Mustang convertible are over. Her red nail polish is already removed so we can get accurate oxygen readings.  She has cooked her last meal for her sweet husband, and the cleaning will be done by someone else hereafter.  She now resides in that realm somewhere between this world and the next while her family looks on with sorrow.

Remember this when you consider whether you have time to visit a loved one this weekend.  Go to them, enjoy time with them, hug them and tell them you love them.  Teach your children to do the same, so someday they will come visit you.  Life is fleeting, live it well.

 Nurse Ames RN

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