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? ūüėāūüėā. 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. ūüėä

Katie Brack Day

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So… I know we all have them. ¬†If you don’t, you will sooner or later. ¬†(And consider yourself very lucky if you don’t already.) ¬†You know them, those days we all dread…those silent, looming anniversaries of some terror, some horror, perhaps the loss of a loved one. ¬†Maybe it was the day you were told you had cancer, or that your loved one was killed unexpectedly in an accident, or the day you realised you’ve lost everything you’ve ever worked for. ¬†Your spouse was unfaithful, your dog died, another war started and your loved one didn’t make it back alive. ¬†So, so many things in this life can and do go wrong. ¬†And we go through the stages of grieving, and we gradually recover, because we are a resilient people. ¬† But there’s always that day that comes around once a year, that day on the calendar, that marks for you a space in time to stop and remember. ¬†To grieve anew, to honor what was lost, to put into perspective what time and change has wrought. ¬†Everyone deals with that day on the calendar differently.

I have been radio silent the past two weeks for that reason. ¬†(Well, that, and partly because I was on a Carribean cruise soaking up some sun–I really was radio silent and unable to write during that time. )

This past week marked the 21st anniversary of when my beautiful five year-old goddaughter passed away unexpectedly in my home. ¬†A whole person’s drinking age life-time ago. ¬†I have had three great kids of my own, helped care for numerous foster kids, have taken care of oh-so-many kids in the healthcare system as a nurse, and still the ache remains. ¬†Oh, time has greatly helped heal the wound. ¬†Now the anniversary is more of a tug at an old scar vs. ripping my heart open again, like it used to years ago. ¬†The way I remember the day is different now than what it used to be–I don’t fall to pieces anymore, for one thing. ¬†I still cry a few bitter tears each year, and we still plant flowers in her “memory garden”, and my hubby makes sure I know he remembers too. ¬† I message her parents, who are divorced now and live in different states than we do. ¬†We check in on each other, make sure the other is doing okay. ¬†And I look at her scrapbook, and remember all the beautiful, wonderful things about her. ¬†All the things that made her so uniquely “her”, that made her so sweet and loveable, despite her severe level of cerebral palsy.

To this day, I have a hard time talking about the details of that day. ¬†We’ve since moved to another state, where no one knew her, or what happened. ¬†It’s easier to not talk about it at all. ¬†But I made a promise to her and her parents. ¬†That her short little life was not lived in vain, she did have a purpose, and I will always strive to keep her memory alive in whatever way I can. ¬†I tell my friends and coworkers about her. ¬†I tell my kids about her. ¬† When we go “back home” to visit every couple of years, I take them to the cemetery with me to visit her. ¬†(And then I choke up and start crying and I whisper to her I will see her in heaven someday, and I have to leave before I’m a complete wreck.)

I suspect you know what I’m talking about. ¬†Your scenario might not look the same. ¬†You might handle grief totally different than I do. ¬†But we all have those memories, those moments in time that stand out starkly in our minds. ¬†It’s one of the things that bonds us together as humanity. ¬†Just as a smile is universal, so is crying and shaking your fist at the sky.

Whether it’s been two years or ten, or way longer than that, grief and loss never totally go away. ¬†We are grateful that the sharp sting fades away, and the jagged edges smooth away like rocks worn smooth in a stream. ¬†But that takes time, and time means days and weeks and years. ¬†Which, of course, means anniversaries that roll relentlessly by.

If you still struggle with the anniversary part of the grieving process, I encourage you to start something new to carry on as a tradition for years to come. ¬†Something that lets you vent your grief in a positive way, to honor your memories, to help you get through it. ¬†And when it’s come and gone, and you can breathe a sigh of relief again, whisper a prayer of thanks that it won’t roll around again for another year. ¬†And hopefully by then, it will be easier to deal with. ¬†Trust me, I’ve been there.

Rest in Peace,  KatieBug,  I Love You

4-25-93 ¬†— ¬†6-6-98

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                            Nurse Ames, RN

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. ūüėúūüėāūü§Ēūü§£

                           Nurse Ames, RN

 

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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! ūüôā

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

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 doppelg√§nger. 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