I hear God laughing!

You see...

I had plans, even was making some new ones.  But once again, I was humbled.

You would think I would know better by now!

Someone asked me...

'Why do you do what you do?'  The question was related to being a nurse, specifically an Emergency Nurse.  It was in regards to a patient that was totally dependent for all care, that I asked the 'questioner' for assistance in providing some ADL's.  It was a messy situation... even the family stepped out of the room!  This person is  considering furthering their education and becoming a nurse...

Think about that question for a minute... "Why do you do what you do?"

Of course every one of us, has an immediate answer; however, there is a deeper reason that most don't think about often and find it difficult to articulate.

I could have done anything I wanted!  Got the education, the degrees, been/done anything!  But I followed a path... and here I am.  It has been the right direction for me, but I may be a little off center, so to speak...  time will tell!

What was your path?

I am comfortable where I am.  What I have done, what I have learned, what I do...  but I find a longing for something more.  Perhaps I will continue my 'formal' education and get the appropriate degree and letters to put after my name.  It won't change what I do much... only that I can 'officially' do what I already do, autonomously...

Then again, I somehow think I am where I need to be... the opportunity to teach and mentor others has been exhilarating!  The sharing of knowledge, experiences, teaching... being a part of another person's professional growth...

So I will ask the question to you...


Why do you do what you do?

The company you keep...

Had a great shift!

Got to meet/see some repeat customers last night!  Had a great crew on, back and forth... the support and help was constantly flowing!  Even had a co-worker profess "their love for me!"  Not really... I just helped them get things done and caught up.  On my part, a triage/check-in, an IV start, blood draw, settling in, initial interventions...  They helped me a few hours earlier do the same.  I had the time and opportunity to pitch in to help them, just as they had done the same for me when I had a critical patient!

This shift was easy for me, as it was my "Friday."  Meaning, last day of work on this rotation... I now have 5 days off!  Woo Hoo!  Nothing would have made it any harder!  My 'theme' of the night was "Bring it on!"

I got off easy... most of my patient's last night were either very ill and straight forward, or not so ill and very easy dispositions. Some of my co-workers however, deserve some "hazard pay!"  But such is life in the ED!  My turn will come around in a few weeks... this I am sure of!

My most momentous accomplishment?  Well there were two...

My first was when I got a patient that presented with an early sepsis... fever, hypotension, decreased LOC... got the 3 "L's" in less than 10 minutes of arrival  (Line, Labs, and specifically... Lactate level)... ABX in less than 30 minutes for a 'raging' Urosepsis... admitted within 2 hours!  More nursing interventions done in the first 30 minutes than physician intervention...

The second... not so glamorous, but the most appreciated by my peers!

A frequent patient....  who was discharged, and was not leaving the ED quickly... kept stopping to talk to other patients, staff members, etc.  This patient ended up directly behind me, and I heard the conversation, directions, and interaction.  So I stood up, turned around...  This patient realized my presence and said, "I'm going...chill 'Bro!'..."  But they did not move... I discreetly took hold of a loop on this patient's "luggage," and truly, gently, directed them towards the exit.  They walked, followed the "guidance" towards the exit, then our Hospital Security took over and made sure they safely exited the building.

I have now been 'voted,' at least for this shift... "most needed to be in the area to deal with 'difficult discharges!'

And through it all... I still love my job!

I am an Emergency Nurse!  I love you to death, but my ultimate goal is to get rid of you!  Discharge or admission... I want you out of here!!!  There are a bunch of sick people here in the ED... you don't need or want to be here longer than you have to!

I have been truly blessed with the ultimate team of co-workers!  We have our shifts... we have our difficulties...

But it truly is amazing how teamwork makes it all work!  I'll keep these friends!  I'll keep this company!


Peace!

Business is business...

You wanna work here?  You gotta pay!  We expect at least 33% of what you earn... if you don't pay... well, we'll come after you!  Take your stuff, maybe even make you go away...

You wanna buy that?  You gotta pay!  We expect about 10% off the top!

This is all for your protection!

You wanna sell that?  You gotta pay!  We expect about 10% off the top of that too, maybe even more if you sell it for a lot!

Hey... Business is business...

I think a RICO Investigation should be launched at once!!!

Unbelievable! Unsustainable!

As a Nurse, if I start an IV and give someone a fluid bolus, like a liter of 0.9% NS... I must now document the "end time" of the fluid bolus!

On the surface, this seems like nothing! But if the IV catheter I used to start said IV, happened to be an 18, 16, perhaps a 14 gauge... the fluid bolus might be completed in 20, 10, maybe 5 minutes.

Why is this important?

Well... it seems that my employer won't be payed for care provided by there employees, like IVF boluses now... unless it takes 31 minutes or greater to complete! So I must either slow my IV drip rate to make a bolus run longer, therefore no longer being a "bolus"... or I have to falsify my documentation, saying it took longer than it did! So I am being encouraged to lie!

Likewise...

An IVF bolus can't take longer than an hour to go in, unless I document a reason! Positional IV, small IV catheter, stopped for a procedure, etc...

And...

If I document an IV initiated, but don't document an end time of the IV, even if it is a Saline Lock...the procedure is not billable!?!?  I started it, the procedure was done, what's the problem?!?!

Please tell me! Who are making these "rules?"

I can tell you that whoever they are, they have absolutely no concept of medicine, nor of the reality of how medicine works!

And did I tell you, these are Medicare Rules?

Guess I should just shut up and let the government continue its take over...

Got It!

Figured it out!

Gonna take a day then press!!!

Five and five...

Five days off... nothing accomplished?  Getting turned around for a five day stretch!

Wonder what I will be presented with/do/come in contact with/have to experience?

Wonder what I impacted these last five days...

Mild... Medium... Hot... and....

Habenero?

I just took a spoonful of a "mild" salsa... said so on the green label!!!!


And someone literally ran away!  This person doesn't do salsa (too spicy)... and Habenero (OMG!)... would probably cause them to drop dead!

I laughed, as I shook that bottle of habenero sauce out on my quesadilla!  Put a single drop on my finger and tasted it... they ran 10 feet to the couch!  A single drop on a plate... luckily, my nephew has just the same palate as I do, and tasted it...  I never saw Jared again...

I think I need to find a "Ghost Chili" or "Scorpion Chili" sauce...  that might be interesting!

Two hours...

When the patient arrived at 9:10pm, the EMS report was basically an altered level of consciousness, fast heart rate, possible dehydration (as the home had no A/C)...

When moving the patient from the ambulance stretcher to the ED bed, it was recognized that the patient was actually having a seizure...

The IV fluids were opened wide, Ativan was administered, monitors applied, and a quick assessment... the patient's core temp was 103+  Immediate ice packs to the axilla and groin, cool IV fluids, tylenol...  second IV and bloodwork (labs) drawn.

Still seizing, more Ativan...

Still seizing, time to get the ED physician.

The patient was given more Ativan.  The decision made to do a RSI intubation.  NG tube and a temperature probe foley placed.

Seizure stopped, core temperature starting to come down.  A Lumbar Puncture, Propofol drip started, more cool IV fluids, an Arterial line initiated to monitor B/P in realtime...

More labs are drawn, off to CT Scan, and IV antibiotics are started.

Report called, and patient transported from CT directly to the ICU at 11:15pm.

Two hours from arrival in the ED to the ICU... not bad.

But the weird thing is that the patient arrived two hours after the start of my shift, had two hours of Intensive Care provided by me, and two hours after they got to the ICU, I got to "flex down" and leave early!

I had contact/cared for only five patients in my short six hour shift.  My two other patients during this resuscitation, received the benefit of one of the greatest Emergency Teams I have had the privilege of working with!  Not only was I given the support for my "critical" patient, but the two other patients in my assignment at the time were being monitored and taken care of!

At the time I left, we still didn't know if the patient was septic and seized due to their temperature, or was it a heat injury, or was it a fever due to prolonged seizure.  But a temperature from 103+ down to 99-ish, pulse from 160 down to 99, B/P from 180/100 down to 100/70...  let's just say these are very positive trends.

All this on my last shift of a 5-day in a row marathon...

Right place, at the right time.


Peace!

Divine Providence?

So last night, I cared for an elderly patient that was involved in a single vehicle accident.  Seems my patient drove their car off the road into a ditch...  severe damage, airbags deployed.  In addition, the car started on fire and was a total loss.  So already two instances/situations that this patient could have died...  the third was the extreme Phoenix heat, ~109 F yesterday afternoon!

But this patient was able to self extricate, avoid the fire, and was injury free!

But what saved this patient was the fire.  You see, the accident was in a relatively remote location, not well traveled.  This patient could have been sitting out in the desert heat for quite a long time before someone would have happened along to find them... but a big black smoke plume got someone's attention and they called 911 to report the fire.

Ends up, this patient suffered from Alzheimer's Disease, somehow got a hold of the car keys, drove from the East Valley, way out to the West Valley.  Survived the crash.  But in the ~109 F heat, decided they needed to light a candle they had in the car, "in order to stay warm."  The candle tipped, ignited other things, whoosh... the entire car is on fire!

So, it was a debilitating disease that caused a chain of events, that very well might have caused the death of this person in one of three ways.  But it was one of the things this person did, that ultimately saved their life!

For the smoke from the fire caused an emergency response.  No fire, no response.  The patient would have been out in the heat of the desert, stranded for days!  But the fire they caused by the lack of cognitive ability... ultimately saved their life.

Divine Providence!

Pride!

This morning... I went outside to watch the early dawn!  From black sky with stars, to early sunrise... when the stars disappear and the sky begins to turn a blackish blue, into a reddish blue, to whitish blue...  those that have seen it will understand!

While I sat on the porch, I looked across the street and noticed that my neighbor was displaying an American Flag.  Not only was it billowing in the early morning breeze... it was also well lit!  I had seen this Flag several times, but normally during the day.  This morning I realized that my neighbor was following etiquette!  And that made me proud!

For it was displayed overnight... and it was well lit!  The field of blue was somewhat obscured... but the red & white stripes were well displayed!  I walked to the sidewalk and saluted it!

I must be one of those middle generations...  not a Baby Boomer... Gen X or maybe Gen Y...  I do dislike labels!!!

For I knew my maternal grandparents, and they experienced the Great Depression and the World Wars...  I heard the stories, I heard the tales.  I was even honored by my own Grandfather, who told me his own experiences during WWII... something he withheld from his own children, even my mother...  I was the only grandchild to hear it, his story, his history.  And he entrusted me to tell his story, to those that needed to hear it, when it was necessary, when it needed to be told...

A great Honor, but also a great responsibility.

So a lesson learned.

My dad, who is a Baby Boomer started it, but I adopted it and still continue it to this day...

When I identify an individual as a Veteran... I thank them... I literally hold out and offer my hand... and when they take it, I say, "Thank you for your service."

I have been thanked for my service too...

And when that USMC Sergeant came to attention, saluted me, and thanked me for my service... my heart dropped!  Because I didn't deserve it!

I didn't deserve such an honor from someone that risked there life to ensure my freedom... or even someone that represented those that do...

God Bless America!


Peace!

Applying vs. trying...

It's a strange concept for some... but there is a difference between applying yourself and trying to do something.

I tried to explain to someone the difference... the best I could do was hold one hand out to the right emphasizing applying, my other hand to the left emphasizing trying...

I applied psychology, sociology, even adult influence to affect the situation.  But I truly tried to explain the reality of the situation and felt I got a little farther...

I guess that means honesty and reality checks go a bit farther than conceptual ideas, at least in this one limited experience.  I wonder if it can be applied to other situations?  It would need a lot more research, a bit of funding, and a bit of asking questions of previous generations.

All I will promise you... is that I will try to do my best for you!  Regardless of the situation!  And I might even apply some education and experience too!


Peace!