Postscript last post

He's doing very well. Long way to go, but on the right road.

Open Heart

For a majority of my nursing career, I have been primarily involved with cardiac patients on a step down telemetry unit.
After you have recovered enough from open heart surgery to leave the intensive care unit, you come to us, where we make you get your sore self out of bed, walk down the hall on legs that have usually had part of their circulation stripped from them, deep breathe and cough from a chest that has had its bones sawn (is that a word?)open and pulled apart, then wired back together with something that looks suspiciously like chicken wire, and generally torture you in ways that will make you SO ready to go home! We remind you in very somber tones and with serious faces what will befall you, should you NOT do exactly what we tell you. We hand you this cute little heart shaped pillow when we make you cough and move, and we tell you to give yourself a hug. Open heart is not for wimps, but most people survive it and go on to live more normal lives, quality lives, for years to come. Some become cardiac invalids, we describe many of these as people who are "enjoying their poor health". Some quite literally kill themselves by not doing their share to recover.
Recently took care of a patient who had come back in with a sternal abscess 7 months post op. Kind of unusual, we generally see them come back in much earlier with infections. Others who had seen him before they took him back in to "clean" him out said his chest looked like an alien should be jumping out of his chest at any given moment.
When these infections occur, they have to remove part or all of the sternum, and for a while, we do what is called "wet to dry" dressing changes. This involves packing the wound with sterile normal saline moistened rolled gauze. You have to have timing and a certain "touch" to do this, as the chest wall is moving with the patient's breathing, and the ribs move away from, and towards each other with each one. You want to gently pack the wound so it touches all exposed surfaces, without putting too much pressure on the heart and lungs that are now pretty much RIGHT THERE! Everyone watches the heart beating for a few seconds before they repack, just because they can. You also have to have timing, because the ribs will pinch your fingers as you pack the dressing in, and bones are hard! You evaluate the drainage while you are doing this dressing change for purulent drainage, oozing of blood into the wound, and the quality of the tissues at the wound bases.This dressing debrides the wound, removing dead tissue and nasty drainage . After the infection is under control, surgeons with go back in and crate a "flap" to protect the heart and lungs and generally stabilize the chest wall again. Not a good situation, many patients don't survive long after they have gotten a sternal infection, and they go through an awful lot before the end comes.
Changed this patient's dressing, wound looked good, tucked him into bed for the night......an hour later, one of my coworkers heard a noise in the room , walked in and found him covered in blood, and yelled for me. When I went in the room, he was sitting at the side of the bed with his hand on an IV site in his neck that might have been the source of the blood if he pulled it out, as it was in a pretty good sized vessel. But, he had a lap FULL of blood, the side of the bed was covered, and a puddle the size of a large pizza was on the floor beneath him. The dressing on his chest was swollen with a huge blood clot, and the blood was still coming. I called a CAT team call and began directing my babies, all with eyes the size of dinner plates. We held pressure, got more dressing material and got him moved to the unit in record time. Not once did they falter, not once did they fumble, looking for what we needed. Like a well oiled machine, each one did what they were told, ignoring their racing hearts and brains and attending to the task at hand.
We got him to the unit with a very cute tiny nurse straddling him and pressing on this chest that had no sternum to protect his heart and lungs from the edges of his rib bones. The surgeon was called in, the open heart team was called in, four units of blood and two platelets was ordered, and the family was called and informed that their loved one was in big trouble and was going back to surgery. For two hours this tiny nurse held pressure on his chest while everyone involved watched closely, both patient and monitors, for the changes that could happen any second from the massive blood loss.
The surgeon told me that he thought the patient had torn his right ventricle, as they had found parts of the sternum adhered to the heart when they went back in to clean the infection. He very plainly told me "He's not going to survive this". HMMMMMM. But, you have to try.
Wife is coming from a little town far enough away she won't make it there before the patient goes to surgery, but it can't be helped, if we wait for her he dies, if we don't wait for her, he probably still dies. But, we had to try. I go back into the room and ask the patient how he managed to get a bunch of good looking women in the bed with him like that, he grins and says, "I'm not sure". Still somewhat with it, but he's beginning to pick "ticks" off the tiny nurse's arm, even tho she keeps telling him they are freckles.
Nothing for me to do now, I have turned him over to the crew who will help get him to the OR. All we can do now is see what happens. I go in the hall, and the patient's daughter is running down the hall. I stop her, take her to the waiting room, and get the surgeon. He gently tells her the truth about her Dad's chances, and she goes in to see him. She holds up very well, then comes back into the hallway and sobs uncontrollably in my arms. I call the chaplain to sit with her until her Mother can get there, and call security to keep an eye out for the Mom.
Then, I go back upstairs to my floor, where my babies have been holding the fort for over an hour. And we wait.
This surgery could be over in a matter of minutes, with the terrible expected outcome, or it could be many hours, and still with a terrible outcome, OR there can be a wonderful mixture of skill and miracle.....we hope.
An hour later, we get the phone call. Patient will be out of surgery in a few minutes, he had torn a major blood vessel, NOT the ventricle, and our holding pressure on his poor, unprotected chest wall saved his life!! My babies, not faltering, not fumbling, have been a team that got this guy safely where he needed to get to live! WE DID THAT!! Not by following a bunch of orders a doctor gave us, but by knowing what to do, when, and doing it! WE did it!
I couldn't have been prouder. We couldn't have been more pumped! I have gotten over the need for the adrenaline rushes that this job provides, I leave that to the new babes who secretly wish for it, while not wanting to wish bad stuff on our patients. When we have a code, unless it's my own patient, when the room has filled with the usual 30 people, all in each other's way, I go to care for the other 20 something patients they have forgotten are still out there. I let them have the excitement. But, this was something entirely different. Something none of us will forget, and will be a story we tell for the rest of our lives. We did it.
Experience, not including myself? Still less than a year. Competency? Quantity beyond sufficient.
Next time you are in the hospital and you ask that fresh faced nurse how long he/she has been a nurse and they say "Six months", don't fret. If they are part of the right team, it will be just fine.

Wahoo!!!

How many times in your life has the anticipation of an event been more fun than the reality?
I am happy to report that the first annual girl's only weekend at Styx River met and even exceeded the anticipation!!
4 kayaks, tubes to rent, more GOOD food than we could all eat, and a tightknit group of coworkers who we now know, enjoy each others company at work AND play. We work together well, now we know we play together well. The behemoth is not such a behemoth that we can all be in the kitchen at the same time, so we set up an outside cooking station. I tend to do that anyway, because his airconditioner struggles these days to keep him cool, and cooking inside just taxes it more. Besides, everyone knows that food cooked outside tastes better anyway. Everyone had their jobs to do, and we did them well, without a lot of direction from anybody.
One of my coworkers, "Wee One" went with me on Fri to begin the setup. We have a humongous screen room we call space mountain because that is what it resembles when up. It is 30'x30' and octogon shaped. Very easy to assemble, 2 short women can put it up. Great for feeding a bunch of people, playing games, etc.
She and I got busy the next morning and filled up water balloons, and took turns watching for our other participants. Both were successfully greeted with a barrage of water grenades, and then allowed to pull from the ammunition stockpile, and to fill their super soakers. Wonderful in the 90 degree weather.
We played Farkle the first night, stayed up until past 0100, and slept in the behemoth because as soon as we had our air mattresses up in space mountain the wind blew a couple of gusts with rain sideways. The weather report promised more, and of course, we didn't get any more for the rest of the night.
The next morning, we lost one member to Father's Day duties, and gained 3 more for a day visit, one of which had to be declared an honorary girl. Daddy (the Rooster) came out for a short visit, played some Bingo, then went back home to chores and the Basketball championship game on TV. And yes, they were all greeted with water grenades, and allowed to borrow their choice of super soakers. We armed ourselves with our stash of handguns stashed in our bathing suits. A river trip with the 4 kayaks, and two tubes ended an almost perfect afternoon, then we ate like pigs again.
Got to sleep in space mountain that night, and the Wee One had to leave that mjorning, she had to work that night. Left with just 2 of us now, we got in another river trip on the kayaks, got back and broke camp with an hour's daylight to spare, and came home tired, relaxed and planning our next weekend as soon as possible. This time, tho, we will include our S. O.'s in the fun. They have to buy their own super soakers, tho.

First annual....

Am so excited about the coming weekend.
If the weather holds, should be a blast! The event I so look forward to is the first annual Styx River Girl's weekend. First participants are 4 of us from the unit where I work, and part of the uniform of the day is a Super Soaker. There are also water balloons involved, kayaks, the game "Cranium" ( which I have yet to play, but hear it's a hoot) holey board, farkle, and whatever else suits our fancy at the moment. Will be sure to report on it, but I don't see how it can miss.

Imaginary friends

When I was a little bitty girl, I had imaginary friends, like most of us do. My first one, I don't really recall on my own but have heard many stories about her from my Mom. One was that we were driving down the road , and my Dad had either come to an abrupt stop, or had turned a corner too sharply, and whichever the action, had thrown my friend from the back seat into the floorboard, and I began to cry.
The other "friend", or rather set of "friends" was my pet "Stunks". Not sure if they were skunks or squirrels, but they could fly and I kept control of them by having each one on a string, like a handful of helium balloons. They didn't, in my memory, do anything spectacular, other than keeping me entertained, but who knows what I have since dumped from the fantastical memory file to be replaced by more mature, mundane "reality". What a shame.
I may have mentioned in earlier posts that nurses are taught in school to orient our patients to reality. I become very selective about which patients I decide need this, as reality is often not so much fun. If their delusion is calming and soothing them, why fix it if it ain't broke? Especially since I work nights, and often come across what is known as "sundowner's syndrome." Reality fades and returns with the sun's fall and rise, but if the fantasy is nonthreatening, why remind them that they are in the hospital with very little control over what is happening to them?
I have spoken to athiests who label faith as equal to having imaginary friends, and provide us poor deluded souls with somebody else to "blame it all on". HMMMMM.....I, at the very base of this equation, would much rather be wrong along with the much greater proportion of civilization, than with them.
I may still have imaginary friends. I mentioned in a comment to another post that for a timeframe of several weeks at work, I would walk up to one of the elevators at work, and before I could push the button, the door would open for me. No one would be on the elevator, and a classmate of mine who is now long departed, would pop into my head. Hadn't had any reason to think of him, or talk about him with others for maybe years, but there he was, in my head, grinning at me. This was behavior that would fit his personality to a "T". When it happened so many times that I couldn't write it off to coincidence, I started thanking him out loud.
What is intuition? Is it nothing more than enough experiences in any given situation to provide us with answers to problems without our conscious thought? One situation I will never forget happened very shortly after I began working at my current hospital. I had not been there long enough to know any of the doctors well, or they know me. I walked into a patient's room for the first time, and alarms started ringing in my head. Vitals were good, O2 levels were good, patient was alert and oriented , and without any specific complaint. SOMETHING just wasn't right. That something was screaming in my head so loudly, that I ventured to make a fool of myself with his admitting physician by calling him.
"Dr. Tom, I don't have anything specific to tell you, but my gut tells me that something is very wrong with Mr. Jones. His vitals are good, cardiac rhythm is sinus without ectopy or blocks, sats are okay, he's breathing is okay......but something is just NOT right." The sensible thing for that doctor to have said would have been " Okay so what do you want me to do about it?" at the very least, or to have gone into a tirade about bothering him with my nonsense. To my surprise, he said, "I'm just coming into to parking lot, I'll come to you first." Within less than five minutes, he was walking in the door, and we were in the process of putting this man on a backboard to begin CPR. That MD and I bonded from that day on, and that trust in judgement didn't waver for the next ten years or so, until he retired. Who was talking to the BOTH of us? Sure, he knew much more about this patient than I did at this point, but if he suspected he was THAT critically ill, the patient would have been admitted to a CCU, not my floor, from the ER, where he had previously been evaluated. The patient survived, by the way, and with a future of some quality of life in his pocket on discharge.
Guardian angels? Imaginary friends? My daughter was hit by a car when she was 12. She was hit on the right side on her bike, flipped and took the windshield out with her left shoulder, went up over the top of the car, and landed behind the car,in a road that, on any given day, in any given moment, SHOULD have had another car right behind to run her over again. She was in middle school, and her schoolmates sent 3 full bags of cards to wish her well. One I will never forget when she read it to me,"Sorry to hear about your accident, God must have been busy that day.". May be, but there was Somebody there to catch her as she landed, and there was no car to take her out behind the first. Her worst injuries were a terrible loss of flesh on her left shoulder, a few broken ribs, a concussion, and multiple areas of road rash all over her body.
Some cynical yahoo will want to give me scientific explanations for all of these phenomenon. Save them. If these are all delusions, I will keep them, thank you very much! They make much more sense to me than there having to be answers for every question! And just like the bunch of "lil chilrens" over there in the corner who are giggling and playing, and keeping my patient entertained through a long night, they are doing no harm to you, me, or anyone else.

Kooties!!!

We all have 'em. Some are more creepy crawly than others. Some are supposed to be there, some are not.
Right now, my Mom and I have the kind you are NOT supposed to have. The kind that make you cough and hack until your ribs and chest muscles hurt. Mom is in the hospital because of them. My little old grey haired lady tends to roll right on into pneumonia every time she gets these kinds of kooties, and could very easily crack a rib or two with her coughing spells. Viscious cycle.....
It amazes me how many people I talk to in the south give me the blank stare when I mention kooties. I haven't yet made it a point to pay attention to whether they are native southerners or not, I just thought certain things were universal. Like poop, booboos, and giving babies raspberries on their tummies to make them giggle. Some people only know kooties as that game where you put bug parts together until you have a complete bug. That game and Mr. Potato Head always seemed so pointless to me, what do you win? Maybe no one ever told me the right way to play them, or I just wasn't listening.
Kooties were something the opposite sex had until you began to notice that maybe they weren't so bad after all, and sometimes for awhile after, but only in public. In private, you were composing little notes that said " if you like me, check yes " and hoping like crazy you didn't find them showing the note to all their friends and laughing.
Family members and boyfriends have the same kind of kooties, that's why it's okay to drink from the same coke can. Babies kooties are harmless to everybody, so wet baby kisses are okay. Same thing with puppies.
Obviously tho, not all kooties are harmless, and whoever it was that gave these nasty ones to Mom and me , "GEE,THANKS ALOT!!!"
Please, before you go to work sick, consider the ramifications. You honestly could be killing somebody's little grey haired lady. Not mine, this time, Thank God, but no thanks to you, whoever you might be.
WASH YOUR HANDS often, cough into your sleeve or a tissue, then WASH YOUR HANDS. DON'T cough into the phone for the next person to breath in, and WASH YOUR HANDS before you push buttons. When you are done WASHING YOUR HANDS, turn the faucet off with a paper towel, and open the door handle with the paper towel as well. If you have a cold and have not been able to WASH YOUR HANDS, or notice someone who is coughing and hacking into their hands, then offering to shake your, politely decline, and cite the cold as your reason why. You teach people how to treat you. Teach other people by example. When in a public restroom, use your towel to provide the next person with a towel, and say , "so you don't dirty your hands on the faucet again." They might look at you oddly, but they will usually thank you. If they don't, screw 'em!