Category Archives: Why?

Of Grief and Power Tools

Today marks a month since my husband’s been gone. So, I decided to engage in a little retail therapy to make myself feel better – one trip to Costco later, I have tamed an annoying cupboard with these sliding racks.

Aaaaaaaagh!  Run Away!
Aaaaaaaagh! Run Away!

To achieve this, I had to
1. Get over my fear of using a power drill.
2. Figure out whereinhell DH hid all the dang drill bits (finally found them after searching four toolboxes in, you guessed it, the fourth one) *and*
3. Actually install the things!

I’m pretty happy with the results and I think he would have been, too. So, Honey, here’s to the 25 great years we had, and thanks for leaving me all your gear. I finally understand the fascination with power tools!

Much better!
Much better!

 

Julia Child’s Boeuf Bourguignon

Julia Child’s Boeuf Bourguignon

One of the things that sucks the most about being a new widow is the loss of my favorite dining companion.  My love was my best cheerleader/supporter regarding my efforts in the kitchen (well, except for that fruited pork spaetzle disaster about 24 years ago. . .) and I often was the happy recipient of a new cookbook with a sappily romantic message inscribed inside the cover.

To combat my grief and loneliness, I’ve been accepting a few invitations to dine with friends, and having a few people over here and there.  The food of grieving should be, in my opinion, extra special, because by dining together, we celebrate human connections, and a shared love of good, home-cooked food.

Last night I whipped up the following rich stew. . .I suppose one could make it in a slow cooker for convenience, but I just don’t think it would be the same.  I like to bake this one in my vintage Descoware enameled cast-iron dutch oven.  This savory dish serves 5 easily.  It can be plated over brown or white rice, or eaten alone in a bowl.  While I don’t recommend a sprightly discussion of septic shock while eating it, unless you already work in health care or are a nursing student, I think a good time was had by all, and having company for dinner eased my loneliness, at least temporarily.

So, without further ado – here is the recipe for JC’s Boeuf Bourguignon.  Yummy, yummy, yummy. . .thank you to food blogger Tara Noland for this savory treat!

Full Code

So, my heart, my love, my life-long mate, my best beloved in the wide, wide world (he so loved Kipling) died today.  Right in the living room.  No rescue breaths or compressions were going to bring him back.  He lived long enough to smile brightly at son-of-disorderlyCNA, who had come home to visit from college for the weekend, to flick him some crap like usual, and then he had the big one. The widow-maker.

This was not unexpected.  He’d bravely fought cancer for over seven years. . .was the king of the infusion floor, the oncologist’s most interesting patient, the guy who’d outlived every one of his diagnostic cohort.  But he’d been short of breath this week.  After chemo on Thursday, he had a chest x-ray. . .an ugly, ugly thing.  I’ve seen some nasty images of lungs, peeking over the shoulders of the intensivists and nurses during my CNA days in the ICU.  But this one took the cake.  Imagine the thick, evil webs of funnel spiders, and that’s what my husband’s lungs looked like, all the way up to the middles.  The oncologist returned my call the next day, in response to my question whether it was partly pneumonia?  Nope, he said, it’s the cancer.  And I felt all the fight drain out of me, right then.  I didn’t say anything to my husband.  I think he knew, anyway.

I almost lost, him, I thought, last night.  He was sitting in his recliner, and the way his mouth hung open, his pallor, and the protruding tongue didn’t look right.  He was unresponsive to a sternal rub, to peripheral pain, to me shouting and shaking him by the shoulders.  And then, he came back. . .like he still had something to accomplish.  Looked at me like I was a total jackass and said “why are you shouting at me?  Are you PMS-ing?”  Coolest, toughest sonuvabitch I’ve ever met.  Should we take you to the hospital, I asked.  No, he said, I’m fine.  Please get me some ice cream.  So I did. . .he really, really loved ice cream.

So today, he had cream of wheat and raspberry preserves.  Watched TV.  Had coffee.  Laughed at the antics of our cat and dog chasing each other up and down the hall.  It was really sunny outside. . .a beautiful day.  At 1430, I told him our son was about 20 minutes away.  He flipped channels on the TV.  I was bathing our ridiculous little dog in the sink when the boy came in with a breezy “hello!” He and Papa began to talk.  Life was good.  I was out of the room when the boy shouted, “Mom, there’s something wrong with Dad!”  1525.

I would say a full-on grand mal siezure and hypoxia certainly qualified as bad.  The boy dialed 9-1-1.  I felt for a carotid pulse. . .there it was, I thought.  I gave two rescue breaths – they bubbled back out at me.  The boy said “we need to do compressions now.”  I started them, yelled for the boy to bring the breadboard from the kitchen.  We lifted the man, slid the board under, and I continued compressions.  I went five rounds of 30:2 and the medics arrived.  1533.

They took over compressions, and I told them – he wants everything, full code. The shirt was cut, the pads placed, the IO started in the right tibia, the epi pushed.  Backboard placed and strapped, lifted, gurney scissored up, out the door.  1538.  Ambulance leaves our house.  I look numbly at my son.  Who’s driving, I ask?  He says he will.  We leave, go to the hospital.  Walk through that front door for the zillionth time.  I go like a robot to the security window, tell them I’ve parked in the ER lot because my husband is in the ER, so please don’t email my manager that I’m in violation.  We go to the triage window.  We are ushered back to one of the trauma bays.  We go in.  Full code in progress. . .a compression line of 3 ED techs.  I know them all.  The nurses, the doc, the house super, the charge nurse.  All of us, faces stony.  Pulse check. . .asystole.  The doc talks to me, says that nothing’s coming back.  I know, I say.  He wanted everything done, has everything been done, I ask.  Yes.  All right, I say, that’s it, then.  Time of death 1611. He is gone.

I think, looking back, that he might have insisted on being a full code because he knew where it would lead – either to the ICU or the ED, and either way, there would be people there to take care of us, to hug us and help us through that first awful hour of shock, to ease us into the unending hours of grief to come.  And they did.  And I am grateful.

Is it enough?

Ren & Stimpy get Superstitious

In studying my ACLS text for my upcoming class (dreading. . .dreading. . .anything remotely approaching a skills lab setting makes me shake with apprehension), I found myself thinking of how my perspective has changed since entering the health care field.

I used to just be-bop into the store with nary a thought of what I’d do if someone collapsed in front of me.  Sure, I’d taken the occasional first-aid course, but still, I hadn’t really internalized it.  Now, I walk into a large store or building, and find myself scanning the walls to locate the AED, avoiding anyone who looks like they might not feel well (I used to only avoid the actively sneezing and coughing, but now my immune system just shrugs and says “whatever” when confronted by someone else’s germies, for the most part), and just trying to get in and out with the least chance of a medical incident possible.

For you see, my friends, at work I am becoming what is gently known as a “magnet.”  If a patient will try to become unstable, have a cardiac event, de-sat into the 80’s, whatever, it will probably occur on my watch.  Doesn’t really matter that I’m new. . .it has only taken three weeks on my own for the patients to get the memo that they can feel free to have some sort of incident while I’m caring for them.  Already, I’m greeted on my floats with “hey, good to see you, I’m sure you won’t have a Rapid Response this time!”  I have tried everything to get off this streak, including a float to Psych (where I was nowhere near anyone even remotely medically unstable). Nothing has worked. It’s only a matter of time before this tendency follows me into my off-hours.

I’m hoping that by outing this possibility on my blog, I can somehow prevent it from occurring.  This is somewhat akin to the superstition that causes nurses to pull the code cart outside the room of a patient whose condition makes them nervous.  We’ll see!

R.E.M. Daysleeper

Quit waking us up during the day!

Lyrics, so you can sing along in a grumpy, resentful, sleep-deprived fashion with the rest of us vampires who work nights:

Receiving dept. 3 a.m.
Staff cuts have socked up the overage
Directives are posted.
No callbacks complaints.
Everywhere is calm.
Hong Kong is present
Taipei awakes

All talk of circadian rhythm
I see today with a newsprint fray
My night is colored headache gray
Daysleeper

The bull and the bear are marking
Their territories
They’re leading the blind with
Their international glories
I’m the screen the blinding light
I’m the screen, I work at night.
I see today with a newsprint fray
My night is colored headache gray
Don’t wake me with so much.
Daysleeper.

I cried the other night
I can’t even say why
Fluorescent flat caffeine lights
Its furious balancing
I’m the screen, the blinding light
I’m the screen, I work at night
I see today

Don’t wake me with so much. the
Ocean machine is set to nine
I’ll squeeze into heaven and valentine
My bed is pulling me.
Gravity

Daysleeper, daysleeper.
Daysleeper, daysleeper, daysleeper

 

What to do? What to do?

Geehosiphat!  My final term – and nursing preceptorship – are flying by.  I realized it was time to update the ol’ resume, start putting in some job applications for when I’m all grown up and a real nurse, and to finish up some scholarship applications that I’ve been cheerfully ignoring.

I realize, the job market being what it is, that choosing a nursing specialty might not be my option, but that it will instead choose me.  I personally think I’d make a hell of a med-surg nurse – I actually enjoy meeting new friends all the time (but not at the turbo pace of the ER).  I realized that getting people excited about eating hospital food, getting them their meds on time, and making sure they are safe actually makes me happy.  Let me tell you about our pudding and jello options, folks!

Don’t get me wrong. . .I have loved my time in the ICU, and if I landed a critical-care job or new graduate internship I’d be wildly happy. . .but at the same time, the ICU doesn’t always afford a lot of chances to be joyful.  Every day, bottom line, you are guaranteed to be surrounded by people who are having a crappy time (at a minimum) and are possibly dying.  Yeah, yeah, I know death is part of life, blah blah blah.  Try telling that to little kids who just lost their mom or dad because they couldn’t sustain life and the grownups had to let go and turn off the pressors and the machines.  Tweakers who OD’ed trying to get out of bed and painting themselves with their own offal.  People who may never get out of bed again, period.  The sad, sad, futile sadness of some of it.  There’s just a lot, and it’s hard to describe it until one’s wallowed in a large ICU for some time.  Yeah, the machines that go ping! are pretty neat, and I know they save lives, but sometimes it’s a bit much.  (The ice cream parties for the staff, courtesy of the organ transplant coordination agency aint bad, either.)

My coworkers tease me sometimes. . .”Oh disorderlyCNA, sounds like a long-term care nurse in the making!”  So it’s not like there’s a betting pool, but some of my coworkers are starting to put down bets one where I’ll end up.  I will end up somewhere!  I’ve told them that if I’m still there as a CNA six months from now to kick me squarely in the ass!

Some think I’d be great in peds (they are insane!) or in the NICU (yeah, right. . .tiny sized critically ill patients sound so much better than adult critically ill patients!).  One of my managers thought I’d be a great psych nurse.  Really?  (Are you mad at me?  Writing me up?  Glaaahhhh. . .)

So, I guess it remains to be seen where I’ll end up.  So for the time being, I’m enjoying the learning opportunities afforded to me by my preceptorship, and acquiring the rest of the RN role.  Long way to go, though.

 

An Anthem for CNAs and Nurses Everywhere

 

Here’s a little ditty I wrote and performed, inspired by creepy patients everywhere – I call it the Patient Care Song – click here to listen.  Special nod to our friend, Clostridium difficile.  Enjoy!

 

The Patient Care Song

 

It’s impossible for you to get semi-solid stool, all the way up your back.  It must be deliberate, ‘cuz you are alert and orient(ed) – for gravity don’t work like that – no, gravity don’t work like that.

 

I find it really strange that you asked me where I live, and if I had a man.  This violates boundaries, it’s JUST PLAIN CREEPY, for our relationship don’t work like that – no, our relationship don’t work like that.

 

These folks they sometimes try our patience, yes they do, and that goes with the job. You learn to grow a thick skin, and have a sense of humor, ‘cuz we all deal with that – for we all deal with that.

 

All Rights Reserved

 

Image

 

Why Did I Choose this Path?

Group of nurses, Base Hospital #45
Group of nurses, Base Hospital #45 (Photo credit: The Library of Virginia)

Many times, I’ve had cause to question just what the heck I was thinking when I decided to work full-time nights as a hospital CNA while going to nursing school.  I stumble/limp into lecture after a shift, feebly clutching a giant latte, hoping to stay awake for most of the lecture.  I would be lost during this second year without my trusty digital recorder, although I’m currently avoiding becoming the class bee-yotch (no, I will not post all the lectures so the rest of you can leech off my effort – the nice guy who did that for y’all last term failed out, so I’m leery of following in his steps).  Yes, health insurance is a nice thing to have, but I still question my choices – especially when my grades are not on a par with those of those that don’t work (except at school, which is hard work enough).

So the other night at work, one of my nurses asked me to help her student RN (from a distinguished local BSN program) with a bed bath on a vented patient.  The experience went well, as I like to teach (although I have a hard time keeping my hands in my pockets so the person learning actually has time to learn).  The student was careful, and seemed to treat the experience seriously.

So where was the problem?  The student said that she had taken a CNA class, but that she never really wanted to do “that kind of work.”  (‘Scuse me? I mean, I didn’t know that the work many choose as a long-term career was on a par with pole dancing, or something.  No disrespect meant to the dancers out there. . .I’ve seen your tax returns, ladies, and you sure have to spend a lot on shoes.  Noamsayne?)  I bit back on my hair-trigger response, and asked the student what she meant (because I prefer not to second-guess people).  The student said “well, they are such different jobs, and the CNA job doesn’t really have that much to do with the RN role, so I didn’t want to get confused.”

Fair enough – I’ve sometimes had difficulty trying to step beyond the CNA mindset at my own clinical shifts – which is task-based, because it has to be, or you’ll drown/cry after every shift/get fired.  But it’s not impossible, as evidenced by the many RNs I work with who were CNAs first.  

I would argue that students should not be allowed into nursing school until they have worked in some clinical situation – medical assistant, EMT, ED tech, CNA, assisted living aide, whatever – because the practical experience gained is invaluable.  As a grunt, one is in a unique position to observe and learn in many situations – particularly in critical care or the ED.  I’ve been a helper/fly on the wall during codes, new admissions, transfers, road trips to CT, etc.  Each experience has taught me things I need to know as a nurse, in any situation where I find myself after graduation.

I asked one of my coworkers if lack of clinical experience and skill displayed by this BSN student, compared to the students in my community college ADN program, was typical in our geographic area.  She responded that in her experience, that was generally the case, if the student had not worked in the medical field before.  I have heard – not just from this coworker, but also from others, that BSN programs prioritize teaching the leadership aspects of nursing over skill development, telling their students “you’ll learn your skills on the job.”

I wonder to what extent this has contributed to the woes new graduate nurses experience when trying to get jobs in the current tight nursing job market?  Is nursing education shooting itself in the foot in the effort to “professionalize” nursing?  The statistics would seem to indicate that BSN program graduates are successful in being hired.  Are the educators attempting to shift clinical training back to the hospitals, where nurses used to be educated and trained, not colleges and universities?

Even though this student’s opinion of the value of CNA work caused me to have an indignant knee-jerk reaction, I am glad she shared it, because it’s helped me do some thinking about the future of nursing education in this country.

 

 

Endings. . .

Some say life is a series of beginnings, others a progression of endings.  Perhaps it’s a matter of perspective.

So, far, 2012 feels somewhat like a year of final things, like the end of my first year as a CNA, the end of the first year of nursing school, and other endings far too personal and painful to discuss here, dear readers. 

I have seen others’ end times. . .watched patients slip away (into what?), seen their families grieve for them.  Hospital work provides many opportunities, sometimes too many, to spend time with Death.  He sits in every corner, patiently waiting for brave patients, families and healthcare warriors to exhaust the possibilities so that He can have a turn. 

There are some sights and smells I will never be able to forget. . .the plastic-y scent of a new body bag, just removed from its wrapper. . .the wreck of a hospital room, post-code, the sight of a widow numbly trying to come to grips with the loss of the man she’d been with since her teens, the harried, red-eyed relatives rushing up to the front desk.  Numb-eyed nurses, feet aching, charting still to be done, absorbing the impact of their task, once the adrenaline rush has subsided.  And the patients. . .the dying woman gripping my hand, fear in her eyes.  I had just helped her walk in the corridor the day before – how could this be?  Another patient, asking me “Am I alive?” 

So, I have no answers. . .except that despite all this, I know I’m in the right spot.  As a nurse, I will become close to patients, yet without knowing them in the fullness of their lives.  I will care for their bodies, and their spirits, lacking full understanding of who they are.  And, that will be OK, because perhaps these things are the privacy that remains, even after the indignities involved in being a hospital patient.  I can be at peace with that.