Spare the little ones

 Recently had a CPS case (Child Protective Service) where I was brought a little one with suspected child abuse.

And the signs of abuse were so unbelievably obvious, there was no mistaking that this precious little person was abused. 

Makes me angry because while I know what it feels like to be a young mom and to be in an abusive relationship and to be basically in charge of the care of a little one and not really know how to care for a little one and having points in time where I was angry at my little one.

But never once did I take that out on my little one. Whenever I got to that point, little one would go into their crib so that I could take a breather. Even if that means that little one would be screaming their head off. 

You can't take care of a little one if you aren't taking care of yourself first..... but that doesn't mean that you forget that you're the sole person who is responsible for the care of the person who can't live without you.

I hope I don't have to take care of any more CPS cases. It just makes me so sad for the little ones and so angry at the people who swear they love this little one.

Backstabbers and two faced

 Started the new job. I think I've done about one week of orientation and I get called into the manager's office (my union rep is present as well). 

None of the complaints had to do with my ability to be a nurse. It was all two people in particular and their complaints against me, including the fact that my husband googled someone and they didn't like that!

Actually, I was told that I breached confidentiality - I was like, OH HELL NO! Then they told me that it was the confidentiality of my coworker and I scoffed. I couldn't believe that they were saying that because I found information about my coworker that that somehow meant that I broke confidentiality.

Since when is it against confidentiality to not be able to find info into your coworkers if you so choose?!

Then I was told that I "sit too much" - I told them to pull the charts from the shifts and see how many of them had my writing on it and then tell me how much I was sitting if I was doing all the triaging and work?! Plus cleaning beds afterwards. Such bullshit!

And because this is a new workplace, I'm still in the midst on learning the policies and procedures, the ins and outs and what stuff I need in order to do my job.... I get shown a tool once or twice and am expected to use it and remember to use it.... instead of asking my preceptor about things.... the tool had to do with medications and because I asked my coworker about a medication and how they mix it here, it was used against me in the meeting. That I was shown that tool and should have just used that.... that I wasn't "receptive to learning from others"..... all because I forgot about the damn tool!

Needless to say I feel very  much once bitten twice shy.

The next shift I worked after that I worked with a couple of nurses who were very different and advised me that there are certain people within the department that I should be "careful" around and avoid if possible. Hopefully I can. Otherwise, I'll be moving to travel nursing and then I'll end up being separated from family again.... something I would prefer to avoid at this time.

Big life change

 Life is about to change in a big way....

Just worked my last shift at my hospital cuz we're out of here.

Hubby finished his training and got a job in the field that he's been pining for for the last five years. As such, we are moving where his new job is.... several provinces away. 

When we told my family, my mother says "you sure you want to move allllll the way there, it's going to be cold"..... such a silly sort of thing to say considering I was raised in northern ontario! It's not like I'm not used to cold - not that I like it either, but it's not like I plan on living in the outdoors!

So now we're packing up all our stuff and purging the stuff we don't need or want, etc... Hubby keeps asking me, "you sure you don't want to keep that". Ya I'm Marie Kondo'ing  - if I don't love the thing and use it all the time then it's "out of here" as the saying goes. I'm definitely in the process of getting rid of a lot of things. 

What surprised the hell out of me is that hubby said he wants to buy things new when we get to our destination.... it's going to cost a bloody fortune but he's sticking to what he says (at least for now!). Knowing him, once the price tag keeps going up and our bank account keeps going down he'll change his mind and say I need to hold off. I suppose I should make a list and prioritize things I need immediately vs things I can wait for. 

I'm absolutely excited to going. Little tyke is staying behind for now. I'm not happy about it but I've been advised that my say doesn't really count. Little tyke wants to stay behind for now and my MIL wants to keep her with her - we'll see how long that lasts! Little tyke is now 12 and has major attitude and tends to only listen to myself and my SIL - so I can see the fights that will ensue when I leave. I told my MIL that if she keeps her, I don't want to get a phone call from her saying that little tyke isn't listening or is being a brat, etc.... and if she does, then she's responsible for getting my daughter to me in the other province. I have a bet going that she'll bring her to me by august, december at the very latest. We'll see if I'm right.

So for now it's just hubby and I going.... which isn't too bad. I like that I get time with just us, no one else around. Right now there's NINE people in our household, it's hard to get alone time with your spouse outside of your bedroom. So it'll be wonderful to have that, we haven't had it since we were married for like 6 months. I suppose with it just being us there it'll make it easier to try to have a baby - hahaha

It's exquisite

 I took care of this really sweet patient over the weeend. 

Sepsis caused him to become delerious and he kept asking for something to drink. The first shift I had with him he was NPO (nothing by mouth) and so I couldn't give him what he desperately asked for. My second shift he was allowed to have clear fluids and he kept asking for water... he was also on D10 (sugar water basically) and so I told him that if he was thirsty that we would give him some apple juice.

When I advised him that I was going to give him apple juice the conversation went like this:

him: "I don't want apple juice, why do I need that, why can't I just have water"

me: "because the apple juice has sugar in it and you need that right now"

him: "but that's exactly it, apple juice has too much sugar in it, that's why I don't like it"

me: thinking in my head - yep then you will DEFINATELY like our apple juice cuz it does NOT taste sweet! - instead I said to him - "how bout we try it out, I'll even make it really cold and add some ice"

him: "well if you're going to add ice, I'll try it"

me - make his apple juice with a ton of ice and bring it to him, give him a sip

him: "my, I don't know what you did but this is exquisite!"

hahahaha - I laughed so hard let me tell you. He was just so earnest. He would take a sip and kept commenting about how wonderful and delicious and how it was hitting "just the right spot". Oh he was so cute. He just made my heart melt.

Same patient the next night I was getting him all tucked into bed to sleep, got his pillows all fluffed and set up all around his head, tucked his blankets in all around him and under his chin and he turns to me and says: "thank you for being you, I love you, thank you for taking such great care of me".... and subsequently closed his eyes and went to sleep.

Melt my heart!

These sort of moments make me realize even more why I love being a nurse.

When Dr's kill patients

I'm so very sad to say that one of my patients died because of physician negligence, this is their story...

I had a patient return to our unit after getting several heart stents.  I got this patient 5 hours after they returned.

I worked night shift and the report I got was this:

Such and such a year old person, full code, just returned from getting several stents. Have been busy because said patient is having diarrhea. A&Ox3, no neuro issues. NSR, BP stable. Pt is SOB (which I interjected and asked if the SOB was new or not, did it improve at all post stents, is it worse with exertion, is the pt SOB with rest) - to which the person giving said report was unsure about some of the answers and so we stopped report so that they could give me these answers. Then we continued with report - I was told that the patient had diarrhea, has had it since admission, CDiff pending. I get told that pt has a foley and output for last 5 hrs was 150cc total, and that the pt got a dose of Lasix upon returning from the other hospital. I again interjected and commented that that is the bare minimum for the pt to have.... and that means that the patient didn't diurese at all, and that is something that should have been told to the physician before they went off duty. I asked if blood work was done upon returning and they said that it was, and find out that the patient's creatinine is sitting at 262 - and am told that the patient's baseline is in the 200's. The nurse basically said, oops, my bad.... and we completed report.

Now, I don't know about you folks but we are doing team nursing and so I got report on all but because there were other patients who were worse off and I had a cardiology nurse who was redeployed to be my "team nursing" person, I made this patient their focus....

Now fast forward a couple of hours and the redeployed nurse came to me to give report for their break and they proceed to tell me in passing that the patient's urine output "isn't too great".... which I made them give me a definitive u/o per hour - and when I'm told 10-15cc/hr I asked for how long that's been the case and I was told basically since we started shift. I was miffed to say the least and told them that they needed to now call the on-call MRP and advise them of everything.

While waiting for the MRP to call back, we looked up the blood work from before going to the other hospital and getting the stents done, and compare it to what it is upon returning..... to find out that creatinine rose from 97 to 262 and GFR (how well the kidneys are filtering) went from 40 to 15.... so ya not good!

When the MRP called back, the other nurse told em everything and the Doc asked, well how is the BP and oxygen requirements - MRP is advised that BP is stable and O2 requirements haven't changed and so is told that "it's a days issue" and completes the call. I told the other nurse to document the crap out of that (they were shocked I told them to do this, but advised them that that way if anything bad happens because of their decision, that it's on their license and not ours!) and they go and document said call. I then take over care of the patient and when I went to go tip the urometer to see the hourly u/o I find out that the patient doesn't even have a urometer.... so how in the hell is everyone checking the hourly output, I doubt that they are emptying the bag every time and measuring it. So I proceed to swapping it out for a urometer so that I can actually know an accurate hourly output.

I do my 0600hr blood work and the results show that creatinine is up to 403 and GFR is down to 9 - and the hourly u/o is <5cc/hr - so I call the MRP again and advise him of this. I get asked what the BP is and O2 requirements. I advise him that they haven't changed yet but asked if there was anything that they wanted done. I'm told again that it's a "days issue" and they could deal with it on the day shift. I commented that isn't there something that we should be doing now. I'm told, "well they could try a dose of Lasix" - I responded with "well we already tried that and there was no response, the patient didn't diurese when the patient got back from the other hospital" then the Doc said "well they could try some fluid" and I told him that the patient's already SOB and overloaded and her BNP was 4000+ and so more fluid when she wasn't making any urine was probably  not going to help. I got shot down and am told that this could be dealt with by the days MRP. And the call was ended.

When the next nurse came onto shift - same nurse that gave me report.... I told her all that had transpired and what she had screwed up. The nurse felt bad for not catching the errors of her way and doing something to fix it. I told the nurse that the patient needed a STAT nephro consult and if the MRP  wasn't on unit by 10am to call them and advise them what was happening.... then I go off shift after finishing report.

I come back for my second night shift and as soon as i'm on the unit the patient is being packed up to go somewhere.... come to find out that nephro had only shown up at like 1800/1900hr and had ordered a STAT kidney u/s and so off the current nurse and I go and I get report while we head out. She goes on to tell me that the MRP did not arrive before 10am and had to get a hold of her. Then the Doc goes and gives the nurse a hell of a time because she wasn't informed what was going on with the patient. I told the nurse not to fret about it because that wasn't her fault overnight because that's on the other Doc - she shouldn't be getting upset with her because the other Doc didn't call her and advise her what was going on with her patient overnight. I get told that nephro did come onto the unit and the nurse did try to get him to see the patient but wouldn't listen to the nurse and instead saw the other patient that had a pending nephro consult - even though the nurse had advised him that this other patient required it more than the one he came to see.

Regardless, I take over responsibility for this patient and am told that this patient was going to be transferred from the step down area to the main ICU area... but that we needed to do a bed swap first. The nurse tells me that nephro indicated that after the u/s results came back that he wanted to be advised of the results and had left his number on the chart. So about 45min goes by and in this time the RT comes by to see one of the other patient and I comment to her that my patient's work of breathing had significantly worsened since the previous shift and I wondered whether they would benefit from some optiflow.... because they were stable on the amount of oxygen they were on but I thought would benefit from extra flow because the patient indicated that they felt like they couldn't take a deep breath. So the RT went over and talked a min with my pt and said that she thought that a ABG would be a better bet to see where they stood and sort of go from there. So the RT did that and I waited fro that result to come back.

About the same time I get the results of the u/s and the ABG and proceed to call the nephrologist. I get his voicemail and I proceed to leave one, with my direct extension. Then I wait another 30 min and don't hear anything so I call the daytime Doc who is ultimately responsible for this patient but that isn't on but does have a history of wanting to know what's going on with her patients.... so I go ahead and call her and advise her that I've called the nephrologist, left a voicemail and haven't heard back from him. I told her the results of the ABG and the u/s and she tells me that nephro is aware of the results and will be calling in orders. BTW, the ABG showed that the patient was in metabolic acidosis with a pH of 7.26 and a bicarb that I think was sitting at 5, and lactate was sitting at 7 if I remember correctly. So pt totally needs some dialysis.

Another hour goes by and I don't hear from any Docs but I get the other patient up in that time and then the nurse who's taking this patient shows up to bring her to the main ICU and I proceed to give her report, telling her evyerhing that has gone down. She then tells me that nephro called orders to our charge nurse. Which miffed me for sure. It'd the equivalent to me calling the chief of physicians to get orders. Ya I was pissed but whatever. 

Then the pt gets handed off, I wish them good luck and tell them that a few rounds of dialysis and they'll be back in business. I truely thought that at the time. 

I finish my shift and when I get to the main ICU and ask how the pt is doing, I find out that the patient crumped at like 5am and required intubation.... that their ABG showed pH at 6.97 and bicarb sitting at 2 I think.... so not good. And that the patient did NOT get a dialysis line put in after they were transferred and didn't get dialysis like they should have.

And by then it was too late.... two days later and the patient died. For no reason. If these Docs had just done their jobs.

I can't quite fathom why nephro went home after ordering that kidney u/s and not putting in a dialysis line. Having the u/s done wouldn't have changed the need for dialysis. I just don't understand it all. I don't understand how the night shift Doc put it off on the dayshift Doc, how nephro wouldn't see the sickest patient and doesn't come see the patient til the end of the day and then chooses NOT to line the patient before they leave.... or don't return when they hear that the patient is doing so bad.

This patient didn't have to die. It's so sad and really angers me. It's such a senseless death. And THIS is what gives nurses emotional burnout!

ETOH is out of control

 It seems that COVID has hit ppl hard right now. So many of our patients are in due to ETOH abuse/detox issues. 

I wonder what happens in one's life for a person to give up sobriety and hit it so hard that you cause yourself to have a seizure from hyponatremia?!

Any of you know about hyponatremia and why it can be so dangerous? When you have someone's Na level so low that they have a seizure or fall into a coma, you really want to make sure that it increases slowly. If it increases too quickly, you can get demyelination, brain edema or brain herniation.

Unfortunately, my patient had other thoughts in mind. 

We were doing serial q4hr electrolyte checks to make sure we were aware of where the sodium levels stood. I checked the level and then my partner encouraged me to go on break. I advised her that she needed to make sure she was looking for this value and to ensure that the MD was made aware of the level.

I came back from break, our usual time frame and yet there was still no level back. We are in the midst of doing team nursing and so I had four patients to tend to - one needy patient, one trying to climb out of bed and pull lines, and then I had a legit sick patient.... plus all the usual hourly things that I was responsible for.

So of course the sodium level was overlooked, and lab didn't call me because said level normalized and they don't call anyone for "normal" values.... shitty in this case.

Long story short, the value rose much too quickly - like by 13 points in like 4 hours.... damn. And the MD comes down the hall saying "hey, why didn't you call me with this value like I told you I needed you to? They patient has been getting too much of this kind of fluid for at least 2 hours".... I advised him that I couldn't help it, when I got back from break the value wasn't returned and then I got busy with these other ICU patients.... thankfully he's an understanding MD and was like, ok, change the fluid.... which I did promptly.

Doing q1hrly neuro checks denoted no changes in said patient's neuro status thankfully. Even 24 hours later, no obvious damage was noted. It didn't seem to matter what fluid we put this patient on, because the sodium value still rose of its own accord.

I'm sure that in a couple of days the patient be back in their own abode, going back to the alcohol that put them in the ICU in the first place. Such a shame.

Long term effects from COVID 19

 Being on the front lines and seeing this terrible illness ravage people is not easy. I regularly get frustrated that the population at large just don't seem to grasp the fact that COVID is not just life threatening but even when you have a "mild case" of it, that it can affect you for the rest of your life.

I've recently cared for someone who caught COVID and is now extubated and "recovering".... but is left with permanent cognitive issues because he was starving for air for too long and it starved his brain of the oxygen it requires, leaving him with an anoxic brain injury. Never will he work again because he can hardly talk, can barely move, and the brain injury makes it difficult for him to even respond. It will take him years probably to walk again, with many months of physiotherapy involvement to gain strength. He will need speech-language pathology involved so that he can learn to swallow and talk again. He will need occupational therapy to help with the daily activity of living.... with being able to manipulate a cup, spoon and hair brush. Things that we absolutely take for granted.

I know of two staff members who have caught COVID from work. Both are young and healthy. Thankfully they did not need to be hospitalized but required months to get back to functioning levels. Both state that they have lingering lung issues almost a year after they caught this illness. They say that going up a set of stairs makes them gasp for breath and forget being able to work out, that's just not possible. 

There are many patients that our ICU has cared for who have caught this illness and while they weren't hospitalized because of COVID but because they are experiencing the after effects of this illness - having a stroke or a heart attack. Or experiencing renal failure because their body sent tiny clots to areas of their bodies and caused damage. We've had patients go into DKA because of COVID after the fact because it taxed their system and it couldn't cope with stupid COVID.

But I also wonder about the after effects that COVID will have on the rest of us who don't catch COVID, but still are affected by it because we're wearing these masks for such extended periods of time. I wonder how much CO2 we are rebreathing. If anyone has seen someone whose CO2 has risen, they can attest that these ppl kinda go coo koo. Anyone who is relatively healthy has a pretty good buffer system in play and so their body buffers this rising CO2 - but it has to have lasting effects on our body. I wonder about the kids who have to wear masks for 8+hrs a day when they go to school. Are we going to see issues with psychiatric conditions in 10+ years? Are us adults in 10-15years going to see more psych conditions or dementia/alzheimers? 

I wish that people would stop being so damn selfish and stay home and away from people. Stop visiting anyone, unless they are bedridden and require daily care. Otherwise, stay away. People don't understand or just don't care - or they think "that won't be me" - but with the way the numbers are going - damn right it will be - it will be you.... or someone you love. And then what?! Are you going to turn around and be "20/20 is hindsight, golly I wish I had done things differently".  How is that going to help when you no long have your parent/grandparent/spouse/brother/sister/cousin, etc.... around because you just had to go visit them. 

You and they will survive being apart for a bit. If it keeps ya all alive, it's worth it!