Where will I go now?

27 Jan

That was me after experiencing a real GI bleed for the first time.

 

I will never forget the first patient I cared for with an acute GI bleed. It was insane and bloody smelly. The patient came to telemetry after having blood in the stool and feeling weak and chest pain. The hemoglobin on admission was around 10 [not so bad right?]. The patient gets to the tele floor and tells me he has to poop. He looks pastey white and I give him the bedpan. I stay in the room and the smell really surprised me: I had always heard that GI bleeds were smelly. I turn the patient over to take him off the bedpan and find the bed pan full of frank red blood [and I did not see any hemmroids]. No urine in that bed pan, the patient had a catheter. The bed pan was literally filled. I called the GI MD and revealed this information and naturally the MD requested the patient to be transfered to ICU: there were 2 units ready in the blood bank [thanks to the ER type and screen]. The patient did not need to be packed up because the patient just arrived, we are leaving to roll the big bed to ICU and the patient tells me: I have to poop again. We are half out the door and I roll him back a few feet, shut the door, put him on the bed pan: he fills it with blood again. I sent the tech to the blood bank with the request slip and ask her to meet us in ICU and we go. This has nothing to do with this post, but the artwork above reminded me of that first GI bleeder. While late entry charting I could not resist checking the hemoglobin that was drawn 8 hours after the first hemogram done in the ER: it was 6. <gasps> the patient was not actively bleeding in the ER.

The place I work has bad reputation, some of which might be  blamed on the nurses bitchy attitudes, but not entirely, there are some great nurses there. A lot of it has to do with the atmosphere, there is no space, it is loud and it is messy. Mostly I have felt that it has to do with the lack of leadership and control. There is no control. We are the red-headed step children of the hospital.

Is that why I stay there? Inherently drawn to chaos and instability by nature?

Why do I stay there? I like the fast turn over of spinning tele packs. I like skating on IV poles down the halls. There are some really cool nurses there to off-set those who are less-than-cool.  I like learning about all kinds of arrhythmias and the electrical conduction system of the heart and the effects of medications on that system. I am still missing retired Fave Cardio and still see him standing at our watch station saying to me: Holy long QT interval  bat girl, no wonder her family history includes early deaths. Just as I will never forget the first time I pushed Lasix 80mg on the heart failure patient filled with rales, I nearly peed my own pants looking at that big vial.  I get a huge thrill watching the heart rhythm in atrial fibrillation, pausing, pausing, then converting to sinus rhythm. [the artist in me feels that hearts struggle]  Nothing tops the code in ventricular fibrillation run by Zorro MD, blasting the patient with 360 joules over and over again: the patient lived with enough strength to try to pull out the ETT while en route to ICU after being stabilized on the floor. Everything I ever hated about Amiodarone was suddenly made up for on that day. [I still do not like Amio, but I now appreciate its usefulness much more]

I now have three years running on telemetry. I do get tired. The shift, the house census, the acuity, the assignment/floor all contributes to the stress level. There are many stable shifts, followed by: wow, some of these patients would probably be better off in ICU if there were beds available.  I mean it  is difficult to assess these patients every four hours or more often actually to do it right [and check the outcomes]  when there could potentially be six patients to care for. Even if only two are really sick requiring all of your attention, the other four still need you; and the ruled out MI is patiently waiting for the discharge instructions. [lifestyle changes +cake walk= i love my job] 

Tele nursing has been a  huge lesson in: prioritizing. Those questions from nursing school of: which patient will you go to first?  Is reality especially when the night nurse gives you  a patient having a systolic pressure <70 and you are thinking the MAP is greatly <65 [also thinking of hypo perfusion to the vital organs, did the patient even make urine?] and that nurse is acting clueless and you know where you will be for the first half of the shift.  It has been a chaotic dance where just when you think the routine is on task: you stop everything you are doing for the chest pain in room four. Or you go into the room where the DNR is dying with no family member in sight and hold her hand, watch the irregular resps, agonal, wonder about her life and why there is no family around, and throw another blanket on top instead of watching the monitor brady-ing down.

I plan on attempting to transfer to ICU nursing when a place becomes available. I like to assess patients, that is why I want to go there. I am obsessed with hemodynamics: If I had time I would be in my patients room measuring the JVP with a centimeter ruler.  Here is the thing though: I secretly harbor social angst inside. Fear of rejection: what if they will not have me?  I still feel like a new nurse after 3 years, although I do not deny the skills, knowledge and experienced gained quickly on telemetry. I almost rolled on the floor laughing last week when a so called experienced nurse, even with ICU experience was telling a new nurse [trying to interpret a rhythm strip] that she was looking at a burst of a fib: I almost died telling her: No what you see is a burst of  PSVT, paroxysmal atrial tachycardia to be more specific, just go ask Fave Cardio sitting over there.  Isn’t it easier to stay in an atmosphere of knows something, than to switch to knows much less. Starting over? Will they nurture me? Feed me to the wolves?  Should I take into consideration my personality? In the tele whirlwind of where I now stand, all the nurses think nothing of my high energy caffeine fueled mania. They are used to me, used to my chronic blush [idiopathic cranio-facial erythema], and my talking out loud, to myself or anyone who will listen. My co-workers love me! [most of them]. In my inner world of fragile security that means lots to me. transferring would mean no more skating on IV poles because then they would all know I am goofy!

The truth is I am a sucker for forever learning so the end result of this self debating of where do I want to go and who will have me?  I will be so afraid actually, but I will never know that I can do it [or can not do it] unless I make an attempt.

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8 Responses to “Where will I go now?”

  1. Christopher Zara January 28, 2010 at 02:50 #

    They will accept you at that ICU, or I’ll play the Velvet Underground’s Sweet Jane over the loud speakers until they do.

    They’re going to love you and your big, idiopathic blushing smile.

  2. Halie January 28, 2010 at 23:01 #

    Just discovered your blog and love it. You have a unique voice, love how you pepper in humor with the technical. Keep up the good work!

  3. my2ndheartbeat January 30, 2010 at 13:39 #

    I have had a love affair with all nurses since my heart transplant. Young, old, male, female, it doesn’t matter as I love them all. They are an incredible group of people that, in my world, really do care for the patients. And, they are also very human. I saw a “code” up close a couple weeks ago. My first since I was the one in the bed being lit up with the paddles. The professionalism, the teamwork of these people as they fought back their own emotions was awe inspiring. I have to say that ICU nurses are the cream of the crop. I have a feeling you are cream as well.

    Be well & good luck!!

    • seejanenurse February 1, 2010 at 15:30 #

      Thank you for your love! I want to be cream!

  4. Amy Sellers February 7, 2010 at 07:09 #

    I love your complete honestly – you really seem to open up in your writing. It’s hard to leave your comfort zone, especially when you love your surroundings & coworkers. But, keep the positivity and know that you will find people that you love (and people that you don’t love so much) in any area that you work.

    I work in a CVICU and I love skating around on IV poles 🙂 You’ll find your crew, just follow your passion in hemodynamics and the patients.

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