Jekyll and Hyde

Have you ever walked into work and the air electric and then there was something mischievous that made you feel a bit nervous? Let's just say that the day this happened, that was most certainly the case for me.

I was getting report that morning from a well-seasoned nurse. Her humdrum speech always made me sleepy and calm. Loved every minute of it.

The report was on an older individual with an uncomplicated urinary tract infection (please understand how hard it was for me to not abbreviate that). My report seemed quite simple to be frank. My entire patient load actually seemed to be that way.

I was entirely wrong.

 

The morning was fairly routine for me. Checking the telemetry monitors, watching the colorful heart rhythms dance across the screen, checking my blood pressures and blood sugars, passing meds and giving everyone insulin. (You RNs all know how that goes, the BEETUS is EVERYWHERE)!

 

How to describe what happened next, I have no clue how to begin. The only phrase that I can muster, of which is all-encompassing, is Kicking off. I believe I actually used that in more than one sentence when begging doctors for Haldol on this incredible day. (If you don't know what this lovely drug is, google it NOW so you can appreciate the resolution to this twisted tale).

 

It began with a deafening ring. My phone and the call bell system simultaneously graced me with their presence. My next thought was here we go. (Oh Jacquie, my dear, you have NO IDEA)

 

I had forgotten about the mega-moon that was shining beautifully outside the past couple of nights. (If you are not superstitious, just ask ANY healthcare worker, fireman, police man/woman, or really anyone who deals with extreme situations and "answering the call"-- they will tell you)

The first room I entered had a confused patient, who was, luckily, laughing hysterically. I walked in with a smile, bringing out the big guns (so to speak)-- kill em' with kindness! My patient turned to me, almost oblivious to my presence, but they knew I was there. I am so clueless as to how to explain this. It's like... You are being looked at, without someone actually looking at you. Almost through you.

 

My grin was met with a grin, and the patient asked me about where her coat and hat were and that it was time to go. My eyebrows shot up, "Honey, you can't leave, I actually need to take care of you because your heart is sick. The doctor called and said for you to take your medicine." I held my breath, this usually works. My patient nodded, their head floating in a place of snowflakes and rainbows (No, seriously, they actually asked why it was snowing from the ceiling). 'I think I can do that, yes, that won't be a problem.. Have you seen the snow?' My eyebrows remained reaching toward the ceiling, speechless. "I haven't seen the snow, but I have seen your pills, do you think you will take them?" 'Why yes, I guess I can do that... Have you seen my dog? I think there is a zoo. I'd rather put my coat on, but I think I will just wait. Thank you.'

 

I just grinned my grin and nodded. I then checked their mouth 987345978245987245982734509827345 times before I left the room to make sure those pills DID go DOWN. I set that bed alarm so hard the floor rumbled with the promise of ill will to anyone who removed it, and then hurried out to answer the next phone call request.

 

I walked into a dimly lit room with a very petite patient with hair all over town. I mean crazy curls and sleepy time head at its best. This individual was looking up at me with a smirk and facial expressions that changed every 0.000000827345 seconds. This little thing was a ticking time bomb and I could feel it. "Good morning to you!" I said as cheery as I could. This resulted in a massive smile from my patient who seemed to be pleased as pie that I had walked into the room. Whew!

 

Dear ones. Dear dear ones. Please. Don't be fooled.

Outward appearances can be entirely deceiving.

 

And this marks the last time that cordiality was maintained..

 

I tried my best to describe what the plan was for the day then give this patient their morning meds (entirely necessary if you must know--that blood pressure was pushing stroke probability)! After the pills had been swallowed down, I was beginning to feel comfortable. Whew, starting off on a good foot. WIN!

 

Mind you.

 

I had report that morning describing the confusion levels of this patient as well. Two patients, doors away from one another, that were living on planet Z where snow falls from the ceiling and people randomly appear (who are always up to no good).

 

There was an uncomfortably long pause and a very hard stare from my patient that made me pause for far longer than I was planning to. I actually waited for them to speak first.. Mistake numero UNO.

 

'It's okay dear, I can keep your secret.' The last word uttered with disgust and malice.

 

I turned to face my accuser, totally stunned. "What secret might that be? I don't remember sharing any secrets with you earlier. Well anything for that matter actually... We've only just met."

 

There was another uncomfortably long pause, as my patient thought about their next words. 'I.. I... I just can't talk about it right now, it's just too stressful, and awful. I will never speak of it! NEVER! You can trust me to keep your secret.' At that, they raised a finger to their lips, and shushed me softly.

 

I drew a blank. I've worked with many patients who've had hallucinations, vivid and not, delusions, and just flat out mental breakdowns-- but I've never had someone be downright determined to keep a dirty little secret of mine, that didn't actually exist, and be contingent upon keeping it hushed up and take it to the grave. It was terribly odd, and just unsettling (to be completely honest). The immature side of me really wanted to know that kind of secret that could be. (Fast forward a few hours, I found out what it was!) be prepared to have your mind blown.

 

Whatever time in the day it was, I can't remember exactly. All I know is that it was time for blood pressures-- which my unit did every four hours due to the critical nature of our patient load. Instead of a call bell (of which I was expecting) my phone rang... And then I heard screaming.

So I started running.

I found patient #2 (the one who was keeping the secret, not the one playing in snow), with a death grip on my CNA's wrists, shaking uncontrollably, horrifyingly screaming the most unsettling obscenities I've heard come from an 87 year old person's mouth. My CNA looked at me completely terrified, stunned and unable to release her wrists from the patient's hands.

**A quick aside, patients with dementia have the MOST INCREDIBLE GRIP! I have been punched, kicked, pinched, slapped, spat on, grabbed, bruised and almost bitten by numerous individuals with this debilitating disease. It's horrible because you want to protect yourself and get mad at a blow that catches you in the jaw-- but then, this person has NO CLUE what they are doing. It's a terrible and  awkward predicament.

I was at a loss of words, between the sounds of screaming, accusations, depictions of scenes I had no exposure to-- I was LOST.

I tried to talk my patient down, "please let go of my friend. They are here trying to help you, can you please release her hands, you are hurting her." Bruises were actually beginning to form on her wrists. My chest got tight as I started to panic (just a little). My patient looked at me with a slow turn of their head and a dark glare. 'You helped her didn't you? You are an accomplice! She listens to your orders doesn't she?! HOW DARE YOU! MY HUSBAND IS DEAD AND YOU ALL KILLED HIM!' With that she put her head into her hands, thus releasing my CNA.

Without a word I excused my poor friend as she was rubbing her wrists. If there was a moment where someone had their tail between their legs, she most certainly did.

I stood on that cold, hard, tile floor and stared at my demented patient (no pun intended here, just referring to their illness). They were entirely broken, in complete despair and I knew that whatever I wanted to do to help  -- I couldn't. I just couldn't.

Out of luck doesn't even touch the hem of these circumstances. The entire interlude really, entirely, plainly, just downright SUCKED.

The room fell still, the crying stopped, and my patient looked up at me as they eerily sneered. The hair on my neck stood up and my arms became riddled with goose bumps. 'You killed him!'

My jaw fell open. Here is the secret you big dummy. Mistake numero.. I've lost count.

I took a step toward my patient.

Big.

MASSIVE.

Mistake.

This sent my patient into a frenzy of which I've never seen the like before. They wanted to stand up, sit down, punch at me, kick at me, and they began screaming a piercing blood curdling scream.

I would have been increasingly worried that they were going to upset the other patients on this 32-bed unit.. But unfortunately, they ENTIRE unit was suffering from people who were being encouraged by the full moon and the far reaches of their dementia. I have never heard so much screaming on a unit at any one time. Ever.

Overstimulation you may think? You have NO IDEA.

As this individual of extremely high fall risk began to hurriedly and shakily stand, I rushed to their side to assist them back to bed.

Another big mistake.

 

I got kicked square in the shin AND they began to scream even more loudly. How that was possible, it eludes me to this day.

But, one thing did go right. The bed alarm rang, and rang loudly. An almost frenzy. It was as if God reached down and said 'Sister, I see you need a hand, let me get you 6!'

Sure enough, my charge nurse, a CNA and another nurse ran in. I am sure it was mostly the 'HELP! HELP! SHE IS GOING TO KILL ME! FOR THE LOVE OF GOD! SHE IS GOING TO MURDER ME IN COLD BLOOD!' screaming that was emanating from the door (that send everyone feeling in). Regardless of what brought my comrades in, I am forever grateful.

When my team arrived I was being kicked, punched, bitten at and taking a serious verbal beating (of which I refuse to recount for anyone, no matter how close of friends and non-judgmental you are). The words that were chosen to slander me were striking, it actually made me warm and a bit nauseated.

My wrists were in the death grip that hold true for most dementia patients that are having an episode. Thumb marks began to show up across my forearms, wrists and hands. My charge nurse held her hands out in front of her in disbelief: What is going on?!  She asked with a flabbergasted exhalation. (I can only think that she just ran from another room in the same predicament as my own).

As I opened my mouth to explain the situation, my patient quieted down to throw me to the wolves. Imaginary wolves that is.

'This b!%$@ killed my husband in cold blood. This spawn of SATAN shot him point blank in the head. I watched the blood collect under him. I watched my husband BLEED to DEATH because of this horrible woman! She works for the mafia you see. I wanted to keep her secret, oh but she wouldn't allow it. NOW SHE IS GOING TO KILL ME!'

I turned to my charge nurse, exhausted, spent and clueless as to what was the next move. How this confusing turn of events transpired in this person's brain, I will never understand (unless one day I end up in the same boat, I'm sure). But in all truth, this individual was convinced that I was the one who had instigated every ounce of horrible occurrences the World over. How I portrayed the person from her nightmares, I don't know, but I was struck speechless, saddened and a bit peeved at the four-letter words I didn't think this person could know.

Somehow (I believe I may have blocked out how I left that room)-- I ended up at the nurse's station with my hospital phone in hand and STAT dialed the physician. My doc answered in a flippant tone, protesting to bringing Haldol on board for this person's immediate crisis treatment. As I do, and often find myself doing, I didn't give the physician a choice and got the order for the medication, ASAP.

It took the ultimate distraction of three other people in the room for me to be able to give this medication IV. But, WE DID IT!!!

My patient was asleep in minutes. They slept the rest of the shift as a matter of fact. Stunning, I know.

I hoped and I prayed that the psychosis would pass and night shift would make it through unscathed.

As I walked away from the room, wiping sweat from my brow, I headed into the "room of snow." My patient was sitting up in their bed smiling. Just grinning the World's biggest grin from ear to ear. "Why hello my darling, where have you been? It's so noisy here." She said with a chuckle.

I smiled. "I'm sorry, I've been a little busy with a situation. But everything is okay now. How are you? Is there anything I can get for you?"

My patient looked at me with eyes agleam, "Oh my dear, just sit here with me and watch the snow. It's just beautiful."

...And so I did. I sat there for a few minutes and imagined what that perfect, fluffy snow would look like. How it would crunch under foot. How it would taste when caught on my tongue.

We sat there in silence, she in her world of snow, me in my World of imagination-- as the unit outside her door churned in utter chaos.

I did go back into the fray with my team.

I just needed five minutes of bliss,

snow,

and uninterrupted,

uncorrupted

happiness..

 

Even if it all was pretend.

 

 

 

Believe in Me-- A plea from the heavy-hearted nurse

From all that I have seen.

I am reaching out to you.

You are hurting, you're in pain.

  Know that I am with you.

Dear one.
Sweet soul.

Hear my plea.

I want to help take away the suffering that this World conjures.
But please.
Give me a chance.

I've chosen to help carry these burdens.
       I see you
And deep in my chest emotions spring forth, all unbeknownst to me until the cup runs over.

Please. Lower your voice. Place those angry words aside.

In that bed I see my mother, father, brother, sister, grandmother, grandfather.

Most importantly, I see you.

  I see those who've gone before you, those that were saved and those I've lost.

It's okay to cry, it's okay to be upset.

But when you tear down on my strength, on my hopes in you, I grow weary.

I don't have enough power for this and so I reach above.

  We are in this together..

But you must give me a chance.

You are family, you are friends, you are patients.

Hear my pleading cry.

I worked hard for this, I worked hard for you. I've spent years waiting to be here for you at your lowest moment. This is a choice I knowingly made.                                 I've been called to your side.

Sweet love, sweet angels.

Please see me standing here

wanting,

hurting,

desiring to do nothing more

than to help you heal.

To have a better life.

To be free.

To grow.

To give light.

To touch another soul, to lift them from a dark and unruly place.

Please see me and my intention.

      I am a messenger and a mediator in this scary place.

I reach above for strength and yet I waver when the onslaught is strong.

I am humanity.

I am the embodiment of all that is imperfect.

But I will always try.

I always will try for you.

Sweet love.

Please understand I want to be here with you. All of you.

I am all in.

I will strive.

I will fight.

I will fight through all obstacles in order that you may feel strength again.

When at first note mistrust and anger spring forth in waves from you, my dear ones, all comes crashing down on the goals that have been intricately woven for you on this journey.

Release and relinquish that control.

I am a messenger.

I am here for you. I was sent here to be with you.

I have these hands, this spirit, this heart-- it is willingly given.

All you have to do is allow it my love.

 

 

All you have to do is just listen.

Do No Harm

Do. No. Harm. We hear this phrase through school, on medical TV shows, more than likely on the news. I know that myself, and really anyone else in the medical (or really public sector/service) field know that this is the center of our universe. But, dear ones, there lies a complete and total conundrum in this statement. I am held to a higher standard, I do no harm, I practice what I preach. For lack of a better phrase, the buck stops here. I want to show you a glimpse of what it's like working in this field, yet again. But this time, I want to relay to you the dangers we face, with absolutely no pun intended. These were situations of little to no comic relief.

I've been wanting to write a piece like this for some time. After going to a Critical Care Symposium and spending a decent amount of time in talks about disaster preparedness, and the like, I realized that many things we face are NOT OKAY. This point was driven home that much further whilst visiting a friend and meeting their acquaintance who happens to be participating in a National study on violence in the workplace. Did you know that nursing actually is one of the MOST dangerous professions? My first thought was policemen, firefighters, FBI agents, you know-- the real stuff! Little did I know that statistically speaking, my profession is actually one of the most dangerous in rankings for the United States (obviously there are other jobs that may or may not have been included in this study). I digress.

When I think back on these next few stories that I am going to share, maybe you will agree. Maybe you won't. My biggest plea that I wish could ring from the rooftops, mountaintops, cliff sides, what have you-- is DO NO HARM. But please, realize that this standard does not ONLY apply to people in professions like my own. It also applies to YOU. Yes, patients sign a paper upon being admitted to the hospital, saying that they will conduct themselves in appropriate ways... I hate to break it to you. This more often than not, does not happen. I myself have been in dangerous situations where I questioned humankind and asked myself-- If I am being held to a higher standard, why aren't you?

Here we go..

Clickety-Clack

It was a pretty typical day on my medical unit, ages ago, and I was hustling and bustling my tail like you wouldn't believe. Nurse to patient ratios out of the wazoo and all I wanted to do was have a drink of water and maybe go to the bathroom, once, heaven forbid twice! Obviously, as life goes, when you get caught up and you seem to have a wee grasp on things, something has got to arrive to shake up your world. Am I right? Or am I right? My charge nurse headed up the hall to let me know something wonderful was happening-- JUST KIDDING! In fact, I was getting an admission from the emergency department,. Blah blah blah, something about foot pain, blah blah blah. As we all do (do not lie if you're a nurse!) I waiiiiiiiiiiited for the ER nurse to call ME with report. (Sideline: report is what we use in the medical field to quickly discuss a patient's status, allergies, etc. when they are being sent to a different level of care).

As sure as the sun rises, my phone rang with a deafening call. "This is Jacquie." I announced, quite nonplussed. My disinterest made the nurse on the other end of the line huff a bit. My bad. I can't help it some times, I should, but when you're drowning in 20 feet of water and you have cement blocks tied to your feet, it's a bit difficult to be thrilled with yet another cement block. Tied to your bum. Or something of that sort. Either way! "This is (so and so) and I have (so and so) patient for you, here for foot pain, uncontrolled, level of 10 on the verbal number scale. Xray and MRI are pending, is the room ready?" All other details aside, the most important question-- is the room ready? "Yes the room is ready, but you are more than free to take your time." This makes my comrade laugh, the phone hangs up, and I am aware that regardless of my busy situation, I've got more responsibility coming.

When I round into my new patient's room, I literally walk into a big stink. No, this individual was not passing awful gas, his aura was pulsing with something that made me want to throw up. I could not pinpoint what it was that he was feeling, but I knew that something was wrong and it wasn't good. He was quite cordial, extremely tall, and a tad impatient. Fair enough, he came in for active pain and he wanted more pain meds. This being a common theme in the hospital-ing world, I informed this man that the doctor was putting in orders at the moment and I was unable to pull any meds from our dispensing machine (especially narcotics).. Duh.

He was okay with this report of mine. So I let him know that I would return in few moments with personal belongings for him to make his hospital stay more comfortable. I stepped out of the room and rounded back in, in less than five minutes-- I kid you not. This very large, intimidating man was pacing the room. His foot IV was clacking across the floor, a sound I still cannot forget. The air had changed and his pacing grew insistent. His motions were larger. Louder. Each action was laced with anger. I heart began to beat faster, because that gut feeling was back. It shouted for me to get out of the room as quickly as possible.

Scary air or not, I wasn't going to leave. Something wasn't right. I knew it wasn't. But I also don't just walk out on people, no matter how difficult, conniving and angry you may be. So I stood my ground. "Is everything okay?" I asked, obviously a loaded question. 'What in the world is taking so long! I am IN PAIN, that is why I CAME HERE. WHY AREN'T YOU DOING ANYTHING ABOUT IT?' I took a very deep breath, set this man's things down that I had collected, and put my big girl panties on (so to speak). "Sir, I understand you are in pain, if there was a way I could override that medication, I would. But unfortunately, that is not in my jurisdiction. I would be happy to call the doctor to see if the pain medication would be the first thing on his to-do list." This seemed to suffice, somewhat. He sat back down and said okay.

Oddly enough, he was shaking. Breathing fast. Face was red. I knew, as per report from the ER nurse, that this man had a very large dose of pain med before coming to see me. I left the room to call the doctor, knowing that this situation was a ticking time bomb. I didn't know when it was going to explode, but it wasn't going to take long.

I don't really know what happened next, or how much time had passed since our last conversation, but loud crashes, screaming and cursing echoed down the hall. I half ran, half walked, knowing that the time bomb was officially breached and letting out puffs of steam, little by little. Oh no. No, no, no, no. When I walked into the room, my new admission was throwing things, hitting the wall, screaming and cursing. As soon as my presence was known, he turned to me, and I knew I was in trouble. Oh God. A plea, a prayer. Here we go.

'Why haven't you done anything to help me? Isn't that your job. All I want is Dilaudid. [Aside: this is one of our BIGGEST issues in healthcare right now, this pain med is tearing apart people's lives]. It's your job to fix this and you are doing nothing!' It was at this point I knew I had to make a choice, talk or run. So I talked. "First off, I understand that you want pain medication, but I cannot just give it to you that easily. The medicine you want has to be titrated. It may take away your pain, but it also has the power to kill you. I can understand the doctor taking his time to figure out what dose is safest for you, seeing as we'd rather prefer to help you than hurt you. So if you could please be patient with us as we try to remedy this, I will do whatever I can to help you in the mean time." Well friends, this wasn't enough. This man puffed up to the size of a bear. He got up and walked towards me and began to step closer and closer. Naturally, one backs up so as not to be run into. This is what I did, this was the problem. I didn't have my hospital phone in my pocket, I did not have a cell phone.

This realization hit as soon as my back hit the wall and I realized that I was stuck, literally stuck, in a corner. This man was between me, and safety. Oh God. Became my plea.

What he said next was slurred, almost incomprehensible, save numerous four letter words. His shouting and screaming must have rung out down the hall because it was then that I heard feet. Loud persistent feet running down the hall. As I was looking up into an angry face, veins pulsing and bulging out of his neck, I was wondering who was coming to help. As my patient put his hands high up in the air, all I could think was oh no, he's going to hit me. My breath caught and I braced myself. My brain didn't want to make sense of the situation, but rather brace for what was going to come. I'd never braced myself for someone to hit me before. It was not pleasant feeling as if I had no choice.

As sure as the sun rises, someone shouted NO! And came bursting through the door. If I could explain the sight to you, you wouldn't believe me. But I'll try. My very pregnant boss, all of 5 feet ran in, placed herself in between my enraged patient and me screaming DO NOT TOUCH HER!

This reality check caused my patient to take a few steps back and momentarily pause. I couldn't breathe. So my boss continued to save my tail, my face, my life. You will NOT talk to us in this manner, you will not harm our staff, you are welcome to leave right now. Do you understand what you signed downstairs, you will NOT HARM my staff!

My patient decided that we weren't worth his time, he sat down on his bed, screaming and cursing, attempting to rip out his IV threatening all sorts of things that I cannot even remember. I carefully walked over, feeling like the mouse that helped the lion, and pleasantly asked if I could take out his IV in order that he didn't hurt himself. He agreed and I hurriedly, carefully, did my job with my hands shaking. Adrenaline was pumping loudly through me, my ears hearing nothing but ringing and the sound of my own blood rushing about.

As soon as I had his blood tainted IV in my gloved hand, this man grabbed his coat and literally ran off the unit. It was then my mojo came back and I called security. "There is a man in the hospital who needs to be escorted out. He just left the medical unit and is angry. Make sure he doesn't hang around."

About a half hour later, security came up to the floor and requested to speak to me personally. They reported that they found my patient wandering around the hospital, yelling and cursing, basically standing out like a sore thumb. They had to handcuff him and escort him out. They added that he should not come back again. If he came back in today, he would be arrested. I breathed a sigh of relief, walked straight to my boss' office, and hugged her with every inch of love I could muster. She put her life and her unborn child's life in jeopardy to make sure I wasn't hurt. A woman can never forget an act of valor like that. Never.

Here's your next gem.

The Man in the Cowboy Hat

I had heard through the grapevine that there was an exceptionally difficult patient down the hall who was just wrecking havoc on the staff. Another gem requesting pain medication by screaming, shouting or cursing and expecting it as soon as possible-- that is, before it was actually safe to give another dose. Sure enough, the nurses banded together and would take turns administering his medication. His assigned RN was so burnt out from his disrespect and character that she would have a near panic attack before going in the room. I took it upon myself to administer the next dose and hopefully relieve some of her distress. We share the load. We help each other. That's just what we do.

Let me tell you friends, I did not know what I was getting myself into.

I walked into this patient's room, smiled, and offered him his medication as per his request. He briskly nodded and then flicked his head toward where his IV was-- as if to tell me this is what you are going to do, without actually saying anything. So I went about my business and set up his med. As I was prepping everything, his voice took on a different tone, discussing with his family and friends at the bedside how horrible we were, how terribly incompetent we were as a hospital, and that we were totally worthless human beings and the bane of his existence (to put it nicely). Obviously, I bit my tongue, held my breath, and let him know right before I administered his medication what I was about to do.

After he got his rush from the medicine going straight to his head, he turned to me, looked me dead in the eye and said a very awkward, even angry, thank you.

I smiled, said not a word, nodded and left the room in a hurry. I got that sick feeling in my stomach that I had felt only months before, and unfortunately knew too well. This one is going to be trouble.

Like clockwork, a commotion started down the hall. Now, I knew that this person had some background that made them emotionally labile, but I wasn't expecting the next few moments. I saw this patient walking (with a vengeance) down the hall. When he got to the nurses' desk he slammed his fist down with a resonating BANG! I looked up calmly as my heart began to race, feeling blessed that people cannot see this internal mechanism.

Calmly, slowly, I addressed him, as if I were talking to a child about the throw a temper tantrum of epic proportions. "I want to leave, now, you guys aren't helping me any more than I get when I leave here. At least when I leave I can have as much pain med as I want. Come down the hall now, take out this !@#*$&% IV because I'm leaving." Obbbbbbviousssslyyyyyy, there are a few more steps that need to happen before he could leave--safely. So I happily, almost chirpy, stated 'I would be happy to let your nurse know that you are ready to leave, so if you wouldn't mind, please go back to your room so I can have them meet you there to take out your IV safely so you can go. I will also need to call the doctor to let him know.' Crazily enough, this seemed to suffice. This man gave me that same odd nod, turned on his heel, and briskly walked down the hall.

Having learned the way things go in the unsettled patient department, I immediately called the doctor, nurse and security. Here we go again. I thought with an exhale that was far from relieving.

I don't know what transpired between this man, the doctor and the nurse, but I heard screaming coming from down the hall about 15 minutes later. It was the patient practically running down the hall. "I AM GOING TO LEAVE NOW, TAKE OUT THIS (*&#^$% IV OR I AM GOING TO RIP IT OUT!" I turned to his nurse who was trying to get his papers together, silently asking her what I should do. She sighed, totally exasperated, 'Just take it out Jacquie.' So I did. I walked up to this man who was radiating anger, slowly slipped on my gloves, and took out his IV. I smiled a halfhearted smile. At this, he slammed his hands down on the counter at the station and screamed. "I WONDER WHAT WOULD HAPPEN IF I JUST WALKED UP IN THIS PLACE ONE DAY WITH MY SHOTGUN AND TOOK OUT ALL OF YOU!" He paused and turned to me, "except you," he said, "you've been nice to me, and I like you." I froze. I can handle belligerent, but threats concerning fire arms. This woman doesn't play. At that, the patient left to go back to his room to get his things. My boss called the cops and they showed up almost immediately.

With the blue uniforms form the cops, the black uniforms from security, I could just stare. It was almost childish, but I was frozen to the spot. I didn't know what was going to happen next.

As if on cue, the patient came hurrying down the hall, as if he was outrunning something. "I hope you know I would LOVE to shoot this place up, it would be amazing! BAM! BAM! BAM!" The cops were following to make sure he left.

Of course he paused at the nurse station to drive home his point. He raised his arm, pointed it straight at me. "Get that look off your face, I don't mean you. I wouldn't shoot you." Because, that made the whole situation better.. Not.

With this last exchange, the cops gave him a very insistent push toward the door. This sent the patient into a fit of laughter, "SEE YOU SOON!" He screamed.

I turned to the cop and I asked 'So?! What are you going to do about that?!' His reply... Nothing mam, he doesn't have a firearm. And it wasn't a direct threat. We can't really do anything.

It was my turn to get serious. 'Then you better pray he doesn't come back in here in the future. Because then we are ALL going to be sorry.'

I let my words sink in. The cop made a face, turned on his heel, and left to follow the screaming.

--

You tell me friends.

Do. No. Harm.

I understand the standard.
But sometimes..
I truly wonder..

About everyone else.

Merry Christmas! And to all... a good night?

Please forgive the sabbatical that I've taken since my last post. It honestly took more from my heart to post that last story than I thought. I couldn't place myself near a computer to even think of writing another tale.

This evening, I realized something. I will write when I feel inspired, when I have a funny tale, sad tale, angry tale, or just when I have something to share. There is NO timeline, there is no need to get stressed out. In a way-- sharing my stories, as well as other people's stories, is simply therapeutic. My life is brightened, soiled and sometimes down right ridiculous because of my profession. Please believe that I love every instant (well, maybe not EVERY instant).

Regardless my friends..

I have quite the amazing story that actually fits our current Christmas situation. Without further ado, I shall let the bells ring..

It was another night shift, nearing the Christmas holiday.

You know, the hospital feels very different at night. I don't know about other places, but someone would turn our lights down low and it seemed like a bit of a ghost town. Please, do not get me wrong, this does NOT mean that night nursing is easy. This just means that there aren't oodles of specialists trolling the floors (yes, I did just say trolling). Nor does it smell like way too many meshes of multiple perfumes and colognes, or even general B.O. It smells (mostly) sterile (save code browns), looks sterile, but please believe.. The bells do ring.

If you do not know the pun, then you have not spent enough time in a hospital. Good on you (number one), and may it remain that way (number two). This night was incredible. It was fairly.. How do you say... Admission-less? Yet again, I digress. Nights are typically the stomping ground for insane amounts of admissions that are spilling over from the Emergency Department.

If you've ever been to an ER you will know that the wait (if your situation isn't critical) can be an excruciating process of waiting that likens the years in the desert that you only hear of in the Bible anymore. Some how, some where, there weren't too many admissions. [Praise be to..Florence!] The ED was sleeping like a lamb, but the floor was hopping like John Travolta in Saturday Night Fever. It wasn't really all of the patients with sun-downers syndrome jumping out of bed, but rather a very colorful one.. Who just happened to be my patient.

As this situation was long long ago, I feel safe to tell you the gender of this amazing being (of which I do not say lightly, she was a wonderful, incredible woman).. My little lady was all of 100 pounds of fury with an altered state of mind due to extremely progressive dementia. This disease is an awful thing that can really tear apart a person's life and family, of which I am totally aware. But for lack of a better explanation, I feel that I need to elaborate. There are two kinds of dementia patients, the happy confused, and the combative confused. Sometimes, the combativeness is only for the night, and that happens.. A LOT! Sometimes they are fighting, the whole time. But, more often than not, dementia takes of the form of friendly confusion of dusting for missing fruit-baskets that the elephant from Puerto Rico took on holiday to the Bahamas to share with his cousin Vinny, the girl with the pig-tails. It doesn't make sense, but it makes for the most beautiful conversations.

It is in no one's best interest to correct anyone who is confused. Reoriented is one thing.
Correcting is simply another.

They do not understand, nor do they really care that you have an explanation for everything.

What they know and care about is that everyone is functioning quite happily in 

THEIR world 

that THEY created.

Or really.. That dementia created, but has pulled from interesting areas of the subconscious.

Welcome to digression again people, so sorry. I can't help it. Honestly, my elderly patients with this alteration have definitely made an impact in my career. Whether it was the 90 year old lady who tried to bite me with her gums, and then when I wasn't looking punched me with full force in my sternum, knocking the air out of me. And yes, it DID hurt (and for days afterward).

Or this lady...

My sweet little patient was fairly alert and oriented during the daylight hours. But as the sun went down, so did her capacity to reason and separate hallucinations from reality.

If you think about it. This concept can be absolutely horrifying. Like being trapped in an episode of paranoid schizophrenia. You cannot tell what is real, or what your brain is telling you that's there.. Sights, smells, feelings, sounds. Really though, unsettling!

At times, my little dearest would explain to me that there was a little girl popping in and out to use the swing-set. They also had a picnic. It sounded quite lovely. Almost.. Sound of Music-esque.

As the day grew weary and the night rolled in with a vengeance... So did her hallucinations.

This is when things got serious..

And then again, not so serious.

I should have known there was an "emergency" a-brewing, but this lady was my first patient who ever had VERY lucid hallucinations that accompanied her sun-downing syndrome. She began by pushing her call bell, about q5min (every 5 minutes... don't you feel smarter now?) Her voice was growing more and more distressed, there were people in her room and they were being too loud! So I went in and found an empty room, dark, and very very quiet. So I proceeded to get a picture of what she was seeing.

"How many people are there?" 'Oh, there's at least twenty. Everyone is happy and being loud, like it's a party. I keep hearing them clinking their drinks together. It's very annoying, I'm trying to sleep.'

Right. So.

I was trying to figure out how to reorient my patient, but not entirely upset her. "I don't see all of these people at this party." This was not the appropriate response. Because her reply was almost a high-pitched screech. 'How could you NOT see them? They're right there and now everyone is looking at you!'

The creepy factor increased by ten-fold.

"They are looking at me?" 'Yes... Especially that one.' I didn't inquire about that one. But I should have. I asked permission from my patient if I could ask the party-goers to please leave in order that she could sleep. With the cutest nod that I can only imagine coming from a very saucy lady, I obliged and asked our.. guests.. to leave.

Not particularly sure of my cue to leave, I had to ask.. "Did everyone go?"

'Yes.'

Brilliant!

Back out into the hallway I headed in order to round (aka, check) on my other patients. Who luckily, were all fast asleep-- actually, I could be lying.. I only remember what happened next.

RING RING RING!

The call bell started to go off again for my lady's room. I picked up the phone and sure enough, 'I need some help in here.' Off I headed in that direction, mostly curious what the situation could be this time.

I knocked and announced my presence. She had her covers pulled up to her chin. 'There's a man in here and he's wearing a dark suit.' 

This sent the hair standing up on my neck. Typically, in hospital lore, men in dark suits aren't typically good news. There are tales of people seeing certain things before they leave this World. I was praying that this was not one of those moments. 

"Honey, what is he doing?" She seemed almost too horrified to speak. This really upset me. It's very hard to reason with hallucinations. 'He's looking at me darling. I don't like it. He has very dark eyes. I can't see anything in them.'

At this point I was getting more and more uncomfortable. I had no idea what to do. "Do you think he will leave if I ask him to?" She seemed to agree that this would solve everything. So, with my most demanding and strong woman voice, I spoke up, throwing my arms out like I was splitting the seas.

I don't know why you are here bothering my friend, but I am here to ask you to leave.

Your presence is frightening her, and since I am her nurse, and her guardian,

I have to ask you to leave. So please leave. NOW!

I waited a few moments before speaking.

"Is he gone?" I asked over my shoulder.

'Yes, he left."

"Wow, I'm really glad he listened."

'Me too, I didn't like him.'

"Me either."

I tucked my little lady in again, handed her her phone and call-bell (as we're taught to do, as per nursing-school brainwashing.. And good hospital etiquette). 

I sat down to chart, thinking after a few minutes had passed that it had been awfully quiet.

Then my phone rang.

'Is this (such and such) hospital?' 

"Yes, yes it is, I am Jacquie, a nurse here, how can I help you and who is this?" --> I can't stand it when people don't introduce themselves.. It's awfully rude.

'This is the emergency dispatch calling about a patient report of a gunman in your hospital.'

WHAT?!!!

'There were two phone calls from a patient of yours stating there was a man in their room with a semi-automatic.'

I paused. Looked up and down both the halls. It didn't make ANY sense because I was at the main nurse station, and I could see down the halls perfectly fine. Absolutely no one was walking, anywhere.. Let alone, WITH A WEAPON.

I asked what the man was supposedly wearing.

'A Santa suit.'

"Excuse me? A what?"

'A Santa suit ma'am.'

Then it dawned on me.

"Who called you again please?"

               'Your patient (so and so-- aka cute little older lady who had been hallucinating all night)'

"That makes sense."

'Excuse me?'

"Oh! Sorry, this patient of mine has been hallucinating all night. I'm assuming that because it is near Christmas, she is seeing a man in a Santa suit. Not sure where the gun idea came from through. We actually had a little problem like this earlier."

'So, are you verifying to me, RIGHT NOW, that there isn't a GUN MAN in your hospital wearing a SANTA SUIT?!?!'

I had to pause again to keep from giggling.

And of course, to make it entirely clear.. Rinse. And.. REPEAT!

"No mam, there is NO man in the entire hospital, especially on THIS floor, that is walking around the hallways with a semi-automatic weapon.. Wearing a Santa suit.."

There was an exhalation of annoyance on the other end. 'She sounded pretty distressed.'

"Yes, I understand that, but you would be upset too if you had been hallucinating all night and then saw a man in a Santa suit with a gun and scary eyes.. He is supposed to be jolly and nice... Look, I know how it sounds and that you are to take these things VERY seriously, but I can guarantee you that this is not an actual situation that needs emergency response.."

Pause.

'If she calls one more time, I am sending the rescue squad, you WILL go into lock-down, we will SWEEP the hospital, and YOUR NAME WILL come up in the future. Understood?!'

"Loud and clear."

I hung up the phone.

 Andddddddddddddddd 

sprinted down the hall!

I came to a skidding halt at my patient's door.

Knock. Knock.

"Hey honey, I wanted to come and check on you."

'Oh darling! You missed it! There was a man in here in a Santa suit with a gun! It was awful.'

"Don't worry love, I told him to go away. And I kicked him out."

'Oh thank God! I will call 911 again if he comes back..' CUE IN INTERVENTION HERE.

"You know what love?" as I'm unplugging the phone from the wall. "If you see that terrible man again, you push this red button here. That is the ALARM to let me know that I need to come back in to send him away. Can you do that for me?"

'Like this?!' Here ensues multiple frantic call bell rings, all in a row. With wee hands mashing the "alarm" button.. Over and over again.

As I equally as frantic press the cancel button, "Yes darling, just like that."

With a grin and an air of pride, 'Yes, I can do that.'

With that, there were only a few more call bells. But the little girl came back to swing again, and then wanted to play, but my patient was too tired to play.. So I had to send the little girl home.

But safety was restored.

The next morning and very ANGRY woman walked up to the desk, radiating fury. 'WHO UNPLUGGED MY MOTHER'S PHONE LAST NIGHT?!' With instincts sharp as a whip, and slightly groggy.. "That would be me ma'am." 'HOW DARE YOU UNPLUG HER PHONE, I COULDN'T REACH HER!' "With all do respect ma'am..." I tried to tell her the story about the hallucinations and the MULTIPLE 911 phone calls. How we don't like to cause 'traffic' for emergency dispatch in order that the real emergencies get through.. blah blah blah blah...

She wasn't having it.

'I AM GOING TO REPORT YOU FOR LACK OF CARE FOR MY MOTHER AND HAVING AN AGENDA TO SIT AROUND AND DO NOTHING. HOW DARE YOU. IF YOU UNPLUG THAT PHONE ONE MORE TIME I WILL GET YOU FIRED! DO YOU UNDERSTAND ME?!'

I paused. (As I often do when things like this happen)

Took a very long deep breath.

"Oh, I understand completely. Let me go plug it back in for you."

As I walked down the hall to plug it in, I rounded into the doorway and glanced up at the clock. 0715 in the bright sunny morning. "Good morning sunshine." I said to my saucy little friend. 

A big smile stretched across her face.. Then a furrowed brow. 

'Oh! Hello darling. You wouldn't believe the noise last night! There was a party around here. I'm so sorry you missed it. You really would have loved it. Beautiful dresses. You could have met someone you know...'

With that I walked over. Patted her hand gently.. Then handed her the phone, winked, "Use that wisely."

She smiled big and great, ear to ear even 'Oh! Good-bye darling. See you soon. Maybe we can have a picnic later.'

The Story That Took a Month to Write: My First Code

I know that I’ve not written in weeks. There is no excuse for me to share but rather the fear of writing. If you’ve not noticed I always have something to say. This time though, I am afraid to say. I want to tell you a story that comes from the opposite end of the spectrum in comparison to my quirky tales of mishaps and hilarity. As we all know, there is another side to reality, of which I would like to share. With life comes death. This is a story that touches on this harsh truth. But truth nonetheless. May this tale honor an exceptional being that has changed my life forever.

I was so proud to be sitting in a classroom and sweating it out as I hashed out EKG readings and acting out a mega code. For those of you who don’t understand my lingo, this is the case of ACLS certification. This coveted certification is for Advanced Cardiovascular Life Support. The phrase makes nursing students shudder in their shoes and full grown adults immediately grow anxious (maybe a palpitation here or there). I had spent my week studying my brains out. It felt like nursing school all over again. In the back of my mind I knew that with this certification I would have the skills I needed to participate in a code situation in the hospital. My certification for Basic Life Support for the Healthcare Provider was already housed in my wallet. I guess you can say that the biggest difference between these two certifications are that you can administer medication to start or reset a heart again with ACLS. BLS is more basic. My friend and I sat in the classes giggling to one another at the scenarios on the screen being played out to perfection. The handsome doctor in the white coat giving orders and the also good-looking nurse pushing “Epi” as per order. Calm. Cool. Collected.

We had our hands on experiences with the manikins as well as mock situations in smaller classes. After a written test, if you passed of course, you walked away with a card stating you were absolutely, no questions asked, certified. I walked out of that building with my head held high, beyond thrilled to have my card in hand. Look at what I did playing over and over in my head.

The next morning began like any other. I woke up at 0530 to get ready for work. After a swift body cleanse in the shower, some food in my stomach and coffee to go, I ran out the door ready to tell all my coworkers of my good news. When I hustled onto the floor and rounded the corner, the main nurse desk was bustling with activity with many concerned faces. Too many even. I shoved my news into the back of my mind as I was approached by a coworker, “Thank God you’re here, I need to give you report on a situation now.” My stomach dropped, my throat became dry and my heart sped up to break-neck speed.

My coworker began her story with a young patient’s admission in the night. The gist was that the patient had presented with respiratory distress due to end stage cancer that had riddled their body with tumors. The presence of these toxic growths were altering the patient’s ability to breathe, their heart rate, and many other things crucial to life. To survival.

I had cared for patients in respiratory distress in the past but the thing that stung me to my core was the patient’s age and their circumstances. Cancer is a terrible thing that I have seen as a nurse on a daily basis. This case was no different. Yet it was. It is a difficult battle to fight but having your childhood taken from you by a force that attacks your entire body, well, this idea alone was enough to bring me to my knees. You better believe that it did. I began to pray. With all of me I was praying.

I walked into the patient’s room and was somewhat stunned to see the entire family there. My patient was leaning forward, holding their body up with their arm (what we in the medical field call the tripod position). I spoke to the patient and their family and learned in that moment that there had been a do not resuscitate order revoked just that morning. I looked at the clock. It was 0800.

As a good nurse does, I got report on the rest of my patient assignments for that day. I said my good-mornings to them and tried to settle their needs and orders to the best of my ability as I hurried in and out of my young patient’s room. I knew something was coming. I didn’t know what. But I felt it. With every part of my body. Every inch of my brain and will power. I knew.

I don’t remember my other patients from this day, their faces, or their cases. This does not surprise me, as many of us sort of “dump” this information from our brains as we leave the hospital grounds. This natural occurrence, I feel, is a mechanism of protection for our hearts, minds and souls. We are able, once we are home, to regenerate and partake in some semblance of a normal life outside of our workplace. This is a protective mechanism I am grateful for. This does not mean my patients aren’t important to me, or any health care worker for that matter, but rather it helps us be OUR BEST on a daily basis when we come back in for a shift. We can start new. We can leave our cases within the hospital walls. Unfortunately, this does not always happen. Many cases do come home. They can keep one up at night. They can prevent normal daily activities. Of this, I am also thankful. This reminds me of my heart, that I am a feeling human being. But oftentimes, this form of compassion can drain you to the bone and leave you a crumpled heap on the floor. This happens. More frequently than many of us speak of.

I don’t remember the time, nor do I wish to pretend to disclose every detail of this day, that is not the point of this tale. What stands out the most is what transpired next.

I walked into my patient’s room and found them sitting in that same tripod position, with a sibling at their shoulder, holding on tight. My chest tugged at the look in their eyes. It was the question, the burning question, how much longer do we have? I never get used to this look. In a sense, I hope I never do.

I blinked a few times and turned to my patient who was leaning forward, eyes pursed shut, heaving gulps of air. “What can I do for you, right now in this moment?” I asked. “Are you in pain?” At this, my patient opened their eyes as if seeing me for the first time. ‘Yes, I am.’ I nodded agreeing, having known this detail for some time. I just needed to hear it. It is only then I can medicate.

We discussed this issue quite plainly, I was thanked, and then I paused. Something felt troubled. Adrift. I am unsure of the right word or phrase. Even now, it still eludes me.

I looked across the room and saw mom, sitting in her chair, very quietly, unobtrusively even. She was cold, in shock, and silent. At this I asked the family if there was anything I could get for them to bring back into the room upon my return. Mom looked at me and said in a very low voice, “help my son, and do absolutely everything you can.” I nodded. This I could understand on a level, yes, I would do everything within my power. But from a mother to someone who has never birthed a child, at the same time, I could not understand the depths of this request. I believe I never will. Not until I bring my own flesh and blood into this World.

As I turned to leave the room, my patient gasped an odd sound. A word. Maybe it was my name. I was unsure. I turned as they grabbed my hand. ‘Please,” my patient begged, ‘please let me go.’ I know, for lack of better control, my jaw dropped. ‘Please,’ they said. Over. And over. It was almost a soft, melodic chant. My eyes darted across the room to this patient’s mother. She leaned forward, exasperated. “She will do everything she can honey. To help you.” Her eyes bore holes into my person yet held waves of sincerity and concern when looking at her child. I knew that this was not a request. I leaned into my patient’s ear, grabbed their chin and looked them straight in the eye. “I am here for you. I will be here to fight for you in any way that you need. Right now, and until you leave my care, I will be your nurse. I am your advocate.” I turned to my attention to the patient’s mother, “With no DNR status, I will do everything in my power if there is an emergency. As for everything else, my patient’s needs are my ultimate concern. I will do as they ask because I am their advocate.” She nodded. My patient smiled. A very small turn in the corner of their mouth. ‘Thank you Jacquie.’

I turned to leave the room and retrieve the pain medication.

My patient needed to be comfortable. They needed to feel in control. They knew what was happening, as did I.

As you and I both know, I didn’t even make it down the hallway, not even half of the hallway. A male voice rang out into the air and everything stopped for a brief moment. It was as if the World had stopped on its axis. “THEY STOPPED BREATHING! THEY’RE NOT BREATHING! PLEASE! PLEASE!!” It was my patient’s father. And it was that word again.

Please.

Please.

It was as if I had wings. I don’t remember my feet touching the floor. I don’t remember hearing any sounds except for screaming. A heart-wrenching wail pierced the air as my patient’s mother was dragged into the hallway by her husband. I flew in through the door past family as they ran out covering their eyes and moaning. There in the bed was my patient, for the first time, lying very still. I looked up into the eyes of my coworker as she pulled the pillows from underneath my patient’s head as I pressed the Code Blue button, “I’ll start compressions” she offered as we rolled my patient onto the back-board.

In my head things were moving slowly, but my ears were deceiving as all sounds sped up with real time.

Feet pounding down the hall, screaming from a horrified mother, and the sounds of a room in a very fine frenzy—trying to bring back a heart that was trying to be still. The patient’s doctor, the ICU doctor, nurses and nurse techs filed in to perform their duties. My coworker was working on the patient’s chest, pushing hard and pushing fast. I had bagged the patient’s airway and was counting to keep up. The code cart flew in and I hurriedly set up the monitor as my Respiratory Therapist friend tapped my shoulder to silently take on his assigned task. It was a dance of the strangest kind. The odd thing was that this dance worked. We had our roles. We had our knowledge of what was expected. And we did it. We did it one by one and all together. Somehow, some way. It just worked.                                                

It was 0945

We were all talking to one another in the room. In unison. As more specialties showed up the room grew more crowded. My boss arrived to tell me that the rest of my patients were being covered by my coworkers, and most importantly, friends who I’d trust with my life. I nodded. “Okay.” My boss took one more look at me, and was gone. I turned to a friend, one of the best nurse technologists I’ve ever met, “Please go close the doors of the other patient’s rooms on the hall.” The screaming and wailing continued in the hallway, ripping into my chest with each rush of sound. I knew the whole floor could hear. It was as if we were stuck in a scene from a movie. But this was real. More real than I wanted it to be.

Two rounds of epinephrine later, we had a pulse, we had a heart-beat. So we stopped.

The monitor was registering an irregular heart rate and my patient was breathing. It was not real breathing. It was a pattern known as agonal breathing.

It is a gasp. An entire body reaction-- gulping air. There is no certainty in this movement. There is no support for the body with this motion. It is a last and final effort.

As licensed personnel filed out of the room, save myself, the family rushed in. Mom immediately grabbed her child’s hand at the bedside apologizing over and over, begging with that word.

That word. Please.

Dad walked in. Calm. Quiet. Radiating. Pulsing energy. It was a still energy. Knowing and gentle. He touched my shoulder and looked me straight in the face. “We will not be doing that again.” With that, he walked further into the room, grabbed his child’s other hand, bowed his head, and began to pray. As did I.

Or rather.

As I became aware of my prayer that had started two hours earlier.

The family prayed. Sang. Said their good-byes. One by one everyone came in to say their peace.

I remained. I stood there and encouraged everyone in the room to speak to the patient, their friend, their family, their brother, their son. To touch. To hold.

I reassured everyone that the patient would hear it. They would feel it. They would know that everyone was still there. Patients can sense these things. No matter how close to life or death they are. It’s an incredible sight and experience. 

Then I stepped out into the hall to wait.

Some time had passed. I don’t know how long.

Everything fell very still. Very quiet.

Dad appeared in the doorway with a look.

That look.

“I think..” He paused. Then he turned and walked back in.

When I walked into the room, I already knew. I took out my stethoscope.

Silence.

I looked around the room. It took a second to find my voice, but when I did, it sounded foreign, hushed even. “They’re gone.”

Mom crumbled into her child and wailed. Dad nodded.

As I stepped out into the hallway, my own tears fell. I held my breath so as not to lose myself completely outside the room of a family in mourning. The doctor on the case looked at me and asked, “Are you okay?” I could only shake my head.

No.

When I showed up to assist the family out, my patient’s father stopped in front of me in the hallway. 

“Jacquie,” he said in that calm way, stunning me again. “Thank you for helping my child. I know that you did everything you could. It was their time to go.” With that he hugged me, grabbed ahold of his family, and walked away.

I turned to look at the room.

There was no darkness surrounding it.

No heaviness.

My friends, my coworkers, asked me if I wanted help with post-mortem care. I could only shake my head.

“No, it’s okay. I want to do this on my own.” And so I did. Handling every detail with a slowness that I can only liken to poetry. Slow. Steady. Whispering to myself with each touch. Whispering prayers over a battle fought, long and hard. It’s time to rest. The pain is gone.

I walked my patient down to the morgue--Not because I didn’t trust anyone with their care. But rather. I needed to do it. I needed the closure.

I needed the opportunity to pay this individual, mature beyond their years, the amount of respect and care that they ultimately deserved. I knew in this moment that yes, what was left was only a shell, a body. No matter to me. Shell or no. You are my patient. You are in my hands. You are in my care. I will carry you when you need strength. I will see to it that your life here on Earth is honored by all that I do. And when you choose to leave this World, I will help carry you to that final resting place. We will do it together.

I do this with respect.

I do this, because it is an honor for me to have these last moments with you. Providing a means to give you rest. To give you peace.

For my patient. 

The one who didn’t give up fighting until their body was through. Your strength. Your immense power. The ones who were left behind. I know now of what adoration looks like. You, by far, have left the most incredible imprint on life that I’ve ever seen.

What has transpired will be. 

I am forever changed. 

Thank you for changing my life.

Hilarious Happenstances involving AIR

In all honesty, nursing is quite serious. More often than not, we have our serious faces on and we are quickly and aptly jumping from one task to another, making sure that our patients are okay, everyone is safe, we’re doing everything we can to make sure everyone is on one page, etcetcetc. You get my drift. But, there is always time and space for a mishap. Now if you know me personally, I am not above tripping on air, running into the door frame, or accessing an embarrassing repertoire of Freudian slips. Yes, a major screw up can ultimately cause or lead to death, unless the celestial discharge occurs naturally. Hence, nurses and any medical worker for that matter, have a sense of humor that many people cannot level with, handle or fathom. We look crazy oftentimes in the eyes of the general public. This definitely happens when we can’t help the discussion of grimy details in public places or even cause a break in a romantic conversation to tell this hilarious story when someone farted in our face. I can say with every bit of my heart that we have the most interesting jobs on the planet, and that I would rather spend time with some of my coworkers than others who cannot particularly grip my morbid and often cynical sense of humor.

Please believe that I always operate under the notion of hope and faith. But, I am the same as my likenesses: a total cluster of sane, insane, jokester, with an immense sense of self and my belief systems. Without further ado, I would love to share my own and some other hilarious mishaps that have occurred in my realm that is the World of Nursing. Here is a selection of some of my mini tales.

HOLY HUMIDIFIERS!

In preparing to set up a room for a surgical admit that is fresh out of the Post-Anesthesia Care Unit, nurses are aware of a number of things that are expected to be arranged prior to the sleepy-head’s arrival. To walk you through a brief synopsis of details that I’m sure you could care less about, you must: #1) have the dynamap set up for post-op vitals (this is the machine that takes your blood pressure, measures  your heart rate, and obtains your body’s oxygen saturation in your blood—to make sure you’re breathing enough to LIVE), #2) prepare oxygen tubing for your arrival, because no matter how hard you try, you don’t normally breathe as appropriately straight out of surgery (the lovely meds that we give you that cause sleepy time and amnesia don’t particularly encourage that medulla oblongata to remind you to take nice healthy deep breaths on the regular—no lie), #3) tissues, barf bucket, etcetc are all within reach so when you arrive you hopefully don’t ruin our scrub choice for that day. Regardless of the rest of the details, you come up to a medical-surgical unit and immediately become attached to a multitude of machines that beep, sing, hum and administer medications. Gotta love technology.

It is in the nurse’s best interest to collect and prep all of these things prior to the snoring patient’s presence to decrease frantic chicken with its head cut off performance at their arrival. As many may know, hospital air is terribly dry. It normally stinks, it’s loud, stale and VERY VERY dry. So in prepping this room, my friend thought that it would be a great idea to provide humidified oxygen, instead of plain O2 (that’s oxygen in cooler typed form my friends). NOW! To prepare humidified oxygen, you need to assemble a few more things. (Half the battle of nursing is assembling—mostly your sanity, but that’s beside the point).Basically you need this oddly shaped canister that has water in it. This canister has two hook-ups. One hook up clings to the wall to obtain the O2 that comes out of the wall, the other port is a sort of spout (like a teapot) that you connect the oxygen tubing to that goes to the patient. This fantastically closed port system provides humidified air that it is that much easier to breathe, and in turn doesn’t create snot blockage.

Please understand that for this system to work properly you HAVE to OPEN the canister at BOTH ends. This is EXTREMELY IMPORTANT because if you only open the one port that obtains the air, and not the second port.. Well, the canister will fill with air and it becomes compressed. Very. Tight. Squeeze. This will further lead to a teapot effect.

It didn’t ring a bell sometimes that my friend made this mistake. It didn’t occur until a loud train like whistling sound filled the room. And of course! He looked around, worried about the arrival of this impending train, with no tracks in sight. Seriously?! What the heck?! Then the bubbling sound brought him back to Earth. Realization hit. He had booby-trapped the patient’s room with a bubbling canister of sterile water. Here was the catch-22. If you open the second port, water and air will shoot out.. What’s the next best thing?

PULL  IT FROM THE WALL!

That would stop the whistling and compressing even more air in that tiny little plastic piece.

So, what does he do?

Rip the apparatus from the wall-- Ah, peace and quiet.

NOT!

He’s just built up enough pressure to power wash the entire hospital’s windows. As the truth sinks in deeper, so does his fear. Oh. My. NO!

Water explodes from the top of the bottle and saturates the fresh bed, walls, floor, and his scrubs. Soaking wet. How in the World can that much water and pressure create such a mess? WHY DIDN’T YOU SET IT UP RIGHT IN THE FIRST PLACE?! His patient is on the way and he just recreated Water World, on the floor and on the walls. What’s the next move? Strip the wet linens off the bed, throw them on the floor, and dance some serious Boogie Nights rip off—scooting across the floor trying to mop up the mess. 

Somehow, by the grace of the heavens above, the water was cleaned up, a new humidified O2 was put in place, a new fresh bed was remade and my friend welcomed a sleeping bear with open arms.  Though no one knew of the shenanigans involved, though all questioned the odd whistling that occurred moments earlier, he was off the hook with only this lovely tale to share at a later date. This story, of which all of you missed out on the acting involved to recreate the amazing scene, was pulled out of the vault to make me laugh on one of those days you have to laugh to keep from crying. And that my friends, is how we make it through. 

CPAP EXPLOSION

I was preparing for prepping my own post-surgical room for a person who needed a CPAP machine to breathe properly. CPAPs are interesting machines, they have a whole face hook-up or just a nose hook-up. When the seal isn’t that great it makes this farting sound. Really funny actually. It’s like this suction-fart sound. It gets louder when people try to talk to you with it on.

CPAPs are hooked up to a massive rolling machine thing that is ALSO hooked up to the oxygen in the wall. I needed to prepare my surgical room as well, pretty quickly, and wheel this machine down the hall to connect in another room. Here comes the fun. To DISCONNECT  the CPAP from the wall you need to pull the whole connector from the oxygen connection. I was in a terrible hurry mind you, so I began to unscrew the tubing from the wall, not thinking my whole process through.

Oxygen is a force to be reckoned with. The air rushing into the CPAP was turned up, basically, as high as the settings could go. I am sure you can guess.. That the CPAP oxygen hose BLEW off the wall entirely and shot across the room. Air rushed into the room, blowing my hair in all directions as I stood there trying to cover the air with my hands. Because that will stop it.

My friend came running into the room, her face was bright pink, worried that something awful had happened. When she arrived she stood there wide-eyed, mouth hanging open, not moving as I stood there, trying to affix the hose to the wall.. And continually getting blown away by hurricane force winds. No joke. Finally the “silence” was broken.

My friend shouted over the rushing air, “WHAT TO DO YOU WANT ME TO DO?!” I looked at her in disbelief, “YOU CAN SHUT THE FREAKING DOOR!” She disappeared momentarily and I could barely hear the door slam. When my friend walked back in she took one look at me, and we both started laughing hysterically.

I fought with the rushing air and affixing the bloody tube for what seemed like an eternity. Somehow, I got it, properly removed the apparatus from the wall, and moved the machine to the other room.

As my friend and I stepped from the room together, breathing heavily, trying to regain composure, another coworker stopped us. She looked entirely distressed. “What’s wrong?” We asked worried, thinking that we had missed something awful as we laughed ourselves silly minutes before. “Did you guys hear the power washing going on? Why would they do that in the middle of the afternoon?! It was SO LOUD! This place is RIDICULOUS!”

As my partner in crime and I rounded the corner, we yet again, exploded into tears. A major win in the middle of a busy day.

Never underestimate the power of laughter… And medical air.

Claustrophobia and Sterile Fields

Do you ever remember doing something you’d never done before, and you had that sickened feeling where the presence of butterflies was bordering the unkind verge of vomitus maximus? Well, I would like to say that this is quite the normal sensation as a nervous ninny in nursing school.

The fine day I want to walk you through was like most others: I woke up and immediately began force feeding myself mantras to get out of bed in a timely fashion and furthermore attempting a hand at an 0530 breakfast. Now, these weren’t exactly breakfasts. I mean, I DID break my fast, but this was different. These occurrences were major meals that I couldn’t process or rather feel at this early of a start. BUT! I knew deep down that I wouldn’t get my hands on food for a hot minute once my shift started. Therefore, reason enough to have a scrambled egg, toast and coffee feast. The flavors always eluded me, as they always would at the butt-crack of dawn. (Welcome friends, yet again to digression).

This morning, as similar as it was to many others, was also incredibly and wonderfully different. My very hard-core persona of the nurse-in-training was dead set on rocking an awesome day in the operating room. Yes, I would be on the outskirts, yes my hands would touch absolutely NOTHING, but the excitement of being present while someone’s insides were exposed to the World always sounded heavenly. 

I know this is troubling to many, but I have a stomach of gold when it comes to the Nursing World. I can handle gaping wounds, blood, gore and basically any Quentin Tarantino movie being acted out within the walls of a hospital establishment (some of these characteristics have changed mind you, but that’s besides the point and totally another story). In all honesty, this was the holy grail of days to go to clinicals. I had been praying for a triple bypass, mitral valve repair or even some form of transplant, but really, I was ready to take what I could get!

I showed up like a deer in the headlights, blinking uncontrollably into the harsh fluorescent lights radiating off of the freshly polished linoleum floors. Of course, not knowing my head from my tail, I had to ask some extremely well-seasoned nurse as to where in the heck I was to put myself. What an odd situation clinicals are. You show up at the designated time and usually there’s an awkward scramble to figure out what to do with you until someone claims you (like a bad game of dodge-ball). 

Soon enough, a woman donned in her OR gear grabbed me by the elbow and showed me where I was to change. Here was the second dilemma. I am a peanut of sorts. All 5’3’’ and 120 pounds of me was staring at a rack of OR scrubs that I needed to somehow find the right size. APPARENTLY, these things are color-coded. I had to ask yet another nurse for assistance, then put on the LARGEST extra-small set of scrubs I’ve ever seen. They made WalMart scrubs look like apple-bottom jeans, just sayin’.

People, people, people. 

There is so much more to getting dressed, and I’ve not even gotten to the best part! Apparently you grab a sterile mask, hair net thing, and booties. Goggles are an option too (mind the back spray)! There is also the unfortunate circumstance of the temperature gracing, oh I dunno, minus 10 I think? Maybe I exaggerate, but some lovely soul gave me some other unkown soul’s OR jacket to wear so I didn’t turn blue. Whoever you are, and you’ll never know me, thank you SO MUCH for sharing..Even though you had no idea.

I waited in the sterile area for my preceptor. Ah, the preceptor. For those of you who DON’T know, the preceptor is the person responsible for you during the shift. This role is reserved for guiding frightened nursing students and nurses entering a new job position on the floor. This is the person whose license you are operating under. Whatever shenanigans you cause can lead to sticky situations for these people. God. Bless. Their. Souls. Round of applause please.

She showed up smiling at me, and then very quickly furrowed her brow. “Jacquie, mask!” Right, right! Because in the designated sterile areas of the hospital, it is literally sterile. Even from your halitosis. So put your flipping mask on! Please understand that I was so excited and nervous, this sentence happened well over a dozen more times. When I sensed it was coming and I wasn’t prepared, it was that deer in the headlights look again as I slowly pulled my mask over my face. Let’s talk about the surgical mask for a minute here...

The surgical mask comes in many forms. The one of which I realized I despise with ultimate hatred and deem to be the spawn of everything unholy, is the mask that comes in one piece. This is the mask and face shield combination of which I am speaking. Recall that this was my first choice. All will unveil shortly, I promise. The other option is the mask you tie around your face, and then you can put on goggles separately. This is the better choice for me as I learned so beautifully only an hour or so from this moment we are speaking.

Now that my mask was on, it was safe to head into the operating room suite. This was a smaller hospital, so there were only 6 or 7 suites. If you know me, and you might, I started tooshie kissing as soon as I had the chance. I realized I was in for hernia repairs, gall bladder removals and it’s not that I wasn’t excited, but it’s no open heart surgery. The nurses at this point were laughing at me, but one surgical technologist overheard me and slipped into the adjoining suite to sweet talk my way into this totally brilliant open heart surgery that was to happen only two hours from that very moment. I struggled to control my excitement.

The cases I was assigned to began. The first patient was wheeled in and I was given a trusty stool to stand on so I could see all of the action first-hand. So, thoughtful those nurses. I was standing next to a HUGE machine that was behind me, the sterile field/operating table/patient were all in front of me. The surrounding areas were lights, the anesthesiologist’s corner (at the head of the patient), and the surgeon to my front left-ish. This surgeon was hilariously short, like me, but his head filled the room. He strutted in, swinging his arms and looked at me as if I were standing there next to my new bike with streamers and pigtails in my hair. Fair enough, I’m in the beginning of this career choice, but give me some credit man!

Introductions ensued and then the business began. The surgeon would tease/teach/ask questions over his shoulder as I stood on tiptoes to see the laparoscopic surgeries happening in front of me. Please note, laparoscopic = nothing to see. Literally two to three small incisions in a localized area, and then everything else happens internal. But, I can make a "dull" moment exciting. This is where things get very, very interesting..

It is maybe the third or fourth hernia repair with mesh placement and I’m trying to get a better view, when some terrible awful stench reaches my nose. I realize with absolute disgust that this scent is that of burning flesh. Not because there’s a fire everyone, but because you use a cauterizing machine in operating rooms, especially to prevent bleeding during procedures. Therefore, I realized that the giant machine behind me was actually the cauterizing machine. What a lofty piece that thing is. Positive and negative cables run out of the machine itself that you place onto the patient, and then a third cable is the actual tool. Not that any of you really care what this thing looks like, but if you’re visual like me you need it for “setting the scene”..

Well this stink hits my nose like a grizzly bear chasing you from it’s cubs in the wilderness. If you didn’t get that, it hit me with a vengeance. A terrible awful vengeance. At that point in time I realized that the air turnover in my surgical mask wasn’t as great as I originally had realized. It at least felt that way. Trying to maintain sterile procedure, especially considering I was standing above the patient’s body, I would pull the mask off of my face about a millimeter, and try to take a deep breath. Well, when you’re freaking-out-ish, breathing comes rapidly and heavily. So the heavy breathing just led to me fogging up my own eye shield that was so fantastically engineered to the whole STUPID apparatus. Whoever thought that up, I understand the ease that you take care of two VERY important situations, but is it really that necessary?!

For lack of a better description, little to no air turnover, fogged up mask all lead to the feeling that the room is MUCH smaller than it actually is.

Dizziness hit me and I suddenly became aware of the fact that I was holding my breath. WHOOPS! Oh yes, locked the knees too. Not breathing and locking knees. Not good people, not good at all. 

My first thought was, if I fall, I either land on the patient by falling forward, or on the cauterizing machine in falling backwards. So I chose to step off my platform after trying to regroup and failing miserably. I walked very unsteadily to my preceptor who was seated in the safer outskirts of the operating room, you know, away from the sterile field. She looked up at me and noted oh so sweetly, “Jacquie, you are white as a sheet!” I asked if I could sit, not even able to further formulate words to suggest that I totally agreed. So I sat, hard, on a stool. As soon as my bum hit this lovely chair, the stars began to collect in my peripheral vision. Seconds later, the tunnel vision hustled in rapidly. Oh no no no no noooooo!

All I could think of was totally embarrassing myself by passing out on this amazingly sterile floor in the middle of surgery being performed. Talk about making a name for yourself!

I turned to my preceptor, feeling very green, covered in sweat, and sensing that I may possibly die in this very moment. Not dramatic, I know.

“Hey, uhm, I think I’m going to pass out…” Talk about eloquent word choices. My preceptor squealed, “WHAT!?” And literally, simultaneously pushed my head between my knees. “BREATHE!” She shouted. So I kept on breathing, with this feeling of impending doom—face hitting floor doom. 

Her next statements came in a really quite fast accusatory tone, “Did you eat this morning? Does blood freak you out? Are you sure that you ate?” If I could sigh, I would have, but all I could muster were puny responses, “I did eat. It was at 5:30 AM. Blood doesn’t scare me. Do you realize I made it to four surgeries and now this is happening? Of course I ate, I TRY to eat every three hours.” A little snarky mind you, she was only trying to help, but being out of your element something fierce with your head between your own knees doesn’t make sweet-talk a priority.

At that point she grabbed the back of my scrub top, brought my head up really fast and looked me dead in the eye… “Are you claustrophobic?!” At which I paused, as if the light-bulb just came on, and nodded.

Like Superman, she ripped the eye shield cover from my mask, exposing my eyes to the lack of back-spray (thank you laparoscopic surgeries!) and began fanning my face in a hurried fashion. “How does that feel?” My preceptor asked in a worried voice. “Better actually.” With that, she shoved my head back between my knees.

The surgeon continued to do his fancy handy work with that patient’s insides as I sweated out a fierce almost-passing-out situation. He giggled and made comments, of course. But at that point, I was gracious to have not broken sterile field by passing out ON the PATIENT or breaking a VERY important surgical machine.

Toward the end of the surgery I was led out of the room by the surgical tech that I had spoken to earlier that morning. He got me snacks, ginger ale, and commented on how sweaty and white I was. Thanks for that. He was kind, and even apologized for my circumstances, which only made me laugh. I explained that I have a knack for really strange adventures at the most inopportune times.

How much times passed, I will never remember, but somehow I collected myself and was summoned back to the operating room. The doctor was RELENTLESS with jokes. Holy smokes was he terrible. Determined to not feel small I interjected my own replies and then began asking questions about the surgery.

To my astonishment, he paused, and asked me to come and stand at his shoulder for the rest of the surgery and through the next few.

I guess if you are me, and you find yourself in interesting situations, and then furthermore live up to it and not cave when someone comes swinging, you reap the reward (whatever it may be).

Now, I would have MUCH rather gone about it TOTALLY differently.

But.

Well..

Beggars can’t be choosers friends.