Rural ED

lead it as a slave

2006-10-24T12:07:00.000-04:00

I miss physical touch so much that I have been considering some things that usual me would never think of.I want some warm insistent lips pressed against mine and eagar hands exploring my body. For so long I thought it was Husband that would fufill these needs.I would steal it where I could, snuggled up firmly against him in bed, tryting to insist on more than the prefunctory hello and goodbye kisses, not letting go when he gave me a hug.It wasn't enough, but it held back mysexual aggression/
I read the blogs of sexually frustrated folks and identified with their pain.I even commented under another Blog ID of mine to SO GONE that a 90% right partner was pretty good and I would try to reconcile myself to that.WRONG!
Last night Husband wanted to take a drive and so we did. I needed a break from ACLS study.I began asking all those uncomfortable questions and ended my monologue with,
" I probably still love you but the pain you have caused me makes me have this cold anger deep inside along with depression and it is eating at my soul.I cannot even look at you without feeling my insides are being pulled out through my aorta. All I wanted was nothing less than I deserve, to be cherished, honored and faithful to.I hate that I feel there was something missing in me that made you look for other women."
His reply,
"There sure are alot of leaves on the ground"
More ranting on my part.

Anyways I am trying to take apostle Pauls advice and pummel my body and lead it as a slave ( yes I KNOW you can read Ds into that too ) but meaning that I overcome my desires and that I will be in control of my actions. I see so many women in this emotional,raw state who have sex with many and do things outside their character to soothe a void. I may have a bit of fun but I am really going to try to keep my wits about me.

2006-10-23T08:30:00.000-04:00

I may have to take my photo down. This started as primarily a blog of a fledgling ED nurse but has been overtaken by my " situation".Emotions may be brutal and some behavior may need to be explained incognito.(groans)yes it was me.
Last weekend I went to a Jazz concert with a gal from work then went to Denny's to gab. We are both "single"---ok I am not quite but getting there...and she listened to my tale of Husband and mentioned "Gee he sounds like a really nice guy other than some indiscretions, maybe you ought to give him another chance"
I began to think...well, yes, he DOES have alot of good attributes and I may never find someone else, perhaps I SHOULD hold on to him!
I went home and asked Husband for a hug.It felt so good! maybe I was making a huge mistake! There was still time to avert relationship meltdown.

WAIT!
WHEW
Yes I had a nanosecond of insanity there.Why would I want to be with a man who was willing to date other women?Should'nt I settle for no less than to be cherished as he did his former wife? Clear out all the bull and what does anyone want? Love, fidelity and honesty. I got none.
I told Belle at work the other night that I was considering letting Husband stay and her head whipped around so fast and said to me "Do you want room 7 or 8?" Those are our psych observation rooms.Okay point taken!!
No doubt this is hard. My eyes leak at irregular intervals and my chest aches with sorrow. I went to a party this weekend
Vulgar details to follow.

Someone wrong is not better than plain noone

2006-10-12T19:45:00.000-04:00

I am near the end of almost a week off from work. I feel sheepish to admit that I have enjoyed puttering around the house and just relaxing.
Husband has an apartment he is supposed to be in by November first. My eyebrows raised when I heard from his best friend that he still thinks this move is a bridge to a better realtionship between us.STILL!Yes, we are getting along better, but I attribute that to me not caring what is on his laptop, email, TV, DVD collection, why he is late, what numbers are on his answering machine. I am too worn out to investigate a damn thing.
I know he will leave many, many things behind and come back to pick one more thing he really needs.(sigh)
He told his friend that the reason we are separating is that he cannot "prostitute his principles " because he does not agree with how I raise my children ! NO mention of ignoring me sexually in favor of courting women he has not even met!
Husband has been very affectionate and playful with me. It makes me tearful, because I am mourning what our relationship never was. I don't want this reformed man that I fear will revert to past infractions once I am lulled into complacency. I dont think he is worried about losing a wife because he has not treated me as one in so long. He is losing "mommy" a home, security, meals,laundry done. No worries right?
I undress with my back turned to him. I wear sweats to bed because I cannot stand the thought of him "casually" brushing my breasts with his fingers as we sleep makes me ill.He actually called me on it the other night,"Are you afraid I will touch your boobies?" UH yeah, You never would before even though I went to bed stark naked or in wisps of transparent fabric begging for a passionate kiss and to be teased, held and revelled in.The desire stopped when I found condoms in his backpack.Fuck off ass and all your excuses.
Husband augments his incom with selling cameras on MY ebay account. I need to change the password AND get a new primary bank account since so ebay is connected to my account!This will suck because my bank account is deducted automatically, child support and pay check is auto deposited.ARGH. Better than being defrauded.
There is the matter of $3300 he owes for a car I purchased for him on my credit card. I suspect I will have to cut my losses and say good riddance to him and the money.
I have a new lock all ready to install when he leaves. WHy do I feel guilty? I know that what is happening is a direct result of HIS actions and misbehavior but I hate being the meanie.If I don't do this now I will be miserable in a year wishing I had.Remind me will all of you? I want to be treasured, held,respected,loved. I may never find it.Someone wrong is not better than plain noone.

an accomplished liar

2006-10-08T10:25:00.000-04:00

The last few months have been the very definition of confusion and angst. I have learned of further evidence of my husbands deceit and twisted thought processes, I was prepared to attempt a full forgiveness and reconciliation until I realized that he played with not only my own feelings and trust but that of at least 6 other women. This is not a man to be trusted I alternate between crying and being hopeful for myself. I fear that noone will care for/about me.
Husband has found an apt an hour away, closer to his work. I suspect the apt is in the home of one of his "girlfriends", but I have had my "give a damn" put on hold. He will be out by November 1.
Somehow he has the idea that this is a step to healing for the both of us, but I will be changing the locks as soon as he is gone and pack up anything left .I am done.I removed my keys from his ring. He is fully aware I can royally mess his life up should I want to be malicious.
He keeps calling me "honey" or sweetie" and asking for kisses. I have no desire to be touched by him.I wear clothes to bed now and lock the door while showering. He has lost all privileges to this body.
An acomplished liar is the most dangerous advesary. There is nothing to base trust, forgiveness,or a relationship on.

Getting Personal

2006-09-03T01:39:00.000-04:00

I have been trying. I swear. I DO want to be a good blogger.I DO I DO I DO!
But you see... I am having issues. My husband of just over a year has admitted after much suspicions on my part to "talking"of other women on the internet and phone.He had a meeting planned for a day my boys and I were going to be out of the area.He took a woman to a baseball game with tickets yours truly bought.
Husband says this is due to not feeling attractive. He needed other women to notice him.
HUH? He says that now that he realizes the issue he can cut it off before it develops into anything.
HUH?
I do not know what do do.
There have been many many lies that do not include this latest debaucle.He is over $20,000 in debt with the IRS that he failed to tell me about. He married his ex TWICE and I had to learn THAT tidbit from my mother in law.He has never come forward to admit anything I had not found out about first.There is more but I am too weary even to hash it out enough to type.
It kills me that this man who could only grunt at me could spend hours on the phone and online with other women.
I found their numbers and I called everyone and introduced myself.
Work is my refuge.
I cry alot. I do not even know what to do.
Deep inside I don't think I will ever trust him again. I HATE HATE HATE being lied to.This is my house.I have my own money. I have my career. I have my pride.

Oh what a night

2006-08-31T20:05:00.000-04:00

Last night in Rural ED started out with all the rooms full, a full waiting room and only 3 inpatient beds available.Add to the mix back to back to back ambulance arrivals and we then lined the perimeter with hallway admits.Fortunatly Dr.D , the ED medical director and rescue flight coordinator was on. Dr. D is quick ,decisive and moves and groves the house.
The unheard of happened. We went on diversion at 2145.Diversion means that we do not accept any ambulances because our acuity dictates a possible unsafe environment. NO more monitered inpatient beds or ED units were available as the portable baby zolls were already monitering the hallway patients.
The local radio station must have announced fracture night . In a 90 minute period we booked in :Wrist fracture on a skateboarding kid , wrist fracture,L-1 fracture and hip fracture on a man who was on a ladder under the influence, wrist fracture on a kickboxing woman, ankle fracture on a man who chased after a car to remind his wife to drive safe, orbital fracture on a fellow vs baseball altercation.
At midnight we went off diversion. Whew.
I discharged my abdominal pain patient at 0108. WE NEVE HAD ANOTHER PATIENT FOR THE REST OF THE NIGHT. I was floored.I flipped through gossip magazines left behind. I sat in the waiting room watching TV. I re-organized the IV trays.I played spit ball soccar. I cleaned out my mailbox.We gossiped mercilessly.
WAIT.
I feel guilty.
I am getting paid for this??
My co-nurse explained it to me :You are getting paid for the skill and ability to perform live saving feats at a moments notice.You do not get paid extra during periods of insanity. You do not get penalized for just taking up space either.
Makes sense.

The tour

2006-08-20T22:15:00.000-04:00

Welcome to the tour of the Emergency Department at Rural Hospital for all of the frequenters of blogville. I am asked what type of emergency treatment is provided in "my" ED.Pediatric?Trauma 1?Urgent Care? All of it.I truly have no idea what my next chart will bring into my care.Being a small hospital there is no ability to specialize. I do have to admit that I prefer a chest pain client to a whining toddler anyday.
I start my shift by using the lone ambulance bay entrance .At 7 pm the other option is either a hike around the hospital or to stroll through the ambulatory waiting room .(no, thank you)To the immediate left as you enter is a very large room divided by a curtain designated at rooms 1 & 2. The traumas or concious sedations usually done here because of space and that the crash cart resides here too.

Rooms 3 & 4 are known as the private rooms because they have solid doors and are equipped for GYN exams and for sexual assault evidence collection and treatment. Sometimes very loud folks are put in these rooms and the window shades are opened to observe yet not hear them so intrusively.

Rooms 5 & 6 are directly opposite the ambulance entrance at the far end of the ED and are curtained rooms.

Continuing to move in a circle is the door to the waiting room, then nurses desk which is equipped with three computers. There are two nurses on each 12 hour shift plus an additional one from 2pm to 10pm.An ED tech is on from 10pm to 10 pm. Behind the desk is the entry to the registrars desk , the pyxis "compound" ,and the supply room.The triaged patient's charts are placed in a rack and the nurses self assign. This works out well and noone ever slacks. If anything we accuse a few of being patient hogs.

Still moving in the circle we arrive at the psych rooms 7& 8. They are devoid of the usual supplies and devices in the other rooms , camera observation enabled, with additional protective meaures to ensure the saftey of an agitated or suicidal client.

Viola! We are back at he ambulance bay.Alas! We need the code to get out.Now that I have you trapped here.... You feel like taking the baby in 5?

Primary Attachment

2006-08-19T21:54:00.000-04:00

People are attached to their primary physicians.They are like family and assuring presences rolled in one.Several times I have had a patient hopeful that their primary would be treating them in the ED instead of the Emergency Doc.Nice Try, but no go.

This affinity of people for their personal doctor was never demonstrated fuller than this past week. We recieved a call through the main desk in the ED.

CALLER: "I am on major route in Prestigious City and my father is having crushing chest pain!!.I am on my way in!I'll be there in an hour."

NURSE: "NO!Go straight to University Hospital. It is one mile from you!Better yet, pull over and call 911"

CALLER: "His doctor is at Rural Hospital,Dad wants his own doctor. We are coming in" CLICK

Indeed, son and father did arrive.Son gave us a tongue lashing because he expected we would be waitng at curbside to meet his vehicle.(Emergency Concierge service?)We extrated a pale and anxious man out of the car.
Nitro, aspirin,lopressor,labs, EKGs,X-Rays,two IV lines,cardiac moniter,morphine and much hand-wringing later this gentleman was indeed experiencing a "major" myocardial infarction.

The irony was not lost on anyone when the decision was made to transport the patient via helicopter to University Hospital back at Prestigious City from whence they has just travelled.
I felt for the Son when he realized the gravity of the situation and the possible ramifications of the choices made.
More dead people are pulled from private vehicles than ambulances.
Speed of treatment directly corrolates to chances of survival and full recovery.
As much as you adore and trust your primary, She or He cannot help you from a distance,so please ,please Please for go familiarity for proximity.It may save your life to be in the hands of strangers.

Symptoms of significance

2006-08-12T14:27:00.000-04:00

Last night a woman presented, bringing her mother that she was concerned about. There were no specific complaints,other than,"She just isn't right".We were able to get the elderly woman back quickly .She has purplish mottling from her toes to the tops of her breasts with cool slimey skin. Oxygen Saturations were in the 70's. As we rolled the woman over to assess her back and removed clothes she began to projectile vomit foul smelling green and black tissue matter. The doc later said this was bowel tissue and she had a bowel ischemia with necrotic (dead) bowel that poisoned her system.The woman died within 30 minutes of stepping foot in the Emergency Dept.

This woman was seen at a different ED in another town the day before, with discharge instructions to increase fiber and take an antibiotic.Sometimes the more cynical staff refer to this facility as "Other Hospital and Veterinary Clinic",clearly pointing out their perceived inferiority to Rural Hospital.
Although I like to believe that this oversight could never happen at a quality establishment,but I wonder what happens to those who we see with vague complaints and a poor history. DO they later show a serious malady? I recall one woman who was seen with sharp pain around her trunk. She was not sure if it was topical or muscular.After an exam and films she was sent home with an analgesia script. Two days later she presented again,but now with with a red ,vesicle encrusted rash along the same lines as the pain she previously complained of.She had shingles, a painful adult version of the chicken pox that manifests along nerve tracts. She has sought treatment early ,however, before she could be diagnosed correctly.

What did the other ED see or not see that caused them to send this patient home with a decaying gut?Would it have made any difference? Probably not, except that her family would have known sooner her prognosis, would not have questioned the quality of care she received at Other ED and may have been spared the feelings of guilt they so heartbreakingly expressed.
I cannot point fingers or bask in any false sense of working for a superior facility.Noone is superhuman with the ability to immediately diagnose correctly.The human body is a mystery,giving clues that are sometimes contradictory .Unlike a car whose problem remains the same until it is repaired,our bodies are ever
changing,trying to stay in balance.How many times does the patient tell the triage nurse one thing, the admitting nurse another, the ED doc yet another symptom? All may be true and it is up to us to gather that data and come to a reasonable conclusion.
I pray I do not overlook any symptom of significance, and am able to serve my patients to the very best of anyone's ability .

Lack of Progress

2006-08-12T14:00:00.000-04:00

On a more personal note, My quest to find a rheumatologist who will accept me has

been a bit arduous. I called the closest one and she is not seeing new patients for

six months.I want my instant gratification too when it comes to pain and symptom

control as well as maintaining my functioning ability.On suggestion, I

called University Hospital in the Major City that has a department of 12

rheumatologists.In order to be even evaluated

I had to ask my primary to fax my lab values ,as well as a note outlining WHY

I was seeking their care .I will then be evaluated on the merits of the info

contained in said fax, and get a call

to present at a certain time (and do not be tardy) if and only IF I am assessed to

meet criteria.Two weeks has passed and I am still waiting.I feel like I am

being auditioned for a part.I do under

stand that time is a precious commodity,however as this is still the United States ,

I am a consumer of healthcare, my primary wishes me to be seen .If I am deemed

worthy of sullying their exam room with my person I wonder if I should bow and

genuflect before or after the visit. I better be safe and do it both times.

-----------------------------------
My personal relationship life is in disarray. I am trying to come to grips and pick the course that will cause the least damage to my heart and soul in the long run. I am working on a blog entry about it, but it is not something that can be easily put into words by me because of the emotional impact it is having on me.
----------------------------------
The Effexor seems to be helping. I have lost 6# and I do not know if that is from "other issues" or the switch in antidepressants. I do feel a bit numb however and do not know if it is again from my relationship drama or the effexorTime tells all.

Coming to an Emergency Department near YOU!

2006-08-04T19:18:00.000-04:00

In the interest of expeditious Emergency care our Emergency Department will be implementing an exciting time saving program. After careful consideration of Rural Hospitals Emergency room clientele needs and desiring the best feedback possible a fast lane will be installed, bypassing the registrars desk.
SO many of our esteemed "Mastercaid" customers have lengthly waits foisted upon them even though they know exactly the treatment needed to improve their quality of life and progress them to discharge.

Why deal with the mundane triage query,nurses assessment ,physicians assessment to get what they came for?!

In a collaborative effort with other area hospitals Rural Hospital will install a vending machine.Each of our frequent fliers will be finger printed, have their drug and route of choice pre-programmed into a super computer that communicates with all the other emergency departments.

Our patient will choose from diagnosis de jour,present finger to the infrared scanner and have the pre-determined dose of dilaudid,xanax or whatever propelled into their body.

No waiting.No waiting room drama.No inventing of creative new diagnosis.No lying about losing the script provided last night.No embarrassment.

As the vending system has dosage limits and networks with area EDs there is no overdosing or need to shop hospitals.

Think of the happy customers! Think of the staff time freed up!No more wasting of funds on diagnostic tests when the patient knows what they are REALLY presenting to the Emergency Department for.

Truly a healthcare revolution.

Ready or Not

2006-07-29T20:42:00.000-04:00

After a challenging shift Wednesday Boss called me into her office. As I followed her into the office I asked,"Am I in trouble?" Boss looked back over her shoulder and said ,"Oh yes,more than you know" Here goes, I thought.
After seating me in the very chair I interviewed from Boss clapsed her hands togather and gave me what I call the peanut butter mayonnaise sandwich, which is praise (the bread),an observation(the peanut butter),the stunner(mayonnaise)and more bread (praise)For me it went something like:
"YOu did really well with that 422 BAL woman all shift,and you did wonderful in the room,but I noticed you were negative when you came back to the desk."
ME:uh huh (waiting for THE point)
"With some of the staff leaving, You will be off orientation in two weeks(6 weeks early) as there is noone else to work now,But you have come a long way and you will be fine"
ME:glakgnerum..uh...(help!)

A dose of reality

2006-07-22T14:47:00.000-04:00

As Disappearing John pointed out, playing doctor with my meds is not a wise thing to do.My bad.Nurses are that way.I went to New MD last week and after my height and weight was taken she consulted the chart and said" You are in the obese catagory" Ick. I know I have 45# to lose but what a title to have silently follow me everywhere, seeming to announce "Make way for the obese woman!"I do not believe the height and weight scales are a realistic reflection for all people.
New MD looked at my lab work, questioned my state of depression and said"WE will deal with your weight lastly" Huh???It turns out that I have a positive ANA, which translates to an immune disorder, most likley SLE,Systemic Lupus Erythemia.An AHA moment indeed. No wonder I hurt all over, no wonder I have inescapable depression, no wonder I get pneumonia 2 weeks a year.I am not crazy after all .I worried that with the vague and inexplicable symptoms I had that it was all attributable to the depression. Instead I have a physical ailment that causes the depression. Not that it matters.
I have been a barely functioning emotional time bomb since tinkering with my meds. After an tongue lashing from the New MD, she discontinued the zoloft , saying she did not like it for women anyways.I will start Effexor 25 mg TID Monday. I have never heard of dosing like that. I also Have to see a Rheumatologist,and a Psychiatrist this month and report back to primary New MD.
I hate being confined to one pair of "fat pants" since I will not buy anymore.I am going to try to take a pic of me to post on my next entry. I even cruised site like "Crazy for fat chicks" and "Chubby Chasers " to see if there was hope for me.The thing is these girls are delighted with themselves and I am not.I have never been"thin" But I have been more comfortable in my skin. I sound so shallow.

demonic depression

2006-07-14T22:23:00.000-04:00

Okay comrades of the blog world, RuralRN is struggling with depression.I have been trying to titrate my Zoloft because I have gained #30 on it in the last 6 months despite a 3 liter daily water intake, and 5 weekly work outs.I figured being overweight did not help my mood.Stepping on the scale to find I have dropped #5 is an amazing elevator of my mood...and a #5 gain is a reason for everyone to clear out of my way...I am talking snarky,evil RN who emerges with a scorch and burnt earth policy freshly renewed in my hip pocket.
Don't tell me I have every reason to be happy. I know that. I have finally finished school. I have my goal job.It is summer.I just cannot help it.

In a perverse way I feel like I am looking over a ravine and drawn into the dark bottomless abyss. I want to be swallowed by the depression and taken into the comfortable arms of darkness at the same time I am terrified of the demons that will torment me and make my whole life and thought painful.

I know what I should do.

I am a deer in the headlights of my nemesis staring, fascinated and helpless.

A dear friend noted that I had my bad spells whenever something good happened. I would pass a final and promptly crash.The stress would build up I would make it through my little mountain and fall .Do I think that I am not deserving of success?

I am such a fraud.

I search the psych patients,watch them change and lock up their belongings when perhaps lurking in my head is a sickness more insidious than their.

Why??
Because I can hide it. Noone knows.

Noone will know .

Until I am so far enveloped into depressions grip that I stop caring to put up pretenses.

I know how to distract the suspicious and say the right things.

I need to tear my eyes away from the pit .Stop tempting myself from giving in, allowing myself to be taken over.

Fighting the inevitable is exhausting.

I want to let go.

Fall freely.

I am going to have to ride this nightmare until its finish.

Which will be the rest of my life.

one way

or

another.

a smattering

2006-07-10T20:43:00.000-04:00

I am having trouble. Oh yes, Rural RN needs someone to float her a line. about 5 pm today my preceptor looked at me then the Doc and said,"She is out of service,for now" Who me??? "Yes, you, now eat.breathe.pee" I ended up with the lecture that my brain is burning so much energy right now that if I do not replenish said grey matter with nourishment I am no good to anyone.Makes sense.
It has always been such a no no to eat while charting or anything else that it is a hard habit to break. Here I am being encouraged to eat AND chart!
I also get caught up in trying to do so much for my patients.Everyone looks sickly in those mismatched hospital PJs and I feel obligated to heal all their woes.I need to remember that the ED is ala cart medicine.We treat and street ideally.
I am working on a soothing ,confident demeanor.That will probably come with experience and as my nerves relax.I have all these training classes coming and packets of material to read and test on.PALS,BMT,EKG reading...ugh the strips are looking alike to me at this point.The more I look at them the more they blend together.
On the bright side I am getting better at IV starts. I do need to remember to remove the tournaquit when I am done.Time still flies as fast. TodayI saw the night shift standing next to e and I asked what they were in early for and almost fell over when It was in deed 1900.

Excuse me Nurse,there is blood in my Alcohol stream!

2006-07-07T10:46:00.000-04:00

My last few shifts dominated by many sad and pathetic people who crawled into bottles of alcohol or narcotics and lost their way out.I am lost between compassion and disgust.Anyone who presents in a distraught and miserable state needs kindness, however my kindness is tested when the same person arrives with a blood alcohol of 0.300 to 0.450 three days out of four.

These people lie, deceive, manipulate and often even steal to supply their need.None of those traits are anything that I find likeable. This past week I have witnessed multiple feigned seizures,dodged reeking breath, washed the hygeinicly challenged,been threatened with harm if I did not medicate them with their drug of choice,and totally had the pity sucked out of me.
Yes life can be cruel. I have felt the backhanded tough love that life hands out and admittedly wanted something, nay anything to take the pain away.This is the very thing that keeps me humane, the realization that all of us have our frailities

Boo Boo DE Doop

2006-07-01T22:52:00.000-04:00

I am going to get a Betty Boop nurse tatoo with "Boop happens" written below it. Why a tattoo? It is art work you carry with you. I know someday I will be 85 and the snot nose CNAs will snicker at my tattoos but I will hopefully be reliving my foolish youth and take no mind.I had a "secret" piercing for a while until I removed it for a day and it healed over. I remember the pain too well to be in a hurry to bare my girls to the overly appreciative piercer any time soon.
I actually an enforcing a self imposed waiting period before I get inked.You know how you LOVED the shoes in the store but the following week you were wondering who spiked your corn flakes to get you to buy those hideous things?
A tat is not returnable. Nope.The removal is worse than the application.Another consideration is a site for planned tattoo.It would have to be where noone at work could see it.I am not ashamed of who I am by any means but I know the public has different opinions on body art and I want to be taken as the professional .
Why not a Betty Boop picture on my wall? It doesn't go with my decor of early farmhouse.
SO Betty is still on the drawing board , being tweaked and mulled. I promise if she materializes on my epidermis I will post the picture!!

a reason to drink

2006-06-30T23:32:00.000-04:00

Yes, I am a sexy night nurse here for your viewing and fantasizing pleasure.Not really but I thought I would let you mull that over for a sec...was it good?
I love introducing myself to the patients...I am your RN..it rolls off my tongue...
Before I left for home tuesday I had a woman brought in by EMS unresponsive secondary to alcohol consumption.Her family wanted her admitted for mental health issues, but there is a drying out period that has to take place before any one from CPEP, our behavior health dept can even speak to a person. After all a drunk person cannot be accurately be assessed for soundness of mental health. We use a formula based on admitting BAC to determine when the patient is cleared.Admit was not cleared until I returned the next day.
Admit was anxious ,vague and visiably suffering from alcohol withdrawal. The off going shift reported administering her 6 mg of Ativan and 5 mg of haldol with out slowing her at all. Admit tried to follow me into other rooms and called my name accross the unit to ask when she could leave 5 times before I had been there an hour.
I was relieved to see her family show up. Daughter was attentive.Husband however was a different story.

HIM:"SO is it true what they say about HEAD nurses"
ME:"Why yes, they are very organized and strong unit leaders"
HIM: "you know what I mean,looking like you,I bet you're a doctors favorite"
ME:"I work for for the hospital, not the doc"(all this in front of Admit, his wife while I was setting up her breakfast tray)
ADMIT: "I am not hungry" (looking at the floor)
HIM: "How about some food for me"
ME:"Sir, you just arrived,surely you ate at at home"
HIM: "I was hoping you would sit on my lap and feed me"

No wonder this poor woman drinks and numbs herself against reality.
I have to wonder how much of the anguish we feel is of chemical imbalances, uncontrolled circumstance, or us allowing other people to negatively impact our lives because we hope that by being agreeable as possible and accepting of agregious behaviour we will finally get the love we seek from the one person that holds our hearts .

earning the Raspberry

2006-06-29T22:50:00.000-04:00

Rural Hospital is always concerned about its customer rating.For the past few years every single employee has been required to attend "pickle" inservices. The pickle program was conceived by a restaurantuer who encouraged giving the customer whatever it took to make them happy ergo...give the the pickle.All employees are encouraged...NAY...REQUIRED to make the utmost effort to keep the people we serve happy and give the pickle so to speak.Plastic pickle pins were handed out tobe worn as a reminder to do that bit extra.
Amongst employees if has been somewhat of a point of contention.Dealing with the public is tricky. .Some folks cannot be satisfied and the effort to appease can be draining.Staff are concerned that we will give the pickle to the detriment of our dignity and pofessionalism. Gone are the days when what the RN said went on the floor.Nurse Cratchet where are you?? Yes, people are health care consumers and should be informed, treated politely and have needs met. However , this is NOT your private spa,that machine is not for your child to play with ,and I am an in demand commodity...I cannot be at your bedside for the entire twelve hours .
"UH, huh, yes , no problem,um, sure....I'll see what can be done... really? oh .okay then.yep, its my pleasure" My admit was gleefully testing her limits at the Rural Hospital ED Hilton. I walked out of the room,pulled a face and slowly banged my head against the wall when admit asked me to change her incontinent father's brief.
Tom called me over to the desk and was silently laughing. He patted me on the back and said,"You will earn your raspberry quick , I can tell"

"Whats a raspberry?"

"Well theres the pickle we give the customer, here in the ED we give the nurses the raspberry "
He showed me the raspberry sticker on his name tag.
"You get one for dealing with the impossible with humor and a lil ' tude"

cool, im ready...I would like to thank the academy for this honor of the raspberry...
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I am struggling if to include bits of my private life in this blog.I do have a personal blog that I have left stagnant as of late.I only have energy for one blog.Jo at Head Nurse has made a few outstanding posts on depression . I am quite tempted to follow her lead.I may sprinkle with a few details and see how it goes.

ants and uncles

2006-06-29T13:08:00.000-04:00

As busy as the ED can be there are moments of pure hilarity. A seasoned nurse ,Babs(She introduce herself to me as ,"I am Babs, Babs the Bitch") shakes her head daily and says,"People do not listen.People do not read." As prickly as Babs is on the outside I have come to like her already. It may be a mission on my part to get along with the One Person everyone has warned me about.
One of our patients was accompanied by a caregiver who introduces herself as her RN,however it is well known that this caregiver is a home health aide .Some of the staff find it very difficult to deal with the caregiver's theatrics that include directing the staff and interjecting into conversations with her own expert opinion.
Caregiver: Can I ask you a legal question?
PCT: I am not allowed to give legal advice.
Caregiver:okay then..how about a medical question?
PCT: Perhaps or you can speak to the RN
Caregiver:Isn't it ILLEGAL to have ants in a hospital!!!(points at lone ant on floor)
PCT:I'm sorry that bothers you.I will remove it.
Caregiver:I have never seen such a thing! Ants in a hospital!!!!We may sue.
PCT:(scoops up insect) See, its gone.
Caregiver:I am appalled.......
Babs:(bustled over) (loudly) Not only do we allow ants , we allow uncles too, I think you would be more comfortable in the waiting room.

Bravo to Babs. the caregiver was neatly deposited in the waiting room to sputter without an audience.Babs is a formidable entity,has no trouble whisking cells phones out of peoples hands who ignore a polite reminder ,and is a damned fine nurse.my hero.

a bit of heaven

2006-06-26T20:23:00.000-04:00

She rolled her instrument to the vacant area at the far end of the desk,adjusted her seat,tilted her head back with eyes close and poised her delicate hands over the strings of her harp.I am sure the angels swoon with the celestial music that permeated in our ED.Yes, at Rural Hospital with are graced with a harpist a few hourly sessions a week.
The change in the atmosphere in the ED was instant and soothing. The belligerant psych patient mellowed and smiled, the nurses seems to glide accross the unit in a waltzing lilt,even the phones cooperated.
We had a bit of heaven in our midst.

First impressions

2006-06-25T16:49:00.000-04:00

I survived my first few days in the ED. I had no idea time was so slippery.Or the volume of people that could be seen in a period of time. A few trends have been noted in some other blogs I read. They bear repeating because of their truth:
1) People use the ED as primary care providers. Uh HUH so you have has this feeling of heaviness for a month with no shortness of breath or pain and you needed to come in wednesday afternoon at 4 pm to have it checked why??...So you want me to make your 20 year old daughter douche after menses...um no...and no I will not force her to do it here in the ER.
2)primary care providers use the ED as a diagnostic tool.Patient reports to their office with a complaint and gets sent to the ED to have it 'assessed'.ISN't that the exact job description of a primary??!!!
3)There is a corrolation between the asinine trivality of a presenting problem and the histronics of accompanying family
3b)There is a direct corrolation between the asinine trivality of presenting complaint and sheer numbers of accompanying family
3c)said family that shows histronics and shows up en force usually has a high dirt bag/ deliverance quality
3d)dirt bag families treat the ED as their own social club.
4)The less effort someone will have to put in to reconcile their ED visit bill increases their sense of entitlement and requests for things like vouchers,meals,and stat results on their pregnancy test.
5)The moniter is a source of facsination to most and the patients will crane their necks to stare at it even though they have no clue what the numbers or thr Rhthym means.
6)The moment I have to stuff a morsel in my mouth, someone will see me and complain that all I do it eat and ignore their needs.
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The things I LOVE about the ED.
The Docs trust the nurses , remember my name and are called by the first name by everyone.
I know that in time the PITAs will move elsewhere.
Unpredictability.
Noone gripes. There is a real gir er done attitude.
The techs are awesome.They groove the ED. They are the Radar O Riellys of the ED.
Availabilty to services and supplies...nothing is lacking
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This has been a real general post. I have a few in draft I am going to change up a bit for HIPPA sake. Over all I know I made the right move. I am nervous that My speed will not catch up to that of the senior nurses. I feel like I am forgetting things I already know well, that the new atmosphere has purged my brain.I will adapt and grow and hopefully be a valuable asset to my ED.

accepting limits

2006-06-24T19:15:00.000-04:00

"Incoming from Dr.Nigels office.Its Mrs. Arrythmia" My preceptor took a deep breath, and let it out slowly as she rolled her eyes.All the rooms were full.We already had 4 hallways patients."Okay pull 6 out and we will put her in there , we will need the monitered bed for her" Make that 5 hallway patients.
I helped preceptors undress this feeble,brittly ancient, woman , I noticed her atrocious hygeine,filthy colostomy appliance, and poo on her shoes.Mrs. Arrythmia had poor balance and difficulty hearing even with her hearing aides in. The preceptor whispered,"she is in here once a week at least" I shot her a questioning look and asked,"Why isn't she in a LTC? or getting more help?"
I learned that Dr. Nigel owns a nearby senior housing complex with only medication aides for assist, we call Garden Terrace and it financhially advantageous for Dr. Nigel that Mrs. Arrythmia return to Garden Terrace instead of to a LTC. The elderly are promised the attention of Dr. Nigel who does stop by the complex and is on call for them.Most of the older population treasure indepenadence and are happy to be encourage to remain at the complex by Dr. Nigel. I have sincere doubts if their perference and his wallet are truly in the best interests.
We pushed Cardizem to bring her from a tachy 170 to a reasonable 98 bpm.Dr.Nigel made an appearance and a hearty " How are you you lady!", to our Mrs. Arrythmia. She was released to the van driver of her senior complex.
There was so much I wanted to do for this woman.I loathe to accept limitations.I will see her next week...and the week after and.....

Good company

2006-06-20T18:18:00.000-04:00

I am very pleased to have been added to the company of two individuals I read regularly and admire in the blog world....Disappearing John and Kim at Emergiblog.After much fussing and over an hour of bloopers I have been able to link John on my Blog(it looks maligned but the link functions!). I will link Kim as soon as I have regained my PC stamina.
I DID get my new Photo and badge today. The picture is not too bad. However I do not have RN after my name.Someone asked me if it really mattered. I paused and you know what? Yes it does matter. I worked hard as an adult learner, suffered through odious schedules, fretted over the NCLEX (now I fret over the NCLEX 15# I have found. M&Ms are NOT my friends! beware)I will wear the tag I have to start but am proud of my achievment and WANT to be identified with my credentials.
Security and the ED nurses have a close relationship at Rural Hospital as the facility also boasts and alcohol and mental health treatment units and most of those admits come through the ED.The buildings the units are housed in has a high brow name. For the sake of this blog I will call it Briar Commons. When I was getting close to finishing school Human Resources called me at home to offer me a full time night position in Briar Commons. I had no passion for the idea of it so I quickly declined. Life takes passion.I have a passion for the ED and hopefully soon the skill.

a spider's labyrinth

2006-06-18T17:39:00.000-04:00

This is a cool picture I took early one morning looking outside of Rural Hospital's window. Notice the meditation labyrinth below.The labyrinth is a maze meant to be walked by employees,patients and visitors to assist in finding inner peace.The spider has it's own self made maze with it's web.Nature's Labyrinth overlaying man's.The spider was a dark grey but reflected brightly when I snapped the shot.

ID and insurance

2006-06-18T07:41:00.000-04:00

I feel a bit fraudulant posting in this blog when I have not yet started the ED position. Wednesday I signed my intent to transfer form and have Old Boss sign off it too. Old Boss was very abrupt."Congratulations,enjoy the new job.Goodbye" Just like that I was not pertinent anymore.
I am so excited that I will be allowed to pose for a new photo ID Tuesday. My original one was so hideous, I would turn it around so noone could see it. The day the photo was taken I had been crying,in the rain, wearing overalls.I looked like a soggy depressed redneck. Argh.I did get a new badge last year after presenting proof the old one was unusable. ( it fell in the shredder and I barely escaped with my limbs intact). I dressed nice, smiled wide and *click*
My face fell when I was handed the badge two days later with the depressed redneck picture on it!! Third times the charm?
Another exciting prospect is signing up for insurance! I have worked 24- 60 hours most weeks but could never commit to regular full time hours to get reasonable priced insurance rates.I will get my boobies squished and scanned when the time comes!I will not tough out pneumonia!The thing about not having insurance and not yet poor enough for Medicaid is that it makes one afraid to go in for even simple check ups because SOMETHING might be found.SOMETHING is usually expensive .I will not take up free fall sky diving or neglect my teeth because of having insurance but I will no longer consider wrecking my car should I have a fracture just so the auto insurance would cover the pre-existing injury!

a new beginning

2006-06-16T16:26:00.000-04:00

I have decided to begin a blog journaling my transition from a long term care LPN to an ED RN. YES I signed papers today to begin the transfer. I have read blogs such as DisappearingJohnRN and Emergiblog and been encouraged to first of all enter emergency nursing and secondly to write my experiences.
I think I will call my blog:RuralED
The hospital I work for is small by about any standards but very forward thinking, embracing mineral baths,acupuncture and Qi Gong for its employees and patients alike. If I did not see the date on the calendar, I would pause to think I was in the 60's.
In the LTC a nurse manager does energy field work and uses the nepalese/tibetian drum on residents.Rural hospital is proud of its history and considers itself a pearl in the healthcare world.
A bit of my history: I was an LPN for 16 years and recently passed the NCLEX for my RN. I have worked acute,neurosurgical,and LTC. I saw the posting for the ED position months ago and began campaigning for it.I was initially met with skepticism that I would be able to transition from LTC to emergency nursing but I made an argument that everyone has to start SOMEwhere.I point blank said "I WANT this job!"Perhaps not the most eloquent but it was succinct and here I am on the verge of my new job. I go from working 11 pm to 7 am to orienting 7 am to 7 pm next week. Between orienting and finishing out my present job I will be putting in 64 hours next week.
To be honest, I am very nervous.Emergency nursing is like nothing else.Where else will I be able to experience as much in as short a period of time? New Boss has helped put my anxiety at rest a teensy bit when she called this afternoon and exclaimed,"We are soooo excited to have you come to us!!"
I hope you all join me as I make mistakes, learn and grow as a nurse.

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