15 September 2007

busy, busy

It's been a while since my last post as life seems to be overtaking my time to blog. Memorial day brought family to town for a visit. We all ended up at mom's house to eat and spend time together. We also visited the local waterpark and had a blast riding all the slides we could find. Later on my brother astounded us with feats of strength!

In July went on the high school missions trip with our youth group from church. This year the group headed to Jamaica. We built a house for a pastor there and ran vacation bible school (VBS) for a week. In the rural community where we went to build the parsonage, pastors rotate through or visit sporadically while staying with local congregation members as there is no where for these pastors to stay. So we decided to go and build a two room house in order to plant a pastor in a church! We went with members of our 'sister' church in all there were 36 of us.

I was part of the VBS group and got to organize the games for VBS. The theme was 'SCUBA' which was an acronym for Super Cool Underwater Bible Adventures. So my games centered around the Bible verses and concepts we were teaching and I tried to name them something to do with animals found in the ocean or Bible characters. The pic below is of the Jonah boat races where is each child has a bowl, a cotton ball (Jonah), and a straw. They put Jonah in boat and use the straw to be the wind and race their boats against one another without blowing Jonah overboard.

The kids loved it as they were quite a distance from the ocean up in the hills. I think they loved playing in the water more than anything. Me too!

Oh, yeah, I found a new job, too. I started right before I left for Jamaica. I've been at the new hospital for two months and, get this, I'm the boss!!

29 April 2007

whatcha doin?

Have you ever felt like putting on your wrestling suit at work? Well, this past year has been very difficult at the hospital where I work. Reading TrenchDoc's blog
made me think about how it seems that none of the administration ever values the experienced staff. Anyway, I definitely have felt the call of the luchadore. I think I'd be the one on the left, but add a flowing turquoise cape to my ensemble.

So, after a year of experiencing my new manager's feeble attempts at managing staff much more experienced than her, I am searching for a new job. I have updated my CV and resume, bought a new suit from Brooks Bros, and warned my immediate family members that I may need to relocate in order to find the right spot for me. I hate doing this, but after bringing forward issues as a group, my colleagues and I were told that "there weren't any real issues presented." Now, I'm not one to rock the boat, but as many of us were targeted and treated unfairly, we banded together to go to HR. To be treated like this has made many of us leave and others to look for new positions. Of course, manager and her boss are spinning this to their advantage; all the while, morale sinks to a new low and turn over rises to a new high - 50%.

If not a luchadore, how about manager of the local Starbuck's? Stock options, beautiful green apron (which may double as cape), and a free pound of coffee a week for those suffering from caffeine addiction. Sounds pretty good to me! If you screw up, everyone gets a free coffee. Much better outcomes than some of my patients. I wonder if Starbuck's experiences as much turn over as our department has in the last year?

How about ER nursing? I could ditch the ole suit and wear my awesome collection of scrubs to work! I'd be able to use my background in triage with my keen wit to learn a new and exciting specialty. When my kiddo goes to college in 3 (count 'em with me) years, I could take my act on the road and see the world. And, I would be able to wear my favorite scrub dress of all time. You know, the one all the old folks think are flowers, but are really flying pigs :D
Hmmmm...that might be fun for a while.

17 March 2007

Acute Liver Success

Got a page late in the day from the PI, "The fellow admitted an ALF patient yesterday (Sunday)." That's code for some poor patient is in the ICU with acute liver failure and I want you to go sign them up for our study. Honestly, I enjoy being the research nurse/coordinator, but it doesn't mean it gets any easier to go and sign up potential participants. This poor guy in particular....

"Hey, AZ! Whatcha doin' up here in the unit," asked MH, the charge nurse? "I came to screen the ALF patient. Do you know who's taking care of him, right now?" "Sure do, he's in 7 with Linda. Let me give ya her number...."* "Hi, Linda, it's AZ. Is there any family in the room with ya? Great, I'll be in after I check the chart."

I start flipping pages looking for the EMT report. The paramedics and EMTs have the best record of what happened at the scene as well as documenting the time when this all started. This is really important as I have 24 hours from incident in which to enroll participants. I start looking for the things that will disqualify the patient from my study. So far, so good. I grab a chair and pull myself up to the computer to check his current lab results. Okie doakie, looks like we're good. I grab my consent form, take a deep breath, and walk into room 7 to see the family.

It always amazes me how different people look when they're in the unit lying in bed intubated. This poor guy must have taken a tumble from the bruising on his face and arms. His wife is sitting quietly watching him from across the room as I enter. She is slightly older than me and reminds me of my neighbors. I introduce myself to her and tell her who I am. I explain that we are participating in an international study trying to figure out more about ALF. She gives me permission to discuss the consent form with her and I do...page by page. I explain everything and answer her questions. "Can I keep this and think about it a little more," she asks me. "Of course, you can. I need to let you know that we have to enroll everyone within 24 hours of coming to the hospital and we only have 4 hours left. I'll come back in a little while."

I finish reading the dictated history and find Linda to fill in the blanks for me. "Well, let's see...around 0200 he came into the bedroom and his wife told him to go downstairs as she was trying to sleep," Linda said. "Around 0600, she heard a 'thump' in the bathroom and found him down on the ground. It looked like he had vomitted up a plastic bag with some crystals in it," Linda shook her head as she said this. "We think it's meth, but we're not sure," Linda finished. I was at a loss for words. That guy looked like the guy down the street who mows his lawn with strategic precision. I couldn't believe my ears...meth?! I mean all my other ALF patients (so far) looked a lot more worldly than Mr. 7. I was floored. This man was the father of two small children 10 and 7. How do you explain this to them?

I went back to get the consent form and see if Mrs. 7 wanted to enroll her husband. She said, "I sure do." She handed me the consent form and everywhere it read 'acute liver failure' she had crossed out failure and written in the word 'success.' I asked her about the changes, and she responded, "I believe we need to be positive that what the doctors are doing here will be a success." "Well," I started, "this is a legal document and we can't sign one where it's been changed like this." "I'm sorry," she said, "I won't sign one that says 'acute liver failure.' I just feel like that's giving up on my husband." I thanked her and headed for my office. I called the PI and let him know what happened. You know, folks have to cope the best way they can.

I do know that the intensivists and nurses did their magic and brought this guy back from the edge of the drain. Last I heard, the patient had been discharged to a skilled nursing facility of some sort. I don't know what happened to him after that, but I do know I'll never forget him. I hope he has more than just acute liver success.

*Our hospital is extremely communication friendly; so, the staff nurses all wear portable phones as do most the inpatient staff. The others, like myself, wear pagers; so, we're obtainable at all times (during working hours).

17 February 2007

Didja screen 'em, yet??

I just hate this question, my being a research coordinator and all. If you think you found a patient for a study, then, you must be part of the study team. As said member of the team, I have not only put together consenting packets, but have also posted study inclusion/exclusion as well as the most current version of the consent form on the transplant server (you remember the computer??) in the nicely organized study folder. Why don't you screen and consent them? You just saw the potential participant. Not to mention the fact that you just paged me away from the bedside of a patient I'm consenting in pre-op....Hello??

10 February 2007

Memories of Amy...

Well, here it goes. I'm not sure what I'm doing, but I guess I'll take a stab at the blogosphere. Welcome to my world where the sky is cerulean blue....

I read oncRN's blog and started thinking about some of the folks that have come into my life that left an indelible mark. Her name was Amy and she was ~19 years old when she came into the chemo room the first time. She was beautiful and courageous, and was about to start the fight of her life. I remember talking to her about the chemo (we treated her with ABVD/MOPP) and reassuring her that we (the docs and the rns) would be there to take good care of her .

Amy fought her battle with Hodgkin's Disease and went into remission...briefly. When she recurred, I was there to start another round of treatment and support her. We used up her veins and she got a central line. She became septic and we treated her with triple abx and a trip to the hospital. She developed a fistula between her trachea and esophagus that was patched with a gortex graft. That was the beginning of the end.

Several months went by and I left the hem/onc office to take a new job as the night charge nurse at the hospital in town where we usually admitted our patients from the office. I went to work on the oncology floor and was there for Amy's last trip to the hospital. As she and I had gone through so much already, I came on and quickly assigned her to me for the night. It was so good to see her, again. The fistula had been patched, but it seemed to be giving her problems. She still had a productive cough, but was bringing up old blood (ie: drk red).

Around 0200, I was making my usual rounds to check my patients. I poked my head into Amy's room where the light was still on and Amy lay awake. She wasn't sleeping. I looked on her bedside table and noticed the bright red clots in her specimen jar. "When did you start coughing up this," I said, pointing to the cherry red blobs? "Just a little bit ago. It's nothing." That's what I wanted to believe while I started to panic on the inside. "Amy, the change in color concerns me a little; so, I'm going to check your bp and stuff." The stuff being a head to toe assessment. Amy was young and everything looked and sounded good. VSS with clear breath sounds, no dyspnea and her sats were >90%. I reassured her and told her to call me if she started coughing up more blood.

Once I was outside the room, I went to call Dr. G to let him know of her change as she was a full code. "Keep an eye on her and if you need me, call me back," was Dr. G's calm reply. Really, other than the change in her expectorate, Amy looked and sounded ok. I discussed with Amy calling her mom to come in and be with Amy. Amy answered, "Do you think we should? I'd hate to wake her up." I hoped that Amy couldn't tell I was uber super duper concerned, "Yeah, Aim, if you were my daughter, I'd want to be here just in case."

Call it a nurse's sixth sense, but Amy wasn't ok and I was starting to worry. Every time I went back into her room, I was met with more and larger clots. Although her pulse went up slightly and her bp barely dipped, I called Dr. G, again. "Hey RG it's AZ, again....I know, I can't put my finger on it, but she just doesn't look good and I'm getting worried." Just the words Dr. G didn't want to hear. "Ok, AZ, I'll come in. It's almost time for rounds anyway."

"Hey, AZ good thing you called, let's get her transferred to the ICU, now," Dr. G said coming out of Amy's room. My team helped get the transfer going while I finished charting and calling report. Amy's mom arrived before the transfer and went in to keep Amy company. My friend and I transfered Amy to the ICU.

After my shift, I went up to the unit to see Amy. There she was in the bed, intubated with her eyes closed. Dr. A, her primary oncologist was in talking to Amy's mom. "Amy, it's AZ." Amy's eyes flickered open as she raised her head to look at me, briefly. It looked like it took all her effort. "I'm heading home, but I'll be back tonight. I'll come see you before my shift."

That was the last time I saw Amy. When I went in that evening, the ICU staff told me she had died?! My Amy!! I was stunned. Down on my unit, my friend Dave asked, "Hey, AZ, I heard you transferred Amy to the unit. How's she doing?" I looked at him and started to cry....

Amy, I miss you. Thank you for allowing me to take the journey with you.