Thursday, 28 January 2010

Are you sure it's not a full moon?

One of the advantages of working as a nurse in a hospital is the ability to pick up a bit of overtime for extra cash when expenses build up. Yesterday was one of those days when I did an extra four hours before my scheduled eight hour evening shift. Usually not a big deal... but the pay out, if a few accumulate in a pay period, can be significant.

But... working in health care also means that things can go from bad to worse in a split second many times over.

Today was one of those days...

Working in an outpatient area of the hospital means that most of the patients we see on a day to day basis come from home for treatments and then go on their merry (or not so) way after it's all said and done. We do get some inpatients as well but they come down to our ward for a treatment and then get to go back to their own ward after. Nobody stays... Nice eh?

So the first patient I start working with comes in, sits on the edge of the bed, and I open his chart to check for new orders. There's one that was written yesterday... put patient on contact and respiratory isolation pending consult with Infectious Diseases doctor.

He's on a bed in the middle of our wide open unit... surrounded by other patients. Turns out he's got a viral skin infection that can easily be transmitted to our other patients (and to us nurses) if not handled properly.

Properly, in this case (as set out in our Policy and Procedure manual), means putting the patient in a negative pressure room and keeping the door closed. Anyone who goes in the room has to put on a gown, a mask and gloves. And not just any mask... but the N95 masks that we use for the H1N1 virus and things like TB....

So this means moving this patient (on his bed, covered with sheets to keep him as virus-spreading free as possible) into our one and only, rather useless isolation room. And the Infection Control nurse came up and recommended a large portable air filter thing (about the size of a refrigerator... so, yeah, really portable) be set up in the room.

So while trying to get him sorted out, one of the patients who'd come in first thing in the morning was just finishing her treatment when she decided it was time to exit stage left. Full blown cardiac arrest. No pulse. No breathing. Grey as freshly poured concrete.

Spring into Emergency Response mode. All my ICU training comes back very quickly when this kind of crap happens and I was bagging her within a minute or so while a bunch of other nurses gathered around doing stuff like pumping her full of saline and doing chest compressions in an effort to move blood through her body.

I spelled off the first nurse. Doing chest compressions is very hard work... labour intensive, you might add. You go at it hard and fast... the routine nowadays is about 90 - 100 compressions per minute. That's less than one per second. You can imagine how quickly you work up a sweat doing that. The bad part is how you can feel the ribs and sternum crunch every now and then and you know you've just broken some bones.

But hey, better to wake up with a couple broken ribs than to wake up dead.... right?

Just as that patient decided she wasn't quite ready to head off for a celestial transfer and we were getting her ready for a stay in the coronary care unit, we heard an overhead page for a code blue in our satellite unit.

Oh great. Two in one day. That little offshoot area is on the same floor, but down a couple of long hallways. And in between us and them is a whole ward that's closed off as they are doing asbestos removal during renovations. Closed off as in you can't even walk down the hallway. Not even to respond to someone trying to die...

Turns out that guy wasn't truly trying to die, but he did collapse on the floor and have a seizure. That satellite area has two nurses and five patients and a whole whack of machinery in a room designed to hold four patients in four skinny crank up beds. I'm sure you get the picture... It's very crowded. And not easy to get to, because of that closed hall. The Code Blue team, who has just paid the us in the main unit a visit, had to run up the stairs to the next floor, run down their hallway, and then take the stairs down again. That guy's now doing okay.

So we get most of that crap sorted, or at least under a semblance of control, and try to carry on with the remaining patients in for their afternoon treatments. I am talking to one patient and she informs me she's been having chest pain for about 45 minutes and it's rather annoying. Check her blood pressure, draw some blood work, slap the oxygen tube in her nose and crank it up and haul the doctor over, as he's still in the unit because of the cardiac arrest and the isolation nightmare. When asking her to rate the pain on a scale of one to ten, she states it's about a seven or so. Now, she doesn't look in much distress. She's older... and has kids... so the doc (a young but very astute guy) tells her that child birth would probably rate an eight. Oh, she says, well in that case, it's about a four. She remembers having her own kids... this ain't nearly that bad. So we get her sorted out with a shot of Nitroglycerin spray under her tongue, which resolves the chest pain in about six minutes and she's right as rain for the rest of the afternoon. Turns out it was angina... and not an imminent cardiac arrest.

Thank the gods that be for that one. I wasn't in the mood for cracking more ribs, thanks very much!

A short while later, while attending to another patient, a call bell in our other room (lovingly called The Parlour) started ringing. Because it's a bit off the beaten path from the main area (this is not the same place that Seizure Man decided to strike - this is much closer, as in just around the corner), when a call bell is rung, it is a long continuous beep and alerts us to an emergency in the Parlour and several people always drop what they are doing and bolt in to help out.

Ms. Grumpy, a very acidic and sharp tongued patient, accidentally pulled the call bell cord out of the wall, which has the exact same effect as pushing the button.

So it was a false alarm but still... got the adrenalin pumping once again!

The remainder of the evenings was mostly uneventful, other than a few alarms on machines that were easily reset. Towards the end of the evening, however, things turn another turn for the worse.

One of my patients for the evening was a very pleasant lady who is confined to hospital awaiting placement in a personal care home. She can normally stand and transfer with some assistance. But not tonight.

And of course, we did not know this until we were helping her stand to get into her wheelchair and her kneed buckled. Down she goes like a sack of potatoes... a 150 lb. sack of potatoes. You know what that does to a back that is already horribly compromised from a brief but forceful connection with a sand riding arena? We managed to not drop her completely to the floor but between my now acutely aching back and my coworker's buggered shoulder (old tendinitis injury) and some help from a couple of other nurses, we heaved her back into her chair, none the worse for wear.

I, however, am now one hurting puppy. The appropriate WCB form has been filled out and how I feel tomorrow morning will determine if I make it back in for my scheduled shift in the evening. Or if a trip to the physiotherapist will be my excitement for the day...

So, the end of the shift finally rolls around and as I am driving home, with my aching back and my frayed nerves, I realize just how achy and tired my poor paws are... I am certain I put many miles on them today!

What I wouldn't give for a nice, long soak in a bubbling hot tub, a glass of cold Bailey's over ice within easy reach... and perhaps a really lovely foot massage.

Option Number Two: Take two naproxen and crawl into bed. See if I can move in the morning...


  1. I'm glad you decided to give us the short version! :¬)

    Hey, someone is alive today because of YOU!

    (Smiles at passing stranger while nodding in direction of Nurse Pon, "Friend of mine, that nurse"! Beams Proudly!)

    Hope the back feels better soon hon.



  2. and that was just one night! y'all are incredible, sugar! xoxoxox

  3. I did not realize that you lot get paied for cracking bones ... :) Rest and sleep well. No footrub in the bath tub, you'd fall asleep and "gluck", no good.

  4. That was scary just to read!

    Thank you. What you nurses do makes all the difference it the world.

    Take care of yourself, too!

  5. What an exciting and scary experience...and the fact that you jumped into rescue mode means that this happens often enough that you've become an expert at saving lives and managing crisis. Great job, Ponita. You do hard but important work. And it's not just the patients you help--it's their families, their friends, and the community, too.

    Take a well deserved've earned it.

  6. You know, I sometimes complain about how demanding my job can be, how stressful it can be. I'll tell you a little secret, though: rather mine than yours!

    As everyone says, though, your job makes a real difference to so many people so a big thumbs-up to you :-)

    And, most importantly, I hope that you're feeling rather more mobile and less pained than you were last night.

  7. Thanks, everyone! I know what I do makes a difference... and that is what compels me to keep in nursing, despite the tough and often hairy conditions!

    The back is much better this evening... although this morning was pretty bad - couldn't sit for more than about 5 minutes. An afternoon nap certainly helped and am feeling much improved now.

  8. Blimey, you have a proper time of it at work. I admire people like you who actually make a difference. More power to your (tired) elbow.

  9. We share about four Blogger friends and I often see your comments, so I decided to drop in for a visit. I also collect Canucks (5), and I was pleased to see that you're Canucklian.

    Thank you for being a nurse. I worked in a behaviorial hospital, and it was the nurses who taught the shrinks how to Dx and Rx.

    A funny story, if that's possible, about CPR. I took it from a young woman who was a paramedic for the fire department. She told us, "The consensus is to do chest compressions just below the nipple line. If you've ever seen the nipple line on a ninety-two-year-old woman, the consensus is wrong."

    Map will probably complain that my comment is too long, but you have a wonderful blog—including the mastHEAD.


  10. Hey Charlie! Hello and welcome. 'Canucklian'... that's kind of like Canucklehead. ;-)

    Can't ever go by nipples... have seen a few people with more than two. Then you have to decide which ones to use as landmarks??? Not bloody likely!

    Nah, your comment's not too long... and Map sometimes leaves long ones too, so he can't say a word!

    Thanks so much for the compliments. *blushes*


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