~ Dust in the Wind ~

You Bleed, We Speed

2009-08-22T17:22:00.002-03:00

Unit 299, go mobile, to 24 stupid street for a 70 yo male with fall. Injury to a dangerous body area, possibly hip. Breathing abnormal. Code 1.

Lights on. Sirens on. Go....

Weave between lines of traffic. Cycle through your sirens to help people hear you coming. Creep through red lights. Worry about the poor man lying on the ground in pain, while you struggle to move through the dense traffic that forgets that they should **Move to the right and STOP* when an emergency vehicle is approaching from *either* direction**. Arrive. Note the elderly gentleman standing at the curb smiling in glee at the flashing lights. Smile.

Climb out of ambulance only to realize that the elderly gentleman has just climbed in the back. An elderly man who is breathing and moving normally and who climbed up into your ambulance without assistance and without difficulty.

"Hey! Can I help you there, Sir?"

"Yep. You can take me to the hospital. I fell and broke my hip a couple years ago and it still hurts when it is going to rain. Hurry now! (*clap clap*) If we take too long I'll be late getting home and will miss the news!"

Smile again reflexively while you resist the urge to break both his hips with your portable O2 tank. Secure the patient's seat belt. Climb back in the cab. Shut off the lights.

S l o o o o o o o o o o o o o o o w l y pull back into the rush hour traffic. Drive with extreme caution and decreased speed to the local facility. After all, you wouldn't want to hit bumps and make his pain worse, now, would you....

Shake it Like a Polaroid Picture

2009-07-22T23:50:00.003-03:00

An elderly lady arrived by ambulance to our emergency department for assessment after an MVC (motor vehicle collision).

On arrival we noted that she had extensive (and I mean *EXTENSIVE*) psoriasis. Head to toe she was covered in huge dry patches of flaking skin. There was no visible inch of her skin (including her face, torso and extremities) that was not affected.

During report the medics listed the psoriasis as one of her past medical conditions, and then commented:

"I know you think that her skin is bad now, but you really have no idea. When we opened the door to her car it was like someone shook up a snow globe!"

In Memoriam

2009-03-07T14:18:00.001-04:00

Manny Grewal

04 February 1971 - 24 February 2009

Our heads are hanging low
And our hearts at half mast
Ever since the day
They took you with it when it passed

Ashes to ashes
And dust to dust
We let go
Because we must

And where does it
Take you when it goes?
No one really knows, it's
Anybody's guess

Some folks say
It's where the wind blows, and
Where the sea flows
And the sun sets

But here we go
On with the livin'
And try to match the love we give
With the love that we've been given

Ashes to ashes
And dust to dust
We let go
Because we must

And days pass
And nights continue to fall
Time moves ahead with it
Like nothing at all

But at some turn
We reach the final page
When we die too young, or
Of old age

Ashes to ashes
And dust to dust
We let go
Because we must

(Ashes to Ashes ~ Jill Barber)

Great Ad

2009-02-07T11:53:00.001-04:00

I love it. Makes me laugh every time!

Not that drunk, eh?

2009-01-31T15:40:00.004-04:00

It was a busy night and we ran from call to call to call with nary a minute to eat or visit facilities. Finally the tones slowed and it looked like we might have a minute to breathe when we got called out again... another trip to the cells booking area to assess more of the nights inebriated young souls prior to their entry to the drunk tank.

Our patient was found with his head and shoulders deep in the garbage can provided to him by our local constabulary. He was moaning and puking with great abandon, totally ignoring the questions of the medics when an officer exits the cells and states to her coworkers "now that crack whore has stripped off her pants and her thong and has thrown them out of the cell. She is standing there in just her bra shouting that she is going to kill us with her coochie!"

Suddenly our fine young citizen pulls his head out of the garbage can, vomit dripping from his face, and states "Awesome! Can I see that?!"

Quote of the week...

2009-01-27T20:04:00.006-04:00

Pepper-sprayed young patient, climbing on the snow bank: "Aaagh! You have to help me!! It burns!"

Nurse masquerading as a student Paramedic: "Come down from there and I can put some drops in your eyes...."

PSYP climbs down, spitting...

NMaSP: "Stop spitting on me!"

PSYP: "It`s OK! I use condoms! I don`t have HIV!"

New Year's Eve

2009-01-01T09:19:00.002-04:00

The snow is falling

The lights are low

The night is quiet

And we are at peace

A new year, full of hope

So much promise

Then the bad choices

Made last year arrive

drunk, disorderly, disrespectful

The magic is broken

It's just another night

Waiting Room Watching

2008-10-11T12:53:00.003-03:00

Today I arrived at the hospital triage as a patient, not as a nurse (yes, I'm fine - just a little pneumonia) and got to experience the world of the waiting room... what a hoot! I think that someone should do a study on waiting room behavior. People watching at its finest.... I saw:

* the 'where do I sit' dance - women generally choose to sit by women, but only if there are no seats open where they can sit by themselves; old men sit by other old men, even if there are lots of open seats. Old people sit so they can see the door to the emerg department. Middle aged people sit as far away from the old folk as possible, except when they have kids - then they sit by the alert elderly.

* old man who thought that because he turned his head, none of us could see him pick his nose

* middle aged man who made a point of moaning and sighing whenever a staff member was in sight, but who sat quietly when they were gone

*Skanky mid 30's woman who could not sit still. Could. not. sit. still. I started counting after about 15 minutes and was at 48 times getting out of her chair before I got called in

* youngish man with three children under 10 - are they actually your kids? Because you totally don't have a clue.... It really isn't a great idea to let the twoish year old kid play between the doors - those open by a sensor and go straight out to the driveway... you know... where cars are driving? and the fourish year old? Definitely shouldn't be racing the 8ish year old *over* the chairs in the waiting room (and banging into nosepicker and guy with the cane)

* wife of healthy looking guy with the cane who complained constantly to her husband about how unfair it was that people who could walk without a problem were getting in ahead of him. Constantly. For the entire time I was in the waiting room. Constantly. It was so unfair. So. Unfair. They could walk. Why would they go first. Why?

* elderly gentleman with the kindest smile and most contagious laugh who dramatically improved the mood in the waiting room - excellent counterbalance to the complaining lady. Thanks.

*me. Hacking constantly. Funny, no-one chose to sit by me!

Trauma Night

2008-07-20T17:07:00.005-03:00

Well it's a trauma night, and the feeling's right

It's a trauma night, Oh what a night.
Oh, what a niiiiight...

What did we have as a cause for the trauma tonight you ask? Well let me tell you:

We had:

Bunk beds, bicycles, and baseball bats
China, curtains and crazy cats

skateboards, scooters and soft soled shoes
fights and fireworks with a short, short fuse

swinging golf clubs and gas with matches
stumbly feet and broken glasses

steps and stairs, shocks and swings

drunken men who don't have wings

car vs pole, a foot in a hole

getting home alive is my new goal!

Quote of the week #5

2008-06-30T08:04:00.002-03:00

Man who has been waiting 30 minutes to have the cut on his thumb assessed:

"You call this the emergency ward?! You should call it the death ward - you move so slowly that we'll all be dead before you get to us!"

The Apple and The Tree

2008-06-06T17:51:00.003-03:00

The child is brought in by police for a mental health assessment after engaging in some very high-risk behaviour.

When the hospital phoned the parent for consent to treat, the parent answered the phone and then said "Hang on. I need to put you on hold. I've got Children's Aid on the other line."

When the parent finally arrives at the hospital, hours after the child did, they are observed sporting a t-shirt with a very inappropriate saying and picture, and a ball cap emblazoned with a pro-drug emblem.

Now I'm convinced: losers are made, not born.

Bingo!

2008-05-01T13:51:00.003-03:00

It is 6:45 am, and the Emergency Department has been steady all night - no horribly sick patients, just a constant, unrelenting flow of clinic care style concerns.

The young boy skips in the door, singing. He has a half eaten cereal bar in his hand. He happily approached triage with his Dad and, with a huge smile, states:

"Hi Nurse! I'm sick! Really, really sick! Dad had to bring me to the Doctor first thing this morning!"

Dad follows with:

"He has been up all night with belly pain. He seems fine otherwise - he doesn't have a fever and he hasn't thrown up or had any diarrhea. He didn't eat his supper last night - he doesn't like meatloaf - and only had a cereal bar before he went to bed. Maybe he is hungry? He is eating a bar now and seems to feel better"

Can we please install a piece of rubber on the wall? Banging my head constantly on this hard plaster is starting to leave a mark!

The Things You See When You Don't Have a Gun

2008-04-24T17:38:00.001-03:00

The med student was a bit odd.

He was big (6'2") and brawny (obviously a weight-lifter) but not particularly bright.

When he was on the spot (being pimped by the ERP) his voice was soft and slow with lots of 'umm'ing and 'uhhh'ing, but very few right answers.

When the ERP's attention was elsewhere however he had no problem flirting with the nurses, whistling, humming, drumming on the desk incessantly and wildly playing air guitar around the nursing station. Basically he totally disrupted the entire area with his antics.

The capper was when the doc pulled out the metal detector to investigate a 'piece of metal in foot' complaint. Odd Med Student decided to show us how he could make the metal detector buzz by running it over the pins in his ankle, his prosthetic knee, and...

the piercings in his penis.

ICK.

Tips to Understanding ...

2008-04-16T23:11:00.002-03:00

Understand...

if someone starts a sentence with "I'm usually the most sane and rational person I know..." then you know something irrational or insane is about to come out of their mouth. They know it too - that is why they forewarned you.

Vomick Analysis: the New Diagnostic Tool

2008-04-16T23:03:00.002-03:00

The child presents with abdominal pain and a fever.

"It started all of a sudden 45 minutes ago, and then she threw up!"

The parents are convinced that it must be an appendicitis:

"It must be appendicitis - it came on so quickly!!"

The triage nurse requests a urine sample as part of a thorough work-up to rule out the appendicitis, and to make some use of the 3-4 hour wait this family faces.

After 3 hours and several refusals to void, the child vomits again. The father presents the bowl full of emesis to the triage nurse:

"She vomicked again, and she's not going to pee for you. She doesn't want to, and she doesn't do stuff that she don't want to do! Test this puke instead. It will tell you that it's her appendix."

Different Beds : Same Result

2008-04-16T22:58:00.002-03:00

My friend's kidney is failing. Her third kidney. The one that was a gift from my husband. She has done everything right: good diet, taken her meds, exercised regularly, and still the disease progresses. She waits in the hospital bed to see if the new experimental drug will work. If not, returning to dialysis is the plan.

The child's kidneys are failing. Her two good ones. The ones that were gifts from her parents and God. She has done everything wrong - crappy diet, no exercise and deliberately ingesting a bottle of ibuprofen, and so the damage progresses. She waits in the hospital bed to see if our regular meds will work. If not, starting dialysis is the plan.

Pink

2008-04-08T18:34:00.004-03:00

A long time ago, I completed a meme discussing things I couldn't live without...

No. Go read it. .... I'll wait....

Ok. Good. Now guess what I just bought???

.
..
...
....

a hint? OK. They are pink.... :) :) :) :)

Yippeeee!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Now can you guess *why* I bought them???????

The Waiting Game...

2008-04-02T09:51:00.002-03:00

It is done. My application for paramedic school is in and complete...

My application interview and testing process is finished...

All that is left is to sit and wait for the phone to ring - a ring means yes and silence means no...

I haven't waited for the phone to ring for 20+ years.

It is hard....

When in Rome..

2008-02-17T13:38:00.003-04:00

Our mental health nurse escorts a mental health patient to the mental health room for assessment, then returns to the desk looking frazzled.

"The bed is up high. Can someone put it down for me?"

The nurses are busy and moving quickly - unusual, I know! - but one takes the time to stop and describe where the pedal is for lowering the bed to floor level.

"No, I can't do it - I need you to come put the bed down. I have a phobia about mechanical things!"

I see.

The Right Decision

2008-01-26T10:42:00.000-04:00

You are a nurse.

You work full time plus.

You have an 8 shift stretch - all 12 hours, with no day off.

You work hard - pump chests, start IVs, push drugs, hold puke buckets, give enemas, pass catheters, assess, assess, assess, chart, chart, chart.

You wash your hands. Constantly. Religiously. You could be OCD. You wash when you start work, when you end work; before you touch a patient, after you touch a patient; before you chart, after you chart; before you eat, after you eat. You use alcohol hand wash and you use soap and hot water. You even use chlorhexidine to scrub before you access that port-a-cath.

You have one day off before you start your next 7 shift stretch.

So what do you do???

You get the kids to school, do some volunteer work there, come home, throw supper into the crock pot, throw in some laundry, pick up toys, do the dishes, sweep and vacuum the floor, fold some laundry and throw in more, get the kids from school, serve supper, and....

...instead of doing the dishes immediately you decide to sit for a minute and have a break. As you sit you notice a funny rumbling in your belly.

That's right - you now have gastro, and spend the next several hours making mad trips to the washroom.

Morning comes. You are a limp washrag, but no longer puking. You are supposed to work. You know that the unit will be short without you, and it has been busy. You want to stay in bed.

So... do you get up and crawl through work exhausted, but still doing your share or do you call in sick?

What is the right decision?

Remembered

2008-01-25T13:10:00.000-04:00

After a sad shift I again remember:

1. S*&t happens. Often.
2. Bad things happen to good people. Children are good people.
3. Miracles are rare. That is why they are called miracles.
4. If the media doesn't know what is happening, they will make something up. Usually what they make up will be completely wrong.
5. Giving someone false hope is worse than giving them no hope.
6. We are good at what we do, but sometimes that is not enough.
7. Death is not necessarily the worst possible outcome.
8. It is hard not to hope, even when you know better.

On the positive side I also remember:
1. A popsicle can be just as good as a hug.
2. A team that clicks makes the difference between a good case and a bad one, regardless of the outcome.
3. My coworkers rock.

Stella and the Pain Pills

2008-01-23T18:27:00.000-04:00

I noticed an interesting trend today while I was in triage: Within an hour I triaged 15 patients and subsequently I had given either acetaminophen or ibuprofen to 13 of them.

Among this group we had:
* 4 'slip and falls' on the ice: one arm, one ankle, one knee and one head - no obvious deformities, some mild swelling and a couple abrasions
* 3 headaches (not migraines, just regular headaches), one of which had started less than one hour prior to triage
* 1 'hammer to thumb'
* 2 lacerations
* 2 kids with fever & cough
* 1 infected toe

So what were the other two?
* 1 chest pain (This patient got ASA and a bed)

and

* a sweet 84 year old lady named Stella (No, not really. Duh!) who had a sore, swollen arm after slipping in the tub 2 days ago. She had taken her own ibuprofen at home and waited to see if it worked before coming in.

As I took care of Stella, I couldn't help but wonder why none of the other patients (all of whom had less serious concerns) had tried medicating themselves prior to presenting to Emerg??? Well, the 'slip and fall's I could excuse, since they were not at home when they got hurt, but the headaches? the infected toe? the lacerations and the hammer to thumb? They all came in because "It hurts!", and the kids with fever were brought in because their parents were worried that they looked so sick with the fever.

Could it be generational?

Stella grew up in a time when help was less readily available. You learned to be independent, to cope with some discomfort and to make do. In contrast my generation, the 30-40 something crowd, had all grown up with easier access to resources of all kinds. We seem not only to look for help more readily (which is not necessarily a bad thing), but to feel entitled to have all pain removed and all difficulties eliminated without any effort on our part (which is a bad thing).

Please don't mistake this post as complaining. It isn't. I definitely do not mind giving out appropriate analgesics in triage. Not only is it part of my job, but I actually enjoy being able to do something right away for the patients, so that they know I care, and that we are doing our best to make them comfortable. I just wondered why people were so reluctant to take ownership of their own care.

That is all.

Rules for being Smart

2008-01-18T16:10:00.000-04:00

1. Don't do cocaine.

2. If you are going to do cocaine, don't do it every day.

3. If you get crushing chest pain that knocks you to the floor (especially after snorting coke) come to the hospital right away, not the next morning.

4. If you wait for 12 hours after your chest pain has started to seek medical attention then call an ambulance to get you to the hospital.

5. If you decide to have a friend drive you to the hospital instead of taking an ambulance then don't yell at him for following the traffic rules and stopping at the red light.

6. When you get to the hospital with your crushing chest pain for 12 hours after daily cocaine use, pony up, be a man, and admit that you snorted the coke, and that the pain started 12 hours ago. Don't blame the pain on stress caused by your friend's driving.

7. Even if you are going to lie about the coke and when the pain started, do what the nurses tell you, get your butt in the wheel chair, back out of the chair, and onto the bed.

8. Once you are in the bed, *lie still* for the EKG.
9. When you have finally stayed still long enough for the nurses to acquire a 12 lead that says you are having a massive MI, let the nurses put in the IVs. It looks particularly stupid if you are covered in ink and have a 10 guage nipple piercing, but are whining and teary about the 18 gauge IV. Stop being a baby. A 45 minute delay in receiving TNK could be the difference between you living or dying.

10. When the doc is explaining to you the risks of TNK, stop whining about how you want a cigarette and listen to him.

11. When the nurse is pushing the TNK and heparin into your IV, stop messing with the other IVs we put in - yanking out an IV after you have just received clot busters and blood thinners will cause an unnecessary blood loss, and a mess. The nurses, doctors, paramedics and housekeeping staff shouldn't have to be exposed to your drug and likely infection ridden blood!

12. Basically, all 11 of the previous rules could be boiled down to one simple life motto ...

**Don't be an idiot!**

or this could be you:

Just Read The Sign!

2007-10-18T00:02:00.000-03:00

But is this for the patients or for the staff??

Red Flags

2007-10-12T01:59:00.000-03:00

You know what follows won't be good when the triage story starts with

"Well I just got out of jail, eh...."

There was a Young Lady...

2007-10-09T02:26:00.000-03:00

A young, sweet looking woman timidly approached the triage desk, a beautiful, smiling and happy baby in her arms.

"I'm sorry to take your time, but I'm really worried" she said.

"This is what I am here for." I replied "What has you so worried?"

"Well" ... she hesitated. I waited patiently, making faces at the baby and making her giggle..."I feel kind of silly, but still....."

I continued waiting....

"Well this afternoon we were playing outside, and there was this fly. It was flying around the baby and I tried to shoo it away, but it flew right in the baby's mouth!" Mom's eyes are huge and round by this point in the story, and the tears are starting to well up in her eyes...

"And she swallowed it!! and then she BURPED!" and with this the mom started to cry in earnst, tears coursing down her face. "I've worried all afternoon that the dirty fly was going to kill her and I just couldn't stand it another minute!!!"

"Oh Sweetie" I said, putting one arm around Mom and handing her a kleenex with the other. "Dry your eyes. Your baby is absolutely fine!" I said. "Look at her - she is happy, smiling and healthy. That nasty fly has no chance at all against her excellent stomach acid!

"Really?!" said Mom "it isn't going to hurt her or make her sick?"

"Positive. There is nothing to worry about. I promise." I stated. I hesitated, but the urge was too great and the words came out... "but if you are still worried we could see if she would swallow a spider..."

Mom looked at me blankly for a second and then started to giggle. Suddenly I was enveloped in a huge hug. Mom kept hugging me and laughed until the tears poured down her face again, this time accompanied by a smile.

:)

What's in a Word?

2007-10-03T23:24:00.002-03:00

The development of language is a amazing series of steps, some slow and some amazingly fast. During this process, young children will reach a stage where they often use a specific noun to characterize all items in a similar category (such as 'apple' for any food or 'dog' for any animal). This is a very normal and common part of learning the language, but it can lead to some confusion in the medical world.

For example: everyone knows that some signs of meningitis are fever and a stiff neck, so when a child with a fever says that their neck hurts parents understandably become concerned and rush to hospital, often without any further discussion. Once in triage the parent describe their concern and then their child points to the pain in his or her neck. Funny enough, they usually point to the front of his neck. If questioned further, the pain is on the inside of his neck... That's right - good guess - they have a sore throat. Instant relief flushes across the parent's face.

However the best of these medical generalizations was relayed to me by another nurse: A young boy was brought to to hospital because he had a simple balanitis (a superficial infection of the foreskin/penis) which he described to the triage nurse as "an ear ache in his penis".

From the mouths of babes.

You don't always die from tobacco.

2007-09-22T18:36:00.001-03:00

Sounds of the Night

2007-08-17T18:26:00.000-03:00

Then:

"Night honey." "Night. Sleep well." "snore snore ............snore..... Snore Snore................................ SNORE............ Snore snore ....... ...... .... ......... ..................................................... *poke* .......... *POKE* *POKE* *POKE* SNORE!"

*KICK*

"What???" "Roll over." "Why, was I snoring??" "Yes." "I couldn't have been. I wasn't asleep yet." "Whatever. Just roll over". "OK" "snore snore ............snore..... Snore Snore................................ SNORE............ Snore snore ....... ...... .... ......... ..................................................... *poke* .......... *POKE* *POKE* *POKE* SNORE!"

"AARRRRGGGGGGHHHHHHH!!!!"

Now:

"Night honey." "Night. Sleep well." "woosh woosh woosh woosh woosh""Good morning honey." "Good morning :) "

CPAP-a-loo-la. He's sleeping like a baby. And so am I :)

Sounds of the Day

2007-08-02T15:59:00.000-03:00

The shift was busy, lots of sick kids...

"Waaah, waaah, waaaaaah..."

The day was hectic, lots of words...

"Let's go to resusc! Give me a hand! Put in a line!"

The day was warm, lots of discomfort...

"Can I turn on the fan? Why is there no air conditioning? Woosh, I'm hot!"

The break was late, and sorely needed...

"I'll be in the garden. I've got a pager. Call if you need me!"

The salad was wet, lots of fresh veggies...

"Crunch, crunch, crunch."

The birds and bees were flying, the cars were driving ...

"flap, buzzzz, vroooom."

The rat was sitting...... beside the nurse on the bench!!!

"Oh, F#$% !!!!! F#$%ity F#$%ity F#$% !!!!

The nurse stood up suddenly, and the salad fell down....

"Ploppity, ploppity, plop."

The beeper vibrated. The nurse jumped and ran....

"Thwap, thwap, thwap"

The shift stayed busy, lots of sick kids...

"Waaah, waaah, waaaaaah..."

Definitely Not Common!!

2007-07-19T17:26:00.000-03:00

Common sense... if only it was... Just a scattering of the patients cared for in recent days:

A 15 year old girl is brought to the Emergency Department at 3 am for assessment of her "terrible stomach pains" per her mother. Child looks well, moves well, v/s are normal, abdomen is soft and non-tender to palpation. Last BM this morning. Last period? Also this morning... "Have you tried any medications for your menstrual cramps?" I say... "No, I didn't think of that." says the mother. The girl just glares at her mother.

A 46 year old man arrives at 7 am to the ED. "I got a bad splinter yesterday" is his reason for coming. I examine his hand and indeed there is a 2cm splinter in the palm of his left hand, with ~1/2 cm of the splinter sticking out. I reach over with the tips of my gloved fingers and slide the splinter out. "There you go." I state as I reach for cleanser and a band-aid. "Aaagh!!! What did you do, you stupid nurse!!! You're not supposed to remove embedded objects!!" he screeches. I resist the urge to embed something somewhere he won't forget for a while.

A woman arrives at 6:20 am with her 10 year old child in tow. "His cast is cracked on the bottom - he keeps walking on it." she states. The cast is indeed ruined and needs repair. During the triage the woman casually comments "I knew it was a good idea to set my alarm for six - it is so quiet here early in the morning. I called the orthopedic doctor last night and he told me to come for clinic this afternoon and they'd fit me in, but I didn't want to wait." What she didn't know was that there were several very sick patients in the department so she wouldn't be roomed for a couple hours at best, and ortho was in the OR so likely wouldn't get to see her until after lunch at the earliest.

Thank you!

2007-07-03T22:39:00.000-03:00

The child's face was covered with dirt, and food, and snot. Lots of snot. Mixed amongst the various colours and textures a variety of blister-like lesions were visible around his mouth. Drool coursed down his chin in a constant river.

"He's got sores in his mouth and they are getting worse!" the Mother stated. This prompted the child to open wide and display for me a mouthful of partially chewed food and multiple ulcers over the surface of his lips and tongue.

"Come with me, little Buddy, let's get some medicine to make your mouth feel better." When the medicine was finished the Mother prompted: "Tell the nurse thank you! You show her, like I taught you!"

I angled my head and crouched down to the child's height, preparing to hear his words. I focused my eyes and then almost gasped in horror! The child's lips were pursed and he was heading for me, coming in for the big kiss. My head turned just in time, and instead of lip-on-lip contact I feel the smear of his sticky face against my cheek.

"Thanks, Bud". Hope you feel better soon." I say, hopefully sounding more sincere than I feel. I resist the urge to madly scrub and to vomit.

"Lucky you!" says the security guard who saw the whole thing from his post "That was quite the thank you! By the way - your face is dirty..."

Rated

2007-06-21T22:27:00.000-03:00

This rating was determined based on the presence of the following words:

* pain (10x)
* breast (1x)

Who knew? Now some nutbar is going to think this is a fetish blog. Not.

Bring me your Tired, your Labouring, your Hungry...

2007-05-24T05:14:00.000-03:00

A long time ago in a hospital far far away was a labour and delivery unit located on the 2nd floor of the maternity hospital, reachable only after climbing a long ramp and ascending a rickety and unreliable elevator. At the front door of this hospital was located the switchboard, and the admissions clerk who greeted all new arrivals.

At this front door it was common for women to arrive in advanced stages of labour, causing the people manning said desks some consternation and necessitating somewhat emotional calls to the Delivery Unit for nursing assistance should a baby decide that he preferred the 1st floor for his or her entrance into the world.

So there came a night when a young nurse answered the phone and heard the phrase "I've got a delivery in the lobby....". She rallied the team and said team responded with great speed and much clunking of equipment to the lobby to encounter.....

a very surprized Pizza Delivery man.

At least the incubator kept the pizza warm for the trip back to the 2nd floor...

Fate or Fluke

2007-04-29T10:39:00.000-03:00

Sometimes things happen that at the outset seem bad, but later are revealed to be providential. In the last few weeks I've seen some pretty interesting 'lucky saves'... for example:

* - a preschooler comes in to Emergency with an arm injury. The arm is actually fine, but on exam the child is noted to have big nodes - a few blood tests later and a leukemia diagnosis is revealed, but in an early and very curable stage.

* - a teenager presents to Emergency with a lacerated arm. The laceration is repaired, but an ongoing and out of proportion to the injury decrease in sensation is noted in that arm. Carefully history taking, a few xrays and a CT scan soon reveal a stable C3 fracture from a recent football game. He is admitted and placed in a halo.

* - a baby is brought to Emergency for assessment of a very minor injury. During exam the child is noted to look wasted and gaunt. During the history parents reveal that the child has lost significant weight and is feeding poorly. Blood work reveals a severely elevated (life threateningly high - 166!) sodium level and child is quickly admitted to ICU for careful monitoring and correction of electrolytes.

After each of these events it is inevitable that at least one of the nurses says "they were meant to hurt themselves today - that injury saved their life."

So is it fate? Or is it fluke?? Or is it Dr. Fate???

I'm Late, I'm Late...

2007-04-10T16:19:00.000-03:00

Many years ago I used to work with a nurse (not really named Minnie, but we'll go with that for now...) who I loved dearly, except for one very annoying trait - she was always late, and I mean ALWAYS. Every shift. Every single one.

I didn't usually say much but one day I was really tired, the shift had been dreadful and I really wanted to go home. Of course, in the Birth Unit we worked one nurse to one patient, so I had to wait for Minnie to relieve me. When she finally sauntered up the hall, 20 minutes late I snapped and made some comment like "I'm glad you finally showed up!"

Her response was: "Better Minnie late than the late Minnie..."

Despite how annoyed I was at her lack of consideration for me and for the other nurses that she always kept waiting, I realized that she was right. Rushing is only good for creating ulcers.

So why am I telling you this tale??

Because today it is me that is very late. I totally missed the deadline, yet again, for Change of Shift, and the latest compilation was posted nearly a week ago, yet here I am, just getting around to mentioning it...

I guess its better Mama late than the late Mama. None-the-less, I apologize for my tardiness.

The Magic Words

2007-04-10T16:00:00.000-03:00

So. The secret is out. Everyone seems to know what the magic words are to jump the triage line-up and gain entrance to the inner sanctum of the Emergency Department ... and no they sure aren't 'please' or 'thank you'. They are:

"I've got chest pain!"

During a recent four hour stint in triage I processed seven different patients with "chest pain". All were pulled from the line-up of patients waiting for triage and processed quickly, as is required when someone presents with such a concern.

So how many do you think were having cardiac events? ...

None.

What were they really?

... a bruised sternum from air bag deployment during a minor motor vehicle collision
... a broken rib from a check into the boards during hockey
... a kidney stone - the pain was actually flank pain
... reflux that was under control until the patient stopped taking the meds that were prescribed
... a urinary tract infection - the pain was actually low abdominal pain
... a gall bladder attack - the pain was actually epigastric,

and the best one of the night?

A minor case of mastitis - the pain was actually breast pain.

Chest pain ... not.

Bye bye Butterfly

2007-03-16T03:39:00.000-03:00

One of my favourite blogs, high on my list of every day reads, is gone. Barbados Butterfly, (link now inactive) recently began a new appointment, and now has suddenly closed her blog to the public. Another blogger has posted an email which states:
Dear Fellow Blogger, I hope this email finds you well. I have taken down my blog this evening. Working and blogging are, I have been
told, incompatible activities. One day I shall fly again, but for now it is goodnight. Barb (Barbados Butterfly)

I have never spoken in person to Barb, but none-the-less, I feel as if I have
lost a friend.

Barb, I will very much miss you and your blog.

Sweet freedom whispered in my ear, You're a butterfly And butterflies are
free to fly. Fly away, high away, bye bye." (Someone Saved My Life Tonight -
Elton John)

Yummy in my Tummy

2007-03-11T12:39:00.000-03:00

Totally off the topic of nursing, I think I have a new favourite food.

Risotto.

With a specific nod to the absolutely delicious lobster risotto that is the main reason I frequent a local restaurant (which I would love to name but can't as this is still a quasi-anonymous blog...)

and almost as good as the steaming-hot, fresh-from-the-pot dish is being able to have the leftovers for lunch the next day.

Delicious!

Change of Shift.

2007-03-08T21:04:00.000-04:00

Usually at the change of shift I'm tired, a little droopy, and my words are a bit stumbly. But not this time. This Change of Shift gives me new energy. I am picking my way through the many awesome posts, one at a time, and finding some new blogs to read in the process.

Awesome collection, as always, Kim! Thank you!

Things Nurses Cannot Live Without

2007-03-04T13:58:00.000-04:00

A short while ago Shane from Nursing Jobs.org started this meme, based on the successful 'Things I Can't Live Without' series at Inc.com. *(Whew - that was quite the link fest!!)

I've been reading my colleagues responses with great interest, pleased to be on the sidelines and not have to think about a topic so deep. Then it happened. I was tagged by my esteemed colleague TC from Donorcycle. Thanks TC. :) I'll remember you for this one :P

So before I dive in, it makes sense to have the understanding that there are some things so completely essential to my very being that placing them in a list of this sort would minimize their importance. These include:

Family, friends, and coworkers
Sleep, food, fresh air and sunshine

So with those out of the way, here I go!

1. My 7 1/2" trauma shears ($7.99/pr CAD)

I started my nursing career with a royal blue handled pair of 5 1/2 " bandage shears. The colour was chosen because a) it is my favourite colour and b) it matched the theme colour for my nursing school. These worked well for me for nearly two decades and were fine for Obstetrics, but quickly proved not to be up to the task of Emergency nursing. One night out with paramedics and I broke them on the seam of some jeans (much harder to see the seams in the semi-dark of the roadside). This night resulted in two different gifted pairs - one from the paramedic I was with that night and an one from the firefighter/paramedic who saved for me the pair I borrowed from her that night. Both hold a great deal of special meaning for me, and I love to hold them in my hand. If I ever manage to earn a paramedic license I will purchase myself a pair of pink handled ones, but that is for later.

Trauma shears are invaluable to me. I use them multiple times in each shift - to cut off clothes, to size bandages, to make bandages and slings (no, I have no idea where those old sheets went...LOL), to open the outer wrap on IV bags, med bottles and juice packs, - and in a hospital they are a trademark sign of a nurse (or paramedic in the few hospitals that are lucky enough to have them on staff).

2. My Palm handheld. I currently use a Palm Zire 72s ($399 CAD), [since my children inadvertently broke the screen of my beautiful blue Z72 while piling on to Mommy in a 'welcome home from work' dog pile], but since hubby will soon be getting a Blackberry, I likely will take over ownership of his Palm T/X - $499CAD).

Without this tool and its calendar program I would never arrive at the appropriate facility at the appropriate time. It keeps my entire crazy-@&& life in order. I also frequently refer to:
the calculator to double check my pediatric medication doses,
Epocrates to clarify for me what meds my patient is on, and the appropriate way to mix and administer the drugs requested by the physician
RN Emerg Suite regularly for pediatric vital signs, ACLS algorithms and many other quick checks that I need throughout each shift.

I used to feel like I was cheating if I used my palm - like I should have all this knowledge firmly stored in my head. Then one day on my way home from a breastfeeding conference (that featured Karen Kerkhoff Gromada & Kathryn Dettwyler, and was easily the best conference I've ever attended, but I digress...) I was lucky enough to be invited into the cockpit of the plane by a family friend who was the pilot (yes this was well before 9/11). He instructed me that he could not talk to me for the next 10-15 minutes as they had to do their preflight checklist, then pulled out a laminated checklist and went through pages of items, some of which were as simple as 'turn on the ignition' and 'lock the door'. Once we were in the air and the ban on talking was lifted I asked him about this part of his preflight ritual. His response was that pilots world wide were required to follow a very similar checklist process, so as to ensure than absolutely nothing was missed. They were not permitted to rely on memory. From that day on I always felt that it was not only OK, but a bit safer if I double checked my info.

On top of the medical software I use my palm's MP3/WMA player to help me wind up for and wind down from work - I plug it in to my cassette deck (yes, I know - I don't have a CD player - my car is old, like me) and play the music loud, loud, loud. Not to mention that I use it on my break to read one of my e-books or to play games, including my favourites like Sudoku, Text Twist and Alchemy.

3. Good Shoes (Danskos - $199 CAD, Crocks - $35 CAD, Nurse Mates - $75 CAD)

I started my career with a pair of NurseMates very similar to the pair in the photo on the left. Now don't laugh. 20 years ago they were the very pinnacle of 'good' nursing shoes. Not only were they comfortable, but they were white which was a requirement of the nurses dress code everywhere at the time. Within the next five years shoes of this nature began to be replaced by a variety of running shoes, most of which were white with perhaps a hint of blue or gray, all of which were infinitely more stylish than the traditional nursing shoe, and again, were comfortable. This phase of nursing shoe lasted about 10 years.

In the last five years we have moved away from running shoes to a new style of 'Professional' shoes, designed along the lines of orthopedic footwear, but with a bit more flair. For my last four pairs of work shoes my choice has been the 'Jocelyn' by Dansko. These are the best things I have ever had on my feet, and are worth every single penny I paid for them. I regularly walk between 8 and 12 KM in a 12 hour shift (this info from the pedometer I wear), and even with great shoes my feet are beat at the end of the day. I cannot imagine how they would hurt if I didn't have this footwear de jour.

At home and in the summer I wear my Crocs. These are also an incredibly comfortable shoe, although I cannot bring myself to wear them at work. I spent a few too many years in the Birth Unit and was always thankful for my enclosed shoe which helped me avoid a very unpleasant toe bath when a patient's water broke or when the baby came quickly. I have similar issues with blood and vomit in the resusc room and thus cannot bring myself to wear shoes with holes to work. However, I love my Crocs for kicking around. They are wonderful to wear in the backyard, at the playground and at the beach, and all three of my younger kids have a pair. However my joy in these shoes is tempered somewhat by my eldest daughter's reaction to them. She has joined a Facebook group called 'I don't Care How Comfortable Crocs Are, You look Like A Dumbass'. Way to spoil my fun kiddo!

4. My Nalgene water bottle. ($9.99 CAD)

I need water to make it through each shift. I'm always amazed at how a quick drink of water perks me up and helps me to keep on going even when there is no hope of a break or a meal anytime in the near future. My water bottle is far more spill proof than a styrofoam cup, and is far less likely to have 'stuff' land in it. It also helps me monitor how I'm doing - if the day is passing and the bottle is still full I know I need to take a minute for a drink - just a couple seconds of self care renews and rejuvenates me enough to deal with the next patient and crisis.

“Water is life's mater and matrix, mother and medium. There is no life without water.” (Albert Szent-Gyorgi)

Now on to the thing I covet: within my working world these are many and varied. They range from the very simple to the essentially unattainable and mimic what most other nurses have already said ... ongoing and readily available education (and time to access it), mutual respect between all parties (patients, nurses, doctors, housekeepers and so on), the newest of equipment and knowledge, appropriate nurse-patient and nurse-patient acuity staffing levels and so on. However the real thing that I want that I feel would truly make me a better nurse is a Paramedic license. I feel that the prehospital care providers have such an incredibly unique role and such a vast scope of practice that any nurse would benefit by exposure to their world. I certainly have learned tremendous amounts simply by riding along with the medics.

Now to follow this through to the end, I must tag two other nurses. This is an incredibly hard choice - there are many, many blogs out there and many nurses I'd like to get to know better. After much thought, I think I'll send this little love tap out to three nurse bloggers, just because I couldn't narrow it down any further:

Labor Nurse at 'The Life and Times of a Labor Nurse' as a nod to my Obstetric past,
GirlVet at 'Madness: Tales of an Emergency Room Nurse' in recognition of my Emergency present and
TwinMamaLinda at 'Nursing, Life, Cooking, Twins, Politics, Curiosities' a) because I think it is important for our students and future RNs to have their voices heard as part of the nursing community and b) because she is the only other nurse blogger I know who has twins.

If you are still with me then thanks for reading! Play safe out there!

And They All Fall Down

2007-02-26T14:33:00.000-04:00

I was assaulted last night at work. Not for the first time, and very likely not for the last.

This time it was a two year old child who planted a foot quite firmly into my chest while I was starting an IV. Quite understandable, you might say, and not really his fault - he is little and I'm hurting him. Fair enough. But I'm still sporting a bruise today.

The last time it was a 84 year old man with Alzheimer's who was twice my weight and had a full foot on me in height. He didn't like me taking his temperature. His hand was as big as my head, and connected quite nicely.

Before that it was:

the 17 year old severely developmentally delayed boy who will pinch anyone who is foolish enough to walk into his range of grasp

the violent suicidal woman who was in cuffs and didn't appreciate my trying to stop her from strangling herself with them.

the mother who asked me to force her child to take a medication and then became angry when I gently restrained her child's hands while administering the med

The post-ictal seizure patient who woke combative while I was providing airway support

the man who pushed me out of his way when he stomped out of the department after waiting 6 hours to be seen

The drunk who kept yanking my arm as he sobbed about his horrible life

The 14 year old who was having a crisis assessment and who was demonstrating displeasure at the process by throwing toys around the waiting room

the woman in labour who was completely out of control and thrashing around trying to escape her contractions

These are only the ones I can remember off the top of my head. There have been many many more, as well as the daily episodes of verbal abuse that we endure from frustrated patients and families.

The stats I've read indicate that workplace violence is common part of the job for nurses, particularly those that work in the Emergency room that 98% of assaults on nurses are done by patients. So who does the other 2%?

Our co-workers. Doctors, nurses, etc. Hard to believe that the people we work the closest with can also endanger us, but its true.

Twice in my 20 year career I have been physically assaulted by a coworker.

The first time was an eminent Obstetrician with a well known temper. He was using an old fashioned suction device (called a Dee-lee) as the baby's head delivered. These came in two parts - a glass bulb and a rubber catheter - which had to be put together. I didn't put them together tightly enough and the rubber part dropped on the floor so he pulled the glass bulb from his mouth and threw it at my head. I ducked, it smashed, and I left the delivery room. Later I was castigated by the head nurse for abandoning my patient. The physician was not in any way reprimanded for his behavior.

The second time was a intern, who had previously been a midwife and a nurse. She was well know for her acid tongue and her strong dislike of nurses and other subservient creatures. I cannot remember for the life of me what caused the problem but I clearly remember her charging at me in the hall, lifting me to my tip toes and pinning me against the wall while she snarled something at me. The charge nurse told her to cut it out so she put me down and stomped away...

A lot has changed since then. This sort of foolishness would no longer be tolerated in my workplace today, both because I have changed - I would report that doc and press assault charges in a heartbeat today - and the tolerance of such behaviour by the higher-ups has diminished. That said, incidents of this sort do still happen. For an extreme example, there is the 2005 case of the twisted workplace romance turned domestic dispute where nurse Lori Dupont was murdered at work by her ex-lover who was also a physician.

But despite decreased acceptance of violence against nurses, patients and families continue to verbally and physically assault us.

Why is this tolerated??

Come play with us

2007-02-26T12:46:00.000-04:00

The other day I saw a bumper sticker. It said

"Get involved - the world is run by those who show up"

The thought is amazing in its simplicity, but it is true. The world is not necessarily run by those who are smart, or those who rich, but simply by those who bother to take part.

When we decided to start a family my husband and I decided that we would be active participants in our children's lives. And we are. We are involved in our community, are leaders for our children's Guiding and Scouting troupes, volunteer in their schools, and are on the boards that run their extracurricular activities.

We do not live in a tiny rural community, so there are vast numbers of people available to participate. Despite this I repeatedly see the same people in every group. In other words, the same people are on the school advisory committees as are in the home and school group as are Guiders and Scouters as are on the board for the local dance group as are the coaches for the children's sports teams as are the Sunday School teachers.

Now apply this to the workplace. In both the emergency departments that I work in there are committees that help decide the direction the unit will take. These committees are the ones that develop the policies that say how we as nurses must practice and the ones that determine what procedures will be considered for standing orders. I am on at least one committee in each workplace and come to every staff meeting, where I have no hesitation in voicing my thoughts and opinions. My words and actions are helping to shape the world around me. Who knew that power was so easy to come by?

When things aren't going the way I like I often joke:

"When I'm King of the world, things will be different!"

So the question for you is: do you really want me deciding how things are run??

If not - time for you to step up! Come play with us!

What do you do with a Drunken Sailor?

2007-02-24T00:00:00.000-04:00

The post 'Minor Complaints' at 'Rickety Contrivances of Doing Good' has spurred me to write a response (which has unfortunately taken me 4 weeks to complete...).

I read Susan's post and instantly felt guilty for the griping I do on my blog. Then I realized instead of feeling guilty, I should use this excellent opportunity as a time for me to share what really happens when someone comes in with what I consider to be a 'minor' complaint.

I would like to remind my regular readers (all three of you... Hi Dad, Hi Tracy, Hi Robin) that my blog is only one aspect of my nursing persona - I use it as an opportunity to blow off steam in a creative way. The frustration I show here would never be displayed to the patient or family in front of me. My goal when I speak to a patient is to treat them as I would want my family member to be treated, or how I would like to be treated myself. I have had some excellent experiences as a patient and family member, and I've had some really not so nice ones. They have all shaped the nurse I am.

The most recent experience I had as a patient was when I had a herniated disc. Next to having labour this was the most pain I have ever had. Now, I am stubborn, and I will carry on through most illnesses (fever, cough, cold, pneumonia, gastro), but this was completely beyond what I could work through. I could not move, and I certainly couldn't care for patients. My family, co-workers, chiropractor and massage therapist understood, but my doctor minimized it completely

"I don't think it's a disc - your symptoms are not severe enough."

and then once it was diagnosed on CT as a disc,

"It's only a small protrusion - you'll be fine."

I found this infuriating! I am telling you how I feel and you are telling me that I am not feeling what I say I'm feeling. I'm telling you that this really hurts and you're telling me it isn't. I'm telling you that this is interfering with my daily living and you are poo-pooing me.

This very small event reminded and reinforced for me that every patient who presents to Emergency does so because they perceive they have an emergency. It is my job to determine if it actually is an emergency or not. That is why I have taken all those physical assessment courses and have had all those workshops on triage. I don't come by this naturally - this is a learned skill I have, this ability to determine who is really sick and who is sick but can wait.

For some, it is a lack of knowledge that makes their non-emergency bigger in their eyes.

"I knew when her fever hit 104 that I had to rush her here before she had brain damage!"

These are sometimes the easiest and the hardest patients/families to care for. Most will listen to your reassurance and explanation and relax a bit. Others just think you are brushing off their concern, and obviously don't know what you are talking about "because my mother's brother's wife's sister-in-law's aunt's baby had brain damage after a fever!" Is this the way that the information is delivered to them or is it their fear making them unable to hear the information? Maybe both. I have no doubt that my physician was not meaning to put me down or minimize my concern - she was trying to reassure me that I would be OK. Even when she was wrong (it was a disc) she was right - I have recovered.

For some the emergency is acknowledged at the beginning as a non-emergency

"I know this isn't really an emergency but I didn't know where else to go - I called my family doc on Friday and I have an appointment booked for next Thursday, but this is getting worse and I didn't know were else to go!"

These are the people I feel for. They know that they are not critically ill but they do have symptoms worthy of assessment by a physician. They have tried to go the appropriate route but have been turned away or put off and are left with us as a path of last resort. They know that they are looking at hours of waiting for something that is clearly non-urgent, but still requires a physician's care.

Then there are those in pain. Pain is a hard one because it is so individual. Your broken toe may be as painful to you as my herniated disc was to me. Who am I to judge your pain? Again, I try hard to treat your pain and to acknowledge that you have it (I freely give out tylenol, advil, and ice packs in triage) while still placing you appropriately in the triage system. No matter how annoying your lacerated finger is, it is not a life threatening injury, and those with potential heart problems, breathing issues, broken long or joint bones, blocked bowels, dehydration, seizures and intractable cancer pain and many other concerns must all go ahead of you.

I find myself very annoyed with the people who while expressing frustration with their wait say things like:

"It's good this isn't a real emergency - if it was I'd be dead now!!"

These are the people who have come in with an acknowledged less-urgent concern and who are frustrated with their four or six or eight hour wait. The snappy response would be

"No, if this was a real emergency you'd be being treated by now. The fact that you're still here bugging me is a clear indication that you aren't sick!!"

However I bite my tongue and nicely reassure them that the reason for their wait is that we treat people based on acuity, but that we are still taking their concern seriously. I remember clearly one father who, after watching a child have a full-blown grand-mal seizure in the waiting room, stated

"I wish my kid would do that so we can get seen!"

I was definitely not at my professional best that night because I laughed out loud and said

"No you don't, silly man! You're lucky your child is well enough to wait to be seen!"

Luckily he saw the humour too and laughed with me, responding

"You're right. It's just so hard to wait."

And it is. Waiting is absolutely painful! In North America we are a culture of people who are used to getting what we want and right away. We have internet access to any information we want. We have cell phones and email for communication. We have fast food 'Your way. Right away!' We do not know how to wait. We would never survive in a bread line in Russia - imagine waiting five hours to purchase a loaf of bread! So after living our lives with instant gratification we are asked to wait what seems like an interminable length of time for care, at a time when we are feeling our worst and most vulnerable. We are scared, nauseated, dizzy, in pain. Every second we wait makes our symptoms seem worse and makes our fear grow.

So what is my point? Only this - the less urgent concerns are still the bread and butter of Emergency Nursing. Without these patients 60% of us would not have jobs. I'm happy to care for you. Please just recognize that I am doing the best I can with the resources available to me.

And lets agree to be mutually respectful. Deal?

For a real-time example of how I really respond, you can read (or re-read if you were already there, as there is an addendum) my post 'What to do?'.

Follow the Leader

2007-02-23T22:31:00.000-04:00

The ambulance arrived with a beautifully kept, very stoic little 90 year old lady.

"The dogs were fighting and they tripped her up. I think her hip is broken. Her husband is getting a sitter for the dogs and then he'll be in. He's 91." says the paramedic.

Tears roll down her cheeks as we move her from stretcher to bed. "Oh no dear, it's not that bad" she responds to our apologies. "I'll be fine as soon as Harold gets here."

Harold arrives. He rushes to her side, holds her hand and strokes her cheek. "You'll take good care of her, won't you? She means everything to me!"

A month later Harold arrives by ambulance. I almost don't recognize him - he is pale and gaunt, with a shroud of sadness so dense it clouds my vision and brings tears to my eyes.

"He's been like this since Mom died last month. He won't eat or talk." says his son.

He doesn't respond to voice but turns his head when I stroke his cheek. "Hi Harold" I say. "I'm Mama Mia. I took care of Esther the night she broke her hip. I'm so sorry."

"I know" he says "but we'll be together soon." He closes his eyes and does not open them again.

Love of mine some day you will die
But I'll be close behind
I'll follow you into the dark

No blinding light or tunnels to gates of white
Just our hands clasped so tight
Waiting for the hint of a spark
If Heaven and Hell decide
That they both are satisfied
Illuminate the NOs on their vacancy signs

If there's no one beside you
When your soul embarks
Then I'll follow you into the dark

(I Will Follow You Into The Dark ~ Death Cab for Cutie)

The Silver Lining

2007-02-16T08:44:00.000-04:00

Good things about working night shift:

I get to drive home the opposite direction of the rush hour traffic
My eyes feel so great once I remove my contacts
When I get up I can take a really long hot shower because no-one else is needing the water
Nothing else ever compares to the pure joy at being able to close my eyes in the 30 seconds between when I finally crawl under the covers and when I feel myself start to fallllllllllllllllllllllllllllllllllllllllllllllllllllll..................................

It's Getting Harder and Harder to Breathe

2007-02-07T17:11:00.000-04:00

I hate Bronchiolitis.

Bronchiolitis is a viral infection of the tiny airways, usually caused by RSV (Respiratory Syncytial Virus) and usually affecting children under age two, (but most serious in the premature or under 6 month old babies). The kids come in to Emerg sounding and looking like crap, accompanied by their very frightened parent (and rightfully so - breathing is pretty important) but actually are usually OK.

Except when they are not.

We've had a huge run on bronchiolitis this weekend, and most of the kids are actually quite sick. Many of the babies have needed oxygen support and we've had so many admissions to hospital that we are actually out of saturation monitors which are important for keeping an eye on these kiddies while they recover.

Not to mention the extra emotional outlay that is required to constantly reassure the very scared parents. Their anxiety level is so high that most of them are unable to hear what we are saying about their child, and require repeated explanations.

As well there is the constant vigilance over a bunch of little babies who can be good one minute and gasping and apneic the next.

RSV truly is one Really Scary Virus.

Code Quiz

2007-01-25T22:03:00.000-04:00

Imagine for a moment that you are at the end of a line of people waiting to pay for parking, and that this line is completely blocking the hallway to the outpatient clinic areas of the hospital. ...

Then imagine that you see three people running towards you - one of whom is pushing a big cart with a defibrillator on it. ...

Would you:

a) Stay where you are, open your mouth wide and stare continuously at the three running people?

b) Take a step to the side, still completely blocking the hallway, open your mouth wide, and stare at the three running people?

c) Stay where you are and turn your back on the running people?

If you said that NONE of these was the appropriate answer, you are entirely correct. The correct answer is:

MOVE OUT OF THE WAY!!!!

Duh!

This was exactly the scenario I faced today while running to a code. The people continued to do these three things listed above while we traversed 3/4 of the hallway, only moving when we began shouting "Excuse us please! Move to the side! Let us through! MOVE!!!"

Even then the result was a minimal and sluggish shift to the right - I guess saving your place in line-up is more important than the heart and brain of the person arresting!

When complaining about this after, the Security Officer noted: "Well they don't move out of the way for the ambulance, which is a lot bigger and louder than you, so why would you expect them to move just because you are running?"

Come on people! Lets be smarter out there!

Are you Sleeping? Are you Sleeping? Dormez Vous?

2007-01-23T09:28:00.000-04:00

Today I'd like to send a little shout-out to our local Paramedics and Police department for saving a particular Mama's mind from melting to mush and sliding out her ear. Thank you.

Driving to work seemed simple, but it wasn't. There was snow, then salt, then more snow - just a couple of centimeters total, but it was enough to make a slippery sloppy mess. The 360 was over so fast that it was hard to believe it had actually happened and that the car was again facing forward as it should have been all along, and if it wasn't for the clear evidence of my tracks in the snow behind me I could almost have thought I dreamed it.

"Whew. Thank goodness I'm ok!. I need to call daughter and let her know how bad this patch is so she can leave early for work."

Unfortunately my work was too busy and I didn't get to make the early call, so instead I tried to call to check on daughter's arrival status and to have an opportunity to commiserate on the road conditions. No answer on the cell phone.

"Well that's ok - she is driving and not answering the cell. That is good. She'll be at work in a couple of minutes and I'll catch her there."

Ten minutes later I begin trying to call her place of employment. She is the opening employee and the only one present in the facility for the next couple of hours. The phone rings 6 times, then clicks on to voice mail. I hang up and again try her cell. No answer. Five minutes later, same thing. and again in another five minutes, and then in another five.

"Did she sleep in? I'd better call home and get her up!"

Thus begins another round of unsuccessful attempts to raise a living voice by phone. The time is now 40 minutes past opening time and daughter is unreachable at home, by cell or at the work number. Voice mail becomes my enemy, and I want to strangle the cheerful people who recorded the ever so chipper

"Hello!"

(even though one of those was in my voice at my home number...)

My colleagues begin to give pitying glances and to give me more and more room as my dialing finger moves faster and faster with less and less time between attempts. They are all envisioning the same things I am, and there is nothing to say...

After more than 150 times dialing without success I call in reinforcements.

"On-duty Paramedic friend, I haven't been able to reach my daughter at her work for close to two hours. Have there been any MVCs (motor vehicle collisions) today in the slippery hill section of town? Any 17 year old females taken to hosp in the last couple hours? Is there an ambulance posted at that close-by base that could go mobile and check on my honey?"

On-duty Paramedic friend (ODPF) is also a parent and instantly gets the reason for concern. He offers to check with dispatch to see if any of the morning's calls might be worth following up on.

A few minutes later ODPF & partner arrive at my work. They tell me that there have been no reported MVCs and no calls for a person matching daughter's description. They make small talk and provide a Paramedic's version of moral support...

"She's probably got a new tattooed boyfriend named Snake and she's on the back of his harley, half way to Montreal by now!"

even as I laugh I continue to dial constantly, an ongoing succession of beeps and rings in my ear.

"Off-duty neighbor paramedic friend (ODNPF), could you drive over to my house and check to see if my kids are dead in their beds? No-one at home is answering the phone!"

At two hours and thirty minutes (sometime after ODNPF packed up his kids and left his house, but before he arrived at mine) teen-aged son finally decides to wake from his teen-aged stupor after a nintendo all-nighter with friends, and answer the phone.

"Nope. She's not here. Wait a minute. SISTER!!! SISTER!!! ARE YOU HERE????"

He screams at the top of his lungs into my ear.

"Nope. She's not home."

"GO. CHECK. HER. BED. ... NOW!!!"

"Fine." clunk. thump thump thump thump thump. "Nope. She's not in bed and the car is not in the driveway."

ODPF & partner get toned out. As they're leaving ODPF says

"Why don't you ask the Police to do a wellness check? That would be very reasonable given how long she has been out of contact, and the fact that she definitely left home this morning."

Fantastic idea. I mull it over only briefly before I make the call to the non-emergency number of the local Police department. I explain my concern and the call taker efficiently and dispassionately takes my request and info. She says there is a car in the area so I will hear back from them soon. I hang up from the PD and begin again alternating calls between daughter's work and her cell.

Twenty-seven minutes later my cell phone begins to vibrate in my pocket. Daughter's photo pops up as the incoming caller. I ignore all rules of the ED and flip it open, with shaking hands and pounding heart...

What is wrong??!!?? Why did you send the Police to my work??!!?? Of Course I'm here!!!! Where else would I be????? We were hosting a birthday party and turned off the phone!! You are so overprotective!!

Now the day is over and the story has become fodder for amusement throughout Daughter's circle of friends, but I continue to feel anxious when I recall my day.

I never knew parenting would be this hard. Sorry Mom. I get it now.

Show me the Money!

2007-01-16T22:09:00.000-04:00

If you are a student nurse than this post is for you. (and welcome to the Profession, by the way - great to have you here!!)

Nursing Jobs is offering three scholarships (for a total of $5000!) to student nurses at accredited nursing programs in the US.

Current there is only one entry posted. Surely there are more nursing students out there who could use a little helping hand with tuition!

Bring on the blogs!!!

I'm Driving in my Car... I Turn on the Radio...

2007-01-14T17:40:00.000-04:00

I've talked before about how I think that night shift sucks. It doesn't suck any less as I get older..

One of the things I hate most about nights (after the dry, gritty eyes, the nausea, the unending hunger, the nausea, the hangover feeling of being awake when your body wants to be asleep, the achy, fatigued muscles, the nausea, the feeling of moving through glue and did I mention the nausea??) is the drive home at the end of the shift.

I have also mentioned in the past that we are a family of careful drivers. I have never had a motor vehicle collision, and my working in the emerg and doing ride-alongs with the paramedics makes me somewhat skittish of ever being in one. I pride myself on driving with care and attention.

Many, many, many (or at least three) different people have described how driving after being awake all night is very similar to driving after drinking. While I have never driven after consuming alcohol, I can certainly attest to how poorly I drive home from an overnight shift (which sucks by the way - have I mentioned the nausea??)

It pains me greatly to report that on drives home from work I have:

Tailgated quite angrily because I wanted to get home before I fell asleep.
Swerved in front of other vehicles while changing lanes because I was too tired to check over my shoulder and see if they were there.
Weaved all over the road while rolling down the window or turning on the radio, because my fatigue level was such that I no longer had the ability to keep the car from following my eyes and my hands.
Caught myself with my head on the head rest, looking out from half closed lids, with no recollection of letting my head go back.
Closed my eyes "just for a second" while stopped at a red light. Luckily the rolling forward did not cause me to collide with another vehicle...
Had numerous 'wheels on the shoulder' sudden waking events.

Scary. and the adrenalin on waking only lasts for a few seconds before the cycle starts again.

Since there is no option to remove nights from my working life anytime soon I'm going to have to find some other method of improving my post-noc driving.

In the meantime, let this serve as a warning beacon to those of you in my path.... if you see me weaving towards you - I'm not drunk. I just have visions of sugar plums dancing in my head.

Falling asleep at the wheel again baby. You're drifting over the line, yeah! Your hands are tight but your losing grip quickly. Fix me - can you read the signs? (INXS ~ Vegas)

That's Why..

2007-01-14T17:00:00.000-04:00

I'm sitting on the couch (typing a blog post, if you must know...) and my 5 year old starts screeching... "Daddy, come here. Daddy! DADDY!! COME HERE!! DADDY!"

My husband gets up from his supper (which is not yet finished because he actually served seconds and thirds to everyone else before he had firsts...) and comes to the living room. Then the boy states "Pick me up - I want to see that book on the top shelf!"

Now, everyone drop your jaws in unison as you picture the father bending down and picking up the child!

I have just watched this entire vignette play out in front of me so I say to the child "What in the heck is happening here? Did you just shout a bunch of commands without any pleases or thank yous?! There is not a chance on this planet that I would respond when you are demanding so rudely instead of asking politely, and I have no idea why your father just did!"

The son says "Please! Please Daddy?"

And the father looks at me with a sheepish grin and says "That's why they'll bring me comics when I'm in the nursing home."

Rules for the Holidays and a Round of Applause

2007-01-01T23:35:00.000-04:00

Some behaviors would always give pause for thought, but when seen during the holidays seem particularly senseless. Based on some of my experiences this year I would like to share the following 'Rules for the Holidays':

1. Don't dump Grandma on Christmas Eve. She hasn't known who you are for the past six months and has needed assistance with toileting for two months so why is she suddenly too much to care for tonight? To quote Captain Hook: "Bad form, Peter. Bad form."

2. Don't drug the baby with Gravol just so you can have a party without her waking. That said, if you should decide to drug the baby it is rather pointless to become concerned when the child does indeed sleep soundly, and then bring her to the hospital for assessment of her 'lethargy'.

3. When you do have a party, put away the bottles and pour out the leftover alcohol before letting little Johnny play unsupervised in the living room for two hours while you sleep off your hangover.

4. If you know you are allergic to shrimp, for heaven sake don't just pick the shrimp out of the dip before you eat it! And that epi-pen you carry for just such an occasion as this?? Well it works better if you actually use it.

5. If you have post-op instructions that state to call the surgery service if you see redness at the surgical site or purulent drainage then perhaps you should follow those instructions. Raging wound infections don't usually improve without treatment, even if it is Christmas. Also, it is not a currently recommended treatment that you wash your infected incision with rum, either light or dark, and I certainly do believe you that it “stung like a bugger”.

6. When the babysitter calls to tell you that your baby is sick, it is also bad form to wait 2 1/2 hours until you finish your fancy New Year’s Eve dinner before returning home. It is even worse form to then rush your child to the hospital and crank at the staff because your child is not seen immediately on arrival.

Now after all this you might wonder if silliness was the only things seen this month. Thankfully, there were a couple examples of true Christmas spirit.

I am happy to be able to request a huge round of applause for the two people who helped a gentleman who accidentally put his hand through a glass window at the shopping mall. These two strangers (to each other as well as to the injured person) helped the injured man up, bandaged his hand and then one drove him to the hospital while the other drove his car to the hospital so it would be there when he was ready to go home. The added factor is that the injured person was deaf. He signed, but neither of his helpers did. All their communication was through an elaborate series of charades.

I'm also happy to applaud the health care worker who cannot be named (as s/he would definitely get in trouble for this very unselfish act) who gathered up the left-over box lunches (provided by our facility to the staff who are working on Christmas) and distributed them among the homeless on his/her way home from work that night.

Hope you all had a happy and healthy 2006, and all the best to you in 2007.

What to do?

2006-12-28T17:46:00.000-04:00

What do you do for fun with your family during the holidays? For one family's answer, just put yourself into a generic living room and listen to the following conversation:

Scenario:
Paw: "What should we do with the kids today? They're bored with school out so long and they're already tired of all their new piles of Christmas loot."

Maw: "Why don't we go shopping? There should be some good sales on!"

Paw: "Naw, too crowded."

Maw: "Well how about going to the playground? The kids could use their new sleds!"

Paw: "Naw, too cold."

Maw: "Well, Little Johnny has had that cough since September, and Billy has had that rash on his neck since Halloween. Oh, and the baby was pulling on her ears today. I bet it's quiet in the Outpatients today - lets take the kids down and get them checked out proper before school starts again."

Paw: "What a great idea - I'll call Gran & Gramps and we'll make an afternoon of it!"

A few minutes later, here is the nurse in the Emergency Department:

(Addendum: No, I am not joking. This was what the mother relayed to me as the reason they came to emergency today. I, of course smiled and said "No problem. Our physician will be happy to see you, but our department is very busy today with some very sick children, and our wait time for less urgent concerns is 5-6 hrs. Your children's concerns do need assessment by a physician, but not necessarily today." She chose to take them to the walk-in clinic up the street.)

Merry Christmas to Me!

2006-12-21T18:23:00.000-04:00

I'm not usually in the habit of giving gifts to myself at Christmas, but this year I made an exception.

I've been unhappy with the look of my blog for quite a while, but thanks to the great work of Denise at Moodswing Creations, I now have a sharp new style and an aesthetically pleasing colour scheme. Thanks Denise! :)

So, that is my opinion. What do you think?

Addendum... I also want to send out thanks to Shane (one of the hidden people behind the great look of Nursing Voices) for so kindly fixing all of the freaky code things that (among other things) made the text run off the side for some people. Thanks Shane!!!

The Clean and the Dead

2006-12-15T16:07:00.000-04:00

I don't know anyone who would list providing postmortem care as one of their favourite tasks. None-the-less, it is a task that most nurses have done more times than they can remember.

I somehow made it all the way through nursing school without once being present for the last bath. I had only one patient die while I was on-shift and this expected death occurred during my lunch break. The nurses on the floor thought they would do me a favour and by the time I returned to the floor the patient's body was washed, dressed and en route to the morgue.

Then I began working in the birth unit and a stillborn baby was born during my first week on the job. The baby was newly deceased and was perfect in every way. My preceptor walked me through the ritual of washing and dressing the body, then gathering footprints, hand prints, a lock of hair and photos. The entire event was heartbreaking, but the process itself gave a sense of closure to the event.

Since then I was both fortunate and unfortunate enough to complete this rite of passage with many many other precious little babies who were unable to survive the pregnancy or birth.

In the years since that first baby I found that I became comfortable with what needed to be done. I would cuddle the baby, dress them with care and work to get the best photos possible. Through all this I would talk to the person who was, and tell them how special they were. I always felt a little foolish having this one sided conversation, but then pressed on and continued to talk, just in case...

When I moved to the Emergency department I expected that postmortem care would be a common occurrence, but I was wrong. The white cloud that was present throughout nursing school returned and in the past five years I had been only on the peripheral edges of caring for a deceased person's body a few times. Until recently.

When I arrived on shift I was requested to prepare the body of the patient in the resusc room. He had passed away a short time ago, but the unit was very busy so all the other nurses had been pulled out to care for the living.

I gathered what I thought I'd need, feeling a little empty handed without the camera, the ink pad and the other items used for the babies and children, but not for adults (although I'm not sure why we don't memorialize the adults in the same way...).

Then I entered the room and pulled back the sheet in preparation for the bath and was struck something I had never before encountered during postmortem care. This man was dirty. Really, really dirty. The type of dirty that says he had not bathed in a very long time.

The babies were never dirty. Even the children, though they may have been grimy from a day at play or from the event that caused their death, never had the ground-in look that this man had.

I washed and I scrubbed. I changed my water and my cloths and started again. I was able to remove the residue of the resuscitation - the blood, the mucus, the tubes and the tape, but was completely unable to get this man's skin clean. I found that the harder I worked at getting him clean, the less I was able to talk to the man in the manner I had become accustomed to.

By the time the undertaker came I was far more upset than I had ever been during this ceremony, even more distressed than I was with that first baby so many years ago.

Other nurses talk about the bodily fluid that bothers them the most. For some it is sputum, for others feces or vomit, but I think I've just found my nemesis.

Dirt.

Christmas Crash

2006-12-08T10:05:00.000-04:00

There are four vehicles in my driveway and we are a family of careful drivers. We do not normally herald orange garbage bags duct taped over light panels or dents as badges. None-the-less, the recent spate of winter weather has taken its toll on our cars. We have one with a non-functioning alternator, one with a broken belt on the front passenger side tire (a result of car vs curb in the most recent storm), and one undriveable vehicle, thanks again to the early onset of 'rain turning to snow in the evening' and the car vs school bus event on Monday.

So that would leave us one fully functioning and structurally intact vehicle, right?

Wrong.

Place one slightly nervous, recently post-mvc driver in a large van in a parking lot of narrow spots and frantic holiday shoppers and this is what results.

And what did you say you want for Christmas??? A new rear quarter panel? Certainly. Santa has one right here in his workshop.

And to add insult to the injury - look carefully at the photo above... only in Nova Scotia could a car be damaged yesterday and be rusted today!!

Deck the cars with bumps and scratches. Tra-la-la-la-la La-la-la-la.

(Cartoon by Bruce MacKinnon)

Powerless: lacking power to act; helpless

2006-12-06T21:58:00.000-04:00

As a parent there is nothing worse than the feeling that accompanies a distress call from your child. As a nurse there is nothing worse than watching a friend and coworker deal with an ill or injured family. Unfortunately I’ve been in both sets of shoes in the last couple of weeks, in ironically similar circumstances:

The ambulance phone rings with a familiar story: Motor vehicle collision; young driver; neck pain with palpation; minimal injuries noted; patient fully immobilized: doesn’t sound like much but when the bay doors open and a very respected co-worker rushes in beside the stretcher, crying, the ho-hum stops and the heart pounding starts.

“Bring him down here, Hon, I’ll triage him at the bedside – is he ok for a bed or does he need resusc? Is he boarded for mechanism or because you're worried?”

Years of critical care nursing experience kicks in and the routine proceeds, even as you try hard to shut off the friend valve – if you get distracted by the worry and grief you will not be as alert or thorough in your assessment… “What is your name; when is your birthday; do you know where you are; do you remember what happened; just a quick light in your eyes; squeeze my fingers; pull my hands up; does this hurt when I press here; does this; does this; hold your head still; Shh, Mama, shh, he’s ok, everything is looking good. What a scare you’ve had…”

You do your best to be both friend and nurse, and that line is hard to swing. Then the shoe is on the other foot and you are so happy to hear respected coworker's voice on the phone…

“Friend,” you say with a shaky voice, trying hard to maintain that nurse's famous calm, “Oh, Friend, can you do me a turn-about? This time it is my honey that just had an MVC. I can’t get through to her cell, and I’m an hour away, and the snow is awful, and the message I got is that her neck is hurt and the police called the ambulance. Please take care of her for me! Please tell her I’m on my way… Please….”

Thankfully for all of us the children, while dazed and sore, were otherwise uninjured. But we, as mothers and as nurses, remain just a bit more shaken.

The patient and family will never see the little tremble in our hand or hear the quiver in our voices as we continue caring for our next patient from an MVC but my friend and I will catch each other’s eye and nod, acknowledging that we understand all to well the pain of powerlessness.

(MVC = motor vehicle collision, also known as a road traffic accident = RTA)

2006-11-29T12:21:00.000-04:00

Need I say more?

Guilt

2006-11-20T09:07:00.000-04:00

Parental guilt is a terrible thing to see.

Most parents truly love their children and try to protect them from harm. When an accident happens (and I know that there is a school of thought that states there is no such thing as an accident, as all injuries are preventable, but lets set that aside for the moment), the unspoken message is that the parent has failed at their job. That feeling of failure, coupled by the necessary questioning of the health care workers, (designed both to do a full assessment, and to tease out any concerning circumstances such as deliberate harm) often leaves parents very shaken and saddened.

Imagine, then, the guilt of the parent when the child is accidentally injured by parent...

This week alone I have cared for:

* a three year old boy whose morbidly obese father fell on him while they were playing, resulting in a fractured tibia & fibula.

* a two month old baby whose mother fell down the stairs with the baby in her arms, resulting in a fractured skull.

The guilt and distress displayed by both these parents was awful. There were no words that we could say to lessen their upset.

I couldn't help but remember how horrible I felt when my five year old fell out his second story bedroom window and fractured his skull. A window I had meant to purchase safety bars for (but never got around to). A window I had kept locked for 3 years when he was upstairs as I was worried he might fall out it, but had left open this one time because it was hot and I was 37 weeks pregnant with twins and was too tired to climb the stairs and lock it again when he went up.

I had spent that very complicated pregnancy convinced that one or both of my babies would not survive, and when son fell one of my first thoughts was that someone had decided that instead of taking one of those babies, my five year old would be the one to die. Thankfully that was not correct, but the guilt was and still is beyond words.

One thing that never occurred to me at the time, as wrapped up as I was in my own grief and remorse, was how the nurses who cared for us (some of whom I knew) would feel.

But now I know.

In both the cases above, the parent was a colleagues of mine - a person I work with side by side, day after day. A person I trust implicitly - I have no concern with their parenting.

None-the-less, they know how the system works and not only are they feeling a failure of their parenting by causing harm to their child, they also feel a failure to their colleagues. Somehow we are supposed to be smarter and more careful than the people we care for every day - we should somehow have learned from all the mistakes that we see paraded in front of us every day.

But we're not. We are just parents.

Never

2006-11-12T14:26:00.000-04:00

"Never Attribute to malice that which is adequately explained by stupidity" (author unknown)

Sometimes

2006-11-11T10:39:00.000-04:00

And sometimes it is better to stand up for what is right.

That was the choice I made yesterday. The decision had been brewing for a while and when push came to shove I held my ground and resigned from my primary place of employment.

So for the next month or so the work stories may be a little scarce. Hang tight.

Say What?

2006-11-04T23:18:00.000-04:00

Best quote of the week:

Scene: in emerg on a busy Saturday night - multiple ambulances and concerning chest pain patients have presented within minutes of each other. Everyone is moving quickly - nurses with EKG machines and tubes of blood dance in and out of rooms, dodging paramedics with monitors and stretchers, and other nurses with backboards.

A woman approaches the RN, physically blocking her path (while she is wheeling a fully immobilized patient on a stretcher). A well-looking child dances down the hall beside the woman, singing the ABCs loudly.

The woman states: "How much longer till my daughter gets seen by the doctor? We need to get to Wal-Mart before it closes."

Tell Me A Story

2006-10-22T16:36:00.000-03:00

"Everybody has a story whether you're young or old. Everybody has a story that's more precious than gold. Everyone needs a true friend to listen and to care, so tell your true story, a memory to share." (Everybody Has A Story ~ Lorraine Bayes)

You would think he was one of us from the greetings he receives as he walks with his walker down the hall. But he's not. He is a patient who has clearly won all our hearts.

He's a diminutive man, only 5'1". His smile is as big as his face. He recognizes us and greets us individually, calling each of us by name. His impish face is a mass of wrinkles - like a little apple doll, and every single line tells a story. He is 91.

If we ask, and only then, he will tell us stories from the war (he was a wireless operator, his radio weighed 75 lbs and he had to carry it everywhere he went - even to 'the facilities') and of his life with his wife before she became ill (she is now in a home, stricken with Alzeheimers and he visits her every day, despite her having no idea who he is). He has many tales to tell and he is a captivating story teller, but he is reluctant to "bother you with an old man's prattle" or to "keep you from the sick people that need you much more than I do."

Our time together so far has been short - less than 90 minutes on each of his four visits to our ED. Now he has been released from our care - his IV removed and his meds changed to oral antibiotics.

As he turns to wave just before walking out the door this last time I find myself fighting back a tear. I am struck by the thought that I will miss him, and the strong desire to run after him an get him to tell me one last story. I send a silent wish after him that his family takes the time to hear him, and that he has many more years to share the tales of his life.

The Other Side of the Bed

2006-10-12T23:11:00.000-03:00

The Chiropractor says “It’s a disc. No question. Here are exercises that will help. I need to see you again tomorrow.” as he twists me into a pretzel and leans in for that pain relieving crack. I take a deep breath and try to relax so he can do his work.

The GP says “I don’t think it’s a disc, your symptoms aren’t severe enough. Does this hurt?” as she wacks on my low back with her closed fist. I grit my teeth and attempt to remain standing as I suppress the tears that have sprung to my eyes.

The Physiotherapist says “I can see that you aren’t feeling very good yet, but I know you nurses and you’ll push on through anyway.” as she slides acupuncture needles into my low back, creating waves of muscle contractions and pain. I take a deep breath and try to stay still while the needles do their work.

The workers compensation Case Worker says “I’m glad you’re back at work. Nurses aren’t usually malingerers”

The Nurse Manager says “Welcome back. It’s good you got better quickly. We would have been really short this weekend without you. Remember, you’re only to do light duties.” I take a deep breath and try to suppress the maniacal laugh that springs to my lips at the thought of ‘light duties’ in the ER.

The Emergency Physician says “You shouldn’t be back here yet. You are obviously too sore! Here is a note for sick leave and some meds that will help you.” as she writes me a prescription. I grit my teeth and try to resign myself to the thought of taking more stuff that help with the pain, but make me feel gross and stupid.

The Emergency Nurses say “Stop. Don’t lift that – We’ll move that patient. It’s ok – we’re here to help!” as they move me from the backboard and do my work for me. I take a deep breath and give thanks that there are so people who care in so many different ways.

Babes in the Birth Unit

2006-10-11T22:22:00.000-03:00

Babes in the Birth Unit
Originally uploaded by Mama_Mia_7.

Oncoming day shift nurses in the Birth Unit, 1992. Notice anything funny? Yep - our work is wearing off on us - 6/14 nurses in this picture are 'with child'... definitely the epitome of created job security!!

(BTW - this is another one of those 'Flikr' photos with notes - click and read...)

100 Things

2006-09-30T07:48:00.000-03:00

This is my 100^th post. The fact that there are any posts at all is amazing in and of itself, as I only started blogging because my husband showed me a couple blogs and I got hooked. That I have made it to my 100^th post surprises me. I often go days without posting because it feels like I have nothing to say. Then at other times the stories just write themselves. Odd. I certainly could never do this for money or under a deadline. At any rate, in honour of my 100^th post, here is a list, (in no particular order of importance) of 100 things…

Things that make me happy:

1. My husband (most of the time)

2. My eldest child

3. My second child

4. My elder twin

5. My younger twin

6. My youngest child

7. Sitting in the sun on my lunch break

8. Singing in the shower

9. Riding in an ambulance with lights and sirens going

10. Actually hearing a patient’s concern and being able to answer it

11. Writing a great blog post

12. Hugging my friends when we meet for dinner

13. Hearing my kids say something funny

14. Running and power walking

15. Knowing my Mom is doing OK, and that she has a great husband who ‘gets it’

16. Paddling in a kayak

17. Reading a good book

18. Watching a flock of birds do a dance in the sky

19. Watching my mom play with my kids

20. Eating salmon from the barbeque

21. Eating with a group of friends – doesn’t matter what we’re eating

22. Being able to reassure a parent that their child is ok

23. Taking a long hot shower

24. Seeing my sister with a nice guy who treats her right

25. Helping a friend give birth to her baby

26. Watching my Dad and his ‘Committed Cohabitant’ hold hands

27. Snuggling in bed with my kids

28. Listening to the waves at the beach

Things that make me sad:

29. Having one of my children sad

30. Having one of my children scared

31. Having one of my children hurt

32. Thinking about losing one of my parents

33. Working a code on a child

34. Working a code on an adult when it seems like we should be letting them go

35. Taking care of drunk teenagers

36. Taking care of people who are suicidal or depressed

37. Taking care of old people who tell me that they have no-one who cares

38. Knowing that I’ll never have another baby

Things that make me nervous or afraid:

39. Not knowing where my children are

40. Hearing about terrorist acts

41. Prepping the resusc room for an incoming patient

42. Hearing about natural disasters

43. Having my car slide on a curve on a snowy road

44. Watching my child drive away

45. Kids who can’t breathe

Things that make me feel sick:

46. Feeling ribs crack while I’m doing CPR

47. Watching someone cough through a trach

Things that make me proud:

48. Watching my children do something by themselves for the first time

49. Reading something cool written by one of my kids (for example...)

50. Watching my children grow and mature

51. Reading a book or article written by my Dad

52. Reading in the newspaper about my brother when he wins a case

Things that make me angry:

53. My husband (sometimes)

54. People who are rigid and inflexible

55. Stupidity

56. Meanness

57. Laziness

58. Someone stealing a special picture from my blog and using it in a not very nice article in a gossip rag

Things I like to eat & drink:

59. Barbequed Salmon

60. Rare steak

61. Spinach salad

62. Hawaiian pizza

63. Water (+/- a little lemon juice)

64. Kahlua & milk

65. Lemonade

66. Spaghettini c meatballs

67. Sugar crisp

68. Lobster and crab

69. Pink peppermints

70. Chocolate baklava

71. Raisin Bran

72. Pretty much any pasta in a red sauce

73. Hot Jell-O, especially watermelon & lemon

Things I think are more important than most people understand:

74. Breastfeeding

75. The process of childbirth

76. Hugs and smiles

77. Being outside

Things I like to watch & listen to:

78. Fiddles & bagpipes, banjos and bouncy music

79. Hill St Blues/NYPD Blues – Police shows

80. Emergency/Saved – Paramedic shows

81. St. Elsewhere/ER – Medical shows

82. Funny movies – Princess Bride

Things I like to smell:

83. Honey (especially ‘Burt’s Bees’ beeswax products)

84. Wild roses, especially when I’m not expecting to smell them

85. Thanksgiving/Christmas turkey cooking in the oven

86. Real lilacs

87. Whatever the cologne is that Dave wears

88. My kid’s hair when it is freshly washed

Things I’d like to do

89. Travel around Scotland

90. Travel around Italy

91. Take the kids back to Disney Land

Things I do when I’m bored:

92. Sudoku

93. Bite my nails

94. Sleep

95. Read

Things that make me laugh

96. The Princess Bride

97. My friends

98. Hearing children laughing

99. My husband’s blog (most of the time)

100. My children’s antics

The End

I Can See Clearly Now, The Rain is Gone...

2006-09-27T15:50:00.000-03:00

... or at least the brook running through my basement has ceased and the mudbanks are drying. With the dawn of a new morning, the pity party is over.

Our friend Lockie came by today, and while both my useless old back and his tight work schedule (not to mention our combined lack of rhythm and grace) prevented us from actually dancing in the kitchen, my spirits were greatly lifted by the gift he arranged - temporary use of a plumber and a shiny new hot water heater!

Now this is not just any new hot water heater! This is a 60 gallon hot water heater - a full 20 gallons bigger than our previous rust bucket. Perhaps I now understand why in the past shower #4 of the morning was slightly less pleasurable than shower #1.

Now, ask me how long it takes to empty said 60 gallon water heater?

31 minutes!!! Heaven. Absolute heaven! Thank you friend!

Now if only this was me..

http://www.themosaicmaker.com

And the Walls Come Tumbling Down

2006-09-26T20:57:00.000-03:00

So a short while ago I turned old, and despite fearing for the future, I dared the world: "Bring it on!" Well it's been brung and now I'm falling apart. Like a rusty old car, I'm shedding bits behind me everywhere I go.

My hair is graying rapidly, my eyes dimming and fading so that I cannot read the instructions for reconstituting medications, and now this week I'm here, at home, nursing a slipped disk that is finally paying the price for years of nursing fatigue. I've spent days standing only because both sitting and reclining are excruciating, and doing more "MacKenzie's exercises" than I can count. I'm eroding my stomach lining rapidly with a 6-8 hourly cocktail of ibuprofen, methylcarbonol, acetaminophen and codeine, but not really affecting the discomfort much. My career depends on my back, but my sick leave did not carry over when I moved from being mostly at the place of employment where I have 20 years service (where my sick bank completely full) to working mostly at the local emerg where I have < 2 years service and less than 3 shifts of sick leave. I cannot afford to take the time off that I need to recover.

So apparently in the karmic world it is not enough to be incapacitated. It is better to heap the insult onto the injury.

In the past week or so we've also had one of our children attacked twice at school - choked and pushed into a thorn bush, then hit under the eye with a flying shoe - while the administration talks nicely about working things out and learning better coping strategies, despite their stated zero tolerance policy for physical violence. The littlest one was traumatized by the specter of Terry Fox and CANCER, which has him crying repeatedly and waking at night - clearly the message was way too strong for the five year olds! Not to mention that pretty much everyone in the house except me (spit, spit, spit) has had the galloping consumption and has been wracked by vicious coughing (Please don't let me get it! I can barely breath with my back this sore, coughing just might completely kill me!!!).

But wait! That is not enough... this week the oven has stopped working - it will trick you and heat up to about 200 F, and then stop, despite heat coming from both the upper and the lower elements. as well, my fridge is working erratically. It is freezing some things and keeping others warm, as well as having a leaking drip pan despite all my attempts to fix it.

Enough you say? No. I reply. It is not.

Today we discovered that the wet spot in the basement that we thought was the result of a careless child vs dehumidifier is actually the last caress of our hot water heater, which has apparently been leaking for a little while without our catching on, and now has decided make its intentions clear by pouring 40 gallons of hot water across our basement floor, ruining a large number of my mother's belongings in the process.

I know. What a mess. But the real significance of this difficulty is lost to most of you. I doubt that even my family members could tell you what this truly means to me.

I use the 6 minutes of hot water alloted for my shower (the fourth of four showers taken in our house each morning) to convince myself that I am awake, to loosen up my old back which has cramped mightily through each night, and to meditate briefly on the good in my life, allowing me to start each day in a positive frame of mind. I can count on one hand the number of days in the last 27 years that did not start with a hot shower. All of those showerless days were because I was either kayaking or camping with Girl Guides. Even during the powerless days following Hurricane Juan our tank had lukewarm water and I still managed my morning routine.

I am trying to ignore how shallow my complaints are, especially compared to all the loss and heartache in the world, but today I am tired and sore and have decided to allow myself a brief pity party. Wanna come? I sure could use some friends dancing in my kitchen right about now.

Just don't expect a hot meal, a cold drink, or any hot water. We're all out.

Say What?

2006-09-24T23:21:00.000-03:00

Overheard on the paramedic's radio, as they were getting report on an outgoing patient:

"#123, please proceed code 1 to XXX non-nursing home for a witnessed cardiac arrest. Staff on site state that they know how to do CPR but are not permitted by their employer to begin it. Patient has full code status."

Now, since when is someone not permitted to begin a potentially lifesaving procedure on a patient with a full code status?? And what nurse would stand there and watch a patient die in front of her eyes and not use her skills and education to help, when any bystander who happened by could and would start CPR?

The mind boggles...

The Best Sandcastle of the Summer

2006-09-24T01:01:00.000-03:00

The Best Sandcastle of the Summer
Originally uploaded by Mama_Mia_7.

Wow. I've only known about Flickr for 30 minutes or so and I'm sold. It is totally cool! Here is the first photo I uploaded...click it to go large size, and don't miss the notes!

This was probably my best day all summer.

Between seven people's work and camp schedules it was the only event we managed with the entire family all summer. We got to the beach early, staked out an amazing spot, and the whole clan pitched in on the building. It took hours, and was interspersed by sun bathing (yes we wore hats and loads of sunscreen, despite what you see in the picture), swimming and snacking.

It was simply great, and is a memory that I cherish.

Black Bird Fly

2006-09-11T14:54:00.000-03:00

It is a beautiful sunny day with a clear blue sky - not a cloud in sight.

As I walk my five year old home from school I look up. I live on the flight path into the international airport, so planes in the sky are a constant sight. Today I see two jumbo jets coming in to land and at least six other vapour trails higher up.

I cannot help but reflect on how different this is from five years ago.

September 11, 2001 was a beautiful fall day, just like today. Except then I was walking my twins home from school, and the sunny skies were empty. Not a plane in sight. The air was quiet. It was eerie. We were all waiting, watching and grieving.

The towers had only been down for a couple hours, and the death tolls were still projected to be in the tens of thousands. The children had all heard a little of what was happening, but they did not understand. Neither did I. There were not answers for most of their questions.

I had been part of the EMS response when there was a local plane crash three years earlier. This felt similiar. The dream-like quality of the day, the disbelief, the anguish.

But this was worse. Far worse. The first was an accident. This was deliberate act. I could not and cannot fathom how a person could grow up thinking that the way to glory and everlasting life was to kill, maim and destroy. I feel sorry for the people who have so much hate in their hearts.

As I walk and watch the planes above me, and remember the images from my tv screen and the faces I see memorialized today on Project 2996, I wish for peace, and I try to forgive.

Ode to an OB

2006-09-07T12:22:00.000-03:00

He was my colleague for 18 years - it was quite the ride.
Together we were catching babies, working side by side.

He was a kind and gentle man, though sometimes he got mad.
He wanted the births to turn out right and when they didn’t he got sad.

He wanted to be the one to catch when the baby finally came,
He knew that having a stand-in doc just wouldn’t be the same.

He was quick to cut if need be, when time was of the essence
But when things were going well we hardly felt his presence

But most important to this man was taking care of his kin.
Just ask about his grandchildren and then you’d see him grin!

I asked his help in a troubled time. He came, he cared, he prayed.
And by the time we were done, our babies, they had stayed.

Now he’s gone, he died today. Cancer got him in the end.
The world has lost an excellent doc, and I have lost a friend.

~ Dr. Ralph Loebenberg ~

(1938-2006)

It's The End Of The World As We Know It

2006-09-05T17:57:00.000-03:00

My world is about to change.

Tomorrow my baby (who is clearly not a baby anymore) starts grade primary. This is a huge milestone in our family, which is only slightly larger than the other milestones that occur tomorrow: the twins enter grade 4, older son enters his last year of Junior high, and my first baby begins her last year of Senior high!

For the first time in over 17 years I will not have a child at home in the morning, and I will have a taste of the empty nest which is yet to come.

Despite the grief I feel for the loss of my babies, I cannot help but revel in the excitement of watching them grow into independent and free-spirited youth (some times a little too free spirited, but I digress), and then on to being contributing members of adult society.

Not to mention that I'm feeling the (slightly guilty) pleasure of knowing that from now on I can anticipate that when I am not at work, my daytime hours are all my own! Once the kids are safe in their classes I am free to do what I wish on my own schedule! I can go for a walk, read, sleep, or even mop the floor without worrying about making snack, lunch, or some other person's wants and needs!

It's the end of the world as we know it.
It's the end of the world as we know it.
It's the end of the world as we know it, and I feel fine!
(End of the World ~ Great Big Sea)

Do You Hear What I Hear?

2006-08-31T17:19:00.000-03:00

You could hear the noise as soon as he entered the hospital. It came across the foyer, through triage and all the way back to the Nursing Station.

"Guhn guhn guhn guhn guhn..."

"What the heck is that??" Someone peeked into triage "It's a baby! Mama Mia, you know kids! Come here! We're taking this one to resusc!"

"Guhn guhn guhn guhn guhn..."

He looked even worse than he sounded. His face was exceedingly pale with a blue circumoral ring, his eyes were huge, his sternum & ribs fully outlined with each attempted breath and his tracheal tug was the most pronounced I had ever seen. His limbs were mottled and cool. He was placed reclining on the stretcher, and instantly became worse.

"Guhn guhn guhn guhn guhn guhn guhn guhn..." "Sit him up, for goodness sake, sit him up!!"

His respiratory rate was 82 and his sats were 84% in triage, and while upright, with 100% O2 at 10 L/min they were 90%. Mom reported an ongoing history of grunty respirations off and on since birth (10 months ago). She had taken him for physician assessment numerous times, but had always been breathing fine when seen by the Doctor, or had gotten better with a ventolin mask. This grunting had been much worse for the last three days and was constant x 24 hours. This weekend alone she had sought care in an alternate Emergency department twice and visited a walk in clinic once prior to coming to us. Each time she had been told that the child had a cold but was ok.

Chest sounds were very decreased throughout the left side and right base with coarse noise audible in the upper right side. Ventolin and atrovent masks were begun immediately and a chest xray was ordered.

After 2 back-to-back masks (~ 12 minutes) the only improvement was that the sats were 91% on 100% O2. Ventolin was applied continuously and options such inserting an endotracheal tube and a portable xray were discussed. An emergency transport the the pediatric facility was requested.

After continuous masks for 20 minutes the child's chest did not sound any better - no wheezes, only some coarse noise in the upper right side and his breath sounds remained extremely decreased.

A Paramedic team arrived moments later and the child was transported Code 1 to to the pediatric facility. On arrival there the childs sats were 86% on 100% O2 despite continuous ventolins during transport and he had a tracheal and cardiac shift to the right. He was placed in the resuscitation area and a portable XR was immediatly obtained as the transport team had arrived prior to one being taken in our facility.

The diagnosis? Can you guess??.....
.
.
.
.
.
.
.
.
.
.
.
.
.

Diaphragmatic Hernia.

After the xray was read an NG tube and an endotracheal tube were immediatly placed, surgery was called, and the child was in the OR within 1 hour of arrival. He went from there to the PICU where he made a terrific recovery.

And that coarse noise in his chest? Apparently his bowel had managed to do all this expansion into the chest without kinking or being compressed, and those were bowel sounds!!

I still find it hard to believe that his hernia had managed to be undetected through one 18 week ultrasound and two biophysical profiles in late pregnancy, as well as multiple visits to the doctor for breathing concerns, without ever being picked up!

Lucky kid!

Until Now

2006-08-16T23:21:00.000-03:00

"Whoo-hoo-hoo, look who knows so much. It just so happens that your friend here is only mostly dead. There's a big difference between mostly dead and all dead. Mostly dead is slightly alive." (Miracle Max ~ The Princess Bride)

The call came in as a 'code 1 - cardiac arrest'. We were parked less than 1 minute away from the address so were on scene before any updates were broadcast. Dave went first while Eric & I grabbed the bags. Once in the door we had begun opening kits & preparing for the resus when Dave put up his hand & quietly said "No."

Eric and I both paused, mentally shifting gears while verifying that Dave said what we thought we heard, followed by quiet repacking of the gear. Only then did I actually get a look at the patient. There was no doubt - he was far beyond the reach of our drugs and tubes.

Despite my efforts to maintain a neutral face Dave must have seen something there: "Mama Mia, have you ever been on an 'obvious death' call? Come here & I'll explain it to you." And just like that an awkward moment turned into teachable moment. The important scene notes (lividity, rigidity, position of the body, visable meds) were reviewed, and I had the realization that in the nursing world people are either mostly dead (requiring a whole flurry of events while we try to keep them away from the light) or newly dead (which requires quiet & compassion for the grieving family while we respectfully prepare the body for its next journey). Except at wakes and funerals I've never actually seen someone who was completely dead.

Until now.

Not the Brightest Bulbs in the Pack

2006-07-31T20:25:00.000-03:00

It's been one of those days. Significantly more patients arrived today with concerns that would seem to the average person to be somewhat less than emergent. In fact, most of the concerns fall easily into the realm of stupid. Let me elaborate:

* A 66 year old man who presented to us with 'constipation'. States he gets constipated a lot. Last bowel movement was 48 hours ago. He had not tried any over the counter relief measures (ex-lax or other similiar preparations). He was concerned today because there was a bit of blood on his tissue after his last bowel movement. Yes, that was 48 hours ago. Yes, he was straining. Yes, he has hemorrhoids. Yes, he has had them for years. Yes, they have bled before. No, it never occured to him that they were related.

* A 34 year old man who came to hospital by ambulance for a concern of right lower leg pain. It had been bothering him for 48 hours, but after working all day (a job where he walked constantly) he 'just couldn't stand it any longer'. He had not tried any over the counter pain medications. He could not remember any injury. He was not displaying any limp. There was no swelling, redness or tenderness on the leg. There was one small bruised area (2 cm x 2 cm) noted, and the patient was not sure where that came from, but that was exactly where his leg hurt! Yes. That is correct. He came to hospital for a bruise on his shin.

* A 48 year old lady who bumped her head (left temple) this am on the cupboard door. No loss of consciousness, no nausea or vomiting, no dizziness, no weakness, no syncope, no laceration, bump or bruise. No. This patient came to emerg because "ever since I hit my head, my right ear feels 'funny'."

* A mother who brought her 7 year old son to Emergency because "he dropped his glass of milk! He never drops things so I was worried he was having a stroke or something!"

I know, I know - I really do get it. These people came because they had a valid concern. Every patient arrives with an emergency, either real or perceived. Please rest assured that no matter how dumb I thought their concern, I treated them with kindness, compassion and respect. I listened to their explanations and did reassurance and comfort measures. The patient will never, ever know how I really feel. After all, my job is to provide care, not criticism. No matter how tempting that sharp comment or sarcastic statement may be, I will refrain.

I'm Spleentastic, Thanks

2006-07-24T02:56:00.000-03:00

Kim at Emergiblog hates spleens. I do too. I also hate spines.

12 year old boy went down a hill and over the handlebars of his bike. Proceeded to hit the curb with his helmetless head. After 'having a nap' he and his 9 year old brother walked their bikes home (6 blocks) because "I was too dizzy to ride". Presented to triage as alert, oriented, pale, diaphoretic and moaning with 10/10 pain in the left upper quadrant of his abdomen. Patient then vomited, and dropped his bp. A quick trip to the resusc room and a stat transfer to the trauma center revealed a fractured spleen, a lacerated liver and a bruised kidney. Oh yeah, and an epidural bleed and a T-4 compression fracture. Spent 4 weeks in the ICU - not from the head or spine injuries but from the spleen that continued to leak even after surgery to cauterize it and then repeat surgery to remove it.

45 year old man went shopping at Walmart when he was hit by a bad attack of 'gas'. He felt so unwell that he left the store and while walking to his car he 'fell to his knees because the pain in his chest was so bad'. Presented to triage walking after being assisted to his car by helpful bystanders and then driving himself to hospital. On arrival he was clutching his epigastric area, was pale and diaphoretic with pain classed as 7/10. Pt vomited a copious amount on arrival and then his pain resolved. Vital signs were stable. Full cardiac work-up was done (including ASA administration) with no cardiac findings, but incidentally it was found that he had some very mild guarding of the upper left quandrant of his abdomen and his pain had returned somewhat, but was now in his left shoulder. He denied recent trauma, but after a review of his liver enzymes (which were elevated) a CT of his abdomen was done to reveal - yep - a ruptured spleen. After much discussion with his wife the patient was able to recall a minor gardening accident some 10 days earlier. Patient was in the department for 6 hours with stable vital signs. Paramedics arrived to transfer him to a higher level facility for observation. As soon as they arrived the patient vomited, dropped his pressure to 80/40, and became unresponsive. That d*mned spleen (and a bit of clot busting ASA) created quite the stir that night, but the splenectomy was successful and the patient made a full recovery.

An 18 yo male in a single vehicle, high speed, roll-over MVC - rear passenger, restrained. Was mobile at the scene for ~ 15 minutes prior to EHS arrival. When assessed by paramedics complained only of some low back strain, and clearly denied spinal tenderness. All other passengers were OK and patient originally refused to go to hospital, but after RCMP placed a call to his mother and handed him the cell phone he was transported to hospital by ambulance as a low priority - no immobilization, no IV. On arrival to the emerg department he was alert, oriented, and complaining only of low back pain 4/10. He had a clear seatbelt sign across his abdomen and a firm abdomen but denied pain with abdominal palpation and stated he "has great abs - this is what my belly always feels like". MDs were unimpressed with his injuries and did not do a full trauma assessment, but the RNs did complete trauma bloods, initiated a large bore IV and cautioned the patient against movement. Full vitals were done q 15 minutes. After 2 hours in the ED the patient suddenly got hot and vomited copious amounts of stomach contents and blood. At this point a CT of chest and abdomen was ordered. The result - yep - no big surprise - a lacerated spleen, a lacerated stomach and a bruised kidney. Oh yes, and a compression fracture of L1-L2. Patient had a 2nd large bore IV started and was placed in full spinal precautions. Vitals remained stable and patient was transported to the local trauma centre. I'm waiting for word on him.

Actually I say that I hate spleens and spines, but the truth is I hate not having them assessed appropriately and in a timely manner. And I hate them sneaking up on me when I let down my guard and think my patient is stable.

However, if nothing else, I have learned that the patient with a potential spleen injury who vomits does so because he is about to drop his pressure - it gives me a couple of seconds to get him reclining and to open that IV wide.

sorry - a bit disjointed, but I couldn't seem to sleep until I got this post out of my system. Lets see if the eyes can close now.

Calgon, Take Me Away!

2006-07-19T10:20:00.000-03:00

Two patients arrive at the triage line-up at approximately the same time.

Patient #1 is in obvious distress. He is pale, diaphoretic and clutching his abdomen with that clenched-jaw look of someone who is working hard to hold in the moans. "I think I've got a kidney stone" he states.

Patient #2 is moving easily, colour is good and respirations are easy. She is drinking coffee and chatting with her husband as she casually walks up to triage.

Patient #1 is brought into triage. As the triage process is begun patient #2 becomes visibly upset: "Hey!! I was here first!" and to her husband "I told them I was here first but they're just ignoring me!"

I complete patient #1's triage in under 3 minutes and bring in patient #2.

Patient #2 proceeds to *SCREAM* at me about how I was sexist and racist and that is why I took patient #1 first (All three of us are caucasian) and that she was going to report me to the Doctor! (OOOH!! That is a big deal, since the doctor is in no way my boss!).

Security steps up to the door as the woman continues to rant about how she was "rudely pushed aside by me" and how she will "sue the hospital for this traumatic event!"

After more than 3 minutes of drama she finally gets to the reason for her visit to the emergency department:

"Well I've had this horrible yeast infection all day..."

My Fine Feathered Friends

2006-07-18T09:21:00.000-03:00

So my friends (Kim & Ken) and I are on our way to another friend's (Barb's) mother's funeral. After a 5 hour drive we arrive at the funeral home. Great. But we are in travel clothes, not funeral clothes - where will we change?

After seeking briefly and rejecting the 'washroom' of the local Petrocan, we arrive (accidentally) at the local hospital parking lot which happens to be beside a beach. After a minute the two other cars parked by us drive off so we make the split second decision - we'll change in the car. What's the worst that can happen? Someone gets a peek at our middle aged mamma bras?

Ken goes for a walk while we make the quick change, then we wander and he has his turn. He steps out of the car to tuck in his shirt when a car pulls up and this young couple climb out.

After staring in our direction for a couple of minutes the guy asks: "Are you here about the bird?"

"Huh?" The three of us process the question, trying to make sense of it.

Kim is (and I was) a Flight Nurse so we wonder if there is a helipad at the hospital and he is referring to an incoming flight...

Ken is in process of zipping his fly - I'll leave it to your imagination what he thought the guy meant.

Sensing our confusion, the gentleman clarifies: "Are you HERE about the BIRD??"

Thanks. I get it now. "No, we're just in town for a funeral and are enjoying the view."

"Oh, I thought you were here about the bird. There is supposed to be a rare bird from Africa here at the beach. Some kind of Heron, I think."

Ah.

So fast forward to the funeral.

One of the "Ministry of Music" moments is the singing of "On the Wings of a Snow White Dove". Despite the solemnity of the occasion I notice that both of my friends are having as much trouble as I am quelling the smiles.

I don't think the Dove was the bird he meant. But I guess we were here about 'the bird' after all.

Two to Beam Up, Scotty

2006-06-30T09:51:00.000-03:00

My children went to sleep sobbing last night. We had another death in the family. This time it was not a person, but a pet.

Do you have personal experience with Tamagotchis? Unfortunately, we do. They are a hand held computer screen with a 2-d animal that requires complete care. It cries to be fed, has a GI that is more active than any breastfed baby with the flu, and also 'needs luvin'. Be at all slack on responding to these needs and the pet will quickly sicken.

Christmas 1996. K received a Tamagotchi as a Christmas gift, and it was love at first sight. She played incessantly with it. It went with her to and from school. It slept with her at night.

May 1997. The school has had enough of errant beeps and distracted children who dive into bookbags to 'take Tammy to the toilet' in the middle of lectures or tests. Tamagotchis are now banned from school. On her way to school one morning K hands the toy to Mom. "Take care of it for me!!" she says and merrily heads out the door.

I'm sure you can see where this is heading, even without the knowledge that the Tamagotchi had to compete for attention with my non-sleeping, exclusively breastfeeding, 2-week-old twins.

While I managed to feed, clean and clothe the twins without falling into some major abyss, I failed big time as a Tamagotchi Mommy. The pet had already 'run away' by the time the child got home from school. My child was devastated. Her faith in me was completely washed away in the storm of tears that followed. No matter that you simply rebooted the machine and the pet started again from an egg - her adult animal that she had coaxed along for months was gone.

Christmas 2005. Tamagotchis have again become the fad. 'TV2' (version 2) is selling out of the stores like wildfire. A friend and her girls buy a gross and hand them out as gifts to all their friends. In the blink of an eye we are again owners of not one, but two new pets. In an ironic twist of life it is the twins this time who are the proud pet owners.

V2's have improved dramatically in the 10 years. The graphics, music and games are all a bit prettier and more user friendly, but the best addition by far was the 'pause' option. Now a child need not rely on his parents to keep his pet alive - simply press pause and the pet's basic life needs are attended to by the computer until such time as the child can again resume care.

April 2006. A favourite Aunt upgrades the Tamagotchis to the even more exciting V3. Now the pets can make friends, marry and have babies. All four Tamagotchis make the daily treck to school, courting and making long lists of friends throughout recess and lunch. However, these upgraded pets no longer run away. Instead, when they perceive a lack of care, they die.

However, his time the death of the pet was not brought on by intentional neglect. Instead the pause was accidentally released by bumping around inside a school bag. Saddness ensued.

Now stop laughing. It is NOT funny. This is twice that I have had to console a child over the death of a computer generated animal. And there is nothing sadder than a grief stricken child.

Nothing.

Bring It On

2006-06-24T17:52:00.000-03:00

It started with the Stone Soup cartoons the week before my birthday:

I read these, and I laughed. "It's not!" I agreed. Then I realized. I'm not 39. That was last year. Not that it matters - there is not much difference between 39 and 40. "It's just a number." I chant to myself, "I'm only as old as I feel."

Then Garfield joined in the chorus:

Clearly my mind is already long gone. It didn't wait until the big 4-0 to leave me stranded. Otherwise I'd have already known how old I was - I wouldn't have had to count. Thanks. Thanks a lot.

The big day arrived.

"No Way!" I chant, inside my head, "This isn't going to get me!"

Then my kids got in on the action. Particularly my 16 (nearly 17, and just a hair closer to 40) year old. She used my birthday as the vehicle to prove that her math teacher was wrong and she does have a firm grip on advanced math:Yes, it's true. I am 2.5 times as old as my oldest child. Gaak. I am starting to feel the strength sapping from my bones and the colour draining from my hair. Then I see the card from my 5 year old:

Now to the uninitiated this number might just look like a typical preschooler's misshapen 4. However, those in the medical world may have a different unterstanding of this symbol.

The 4, as drawn by my boy, is the exact replica of a (supposedly Greek, but who really knows) symbol used on the white board in my emergency department.

A symbol used to indicate a person in need of psychiatric care.

What more is there to say. The message is clear. I'm old, I've lost my mind, and I'm in crisis.

Happy Birthday to me.

Time for Report!

2006-06-22T09:35:00.000-03:00

Emergiblog usually has the most interesting and insightful stories of nursing in the trenches. Today she does even one better. Today she has a collection - the best of the best - a carnival of posts by and about nurses and nursing - It's 'Change of Shift'.

I just spent an hour reveling in the stories and investigating new blogs, and I have barely made a dent in the list. Wow!

Awesome job Kim!

I'm Just Sitting in the Morning Sun

2006-06-14T17:30:00.000-03:00

In a recent post Big Mama Doc (BMD) talks about a recent attempt at baking.

BMD - do not despair!

I am a reasonably intelligent adult with a professional career. I have never had a stroke. I have no reason or excuse to explain how I managed not once, but twice, to lock a crying baby into a car that was placed in the full sun with all windows rolled up.

Both my first and second babies had a solo car experience where I placed them in their rear facing car seats, buckled the seat into the car, locked and closed their door, climbed into my seat and drove to my destination. Then, frustrated or frazzled or whatever by the crying or perhaps faint from the hunger and fatigue that accompanies every new baby, I neatly placed the keys on the baby's lap, locked my door and climbed out of the car and walked around to remove the baby, only to discover that I now had a baby in solitary confinement.

"Honey! [bang, bang, bang] Honey! Unlock the door!" does not work when the person with the unlocking power has not yet realized that they have hands, much less that said hands should be under conscious control of the owner.

So there baby sat, baking in the sun, while Mama freaked out, knocked on doors, and called local tow truck companies. After a period of years, (but actually about 10 minutes in real earth time), a kindly neighbour in the first case, and in the second a local Fire Fighter (who did nothing to disguise how stupid he thought I was) managed to open the lock with a coat hanger. Baby was free and quickly scooped into the waiting arms of Mama!

They say it takes 2 weeks to fix a habit as a new lifestyle choice. Not me. Two high stress (and high stupidity) events are all it takes me. In the 14 years since I have not climbed out of any vehicle without checking to see that my keys are firmly in my hand, and (if children are travelling with me) that the passenger door is unlocked. The remaining three children have never been accidentally incarcerated (ha ha).

Had either of those conditions been met previously, then I too might be able to be smugly among the "How could you possibly..." crowd. Instead I am here commiserating strongly with BMD.

Be gentle with yourself, BMD. You are, like me, just human.

Do You Feel What I Feel?

2006-06-11T14:17:00.000-03:00

Nursing intuition is a nebulous thing, much like a slightly distorted Spidey sense.

There are many theories on what it is that gives us the intuition - is it ESP, heightened perception, finely honed assessment skills, or education and experience coalescing in the subconscious? It is not well explained or understood, but the phenomenon of the ICU nurse placing the crash cart outside the stable looking person because of a 'feeling', and using the same cart to resusitate the patient a few minutes or hours later, is well known.

Usually the traditional methods of knowing when to worry work for me - the pulse of 210 in a non-febrile child, the bp of 80/60 in an adult, the ashen grey and diaphoretic look or the staring, drooling look, and so on. There are very few times when I have had to rely on instinct to guide me in my care.

This feeling occasionally is present because of something totally unrelated to the medical reason for care, such as the man who was using his wife's visit to hospital as an opportunity to steal a couple wallets from the cupboard at the nursing station, or the family member with some form of PTSD (post traumatic stress disorder) having a flashback while visiting.

On the other hand it may be specifically related to the reason for the visit, such as the pregnant mom who presented with the concern of decreased fetal movement. I would ordinarily have taken the time to assess this mom for labour and to check for a fetal heart rate. For some reason I skipped these steps and took her directly to the Birth Unit. Her baby was in severe distress. A very sick but alive baby was delivered by Cesarean Section less than 15 minutes later. Another time there was the suicidal teen who denied having any drugs or weapons in her posession. Ordinarily I would give the teens privacy while they changed to a hospital gown but something told me to stay in the room with this girl. I was quite glad I had when a bag of pills and a razor blade fell out of her bra while she was changing. Then there was the lady with the very nonspecific and vague mid chest pain with no other symptoms who checked out as completely healthy and was sent home. For some reason I made a special point to stop her before she left the department and reiterate again that if this got worse or changed in any way she should immediately return to hospital. Not four hours later she took an ambulance to an alternate facility where she was diagnosed with a large pulmonary embolism. She was in ICU for over a week for treatment and recovery from the complications.

Most physicians and nurses have come to recognize that this nursing intuition is a very real phonomenon and have learned not to ignore it. This is particularly true in a critical care environment.

Because of this culture and belief in trusting ones insticts, I was surprised when I recently found myself in a very uncomfortable spot. A colleague I didn't know well presented for care with a variety of very unusual symptoms. The doc did some basic testing but was actually quite blase about the whole affair while I felt like I was on red alert for the entire time this patient was in my care. While I was quite calm in my presentation of my concern, I'm sure that a large part of the physician's low-key response was specifically because he felt I was overthinking the situation. It was both frustrating and frightening to have such a strong reaction downplayed by the physician.

I still do not know what caused my concern. The patient went home with a nebulous 'NYD' diagnosis and to the best of my knowledge nothing bad has come of this. However, I have not been able to get this patient out of my mind and I was left with the very unsettling feeling that I had missed some very important clue.

What I do know is that on the rare occasion when my Spidey senses tingle, I'd better listen. When my gut is telling me something is wrong or the hair on the back of my neck stands up I know that there is something important and potentially dangerous that I have missed. Even if I'm wrong once in a while, or reason for the alarm doesn't reveal itself, I'm still better off to pay attention to my instincts.

Better some sleepless night with an alive patient than sleepless nights with a dead one.

Running Hot & Cold

2006-06-04T01:09:00.000-03:00

I had another awesome weekend riding on the ambulance with the Paramedics (Thanks again, Guys!) and have another shift booked for next weekend (Can't wait!).

We did a total of 12 calls, (seven were code 1 - lights and sirens). The boys (half heartedly) complained that this was really busy for them and that it was my fault they weren't getting to nap, but they didn't really seem to mind being able to show me the exciting stuff and I loved it - after all, I was there to see the fun. Now granted, I know that the reality of being on duty for an emergency service is that there is a lot of hurry up and wait, but I really wanted more hurry up and less wait. I got my wish.

I find it very interesting how what I know from nursing follows through to other health disciplines as well. For example, there is the unwritten rule about things coming in threes. We cared for three people whose presenting complaint was a seizure - one hypoglycemic, one focal and one related to encephalitis. We also cared for six (2x3) alcohol related calls - well five really because we weren't called to the sixth because of the alcohol, but it certainly played a part in his injuries and his behavior once we arrived. Which reminds me of the third third: we had police presence at three calls.

I also was amazed to see how often other agencies are involved in medical calls (we needed support from fire twice and, as said a minute ago, police three times). This aspect of the job is for the most part hidden from those of us who receive the patient in the Emergency department, so we are really not aware of how important those people are to the smooth running of a call.

Despite the number of facinating things I saw, the most eye opening moments for me did not come from the patient care, but instead came from the reactions of the onlookers.

I was shocked by how many people are completely useless in a crisis. They often cannot describe the onset of the illness or really articulate why they were worried enough to call the ambulance, they forget important parts of the medical history (yes that car accident last week certainly could have contributed to your leaking aortic aneurysm today, that is why we asked if you had any recent ilness or injury). They try to tell the paramedic how to care for the patient ("Aren't you going to put a blanket on him?" [Yes, as soon as we get this IV in place so we can give him medication to stop his seizure.]), or ask really dumb questions ("Did you get his glasses? They were on the bedside table." [Yah, glasses were our first priority in caring for this unresponsive patient.]) and generally just get in the way of the paramedics.

I was also interested to see how quickly crowds of people gathered whenever the ambulance arrived. Generally the people just gazed and milled about, sometimes offering a bit of help but I was pleasantly surprised at one call when we were applauded by the entire room as we left with the patient. I was equally surprised in a decidedly unpleasant way when at another call we were called nasty names.

Glamorous its not, but it sure does hold my interest.

Just Say No

2006-06-02T08:20:00.000-03:00

I have talked in the past about chaos through chemicals.

What I don't understand is why people continue to make such poor choices. Is the information on the dangers of drugs so hard to understand? Do people really think that they are immune to injury while under the influence??

Let me share with you some of the people I've had the pleasure of caring for recently:

* A young man who was stabbed (non-life threatening, but still!) "because 'someone' came up to me and wanted to buy 'something', but I didn't have 'something' so they stabbed me!" (told in a tone of complete disbelief, followed by absolute denial of use of any drugs or alcohol despite assurances that I was not affiliated with the police, and despite drug periphenalia removed from his pocket by police at the scene and despite his pinpoint pupils and slurred speech).

* A young man who was brought to hospital after a near syncopal episode - upon further investigation it was found that he and his friends had smoked some "bad weed" a week or so ago and the boy had been having panic attacks ever since. Unfortunately he and a friend had also had a wee shoplifting spree while high and this panic attack was triggered by the knowledge that the friend had just been arrested.

* A gentleman who thought the best way to avoid being arrested for selling Esctasy was to pop the handful in his mouth when the police appeared. Bad idea. Bad, bad idea. He spent the next few days in the ICU and then a couple of weeks later had a visit to a psych unit due to his drug induced psychosis.

* A teen who went to her high school dance and thought it would be a good idea to drink (read chug) a 40 of vodka just before going to the dance. She thought that if she drank it quickly the school officials wouldn't smell it and she would be in the door before she started looking drunk. She was wrong. She was found face down in the gravel parking lot across from her school and rang up a lovely ETOH level of 48, not to mention having a major lac to her forehead which will definitely leave a scar.

* A gentleman who went 'downtown', got loaded, and decided to have a swim in our sewer outflow pond. He had to climb up out of the pond, scratching his legs badly in the process. He presented to us 48 hours later with the worst cellulitis I have ever seen. He bought himself an admission to hospital, multiple (different) IV antibiotics and not much sympathy when those antibiotics gave him wicked diarrhea.

* A teen who thought it would be an awesome idea to pop a couple xanax and then take out his ATV for a ride. He ended up with a concussion and in a long leg cast for 6 weeks.

* A gentleman who came to hospital "mainly because my feet are swollen" but he also had a list of 16 (yes, truly, 16) other things that were concerning him. He had seen a family doctor at some point in the past who had told him that the problem was a lack of protein due to his poor diet and his chronic alcohol intake. He didn't believe this diagnosis because he drank lots of milk. He also drank 'a couple' of vodka and water. (A couple being a couple pints, not a couple glasses a day) He did not eat food - he had no appetite. He talked at length about why he was so frustrated with being told that he should drink less -he had no interest in understanding how the alcohol intake was related to his concerns - he just wanted us to fix his feet.

For heaven sake folks, JUST SAY NO!

Is it the small things that matter?

2006-06-01T01:45:00.000-03:00

"Oh no!! I forgot to close my sleeves when I went to bed last night!!" says the little boy as he frantically pulls down his sleeves instead of eating his breakfast.

The Last Laugh

2006-05-26T21:28:00.000-03:00

But the black flies, the little black flies, always the black flies no matter where you go. I'll die with the black flies picking at my bones in north Ontario-io, in north Ontario. (The Black Fly Song ~ Wade Hemsworth)

Well we weren't in north Ontario but we sure were surrounded by the nasty little buggers.

As we climbed out of the car the sun broke through the clouds, giving the impression of a beautiful day. My mother-in-law was waving a hand in front of her face as she tried to warn us ~ "Black flies - look out"! The warning came too late - mere miliseconds after we were divebombed. Entire clouds of black flies in flight formation, wheeled and dived with absolute military precision that would be the envy of any Snowbirds pilot.

We gathered at the grave side, heads down, hands clasped - briefly waving - clasped again as we struggled to hear the Minister's words over the buzzing in our ears and the solid objects flying into our noses and mouths with every breath.

After the ceremony we laughed that Herbie would have found it funny that the bugs were chasing after him even to the grave. And in the end those bugs made the walking away (which I think is always the worst part) just a tiny bit easier.

Who knew that there would ever be a reason to be thankful for black flies?

For Lo the Season is Again Upon Us

2006-05-24T13:52:00.000-03:00

When Tears are Not Enough

2006-05-24T01:23:00.000-03:00

Tonight a cloud hangs over me. A friend and family member has left us far too early and with far too little warning and I did not get to say goodbye.

I have often been on the other side of this particular bed. I have cared for women as they laboured to give birth to their stillborn child and have had an arm around a grieving father's shoulders while his perfectly perfect newborn son died in his wife's arms from unexpected birth complications. I have comforted newly-pregnant families as they were told that the baby they had hoped for and dreamed of would not survive the pregnancy, much less the birth. I have partially carried a distraught mother up the hall to the resusc room where our team worked desperately to save a beautiful child from a senseless and preventable injury, so that she could say goodbye while the child still breathed. I have comforted a co-worker as her nephew drew his last breath. I have held the hands of many grief stricken wives and husbands, daughters and sons.

The many voices of these bereaved parents and children, friends and family have stayed with me. I know the words I have said, and the words I haven't, but somehow the exposure to the grief and the pain does nothing to soften the blow when the loss is your own.

On nights like tonight I understand. And I cry.

R.I.P.
Herbert (Herbie) Joseph MacNeil
1939-2006

A Multitude of Cakes

2006-04-26T14:19:00.000-03:00

In my life months go by without a single cake to stand on my kitchen counter.

Now for most people, cake is just that - a pleasant desert, a treat. To me, cake is a danger. It sits on the counter (or in the freezer if it happens to be the ice-cream version) calling my name at 2 or 3 am, just waiting for the inevitable weak moment when I will pull out a fork and chow down more bites than would be strictly necessessary, or even wise.

The kicker is that I don't even really like cake. But (as frequently happens) I digress...

As I said - months go by without a single cake to stand on my kitchen counter and then ....

April hits .....

BAM!

The last two weeks of April are the Birthday Bonanza for our family and friends. Evad Indigo's mom, my #1 God-daughter, my Father-in-law, our #1 son, our twins (#2 son & #2 daughter), and another good friend (also the kidney's current owner and my #1 God-daughter's mother) all have the joy of being born in the heart of Spring.

This plethora of birthdays also heralds the begining of the 'Festival of the Cakes'. On each child's actual birthday we have a breakfast party. This means we open cards and presents, and (of course) have cake. Then, that night or later that week we have the 'real' birthday party with friends, more presents, and (of course, again) more cake!

Then, just when I think we are safe and that the cake is gone, May comes tiptoeing around the corner, bringing with it the birthdays of StepFather & (not such a) Baby Boy. I'm sure you can guess what else it brings... yep... even more cake!

Now almost as difficult as eating all that cake is managing the intricate maze of choosing it. Who knew such a seemingly simple task would become so complex!

Each cake must be different from its predecessors - no repeats allowed, either in composition or decoration! For the twins there must either be a cake for each, a single slab that is 'double decorated' (a unique section for each kid) or must be so sufficiently cool that they are distracted from the fact that they are being forced to share yet again. We've tried all the ususal chocolate, vanilla & marbled pound cakes. We've had angel-food cake and carrot cake. We've resorted to smaller and smaller cakes for the breakfast, even moving to cupcakes. We've substituted pie for the adults. We've eaten every single variety of DQ's 'Treatzza Pizza'. We've had chocolate chip muffin's. We've had a scoop of candle topped ice-cream with no cake. We've made Brownies from a Betty Crocker mix. We've even slapped together a couple of girl guide cookies with some ice cream 'icing', but despite all of these evasive measures we always end up with far more cake than any of us really want to eat.

I love this birthday crew dearly, but by the end of this stretch I am always happy to dump the last dry and crusty pieces (see we aren't even down to crumbs - there is lots of left-over cake) into the compost!

Please, hear my plea and when my next birthday rolls around, please, please remember that those 40 candles will stand just as well on a tray of chocolate baklava as they would on any kind of cake!

It was the Worst of Days, It was the Best of Days

2006-04-23T22:49:00.000-03:00

Every once in a while something happens that shows me that there are forces at play in this world - forces that I have no control over or true understanding of, but that are here just the same.

Now I'm not talking about the 'minor miracle' version of event that could often be considered coincidence or the 'super-huge but none-the-less every day miracles' like the birth of a baby or the fact that the sun rises, the moon sets, the wind blows, that the Earth even exists. No. What I mean is one of those shake you to your core moments that you never forget for the rest of your life.

Nine years ago my I experienced one of those events. For the details, I refer you to my husband's blog. I am incapable of writing them out or even talking about them very much without being moved to tears.

The boy does not understand why this day makes us hug him so hard each year. I do not know how to explain to him. There are just no words.

At the time, he did not understand: "Why did God let me fall?" At least the Paramedic had the presence of mind to say "It's not that he let you fall, it's that he was able to catch you before you were really hurt."

Suffice it to say: I do not know why my child was so lucky while so many others are not, but every time I think of this day, April 23rd, and I look at that precious boy who is so smart, so funny, so athletic and so enjoying his life:

I Believe, and I am Thankful.

Beauty & the Beast

2006-04-11T22:27:00.000-03:00

The Emergency Department is supposedly the land of the unexpected. You would think that there would be a great variety of reasons why people present for treatment. Why then can we always see so many people with similiar illnesses presenting in close proximity to each other, such as: crowds of kids with croup, lots of people with lacerations, four or five kids with emergent asthma, several men with renal colic, groups of teens with ingestions and overdoses and bunches of people with broken bones.

And then, just when we decide this is definitely going to be an Ortho day or an asthma day, we get a pair of patients of such dramatic contrast that it is impossible not to notice them? For example:

* a lady with a miscarriage of a wanted pregnancy is just curtains away from another pregnant lady who is looking for an abortion or who has had previous children aprehended because of neglect or abuse?

* A group of fully spandex-clad specimens of tattooed and buffed athletic masculinity who are visiting their bicycling buddy - there are so many of them that they cannot help but stand in front of the room of the 350 lb, 5'6" man who is here because he has a fungal infection under his abdominal pannus (the 'apron' of fat on the belly) because his arms are too short to reach under the area and clean it effectively.

* In one bed is a person with a life altering disease such as cystic fibrosis, and that person is doing everything they can to try to live a good, full life and then in the next bed is a young person with no physical health problems, but they are so despondant that they have attempted to take their own life.

* The patient with the major injury such as a compound fracture who is in great pain but who is kind and polite and grateful for every thing you do for them, compared to the person who is loud and rude and ignorant and who wouldn't even begin to think of thanking you while you clean, bandage and medicate their injured toe.

Then, just for good measure we throw in the bizarre coincidences such as:

* The uninjured drunk who caused the accident who, for his own safety, is placed on the opposite end of the unit from the completely sober (and absolutely furious) member of MADD who is the victim of his drunk driving.

* The child from another community who is in foster care and who is unknowingly placed in the cubicle next to her aunt and cousins.

* The two sisters who haven't spoken in years, but both arrive for triage at the same time and launch into another loud family battle over who is sicker and who should be triaged first.

The Emergency Department - Never a dull moment...

Why is it that...?

2006-04-11T22:12:00.000-03:00

Why is it that:

* When you have some important event with your kids planned right after work and are trying your hardest to escape at the end of shift you always run into a neighbour, acquaintance or friend who is "so happy to see you" and ask you ten thousand questions about their illness and the likely care that they will receive, delaying your departure by many minutes?

*When the waiting room is packed with really unhappy people on a day with long waits you always run into someone you know in the waiting room, who asks you loudly if there is any way you can get them in quickly, and then they get called shortly afterwards, (only because of their reason for coming to emerg, NOT because you pulled any strings), guaranteeing that the other people in the waiting room are REALLY angry at you the next time you call a patient.

* When you are on your way to the washroom for the first time in eight hours some little old lady always needs a bedpan, and "just can't wait another second, dear"

* When you are starving, your meal break is always indefinitely delayed because a patient with a probable heart attack or a fully imobilized patient from a motor vehicle collision always arrives by ambulance, but when you are not at all hungry you always get sent on first break.

* You always get a really sick patient requiring all of your concentration and attention at four am when both of those are at their absolute lowest point for the entire shift?

Why?

HEAT ~ Helping the Earth by Acting Together

2006-04-08T15:14:00.000-03:00

**Warning: Proud Parent alert...**

So. I know I have awesome kids, but sometimes they amaze even me. For example: This is what my daughter wrote on her blog site last night:

"So. Guess what I did last night?

You may be surprised. It's not what most people do on their Thursday night. You might think it's weird (it is) or gross (definitely is) or stupid (but its not), but here goes...

Last night I was buried in 1,718 Tim Horton's cups. and not just any Tim's cups. these were cups that, for the last month, myself and my friends collected them from anywhere they didn't belong.

And when I say from anywhere they didn't belong - I mean, from the side of the road, from ditches, fished out of a lake, caught the ones blowing away in the wind...

These cups were caked in mud, soaking wet and soggy, still full of cold coffee, and covered in mold. the less exciting ones were just crushed and sun bleached.

BUT, let me tell you... they are everywhere. No, really. Next time you're walking home from school or driving through downtown, take a look at all the litter all over the place. Tim Horton's cups make up 30% of the litter in Nova Scotia. You're bound to see one sooner or later. You're probably bound to see a few.

But, back to my story. My youth leadership / environmental action team (called H.E.A.T. - Helping the Earth and Acting Together) set out a Tim's Cup Challenge - the point being to collect as much as this garbage as possible. we wanted to make a statement. and, really, we did.

About 20 of us showed up last Thursday night, bringing along the cups we'd found. There were a lot. A couple people entered with none, and a few carried in 5 or 6 cups, but others brought insane amounts like, 5 sobey's bags packed full and (brace yourselves) three stuffed garbage bags.

I know. Disgusting.

but, with the 10 - 15 people that really collected them - we had accumulated one thousand, seven hundred and eighteen cups. Yeah, 1,718. That's a lot for under a month. plus, we all had stories about how many more we had seen but couldn't get to.

And (back to the original point of the story), we decided to do something crazy and fun with them. we wanted to show people (the media and, through them, the public) how many we'd gotten. so we took pictures.

We took pictures of them in the bags we'd collected, we took pictures of them strewn all over the hillside, we decorated them all over the steps of the Dingle and took pictures, and, of course, we buried people in them. and took pictures.

It was a lot of fun. It was tiring. (we had to, of course, pick them all up again after we'd thrown them all around.) it was inspiring and a little disgusting at times, but completly worth it.

You just wait. you'll be hearing about it again. HEAT's taking over (our city). This is how we're starting - one Tim Horton's cup at a time."

Now, isn't that a great post?

It's April Fool's Day and the Joke is on Me

2006-04-01T19:27:00.000-04:00

All my boys are away, watching big brother at a provincial gymnastic's competition (in which he wins a 4th place with his high-bar routine, I'm proud to say!).

The house is quiet. The only other person here is elder daughter who in true teenager form is soundly asleep. I, too, am snuggled in my cozy, warm bed enjoying an absolutely guilt free sleep-in day on my first full weekend off in 9 weeks. I'm not quite asleep but I'm determined not to wake up.

The phone rings.

I groan, and consider not answering it. Then I stupidly pick up the phone, mentally preparing myself to be nice to whichever of my kids missed me enough to call this early on a hard-earned sleep-in day...

"Hello?"

"Mama Mia! It's your biggest employer! We were expecting you to work at 8 for a 12 hour shift!"

I peek at the clock with only one eye - 8:04 am. I wanted to sleep MUCH later than that...

"No. I'm not supposed to work. Remember - they changed me from X rotation to Y rotation."

"Well they didn't mark it. Can you come?"

"No - I have plans - Elder daughter is in several dance performances today and younger daughter and I have plans for the afternoon."

"Oh. Ok. Bye."

I tuck my head back under my blanket and allow myself to drift.

I'm in a kayak, paddling toward the beach, thinking of what I'll eat when I get there when I suddenly find myself talking to my paddle...

"What?" I shake my head. The paddle morphs back into the phone. "I'm sorry what did you say, I wasn't fully awake when I answered".

"I'm sorry, Mama Mia - we are mandating you to work. We are short two nurses without you and have triaged six emergent patients in the last 20 minutes."

"Is this an April fool's joke??"

"No, Mama Mia, it's not. We need you to come."

After several quick calls that wake other people elder daughter's drive to the performance is arranged (she will drive me to work then go to a friend's house to carpool to downtown for the performances) and younger daughter will stay with her sleep-over friend until I can get her. I go to work.

Work is, as expected, a zoo, and we are running like nuts. Suddenly the flood gates slam shut and the flow of the sick and injured slows. I am released from my mandate to try to regain some of the shambles of my day.

I call my Stepfather and request his assistance, as my work is distant from daughter's friend's house where my car is parked. He & my Mom arrive and drive me to my vehicle. They drive off as I turn the key.

'Click'

Huh?? I turn the key again.

'Click'

A quick glance reveals the problem. Elder daughter made the solo drive safely, and even remembered to put the seat back so that I could get in to the driver's seat without banging my knees on the wheel, but she neglected to turn off the headlights.

"Groan"

I quickly dial my Mom's cellphone, figuring they cannot have driven far and will not mind giving me a boost. Except that their cell phone is off. Ugh.

I sit quietly for a moment. I refuse to lose my cool at how stupidly my day is going. April Fool.

I take a deep breath, contemplating who is close enough to come give me a boost, (no names come to mind) and wondering if it is possible to roll-start an automatic (DUH no!) when what to my wondering eyes should appear?

Yep - there's my Mom and Stepdad's car again. They realized I wasn't right behind them and came back to check if things were ok. Hooray for worriers!! A quick boost and off I go.

Now I'm at home. I have plans to go to the movies with the girls in a few minutes, but I'm almost afraid to go out - after all I'm still waiting the last bad thing to finish my curse of threes...

After all, April Fools day isn't over.

But this post is.

Not to be Left out ...

2006-03-31T23:41:00.000-04:00

Who knew - the craze is everywhere!

Well, for once I am hopping right on the fashion bandwagon!! Here it is... what I know you've all been waiting for...

A 'South Park' Mama Mia!

Definitely What Not To Wear

2006-03-30T17:52:00.000-04:00

Back to the topic of nursing attire... a friend and co-worker emailed me this picture:

While I would dearly love to wear it, I have no doubt that even outside the hospital this would not be good PR for nurses.

Not to mention, as my Dad so kindly pointed out: "Those who don't need it would wonder why you were wearing it. Those who do need it wouldn't know that it meant them.". So true.

But still it gave me a laugh.

The Best of Me

2006-03-27T09:13:00.000-04:00

The 'Best of Me' Symphony is up. "The Best of Me Symphony is built around the best posts from your blog archives." I'm pleased to have my first appearance in this forum with my post 'Metamorphosis'.