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JBMmom, MSN, RN 8,230 Views

Joined Jun 24, '09 - from 'CT'. JBMmom is a Nurse. She has '4' year(s) of experience and specializes in 'Long term care; med-surg'. Posts: 452 (41% Liked) Likes: 746

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  • Dec 7

    Hard truth? It is far too easy to "fall down" and get foreign objects stuck in your rectum, or so I am told.

  • Nov 25

    Yes. I couldn't stop drinking on my own. I'd done a bit of therapy and gone to a few AA meetings but nothing was sticking -- I logically knew that I needed to stop drinking but couldn't emotionally pull through to actually stop. The last two or three years of my drinking, you could assume I was sneaking vodka if I was not passed out or at work. I would show up to work severely hungover, in mild withdrawal, or still tipsy. Eventually I was just drinking on the job because, why not?

    I felt trapped. My husband sobered up himself about nine months before I eventually did and that just made it even harder for me to ask for help. Ending my own life seemed like an easier and more realistic option than not drinking. I took a bottle of Fioricet and woke up. A bottle of propanolol. Most of a Novolog pen. (Still don't know how I survived that one.)

    I needed an outside intervention to make me get help. I needed the drug testing to keep me accountable because, after nearly a decade of secretive drinking, lying was second nature to me. Even the various meetings and whatnot got me out of the house and added structure to my day which I desperately needed.

    I didn't need to be screamed at or treated as cruely as I was by a certain person in my monitoring program (who is no longer working for the program and I hope is miserable and forever alone) or by the BON investigator. I didn't need the perpetual anxiety that one missed check-in or piece of late paperwork might revoke my nursing license. I didn't need the program attempting to dictate what psych meds I could and could not take.

    Even today, six months out of my state's program, and I am anxious and emailing the BON because I think I might have made a mistake while answering questions on my license renewal. It's the same sick, sinking feeling that I lived with during my stint in monitoring and I absolutely hate it.

    But I am not going to drink over it. I didn't drink today and I can almost guarantee that I won't drink tomorrow and I am pretty certain that I won't be drunk next week. If my hardened little Atheist heart believed in miracles, I'd say that's a miracle compared to where I was just a few years ago.

    My life isn't perfect right now. I'm dealing with chronic knee pain that limits a lot of the activities I discovered that I loved to do after I got sober. I'm also in an anorexia relapse and am like 25 lbs underweight. I worry about whether my monitoring-friendly job has pigeon holed me and whether my husband resents me for not wanting to move out of state for fear of what trying to get licensed in another state will entail with my history.

    But I am not dead. Or stumbling drunk through a waste of a life. We spent two weeks in Morocco last month which I would have never done while I was drinking. There's just so much more time in the day now that I am not passed out or sleeping off another hangover or drunkenly watching the same TV shows over and over again -- and I am able to fill it with interesting things. I am not a hollow shell of a person anymore.

    So, yes, my life is substantially better sober and I could not have gotten sober without monitoring.

  • Nov 14

    I have not had an experience like that. Either you are feeding into these behaviors in some way without realizing it, or the hospital you work for is truly bottom of the barrel.

    I did 2 cases for homecare years ago and learned it wasn't my thing. You are on their turf, in the midst of all their family dynamics. Ugh, not for me!

    As far as dealing with lowlifes, stay detached and treat everyone with dignity. Try to find out something about their lives. Don't wait for them to get demanding but give small gestures of TLC and consideration without catering to them. Remind them that you need to check on your other patients but will be back.

    As far as your remark about blue collar workers, that was uncalled for. One of my son's is an HVAC guy, very intelligent, skilled, frugal, and prosperous. He has a wonderful wife and daughter and just bought a house.

  • Nov 4

    you can have 1 year of top notch quality experience or 10 years of crap that hasn't gotten you close to prepared for the next phase of your career. there is no definite number, all that matters is mastery and level of competency, regardless of how long it takes. varies by individual. period

  • Nov 1

    My moment wasn't nearly so deep, but I used to figuratively roll my eyes at people who came to the ER for constipation. Seriously??

    Until I developed extreme constipation (and a heck of a lot pain and anorexia) during my chemo. Whole new insight to a "common" problem.

  • Nov 1

    This is a great post. Thank you for sharing. I find that my private thoughts are pretty judgmental until, like you in this situation, I am face-to-face with the person. Then suddenly they are just another human being in need of my care and expertise. It got to where it was my favorite thing, to have the drunk driver, the prisoner, the drug addict, the marginalized. It was humbling and gave me a sense of purpose.

    What we do is sacred work. I have always, personally, felt a bit of relief that I can be suspended from the burden of pronouncing judgment and just take care of another person who has made mistakes. Maybe it is because I myself have made so many - most not as bad as these, but only by the grace of God.

    I am glad you took good care of this person. Thank you for doing that. Sometimes it is the grace of unexpected kindness that really turns a life around.

  • Nov 1

    I think we all have biases and judgements that we bring with us to the proverbial table. It's recognizing those and being able to put them aside and still care for the person behind them that is important. It's also recognizing what our own limits are and being self aware enough to know if we won't be able to do that. I can look past a lot of things-homelessness, mental illness, criminal behavior, bad attitude-these things I can generally overlook. They don't bother me. They won't change the way I look at you or the care I provide for you. Child abuse-now that one I'm going to have a hard time looking past. And it's one of the reasons I choose not to work in pediatrics. I know I cannot handle that in any form or fashion.

  • Nov 1

    I love your story. It inspires me and challenges me

  • Nov 1

    ~Transference~
    One of the many words that I've learned and I, doubt, will never forget from nursing school.

  • Oct 28

    Quote from JBMmom
    When someone comes to the ED, why are they often given opioids without trying anything else? Is it the speed of onset? I never see IV acetaminophen or ibuprofen, but I know they exist, does anyone use them?

    With all the information about the current opioid crisis, I just wonder whether the medical system could be adding to some of this problem by so quickly administering opioids for any pain. I'd like to learn more about this if anyone has experience. Thank you.
    Often when patients present to the Emergency Department they are presumed to be surgical candidates and are NPO until proven otherwise. Oral medications are therefore not an option and very few patients are interested in a suppository (and often are still contraindicated). Belly pain can be caused by liver or kidney damage which further decreases our desire to give Tylenol or NSAIDs in the ED. NSAIDS also prevent some platelet aggregation so we tend to avoid them in suspected surgical cases (although there are studies emerging that suggest that this is far less than was thought).

    IV Tylenol is not often stocked in emergency departments and in addition to the added difficulty of administration over other medications (which means a higher risk of med errors, which should not be quickly dismissed) it also takes quite a while to get the medication, and then even longer to start working for their pain. In the past year I have given IV Tylenol once in the ED, and it was for a complex pediatric case who was on gut rest but presented to the ED with a fever, the GI team didn't even want us to give suppositories.

    Narcotics have relatively few side effects, especially since there are few better places to have those side effects treated than in the ED. Often the benefits of quick onset are not just to help the patient feel better but so that we can image, assess, or perform other treatments.

    We do use many non-narcotic treatments, although this varies from ED to ED. We use low dose ketamine, low dose IV lidocaine, lidocaine patches, tylenol, NSAIDs (both IV and otherwise), reglan, benadryl, phenergan, hematoma blocks, beir blocks, nerve blocks, local anesthetic infiltration, nitrous oxide, heat therapy, cold therapy, compression, elevation, and a myriad of other medical and adjunct treatments for pain. More likely than not you are seeing the patients with more acute medical conditions and therefore are more likely to receive narcotics. We discharge many patients after giving them an ace wrap and an ibuprofen.

  • Oct 27

    Years ago, I was assigned a patient who was homeless after being in prison for burning down my church. He had pneumonia. Ironically, I was the only Catholic nurse on the floor that night, and I was immediately angry at having to take care of him. Why me??

    Turned out, he was very polite and humble. He rarely used his call light, and when he did it was "Ma'am, could I please have more water? Thank you very much". I gave him his psych meds on time and he was appreciative of that as well. Then I looked down at him and was ashamed of myself for judging him...he was just a hurting, sad man who had made a terrible mistake and was still paying a high price. Nobody would rent to him because of his crime, and he was shunned by the general public for coming back to our town after his prison sentence ended. But he had nowhere else to go, and he'd gotten sick from sleeping out in the cold rain and contracting a bad cold from another transient.

    I heard sometime later that a distant relative had decided to take him in. I was actually happy for him, and I wonder from time to time how he's doing. I still have to watch myself for being judgmental---it's a hard habit to break---but I think I'm doing better than I used to. I try to look at a bad situation through the person's eyes and not make value judgments based on my own prejudices. I'm not always successful, but at least I'm working on it.

  • Oct 27

    Thank you both for sharing. I think this is a great topic, and one I'm sure a lot of us battle with.

    Big hugs to you both!

  • Oct 27

    I think this was a great post to share. Personal growth requires moments such as these and a good, hard look at ourselves.

    Mine came after I experienced very unexpected and pretty severe PPD after my third child. I have a stable life, own my home, and a stable marriage. But it still happened and it knocked me down hard. I always though these things happened (depression, anxiety, etc) to "weaker" people who just didn't fight hard enough. I was so, so wrong. At my darkest point, I realized then how easy it would be to escape in addiction or something else unhealthy. Thankfully, I had enough resources available to me that I didn't find that to be my best option. But so many people don't have that support.

    It was the hardest thing I've experienced but now 2 years out, I learned a much needed lesson that made me a better person and nurse. I still judge, I'm human, but now I find I circle back to my own experience and realize we never know what we would do when handed unfortunate circumstances and feel we have no options. So I stop judging and listen instead. I think you will find yourself doing the same after this.

    Thanks for sharing!

  • Oct 27

    ER nurse here.
    In answer to your question- this happens for a number of reasons. Occasionally it results from laziness or poor assessment skills. More frequently it is because we see the patient in an acute phase, and the treatment is warranted.
    And- narcotics for pain is pretty much the default path. And it generally works. The path of least resistance.
    But, sometimes a provider simply overlooks the obvious, and the nurse either doesn't know how to advocate, or doesn't know enough to advocate. Or is just tired of trying to get docs to do the right thing, and picks his/her battles. Toradol for kidney stones is a good example. Most experienced ER nurses have treated kidney stone pain refractory to narcotics with Toradol. This comes not only from the analgesia, but from the effects on smooth muscle. It is not a magic bullet, but it makes no sense not to try it.

    Regarding IV Tylenol- Recently had an abdominal pain who got no relief from nearly 4g Dilaudid in 2 hours. Complete relief with Ofirmev. Not sure why it works so well, sometimes, but it does. Some reluctance to use it due to cost, but that really doesn't make sense. According to Dr Google, it's 13 bucks a dose. A trivial cost in a hospital visit. Those Kleenex were probably $10.

  • Oct 26

    I give Tylenol and ibuprofen all day long. It's not that it's never given, it's just that those pts don't seem to get admitted much, thus you don't know about them.

    Regarding your pts - you weren't there when the ED doc assessed them so you don't actually know what was said or observed about their pain. It's possible they were sweating, clutching the rails and borderline unexaminable and still calling their pain a 3. Tylenol may work now because dilaudid gave them the initial relief they needed.

    If you see it in every single ED pt in recent memory, then you may be seeing more of a culture/practice pattern.

    IV Tylenol is expensive and has limited use when 4mg of morphine will do. Toradol (IV ibuprofen) is pretty much only used for kidney stones, resistant musculoskeletal pain, and occasionally in migraine cocktails.


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