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Melodies of Legend 2,293 Views

Joined: Dec 12, '12; Posts: 28 (39% Liked) ; Likes: 19

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  • Jun 21 '13

    I squinted, opening my eyes into the direct light of the sun. I immediately averted my gaze to the right, my attention held firmly by the rising quarrel among the seven children in the pool. Their mothers, lingering outside the pool gate in their cars, smoking cigarettes and talking angrily on their cell phones, had left their oldest children to watch the younger ones, the oldest of the group probably about fifteen.

    Who needs a birth control pill. I thought, half-serious. The atrocious behavior of the teenagers and elementary-school-aged children alike was striking. The only thing more appalling was their mothers' passive-aggressive reaction to their children's bad behavior, which only served to further incite the kids, seeing that they had gotten under mom's skin.

    This was not what I had been hoping for. I had spent the last two days becoming ACLS certified for the first time. It had been a while since I'd sat in a classroom, and initially, I wasn't so sure about the idea. But then, as we practiced scenarios and our group of 6 got comfortable with each other, I warmed to the environment. In the group was my friend, Anna, the gastro nurse in my clinic; her friend Diane, a PACU nurse; a surgeon, MAJ Johnson; a Warrior Transition Brigade caseworker, LTC Anderson; and an administrative nurse, MAJ Garcia.

    MAJ Johnson was easily the most comfortable with the information and had clearly been around the ACLS block before many, many times. He flew through the scenarios and written test. Close behind him was LTC Anderson, who, despite being away from the bedside, seemed to know a fair amount about ACLS as well.

    I had heard the written test was difficult, but I was confident. After all, I knew the rhythms, drugs, and book and had flown through the scenario test-out without difficulty. What could go wrong?

    Post-test, I was greeted by my old friend, Critical Thinking, which, while an asset to my bedside nursing, was NOT an advantage on this "don't over-think it" written test. I switched off my brain, took the re-test and passed easily. Good deal...I guess. The scenario matters more anyway, I consoled the Type A within who hated the idea of failing anything, ever. No one ever saved a patient by passing a written test. Be content that you'd know what to do if someone crashed in front of you right now.

    At home, I packed for my mini-vacation, ate some lunch, and played with the cats. With the sun high in the sky and the temperature in the mid-80's, the pool was a reflexive move.

    And there I was--stuck in the middle of a bunch of unruly, fighting children and their distant mothers. Finally, one of their mothers came into the pool area while the others ran out to fast food joints to fetch dinner. When her presence failed to tame the roaring crowd, I retreated to the hot tub, now in the shade, for a bit of reprieve.

    The hot tub was a strange choice for me, especially considering the heat in the sun, but I felt drawn to it for some reason. I could feel my blood pressure dropping back down to normal, the warmth of the water soothing away the background ruckus. At the sound of a splash, I opened my eyes.

    To my left, a little boy, perhaps three years old, sat on the top step of the hot tub. He had clearly just arrived from the pool behind him, soaking wet and cold. I smiled at him and he smiled shyly back at me. I'll bet he can't touch the bottom of the tub. A voice in the back of my head warned quietly.

    I glanced to my right. Rose bushes bloomed outside the pool gate nearby. Wasps and bees buzzed excitedly around the flowers. They're pretty, but I wonder why pools always choose to landscape with plants that attract bugs with stingers? I asked myself, building up an unlikely story about the management's secret population control plan. Perhaps that's why so many apartments are empty as of June...

    I glanced back to my left, looking into the pool--when suddenly, I realized in my periphery that there was something in the water in front of me.

    Without a sound, the little boy had stepped off the ledge of the hot tub. He was now completely underwater. Unseeing, his hands grasped desperately for the ledge of the tub. His feet kicked against the bottom, his head tilted upward in a frantic attempt to reach air. He's going to drown.

    Within milliseconds, I had scooped the boy out of the water and placed him on the top step of the hot tub.

    "Are you OK?" I asked, my mind already in nursing overdrive. A head-to-toe survey had already been completed. I watched his chest rise and fall and noticed that he wasn't coughing--he probably hadn't been under long enough for oxygen hunger to force him to draw a watery breath.

    The boy nodded, stunned. He rubbed his eyes and stood up unsteadily, wandering over to the pool.

    "Isaiah! Did you notice that your brother had wandered off to the hot tub?" The woman sitting poolside scolded the 15-year-old.

    Did you notice that a stranger just pulled him off the bottom of the hot tub while you were too busy fighting with each other to even realize that your 3-year-old had wandered into the water? I countered angrily in my head.

    Adrenaline coursed through my mind, which raced at miles to the second. I was terrified and yet on top of the world all at once. It had happened so fast--pieces of the event replayed involuntarily in my memory. He's going to drown. The warning that spurred me to action repeated ominously. He was safe now--but had I done everything right? The Army's AAR (after action review) system was already working its magic in my hormone-soaked brain, logically pulling together the events of the past few minutes.

    I remember catching things back when I worked oncology that had been significant to a patient's health. I remember watching the ICU nurses and doctors pull patients back from the brink of death. I do not, however, remember being the only person standing between another human being and death.

    I left the pool twenty minutes later, still stunned by the rush and how fast everything had happened. Perhaps more stunning was the fact that the boy's family didn't seem to realize that he had been underwater at all. Had I not been there and no one noticed his absence, there was no way that they could have seen him in the hot tub from where they were sitting. The very idea gave me chills.

    Perhaps what struck me the most was how quickly and effortlessly I had gone into nurse mode. Those skills they teach in nursing school and in classes like the one I had been in earlier that day had taken over before I had a chance to consciously choose a course of action, which is, of course, the point of ingraining algorithms and assessment techniques in the learner's head--they become reflexive when time is ticking away the seconds of a fading life and there is no time to stop and think.

    I've said it myself a million times on the way to the beach, on a family hike, or out with coworkers after hours--"Please, no one die today/tonight. I'm not in the mood to bring you back." Everyone laughs, usually someone chimes in in agreement, and the day or night rolls on.

    But after the events of this afternoon, no matter how much I may joke about being "off duty" or "on a break", I have realized that who I am--that core personality that watches over the safety and well-being of strangers--will never shut off. I will always be willing to pull someone up from underwater.

    **PLEASE NOTE: The names in this story have been changed to protect the innocent (and not-so-innocent!).**

  • Jun 20 '13

    How do you feel about your career choice? Are you still happy that you made the switch to nursing? How do you feel about your nursing school? Please share your thoughts with the community...

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  • Jun 20 '13

    so, it was the morning after the "incident". I was caring for a 85yo man in icu step down who has BP that hovered 80/50 and we had finally gotten his a-fibb rate controlled. but he was now diagnosed with pneumonia. he had a hx of dementia and couldn't catch a break.

    well, as you all know, sometimes it is a great triumph when you get a sickly,confused elderly man simply out of bed into the chair. I wanted an award!! It took a lot of coaxing to do this. he was on multiple IV antibiotics and had tubes and wires everywhere.

    then he daughter came in to visit. normally, i enjoy families, I enjoy their help, their perspective and teaching them about our plan for the day or giving updates on loved ones.

    all his daughter would say is "DAAAADDDDDDD, why aren't you walking? Has he walked? You know right before he came in , he went with me to the grocery store! I can't believe you wont let him walk!"

    She repeated the same concept, different anecdotes and phrases, for around 15mins at change of shift. urghhhh. I tired to explain that when he walks, his 02 goes down to 86%, his feet hurt so bad he won't move them, it took 15mins to get him from the edge of the bed to the chair, he has pneumonia so bad I can hear him without a stethoscope, we had to have him in trendelenberg AND a bolus of NS just to maintain 85/55 bp. I said I was more concerned about his heart and lungs than him walking down the hall at this point.

    Oops. Family didn't like that.

    So in the am, I saw case management, and she must have overheard me discussing this with my charge and she chimed in:

    "well, families focus on what they can understand. they dont understand afibb with RVR, pleural effusions, vanc. troughs, the seriousness of low potassium. walking is a measurable, concrete indicator of how her dad is doing. she couldn't care less what the number on the monitor says because she doesn't know what it means. when dad comes in being able to do certain things and now he cannot or refuses to try, its terrifying for families. They focus on what makes sense to them. "


    I now saw the daughter wasn't trying to give me the riot act over walking him, but she wanted me to understand this is NOT dad's baseline. that he is 85, but normally he is strong.
    So i made sure first thing after case management interjected, that I put in a request for pt/ot.
    When I told the daughter that later in the afternoon that as long as he was hemodynamically stable (i say, "as long as his numbers look good....") pt/ot in addition to myself will be working on getting him as ambulatory as possible, but to please be patient because when our older folks get sick, it takes them longer than you and I to get back into fighting form."

    she seemed happy with that answer, and therefore so was i :-)

  • Jun 15 '13

    We don't really understand why people commit murder/suicide, but rationalizing that they must all have some form of mental illness is stereotyping.

  • Jun 8 '13

    I don't like being asked personal questions by patients, but I'll answer if they're not getting too personal. After all, we ask them the most personal of questions and expect answers.

    I'm a single female in my early 30s with no children, which seems incomprehensible to my older patients who come from a generation where most women got married in their teens or early 20s and gave birth to all of their children prior to age 30. They're even more shocked when they discover that I do not really want to have kids.

  • Jun 8 '13

    As a nurse, you have to prepare yourself for the good, the bad, and the ugly. Also, you should probably take some time to steel yourself against the smelly, the disgusting, the offensive, the exhilarating, and the exhausting.

    And wait.... did I forget to mention the terrifying, the grotesque, the impressive, and above all else, the amazing?

    I am a student, and I know I have a loooong way to go in nursing. I'm essentially the equivalent of a nurse toddler: playing with my care plans and concept maps and stethoscope, dressed in my ponytail and shiny new scrubs and HIDEOUS nursing shoes (I would love to meet the person who designed heavy white nursing clogs in a dark back alley some day).

    I won't pretend to understand yet what it fully means to be a nurse...and maybe I never will. But what I can talk about is how even in a few short months, I have seen one of the most amazing parts of nursing: the depth that human emotion can reach.

    I have seen how beautiful and strong relationships can be between people: in couples, in families, and in friends.

    For my first clinical last semester, I was placed on a medical-surgical floor. I was nervous to be cut loose onto the hospital floor...I wanted to run back to my in-class instructors and beg them to reattach my safe care-plan and patient simulation training wheels! Weeks passed, I was able to take a blood pressure without severe hand tremors, and I felt that I was settling in to being on the floor.

    After about a month and a half, I was assigned to a 60-something-year old woman who was in the hospital for a cancer-related issue. Upon completing my pre-clinical prep work, I had seen how intimidating her case was, due to a variety of precautions, nursing interventions, and consults. She had been in and out of the hospital for weeks, and I was nervous to treat someone who was likely sick of nurses and the whole hospital experience.

    I took a deep breath and went into her room to introduce myself, and found the tiniest, cutest, frailest little old lady cocooned in sheets and pillows within her bed. Her husband was at the bedside, and they immediately put me at ease with their warm smiles and kind demeanors.

    As I cared for this adorable lady, it was immediately apparent how much she and her husband were in love. No matter what uncomfortable task I performed on the patient, her husband stayed by the bedside the entire time. As I performed the bedbath, her husband held her hand and teased both of us. As I emptied her colostomy bag, she teased her husband and discussed their plans for the upcoming long weekend while he took notes and made her laugh.

    No matter what I did, this couple kept smiling and reaching for each other.

    The husband would duck in to steal a kiss from his bride, and she would always respond with a little blush and a coy smile. They told me about their many children and grandchildren, and how they had grown-up down the street from each other, leading to their eventual courtship and marriage. But the part that made my heart smile most was when I assisted the patient with ambulating around the floor to help her regain the strength in her legs.

    As I did this, her husband told me proudly that they had been married for 46 years, and that he was "mad about her cancer, because their marriage was just getting started."

    With this statement, the patient's eyes welled up with a small sheen of tears, and she squeezed his arm. We then continued to walk, my throat too clogged up to speak.

    It's amazing to think about such a love between two people, and I hope that one day I am lucky enough to experience the same. But that day in clinical made the greatest impression on me because even in the blur of fluorescent lighting, illness, and pain that is the hospital, there was this absolutely beautiful moment of love between two people.

    There was this impenetrable relationship that was only made stronger by the tragedy of cancer.

    This, to me, is one of the most inspirational parts of nursing: not only do nurses restore heartbeats and give patients breath and save lives in the moment, but they allow for the beauty and strength of love and relationships within those lives to continue.

    Nursing allows you to see not only moments of horrific tragedy, but also sweet, tender, and amazing moments, like the quiet handholding of a couple still in love after over 40 years of marriage.

    This is what I love about nursing, and why I chose the profession: it is not only the care of patients and the alleviation of their suffering, but it's the treatment of those people outside their illness.

    It's not just about saving a person from their pain: it's about saving their loves, their relationships, their likes, their dislikes, and who they are.

    It's about saving their entire lives.

  • Jun 8 '13

    This post makes me sad. Don't get me wrong, kudos to the OP for your tenacity and your willingness to share a successful strategy. But is wasn't long ago that hospitals had to woo the RNs. It was the hospital who worked hard to recruit new nurses. They had to offer decent working conditions or risk nurses voting with their feet. Nurses wages went up enough to keep constant with the increasing cost of living. Management had to treat us like valued members of the care team, a resource to be values, not disposable like now.
    Their strategy of creating a non existent "nursing shortage" with their false and self serving propaganda has achieved the desired results.

  • Jun 7 '13

    Quote from jadelpn
    And unfortunetely, the "my nurse on days was really mean...." USUALLY comes with and the food is BAD, gives me agita, and I couldn't nap because the Price is Right was blaring, which by the way I do NOT watch now that Bob Barker is off the show....And I do like Judge Judy, and when I ring the bell for the girl to come and put it on for me, you all are SLOW.....In my day........."
    I think that a lot of times these complaints about "that other nurse" are just manipulations. Can't say how many times I've gotten the, "That nurse was horrible, not like you." Then the next nurse gets told how horrible I was, not like them.
    That is what the charge nurse needs to in part with patient complaints. The staff nurses may have the finesse (<---or not LOL) to speak to the patient to the complaints, however, only the charge has the power to do (<----or not do) anything about it, and address it as he/she sees fit.
    I think the power dynamic varies by facility. What I do like about the, "Let me get the charge nurse" line is that it makes the patient feel like they're being heard by someone that can/will do something. Doing relief charge for most of my career, I don't generally have any more power on the shifts that I'm in charge than the ones that I'm not. But when "the charge nurse" comes in the room, the patient thinks they're being listened to, even if the charge nurse is ignoring the ridiculous complaint just as much as the staff nurse is. It's all about customer service psychology.

  • Jun 7 '13

    When a patient complains to me about another nurse or doctor, I encourage them to either make that complaint clear in their customer satisfaction survey, or give them the number of our director, who handles such complaints. I don't like to play middle man.

  • Jun 7 '13

    "Advocating for our patients" does not necessarily mean reporting and recording every complaint made by the patients. People in sub acute/long term care, are very rarely happy to be there. There's always plenty to complain about, and out of the several nurses caring for them, there's bound to be one or two they just don't like. That's life. As long as the complaint was not about poor care or abuse, you go to the nurse in question and tell them "so and so said you were mean to him last night, what happened?" You might hear something like, "He called me a racial slur and cursed at me, so I said as little as possible and got out of there as fast as I could."
    You have advocated for your patient by finding out both sides of the story, and can decide whether the complaint warrants being sent through official channels.
    Your DON likely did not have any idea what was going on and told you the policy, just like you asked. When it came across her desk, she may have seen that the official paperwork was unwarranted, you misjudged the situation, and you got into trouble. Not saying it's fair, just what may have happened.

  • Jun 7 '13

    I'm so sorry that happened to you but I just wanted to give you a word to the wise -- lots and lots of people read this forum and even though you didn't use any specific identifiers there is an abundance of detail in your description of the incident. I understand how upsetting this is but just want to caution you that it is possible you may suffer repercussions from it which is the last thing you need right now. I say this out of nothing but concern. All the best to you.

  • Jun 7 '13

    Thanks for all the input. I find myself adopting different study strategies based on my topic strengths and weakness and adapting to these different methods. I still don't get students who look me straight in the face and say they read every chapter...really? every nook and cranny? Maybe they are natural speed readers, I don't know. In any case, I like reading textbooks that got the facts, like comprehensive reviews. What I hate is "fluff". If I ask where is New York located...don't say "New York is a beautiful place, you can do lots of things there..." and on and on... without answering my question or just leaving the answer right at the end. That's how most nursing or all text books are written and that is what makes it so time consuming.

  • Jun 7 '13

    Agree with the person above. Although many people will say you don't need it, it helps. Its a fairly easy course (took gen chhem 1 and 2, easy to me if you study). I will say many of the students in my program who have the A's and high B's took chem or advanced chem. especially pharmacology when you get in depth.

  • Jun 7 '13

    Thank you, I actually have a 50/50 chance of getting in anyways. I'm going to get my CNA, in my current situation I need to start my career and take small steps to lead me to the success I aspire towards. There's a 2 week class coming up and as I see it the work I'm doing now is very temporary. I want to thank all of you for your input, I'm over analyzing myself too much! Grrr

  • Jun 7 '13