Debra ACRN

Dryer than a popcorn fart

Oh me, my class had to. It was in 1982 so it was ages ago. It was horrifying! I remember it was Bev, one of my good friends who did me. She inserted the tube about an inch per painful, grueling, minute. When she finally got to the stomach and the instructor was satisfied I pushed her back and yanked it out. I do have to admit I am really sympathetic to anyone with such a device. We did bed baths, IM, SQ, and IVs on each other too. I am glad we have moved forward and left the past behind. :)

OK, here's another one. I started working in HIV/AIDS in 1989, then we spent a lot of time figuring out how to pay for funerals. Now, we spend a lot of time how to pay for medication. We always seem to figure out a way, now it's just way more satisfying. I sleep a lot better.

I'm so old that I used to smoke in the nurses station while charting. Can you even imagine? For the record, I gave up that nasty habit years ago. Hey we used to have to make room assignments based on if the patient smoked, and I remember putting clean ash trays on the over bed table. I wonder what the new grads will be talking about 25 years from now.

Those long honking loogies that take as long to cough up as a cat with a fur ball, I'm sure I turn green and then they want you to look at it...........ugh

I've actually refused to HIV test a patient who stated that they would commit suicide if the test was positive. We got the patient some psych assist prior to testing. Your first duty is to do no harm. If the results of a biopsy would or could cause suicide it would be the physician's responsibility to postpone the proceedure until there could be some assurance of benefit to the patient. I think ethically you would need to inform the patient that there is a mass on his liver and why you would be concerned over exploring that further. I would fully support the physician.

I think you have an amazing chance of being just fine. First, it was someone who knows they have HIV, hopefully they are on antiretrovirals and have an undetectable viral load. Then you didn't get stuck with a hollow bore needle and that has a decreased risk of transmission. If you had on gloves when the needle penetrated that wicks off about half of the blood so that would decrease your chances even less. You are taking some really great drugs that have a very low side effect profile, although anyone would be woozy with all the emotion that goes with a blood exposure. I have been caring for patients with HIV since 1988, I teach regularly and I am so grateful I have never had to be in your shoes. Just know, that your chances of getting in a car accident on the way to work is probably greater then your blood exposure with antiretroviral treatment. There are no documented cases of transmission in health care workers who took meds in the United States. Let me know if you need any info or hand holding, we'll be thinking of you. Debra

Well I've worked in an HIV clinic for 18 years and never had a needle stick. I think there are less then 300 total health care workers in the U.S. that have contracted HIV from a needle stick in all the years HIV has been around. Thats not many. I'm sure your chances of getting killed in a car accident on the way to work has a much higher death rate. We all have a different comfort level with risk. I just think it's interesting that those most worried about HIV risk from some fluke (i.e. not sex or IVDU) that drive away smoking and not wearing a seat belt. Bottom line is that as nurses we are trained to make our encounters with potentially infectious fluid as safe as possible. It has worked for me and most of my fellow nurses. Take care and good luck.

I worked at the bedside for two long and overwhelming years. I too knew it wasn't for me but I loved the patients and staff so it was bearable. After, I worked for an Indian nation running a home health clinic and then started an HIV nurse run clinic which is in it's 20th year. I love my life and think you need to feel secure that nursing has a big tent and there is room for all of us. Debra

It's been a hundred million years since I did clinical but I wanted to offer my advice anyway. I started out nervous and have a habit of talking to myself. I found that I would do each task with my patient and state what I was doing, why I was doing it, and what I found. As an example, I'm going to listen to your lungs because lying in bed can make secretions pool and if you don't cough it up you can get pneumonia, your lungs sound good. I found my patients loved it. It gave me confidence and I still do it. No one is more interested in their health then the patient. p.s. my first clinical day I stared at my first patient for 15 minutes willing her to wake up. A more seasoned nurse shook her awake or I probably would have stayed there all day. :) Debra

In 1989 a group of us started an outpatient HIV clinic. We were federally funded in 1993 and I have been the director ever since. It's small enough where I get to see patients and it's a nurse run clinic with a physician back up. I love every second of it, except maybe the report writing. I have the most talented nurses on the planet and we have a good time every day.

I think this is where our advocacy skills must be brought to full fruition. Drs are influenced by facts so have it all written down. I would have stood in his face and asked him since when is a pulse ox of 80, crackles throughout, VS of blah blah blah etc.. just a normal variation. Get in her face and say that you think this patient is in terrible shape and needs immidiate intervention. Make her explain to you why it isn't any thing to worry about. I never take it personally, I would have seen them as blowing off the patient, not me. Never forget, you are the one with the most hands on experience in day to day care, you know what you are doing, and are a VALUABLE member of the health care team. If one of the team drops the ball you must pick it up and shove it where ever you need to in order to get some action. It helps that I am 6 foot tall and I can often use it to be a little intimidating but for sure use direct eye contact and carry yourself in such a way as to signal the fact that you are not done with this conversation until a mutually acceptable agreement has been reached. We have way more power then most of us actually use. I run a nurse run clinic and we use docs as consultants, you better believe they listen to us but we also listen to them. If you are wrong and it is a normal variation then have them teach you about it. Let them learn from you too. Just remember we are all there to get the patient well. Don't let anyone shirk their duties.

My guess is chicken. The most common mouth sores my patients get are either thrush or apthous ulcers. If a patient is pretty depleted immunologically esophageal thrush is pretty common and it has been described to me as if a big wad of soft bread is stuck about mid way down. Also thrush loves sugar so I would say that peanut butter would not be the best choice. Although I can say that I've had my share of really dry chicken and that would be no picnic to get down. Personally we just give them a boatload of fluconazole and hope that clears things. I would say eat what you can no matter what. Eggs are usually the best. Apthous ulcers are a whole different story however, yuck. We try to get some sort of vicous lidocaine for that but that can get tricky if swallowed and the throat is numb. Strangely thalidomide works really well but is hard to get.

Engrave the name of every resident on their dentures. I had a nightmare of epic proportion years ago when all the residents decided to swap. EWWW!

Speaking of patients transporting themselves to a bar, I can do you one better. I once had a patient who was in a 4 man room in a nursing home. He was much younger then his fellow roommates but liked them all. So much so that he went out a got a couple of fifths of whiskey, brought it back and got the whole stinking room blotto. There was singing and merriment galore! I'm glad I didn't have to deal with the hang overs the next day.