A match made in heaven

Remember this guy?

He later disappeared from our floor for 9 hours.  With a PICC line.  In that time we went ahead and filed elopement and police were notified.  He returned late that afternoon, upset to find that his room had been given away.  His explanation for his absence?  He was in the parking garage.  Meditating.  Right.  The PICC line was removed and he was informed that he would have to return through the ER.

The next day he was back in the hospital, though on a neighboring unit.  Still pulling the same shit.  Told again and again that he would certainly die if he didn’t comply with treatment.

In a not-so-surprising turn of events, he was found face down in his bathroom.  Blue and purple.  Lying nearby were syringes (not hospital issue) and his own personal stash of Dilaudid pills.

It’s sad to see someone have so little regard for his own life.  What’s sadder is to see it over and over again.

I experienced deja-vu when I was assigned another patient with 8mg Dilaudid po scheduled 5xday.  With an additional 2mg Dilaudid IV q2h.  Who tried to tell me that she was supposed to get the pill and IV at the same time.  Who told me that her pressure was low when she was in pain, and that it would rise after she got the medicine.  Who tried to tell me the druggy behavior I was observing was from anything but the 40 mg of Dilaudid she took everyday.  Who complained how she was tired and sluggish all the time and that the damn doctors couldn’t figure out what was causing that.  Who told me there were some good veins here on her legs if I couldn’t  find  any good ones on her arms.

So, I told her about a patient I once had.  Who also took an enormous amount of Dilaudid every day.  Also for chronic back pain.  Who was told that he was going to kill himself if he didn’t stop.  Who’s now fighting to live.  No.  Scratch that.  Who we’re now fighting to save.  And I asked her.  Should we be trying so hard to save someone who was trying so hard to kill himself every single day?

I realize that wasn’t really appropriate, but I knew she’d heard it all before.  And even as I spoke, I could see that she was thinking of nothing but her next dose.

Foreign exchange

My 21-year-old Colombian cousin is staying with me this month, and the experience has not been what I had imagined… at all. I expected to have fun, hang out, show her around, and practice my Spanish.   I expected a 21-year-old girl to be living in my home, not a 12-year-old.

It’s been frustrating to say the least.  I knew there were going to be cultural differences, but, from my own experiences visiting my family, I was and continue to be surprised by her behaviors.  As far as I can tell, the girl does nothing for herself at home.  I’m cleaning up behind her all day long.  She leaves food on the counter, opened containers in the fridge, trash on the couch,etc.  She’ll actually open some individually packaged snacks, take a bite, then wrap it back up and stick it back in the box – or put in in the fridge – or leave it behind some dishes in my cabinets.  WTF?

She fills my sink every day with dishes.  Only hers.

When she first arrived, she’d ask me for an extra towel to clean up after her showers.  I assumed she was just wiping down the tub and sink until the morning she looked at the large, old towel in my hands and said that wasn’t going to be enough.  I walked toward the bathroom and saw water streaming out from the bathroom, across the hall, and into my hallway closet.  The bathroom floor was soaked, and I walked over toward the shower to see the plastic lining was hanging loose outside the tub.  Right.  I turned and showed her how the plastic liner was to be in the tub at all times.  No more problems since. I don’t want to be negative all the time, so I choose just one or two things to correct each day.  It’s very hard to narrow it down to one or two things.

Most people are familiar with the differences in the pacing of life between America and Latin countries.  It’s very true.  After three weeks, my cousin has finally begun adapting to our quicker pace.  The first two weeks were frustrating when it came to making plans to take her out.  She was never ready at the time we told her we’d be leaving.  In fact, she’d usually just start getting ready to go.  I couldn’t seem to make her understand.  When we were an hour late, again, I finally sat her down, again, to explain, again.  I said,  “I know there are big differences between American and Colombian cultures.  Here it is very important to be on time.  Here it is rude to make people wait for you.  When someone tells you they will pick you up at a certain time, you must be ready to leave the house at that time.”   I’d said this before, but I think it made more impact when said while royally pissed yet trying to remain calm.

So now she’s ready to leave on time… most of the time.  She still moves like a sloth, though.  When walking anywhere with her, I keep losing her.  As in, I turn around and she’s not there. It doesn’t matter where we are.  We were actually late for a movie even though we arrived at the mall an hour early.

All of this, while extremely annoying, would be nothing if we could have some conversations that didn’t center around actors and musicians.  I’m very tired of answering questions about which celebrity I like better.  Though it beats the conversation we had her second night here.  She couldn’t think of the name for the dog she has, so she looked it up on-line to show me a picture.  This led us to the complete breed list of the AKC.  After showing me her dog, she then proceeded to click through each breed to ask if I liked that dog and why or why not.  Mind numbing.

She and I were leaving a restaurant the other night.  A family was standing in front of the door.  A young boy was directly in front of my cousin, and, rather than walk around him, she put her hand on his head and moved him over.  The kid’s mom (I assume) called out, “Excuse me!  Excuse me!”  after her, but she just kept walking.  I was behind her, and the lady turned to me and asked,”What happened? Did he do something?”  I apologized and told her that she didn’t speak English and that she may have thought he was wandering to close to the door – away from the group.

The other thing she does a lot is stare.  I’ll just turn around and she sitting or standing there … just staring.

From the beginning my dad would say she was slow.  “Don’t leave her alone in the house.”  “Keep a close eye on her.”  “No one will say so, but I know my family.” In the beginning, I defended her saying it was the cultural differences, language barriers, her inexperience due to a very sheltered life, etc.  Now, I think my dad is right.  Yesterday we were leaving another restaurant, and we each took a separate (though, side by side) door.  Her response was, “Cousin, we took different doors! “  And then to laugh.  And laugh on the way to the car.  And laugh in the car. “Cousin, we took different doors. Hoo, hoo, hoo.”  (That’s what she sounds like.)  She’s almost 22-years-old.

Reading over what I’ve written, it doesn’t seem too bad except that it’s been a month of this behavior. 24/7.   She leaves Sunday for Philadelphia.  I made sure I was off work so that I could take her myself.

I’ll be returning to Colombia with her at the end of July.  I usually stay with my grandparents or aunt.  I only hope her family doesn’t feel obligated to host me while I’m there.  According to my mother, my cousin and her mother are just alike.

HawthoRNe – episode 2

Meh.

I was hoping it would be good, but so far it’s just like every other bad drama on TV. Everything is exaggerated to the point of ridiculousness.

(Though I totally understand New Nurse’s frustration with Foreign Doctor’s accent.  I had to take verbal orders – over the phone – for a patient’s dialysis treatment the other day.  It basically consisted of MD giving order, me repeating what I thought I heard, MD correcting me, me repeating what I thought I heard…. )

I’m still annoyed by the role Jada’s CNO plays in her hospital.  It would have been more realistic if she had been a unit or department manager.  Or, better yet,  a house supervisor.  Someone straddling the line between nurses and upper administration.   Someone not quite so removed from nursing care in the real world. At least I see my nurse manager and house supervisor.

I don’t want to watch an idealized world.  I want to watch someone striving and reaching for ideals in the real world.  That’s something I can relate to.

HawthoRNe

I wasn’t that impressed with the premiere of TNT’s “HawthoRNe”, but I’ll be watching.   It wasn’t great, but it wasn’t terrible.  More than I can say for most shows.  And I liked the characters well enough even if my CNO could in no way be mistaken for Hawthorne because she would actually have to be seen by staff in the first place to be mistaken for anyone else. ( I hope Jada tones down the cheesiness.  “Don’t die on me!”?)

Also,  because my mom liked it and wants to watch it with me.  I love my mom.

Get the man a salt lick, stat!

There’s this guy whose been a frequent flier due to sepsis from infected IV sites from drug use.   He has 8mg po prn dose of Dilaudid ordered.  Which, of course, he starts asking for 2 hours before the next available dose.  Not surprisingly, his blood pressure and heart rate have been trending downward.

Debbie, my former preceptor, came in one morning to find his pressure in the 80s.  And he was on the call light for more.  She went into his room and told him, “You’re going to die if you keep this up.  One day you are not going to wake up.”  She explained that his blood pressure and heart rate were very low and that she would not be bringing him more Dilaudid.

Later the aide came in to tell Debbie that the man had asked her if salt raises blood pressure.  She told him it did. So he ate all the salt on his tray and was on the call light for more.

Beaner

I love Charge Nurse, but she often says things that could be construed as rascist  or, at the very least, culturally obtuse.  For example, she once said she didn’t think of me as being Hispanic because she considered me an American.

The other day the nurses decided that wanted pizza for lunch, and I was designated as the one to place the order.  I was asking around to see what people liked or disliked for toppings.  Charge Nurse turned to me and said,” Just don’t get any beans on the pizza.”

I and the others nearly died laughing, and she didn’t get it.  Because Charge Nurse thought she was telling me not to get weird healthy toppings.

Send your good thoughts this way, please

One of my dogs ran off during a thunderstorm Tuesday afternoon, and we haven’t been able to find him since.   I drive 2-3 times a day through our neighborhood and the surrounding neighborhoods.  I’ve been checking in with Animal Control and the pounds and  shelters.  I’ve called all the vet offices.  Posters have been made, and ads have been placed.  Last night I had a dream that I found him in front of a friend’s house, and today I went by that place as well.  Just in case.

He’s a sweetie, so maybe somebody took him in.  I’m really hoping someone took him in.

Update 06/13/09: He’s still not home, but we keep getting calls of sightings – all within a one-mile radius from our house.  Last one placed him a few blocks away from our home.

Update 06/17/09:  I was getting dressed for work when I thought I heard my dog’s whine.  It was so faint that I thought I might just still be half asleep.  Every few nights I was still dreaming of finding him.  I continued to get dressed when I heard it again.  I peaked through the window to check out my front yard. Nothing.  Still, I went to go grab my other dog to take a quick look around my neighborhood.  I passed throught the kitchen only to be stopped by the sight of my missing dog lounging out on the patio.  I stood there for a moment, actually rubbed my eyes, and looked again.  He was back.  I opened the door, and he ran in excitedly while whining earnestly with a musical tone – as if telling me a story.  He appears well, if just a tad bit skinnier.  I’m still not sure how he escaped and how he got back in the yard.  I’m so glad he’s home, but damn there are a lot of signs to take down.

Missing 06/02 – 06/17 : What the hell was he doing for 2 weeks?

Nurse Jackie

I’ve read posts that criticize the show (click here to see promo) as yet another poor portrayal of nurses.  I’ve finally seen the promo, and I have to say – I’ll be watching.

She has some rather glaring flaws (including addictions and questionable ethics), but I’m glad to see that she is not simply another angelic handmaiden.  Her knowledge base is evident, and she tries to advocate for her patients.   One of my favorite moments in this promo was  her reaction when she caught a potentially fatal mistake of hers.  This is a person who truly cares.

For those in an uproar over those addictions and questionable ethics, they need to remember that this is a television show.  Of course that behavior is unacceptable (and illegal), but this is a television show. There would be no show without conflict within herself and between herself and others.

I’ve only been a nurse for a year and a half, and I’ve known of nurses who’ve abused.  I’ve known of nurses who’ve bent the rules.  I’ve seen (or heard) of inappropriate workplace behavior.  This show isn’t making anything up; it’s simply dramatizing behavior that can be found in any workplace.

There is so much to be mined from the nurse’s experiences. We have three new shows about us this year: Nurse Jackie, HawthoRNe, and Mercy.

That’s pretty cool.

** In response to The Nurse Practitioner’s Place…

I’m grrrreat!

When I returned from Florida, I found this card from my director.

My brilliant idea?   Set up the computers to reboot themselves to save the nurses (day shift, really) the trouble and time of rebooting the computers each morning just so we can pass meds. (We scan patient’s armbands and their medicines.)  It only took a year to make it happen.

I first mentioned it to my unit manager.  She said it was a good idea.  Then I asked an IT guy if it would fix our current tech problems.  He said it was a good idea.  About a month ago, our unit manager was having to make rounds with nurses.  She asked about problems and solutions to those problems.  I again mentioned the idea of having the computers set to reboot themselves. (The same thing you can do with your personal computer.)   Apparently I have to leave the state before any of my ideas can be implemented.

Inside the card was a meal card good for $5.00 in our cafeteria.  The same expensive cafeteria who won’t give you your employee discount if you use said card.   Which means you still end up paying for your meal.  Nice.

Pet peeve

I don’t normally get riled up when driving, but the one exception is a particular stretch of road on my way to work.

Particular stretch of road

It’s simple enough, really.  If you want to take the left ramp, stay on the left.  If you want to go right, merge to the right.

Ideal

The problem comes from the idiots  who refuse to merge until the last minute.  All the safe and efficient drivers have already placed themselves in the right lane earlier.  Ideally, there should be a nice smooth entrance to the highway without any need to slow the traffic.  Instead, you get this:

Reality

It’s one thing to merge later when there’s little traffic, but to pull that shit during rush hour is unforgivable.  And it’s not as if these are drivers who were unable to change lanes earlier.  They simply speed past the other drivers, who are not driving slowly, to create a mess at the entrance.  They slow traffic to a crawl as they force themselves into the merge at the very last bit of ramp.

Leaving me to exclaim, “Fucker…fucker…fucker…fucker…” to each and every irresponsible driver who would not only slow me and everyone else down – but put us at greater risk for accidents.

The only satisfaction I get is when an 18-wheeler or some other enormous vehicle sees this shit and moves over to straddle the line, blocking those idiot drivers.  I love those guys.