The "Little Baby"

 *I have written this blog for another publication but since I can never seem to get 2 separate blogs written, I am posting it here... It's not a feel-good, positive post, but it is very raw and real. Enjoy. 

        While the Covid “Delta” variant wave recedes and positive cases become fewer and farther between, another pandemic rages on. For those of us in the ER, we see evidence of a global disease almost every day. Some regions of the world seem to be less affected, but some areas, like my area, is consumed by this disease called addiction. We see patients daily who are struggling with addictions to opioids, methamphetamines, cocaine, alcohol, and spice. Many of them are marched, kicking and screaming, into the ER in handcuffs by 2 or 3 law enforcement officers. The opioid users are often found blue, unresponsive, and not breathing. They are given Narcan, an opioid antagonist, on-scene by EMS personnel and brought to us, angry and yelling obscenities, because EMS just ruined their “high.” I can’t count all the times anymore that people have driven their vehicles, wheels squealing, into the ambulance bay, and begged us to help their loved one or friend who lies passed out in the passenger seat, barely breathing. It’s become almost habit just to yell for Narcan on the way to the trauma room.

Several months ago, when I was sitting at the nurse’s station in Pod 1 and heard someone banging frantically on the ambulance bay doors…We opened the doors, and a young man ran through yelling for help. He was carrying an older man in his arms whose face was a very ominous shade of gray. We all scrambled to grab a stretcher and supplies and shortly, the patient was in a room with IV access and was immediately given Narcan. Within 2 minutes, the patient was awake, breathing normally and starting to talk. He vehemently denied taking any substances, even when we told him that we had used Narcan, and he soon tried to leave the hospital. The young man who had saved the patient’s life turned out to be his son. He was so disappointed in his father that he turned and walked away, leaving his father at the hospital to find his own way home. He told us that his father was an addict that had recently gotten sober. Apparently, this was one of many relapses. He, the son, had gone against his own better judgement and given his father a job with the condition that he remain clean. He said this time, he was done. He promised to never speak to his father again and walked away.

Several times, EMS have brought young mothers that have overdosed with their children in the house. EMS brings the children and the patient, and we, the nursing staff, double as babysitters until the Department of Children and Families (DCF) can come for the children. Once, a 5-year-old told our ER nurse that she had called 9-1-1 when her Mommy passed out.

Amphetamine and spice users are in a class of their own. They come to the ER complaining of “bugs crawling out my skin” and have an almost superhuman strength at times. These people often are so convinced that everyone is trying to harm them that they become very aggressive and combative. It will often take 4-5 people just to hold them down long enough to place them in restraints. The restraints keep the patient from harming the nursing staff and themselves until they can be medicated. Here is a typical scenario in the ER, sometimes repeated multiple times in one day: EMS wheels the patient in on a stretcher, escorted by multiple law enforcement officers. The patient is cuffed to the stretcher and may be actively trying to jump off the stretcher or spit and bite the people around them. Once in an ER room, the patient is taken off the EMS stretcher and cuffed to the ER bed. We will put them in 4-point restraints and put a mask over their mouth to avoid the spit. It will take multiple people to get a simple set of vital signs and to remove their clothes. Side note: I have learned to be very careful when assisting with this process. We have found drugs, syringes with needles, and weapons in pockets and shoes. I recently emptied a patient’s pocket and pulled out a broken “crack pipe” with the broken edge against my fingers, but, thankfully, no cut. Usually, the doctor will take a quick look at the patient, get the story from law enforcement and EMS, and then tell us to “B52” the patient. “B52” stands for Benadryl, Haldol, and Ativan. Haldol is a powerful antipsychotic and Ativan is a sedative used for anxiety. The combined effect of all three of these medications will usually “snow” the patient for a few hours and allow them to return to their mental baseline. Sometimes, if the patient has been awake for several days, they will sleep for 10-12 hours straight. Almost always, the patient will wake up hours later and have no memory of their behavior. They will be humble and cooperative and quietly ask why their throat is sore and their arms hurt. They will be escorted to the Behavioral Medicine Unit for a psych evaluation and a referral to rehab before being released to start the whole cycle over again.

Alcohol addiction is the worst of all because an alcoholic who can’t get their “fix” can die. Patients with an alcohol addiction will present to the ER sweating profusely, nauseated, and often confused. The longer they go without alcohol, the more confused they become. They have uncontrollable tremors and hallucinations. If they are not treated with medication, they can have a seizure and suffer permanent damage. So often, the patients we see suffering from alcohol withdrawal symptoms are the homeless population, especially homeless veterans. They use the effects of alcohol to treat their PTSD and to keep them warm in the winter, but when their “stash” gets stolen or they can’t get their hands on any alcohol, they become very ill. A few months ago, I triaged a patient picked up by EMS after someone called for help for a “burned man.” This poor homeless soul had picked the wrong place to pass out drunk and someone had poured lighter fluid on him and tossed a match, then stole all his belongings and left. He ended up being transferred to our local burn unit. Also recently, I had a patient who had been released from rehab. She was unable to walk due to hip or knee issues and had been released to the care of her “boyfriend.” He had taken her home and given her alcohol. Several days later, when the patient’s sisters were unable to reach her on the phone, they sent law enforcement for a welfare check. The officer found the patient lying in a pool of alcoholic vomit. She had been lying there for so long that the skin on her left arm and torso had been severely burned. She also was transferred to the burn unit. One of my nurse friends knew this lady years ago. She had once been married to a physician and lived the “high life.”

As an ER nurse, I find that I often lose my compassion for these people, especially in the heat of the moment when they are screaming curse words at you or loosing their bodily functions on the bed and on the floor. The stench of days old urine and feces is almost unbearable even with a healthy layer of essential oil in my mask. Sometimes they have been in the rain for days and their feet are beginning to rot. That is an indescribable smell. And all because of their life choices…

Then, almost every time, as I drive home from work, I imagine those patients as newborn babies, small and helpless. I imagine them as toddlers, already learning that there is no one in the world that they can really trust. They may have been beaten, yelled at, molested, and abused. They were probably told that they were “stupid” and made to feel worthless. They grew up believing that they didn’t deserve to be happy. Then when they were a teenager and given drugs at a party, well, they found the “numbness” they craved. I think of the veterans and the atrocities they saw and how there are still so few resources for them today. One thing I know for sure; these people who choose addiction over and over are not happy to be addicts. They are always ashamed and angry at themselves and the world. But the alternative is just too difficult. They are unable to face the demons in their life when they are sober, so they turn to substances. I always feel reproved when I could have spoke a word for Jesus and I don’t… when I give way to irritation and disgust instead of seeing that “little baby” in my patient.

The truth is, we are all given trials to bear in life, some greater than others, but you and I have been given the Greatest Gift of all. In this Thanksgiving season, say a prayer for the millions around you struggling with addiction and for their families and don’t be afraid to say a word for the Lord or a word of encouragement the next time someone asks for money at the gas station or begs on the street corner. Think of the “little baby.”

 

Kum Ba Ya and Other ER Tales from Yours Truly

 

    Hello! I'm back! It's closing in on a year since I updated this blog! So much has happened in life and in the ER since I last wrote, I hardly know where or how to start...

    Of course, the Covid saga rolls on but, on the bright side, we are seeing WAY less positive cases these days. The Covid units are now integrating non-Covid patients and the makeshift plastic negative pressure rooms are completely gone from the ER. We still wear surgical masks daily, much to my chagrin, but I haven’t broken out the N95 mask in months. Some people have asked if the Covid vaccine is mandatory at my hospital, and, no, it’s not. I chose not to get the vaccine and have had no negative feedback at all! Several of the nurses I work with opted out while many chose to get it. People have varying opinions on the Covid vaccine, and everyone is entitled to their opinion, however, for me personally, having already had the Covid in December and not knowing the long-term side effects and length of immunity, it didn’t seem necessary.

   One thing I love about working in the ER is the unexpected people. I encounter a lot of so-called "urban survivalists," aka, homeless people, but I met one such lady a few months ago that I will always remember with a smile. I came into work one morning and the night shift nurse told me that my patient in ER 23 was a B&B. That means that the patient is intoxicated and needs sober up before discharge. I glanced in the room and noted that my patient was snoring softly and was vitally stable on the monitor. Moving on to my other patients, I basically forgot about her for a while. Sometime later, I heard strange noises coming from ER 23 and went to investigate. My patient was awake, out of bed, and taking herself off the monitor, talking loudly in some language I did not understand. She was obviously of African descent, all of about 5 feet tall, with a close-shaved head and a particular "smoky" body odor that immediately took me back to my days in Africa. She had obviously decided it was time to see what lay outside of ER room 23, and she couldn't understand what I was saying when I said slowly, loudly, and with lots of expression, that, "No, we don't allow people to roam in the hallways naked." The whole episode was getting the attention of my fellow nurses and they were coming to lend a hand. Marissa, a feisty redhead from the Midwest, said, "Oh, I know what she's saying! That is Swahili!" So, while I watched (and made a mental note to ask Marissa how IN THE WORLD she knew Swahili), she and my drunk little patient started an animated conversation. Soon, both of them started singing and chanting in Swahili and dancing!... Clapping and stomping in true African fashion, my patient and Marissa and a few other happy nurses danced and sang all the way around the ER! The doc looked on warily and decided that if our little friend was sober enough to dance on one foot, she was sober enough to be discharged. I helped her pack her clothes into a tight little bundle which she immediately settled on the top of her head in true African style as she sang all the way out the door. I couldn't help but feel such an odd sense of de' ja' vu as I watched her go and remembered my time spent in Africa years ago. I learned later that my little African lady had been killed when she stepped in to a road way in one of her drunken rambles, such an unfortunate ending for such a fun little person. 

   In September, Hurricane Sally made her way through the area, being far more destructive than many residents anticipated. As a result, I had some interesting days in the ER. I particularly remember an elderly couple who had set up their generator inside the house. They were both unresponsive and hypoxic when they were found by their daughter who called 911. The EMS crew had been successful at reviving them with oxygen but brought them to us for further evaluation and monitoring. I had one of them as a patient and the other was directly across the hall, so I spent a lot of my time relaying messages back and forth. The poor old gentleman was so worried about his bride and was so angry with himself for causing the whole situation. He had set the generator by the back door and left the door open for ventilation. Unfortunately, the generator was on the ground floor and the couple was on the third floor, so obviously the fumes must have traveled up and not out. Both made full recoveries and were discharged home. While they were fortunate, some people were not. Many people who relied on home medical equipment such as oxygen condensers or IV pumps ended up in the hospital due to the power outage that lasted for the better part of a week in parts of our city. This situation stressed our already crowded hospital to the absolute max. Holding unit patients in the ER for days became a reality. In an unprecedented move, our director lined up ambulances and shipped patients over to our sister hospital across the bay.

   It’s pretty common to hear a call come over our radios for “assistance to the ambulance bay, please!” and most of us like to go check it out if we aren’t too busy, because you never know what you might find. Most of the time, the call is just for someone that needs help getting out of a vehicle, but occasionally, it is a little more entertaining. Several months ago, security called for help in the ambulance bay, and this time, there was a SITUATION… A big blue pickup and trailer had stopped just short of coming through the glass doors and was smoking rather ominously. There were numerous bullet holes down the side of the truck and the glass was shot out of the driver’s side. A young African American male was sitting almost in the middle of the truck with blood oozing from multiple gunshot wounds to his chest and abdomen. The ER team sprang into action and he was soon lying on a stretcher and on his way to a trauma room. The ambulance bay became a crime scene and was taped off for hours. The ER went on lock down as law enforcement hunted for the shooter. I never found out with 100% certainty, but we were left with the understanding that the patient had possibly stolen the truck as a get-away vehicle and ended up in a shoot-out. 

   How many of you enjoy cheese pizza? The cheesier, the better, right? We had a patient the other day who was found in the bathroom by her husband, unresponsive. Panicked, he called 911 but by the time the EMS crew arrived, she was responding and vitally stable. By the time she reached the ER, she was very awake and lying in the bed screaming “I have to POOOOOP!!! Get me a bedpan! I got to POOOP!!!! Ross, her nurse, put her on a bedpan which she promptly filled, completely... But the patient wasn’t finished, so Ross thought the easiest thing to do would be to put her on the toilet and let her finish her business. A few seconds after he got her on the toilet, she turned gray and became unresponsive! He pulled the bathroom call light and I happened to be the closest nurse, so I walk in the room to see Ross holding this lady onto the toilet, covered in poo and vomit and looking rather dead, to be honest. I quickly hit the code button and the calvary arrived a second later. The patient was quickly lifted into the bed, not an easy task since she was stripped naked and covered in slippery substances! We were checking for a pulse and about two chest compressions in when she started waking up… Hours later, she kept saying, “It’s all because of a cheese pizza… I ate the whole cheese pizza!” When I left work a couple hours later, she was still pooping! That must have been one LARGE cheese pizza…

   One morning this week, I had 3 stable patients and was waiting on doctor orders when I heard an EMS report come over the radio; the crew was coming in “emergent” with a “large laceration.” I decided to step into the trauma room to help when the patient first arrived so I could see what this “large laceration” was all about. Soon the EMS crew rolls in with a 300+ lb gentleman on the stretcher… one paramedic holding pressure with gauze on the right flank and lots of bloody gauze on the stretcher. After we successfully transferred the patient from the EMS stretcher to ours, (not an easy task, even with 5 people) we pulled back the gauze for a peek. The large laceration appeared to be maybe 5 inches long and 3 inches wide with visible subcutaneous tissue, not exactly a “large laceration” but, ok, it did look rather deep… initially, the bleeding was controlled but after a minute started to stream blood again. I put a pressure bandage back on the wound and the doctor finished his initial exam and began to ask the patient questions. The patient, who liked to talk about himself in third person as “Daddy,” stated that he had gotten out of bed to use the bathroom and upon return, had tried to “line up with his bed” but ended up sitting down on his glass night stand instead, ending up a large glass shard stabbing him on the flank. When the Dr. told the patient that we would be taking him to CT to check his internal organs, the patient replied, “Oh no, you aren’t! Daddy don’t go in one of them things!”

    Also, this week, my patience and PR skills were put to the test when I had a patient who was intoxicated, rich, and extremely rude. She was well into middle age with obvious signs of Botox and carrying a Burberry bag. The EMS crew that dropped her off in my room looked frustrated and kept rolling their eyes at me over the patient’s head. It was soon obvious why. The patient obviously believed that we were her slaves and that we should act accordingly or else she was “going to administration.” I had the unfortunate position as her primary nurse, so I had to get my face right each time before I went into her room and faced the music. During triage, she proudly told me that she had lied to the paramedics, saying that she was going to kill herself, but that, really, she wasn’t feeling at all suicidal… she had just said she was to get EMS to take her to the hospital. She stated that she was there for detox from alcohol and that she needed a room and food now! Also I needed to get her a phone charger immediately because “all hospitals should have one.”  I felt rather vindicated when the doctor came in and told her that there were no “detox” beds available and that she was going to be discharged with follow-up instructions. Boy, was she livid! She proceeded to curse at all of us before taking out her own IV and leaving. The next day, she was back, still drunk, still belligerent, and ended up winning a spot in the behavioral med unit for a mandatory 3 day stay. Thankfully, I was not her nurse this time! This lady really made me thankful for my normal ole’ poor people, even the smelly ones!

   Every day in the ER is an adventure, to be sure, but, I find that my days start to run together sometimes and situations that I may find remarkable one day I often forget the next. One of my aunts recently asked me, “Vanessa, do you ever feel honored to be there when people die and are having the worst day of their lives?” I’ve thought about that question a lot since then, and, yes, I do! I feel so blessed to have a job that I love and a supportive husband and family. I feel honored and humbled to be called to this crazy mission field we call nursing! 

Our Story: Vanessa and Travis

   Never in a million years did I dream that my next blog post would be my love story! But, for all of you who keep dropping hints that I should "write it down,"  here it is! 

   My perspective: His name is Travis and I have secretly been in love with him for five years, if not more! I have spent time reminiscing, searching my memory for the exact moment that I fell in love with him, but I can't find it! I do remember giving him a ride home from a youth deal many years ago and thinking that he was very handsome, but I don't think I had any feelings at that point. I can tell you that we have been friends for most of our adult lives. His family spent time in the mission in Jamaica and then, two years after they returned home, I spent time in the mission in Jamaica as well, so we've always had a common ground that made for good conversation. However, by July of 2015, I had a pretty massive crush on the 6'3," dark-haired Hiebert boy and I remember trying to swap "info" with another youth girl who had a crush on one of my co-workers at the time. That little maneuver didn't end too well for me,... the other youth girl married her crush and I got an apologetic message that "he isn't really thinking that way" or something down those lines. I was rather crushed but still raggedly persistent and a couple weeks or months later, I think I even sent him a text message asking him if he had any feelings! That sounds embarrassing, and, while it is, I will say that I KNEW beyond a shadow of a doubt that there was some sort of connection between us... It was new to me and I didn't understand it, but every time our eyes met, there was SOMETHING there. I told folks about how I felt and Dad gave me some advice that has stayed with me all these years. He said,"Vanessa, just hold it in your heart." So I did, but after my poorly timed persistence, things were a little awkward between us, and I couldn't bear to look him in the eyes because I felt that my feelings were still written all over my face. The years went by, I found a profession that I loved and threw myself into nursing and being an auntie. I still prayed for Travis every day, and I prayed that if these feelings weren't from God, that they would leave me. They never did. Eventually, I stopped praying about my feelings and just prayed that Travis would be safe and happy. Every so often, he would send me a text message and my heart would smile, but life just went on. We didn't see each other often, but when we did, there was still something there between us. I didn't know if I was imagining things or not, but I did know that I couldn't feel for anyone else the way I felt about Travis...

   God didn't leave me with nothing to hold on to during this time... I had an experience at work probably in early 2018 that gave me strength to continue "holding it in my heart." I remember that my feelings for Travis and the whole situation was just a heavy weight and I was struggling with how to accept the future and move on, so I stopped by the little chapel on the ground floor at the hospital and just poured my heart out to God... After I prayed, I picked up a Bible that was sitting in the rack and just opened it up. The first verse I saw when I glanced down was, "Many waters cannot quench love, neither can the floods drown it... (Song of Solomon 8:7) I remember being in tears looking at the verse and leaving the chapel with a renewed sense of hope that maybe I wasn't as far off in left field as I felt sometimes!

   Year 2020: enter the ol' corona virus: Travis and his family spent spring break in Jamaica, just as the US was beginning to truly shut down and lock the borders... I sent him a text message asking him how things were in the Caribbean and so on. Travis got that message while relaxing at the guesthouse overlooking the Caribbean, and for whatever reason, his mental "wheels" started turning. At any rate, a few weeks after he came home, I got a message from him that said. "I've got some coffee here for you if I can get it to you." I was surprised to say the least! He brought it over to the house on a Sunday afternoon. I had told a few of the family that he was coming and they were a bit stunned! Mom said,"I didn't know that you still had feelings for him." To which I replied,"Well, there hasn't been a time in the last 5 years that I wouldn't have said yes if he'd asked!" The whole family was here along with a couple of friends, but Travis didn't seem bothered. He just waltzed in with the coffee and gave it to me with no shame... In the meantime, I was trying my best to act like this was just any ole' day when in reality, my heart was in my throat all afternoon. He stayed for supper and was the last one to leave, if I remember right! I just couldn't believe it! Well, after that, my hopes were definitely rekindled, but the next couple weeks were radio silence. I sent him a thank you card for the coffee with a little letter inside, but only after carrying the card around for days because I didn't quite have the nerve to send it. Another few days went by, and I heard nothing. My birthday rolled around and I was at work all day just hoping to get at least a text message or SOMETHING on my birthday! When I left work in the evening, I was pretty down in the dumps because I hadn't heard a thing from Travis. I drove home with one last hope that maybe there would be a card waiting for me, but when I walked in the door, Mom pretty much just ignored me, and there was no mail to be seen. All disappointed, I trudged to the shower and took my jolly time. I think it was close to nine o'clock by the time I walked into the kitchen for a glass of water before bed. Mom asked me in a very weird voice if they could talk to me in their bedroom... and 5 minutes later, I was engaged! My answer went back to Travis yet that night, and we were able to talk on the phone for awhile... I couldn't tell you what we talked about but I do know that I didn't sleep much that night! 

 Travis's perspective: He remembers coming home from the Houston unit in 2015 and feeling that we had a good friendship at that point... Travis has told me more than once that the most important thing to him was to wait for the right girl and not to lead girls on... well, me being me, usually impatient and impulsive, I sent that first text message during a rough patch in Travis's life and I really should have waited. At any rate, time moved on and Travis says "It didn't really dawn on me that there was more between us than just friendship til' about 2 years ago..." He was at the farm working cows, and for some reason, he messaged me, maybe for my birthday.  And then he says something just came over him that our friendship was maybe more than just friendship. Of course, at this point, we saw very little of each other, only occasionally at hymn sings or the odd social gathering, but I find it VERY interesting that Travis can remember a lot of these occasions and the times we spoke to each other sometimes even better than I! 😉 Then came the day when he got my message asking how things were going in good ole' Jamaica... He was relaxing, just soaking in the beautiful scenery and surroundings, and he says that his thought was "I need to get home and get married to Vanessa!" So he came home bearing gifts...  He says that he was pretty sure on his part after the "coffee date," but was a little shady where I stood by then, so he was doing a lot of praying when my thank you card and little letter came. During this time, he read the account in Genesis 24 detailing the story of Isaac and Rebecca's romance and a phrase in verse 50 really stood out to him. "The thing proceedeth from the Lord..." He also talks about the settledness he felt at that time and that he has felt since then. 

   We are both thankful for God's faithfulness. Either of us could have chosen different paths so many times, but God granted us both grace and strength to hold on during the wait. I, for one, can never again doubt that God has our futures in His hands and that His timing is always and forever, perfect. 

Blog 8: Angels, Eyes, and Last Goodbyes

   Hello! This blog is coming to you live from the balmy Florida panhandle on a beautiful Saturday afternoon... It's been quite awhile since I posted an update on my life as an ER nurse and there has been a lot of water under the bridge. I graduated the LPN-to-RN nursing program in December, took my state boards on January 29, and have been on "orientation" as a registered nurse since then. My preceptor is a nurse that I have worked with since I've been at Baptist, so we work together well. As good as orientation has gone so far, I am a bit of a nervous wreck... There has been a steep learning curve where charting is concerned,... so much to remember and so much more responsibility! I've also been pretty nervous caring for critical patients. It's so different literally being the nurse responsible for a patient that is "borderline dead," with critical titrating IV drips regulating their heart rate and blood pressure. I've had a couple patients that needed conscious sedation to reduce dislocated and broken bones, which is a nerve-wracking nursing experience... and then, last week, I had my first stroke patient that needed TPA, the high-powered clot-busting drug that is given IV. So, yes, I am back to praying every day on my way to work that I don't kill anyone! Having said that, I LOVE IT!!!... even in the face of a "global pandemic." Every day on the job brings something new and exciting... especially in these crazy times! I've had a lot of interesting experiences since the last blog, but only a few really stand out. For some reason, the experiences that have really stuck with me lately are rather dismal, so apologies for that! 

   There is a quote somewhere about nurses caring for patients during birth and death, but ER nurses see a lot more death than birth. Usually, we are fairly callous to death,... we pull off the monitors, clean the equipment, and throw a sheet over the body... And usually, the patient is actively coding when they come to us, so we don't really have time to look them in the face and associate a life with that person. We just do what we are trained to do... A couple weeks ago, we had a patient come by EMS, an older male accompanied with his wife... He was having severe shortness of breath but was still able to talk to us in short sentences. His wife was very worried and stood stroking his head and encouraging him to breath... We put him on a non-rebreather mask with the oxygen turned up high, and he seemed to improve for minute, but he was still visibly struggling and his oxygen saturation was slowly dropping. A nurse called the respiratory therapist while I went in to try for a second IV because it looked like we were probably going to need it if the patient kept deteriorating. As I went in and stood beside him, I noticed that he was looking pretty gray and that his heart rate was slowing...at that moment, I also noticed that he turned his head to look at his wife and was obviously trying to say something to her. She told him to stop talking and concentrate on breathing, but when he turned his head back towards me, I could see that his eyes had changed... they had that "look" and I knew this wasn't going to turn out well! We got a doc in there in a few seconds, and by then, his heart rate was in the 30's. By the time we got a crash cart and extra hands, he was in asystole. We coded the poor man for 20 minutes but never got a pulse back. Bedside ultrasound showed a heart full of coagulated blood and we found out later that the patient knew that he had a heart blockage and opted out of open-heart bypass surgery. I am convinced that in those seconds that I stood by his bed, I witnessed his soul leave his body... I think he knew he was dying and turned to say his goodbye to his wife, and then turned away from her in that final moment to keep her from seeing... It's a strange thing about eyes! They truly are windows to the soul! 

   A few days later, we had a 2-month old Code Blue that came from the area close by the hospital, my first ever infant code. Normally an infant would be sent to our neighboring hospital that has a specialized pediatric ER, but since we were the closest hospital and the infant was in cardiac arrest, she came to us. EMS report stated that the infant had an unknown "down" time and had been found in her bed unresponsive. By the time she got to us, we had a room FULL of people ready to go... A pediatric code is very different than an adult code! A pediatrician is called in... Pharmacy comes to the code to draw the medications since they have to be precise and weight-based for an infant. L&D nurses respond to the ER and the infant warmer is dusted off and powered on. Chest compressions are done with the thumbs instead of with two hands... The work space is so tiny and there are so many hands working within that tiny space. IV's are tiny and really hard to get. I noticed that the doc's hands were shaking as he tried to intubate with the tiniest ET tube I've ever seen. I tried for an IV along with several other nurses, but the poor little thing had no circulation. We tried for an IO (IntraOsseous or in the bone) line but that was also unsuccessful. At that point, the code had been going at least for 30 minutes with no sign of cardiac activity and the doc asked if everyone was OK with calling the code. Quietly, everyone stopped their activities and we all looked at the little girl lying there... She was the cutest little thing with lots of dark brown curls and perfect little eyebrows... Except for the dusky gray of her skin, she could have been lying there sleeping. I suppose we'll never know the exact reason for her death,... the whole situation seeming a bit shady according to law enforcement. The rest of the staff involved in the code were a bit shook up afterward, but for me personally, as hard as it was to see a little baby lying there and not be able to fix her, I was comforted knowing that innocent children have a place in heaven. Who knows what she would have faced in this life? Most likely a lot of heart ache and pain and grief...  

   That same week, LifeFlight brought us a 28-year old female who had shot herself in the head with a hunting rifle. She was technically beyond our care, but was 21 weeks pregnant and still had a pulse, so once again, the infant warmer was powered on and the L&D team came down to the ER. I wasn't involved much with this code, but I did go in for a second, and was amazed at how well so many people were able to work together! Even though the scene was grisly and both mother and baby ended up passing away, the two departments came together for a short while like a well-oiled machine! 

   While there have been other memorable patients in the last few weeks, including an inmate who tried to hide a paperclip in a rather unfortunate orifice and was unable to retrieve it, a wife who accidentally ate some grill brush bristles when her husband grilled bacon for supper, and a gentleman whose football-sized abdominal hernia ruptured in the fruit aisle at Walmart, these days, the question I get asked the most is how we are dealing with corona virus in the ER. Honestly, the answer is... we are dealing with it like we deal with everything else! We just roll with the punches! Almost a month ago, the hospital hired some company to come in and set up a larger isolation unit within the ER... We now have an entire section of the ER that is taped off with plastic walls and zipper doors and is supposed to be "negative pressure." We call it "Covid Camp," or "Tent City," and try not to take the whole situation too seriously...(Although, after this, we'll probably all have PTSD when we hear a tent zipper go down!) Usually we have two nurses assigned to Covid Camp and I would say on average, maybe 5 to 6 people that end up going into isolation per day. Most of these people are discharged home to self-quarantine while they wait for their results. Thankfully, all the testing going on in the community has cut down on the testing we have to do in the ER. As of 04/04, our hospital has only 3 positive patients in the upstairs critical care units, however, the total count that has been seen in the ER is unknown to most of the staff. We are notified by management if we have been exposed to a positive case, but so far, thankfully, I haven't gotten that email! We have long since been reusing N95 masks and surgical masks, and thanks to our many wonderful sewing circle ladies, we now have cotton "Menno" masks to go over top of our surgical masks to help them last longer... we have taken to wearing masks most of the day, because, honestly, every other person that walks into the ER could be a positive case and we don't test nearly all of them, so we just try to protect ourselves the best we can, not just from CV19, but from all the other nasty things that "splash" that we no longer have protection from. Gloves, the remaining masks and gowns, and cleaning supplies are under lock and key as they kept disappearing at a high rate of speed. The entire hospital is on lockdown except for 3 entrances, where everyone coming in is screened for symptoms. No visitors are allowed except for family of trauma patients and dying patients. This has cut down on a lot of the unnecessary ER traffic quite a bit! No more dental pains or ingrown toenails! From what I understand, the hospital administration still expects the situation to get more dire, but we'll see how the rest of April goes! One very silver lining is the abundance of staff we have every day! During this time, management makes sure we have a full staff at all times! Another lovely little byproduct of this global pandemic is the effect on early morning traffic! No more annoying school buses and backed-up stop lights! I can get used to that! 

   Thanks for reading and for the support that I feel from all of you! If you think about it, just say a prayer for all of your local nurses during this time! I feel pretty fortunate to have a healthy immune system and a strong faith in God. I know He is in control and knows the future, but a lot of my coworkers don't share that faith. They are very anxious about the virus, the economy, and the future of our country. 

   And, once again, I would like to say thanks to all of you out there who spent time sewing "Menno" masks! The ER staff put together a collage of photos to share with you, and I will post it here! Earlier in the blog, I talked about eyes truly being the window into the soul... It's been interesting looking at these photos. You can literally tell they are all smiling, even though you can't see most of their face! You can tell it by their eyes!  

   

   

Blog 7: Blood, Brains, and Toilet Paper

 Warning: There's a little excess blood and gore in this one! Just warning you!

  Hello and Happy New Year! After many months, the blog is back! Since the last blog, I somehow managed to graduate from an LPN to RN program and now I'm waiting for my "ticket to test" from the Florida Board of Nursing. In the meantime, I hardly know how to act... My nursing school journey from the beginning prerequisites to graduation with my associate's degree has taken me nearly 3 1/2 years,... now to have no more homework,  clinicals or care plans, research papers, or "make-or-break" exams hanging over my head feels a little surreal! I think most of my friends wrote me off their social calendar long ago, but if anyone's up for an afternoon coffee run or a weekend ski trip, I'm FREE!!! Once I pass state boards, I will continue to work as a registered nurse at the same hospital where I currently work as an LPN, which should be a fairly smooth transition, I hope! I'm a little nervous and intimidated with the level of responsibility and accountability of an RN in the emergency setting, but I know everyone and I'm comfortable with a lot of the procedures, so once I have all the charting down, I think I'll be ok! I'm guessing I'll spend a lot of time praying that I don't kill someone for the first year or so! 😆

    In the months since the last blog, I have had some interesting experiences that I would really like to write about, but these are all overshadowed by the mass casualty situation after the NAS Pensacola terror attack... I feel like that day deserves it's own blog, so I'm going to leave it out of this blog in favor of reserving a blog solely for that experience. 

    In the last semester of nursing school, I had to do 90 hours of preceptorship along with my clinical rotation. Basically this means that I had to spend 90 hours shadowing a nurse, just one-on-one, instead of a whole clinical group. I did my preceptorship in the Critical Care unit/ Cardiovascular Intensive Care Unit, and was literally blown away with the experience! My precepting nurse was a specially-trained CV-ICU nurse, which meant that she was responsible for open-heart bypass patients directly from the operating room. I'll never forget my first patient with my preceptor, Ms. Gwen,... An older gentleman straight from the OR post-CABG (CABG=Coronary Artery Bypass Grafting) surgery... The poor ol' guy had an arterial line, a Swan-Ganz line ( a huge multi-lumen IV in the neck), three chest tubes, an exterior pacemaker, a Foley catheter, an ET tube and ventilator, and incisions on one leg where the veins for the bypass were harvested. The sheer amount of IV pumps and tubing looked like a mass of spaghetti and the number of monitors made my head spin, but my mind was literally BLOWN when Ms. Gwen said, "Ok, let's see if he's got a rhythm yet!" and turned off the pacemaker... the patient did NOT have a heart rhythm or not much of one anyway, so she turned the pacemaker back on and... Ka-thump, ka-thump, a heartbeat!!! She literally sat there and turned the patient on and off! "Now he's dead... and,.... now he's alive!" At any rate, by the time my 90 hours were complete, I had gotten fairly comfortable with the whole CABG patient post-op process... not that I would feel ready to do it on my own AT ALL, but I understand all the meds and how to set up a chest tube and how to use arterial lines, so I know it will be extremely helpful in the long run! Kudos to any ICU nurse, though! They do some crazy scary stuff! In the ER we keep them alive long enough to send up to the unit, but the unit has the job of actually fixing the problem! 

   Whatever the ER lacks in medical finesse, it makes up for in spades with the crazy, psychotic, and the traumatic... This fall I was part of a 5-hour code situation. A 53-year-old female was found unresponsive in her house during one of the first cold spells of this season. She lived alone in a shed-style house with concrete floors and no heat, so her body temp after lying on the floor for hours was extremely low, around 72 degrees when she came to us. The doc was ready to call the code almost immediately, but protocol says that death cannot be declared until the body temp is 86 degrees or greater... this is because lowering a body's temperature actually reduces the metabolic rate and can prolong organ function. That meant that CPR had to be done on this poor lady until her body temperature was at least 86 degrees. Amazingly enough, she did have some cardiac activity, but nothing that was adequate. We pumped warm fluids into nearly every orifice of her body: warm Foley flush, warm gastric lavage, warm IV fluids, and a warm enema, all while using the Artic Sun, an inflatable warm "blanket" that blows warm air on the patient's skin... Even with all the warmth, her body temperature took five hours to reach 86 degrees.... and she received "high-quality" CPR the whole time! We were all exhausted around the 3-hour mark, so LifeFlight was able to bring their Lucas, a CPR machine, that we were able to use for a couple hours. I was not there to witness it, but people in the room at the 2-hour mark say that the patient actually opened her eyes and looked around for a couple seconds... I wonder if she saw the trauma room or if she was seeing eternal life? 

   A couple months ago, EMS called in a trauma-code, a gunshot wound to the head. From the report, we understood that it was a middle-age man with a gunshot wound to the left temple. He had a pulse at the scene so EMS "scooped and ran." He lost the pulse on the way so they started CPR. We all gowned up in the trauma room and waited,... the trauma surgeon leaning against the wall and the pharmacy dropping off the trauma blood,.... nobody getting too excited because gunshot wounds always tend to be a little disappointing if your expecting blood and gore. Then EMS came through the door and I think we all peed our pants a little! This guy had a gaping cavern where the left side of his face used to be! I could see brain and bits of eyeball and bone all down in this gaping hole in his skull! We all looked at each other like, "What the world are we going to do with that? There's no fixing that mess!" The doc initiated the massive blood transfusion protocol but we could see the fresh blood coming out the top of the guy's head... The paramedic just shrugged when we all glared at him, and said, "Well, he had a pulse!" Once the code was called, the dead man became a dead crime scene and the crime scene investigators came in and did their thing... I walked by the room later and the poor guy had a red biohazard bag tied around his head. 

   Recently, on a Saturday, EMS called in another gunshot wound to the head. I happened to be standing near a radio when EMS called the report. The paramedic said, "We are coming to you with a 63-year-old male from the Walmart parking lot. He shot himself in the head on Thursday. He's vitally stable and alert and oriented x3".... We were all confused and the charge nurse asked the paramedic to repeat himself,... but, yes, they were bringing in a gunshot wound TO THE HEAD from two days ago. In summary, this poor man had such painful diabetic neuropathy that he was tired of dealing with the pain, so on Thursday evening, he shot himself in the right temple with a 308. The shot knocked him out and he has no memory of whatever he did on Friday, but Saturday morning dawned crisp and clear, and he wasn't dead so he decided he needed food and toilet paper. He hopped in his car and drove to Walmart, where he was spotted by a shopper while waiting for a parking space. The shopper asked him if he was ok, and he said, "yeah, I'm just waiting for a parking space." But the shopper freaked out anyway and call EMS. This guy came to us walking and talking,... he stood up from the EMS stretcher and walked to the trauma stretcher. He did have a hole still oozing in his right temple and one tremendously black and swollen eye but as far as he was concerned, it was just a scratch. The CT showed the bullet embedded about to inches into his brain. He was transferred to a hospital with specialized neurosurgery to get the bullet removed. Everyone was talking about how depressing it would be to try to kill yourself and screw even that up, but I think God must have some amazing plan for that man yet! I wish I would have had the nerve to tell him that, but I didn't. 

   While I have learned a lot about trauma in the last few months, most days at the ER are still filled with the endless abdominal pains, dog bites, "chest pains," that somehow turn into STD checks, ect., ect... So many people pass through the ER on a daily basis, and so many of them are sad, angry, unhappy people... Recently, a mother and father of four beautiful children, one of them six months, had a car accident. Both parents were on drugs. The dad went to jail and the mom and the kids came to us. The mom slept off her high in one room while our staff babysat in another. Eventually, the mom snuck out of her room and was gone before anyone could stop her. The cops caught up with her a quarter mile down the road and drug her back, but the look in her eyes was one I won't soon forget. She had a look of absolutely no care, completely cold. Thankfully, DCF came for the kids, but still, she was going to literally leave her kids at the hospital... just completely abandon them. That's a new low for me! And now four more children are in an already overwhelmed system! So sad!

   That's all for this time, but hopefully I can get the blog about the NAS Pensacola attack up fairly soon! Keep your eyes peeled for it! Thanks for your best wishes and prayers while I was in school and please don't stop! I still have those state boards to pass! 

   Happy 2020!

Blog 6: For the Children...

    After months of "radio silence," I'm back with a few words to write. First, an apology and an explanation for the time that has passed since I've last posted. I've been prioritizing... School work and sleep unfortunately takes precedent over posting blogs. Now that I'm safely on the other side of the spring semester, I've got a few things to write about...
    The longer I work in this profession, the more I feel like I view the world through different lenses then I used to. Just when I think I've pretty much seen everything, something happens that leaves me in tears for the entire drive home from work. Not that every experience is negative, but the negative does seem to stick around a little longer... At any rate, I'm actively putting the old adage of turning lemons into lemonade to the test. Let me explain... If you've been paying attention to our local media the last few months, you may have noticed story after story relating to child abuse. I've never really paid a lot of attention to these stories except to feel a momentary pang of pity for the child that I don't know and have never seen... until recently. Several weeks ago, I had the pleasure of meeting two of the most beautiful little girls in the world, with a jail bird for a mother and foster parents who somehow let these little girls get into their meth stash. I don't know if they will be OK, because we sent them to the local children's hospital and I have no idea what happened after that, but it literally broke my heart. The youngest of the two hadn't been to sleep in days, and as we were waiting for the pediatric ambulance transport, she fell asleep in my lap. It just blows my mind how anyone could cause harm to something so precious.... I can't remember if I already wrote about this or not, but  awhile ago, we had a 11-year old girl who had ran away from a group home in Montgomery and made it to our area... We think that she may have ended up in a trafficking situation, but, she was located by law enforcement and her social worker drove down to take her back to the group home. Obviously, the group home was worse then whatever she was experiencing here, because she literally bailed out of the car as it was going up the ramp onto the freeway... The poor child was one big road rash from head-to-toe. It took one of the paramedics and myself close to 2 hours to clean all the gravel and debris out of her skin... A few months ago, a 14-year-old girl showed up in the ER with abdominal pain and turned out to be pregnant, which isn't so unusual except that she was in foster care. A week later, she was back with an STD.... I'm pretty sure I already wrote about the cute little man that was brought to us by his grandma and ended up staying for hours until DCF could come get him. His daddy was allegedly trying to kill him, his mama was in jail, and his grandma couldn't handle it all, so she left him with us and walked out the door without looking back. There are more stories like these... but I think you get the point. And then, sometimes we have to take care of the perpetrators, the ones who committed terrible acts of abuse against an innocent child. How do you stay neutral in this position? A few weeks ago, someone was arrested for child abuse and hung himself in his prison cell. I wasn't at work when he came in, but I heard from the other nurses about it... He was given care just like any other patient. To me, that situation sums up the nursing profession! I look up to these nurses that can put on their "nurse face" and walk into the room and just do their job when they know that the person lying on the bed has committed some of the most unthinkable acts on an innocent child. That is true mental strength and fortitude! I'm not sure I'm there yet!... Interestingly, I've found a way to channel my frustrations from these experiences into something that will hopefully be a positive experience... A few days before the little meth girls, I had a patient with a broken foot who was a child advocacy manager with a program called Guardian Ad Litem. In short, Guardian Ad Litem is an organization or an agency that is the legal voice of the abused, neglected, and abandoned child. Guardian Ad Litem works closely with the Department of Children and Families or FFN (Families First Network) to make sure that a child that has been placed in foster care or with a relative is safe and properly cared for. I don't even know how the conversation got started but the lady with the broken foot told me about a great volunteer opportunity with the Guardian Ad Litem for pretty much anyone who had a heart for abused children. She wrote down her number on a piece of paper and told me to call her if I ever got serious about volunteering my time. Well, a few days later, when the little meth girls came through the ER, I decided maybe it would be a good idea to see what becoming a GAL (Guardian Ad Litem) was all about. I've met the local GAL team, taken a couple of classes, and been assigned a CAM (a child advocacy manager) who happens to be the same lady I met in the ER! I'm ready to take on my first case, hopefully, starting this next week! This means I will be assigned a child that is placed either in foster care or with a relative and will be responsible to visit that child at least once per month, basically just to make sure the provisions of the case plan are being met and that the child is doing well. However, I can spend as much time as I have with this little one. I can take him for ice cream or to the park or just spend time reading him books. If it's just an hour or two every month, it's something positive in his tragic little life! I'm so excited about it! It seems a little crazy to start something like this when I'm still in school and life is so hectic, but, hey, it's only once a month unless I have time for more visits! As much as I'd love to be married with a little family of my own, I kind of feel like this is a chance to learn about the foster care system and how it all works. Who knows, years from now when I can be a little more self-sufficient, this will turn into more than just being a GAL! As we all know, God works in mysterious ways!
   In other ER news, I've pulled two bugs out of ears recently, which, in the scheme of things isn't very exciting, I know, but it really is so satisfying! One was a long skinny cockroach and the other was a bed bug... People at work know I have this thing about getting things out of ears and come get me for the job. I bought this little gadget off Amazon that is a camera otoscope that connects to your phone. This way the patient can hold the phone and see what I am doing in their ear. I can look at the screen as well instead of always having to pull the otoscope off the wall where it's attached. It's literally only $28 on Amazon! I'm telling you, it's the coolest thing ever!
   During my clinical rotations this semester, I got to make a couple rounds through surgery. I don't know if surgical nursing is really my thing, but I do find surgery very entertaining! It's very fascinating to watch people being put to sleep... one minute they are awake and talking and the next minute, they are out like a light and floppy as a rag doll. The nurses and the surgeon were very good about letting us get as close as we could without entering the sterile field, and I got to see some pretty cool stuff up close and personal... a thyroid removal, a cancerous mass removal, a human bite repair, and, of course, a good ole' colonoscopy with a GI bleed. I am also fascinated with cauterizers (I'm not sure what their technical name is...but anyways) I love how it zaps the vein and sends up a little whiff of smoke, a little human BBQ.... 😝 That's weird, I know! Which reminds me, I have one of these at home now if anyone has a bleeder that needs cauterizing! I was helping on of the PA's with a head laceration a while back and we used one of the ER's one-time-use cauterizers. We only used it for a couple zaps (He let me do it! I was so excited! LOL!) After we were done, he handed it to me and told me to clean it up and take it home. He said it works really good for starting fireworks... ??? Do I especially look like a person that spends a lot of time lighting fireworks? I guess I must, Idk???
   The summer semester starts on May 29. This semester is only 10 weeks long, so it's going to be fairly intense! From what I understand, we'll be in class or clinical 3-4 days a week, which will put me back to working every weekend. I've gotten to know my classmates fairly well by now, and I have to say, it's going to be entertaining! Most of us have to work as well as go to school, so we are all tired and a little hysterical on those early, early clinical mornings. It's made for some really, really, good laughs and some good times,... I am so lucky to have classmates that are easy to get along with! I'm excited for this semester, but I'm also nervous and dreading the lack of sleep and early hours. I usually have to drive an hour or two to clinicals, and the drive home is pure misery! I've already learned where good parking lots with shade are along the way so I can pull over and get 10 minutes of shut-eye! I've also spent a lot of money on delicious Tropical Cafe smoothies for the drive home, but it's worth it if it helps me stay awake!
   I'm guessing I won't post again until I'm finished with the summer semester, for better or worse! Wish me luck! Thanks so much to all of you who posted encouraging messages on my last post! I read all of them! Much appreciated!
Have a wonderful summer!
PS. If any of you are bored in the least, I can forward you the volunteer information for the Guardian Ad Litem program!!!! Out west, it's called CASA (Court Appointed Special Advocates). Look it up on Google! Get involved! I think you'd be great!

Blog 5: Hopeless Hobos and Toes in Tupperware

     Well, hello everyone! I know I am about 2 months late, but the latest blog is dropping tonight if I have to stay up til the beautiful rare blood wolf moon (or whatever) goes down and the sun comes up! To be honest, I've had this blog in my mind for weeks... I started writing it over my Christmas holiday, but I never finished it. For some reason, the months of November and December were sort of heavy and depressing when it came to my work, and the resulting blog was heavy and depressing. Since I couldn't seem to find any humor to post along with it, I just canned it... This blog will probably still be a little heavy, but now I have some great humor to mix in with it, so here goes!

    I am officially a nursing student once again. I started the ADN Mobility program on January 7. My life went from busy to literally hectic, but I am determined to keep this blog somewhat current. However, if I have to go back to nursing school, you guys have to go with me! As a result, you will be getting a mixture of nursing school experience along with the ER stories. I have classes and clinicals Monday through Thursday at this point, and I work at the ER on Friday, Saturday, and Sunday. I only do a 6-hour day on Sunday, so I can take my heathen self to church at least once a week! I always feel like I drag into church late and sit there looking groggy for most of the service, but, I can't say how much good it does me! If nothing else, the simple act of sitting there and just being part of the group, after all week of just being me by myself... it feels amazing and I am thankful to be part of the Church of the Living God.

    I got into nursing because I loved the "mission field" aspect of it, (as well as all the blood and gore, of course.) I've long loved the idea of returning to Africa as a nurse someday... However, as time goes on, I am coming to realize what a mission field I already live in and the sheer responsibility I have to leave that witness for Christ. I feel like I've probably said basically that same thing a hundred times before, but it's true! I don't think we,... all of us in our comfortable little Mennonite bubbles,... can fully comprehend the hopelessness and sadness that we pass by every day! This Christmas season, several situations made this very clear to me... 

• My ER sees a LOT of the area's homeless population, sometimes on a daily basis. Sometimes more than once a day... it's not unusual for one of our regulars to be discharged from the behavorial med unit in the ER for psych issues and check right back in for some fabricated physical ailment. To be honest, most of these people really aren't healthy. They are addicts, alcoholics, underweight, riddled with various ailments from severe athletes foot to HIV and hepatitis and more. We all know they are in the ER for the proverbial "3 hots and a cot." If they are unable or unwilling to change their lifestyle, there isn't a lot we can do to fix them... I feel like we as nurses get so jaded and used to seeing these people that we tend to ignore them sometimes... "Oh, it's just Mr. So-and-So here for chest pain... he's crying wolf again!" In the week before Christmas, one poor man such as I've just been describing to you came to our ER... He was treated and eventually discharged. He had nowhere to go and no one to help him, so he tried to check back into the ER... (Before you ask, yes, we have shelters and halfway houses, but for whatever reason, they wouldn't take this guy!) I guess things got a bit heated at triage so security and law enforcement got involved and trespassed the guy off of the hospital property. With nowhere to go, he walked up the street to a local wound care clinic and laid down next to some bushes... 3 days later, after some heavy rains, he was still laying there... He was dead... I don't know why this got to me as much as it has... I wasn't involved in his care in the slightest,...but for some reason, it has really stuck with me. I imagine him lying there in the rain, his body losing every shred of life and warmth, becoming stiff with rigor... and nobody cared enough to stop and check on him... for 3 days! For 3 days, people walked in and out of the clinic and he was laying there! They said they thought he was sleeping! I can't imagine the depth of his hopelessness as he lay there and felt the life draining out of him... Maybe he didn't care, maybe he was ready for life to end, but I can't help imagining that the innocent little boy he once was still lived somewhere in that time-worn spirit and wished to live... What little boy at age 10 or 11 says to himself, "I want to live a terribly sad and hopeless life and die by myself by some bushes in the rain?" This poor man once had dreams and hope and spirit. I still think of it and tear up... and I picture my own little nephews and the life they have ahead... Oh, if only I can see that little boy in all my patients. To look past that awful exterior and into that little boy heart and shed just a little ray of Hope in the dark! I truly feel like this is part of my calling in life! This is just as "mission fieldy" as Africa!
• Also in the weeks before Christmas, I "helped" with my first DCF case... (Department of Children and Families, for those of you who were wondering) We had a lady come to the ER with an approximately 2 month old infant. She initially checked herself in, but it quickly became pretty clear what was going on... She needed help with baby. "Baby momma" was in jail and grandma (our patient) had custody. The siblings of the infant were already in foster care but for whatever reason, our warped justice system saw fit to put this infant in her care. She had psych issues that she was dealing with as well as the added stress of the little baby. This particular evening, the baby daddy had come looking for the baby and sought to end his little life. Grandma came to us for help and law enforcement was called... Eventually, with Grandma's mental state becoming clear, DCF was called for the little baby. Law enforcement told Grandma that the baby was going into foster care, but after some weeping and wailing, she left of her own volition. We were left for hours with the cutest little thing you ever saw... by the time DCF arrived we had all taken our turns feeding, changing, and entertaining the little guy. The last thing I saw of him was his little warm brown eyes and chubby cheeks as they wrapped him in a warm hospital blanket and carried him out into the cold winter night... I pray that his little life changed for the better that night! At any rate, it was entertaining to watch some the most stoic, "battle-hardened" nurses become cooing, blubbering idiots over that little guy! I loved it! 
• Once again, in the weeks before Christmas, I was at work and in charge of the lower acuity part of the ER... I was sitting at the nurse's station doing some charting when one of the people in our little sub-waiting room said, "Hey, I know that girl!" It was one of my friends from my first CNA job. I hadn't seen her in probably 3 or 4 years but we had kept in contact for awhile by text message. As a new CNA, I had looked up to her and admired her. She was a lady that had her act together. She knew her job and she did it well. She came in every day with her clothes ironed with creases and not a hair out of place. She walked fast and worked faster.... But, this day, in my ER, I saw her sitting there, barely recognizable... she looked homeless. She was wearing an old coverall suit, hair and face dirty, one leg slung over the arm rest. Her daughter had driven her there and now sat with her in the waiting room, looking embarrassed and barely making eye contact. I got her into a room and pulled the daughter out to ask her what in the WORLD was going on? From what I understood, after a bad break-up and a bout of unemployment, my friend had started making some bad choices and ended up pretty much destitute... she lived with her daughter but I could tell things weren't going well. My friend sat there and spun a delusional yarn about a spider bite that she imagined was a snake bite because snakes are prettier than spiders and weren't as evil as spiders. She had a big open staph sore on her leg and a nasty boil on her hand... those things don't get there overnight. I know something was going on involving drugs and/or alcohol but how can you help someone that doesn't want help? I tried talking to her as delicately as possible but she was paranoid that she was going to get committed to the psych unit and just kept trying to convince me of her sanity.  Eventually, we discharged her with antibiotics for her skin infection and I gave her my phone number again and told her to call me if she ever needed anything... She's never called and I honestly don't ever expect her to. I think she knew deep down that she was in deep trouble but, if I know her at all, she won't want to be a "bother" to anyone. She'll just try to deal with things on her own. I catch myself watching for her now, because I know she lives only a few miles from the ER. I don't know what more I can do??? Pray, I guess... I have a feeling that someday she'll show up in the ER again on a stretcher after a heroin overdose. I think about her often. It eats at me a little... What can I do so she doesn't end up dying all alone in the rain by some bushes?     

    On the lighter side, a few Sunday mornings ago while most of you sat in church, I treated a dapper 83 year old gentleman for an STD.... He came in with his beret, golf sweater, and shiny leather shoes, talking about "some girl done gave him an STD." He said he knew where she lived and that he was calling the health department on her a** and she was going to jail! When I went to give him his IM Rocephin in the hip, he was wearing a pullup😒... I wanted to ask him if he thought it was time to retire, but I didn't... I put on my nurse face, gave him the shot, and listened to his tale of woe. Maybe his discharge paperwork should have been specific... "No more hookers off Cervantes, sir!"                     

   A couple days ago we had a interesting GSW to the foot.... poor guy accidentally pulled the trigger of a loaded 12-gauge when it was pointed at his foot. It literally blew his big toe slap off his foot. He came to the ER on a stretcher but his toe came in in a maroon colored Tupperware container neatly nestled in a bed of ice... His foot was too mangled to reattach the toe, but no worries! The toe was very useful as entertainment for all the ER staff! I even have a picture of it if your interested!            

   I have a fascination with conscious sedation! We do quite a bit of conscious sedation in the ER for dislocated bones, cardioversions, ect... Conscious sedation is when the patient is given a drug that sedates him enough to make him not remember the procedure or barely remember the procedure but not knock him out completely like general anesthesia. A commonly used drug is Versed, also known as midazolem... if this name looks familiar, it may because you've read about it being used as part of the lethal injection cocktail, but anyways, it is some pretty amazing stuff. I love watching people get Versed... sometimes, it works so fast that their eyes don't even go closed... you just get this empty stare while the doctor yards around on their bones. 👀 I got to watch a chest tube get inserted in a guy after he was sedated with Versed a few weeks ago. The Dr was having a hard time getting the chest tube in and kept stretching the incision open wider and sticking his fingers in... the patient couldn't move but he kept making the worst groaning and moaning noises that you can imagine. Later after the chest tube was in and the patient was conscious, I made it a point to go in and ask him if he felt anything or remembered anything. He told me that he didn't remember a thing... Even after all that noise he kept making! I thought surely he wasn't "out" enough! 

    Well, it's almost 2 am. I could ramble on for a while yet but I think this is enough for this time around! I still have a few stories from my list to post, but this blog is already a bit loooonnnggg.... I know it wasn't all light and fluffy this time around, but, if anything, I hope it reminds you, me,... all of us, that we are God's eyes and ears... Let's take a moment to stop and really see those people around us with that look of despair in their eyes because we can offer hope, even if it's nothing more than a smile! 

1st Peter 3:15