Blog 4: Stay out of the Waiting Room

     This is my second holiday season as an ER nurse, and, same as last year, I am struck with thankfulness for the life and opportunities that I have been blessed with! I spend so much time stressing out over $$$ that I don't have, but then I see people coming in wearing 3-4 layers of clothes, carrying beat-out suitcases and trash bags full of stuff, and looking cold, miserable, hungry, and hopeless, and I know I can't complain!...

     This time of the year, the ER waiting room stays full most of the day, largely due to the cold and flu season picking up steam and the homeless population seeking "3 hots and a cot." A full ER waiting room is an intimidating place! The sheer amount of bacteria swimming around out there is scary enough, but everyone is angry and at the end of their limits. Opening the door between the main ER and the waiting room is a gamble each time! If I had to put a sound effect to the words "ER waiting room," it would be the sound of a fuse being lit! I've had to brave the waiting room quite a bit the last few weeks, as I've been assigned to the "mid-level and chairs." This assignment basically means that I am the nurse for the nurse practitioner that sits at triage and sees each patient as they are being triaged for the first time. The NP will put in orders for that patient such as labs, urinalysis, cultures, flu/strep swab, IV insert,  IV fluids, nausea meds, breathing treatments, ect... It is then my job to call each patient back to my little area of 4 reclining chairs and a lab station, get an IV and fluids started, send the blood work and the UA to the lab, and give the meds. When the patient is completed with whatever needs to be done, I send them back out into the waiting room until an actual room in the ER becomes available so the doc can see them. This whole assignment can get a little hairy when you have an entire waiting room of people. The scariest part for me is the fact that some of people waiting out there in the masses actually are very sick, and sometimes they literally try to die on me in the waiting room... THAT is the worst! I've had one guy who kept downing nitro for his "chest pain" and lowered his BP so far that he fell out on the waiting room floor and another lady that started having a stroke as she sat in the waiting room. It always makes me feel awful when we have to carry someone back to the trauma rooms and resuscitate them because they've spent too much time in the waiting room and became critical in those hours.On the flip side, there are so many people that don't necessarily even need to be there and can't seem to understand why they are waiting for hours on end. I used to try to explain to people that the doctors and nurses behind those double doors are NOT just sitting around and eating pizza and that the people that go back before them are actually a lot sicker, but anymore these days, I just nod and apologize and say "I'll see what I can do." I kind of enjoy it when something happens that puts their "emergencies" into perspective...For instance, early evening last week, I was sitting at my lab station with a patient when I heard some blood-curdling yells go up in the waiting room. I quickly got fresh gloves and went out there to see what was up, (along with most of the nurses in the ER, it really was loud and sounded serious!!!).... Some poor lady was running around yelling "MY BABY, MY BABY! SOMEONE HELP MY BABY! OH PLEASE LORD NOT MY BABY!" We soon found out that her teenage child had been shot in the head and was coming into ER via a bystander vehicle. She had beat the vehicle to the ER and raised the alarm along with half the dead of the city. At any rate, the waiting room was pretty docile for a while after that!

      And then, we have the ER frequent flyers who get discharged and don't want to leave... For real, last week one lady who was discharged into law enforcement custody threw herself onto the lobby floor with enough force to open up a nice forehead laceration and splatter the triage area with blood. It's times like that when I really have to silent pray for patience and bite down on my tongue... Still makes me mad just typing about it. 

     At least there is humor mixed in with the craziness! Just Tuesday, I walked out into the waiting room and saw one of our "cute" little frequent flyers sporting only one penciled eyebrow that was raised very indignantly in my direction and I literally snorted out loud! 

    I feel like the last few weeks have had some crazy moments, but so often, when I sit down to write this blog, I can't remember everything that I wanted to write about! Here are a few of the moments that stuck with me from the last few weeks:

• Thanksgiving Day seemed to be Code Blue day... I was in a code literally 10 minutes after clocking in. I was actually able to get an IV on both codes I was involved in that day. May not seem like much, but for me, it was something! Getting an IV during CPR is hard, especially because the blood sometimes is hardly moving in the veins... 
• Cute old redneck codger who got his thigh cut pretty badly with a saw of some sort... he had these jeans with the neatest colorful patches sewn on the knees. When I asked him about them, he said that he had sewn them on himself... bless his heart! You'd have to see these jeans to understand why they were memorable, but I feel like he was an artist at heart! 
• Poor suicidal lady whose family tried to bring her to the hospital only to have her bail out of the car on the way... I remember her because she was all dressed up in Western gear when they brought her in and I had to take off her fancy cowboy boots... Not sure why that stuck with me! It's weird what stays in your head sometimes! Poor lady, I think her son had died recently or something. 
• The brownie guy... Every holiday there is an old gentleman and his son who bake brownies for the entire ER staff. He brings a plate of brownies to each nurse's station and thanks each one of us personally. He came around and gave each of us a hug and a peck on the cheek on Thanksgiving Day... His wife died in our ER a couple years before I started working there, from what I understand, but I guess it made a big impression on him because he literally is there with brownies every major holiday... Just made my day! And the brownies were really good, too! I had 3! 

     Here's to each and every one of you that read my blog! I hope you have an amazing holiday season! I'll leave you this time with a tale of blood and gore!....

                            My First Time Witnessing a Resuscitative Thoracotomy
     This story will be short and sweet but bloody, so don't say you weren't warned!!! 
     A thoracotomy aka cardiac massage is a procedure done in some situations when a patient is not responding to CPR, shocks, meds and any other resuscitative things being done... basically it's a last ditch effort at saving your life. It's usually reserved for young patients, trauma patients, and people that most likely have otherwise healthy hearts... 
     This particular night, we got the call for a trauma alert headed our way... the patient was a young woman who had been hit by a car and was being coded on the way to the ER. When EMS arrived, they hadn't got ROSC (return of spontaneous circulation) so the ER staff kept trying for the better part of an hour... Finally the Dr decided to do a thoracotomy... Basically, this means he is going to literally make a hole in the chest wall and use his hands to directly massage the heart to try to get it beating again. As you can imagine, this type of procedure is a blood bath! It also involves some very large tools to cut the ribs and hold the hole open... This time, when the doctor first glimpsed the patient's heart, he saw massive trauma to the heart and called the code. To this day, I can see that poor girl lying there, dead, naked, with a hole in the side of her body, blood everywhere, but with her fake eyelashes and makeup literally still perfect!  
     We heard later that the patient had been pushing a stroller down the sidewalk when a speeding car hit them from the side, a hit and run... the EMS said the infant in the stroller died instantly from massive head trauma. They said there was brain matter where it shouldn't have been... The worst part was that the lady that was pushing the stroller wasn't the mother. The mother was also hit by the car but just barely grazed, so she had to see her baby lying there like that... I honestly don't know how you can recover from something like that!
     The community came out in full force for that tragedy! I remember leaving an hour late that night and the parking lot was so full of people standing around and wailing (literally!), that the police department had to do crowd control just so ambulances could get in the bay. I wanted to say something to some of those people, something comforting, but I didn't have a clue what to say, so I just walked to my car, got in, and drove away... just so thankful to God that it wasn't my family or someone that I knew! 

*Disclaimer: Any names, ages, or genders may have been changed for this blog. If anyone feels that any part of this post violates HIPAA, please comment below... I'm trying to be as vague as possible about ID but want to give as many details as possible!

     

Blog 3: "Witches" and Weirdness

     I wonder if all nurses eventually suffer from some form of paranoia or anxiety? Maybe I am alone in that category but there have been times that I replay events over and over in my head trying to figure out what I should have done or said,… or, I think about how I could have organized my time better so I could have done tasks faster, or I berate myself for mistakes made… I am guessing that this is pretty normal for a nurse. Honestly, it’s probably good that we do spend time worrying about our job because it makes us better and safer nurses in the long run. I think emergency nursing comes with its own set of worries and anxieties… We deal with so many mentally unstable, addicted, angry people that most of the time we literally hardly believe anything a patient says and we expect the worst from them. I’ve only been at this for a year in December and already I feel myself joining the ranks of the "cynical, unsmiling ones." I have learned that looking people in the eye and being friendly isn’t always a good thing. I have learned to recognize fresh track marks and to ask where that one vein is that they don’t use to shoot up drugs,… I thought when I got into nursing that it would be a great mission field, and it truly is! However, I am learning that I have to be very careful even when I am talking about my faith and inviting people to church. I had a patient recently that made this a little more serious to me...

      A middle-aged male with a history of drug use came in needing IV antibiotics. I was his nurse so I started the IV, set up the IV pump and got the ABT’s flowing all the while making polite conversation. He had informed me that he was a recovering addict in one of the local recovery centers and that he really respected the Mennonite culture and how we did things. He wanted to know more, so I just went through my normal spiel and tried to ignore the creepy vibe he projected. Both the PA and the scribe thought he seemed psychopathic, so I wasn’t the only one that thought there was something weird about him. At any rate, we finished the antibiotics and discharged him. I got security to hang out outside the door because I was afraid that he would be angry that we weren’t sending him home with anything for pain. He wanted directions to church so I gave him some vague directions and he left. (I never know if giving directions to church is a good thing or not but so far only one person that I’ve invited actually came to church.) He showed up again a couple days later with “wrist pain.” I wasn’t about to be his nurse a 2^nd time so I got another nurse to take care of him, but he kept coming up to the nurse’s station when I was charting and asking me what the “rules” of dating were in the Mennonite church and telling me that he was coming to church next Sunday, would I be there? (What am I going to do if he ever really finds church??? HELP!😱) At any rate, if I disappear without a trace one day, find this guy! LOL! I don’t know what it was about him that was so creepy but even with all the inmates we see in the ER, I think this guy tops the list as the creepiest! I have to say, I have the worst of luck with men! I always seem to attract the biggest losers and never the tall, dark handsome ones! The story of my life!!!😂

     In other events since the last blog:

• ·         The Pelican was back in the ER… this is the moniker we gave the girl that swallowed the ink pens! This time she had swallowed a Starbucks cup. From what I understand, it wasn’t the cup as a whole but torn into pieces… She didn’t manage to swallow anything in our ER this time! Lesson learned!!!!
• ·         I got my acceptance letter to for those last three nursing semesters. Classes start January 7 and go 4 days a week, so I’ll be at work Friday, Saturday, and Sunday,… or at least part of Sunday. I am hoping that I can get a schedule worked out that will allow me to still be a full-time employee but also allow me to be at church at least one service on Sundays!
•      The Secret Service showed up in the ER a couple days before the Trump rally inspecting our facility. I guess we were the designated ER for the VP in event of an incident. I am glad nothing happened but, man, what a story that would have been if something had happened! 

         Other than the above, the last few weeks have been fairly unmemorable, just lots of kidney stones, abcesses, broken bones, and MVA's. It never fails to amaze me how many people we get in the ER that have been hit by cars, so maybe I can raise a little awareness of that right here! People, be careful when you are walking or driving at night in our area! There are so many people that walk by the road anymore, especially in the city areas, and for some reason, they all like dark clothes and half of them are drunk or on drugs! Sometimes we get 2 or 3 pedestrian vs motor vehicle accidents a day! I don't understand why, but all I can say, is be careful! I hope I'm not jinxing myself by saying this!                                                                                                                                                                                    

                                 Focusing on more of the weird and creepy, here is the story of...

                                                                     The Hmong Shaman

          Apparently, in parts of Laos, a little country in Asia bordered by China, Myanmar, and a few other small Asian countries, there is a small obscure sect of people called the Hmong. I'd never heard of it before this incident, and, to be honest, I still don't know much about it. I am just going to relate to you how the Hmong dialect came to be spoken in a modest ER in a small city on the Gulf of Mexico. 

         One morning in the ER, EMS brought in a young Asian woman that had been found in a random neighborhood, standing in someone's front yard with her hands raised to the sky. She had obviously parked her car against the curb and walked into the middle of the yard before she assumed this position. Now, it's probably not unheard of for someone in the South to stop their car, get out, and praise the Lord, but I guess this lady stayed in this position for a long time and would not respond to anyone or anything. Eventually, someone in the neighborhood called the cops. The cops didn't know what to do with the lady, so they called EMS. The paramedics that brought her in didn't know what to make her either, because she was physically fine by their assessment, just wouldn't talk to them or respond in any way coherently. About every minute or so, she would yell out something at the top of her lungs but no one could understand what it was. We have several Asian staff members that speak varying Asian languages, but her words didn't sound familiar to any of them. We got her into  a room, assessed her, drew labs, ect, all the while speculating on what was happening. We all thought it was drugs until all her tox screens came back perfectly clean. Then we thought maybe she had seen something horrible or had been abused and was having a breakdown, however, there was literally hardly even a bruise on her! Basically, she was physically in perfect health. By this time, we were a couple hours in, and even the doc's didn't know what to do... Myself and Paramedic T went into the room with the Language Line (the Language Line is a little robot that has a screen and a camera and online access to thousands of interpreters around the world) We spent the better part of an hour video calling all the Asian interpreters on the Language Line and letting them hear our Jane Doe's yells. I wish I had kept count of how many interpreters we tried,... It had to be somewhere near the 20 or 30 mark! (I found out later that the cost to use the language line was astronomical! Nurse J said we probably spent somewhere around $60,000!!! I never heard any negative feedback from management, so hopefully it wasn't that bad!)  We finally gave up trying to translate what she was saying, and she was eventually transferred to the psych hospital. I figured that was the last we would see of her and that we would never know what happened. 

            A couple days later, Nurse J pulled me aside and told me that he had followed up with a friend at the psych hospital. He had quite a tale for me! At some point, law enforcement had traced down the person that our mystery lady's car was registered to. It turned out to be a recent ex-boyfriend who knew the lady's family. He put the PD in touch with her family and this is what they were told... 

            Apparently, the mystery lady had come from Laos with her family and settled in our area years ago, but she was the only one of her family that remained in our area. The rest of the family had moved to the Pacific Northwest. Her father or mother had been a Hmong shaman. Our mystery lady was following in their footsteps and transitioning into a shaman as well. Apparently, a Hmong shaman has the power to leave their body and travel in the spirit world. According to the family of our mystery lady, she had to be taken back to the spot where she had left her body in order for her spirit to enter her body again. The words she had been yelling were her name... 

           I was skeptical at first, but the more I read about the Hmong, the more it made sense... I don't know why she chose some random yard to leave her body, but once her spirit was gone, her body never moved. When she was brought to the ER and kept yelling out her name, was she somehow trying to call her spirit back to her body??? I would still probably be skeptical, except for the fact that she was physically healthy as a horse... absolutely nothing abnormal about her. Having spent time in Africa, I've heard tales of people leaving their bodies and seen some pretty creepy voodoo stuff, but I guess I never thought I would run into stuff like that in the Bible Belt of America! I'll post a link about the Hmong below... Read it and tell me below what you think about this sort of thing! Do you or do you not believe in the spirit world?

                                               https://www.pbs.org/splithorn/shamanism1.html

     *Disclaimer: Any names, ages, or genders may have been changed for this blog. If anyone feels that any part of this post violates HIPAA, please comment below... I'm trying to be as vague as possible about ID but want to give as many details as possible!