Thursday, December 26, 2019

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! πŸ˜†
    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!


8 comments:

  1. Everything stopped here while I sat down to read a much anticipated post!! Always enjoy them! Such heartbreaking things you see, hear and deal with! They all need rays of light and hope and I'm happy you're helping to fill that place! Good luck on passing boards!! You can do it!! πŸ’ͺπŸ™πŸ™

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  2. Same for here at my house!! I was getting ready for our kids to come for New Year's but when I seen your blog it was sit down time for me!!!�� Am as proud as punch for you and will be rooting for you all along��‍⚕️������

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  3. You are so awesome. God definitely gave you a special talent!! πŸ’ͺπŸΌπŸ‘©‍⚕️πŸ™πŸΌ

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  4. Thanks for another peek into your life! Always love to hear about it! Keep up the wonderful work! 🀩

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  5. Congratulations on finishing nursing school! Thanks for sharing your experiences in the ER...I love hearing about it!

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  6. Wow... I always love reading your blog!! I admire you and what you are doing...

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  7. I been checking this blog for months just waiting for another episode and you didnt disappoint! Keep up the details gore or not.

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