Life

Life is real but all people live their own seeing only glimpses of the lives of others.  One thing that I value immensely is authenticity.  One thing that I struggle with is that as much as I love this blog it may not be a true representation of my life.  That which I do post is honest and at face value but the lack of posting about that what I don't post can tend to make my life look like its all sunshine, boats and puppy dogs.  And while I know that my blog, being mostly based on photos, lends its self to this . I don't want to come across that my life is one big highlight reel.

I have a super blessed life which I am so thankful for and live life with joy but I to have days where I struggle, days where I do nothing more then stay home and clean my room ( I do that alot) and do chores, days where I like nothing more then to walk alone in the rain, days that I  feel like I get no where in life, days where I sleep because I work nights, and days lots and lots of days that I work.

Work is actually a bit part of my life that doesn't get a whole lot of blog time.  There are a few reasons for it.  One- by the time I get home I don't necessarily remember what happened during my day, two its hard to change stories enough to keep patient confidentiality without completely losing what made the story so interesting in the first place, and thirdly I read some nursing blogs and while I enjoy them and can relate the tone needed to make what little is funny at work interesting. It usually requires a sarcasm and attitude  and distain towards life and people that I work really hard at keeping out of my practice and my conversation.  While on occasion those attitudes and comments do come out (usually when my mom asked how my day was) it is because its a coping mechanism used when frequently faced with the bad choices people make ending in negative consequences and a lot of bad things happening to people who make good choices.  But it doesn't show alot of grace.  That being said I should work on sharing more from work because really people are great and do something say the funniest things!!

But to give some insight into the rest of my life here is a snapshot of work. If you just prefer sunshine and boats you can stop reading now and I won't be offended but if you want to know more about the rest of m, keep reading.

 I work in the ER - fast paced, ever changing, with great opportunities to see everything and learn new things each day.  In the ER there are a multitude of assignments each which is uniquely different
Acute assignments-2x 4 beds of pts requiring cardiac monitoring and different critical interventions- ie arrhythmia's, overdoses, milder heart attacks, diabetic crises ect
RAZ-  What you would see If you looked at a picture of chaos in the dictionary- 10-25 pts with 2-3 nurses.  Pts must be ambulatory-  usually with abdominal, renal, non critical neuro- complaints 
Fast track - walk in broken bones, cuts, minor things (not to sure as I NEVER get assigned here ;()
Peds- 4-5 beds of the little kiddos
Hallway -( because we all wanted to grow up and be a hallway nurse) anywhere from 5-20 pts - All the left overs- Elderly that cant walk and are critical enough for a monitor,  People who are critical enough for a monitor but there are non, police escorted psych patients, medical admits
Med assignments - take care of medical admits
Trauma- Primary nurse for the trauma rooms, covers breaks for acute nurses, resource for nurses with sick paitents.
Acute Float- Backs up the trauma nurse with critical patients, goes to hospital codes, takes patients on transfers, responsible for one pt room that usually has a secluded psych pt,  resource for acute nurses needing help with their patients.
Triage- person initially sees the patient and sorts the chaos (have manage to avoid this one so far!!)

That being said, of the 13 different RN assignments of a shift I only work as the Acute Float and Trauma.  I can count on my hand the number of times I have had another assignment since coming back from working on the boats.  While I do love this assignment and the fast critical thinking and hard work it requires doing it exculsivly is fairly stressful.  

While my days are each unique and never the same here is a brief snapshot into a day I had a few months ago.  It was average.. one which I would have forgot if I had not taken care to keep in in my memory.

I arrived at work about 700. put my stuff away and headed out to see where I was assigned. I was trauma.  My carpool partner and I always guess where we are going to be on our way into work.. we are pretty psychic and about 95% accurate =)  My float partner for the day is M.  I'm super stoked about that because as much as she says she doesn't do trauma enough to be super comfortable there, she has been ER nursing since before I have been born and has more experience in her little finger than I have in total.  Its always a nice feeling to work with someone who you can totally trust.  I get report from the off going shift about what their night was like and how the department is as a whole.    Getting the heads up on which patients might be sick is always nice as I can check in with their nurse to makes sure that things are headed in the right direction.   Next I check my list of ER docs for the day, who the ICU attending is and the Trauma on call.  Knowing what docs you are working with can give you a good idea of how things certain things will run.
0715- Time to get to work. Both my rooms are empty so I do a quick check of my safety equipment - airways, ambubags, IV lines and defib pads.  With that done I check in with the acute nurses to make sure they are okay , if they are getting a new admit/have three things to do at once I help them get started before doing my comprehensive room checks  A three of them are good so I start to systematically check the trauma rooms.  Ideally this happens at the beginning of each shift to make sure you have everything you need in a pinch.  This takes about 15-20 mins as I  stock masks, check monitor paper, restock some meds, get full O2 tanks, - this is an iphone pic from sometime last fall

0800 With rooms all checked I head out to help C. in the hall.  For 8 in the morning it already is shaping up to be messy.  He has 5 admits behind dividers to start his morning. I give some meds and do some vitals for him
0830- Time to start the break train- I send M. in peds off.  She only has two so I keep an ear out for them and go to start an IV for someone.  5 mins later Success!!! I take a moment to celebrate while trying to be sympathetic to the patient who is complaining about the IV in her thumb. My brain is going more along the lines of "you are a diabetic pt with only one leg due to peripheral vascular disease and one arm is out because you are on Hemodialysis, I don't do thumb IV's because I want to!!
0900- Do the hall break.  CTAS 2s starting to stack in front of triage.  The lack of privacy to take history's and do assessments in the hall is super frustrating to me.
0930- K. our flow nurse is on her game today and covering two breaks for me so I head off for an unheard of early coffee. 
0950- Just finishing off the yogurt when "Code Blue" is called. I know that  M. my float who would normally do the floor codes is up to her eyeballs with a patient so I take off running, taking a moment to be thankful its down one floor. Sometimes by the time I sprint about 200 meters of hallway and run up 4 flights of stairs to codes on the 4th floor I have even have chestpain =).  I get down to the outpt clinic where it is called just in time to be waved off. False alarm.  Im surprised to see C. the nurse working in the Fast Track area there.  I ask her why she came she said while it looked like you guys were busy in trauma so I thought I would come.  They hadn't call me back from my break so I assume its probably not to bad but that thought changes as I step into the room.

I take a moment and process the 12-15 people in the room. The braslow cart is open at the back of the room telling me that the pt is a kiddo.  There is Social work, parents, 3 Respiratory techs, 2 paramendics,2 nurses doc, pediatrician , resident, med student and in the midst looking to small on the bed, a baby.  I  walk through the heart that's in my throat that sits there when ever its a kiddo and get a quick 5 sec storey from K.  Right now the issue is that they cant get an IV so we prep for an Intraosseous.  I get more of a report from the senior paramedic as I prep the leg and hold it for him to drill the needle into the tibia plateau.  Sick Sick baby .IO's are  always horrible in the moment but that turns to sweet relief when the placement is good and I can give fluids and meds.  I do my own assessment, not great.  Portable Xray is there now. I don the lead aprons to stay with the patient and help position them for the xray.  K is doing all the charting now and M. the peds nurse is mixing meds. The two RT's are staying concentrated on the baby's breathing and treating that and doing lots of suction. I'm so blessed by the team I work with. We are really a sum of our parts, situations like this are never about 1 person.   I check in with the social worker and the parents giving them up-to-date information and seeing how they are doing with this unexpected event and let them know about what we are dong and what we are thinking- either baby will respond good to these treatments or else we will need to intubate and fly them to BC Childresn.   Peds patients are always a family event.  1/2 hour later baby turns a corner in the right direction.  I think we will be okay.

1130- .  I stay 1:1 with baby as it is a constant monitoring of breathing, IV fluids/the IO site, talking with parents and collaborating with the peds resident. 
1200- Get a patient into the other trauma room. M. and I check her in together. Acute  neuro focused deficits has M going off to CT with pt and us problem solving to decipher her symptoms. Once back she starts breaks and I manage the two of them.
1230- Baby takes a bit of turn for the worse again- I page RT and working together after about 1/2 baby is once again happy and pink and having a feed. The chart gets put together and I spend sometime going over it with the peds resident and calling the pediatrician for some clarifications.
1330- A bed has opened up and I get busy on moving the adult pt from the trauma room.  I get her moved over and call up to peds to move up the baby. 
1400- Report given to peds and a promise from the nurse that she will come down and get the pt. I pass off to M. and go for lunch.
1430 - Come on back up and find the baby still there- peds are notorious for not taking their patients. I phone up again and then they come down. 

Sweet, both the rooms are clear Time to start some coffee breaks and get a handle on what the departments like. Sometimes when so intensely 1:1 with a pt the sky could be falling and I would never know.   I cover the hall first, C's 5 pts have ballooned to 15.  The granny with a broken hip is stretch is bumped up right against the older man who looks is sleeping beside her.. I stop a second to make sure he is actually breathing.  The EHS doors open and in come more EHS crews, they are starting to off load between the doors as there is no place to off load in the hall. I do an assessment, give some meds and feel like I have my finger on a dam that is leaking from 10 holes. Three people ask when the doctor will see them. I have no clue who they are. I reassure them I will look into it for them and that we are doing all we can.  I make sure blood work is ordered on anyone I imagine will need it and bring some warm blankets to those in front of the door. 

1545-  I cover acute 2's coffee break - S. has a nice little assignment today and I happily work on the tasks she has listed on a sticky for me. 

1600- I may actually get coffee today. No sooner does the thought cross my mind when the overhead pager sqwacks (CTAS 1, ETA 5mins).  I leave a note for S with checks beside that which I did and go up to triage to see what is coming in.  I get a basic info- Post Cardiac Arrest, the current rhythm and an age. I find M to give her the heads up, I find the doc give him the heads up, page Respiratory and head into prep the room.  Hard boards and cooling blanket go on the stretcher, arrest meds get pre drawn, the bed is positioned for easy EHS off loading.  M and I decide on our roles.  She will be bedside and I'll chart for this one.  The 5mins always goes quicker then you think and soon they are rolling through the door.
My first thought is so young.  That thought flees as I concentrate on getting report from the paramedic.  While the pts current condition is very important M will concentrate on that while I get vital details to the events leading up the cardiac arrest and the paramedics treatments and the patients reactions to them.   He is on the monitor and things are critical but for a post arrest pretty good.  A parade of lab, ecg and xray come quickly through the door.  The ER doc sees him and starts putting out orders.  We anticipate most of them and start hanging infusions and putting more tubes in- the pt came in intubated but we add more IV's, a stomach tube, foley catheter and multiple temperature probes(bladder, rectum).  The doc wants the hypothermia protocol (a protocol where we cool the pt's body to 32 degrees to help preserve brain function.  I print off the protocol and start to go through the list of indications and exclusion criteria for the protocol.  The pt doesn't meet all of the criteria.  I show the protocol to the doc.  He says go for it. I'm still not convinced as one of the main indicators for use is not being met.   He insists so we slowly start to do some of the tasks to cool while waiting for the ICU attending to come.  He breezes through the door five mins later.  He agrees with us and the protocol is canceled.  Based on the pts story there is strong indication for a CT to see if that was the original cause of the arrest so CT is ordered. The pt goes on a portable monitor, portable defib and vent for the trip to CT, Just as we are to roll out the door the pts family arrives.  We give them a moment with their loved one and explain what is going on.  Then the pt, RT, the ICU doc and I roll out the door and down the hall to the scanner.  He is fairly stable for having been dead for 1/2 hour the CPR the bystanders had provided had been top notch. He is needing lots of sedation which is a great thing.. nothing worse then a pt that is so out that they need no sedation.   I find out while we are in CT that the pt can go straight to ICU ( that NEVER!!! happens), its fabulous tho so we head up.  I bring him up and handover care.  I stop in the ICU waiting room on my way out to give the family an update.  The next 24 hours will be hard and life defining for them.  (side note the pt did INCREDABLY well!!)
By the time I'm back down its 1845. I start to restore order to the room we trashed,  night shift is just trickling the door.  I spot N. my replacement . 

1900 Into trauma wheel paramedics with a new pt.  I'm just getting report from them when N. steps into the room.  I finish writing and start to get to work on the pt when she waves me on "I've got this" she says "go home".
1915 And that's what I do.  Get in the car with my carpool buddy and go home.  To shower, sleep and come back the next day.  The events of this current day never to repeat again. 

So that my friends was a glimpse into a day in the life of.