Nuggets…

The ICU is filled with wisdom.

Now, the type of wisdom I’m talking about isn’t the kind you find from doctors or nurses about health care, but from the patients and their families. They are the ones that are ultimately unable to detach themselves from the experience, which means that they are the ones that have their lives shaken up like a good martini.

And like a martini, the substance after the shake is usually what matters. Everything else ends up going down the drain.

I’ve done a mere 14 shifts so far… that doesn’t amount to much, but here are some nuggets that I’ve been told by patients and their loved ones. I’ve done my best to write them down. They may not be verbatim, but they’re pretty close to what was said:

1. “Life is about love. It doesn’t matter how rich you are or how healthy you are… if you are unable to show love, then your life is meaningless.”

2. “Don’t wait until you’re as sick as I am (said the patient) to say, ‘Now I’m REALLY going to live,’ just start living and if and when you really get sick, you can face it with no regrets.”

3. “Make sure you tell those you love that you love them… every chance you get. And if they get tired of hearing it, then say it some more.”

4. “Life is like golf. A few degrees here, a few degrees there… and look what a huge difference it makes. But what’s important is that you take a swing.”

5. “Kids will never do what you want them to do, even when they’re heavily sedated.”

6. “The secret to life is to love what you do and to do what you love.”

7. “I’m going to be here tomorrow and the next day and the next day until (the patient) gets well enough to carry me out of this hospital.”

8. “It’s funny how little everything else matters when you realize you could be losing someone you love.”

9. “I will never take my health for granted again.”

10. “Always ask yourself, ‘What is my intended result?’ And if what you’re doing doesn’t lead you to that result, then stop what you’re doing. It’s that simple.”

11. “Sit down and talk to me for just a minute. Believe me, that’ll help me more than all the drugs you can offer me right now.”

12. “It takes a special kind of person to be a nurse. I don’t know what that exactly is, but I’m guessing that somewhere in there, you have to genuinely care about people.”

13. “Don’t be afraid to be confident. That’s the only way you’ll learn.”

14. “It’s hard to talk so I have to choose my words carefully. If only I sound this smart when I’m NOT sick.”

15. “Slow down, son! God gave you time so you could take it!”

16. “Does worrying about what is going to happen mean anything when it happens? No. All it means is that you worried about the sky being blue tomorrow.”

Like I said, the ICU is full of wisdom. In all honesty, I think I’m learning more about life than I am about anything else.

Just goes to show you how little I know.

By the way, this is how many steps I took during my shift last Tuesday…

Sweet.

Laughter…

I swear every word of this is true (as long as you believe it).

12-hour shifts are LONG, and sometimes you just have to find something to help you along. I was lucky enough to find that “something” in the form of a patient. For the past week, the majority of my patients have all been head traumas. This gave me the chance to learn more about Mannitol, ICP, the effects of CO2 on said ICP, and the exquisite pleasure of witnessing a neuro patient come out of sedation.

THAT last thing, good people, is something to behold.

My preceptor warned me that when a neuro patient wakes for the first time, he/she might say some odd things. “Those that don’t cuss, will cuss. Those that do cuss, will cuss some more. In any case, strange things are often said, so be ready for it,” I was told.

This particular young patient had struck his non-helmet-protected-head from a bike fall. Upon arrival to the unit, he attempted to crawl out of bed, pull at his lines, and tug at his Foley… bear in mind that this was all under the effects of Propofol. Soon the doctor ordered some Precedex as well.

I cared for him for 2 days, and on the 3rd day, well… this happened.

6:05am – He self-extubated. I wasn’t there to see it, but I heard that it was an unprecedented event.
7:45am-ish – He tried to climb out of bed and would have succeeded if he didn’t fall asleep halfway through the attempt. He ended up looking like this (imagine the bookcase is a bed):

9:00am – We repositioned him.
9:05am – I have no idea how this happened, but we found him like this:

9:10am – Restraints were applied to protect him from further injuries

10:45am – I had the following exchange with him…

Patient: “Hey, man… come here.”
Me: “Sure. Can I get you something?”
Patient: “Man, touch my NCLEX Book” (except he didn’t say “NCLEX Book”)
Me: “Dude, I don’t think I want to do that.”
Patient: “Come on, touch my NCLEX Book.”
Me: “That’s ok, I’m good.”
Patient: “Come on, just touch my NCLEX Book, ok?”
Me: “Thanks for the offer, but I’d rather not.”
Patient: “Ok… then give it a tug, ok?”
Me: “Then I’d have to touch it, wouldn’t I?”
Patient: “Yeah, you’re right… ok, so just touch my NCLEX Book, then.”

Saddest part is that this conversation went on for about 10 more minutes.

It was a strange, strange day. By the time I left, we had about 50 more deep conversations like the one above. The guy’s lucky… he was able to demonstrate purposeful movement in all four limbs, and his O2sat never dropped below 99% even after the self-extubation. Only time will tell if he regains his full memory of the events that brought him in, and only time will tell if there is any permanent brain damage. For now, he is the classic example of why we should always wear a helmet… whether it be for skateboarding, bike riding, or from the simple act of ordering off the Chinese take-out menu.

Now, you’re probably thinking that I’m making fun of this guy, but that’s the furthest from the truth. In my short time in the SICU, I’ve found that a good sense of humor will get you through the day. I won’t sugar coat it – I find the SICU incredibly depressing. Death is just a breath away and you’re constantly reminded of this, especially when you see a patient you transferred off to a lower acuity unit come back in worse shape than before. It’s disheartening, it’s disenchanting, and at times it’s downright despairing.

And if I don’t find a reason to laugh, then I’ll go crazy.

Even the patient’s parents had to chuckle when they were asked to “give his NCLEX Book a good slap.” It was the first time in 3 days I saw them smile, and they needed it.

Laughter bonds as it heals. A day without laughter is truly a day wasted.

The Calm Before the Storm…

Today was a good day off. I did my quota of N-CLEX questions and was even able to take a nap. Some of my cohortmates have up to 5 days off at a time… the most I’ve had so far is 2. I don’t want to complain, but since this is my blog, I’m going to.

Man, I wish I had 5 days off in a row.

Wish I could say this and mean it!

Ok. Enough of that.

The N-CLEX training questions are showing me just how much more I need to do. It’s scary to think that in just a few months, I’ll sit down and test for my license. Sure, I get multiple shots at passing, but my plan has always been to pass the first time. In order to do that, I need to score a LOT better on these practice tests.

People keep telling me, “Oh, don’t worry… you’ll pass for sure!” Although I appreciate the support, I know that the more confident I am, the greater the chance of failing. So I’ve got to keep plugging away at these questions until I am consistent with my scoring. There are times when I score up to 85% correct, but then on the next round, I get a whopping 30%.

Yow.

If I can keep it above 80%, then I’ll feel ready. I’ve got a loooooong way to go.

But that’s all part of the game.

I work the next 3 days. Today’s the calm before the storm… better make the best of it.

Steve Jobs to the Rescue…

Well, today was a much better day than yesterday. I think I was still bummed out in the morning, but after putting some food in my stomach, I found a second wind and finished the day strong.

Justine and I were able to talk for a while, and she made me feel better about how things were going. Funny – I told her how much her teaching method reminds me of how my parents taught me. I assured her it was a compliment. She laughed and told me that she’s not there to teach me a routine, but to get me to understand why I’m doing what I’m doing. She sure is making me think… she’s got a way of making me either the most confident bastard in the world or the exact opposite.

Time will tell which one dominates.

Actually, when I think back on the day, I can see that it wasn’t all frustration that got me down. I cared for a patient that had a constant stream of visitors (mostly family). While this isn’t out of the ordinary, what was new to me was the attitude this family had. They just sat there with scowls on their faces as if they were scrutinizing my every move.

No, I’m not insensitive to the fact that their loved one was laying on the bed completely sedated… it just made my work more uncomfortable. They didn’t smile, didn’t offer a “hello,” nothing. I think I spent the morning trying to figure out how to talk to these people to make them… not so scary.

It wasn’t until the afternoon that I found my “in.”

That “in” was an iPad. I asked one of them (who had the iPad) if that were an iPad 3. “No, it’s the first one… no camera.” This led to a massive discussion on the benefits of cell phone cameras, smartphones, iPads, etc… by the end of the conversation, they actually smiled at me and thanked me for caring for their loved one. They even complimented Justine, stating that she is “amazing.”

Steve Jobs, you gave us so much more than cool toys.

This just goes to show you that healthcare is so much more than just tending to the sick. The family is sometimes just as big a part of your job… don’t avoid them. They need to share the experience. I think it will help them heal, despite how the situation turns out.

Falling Short…

All I want is to get through one day without making stupid mistakes. It’s frustrating to want so much but to continually fall short.

Justine keeps telling me to relax and to just take it slowly. That’s always been my problem… about time I actually fix that. I work again tomorrow. I’m crashing.

Sunshine and Roses…

It’s Mother’s Day! Happy Mother’s Day!!!!!

I feel much better than I did last night. What happened yesterday? Well, I worked again and things weren’t quite as positive as the previous days. You see, I cared for a patient that had changed her code to a DNR… I don’t know how many of you out there have had the experience of caring for a DNR patient, but it’s not sunshine and roses.

It was depressing. And that’s putting it mildly.

Dave prepares for the day

My first few patients were all on the up-and-up. They improved and were transferred to med-surf floors where they would remain until they went home. I was able to talk to them, laugh with them, and see their progress as they became more stable. Transferring them out of the ICU was such a wonderful moment… they thanked me and promised to give me their first paycheck once they returned to work.

The patient I had yesterday was completely out of it. Not once during the shift did she regain consciousness, but I knew she was suffering. In fact, she was deteriorating right before my eyes, and the best Justine and I could do was to keep her comfortable and as free of pain as we could manage. I would be very surprised if she were there tomorrow when I return to the floor.

I need to understand that nursing will be an emotional ride as well. It’s not always just about doing the skills – inserting an IV, passing meds, setting up pumps – these are actual people I’m caring for, and with people come emotions. Sure, we learn that in class, but it doesn’t really hit you until you see death happening right before your eyes.

Some people tell me that I need to block it out and I need to turn off my feelings when I work because if I don’t then I’ll become depressed. Although I can understand this point of view, and although I’m sure it will happen to some degree… I just hope that some semblance of what I went through yesterday remains.

Before leaving the unit, I stopped by the patient’s bed and said to her, “Be strong, you’ll see God soon.”

And with that, I touched her hand and went home and went on living my life. The same exact thing she should be doing.

It’s really a shame how much I take life for granted.

The Fourth Day…

I think the worst part about clinicals is the night before… you find yourself wondering, “What kind of patient(s) will I have tomorrow? Will I be able to handle it?” It’s about 9:30pm now and although I’m tired, I know I’ll have a restless sleep.

It never fails. I’ll sleep until about 2am and then I’ll start waking up every hour on the hour until its time for me to actually get up. I wonder if Justine still has nights like this?

Demi’s got the right idea here….

Tomorrow is my 4th day. Aren’t all 4th days supposed to be good? Think about it… sure, Jesus rose on the 3rd day, but it probably wasn’t until the 4th day that people really started to hear about it… slow communication lines… and didn’t Luke destroy the Death Star after knowing how to use The Force for only 4 days?

Day 1: Luke meets Ben, gets the Lightsaber, finds out about The Force, meets Han and Chewie, does the Lightsaber training on the Falcon with Ben

Day 2: The gang rescue Leia and fight their way out of the Death Star, head to Yavin

Day 3: Hang out at Yavin, take a shower, find out how to destroy the Death Star

Day 4: Blow up the Death Star

Yep. Looks right to me.

Undeniable proof that tomorrow will be a good day.

The Fear…

What did I do on my first day off since starting the preceptorship? I slept!

Yes, I slept long time. At first I woke up at 5am just to stay on schedule since I work again tomorrow, but then around 8 or so, I thought to myself, “Self? What are you THINKING? Sleep, man! FOR THE LOVE OF GOD, SLEEP!”

So I slept. Until noon. It was glorious and everything I had dreamt it to be.

The rest of the day was spent doing errands. Nothing special. Except that I saved the world from Insane Hulk (3rd cousin removed from The Hulk).

My face was frozen like this on my first day

So looking back on this week, I think the biggest lesson I learned was to remain positive. Sure, I feel stupid, and sure, I think Justine thinks I’m super-DUPER stupid, but that’s where we all start, isn’t it? How can I know everything and be perfect at everything right NOW? It’s just not going to happen. The best I can do is get better with each shift, so that by the end of the residency, Justine can look at me and think to herself, “I did good.”

*** Mental note: take more notes in your little notebook. That’s why you carry it around, idiot.

The good thing is that I’m not scared anymore. The nervousness is still there, but I’m not scared.

I think all of that fear went away after the second day… after I felt like I got the hang of some things.

The fear just gets kicked out of you, and you have no choice but to go through the whole process of letting that happen.

I’m sure the routine will change tomorrow and with every new patient, but that should be welcome… if it’s the same thing day in, day out, then I would join Insane Hulk and his band of renegades.

So tomorrow is day 4. I’m actually looking forward to it. Yes, a part of me missed that hospital today… I started wondering about my patients and how they were doing… I think I will go visit some of them tomorrow.

Funny like that. After all is said and done, maybe I am made to do this.

1 Down, 20 to go…

Today was the first day of my clinical residency. For privacy purposes, I’m going to make up names of A) where I am, B) my preceptor’s name, and C) patient names.

I arrived at 6:30am and waited for Justine. I didn’t know anyone there, so I looked through charts, familiarized myself with the layout of the land, and figured out where to put my stuff (that took about 10 minutes alone). I was scared, scared, scared. It’s a different feeling than clinicals during the year, as those are just once a week. Now I would be working a regular nurse’s schedule, caring for patients the moment I set foot on the floor until 7pm. There is no post-conference, and most importantly, no classmates to lean on.

That last part scared me the most. Perhaps I depended too much on my classmates, I don’t know… but not having a single one there (Dave would join me later on this week) was terrifying. I felt alone, which isn’t a bad thing.

How can you NOT miss these faces???

When Justine arrived, we had our exchange of pleasantries. She’s very cool and I knew we’d get along as long as I didn’t say anything stupid. Well, that lasted for about 5 minutes.

“Where’s the bathroom?” I asked. She looked at me and smiled… I knew she was thinking, “This kid is gonna throw up.”

The first day anywhere is always daunting. I did what I could, but mostly observed Justine go about her business. She allowed me to do just about anything I said I could do… and to be honest, I didn’t do too great without her guidance. “Don’t sweat it,” is what I kept saying to myself… “This is why you’re here.” Justine told me those exact words when I apologized to her for the hundredth time.

I found her words encouraging. Kind of like sim lab… that’s the reason we have sim lab – to mess up. Now, of course, I had real patients to care for, but with Justine’s supervision, I knew I’d be fine.

When I think back on my clinicals during the year, I realized that I learned everything my brain could handle. I have no regrets on my experience so far… they’ve gotten me here. I know what I have to do, now I just have to do it.

The day ended with Justine asking me, “Pretty exciting first day, huh?”

“Yeah… we do it again tomorrow?”

“Yes. Be ready and just relax. We have plenty of time. Nobody can learn everything in one day.”

I’m going to enjoy it here.

1 down, 20 to go…

Getting My Ass in Gear…

Well, the end of the first week is upon us. It’s been a good week, I’d say… but I seriously need to focus. After yesterday’s clinical day, I turned to Carlos and said, “Dude… I had better get my ass in gear QUICK.”

Seeing everyone has been an added bonus. We’ve all fallen back into the groove (physically, not mentally!!!) and we’re ready to tackle the last 7 months together. The intensity of the program is still there, but I think we’re all a little wiser on how we approach things. For example, instead of waiting until the last minute to do an essay, I’ve already knocked it out! Sure, it doesn’t matter that the essay sucks, but hey – at least I’m ahead of the game.

We’ve also decided that teaching one another is the best way to get the information into our heads. Here’s Cindy and Dave in one of these teaching sessions:

“See, Dave? The foot bone’s connected to the shoulder bone….”

Well, Dave really took the teaching and decided to further explore the subject. He was doing just fine until he hit the centerfold shot…

“What the hell is THAT?????”

Yes, I think this new method will bring us a multitude of “A’s.”

Saddest part of this is that I’m the one pictured in that centerfold shot.