I C U P

Quick set up to for the following conversation I had yesterday at work. The 7 days before a person actually gets their bone marrow transplant, they receive a lot of chemotherapy and a lot of IV fluids. Because they are getting so much fluid, we have to weigh them every 8 hours to make sure their body is processing it all well and "eliminating" it instead of retaining the fluid. So we weigh them and if they have gained more than a liter (2 pounds) from their initial weight, we give them some lasix, which is a drug that essentially makes you pee. That way the excess fluid is not hanging out in their lung which could lead to possible pneumonia, pulmonary edema, or general difficulty breathing. It also keeps the extra fluid from building up in their ankles and legs making more work for the body. Anyone who has had too much Chinese food and felt their ankles swelling afterwards can probably relate to this sensation. Another reason we give so much fluid is to help flush the chemo out of their body so it is not doing extra damage to the healthy cells. Long story short, it is good for them.
Mr. F. was supposed to have been weighed at 1 p.m.. In the usual chaos of a busy day (pt circling the drain and finally transferred to the IMU, another patient being discharged, another patient being admitted, another patient needing to be walked and have a bunch of procedures) the weight was not done at 1 pm. Neither myself or my CCP (Clinical Care Partner) had gotten a chance. Apparently she had not been told by the night CCP that it was needed to be done, and I had forgotten to make sure it was done. So even though it was a CCP responsibility, ultimately I would be the one to get into trouble for things not done.
At 7, minutes before change of shift, I realize this, and thankfully my CCP did get his weight, which happened to be 2 kilograms over base weight. This morning he was only 1 kilo over, and did receive lasix that time too.
I entered the room with his lasix, and here is how the conversation unfolded.
"Hi Mr. F. Sorry to tell you this, but your weight is still up so I have to give you some more lasix."
"Well I don't want it right now. Can I have it in the morning after I wake up and have breakfast?"
"No, I need to give it to you now because we are going to weigh you again in 8 hours and so you will probably have to have it again at that time, and if I give it to you now, you might pee it off and not need any more again at 3 in the morning."
"What!?! Don't you know that stuff makes you piss! You should not give that to anyone at night! How are you supposed to get any sleep?"
"Well, yes, I do know it makes you pee, that's the point. And we have to do this if you are over your weight every 8 hours, and so that does fall during the night shift as well. And, you are right, it is very difficult to get any sleep when you have to wake up and pee all night. We are a lousy hotel, I know. We are in here all the time waking you up for vital signs or lab draws too. I am sorry about that."
"Why do I keep gaining weight that I have to have lasix?"
-Insert full explanation of IV hydration and flushing kidneys and so on...
"Then you're reasoning is all backward and you should give me less fluids! That way it is balanced! Stupid! If you give me less fluid then you don't have to give me lasix!"
I explain again preventing kidney toxicity and all that. End with "so even though it is very inconvenient for you to have to pee now, we really don't want you to have to end up in the ICU because your kidneys quit working and now you need dialysis for the rest of your life. Believe it or not, we are doing this for your best interest."
"Can't you just give it to me later then?"
"I can't, I am about to go home, but the nurse coming on could give it to you around 9 if you really want to wait."
"How long does it last?"
"About 4 hours. But that varies for each person. If I give it to you now, you should be done by about 11, or if you still want to wait till 9 you will probably be up peeing until around 1."
"4 hours?!?! Damn it! That stuff kicks in and you don't have enough time to get to the can! I piss all over myself trying to get into the bathroom!"
"I can give you a urinal so you don't have to actually go into the bathroom, you can pee at the side of the bed. I can also give you a hospital gown so your pants are not in the way slowing you down."
"No I don't want a hospital gown! I don't want a urinal! I am just going to piss all over the bed!"
"If you don't want an extra urinal, I see you have 2 in the bathroom, that is okay if you pee in the bed. We don't mind changing the sheets."
"I'm not going to piss in the bed! I will just piss all over the floor!"
"We would rather have you pee in the bed and change the sheets because if you pee on the floor you could slip on it, fall and crack your head open or something and then you would end up in the ICU."
"How many more times are you going to do this?"
"Tomorrow we will be decreasing your fluid rate so you will be getting less fluid and peeing less."
"Promise?"
"Yes. Today is Day 0, tomorrow we decrease your fluids."
"Okay fine! Give me the lasix now so I can get some sleep later."
"Thank you. And I will talk to the next nurse about waiting until later in the morning to get your weight again."
"Thank you. I appreciate it."

I love how patients threaten me with peeing all over the bed or the floor. Like I have never dealt with that before.

I love my job though. It's good to be me.

A girl's take on the Patriots.

Nurse 1: "I want the Patriots to win. I'm from Boston."
Nurse 2: "I don't want the Patriots to win since they beat the Chargers."
Nurse 3: "I just don't want the Colts to win. I hate Manning."
Nurse 2: "But Tom Brady is hot."
Nurse 1: "He's hot."
Nurse 3: "He's hot."
Nurse 2: "Yeah. He's hot."
Nurse 4 walks into room. : "What are you talking about?"
Nurses 1,2, & 3: "Tom Brady."
Nurse 4: "He's hot."

You can lead a horse to haldol...

My homeless man with the large neck mass sprung a leak yesterday. His gown was covered in blood. When I say covered, I mean it could be wrung out. A few drops here and there, or any spot that can be covered with a washcloth does not count. Today the docs decided to get tough and come up with a plan. "Lets hold him down and give him a shot."
Brilliant. And who would be the one holding him down and who would give him the shot? Personal decision: I don't play with combative people and needles at the same time....
New plan: "Lets mix up some ativan, haldol, and benadryl and mix it into his roxanol!"
Much better idea. Now, if he would just drink it!
The rest of the nurses on the floor are all "in" on the whole storyline. They are practically cheering me on in sedating the man. "Can I watch? I won't help, but can I watch?"
Nursing: spectator sport!
So there it sits on his table. I keep hoping he will take it.
I did bathe him. Or rather, I gave him a warm, wet washcloth which he took and wiped his hand. Then I stood behind him and wrung out a few washclothes over his back and chest from behind to which he made a noise not unlike chewabacca! "Sorry."
Now his "cancer liquid" odor does not permeate the hallway quit as badly. Next time he gets out of bed I am soooo changing his sheets. And I took away his urinal so he won't drink out of it.
It is good to be me. I get to go home in 3 hours and be off work for the next 4 days.

People! Please!

Gotta love an admit like this! Schizo, homeless. Found down on Christmas. Please leave homeless people alone. This man's Christmas gift may have been to finally die. Stage 4 neck cancer is not something you want to continue living with. Not to mention that now we are spending hundreds of thousands of dollars on a man who refuses to let us take care of the VERY large mass on his neck that is oozing and reeking, who will probably die without invasive care. So what do we do? Let's put a central line and feed him through his IV for about a thousand dollars a bag. Give him a bag a day. Maybe place a PEG tube. I pray I never, never, ever have to have a PEG tube. Life just goes so down hill from there, and stays down. Being alive but not "living." Not my idea of fun.
And to top it all off, the nurse giving report tells me he likes to drink from his urinal!!!!
I am glad it is not me. But if I ever get to that point, please do not revive me!
For now it is good to be me though, because he will not arrive on my floor until after 7....that means I will already be done and if I am really luck will not even have to meet the man. That is a problem for night shift!

Page for the day

Pager goes off....pull pager off waist band...read page.

"Quit checking your pager like you are paranoid or something!"

I love my colleagues.

Pray for no snow!

Off to Denver Thrusday. There is supposed to be a big storm rolling through. Let's all pray it does not hit until after I have left.
Other than that, I do not have much to add. Except this "Good to be me." One of my good friends, Crystal, is a dietician here at my hospital. One perk, she had to do "test trays." Basically I look through our menu, order whatever I want and a few things some of the other nurses want, and then after it is delivered, she had to check the temperature and quality of the food. Then I get to eat it~! We have the best brownies!!!!! Another perk of being a nurse! It is good to be me!

Smells....ew!

You were probably thinking this would be a blog about work. It's not. You can read it without taking a deep breathe in wondering whether or not to continue with this one....
My roommate is half white boy, half Chinese. Walking into the house after work makes the culture gap that much more apparent. I normally do not notice cultural differences unless I have left to go search it out. But when I open the door and step inside and nearly vomit myself, well, I am reminded.
I have no idea what he makes, but every night it is another funky nauseating smell wafting through the house. Before, when we were still talking, he would explain what he was making, and half the time I could pronounce it. About a quarter of the time I would try it. Half those times I liked it. The past 3 days though, I am holding my breathe to get upstairs so I can light a nice smelling candle in my own room.
You would think nurses could stomach anything. Mostly we can. But we each have our own little "gross out" things. For me, undigested food that has been vomited usually can catch a good little gag reflex off me. List of foods I will never eat again: honey-nut cheerios, certain spagetti sauces, tomato soup and a special "hospital medley" of vegetables (peas, carrots and corn. If they are individual, ok. If all mixed, forget it.)
I still love my job. And a bit of advice: anethesia and food do not mix. Even if your doctor lets you eat after surgery, stick with clear juice until the next day. Unless you like practicing bulemia!