A Tale of a Night Shift from Hell.

The one where my patient flew over the cuckoo's nest, and the resident refused to order restraints, and the surgeon got upset from being waken up and hung up on me.

This is for all of you who think that night shift is easy because all your patients are asleep, and if they're not, you can just give them sleeping pill or ask the on call team for Ativan or Ambien.

I digress. Because if that was the case, I wouldn't be sitting here at home at almost 9 in the morning, eating a meal that I was supposed to eat about 9 hours ago but didn't because I was so dang busy and caught up in the mess that was Patient Cuckoo.

Mind you, some information has been somewhat altered to be vague to honor this thing called privacy. So here goes the tale:

Once upon a night shift (last night), one of Nurse Cee's (me) patients happened to have altered mental status (for you, laman audience, that's the fancy medically and politically correct term for crazy). The only good thing about the patient was that due to their diagnosis, they're not able to get out of bed to run naked in the hallway. However, arms were still flailing freely and mouth was speaking non-sense in angry and inappropriate terms.

At report, there were many a thing to be done with this patient. Ativan needed to be changed to q 4 hours (because Nurse Cee cannot live on Ativan q 8 hours alone with this patient), Foley catheter needed to be re-inserted (the previous one was pulled out by the patient), banana bag needed to be started. Then, Nurse Cee also found out that this patient was to have surgery in the morning and consent needed to be signed (we'll come back to this later in great details).

To make this hell-ish tale short, Nurse Cee managed to get the Ativan changed. However, her request to the resident on call for restraints was denied, only an order for a sitter was received. And after much verbal harassment from the patient, Nurse Cee managed to get the Ativan into the IV access.

The patient was somewhat more calm (and I use the term "calm" loosely in this story), but Nurse Cee then made a decision that it would be wise to wait until the sitter arrive at 11 pm before she would attempt any Foley insertion, as well as another IV (the current IV isn't good for running fluid). The, ehem, rationale (my nursing school instructors would be proud at the use of "rationale") is that a sitter would be there to watch the patient and can prevent them from removing any line.

In the meanwhile, Nurse Cee also had 4 other patients. 2 were alright, 1 was alright but had a series of tests to be done, and a new admission that came in at the start of the shift with orders of labs, blood cultures, urine samples, and a port-a-cath to be accessed. All of this were almost taken care of while waiting for the clock to strike 11 and for the sitter arrive to sit with the patient.

To make the story short, again, Nurse Cee managed to insert a beautiful IV while the sitter held the patient down. Then off she went to take another patient for a scan. Alas, when she got back to the floor, and just as she was about to give the next dose of Ativan to Patient Cuckoo, she received news that the patient has pulled that beautiful new IV. Her reaction was, "WTH??!!!" The charge nurse's reaction was, "What was the sitter doing?! We had a sitter so this wouldn't happen!" Apparently, instead of watching the patient, the sitter was Facebooking on the portable computer. By this point, Nurse Cee had fumes blowing out of her ears and the inability to decide whether to strangle the patient first or the sitter.

Nurse Cee then informed the resident on call of the situation and requested an order for a BUE restraints for the second time. Haldol was instead ordered, and restraints were denied. The resident's rationale was, "Well, that's "Doctor who shall remain nameless"'s patient, I don't want to restraint "Doctor who shall remain nameless"' patient."

Let me tell you that this "Doctor who shall remain nameless" is a very important and powerful figure in the hospital, who happened to be on the teaching service for a few weeks. The "Doctor who shall remain nameless" is like the resident and my boss' boss' boss' boss' boss'...and so on. Nurse Cee understood where the resident was coming from, but for crying out loud, it would make her night easier if the resident would just get over their sissy behind and order the restraints. DIDN'T YOU HEAR, O FEARFUL RESIDENT, THAT THIS PATIENT HAD PULLED OUT A FOLEY AND IV AND IS REFUSING EVERYTHING??!! What, you want to wait until Patient Cuckoo hit the sitter before you finally order the restraints?! Oh wells, Nurse Cee rest her case. At least she tried--twice. She had to settle with Haldol this time.

So then Nurse Cee had to deal with the consent for the surgery. For you who don't understand, the performing physician must talk to the patient about the procedure and risks involved, and the patient must sign the consent in order for the procedure to take place. Now, the physician is supposed to have the patient sign the consent, but nurses can obtain the signature of the patient ONLY if the nurse knows that the physician has talked to the patient.

Nurse Cee then thought, "Wait a minute, this patient is out of his mind. How can he understand what this procedure is for? Has the surgeon really talk to them? Even if the surgeon did, this patient has no clear understanding whatsoever!"

So Nurse Cee paged the surgeon, and was only in the middle of her first sentence of why she was calling, when the surgeon angrily interrupted her and said that he did not appreciate to be woken up for something that is not emergency. Then dial tone. He hung up on Nurse Cee, and Nurse Cee thought that surgeon was the biggest asshat on the planet. She hadn't even gotten a chance to inform Surgeon Asshat of the situation. But oh wells, Surgeon Asshat was going to pay for it in the morning.

To make this story short, morning came and OR called to ask if Patient Cuckoo was ready. Um, no, he was not ready because consent hasn't been signed because the patient is absolutely not in their right mind and the Surgeon Asshat hung up on Nurse Cee before she could explain the situation.

Thus began the phone calls triangle between Nurse Cee and the OR nurse and the PACU nurse, trying to figure out how to solve this. Surgeon Asshat was paged one more time and Nurse Cee volunteered to privilege of talking to Surgeon Asshat to the charge nurse. Of course, Surgeon Asshat didn't know how to proceed and tried to dump the responsibility to the OR nurse, who then called Nurse Cee again to have her basically inform Surgeon Asshat that (surgeon Asshat) needed to grow some balls and make a decision about what to do here. Afterall, it's the physician's decision of how to proceed when the patient is in this state. Nurses cannot obtain consent unless the patient understands. Nurse Cee wasn't about to jeopardize her license, period.

Nurse Cee informed the Chaplain, the charge nurse, the incoming day RN, and wrote in great details about this whole debacle on the chart. Basically, Nurse Cee covered her ass and Surgeon Asshat can kiss that ass.

This tale does not include the details of how Nurse Cee managed to draw blood and re-insert that Foley from Patient Cuckoo's struggling and flailing extremities. Let it be said that between Patient Cuckoo and the other 4 patients, Nurse Cee had no break, no meal, and no drink last night.

Nurse Cee also very much like to kick the resident who refused to order restraints and inflict more bodily harm on Surgeon Asshat. With those two and Patient Cuckoo combined, Nurse Cee wanted to crawl into a hole and cry in fetal position many many times last night.

The End.

Happiness is....

HAPPINESS IS SINGING TOGETHER WHEN DAY IS THROUGH
AND HAPPINESS IS THOSE WHO SING WITH YOU
HAPPINESS IS MORNING AND EVENING
DAYTIME AND NIGHTTIME TOO
FOR HAPPINESS IS ANYONE AND ANYTHING AT ALL
THAT'S LOVED BY YOU

That's a song from "You're a Good Man, Charlie Brown" musical, and I've always loved it. It's simple, yet worth so much truth. The reason I'm posting it is because, goodness gracious, I've not been all that happy lately.

School has turned into madness with having to work on these different group projects that are due one after another, plus doing a couple set of 12 hour shift back to back 3 days in a row to finish the 170 clinical hours, plus the other clinical for Community class, and, of course, exams. To top it off, there is the whole issue with New York and hiring freeze and the decline in hospitals sponsoring international students like me. I've been one exhausted mess.

This past week, I did not stop until Saturday evening. Everyday of last week, sunup to sundown, it was was filled with class, exam, writing papers, reading research articles, clinicals, group meetings, and group presentation. That is until Saturday evening when my group and I left the school computer lab at 5 pm. In the past month, I've become impatience, bitchy, snappy, grumpy, and extra sarcastic. I've neglected my family, my friends, and other this and that's. I've been all over the place and I hated it.

So here's what I'm going to do. For the rest of the semester, for the 4 more weeks I've got left of school, I'm going to try to jot down things that makes me happy. I'm so tired of feeling so beaten up all semester long, and the end is near, and I want to be happy about that. So for every day for the next 4 weeks, I'm making a list, and I'll post it every Sunday night (I'll put extra effort to make that happens, hah!)

So let's start with the happy things of the past week, even though it's hard to find them:

1. The director & manager of the Medical unit I have my clinical at are very pleased with my performance, and the staff is very supportive to having me on board as a part of the team. The director is in the process to get an approval from HR to be able to hire RNs for the unit. I'm praying that she gets approved soon and will give me a call. I had a very positive responses from her, the manager, and the clinical leader when I handed my resume, etc. to her. Yay for a job prospect!

2. After the kind of group meeting where you can cut the tension with a knife (not pretty btw), a few friends and I went to get cupcakes to de-stress. Much to our surprise, the store owner later gave free cupcakes for each one of us. Cupcakes really do make all things well and happy again. :)

3. Despite spending a good chunk of our Saturday doing fire safety presentation (stop, drop, and roll, yo!) for kids at a clinic, and going back to school for more projects (plus my fender bender in the parking lot in stormy weather), we had a good time at lunch and many laughs looking at the pictures.

4. Had a down time Saturday evening with another group of friends to celebrate a friend's birthday. It was nice to sit back, relax, and chill. Of course, I spent the rest of the (short) weekend at my weekend getaway, also known as my bestfriend's house.

So that's for this past week. What are your happy things?

What is this feeling?

As much as I'm at peace with my granmpa's death last summer, today I realized that I don't know if I'll ever be "okay" when I have patients in the similar situation my family and I went through that fateful July.

The first one happened last semester, and I wrote about it. At the time, I thought it was just a one time thing. It was my first and of course I was bound to feel...something. I thought it'd go away and but it didn't. Yesterday, I started to realize that one of my patients is dying and the family was finally able to made that difficult decision to let go of treatment and do palliative care instead. Today, everything is more...official, I guess. All PO meds are on hold, and the Morphine Sulfate surfaced in the order. Again, I got that uneasy feeling I did last semester.

I think what did it for me is seeing the Morphine PRN dose on the MAR first thing in the morning, just because that is the staple drug for end of life patients to keep them comfortable. It's become some kind of a sign for me that, yes, the time is near for that person. We were given doses of that, too, from the hospice care for Grampa when he went home from the hospital. I had to give him that, and so did my cousins.

Then my chest got thighter as I walked in the room. The patient is much like my Grampa was before he died. Eyes opened but no one is there. They can't talk and you wonder if they knew who you were, and you wish they remember who you were. They're just lying there, waiting for their time to come, and it's an excruciating wait for the family members.

It's a weird weird thing to experience, I can't say enough how uncanny it is to watch a dying person, especially when you've watched a family member went through it. I wasn't exactly sad or upset, I didn't feel like crying or breaking down. There is just...an uneasiness to it. There is a voice screaming in my head that this is the same thing as Grampa: the Morphine, the inability to talk, the waiting, the what happens when we bring him home, the ever present wondering of when he'd actually die. It keeps screaming I have been here before and I should never be reminded of it again.

But it's life. People die everyday, and unfortunately, you will witness that more times than you'd like. Heck, I'm only a student nurse and it already happened twice. My career awaits many a future experience of taking care and witnessing dying patients. After the first time, I thought I had to find a way to be okay with this, to erase that feeling out of me. But after today, I realized I can never make that feeling go away, and I'm accepting that I will forever be taken back to Grampa when that happens again. I will always take a sharp breath, my chest will always feel thight, and I'll always get this inexplicable feeling when I have a dying patient.

As if one dying patient isn't enough, the universe, of course, just has to mess around with me some more. Another patient on the floor, although wasn't mine, vomitted, had a seizure, and went into a code. (This was also a second code, the first one I saw was also last semester) Oh, the brouhaha of a code, there's nothing like it. It seems like, in a code, no matter how fast you're moving to get things, you are never fast enough. How many times did I hear that doctor yelled out "I NEED PROPOFOL 10 cc FAST!!! WHERE IS THE PROPOFOL?! GIMME THE PROPOFOL!!!" in the 10-15 seconds it took the other doctor to get the Propofol and have it drawn up in syringe? You're trying to bring someone back to life, get that heart beating again, breathe air into the lungs. It's a person's life literally in the hands of the many medical staff who rush into that room, and I don't think you'll ever be fast enough. No matter how experience and collected these people are, it's still a total and utter chaos.

Now, the code didn't do anything to me. It was actually exciting, to be honest. This patient was actually in a much somber situation than my dying patient, but I was fine. I've never had to watch a family member going through a code, having tube inserted down their throat, surrounded by doctors and nurses doing everything to revive them. After 30 minutes--that seemed like hours--the patient was stabilized and transfered to an ICU unit.

And then I knew there is a difference. In some cases, I'll be fine. In some others, I'll just have to deal with that weird feeling. That's just the way it goes now, and perhaps for the rest of my career. All in all, for me, it's still an other wordly experience to witness births and deaths. They make me appreciate and respect life more.

The play.

Act I of "The Senior Year" is almost done. The curtain is ready to close the stage for a 6 weeks intermission. The final number of Act I start tomorrow, and it's called "The Final Exam". I am one already tired and cranky participant of this production, and I can't wait to prop my feet up on the couch in my dressing room during intermission.

I'm envisioning how glorious Wednesday after 3 pm will be as we finish this Act. We'll finish "The Final Exam" and the curtain will draw close, and we are done. Oh, how the sky will open up, revealing a chorus of angels singing a melodious song of freedom. Oh, sweet sweet freedom, I can taste it. I'm ready for it. I can't wait for it. I want it. I need it.

Just three more days. Three more days of being stuck with textbooks and staring at notes after notes. Three more days until I can sweep those books and notes off my bed and crash until however long my body desires. Three more days until I can sleep in, instead of waking up at an ungodly hour of the morning to start all over again the routine with the books and notes. Three more days until I don't have to worry about what to study the next day.

Just three more days until the 6 weeks intermission will start before the curtain will open again for Act II of "The Senior Year". I'm not going to pass out on the stage just yet. I can do this, I can do this, I can do this. Just three more days....

This is the hour.

So one of my patients recently gave my preceptor and I a scare just a couple hours short of the change of shift after being stable the whole day. That is not fun--and not pretty. The day in the life of a critical care unit, never a dull moment and rarely a predictable day.

You know it's going downhill when you see the BP reading at the monitor, think "Okay, that's not good", tell your preceptor who is nearby, immediately adjust the cuff on patient, hit the Go button again while silently willing the new number to be higher, therefore rendering the previous number a false reading, only to see that the new number is lower, and when you look at your preceptor, she has the same look that you have on your face--which is the "Oh sh**" face. Oh and then the patient is yelping out in pain. I'll say this again: not pretty.

I'll spare you the details of the "Oh sh**" hour that followed, but we thought the patient was bleeding internally and was crashing on us, which turned out to be not the case, but we didn't know that for a good 30 minutes or so trying to figure out what the heck was going and how to manage it while waiting for the stat H&H result to come back. Luckily, the patient was stabilized within an hour and everything went back to being peachy again, like nothing happened.

When I finally got out of my shift, obviously later than I usually do, I rounded up the corner to the waiting area, where a family member who was in the room when it all started had to be escorted out because the shift was ending, therefore visiting hour was too before it resumes 2 hours later. I had told the family member that I'd give an update if I could before the shift ended, but if that wasn't the case, I'd drop by on my way out. So I did.

She immediately stood up when she saw me, I smiled at her and told her that her family has been stabilized, her BP back to the normal range and the pain controlled, and was currently sleeping. I could see the worry in her eyes subsided as I delivered the news. Now, that is pretty. As I made my way home, I was once again reminded of why I'm still here doing this. For a moment like those, when you see your patient sleeping comfortably after what could lead to otherwise, and when you see the family take that deep breath of relief after the gripping worries.

I know that the "Oh sh**" moment does not always lead to this, but it's always nice and appreciated when it does.

Feel free to share any "Oh sh**" moment you have had.

Wanna ask me open ended questions?

Autumn. Fall. It's usually my favorite season. But not this year.

In the aftermath of Ike, the schedule for this semester is as messy and scrambled as Paul McCartney and Heather Mills' divorce. It's got the hospitals involved, the required clinical hours involved, the lectures and exams involved. There are hospitals that don't want to deal with us just yet, leading us in the dark as to when we can come in for orientation and to actually start clinical, there are a week worth of materials need to be lectured, there are postponed exams need to be taken. So far, for my clinical section, we have settled 2 orientations out of 3 this week, 2 exams next week, 1 exam the week after, and that's it. It's just this mammoth of uncertainty at the moment.

Also, this week is known as the Brother #2's wedding week, also known as the week my studying time will be cut down due to family related event in which I will put pageant like smiles on my face as I greet the soon to be in-laws of Brother #2 with higher than usual pitch voice to convey as much as glee as I can squeeze out of my current frustrated, anxious, dark, and gloomy state. I should put a name tag that says "Hello my name is Cee, yes I am the sister, and I'm also a nursing student, so forgive the less than bright and cheery appearance, I'm trying my best to think of rainbows and roses for this occasion that I truly am happy about, but it's just that nursing school is kicking my ass and Ike just ruined what was a bearable semester into one that will undo me. So if I have a faraway look on my face when you're talking to me, it's not that you're boring or I don't like you, I'm just trying to recall the materials for my exams next week."

The thing is, the sufficient study time to pass me is there but I'm just feeling I'm going to be so damn exhausted all week, I already am. This week will be the death of me.

Please send fluffy cotton candies, ponies, chocolates, rainbows, pots of gold, and fairy dusts to the newly opened Things to Keep Cee From Pulling Out Her Hair and Headdesking Too Much donation box, I greatly appreciate it.

Back to school.

After a week off school post Hurricane Ike, we are back on tomorrow. I don't feel like going back to be honest with you, I'm dreading how crazy our schedule is going to be since we have lectures, exams, and clinical orientations (and clinicals itself because we postponed the orientation). Psych test #1 on Tuesday has been canceled, which is such a relief for me since I didn't get much studying done all week. It's difficult to concentrate on studying during all this chaos, plus my mom arrived on Thursday, so I've been taking her around, making good of my time off.

*sighs* Back to regular programming tomorrow.

Recuperating.

Ike has passed, but boy did leave some imprints in this city. Some parts of town are better than the other, some are worst, some have electricity back already, some don't. People are starting to get out of the house, searching for gas for their cars, searching for hot food that they can't cook at home, searching for basic supplies such as water, ice, batteries. Traffic lights are swinging from the post, tree branches blocking the street, fences broken on the ground, signs and billboards torn. Those are some of the scenes I saw as I drove today. The good thing is that I don't see much flooding.

I think I can safely say that all schools are out tomorrow, including mine, meaning Peds exam #1 will be postponed. I'm glad it's postponed because none of us was able to concentrate on studying amidst the chaos that is this hurricane. We don't know when school will reopen, but we have been warned by our instructors that they will do whatever it is to catch us up with our syllabus, even when it means coming to class on the weekends or other extra days/hours. So it's also safe to say that my schedule is going to be even more bizarre after all of this.

So that's a weekend with Ike. I hope there will be nothing like this anymore in the future.

ETA pictures:

Preview to how the rest of the semester is like.

Guess what Miss Cee is doing this weekend before school start on Monday?

Studying!

JOY!

Not.

My Women's Health class has its first test a week after it starts, the Pregnancy Unit, which I believe covers about 10 chapters. The notes are up on the student page. Yes, already. I know, school hasn't even started yet. Those instructors are really dedicated on starting us up early, I tell ya.

So we have been told by various senior students that Junior II is supposedly the hardest semester and it's supposed to be the semester where they weed out the kids who aren't strong enough to make it. It is well known that most drop outs from the nursing program at this school have done so during their Junior II. With that looming over my head, I am determined to make it out--alive, preferably, so I'm off to have a date with my textbook this weekend. It came in the mail this morning, red and shiny--heck, with the price tag, it better comes to me shiny.

Oh, the mentor thing went well this morning. Those new kids, they want to know everything, I mean everything. Which prof. is mean? Which prof. gives freebies? Do we have to be naked for head to toe? Which shoes are the best to get? Which cafeteria sandwich is the best?

Heh.

To be honest, I was a little bewildered by some of the questions and even had to resort to the infamous critical thinking to answer those. YES! Critical thinking! I remember something from last semester, woot! Do I tell them that prof. appears mean but she's a softie at heart if you know how to talk to her? Do I tell them this about the hospital or that? Ya know, you want to be as much as a help to this youngins, but without giving too much information because they've got stuff to figure out on their own. Overall, we had a great time and my mentees wished me goodluck's as I told them I was going to study this afternoon. Aw, aren't they sweet.

Find me in the room with a lot of dummies.

If you need me between January 14th - January 25th you can find me at school, most likely either poking on the mother dummies or dangling the baby dummies. Oh, and if I don't look like my usual--and currently very well rested--self, that's because my schedule for Women's Health says I have to be in the skill lab every single freaken' day for the first two weeks of school. From 8-4 pm more or less. Surrounded by dummies, some of which are talking--or crying.

I'm working on being ready for this.

In the meanwhile, I'm also crossing my fingers and toes to get my first choice for clinicals. Please please please please please let me get the Wednesday/Thursday ones....

OH! Gah, I hate my status as an International student. Hatehate. First, they still wouldn't consider me as state resident even though I've lived here for eight years and have been paying taxes. I'm still bitter about paying the international rate tuition, which is doubles in-state tuition. BITTER, I tell ya. You better bet I'm praying really hard I get the loan I very much need to pay for school. But that's another day.

Today, I found out that I may have to drop one of my online classes because as an International student, I cannot take 2 online classes in one semester. One of those online courses has to have some kind of on-campus activity such as group meeting, or face-to face time with the instructor, or taking the tests on campus, and my instructor has to fill out a form. Of course with my luck, none of the instructors was on campus today and neither was my adviser and neither was the director of the program. ashgdahsfdaghdfaghfdghafdghfd!!!!!

It's not like I purposely chose to take those online classes, they're designed that way by the program and I have to pass both before I could continue to Senior I. Granted, they might, MIGHT, offer those in the summer but even if they do, my space there isn't guaranteed. Blaaaaarrrrrghhhhh!!!!! Right now I'm waiting for an answer from the Student Life lady on campus, who's heard that perhaps if I've already met the minimum credit hours required to maintain my status (12 hrs/semester and my courses for this semester are 16 hrs.), then an additional online classes is allowed. So yeah, now I'm just waiting, but come Thursday and Friday at the new students orientations I'm volunteering at, I'll be chasing the power that be people (namely my adviser or the head of the program) to help me fix this.

And it rained as I got out of the grocery store today. It's just like that Carpenters song, the one that goes "rainy days and Mondays always get me down...." Well, today it is Monday and rainy. Bah humbug....

Save me.

So in 2007, my oldest brother and his wife welcomed twin daughters, and another older brother married. That means out of the three children they have, my parents have married two of them off and even gained grandchildren.

Do you want to know what that also means?!

They have one more they need to marry off.

Me.

And you know what that means?!

My mother's evolving into Mrs. Bennet.

I sadly informed that it has begun. She's in the early phase, not a full blown case yet but oh I have no doubt it will. She will become borderline Mrs. Bennet if I'm not in a serious relationship by the time I'm over 25, and she will be Mrs. Bennet if I'm not married by the time I'm 30.

Look, I could care less about this. I'm taking my time, no rush, but my mother? Oh sweet baby Jesus, give her PATIENCE this Christmas, will you?! If I were to stop the horror of my mother's evolution into a Mrs. Bennet, I have less than 3 years to find me a man and get us into a serious relationship. Otherwise, I'll start to combust from Mother's pressure. Can you say, boom?

My father, on the other hand, is perfectly assuming the role of Mr. Bennet. He's been calm and has not pressed on the issue, but I think that's because for the most part he's quietly thinking no one could ever fully deserve his beloved favorite only daughter.

Thank God, my parents live literally continents apart from me.