A year has gone by............

 

Well my one year journey is almost to a close. My first day actually working in the ER was Dec 26 last year. It's hard to believe that this crazy, insane, wonderful journey has come full circle.

I AM TEN TIMES THE PERSON I WAS WHEN I STARTED.

Becoming a nurse was single handedly the best thing I ever did for myself. People always talk about education and it's importance and jesus.............without it.............there would be no possibilities. Don't get wrong, I loved the life I was living "pre-nursing", but I struggled. It was hard to pay bills, to really enjoy the nice things life has to offer, and I became frustrated with how things were turning out. I always thought," how will I provide for a family? buy a house?", these thoughts plagued me daily and were beginning to wear on my sanity. The decision to go into medicine was an easy one. It was the first steps that were hard. Reading the pre requisite lists: organic chemistry, microbiology, anatomy and physiology. How on earth was I going to pass those? Hell, I could barely even pronounce some of the classes. But one by one, I signed up, showed up and passed. Step by step, day by day, I became a nurse. I real live nurse. What a cool feeling.

So.....I graduated, got hired, began working and began blogging ;)

A year later............ here we are.

 
Is it hard being a nurse? Yes it is absolutely exhausting.
Is it true nurses never eat or pee? Yes it's true. I may go 10 hours....
Is it true nurses save doctor's butts all the time? Yes absolutely. But we work together a lot.
Do I cry? All the time. Sometimes I can't stop.
What is the grossest thing you've ever seen? When someone's ass fell out of their ass. literally.
What do you like the most about nursing? Learning something new every single day.
Would you ever be another kind of nurse? No...ER is for me. It's fast and furious.
What do you dislike about nursing? The physical stress of being on your feet for 12 hours nonstop.
Do you think you'll ever get hardened to the job? I pray I don't. If I do...i'm out.
Why don't you like working in the pediatric ER? I find the peds illnesses not as interesting as adults.
How can you stand the smells? I wear double masks! Or I put rubbing alcohol in my nostrils.
Does anything embarrass you? NO. I HAVE SEEN IT ALL. lol
Why didn't you become a doctor?

Nurses are the front lines, they are nurturing and kind and feel for their patients. Nurses look the patients in the eyes and hear what they are saying. They communicate their opinions to the doctors and doctors often take their advice to heart. We as nurses, are responsible for the medications we give, we must check and double check the dosage, the allergies and the patients reactions to the treatments. I think one of the  most important things we must do is use our sixth sense all day long to feel for issues with our patients. A patient can go from 100 percent to death in a span of 5 minutes and one missed clue, one missed room check... could be the difference between living and dying. It's a tough thing to swallow but it's the truth. And I gladly except the challenge.

I am proud of the nurse i've become. I feel smart, confident and I love that I feel an instinct now that I never thought I would have. I react quickly and efficiently and I trust myself. I trust the decisions I make. I had a patient tonight grab my hand and say to me, "I'm so grateful you're my nurse. You make me feel safe and taken care of. You have a warm heart, I can feel it. Thank you for everything you've done".

It's those little things. It makes me boil over with pride. It just makes me so happy.

My life up until this point has been nothing but an unbelieveable journey. I've won a ton of awards with color guard and drum corps, taught some amazing students and saved a few lives.
I met and fell in love with probably the most incredible man on the planet. I thought I was strong before but having someone be your rock is the most amazing feeling. I am so grateful for him.


Well, to blog or not to blog?My initial plan was to only chronicle my first year as an ER nurse but honestly, I think I need it. I need to let it out, write it down and cry a little while doing so. To all of you who read and enjoyed my blog, thank you! Your encouraging words and messages made it worthwhile. And if I inspired even one of you to dream big, change your life or even just believe in yourself a little more....then it was all worth it.

Forever a nurse,

life & death

A personal note:

I sit here at home finally after an insanely busy night filled with everything from a rash, internal bleeding, to two people that flew off a high speed motorcycle! While I did have a very busy night, I only had one patient that was critical and had to go to the ICU. He was very unstable with COPD (chronic obstructive pulmonary disease) and basic breathing was an immense chore for him. I tried to stabilize him with oxygen and several medications but we had to call the respiratory therapist to put him on a special machine with a mask to help him breathe.

BIPAP: Bilevel positive airway pressure is used when positive airway pressure is needed with the addition of pressure support. Common situations where positive airway pressure is indicated are those where taking a breath is difficult. These include pneumonia, COPD, asthma, status asthmaticus.
Prior to being on the machine his blood oxygen level was 88% and he was using his abdominal muscles in order to breath. He was sweating and having great difficulty talking to me. I had him for quite some time as my patient and I found him to be a very kind, gentle soul. He was scared. I knew he was, and rightly so. He not only had a breathing disorder but his heart was failing and he knew it. He was growing more and more anxious and kept saying  "don't leave me, don't be gone long. I can breath better when your next to me". 

 

cue my heart melting.....

 

Needless to say, I stayed right by his side. I became backed up with my other patients, and all my medications were late but it just felt like the right thing to do. Eventually he was transfered up to the ICU and right  before he was taken upstairs he whispered to me,
"Nurse Emma, am I gonna make through this?"....I answered him the best way I could... "what do you think?"
he answered me, "I think I can do it...I have to do it."

Do I believe he's going to make it? Unfortunately, No. He is too far gone.His heart is failing, His lungs are filling up with fluid and his quality of life is going downhill. Now, I'm not writing this because it's a sad story. I'm actually writing it because I was inspired by this man. He maintained a positive outlook throughout the entire ordeal. Even though he was at his lowest point...he treated me and the other ER staff with respect and kindness. He could feel that his time was coming but chose to look on the up side of things, instead of the down. It's crazy to think that someone in this situation can do that but we, as healthy adults, struggle with that concept everyday.

Everyday in my job I deal with life and death situations and while I feel saddened, they are ultimately patients at my job and not people that I have a close personal connection with. This week, however, was a tough one. I had two dear friends lose loved ones and to be honest, it really got to me. It made me stop and evaluate my views on death and how much it would truly affect me. It's crazy to think that the only constant in this crazy life, the only guarantee is that we are going to die.
Me.
You.
We are going to die. It's inevitable.
Yet, when it arrives, we are shaken to the core and not ready to face it. Even when we know loved ones are sick, we can't seem to cut the heartstrings little by little to make it easier. Would we want to do that if we knew it would ease the pain? I don't think so.
I know it's cliche but I think the only way to make death more manageable is to take every chance we get to tell the people around us how we feel. Someday, when they are gone, we are going to wish for one more talk, one more glance, or one more time to see them walk through the door. My thought is, hopefully if we love them with everything we have while they are still alive, that will tide us over until we meet them again in heaven.

This post is dedicated to my old and newfound friend Glenn. I know this weekend has been tough on you and I think it was so courageous the way you handled it all. I want you to know that watching the way you cared for and treated Brittany was the perfect example of how we should all live our lives.
With Complete Love.
Thank you for inspiring and teaching me things everyday, even when you don't realize you're doing it. I consider you not only an amazing friend but someone who has opened my eyes up to more things than I thought I could see.

                                                                                  

too much...just way too much

I've been procrastinating writing this post

I don't want to write it. I want to stay positive, I don't want to whine or complain or bitch. But I can't keep this shit in.

Don't get me wrong, I love being a nurse. I think it's such a rewarding job and I wouldn't trade it for the world but.....this past week was the HARDEST week i've ever had. The hospital saw the highest patient volume in its' history. We felt it...I felt it. In the ER we have 5 patients each. So we are responsible for 5 rooms. Sometimes they are all full and sometimes you have only 2 or 3 patients. This week every room was full, every hour and every minute. There was no moment of relief.
No second to run and go pee
No second to take a deep breath
No second to think
No second to focus
Just run
run
run
and think later.

I felt like I was putting my license on the line. I could of made so many mistakes. I did make mistakes. I forgot to sign things. I didn't give my best care. I was uptight, stressed and not at all the nurse I want to be...hell...the nurse I AM.
I understand that jobs get busy and I do work in a fast paced job but this was crazy. This was too much for even the experienced nurses. Everyone was losing their shit. Swearing, lashing out, not working as a team. What could have been the solution? Call for back up! Call more nurses to help! Call more paramedics! At one time I had 5 IV lines to be started and 4 EKG's...how the hell am i supposed to get that done in the 15 minute window I have if all the people came in at the same time???? Just insane.

Then..just when i thought i couldnt take anymore...the ambulance bay opens and a cardiac arrest comes in. The guy had been without a heart beat for 20 minutes. Of course he becomes my patient. We all gown up quickly covering our faces, bodies and hands with plastic assuming this is going to get messy. The man is about 70 years old and i'm told he had begun vomiting buckets and buckets of blood at home. His wife called 911 cause she didn't know what to do. Fire rescue got there and as soon as they placed him on the stretcher he coded.
His heart stopped.

They jumped into action giving him two amps of epi and doing cpr. Unfortunately he was in what's called PEA. That means 'pulseless electrical activity'. The monitor was showing a rhythm but there was no pulse to be found. His heart could have been quivering due to meds or other unknown reasons but it wasn't actually producing a pulse. Unfortunately we cannot shock a rhythm like that. All we can do is continue cpr and hope for the best. It turns out he had Lung Cancer and the cancer was now affecting his heart as well.
I was advised that the wife would be coming around the corner any minute and my job would be to stay with her and explain all the proceedings. You DO NOT want that job.
At this point there are a million people in the room, the patient is being intubated, lines are being drawn, CPR is going on, his clothes are stripped off and its loud and crazy. The wife is asking me everything"
"why are his clothes off"?
" why are they pounding so hard on his chest?"
"why isn't he talking"?
"when will he be discharged?"
WHEN WILL HE BE DISCHARGEDDDDDDDDDDD????

THIS LADY HAD NO F---ING CLUE THAT HER HUSBAND HAD BEEN WITHOUT A HEART BEAT FOR OVER 45 MINUTES. SHE LITERALLY WAS IN COMPLETE DENIAL.

 

I had to try my best to explain everything in terms she could understand. Meanwhile I still have 4 other patients calling my name, meds that are late and people that are becoming increasingly pissed off.
The doctor looks at me from across the room basically to say "what does the wife wanna do"? Should we stop now or keep going. The wife says "my brother came back from the dead so my husband will too". Jesus. Doc says that last thing we could try is to place him on a special heart medicine drip. We both know that its been too long now without heart activity but we must try. He advises me to run and get it. I drop everything and go to the med room to get it only to find that it's not available there. I call pharmacy and they tell me they will make it. I look around for a tech to retrieve it from pharmacy but no one is around. I RUN...and i mean RUN up three flights of stairs to the pharmacy. They were mixing it up there and it still wasn't ready. I was pacing. Finally I grab it, fly down the stairs and burst back into the patients room.....only to see them pulling the sheet over his head.

It was too late.

He was gone.

I didn't run fast enough.

I know it wasn't my fault. I know he was gone already. I know all this but somewhere in the back of my mind I hold onto that little feeling that I could have done more.
The next two hours were full of reports, family members mourning and screaming and more patients demanding all of my exhausted attention. I drove home from that shift feeling defeated. I just couldn't take much more of anything. I was too tired to feel emotion and too full of emotion to be tired.

I had the next 4 days off...THANK GOD...and I didn't have a true meter of what a wreck I was until I was over at my boyfriend's house. We were watching tv and relaxing and I was starting to doze off. He asked me about my crazy week and what made it so stressful and that was it...

I COMPLETELY LOST IT. Tears came draining out of me. My shoulders shook and heaving sobs poured out of body. I was an absolute mess. I guess I was waiting for the okay from someone and the flood gates opened.I had been holding the stress and pressure in too long. The death of that man haunted me that week and I couldn't seem to let it go. I sobbed and sobbed and I'm pretty sure completely soaked his shirt with my tears. It felt so good to have someone to talk to (or cry to) and I realized that it's not a bad thing to be filled with so much emotion over my job. It makes me human. I have always said I hope to never get hardened to the likes of death or pain. I honestly don't think I ever will.

You know...someday I might need someone to save me. I pray that if that ever happens and I'm laying there in a hospital bed with my life hanging in the balance, that there will be a nurse there by my side who's just like me. Someone who's maybe a little overly emotional, bursting with passion and wearing great sneakers to get up those damn stairs quick...

 

 Emma Roberts RN

how to be successful in the ER

Qualities Required for an ER Nurse

I found this on a fellow ER blogger's page and found it not only enlightening but also a little silly :)

 

If you want to be successful in the ER :

1. You must be able to adapt quickly to change. The first 60 minutes of your shift may entail finding out about a policy update, initiating a lidocaine drip on a patient, taking a bead out of a 4 year old's nose, finding out the previous policy update was updated again, assisting in a casting, placing a catheter in a 80 year lady with dementia and unique female anatomy, being floated to ICU, being released from ICU, doing pediatric triage, and then going on a run with EMS because they are short staffed.

2. You must be able to hold your urine for 12 hours straight. See number 1 for reference.

3. You must not be a frequent crier. Tears are OK once in a while, but not on a daily basis. Seriously people......if you are that emotional, find a less stressful job.

4. A sense of humor is a must - a vital requirement. You cannot survive without it. Because sometimes it's just dang funny when a man comes in with a foreign object in his "orifice", or Dr Q slips on the freshly mopped floor and lands with his coffee spilled over his scrubs and the stool sample card he was carrying flat open on his face.

5. You must be a critical thinker. You must understand WHY you are doing what you're doing. Being genuinely surprised that your patient is hard to arouse after 30 minutes on a Versed drip makes the other nurses look at you funny and wonder where the hell you went to school (www.easynursingdegress.com?). Also, not doing a urine dip on a patient that has just been kicked in the gut by a 1 ton horse because "the doctor didn't order it" is just not acceptable.

6. You must be willing to train other nurses. How will we devlop competent nurses to cover for us on our vacation days if we don't make the effort to train them? Really - it's in your best interest to show SusieQ how to assist in a chest tube insertion, because you may want to go to NYC next month and there is noone to cover your shift on Trauma Call except a new inexperienced RN who was never trained. Next thing you know, your boss says "No!"

7. You must not mind body fluids. Blood, vomit, poop, pee - they're all part of a normal day in the ER. Sometimes you even get to have them splashed all over your clothes and in your face.

8. You must be excellent at organization and time management (refer to number 1 once again).

9. You must be able to recognize the fact that a 45 y/o obese male with a history of smoking who is experiencing chest pain needs to be seen before an 80 y/o female with complaints of "it burns when I pee." Triage is your friend - know it, own it.

10. You must be able to prioritize. It is more important for you to obtain an EKG on your 45 y/o male than it is to obtain a urine sample on your 80 y/o female. Just because the doctor ordered the UA first doesn't mean that is the order in which you perform your interventions.

11. You must be a cold, hard bitch. Oh wait - no....that's just me.

12. You must bitch endlessly about how unreal medical shows are, but secretly watch them at home cuddled up in a blankie with a cup of hot chocolate while yelling "You don't shock asystole asshole!"

13. You must be willing to keep up on your education and be aware of current practice. Stating "Well, Abby did it last night on GREYS ANATOMY" doesn't go over very well with the Chief of Nursing. See number 12. Another tip - People magazine does not contain any CEU's.

14. You must not screw around with your coworkers. Paramedics, police, firefighters - go for it. But another ER nurse or doc? Not a good decision. First, you're mushy mushy kissy kissy in the hallways, making people want to throw up. Then, when things go south (they always do), it becomes difficult to take care of that patient seeking treatment for syphillis without popping a comment off to Big Bob RN about how you're surprised he's not laying on the stretcher - as much as he fooled around on you.

15. You must be able to handle people yelling, screaming, cussing, and spitting at you without taking it personally. Review number 3.

and last, but certainly not least............

16. You must be able to find rewards in the little things - the smile of a child after they've been sewn up and get to choose a sticker, the reassuring beep of the cardiac monitor after you've resuscitated someone, the way the closet at the end of the hall is soundproof so no one will hear you scream when you are losing your mind.

 

______________________________________________________________________________

 

I think being able to find the humor in my job is essential. It gets hard, real hard and being able to chuckle about things makes it all okay in the end. I know sometimes things are gross or disturbing but sometimes things are also amazing and unbelieveable.

 

It's the miracles that make everything else worth it.

 

Here's to one of the best jobs around...cheers :)

 

EMMA ROBERTS ER RN

PRE JUDGE

Patient Advocacy

We judge, form opinions and often times stereotype certain "types" of people. I admit that I too have been one of those people. We try and try to remain open minded and judgement free but more often than we'd like to admit to, we label people as "different" and ultimately relinquish full respect. This is no different in the medical field. The problem, however, is that this lack of respect could mean the difference between sickness and health and horrifyingly enough... between living and dying. We CANNOT and must not look at anyone in any way other than that of a sacred human life.

I found myself dealing with this situation first hand the other day.

The situation: At my hospital we have a unit devoted solely to pregnant woman who are addicted to drugs. These woman apply to be in the program and once accepted, succumb to intense detox in order to get healthy for their unborn child. There are woman from all walks of life, some homeless, some lawyers and even some doctors and nurses. This program is a safe place to go to start fresh and try to salvage the health of their baby and themselves. These woman should be rewarded and praised for checking into this program...right? You'd think so. Unfortunately they are pegged as "druggies" by many and treated with less than hospitable practice.
I was working and recieved a call from the unit upstairs. They stated that a woman from the unit needed to be seen in the Emergency Room because she has been screaming and moaning for about 3 hours. She states her abdomen is killing her and the pain is unrelenting. The reason they needed to bring her down to us is that this specialized unit is not a medical floor. It is a detox yes, but they do not have the capabilities to treat acutely sick patients. We have doctors, nurses and an abundance of tests and medications so many times patients from other floors are sent to us. We work fast and hard and are able to diagnose serious illness at a rapid pace. This young lady was brought down a few minutes later by wheelchair and I swear to you I could hear her when she was still in the elevator. The screaming, moaning and crying was deafening. She was not going to be my patient but I put her in a room and began to get her information and story. Well... that was my plan except for the fact that she would not speak, only scream. I tried to understand what she was saying but the only information I could determine was that her right lower quadrant was in excruciating pain. I read thru some paperwork the unit had given me and got a greater picture of what we were dealing with. It was amazing having a chart to go through, a day by day account of the patients' history. In the ER we NEVER know what has happened before, we NEVER know what meds they are really taking and we certainly NEVER know what is going wrong now. It is our job to find the cause, diagnose it and FIX it before things go horribly wrong. So...I read.

She had been in jail for a short time
She is 28
She was addicted to pain killers
She hadn't done a drug since aug 10th
She had been in the unit since Aug 12th
She was 6 months pregnant.

Reading this ultimately squashed my first "judged" theory. I had assumed she was going through withdrawls. I had assumed she was seeking her next high. I had assumed she was less of a human than me. I assumed wrong.

I went to find the doctor. Usually I feel very comfortable talking with the doctors but there happened to be a new doctor working. I didn't know her and wasn't sure how she operated. I ran to the doctor and physicians assistant and told them that they should check on her STAT. I didn't like the way she was moving around the bed. She couldn't sit still and the color was draining from her face. She was diaphoretic (sweating) and would have moments of such intense pain that she would freeze up and stare off into the distance. The doctor and PA asked who was in the room and I told them...then they continued their conversation. I mentioned again that I felt like she needed meds as soon as possible only to recieve the same response. I acted on the patients behalf. I directed the paramedic to begin drawing blood and to send it STAT to the lab and then I began monitoring her vitals and entering as much information as possible into her file. Keep in mind the entire time during this process the patient is screeching and screaming at the top of her lungs.So much so that other patients were walking by to see what all the commotion was about. The doctor stops by, peeks in and walks back to the desk. I wait for the meds to pop up. They don't. I wait some more. They never appear. I walk over to the desk and said "I really feel that we need to medicate her. She has thrown up several times and there is obviously something really wrong." I heard a few whispers...."she is probably detoxing, she probably wants morphine, no one screams that loud when they are really in pain". I stood there right next to the doctor until it became annoyingly apparent that I wasn't going anywhere and I saw her finally write the medication order. I then  ran to get it and had it in my patient within the next 2 minutes. This woman had now become MY patient. Not because I was told to take her but because I knew that someone had to advocate for her. Someone had to be her voice because I know if that were me I would want someone with a little compassion to give a damn about me. Little by little tests were done and meds were given. Watching this woman broke my heart. Yes she used to do drugs, and you know what? She'll probably do them after she gets out of the hospital. But who the hell am I in the grand scheme of life to decide who needs to feel pain and who doesn't. Who should suffer and who shouldn't?
Labs come back: she has a white blood cell (infection) count of over 17,000. This is high. Something is wrong~! I knew it. An MRI of her abdomen is ordered to rule out appendicitis or gallstones. The MRI technician is called at home to come in. She arrives and I watch her interact with my patient. She is tired and abrasive and is mad that my patient won't lay still for her. Are you kidding me? The MRI tech keeps saying to her..."lay still, stop moving, ugh, geez, sit still". I put my face close to hers and whisper " I know you're in pain, i want to help you but i need you to do your best to lay still so we can get a clear picture of what's going on. We are going to get you feeling better soon. Can you do that for me?" She nods and muffles a yes. The MRI shows exactly what i knew all along. Appendicitis. She needs surgery STAT to save not only her life but the life of the baby as well. This is very dangerous and if it ruptures can be fatal.  I know how bad this hurts because mine ruptured years ago. If someone would have told me to be quiet or lay still or that I couldn't have any medicine I think I would have found the nearest highway to play in. The pain is unrelenting and unforgiving.

Seeing the doctors face as she looked at the MRI result was priceless. I knew as I watched her writing her final diagnosis of Acute Appendicitis that the lesson was learned.
And seeing her read the final lab result : NEGATIVE DRUG SCREEN was even better.
This young lady wasn't seeking drugs: she was seeking help. And where else should she have gone to other than a hospital? And who else should she have trusted with her life other than a doctor?

Apparently... a nurse.

Moments like this make me proud to have RN after my name.
People often say... "how do you deal with it, the stress, the blood, the sadness?" I never really have a good answer but I guess I don't really need one. You know the quote " do unto others as they would do unto you"? I hope that someday if I'm laying in a hospital bed that I can look up and know deep down that the person standing over me will take good care of me. They will not decide what medicine to give me based on what kind of car I pulled up in, or what color my skin is...or if I have insurance or not. They will care for me because I am a human being and I have a right to life. And NO ONE is above that.

Proud,
Emma Roberts RN

the birthday reflection

Well here we are....another birthday is upon me tomorrow and it's insane as I reflect on what a year it's been.

GOT MY DREAM JOB

A FINALS FINISH AT BOA ATLANTA WITH THE FALCON SOUND

TRIP TO CANADA

WINNING MY SECOND WGI WORLD CHAMPIONSHIP WITH FLANAGAN

NEW FRIENDS

CHRISTMAS IN THE MIDDLE OF SUMMER

 

A YEAR WISER.

 

 

 

The last few years i've been traditionally dreading the inevitable day of birth with the usual "i don't want to get older" comments.....this year though, feels different. I can't quite explain it except to say that after the year i've had, i truly believe ANYTHING is possible. I was discussing optimism with a friend the other day and it got me thinking; am I really optimistic or do I just believe that if i ask for what i want enough times it will happen? Or is there a difference? Maybe that's exactly what optimism is. I looked it up....The definition is :

op·ti·mism/ˈäptəˌmizəm/

Noun:

Hopefulness and confidence about the future or the successful outcome of something     It's been an amazing year of starts and stops, tears and laughter, joy and pain. I am a year older and while I hope to remain eternally youthful on the outside, I've realized that it's what's inside my brain and heart that are going to propel me forward in the years to come. This year will be my best yet.     PLAN34: Make money, lots of it Highest placing fall season Buy a house  Change someone's life Save someone's life Win WGI DCI or both :) Make new friends Learn spanish Fall in love   Here's to wishing for the best year yet, knowing it will happen and enjoying it when it does         

couple new cases...

Dx: minor amputation of left pinky
Story: We recieved a transfer from another hospital because the other hospital could not handle the case. The patient worked at the local grocery store and instead of slicing the deli meat he sliced off his pinky finger. He is young, healthy and incredibly upset about the fact that his finger is no longer attached to his hand. Unfortunately he did not bring the missing finger with him :(
What we did: The hand surgeon was called in for a consult and he came in an hour later to look at the patient and make a decision. He came in and immediately wanted to operate. Here's the problem...he wanted to operate here in the ER. I have 5 patients, the ER is full and this surgeon wanted my full and undivided attention. He was requesting sterile equipment only found in the Operating Room, a private room, a quiet place, more lighting....i was beyond frustrated. We eventually moved him over to the pediatric side where it was "a little" quieter and he actually amputated the rest of the guys finger. I could not believe he did it here but he did. The guy was given a mild sedative and some local anesthesia. The doctor cut the rest of his finger off with surgical scissors so the amputation would be smooth and then we sent him on his way. And that was that. One minute you have 5 fingers..the next you have 4. Bummer.

Dx: Right knee dislocation
Story: Pt states my knee always comes out of place and usually i can put it back in but tonight i can't.
I walked in the room to find the patient pacing the room and washing her feet in the sink. I'm thinking to myself...this lady has a dislocated knee? I asked what she was doing and she said "I'm not on drugs you know", i said "ok" and she said " why are you staring at me?", I said "i'm trying to get some information from you". The doctor came in next and the patient began backing up on the bed. She yells " i feel like i'm in jail and being ganged up on". At this point i'm thinking wtf is going on. Her knee is clearly in place and she is clearly high on something......cocaine, spice...i'm praying she doesn't try to eat my face like the guy in miami.  The doctor tells her her knee is fine but we'll do an xray anyway. She then jumps up and screams at me to stop attacking her and runs out of the room....literally. I hear her down the hall, "i'm checking into a nuthouse". And with that....she disappeared. I love the ER.

Dx: Marijuana drug reaction
Story: Pt states he smoked "spice" (the synthetic form of marijuana) and he feels like he's gonna die. Nothing to report. He rested, recovered and went from basically drooling on himself to being rather upfront regarding OUR future together. He felt that he was the one for me. If a 22 year old black drug addict gang member is the "one" i've been searching for all these years...i may as well end my life now. I had my back to him as I charted some information only to turn around and see two flashes. YES...he took two pictures of me. He said "thank you nurse, I will use those later when I masturbate to them." The freakin grossest part...his mom was in the room the whole time and thought the whole scenario was "so cute". I swear to god I don't get paid enough. Needless to say...i got his phone number ;)

Dx: ETOH (alcohol intoxication)
Story: 35 year old male brought in by fire rescue because he was found wandering around the neighborhood trying to enter other peoples houses. He didn't know where he was but the fire fighters found his wallet and belongings in a car nearby with the doors open. He was brought in and we could pretty much hear him before the ambulance doors even opened. He was sitting on the stretcher, legs wide open, shirtless with only tighty whitey's on....dirty whirtey's I should say. A lovely site nonetheless. And by lovely i mean absolutely repulsive. We proceeded to triage him only to listen to him ramble, stick his tongue out at me, and shout "arnold schwartzenegger is in my bag, get him out..he's in there!" I eventually bribed one of the paramedics to put an IV in him and I administered the medicine prescribed to all drunks...a "banana bag". A 1000cc bag of vitamins and minerals used to replenish those lost by drinking gallons and gallons of alcohol. An hour later his two brothers showed up to find out what happened. It was actually pretty entertaining watching his brothers trying to talk to him. They said he never drinks and he probably just went a little wild. The patient kept telling his brothers that he has to go home now cause he's been here for weeks, I ensured them he'd only been here for an hour....his brothers kept laughing at him. Then they made fun of his belly and undies and took him home where they could "whoop his ass". Another class act.

Another night in paradise......
Maybe tomorrow i'll have some actual cool cases not just drunk druggy smelly weirdos.

Until then........
Emma RN

dream big........

I cannot believe how many things have changed in the last seven months.

I was so scared. So naive. So green to the world of Emergency Medicine.

I am proud to say that I officially feel like an ER nurse.

People often talk about the first few months as a nurse, and how overwhelmed and incompetent you feel. They were definately not lying. They were absolutely telling the truth lol. Hell, there's even a class in nursing school that gives you tips and advice to survive through the first few months. Nothing though, truly nothing can prepare you for what lays ahead. It's shift after shift of having no clue what you will see or how you will handle it. It's new doctors that you don't understand and new patients that completely mystify you. It's seeing the grossest most repulsive stuff you've only ever read about and seeing  the saddest of sad cases that leave you holding back your tears until you've made it safetly to the solitude of the bathroom.
I knew this career would be tough, that's half the reason I chose it, but what I didn't realize at the time was that it was going to change the BLUEPRINT of who I am.

It's funny how many people have told me they enjoy reading my blog. They love the gross stories and the touching ones too. It's a world I never knew about and I can imagine it must sound so interesting to people not living in it everyday. Well....it really IS so cool. I am so blessed to have these stories to tell and extremely honored that so many friends like to read about my day to day life. I haven't posted in a while and I was thinking about why that was the other day. I thought that maybe i've been tired, or too busy but ultimately what I came up with was that maybe i'm finally adjusting and settling in to my job. Things don't seem weird or insane to me anymore.
It was funny, the other day I had a cardiac patient, a crazy seizure case, a drug overdose, someone who stepped on a medieval sword and a guy screaming with a bug in his ear. When a friend asked how work was that day I said.....eh......slow night.
Now THAT is not normal lol.

Last week I went into work and recieved amazing news. The director of the ER and the clinical manager sat me down and told me that they were impressed with how fast I caught on and how well I was doing. They wanted to know if I would be the next preceptor for the ER!  I would be responsible for training new nurses to the ER!!! My jaw hit the floor. What a frickin amazing honor and opportunity. I told them I don't know nearly enough but they assured me that I did and that as long as I taught the right way to do things and kept my positive attitude I'd be a great preceptor. I said "of course I'll do it"!
So....after working in the ER for a lil over 6 months...I'm training other nurses.

I've never felt so proud.

I am a strong, smart cookie and my hard ass work paid off.
Anything is truly possible if you reach for it.

 Wonder what's next for me............ until next time..............

the night of ingestion.

INGESTION PART ONE


Sweet kind 85 year old man walks in cute as can be. When asked to state his complaint he
says he thinks he swallowed his dentures. He said he went to bed and when he woke up his
teeth were missing and his throat was sore. After the initial shock of hearing the story
i sent him to xray to see if we can see his teeth. I'm thinking to myself " how the hell?"
but nonetheless, he went to xray. As we waited for the xray results we chatted. This man was so cute. He was kind and had a gentle demeanor. I asked him what medications he takes at home and he pulled out a crumpled old piece of paper from 1952. He broke my heart,so i took his list and went over to the computer and typed it up for him and cut it to wallet size.He was SO appreciative, it made my night. So....we wait for
the xray results and much to my surprise (sarcasm)...there were no dentures in his throat,
abdomen or intestines. All clear! I told him they were not in his body and you know what he said?

"I had a feeling I hadn't swallowed them, I think i know what happened to them."
"What do you think?" I asked.

"Well,my wife died 4 years ago and she was always playing pranks on me so I figure she probably stole them in the middle of the night and is laughing at me from up in heaven".
I died. I literally felt my heart open up and swallow this lovely man.
I told him I agreed and thought that this was her best prank yet. He winked at me ;)


INGESTION #2


to hate yourself so much that you'd swallow a handful of razor blades

i can't imagine.

to be screaming in pain at something you inflicted upon yourself.

That is a kind of hatred i can't wrap my mind around.

The ct scan literally showed 5 razor blades at various stages of digestion
just destroying her insides. The screams coming from the room resonated all night long and
we, here in the ER, are left to contemplate our own self confidence, self assurance and sense
of value. I know now, after seeing and hearing this patient, that I love and value myself and
that nothing would make me inflict that kind of harm on my body. Our bodies are so sacred. Why
must people torture and neglect them. Whether it be drugs or razor blades....there is no difference.
One day their bodies will shut down, and in those final moments, I know for a fact that they will
wish they had another chance to make the right decision. I know that because I see them here night
after night, dying right infront of me. They look at you with those wide eyes and your heart aches. You know they did it to themselves,but that doesn't change the outcome. Death is inevitable.

Life lesson of the night: love yourself enough to take care of your body, mind and spirit.
AND....always hide your dentures when you take them out, or the tooth fairy might just grab em ;)

"my ass fell out of my ass"

Emma....you have a new patient.....she's in the room waiting for you....

What is her stated complaint?

She says her ass fell out of her ass.

I'm not following you?

Her ass literally fell out of her ass.

Hi there...my name is Emma and i'm going to be your nurse here in the ER. What exactly happened?

I had a baby 2 days ago. I didn't use any medicine, no epidural, nothing. I pushed really hard everything was okay until tonight. I was laying in bed and i felt my ass fall out. It hurts so bad. Its on the outside of my body. I can't move, can't poop. My husband said my butt fell out.



this is what i see:

I call the doc in and we ask the woman to roll over so we can figure out what exactly she is talking about. She rolls over and .....................

brace yourself.........

seriously.......................


............................





........................................you're sure you wanna see this?

no her ass did not fall out of her ass. She has hemmorhoids. Really really large ones that were internal and were pushed out by childbirth.

hemorrhoidsplural of hem·or·rhoid

Noun:

A swollen vein or group of veins in the region of the anus They can be internal and external and can either go away with some cream or can be cut off. Usually a small incision is made and they disappear. NOT in this case! We had to call in a surgeon and prep her for surgery. Poor thing. She was so stressed about the next time she has to poop. I can't even imagine how much that is gonna hurt. Ouchhhhhhhhhhhhhhhhhhhhhhhhhhh. LIFE LESSSON: think twice about having kids ;) or at least have a c section lol.

MY SHIFT ...start to finish....

I love my job. I am feeling more and more comfortable with my day to day (or night to night ) responsibilities and definately don't feel overwhelmed anymore. Everyday there are at least ten new things i learn but I feel like the knowledge is stacking up in my brain and becoming easier to absorb.

For my friends and family that ask what my usual routine is:

6:45 pm arrive at the hospital and put my stuff away in my locker in the breakroom.

6:55 pm meet with the other nurses and paramedics to discuss our nights events. Things to look out for, new procedures etc. Listen the the charge nurses' pep talk!

7:00 head out to the ER floor to find out what area i'm working in that night and who I need to get report from.There are a few different areas I could be in. AREA 1 and AREA 2 are adult rooms and usually the most critical patients go there (including all the codes and trauma). FAST TRACK is where the quick in and out patients go and anyone who is pregnant and having vaginal bleeding(This area does a lot of pelvic exams and obgyn type stuff). PEDS means you are in the pediatric ER and you share the patient load with the other PEDS nurse. You don't really have  patients to yourself, you both just trade off and help each other out. I PRAY EVERY NIGHT TO BE ON THE ADULT SIDE. I am trained in both adult and pediatric emergency medicine but I can't seem to get used to needles and IV's in little screaming sick babies. And if they aren't getting needles they are just sneezing or barfing on you. I hate it. The parents are crazed, the kids are miserable and I can't find a damn vein to save my life. I was told i'm good with the kids but i definately think they are talking about when they are about 10 years and up. I love the teens, I  relate well with them...but the lil ones...no maaaaam.

7:05 I find my area and find the day nurse that's in it. I walk with her from room to room and find out who's in the room, how long they've been there, what their diagnosis is, what was done and what still needs to be done. In a perfect world...the documentation is complete, the labs and blood are drawn and sent and the patient has been medicated. It's awful to arrive at work and have to catch up on someone elses slow pace. Plus, you don't even know these patients, their story, their pain. I introduce myself while double checking that all the rooms are stocked with suction (in case of a breathing issue) and ambu bags (in case I need to be someone's lungs for them).

7:10 I rock and roll. I know that if i get behind now, i'm screwed for the rest of the night. I say hey to the docs and check the giant board to see what is flashing red that needs to be done STAT. I put on my rollerskates and start hustlin. It's always a good indication of how the night is going to go depending on which doc is on. Some love to order every test in the book which slowsssssssssssss you down a lot, while some just use their knowledge and assessment skills to determine the prognosis. The less labs = the less medicine = early discharge home. The sooner I can fix them and send them home the better.....for everyone involved.

7:15-2:30 am Work Work Work, Patients will come, get treated, sign the paperwork and leave, you will clean the room turn the corner and see another patient coming right towards you...its an endless cycle but as long as you are fast, smart and take things in stride, you won't lose your cool or your mind :)

3:00am EAT LUNCH + red bull

3:30am-7:00 continue with patient care, do some online coursework the hospital delegates we do and usually laugh hysterically. The ER slows down "sometimes" at this time and the nurses, techs and docs have a grand old time pranking each other, telling geeky stories and releasing some of the stress of the night. As i said, it usually slows down, that is not always. Some days its none stop and your feet and legs are throbbing come 7 am but other days you can chill for a bit and actually sit down!

7:05am give report to the day shift, clean all your rooms, finish any documentation you may not have finished and smile a lot cause sleep is coming soon.

7:10 head upstairs to the hospital Medical Surgical/telemetry or ICU Floors to visit any patients I may have admitted to stay over night. The patients are always surprised to see their ER nurse visiting and it makes them feel good to be remembered. I think this is a cool thing. It's exhausting to walk all over the hospital after 12 hours on the clock but wouldn't you want someone to come visit you?

7:20 Drive home fast, pee finally and sleeeeeeeeeeeeep.

That's my 12 hours in the ER. It is a long shift and it doesn't involve a lot of sitting but damn, I am so blessed to be in the field i'm in. Emergency Medicine is fascinating, fast paced and everchanging. I work with people who i not only consider my coworkers but some of my best friends. I will be falling behind and be running (literally) into a room to draw blood only to find my buddy in there doing it for me. Then i'll head next door to give a med and i'll see my friend walking towards me with the meds already ready for me to give. These nurses are amazing and every time one of them helps me, it makes me want to pay it forward. It has created this cycle of incredible teamwork and comraderie. I KNOW it's not like this everywhere. I am truly happy with where I am in my career thus far and I cannot wait to see what the future is going to bring.

Here's to loving where you work........Onward and upward..................

I am a World Champion!

I spent the week in Dayton,Ohio for the Winter Guard International World Championships. I was fortunate enough with my job to be able to leave for week with no problems. That's the great thing about being a nurse...you work sun, mon,tues and don't have to work again till the next week wed, thurs, fri. What a sweet deal.

Soooooo..... Flanagan was amazing. Simply unreal. I knew they were ready, I knew they were prepared and I knew they wanted it. But I had no idea what was about to happen. I didn't know that it was possible to have that much fire at such a young age. They showed up and made the arena take notice. They were a class act from start to finish and made me so proud to stand next to and infront of them.

I felt honestly, like i was living a dream. Oh wait.....I am. 
Teaching these kids is a gift I cherish everyday. Saying goodbye to these seniors is something I keep pushing out of my mind. I feel so connected to each and every one of them. The journey to this championship was long but damn was it fun. They all poured their hearts into this product and believed in us as instructors. We said jump and they said how high, we said give more and they did. I don't believe its like that everywhere. I always think to myself...i wish other instructors could get a chance to teach these kids for a year...hell...for a day. They would NEVER want to leave. 

It's always so hard coming home from WGI. I'm pretty sure everyone involved gets the blues. It's a crazy feeling to get home, full of pride, medals and trophies and have to go back to your real life. Tonight I walked into the hospital and suddenly i'm just Emma the nurse. It's emotional in it's own way. I want the rejoicing and celebrations to continue. But they stop. But then I realized something. The reason color guard is so special to me now is BECAUSE it is not all I have. I use it as an outlet. A creative and spiritual release. I used to only have color guard in my life and while i loved it so much, it didn't feel like it does now. It is so much more now. I can't even explain it. Leaving the hospital after a weary shift...and walking into that gymnasium filled with smiling, silly teenagers is the greatest feeling. They are an instant "pick me up" and a perfect start or end to any day.

I absolutely thought that once I became a nurse that would be it. My teaching would be over. But one thing I've learned over the last few years is that NOTHING is impossible.

If you want to do things, do them.
If you want to change careers, change it.
If you want to win a world championship, win it.


NEVER UNDERESTIMATE YOURSELF. YOU CAN DO ANYTHING AND WILL DO ANYTHING AS LONG AS YOU JUST PUT ONE FOOT IN FRONT OF THE OTHER AND BEGIN...ONE STEP AT A TIME. DEMAND GREATNESS AND GREATNESS WILL COME.

Thank you to my Flanagan family for giving me the most amazing years of my life. For making me a better person just by association and for always demanding the best from me. I hope I've given you guys half as much as you've given me.

Let's do this again next year ;)
Emma

One liners............

Lines of the night.....


me: "take your medicine with food"
them: "what kind of food?"
me: "any type of food, breakfast lunch or dinner"
them: "what should i cook for the week, i need suggestions"
me :(what i really said ) " cook some meat, veggies and rice"
me: (what i wanted to say) "i'm not your f#$^$$# personal chef, i don't f#$$^$ care you lazy dumbass".


me: "how many drinks did you have tonight, you seem intoxicated"?
patient: " i got my disability check and bought some vodka"
me: what did you mix with it?
patient: "i don't understand"
me: "what did you mix the vodka with"?
patient: "more vodka".
me: "perfect".

patient : "i keep vomicking"
me: "you keep what?!!"
patient: "vomicking...you know vomicking all over the place"
me: "ohhhhhh vomiting......"
patient: " ya......thats what i said nurse, vomicking".


me:"maam, the doctor and I have to perform a pelvic exam"
patient: " listen honey...if that doctor wants to play little house on the prairie, then he at least needs to buy me groceries first."
me: (excused myself from the room laughing)

another night in heaven :)
Emma RN

bananas anyone?

Case #1

the stats: Eat a big meal, severe stomach pain, obese, female
the diagnosis: pancreatitis caused by gallstones

Gallstones

Cholelithiasis; Gallbladder attack; Biliary colic; Gallstone attack; Biliary calculus

Gallstones are hard, pebble-like deposits that form inside the gallbladder. Gallstones may be as small as a grain of sand or as large as a golf ball. They form for a variety of reasons but usually due to a fatty diet. An attack almost always happens after a huge greasy meal. The gallbladder and pancreas share the same duct or canal so when the gallstone blocks the passageway, both the pancreas and gallbladder get backed up and inflammed. It hurts like hell! Soooo......moral of the story: eat salad.

Case #2

the stats: 65 yr old male, presents with severe abdominal pain, back pain and shoulder pain. Severely low blood pressure and pulse. White faced and lethargic. Shoulder and back pain are significant and pointed us in the right direction.
the diagnosis: Dissecting Aortic Aneurysm

Aortic dissection occurs when a tear in the inner wall of the aorta causes blood to flow between the layers of the wall of the aorta and force the layers apart. The dissection typically extends anterograde, but can extend retrograde from the site of the intimal (lining) tear. Aortic dissection is a medical emergency and can quickly lead to death, even with optimal treatment. If the dissection tears the aorta completely open (through all three layers), massive and rapid blood loss occurs. Aortic dissections resulting in rupture have an 80% mortality rate, and 50% of patients die before they even reach the hospital. All acute ascending aortic dissections require emergency surgery to prevent rupture and death.

Pt was transferred to a heart hospital and directly into surgery. They need to stop the bleed before he bleeds out completely. His survival rate is approximately 5 %. We told him to call his family. He said he hasn't spoken to his kids in years. We told him now would be a good time to start. Moral of this story: you will ALWAYS need your family. Never stray far from them.

Case #3

WARNING...DO NOT READ IF YOU ARE GONNA BE OFFENDED OR PUKE EASILY.
WARNING
WARNING
WARNING
WARNING


the stats: 36 year old male, severe pain upon urination. Swollen penis and testicles. Super embarrassed.
the suspected diagnosis: an STD
the ACTUAL diagnosis: Broken Penis

A penile fracture is an injury caused by tunica albuginea, which envelops the corpus cavernosum penis. It is most often caused by a blunt trauma to an erect penis. Usually from intercourse with the male ontop penetrating the partner from behind.

 

Penile Fracture

A popping or cracking sound, significant pain, immediate flaccidity, and skin hematoma of various sizes are commonly associated with the event. These symptoms are similar to a common bruising or contusion of the penis.

Moral of THIS story: This guy should NEVER have sex again.

 And may you never look at bananas the same way again.

till next time, Emma

the night of a thousand smells....and vagina's

Imagine wet garbage, covered in horse crap, coated with skunk, drizzled in urine and topped with boiling hot vomit. THAT is what my night smelled like. I cannot get the smell out of my nose. I literally have rubbing alcohol swabs stuffed up my nostrils right now and besides from the fact that i'm high from the fumes...i can still smell the stench. I don't understand how people cannot smell themselves. When my perfume is fading i think i smell. Some of these people have not only not showered...ever.....they have infections down under that are bubbling over. Tonight I saw (and smelled) more vagina's than a frat boy in college and if I never see another in my lifetime, it would be too soon. I had one patient after another that just wouldn't pee in a cup for me. I explained time and time again, "if you don't pee in a cup, i have to insert a foley catheter". The pretty much just said "okay." Are they crazy? I literally gave one woman about 100 gallons of water to pee and still...not a drop. So....i dove in.....and believe me I held my breath.

That's all for now. I have to go disinfect my nostrils. good night

where has tiime gone....

soooo much laughter!

Work has been insanely busy over the last few weeks. I'm sure this is just the life of a nurse lol and I just had no idea. On your feet 12 hours a day, sitting for a quick lunch and back at it.Thank god I bought these hideous 140 dollar nursing shoes to save my back and feet. I swore to god i'd never wear them.....i lied. They are saving me.

There's been a ton of laughter to go along with a ton of stress. I think it's what keeps us all sane :)
Last night the docs were up to no good. One of the ultrasound techs had been working a lot and was resting in the sleep room. The doc snuck in there and stole her shoe and brought it back to the nursing station. He then proceeded to order a stat ultrasound on a "pretend patient". We were waiting to see what she would do....we waited and waited for her to arrive. The charge nurse then paged her and said hurry its an emergency....she still didn't come. Finally we see her coming down the hall towards the ER. We remained straightfaced until we saw her wearing hospital booties instead of shoes. We all started snickering and then lost it. She was like "i'm sorry, i can't find my shoe"...the charge nurse and doc were screaming "hurry up and get in there, we need this ultrasound" ....i was hiding behind the desk laughing my head off. Finally the doctor burst out into hysterical laughter and the cat was out of the bag. It was a stupid thing but relaxed us all a little bit and connected us as friends.

St patricks day: I assumed i would have an ER filled with drunk people not an ER filled with drunk Kids?
14 year old female was at a party with her friends and someone brought alcohol. She drank and drank and drank. A neighbor went by the house to check on them and found this young girl passed out drunk. She called 911 and they transported her immediately to us. When she arrived she was pretty much unconscious and had a Glasgow coma scale of 3/15. That pretty much means that she was close to falling into a coma state. She was hypothermic with a temp of 95 degrees and was unresponsive. We jumped into action and since I was in the pediatric ER that night, she became my patient. Intially I had to place a foley catheter in her to make sure we could monitor her urine output. We placed 2 IV's in her arms ready to fill her with fluid and blood if need be. I tried to get her to respond to me but all I got was mumbles. I called the parents and they arrived shortly thereafter. They were so shocked to see their young daughter with tubes in her and hooked up to so many machines.
They asked me " will she be okay? will she survive?". I mean, what do i say? I assumed she would survive but you can't say that. I just simply said " this is gonna be a long road but we are gonna do our best to help her have a full recovery". The parents stayed with me the whole time. I heard the daughter repeatedly mumble.." i had to do it mom, i needed your attention". Then I heard the kicker: "i've been cutting myself mom, you never noticed". The mom said " shhhhh , what are you talking about". I got the sense the mom didn't want to hear it and didn't want her daughter to be looked down upon. I inquired more and got the daughter to show me the cut marks on her wrist. It was in that moment that I knew I had to "Baker Act" her.
BAKER ACT:  The Baker Act is a law in Florida that allows mentally ill people to be committed to a mental health facility for 72 hours, against the will of the patient.

I told the doctor and we got the ball rolling. I stabilized the patient, called report and transfered her up to the pediatric ICU where they can give her more one on one attention. After the time in the ICU she will be sent to a mental health facility where she can get some treatment and hopefully stop cutting and hurting herself. Who knew a drunken st.paddys day party could turn into something so life changing for this young lady. Note to self: 2 drink max on the next irish holiday ;)

until next time.............
be safe and healthy
love you all
Emma xo