Fathers

Patient: So, what made you want to be a nurse? Did you follow in the footsteps of your parents?
Jake: Nope, neither of my parents worked in the hospital.

Enter Doctor

Jake: No, my Dad was actually a minister.
Patient: So, what did your father do, Doctor?
Doctor: He was a renderer

Unheard and Unsaid

Patient: My chest really hurts because of all my coughing.
Jake: A good sign you should stop smoking.
Patient: I have been hospitalized multiple times this year because of my asthma.
Jake: Probably the smoking.
Patient: Oh my god I just feel so terrible, the respiratory therapist says my flow meter results are too low.
Jake: What? With all the smoking? Really?

...

Jake out loud : So, have you thought about quitting smoking?

Pass

The first one I wasn't as worried about. Sure, a little worried. I would have paged the doc if I hadn't known he would be here in an hour to see her.

He came by. He offered nothing. Left before I could talk to him. But what would I have said?

"Hey man. Doesn't she seem a little rough? Can't we do something?"
"Absolutely Jake. I got you. This patient was about to go down the tubes, but your accurate, yet totally nebulous concern saved her!"

An hour later the call light went off. I had just been in there fifteen minutes ago talking with her. Stuck my head around the door five minutes later, but the NA was there. I mean I know when the fucking train is coming. I have my ear to the ground.

Call light. Open the door. She is gray. I mean just gray, man. Shit.

I yell at her. Grind my knuckles into her chest. Her eyes flutter, maybe she groans. Quick assessment yields steady heartrate, BP holding, oxygen...oxygen is for fucking shit.

"Give me a bag!" "Call a rapid!" I can bag her up I think. I've bagged people up before. You just shove that mask on her face and squeeze 100% oxygen into her lungs.

The first rapid nurse comes in the room says/thinks "Oh, shit" and hits the code button. 5 docs and 7 nurses show up a heartbeat later.

We wait, respiratory therapy bags her up to a passable oxygen level. Blood Pressure keeps holding, Heart Rate steady. But she won't breathe on her own. We ship her off to the ICU to be intubated. I could have bagged her up by myself, but it wouldn't have done any good.

One Month Later:


Today, I'm definitely more worried. I take one look at the patient and wonder where the fuck last night's nurse wandered off to. Are you kidding me? Is this how she is? Cause this sucks.

Outside the door sits the doctor. We talk. Sure she is a little worse than yesterday, but that nursing home transfer is just a little away.

Hooookay then, I will page the respiratory therapist, hope that sorts her out. And why do I worry so much, am I a baby or what?

An hour later. Call light. I have a bad feeling. Why? I don't know. Or are the two events so close in my mind that I assume I had the premonition? Call lights go off all the time. Why did I think this woman was in critical condition?

I wasn't surprised, so I could act instantly. This time wax. An empty yellow. I see her take a breath:

Agonal respiration is an abnormal pattern of breathing characterized by shallow, slow (3-4 per minute), irregular inspirations followed by irregular pauses. They may also be characterized as gasping, labored breathing, accompanied by strange vocalizations and myoclonus. The cause is due to cerebral ischemia, due to extreme hypoxia or even anoxia. Agonal breathing is an extremely serious medical sign requiring immediate medical attention, as the condition generally progresses to complete apnea and heralds death.

I only need to see one. I think it takes me three seconds to assess and hit the code button. People start running.

"Its real!"

Before I know it the room is full. So full I can't get to the computer, can't really even touch the patient. The code team is at work. My friends are there, skilled critical care nurses. They run the code like heroes.

"How are you doing, Jake?"
"Oh, geez, you know."

And I think they do.

They work for 20 minutes. But then that is it. She passed.

Contributing to Council

Council Member: So do we have any ideas for the Float Pool T-shirt?
Jake: Float Pool. We do it anywhere!
Nicole: Bwa-ha!

Critical Value

Phone rings

Nicole: Hi, this is Nicole.
Lab: Hi, this is lab calling to report a critical value. Jacob Heath's Blood Alcohol is too low.
Nicole: Jake, you're such a nerd.
Lab: I know.

Nursing Humor

Laughter is a transformation of fear. It first started as an easy communication of misinterpreted danger. When the tribe was grabbing the sharpened sticks for the saber tooth tiger in bush, it was the sharp eyed scout who laughed when he saw a fox instead. Everyone soon laughed with him. Phew, tension released. The biological feedback system worked beautifully. Now our culture uses it to relax after hard stress filled days at the office. Look how Cliff reacts to Theo's haircut! Hah! Don't I feel better.

I guess I do similar things in the hospital. I never thought about the weird shit I say.

"Wow, I gotta thank you. I thought I was going to finish cardiac floor education without doing any medication drips. And just in my last few hours I get to do three with you! Whoo!" I smile and chuckle. He smiles a little feebly. Because he is tired, and no matter my enthusiasm, it isn't very funny.

It was rough there for awhile, though. Blood pressure was 60/15. His body instantly covered in sweat and all his color drained from his face. There were four nurses in there taking vital signs every 5 minutes adjusting the heart medications and fluid bolus to get oxygen perfusing around his body. Four of us at his bedside, staring at the monitor.

You should be worried if your nurses aren't telling any jokes.

Cowboy

Mr _____ was the nicest guy. Everyone warned me though.

Day 1
Nurse: How is Mr ____?
Jake: Oh, he is great. Totally nice guy.
Nurse: Really? Cause yesterday he totally freaked out.
Jake: Yah. I heard. Weird. He is with it right now, remembers me, alert and oriented x 3 (person, place, and time). It's funny, he is my easiest patient right now.
Nurse: Huh, O.K.

Day 2
Jake: Hey Mr _____ , I just wanted to say it was great to have you as a patient. I hope you do well, I may or may not be your nurse tomorrow. That is how it is in the Float Pool.
Mr. ____: I appreciate it, Jake. I have been very comfortable. Thanks for your help.
Jake: No problem buddy.

Day 3
Jake: Morning! I'm back, how are you feeling today?
Mr _____: Good, pretty good I guess.

He was on a video monitor. It was really there for seizures, being that we were on a Neurology floor. Maybe they threw him there because of his confusion three days ago. The first two days he laid in the bed. Relaxing. I didn't pay much attention to the monitor.

The third day he sat at the edge of the bed. Fingers working the edge of his gown. I went in to check on him. He didn't say he needed anything, but he couldn't quite be made comfortable.

Day 3 Later
Jake: Whoa, hey buddy. Where are you off to all of a sudden? We need you to hit that call light when you get up.
Mr _____: Outta my sonny! I need to go upstairs and get my shaver.
Jake: Ummm, We are on the 8th floor of the hospital. There is nothing up there. This is your room. Anything you need is in the bathroom.

The old man rose with his walker, taking three little wavery side steps to avoid falling. I stuck my arm out and grabbed his shoulder.

Mr _____: Get away from me! I don't know who you think you are. I am going to go get my six shooter and put air through you!
Mr _____: Stop smiling!

up my ass

Jake: Here are your meds. They may not taste so good. They have been in my ass.
Patient: I don't want them if they have been in your ass.
Jake: No, see, remember? You told me to shove your pain pills up my ass. Its a joke.
Patient: ...
Jake: Anyhoo