Spinach milk

When changing my exclusively breastfed daughter’s diaper, I saw small chunks of spinach mixed in with her poop. Staring at it for a moment, my extremely sleep deprived brain thought, “Hmm… makes sense.  I did have a lot of spinach this week.” My husband looked at the diaper and agreed. About thirty seconds went by before it hit me: there were no chunks of spinach in my breast milk. I pointed this out to Mike, and we both stood there, staring at our daughter’s diaper, for over a minute. “How did it get there?” he asked. We both denied feeding her any solid food. “Maybe spinach is so hearty that it was able to reform itself in the milk after it was expressed?”  I’m a nurse, I know better than that, but lack of sleep does funny things to our brains.

Realizing that we were too sleep deprived to come up with an answer, we put a new diaper on her and forgot about it.  Several hours later I sat down at the kitchen table and picked up the newspaper. Here’s what I found:

 

 

 

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Running with Needles

I wrote a novel based on my blog called Running with Needles.  I am currently trying to find an agent so I can get it published. Keep your fingers crossed for me!

Here are the first two chapters of my book, please let me know what you think!

Prologue

Clutching the lifeless baby in my arms, the only response I can utter is, “Oh crap.”  This is not the brilliant reaction I was hoping for.

I wait for my nursing school training to kick in.  Shouldn’t my arms start moving on auto-drive?  But in this critical moment, nothing miraculous happens.

I can’t concentrate.  All I can hear is my heart pounding.  All other sounds in the busy ER are muffled background noise.

Focus, Morgan.  Just focus.

I take a deep breath and lay the baby on the stretcher.  His lips are bluish purple and he definitely is not breathing.

Oh, God, what do I do?

Ok, ABC’s–Airway, Breathing, Circulation.  Start with the airway, Morgan.

Where’s that ambu bag?

I see it on the wall by the oxygen.  I rip the bag from its hook and begin tearing at its plastic cover.  Why can’t I get this plastic off?  I hold my breath as I struggle to free the bag.

I’ve got to stop shaking or this baby is going to die.

“Code blue,” I hear myself scream as I bend to pick up the bag, which I managed to drop on the floor.

People are running towards me but they appear to be moving in slow motion.

With the bag and its matching infant mask in hand, I bite my lip as I try sliding the pieces together.  Where does this mask attach?  I’ve practiced this a hundred times, but now when it actually matters, I can’t figure it out.

After pausing a moment, the answer becomes obvious:  the tube on the back of the mask slides over the smaller tube on the ambu bag.  The mask fits snugly and I turn on the oxygen.

As my trembling hand squeezes the bag, I see the baby’s chest rise from the oxygen being forced into his fragile lungs.  I feel myself breathing along with him, as if these are my first breaths.

I look up and see his mother waving her arms in the air.  “Mi bebé! Mi bebé! Ayuda!”

What?

The trauma team rushes past her into the room.

Has she been screaming in Spanish this whole time?

One of the trauma nurses places her stethoscope on the baby’s chest.  She shakes her head, “No.”

Using two fingers, the nurse begins pushing on his chest.  It easily collapses with each push.  I continue giving him breaths with every squeeze of my hand.

Feeling a touch on my left shoulder, I turn to see another trauma nurse.  She places her hand over mine on the ambu bag and I step away, letting her take over.

I take a few steps away from the bed and watch the scene in front of me.  I feel like I am watching a movie, as if I am not really here.  My skin feels clammy and I am sweating.

Walking backwards through the door and into the hallway, I find the nearest trashcan and start to vomit.  The ER swirls around me.

I sink to the floor beside the trashcan and rest my head on my knees, sobbing uncontrollably.  Why did I want to be a nurse?  What had I been thinking?  Real nursing is nothing like they show on TV.

As I sit here on the ER floor, unable to process everything going on around me, I long for the days when I was a student nurse and had no real responsibility.  Those days were easy…….

CHAPTER 1

It’s 7:00 am on my first day of clinicals, where unsuspecting patients will replace the mannequins I have been practicing my nursing skills on over the past few months. My classmate Danielle and I hurry down the hallway towards our patient, Rose Abram’s, unit.  We were both up most of the night learning about Rose’s medications, medical history, lab results, and devising a plan of care for our day with her. Although we realize that Rose is an extremely sick patient, we know we will be able to impress the unit nurses and our instructor. If it weren’t for the “Student nurse” on our ID’s beneath our names, no one would be able to tell we weren’t real nurses.

As we enter our patient’s wing on 6 North, the adult medical/surgical unit at St. Peter’s Hospital of Kansas City, Danielle says, “Can you believe how much Morphine we are supposed to give her?”

“No. I was more worried about her lab values, did you see her hematocrit?”

We pause and face each other. I whisper, “Are you ready for this?”

She shakes her head, “no.”

“Me either.”

Our pace slows, as if walking slowly will somehow save us from the inevitable:

entering a patient’s room for the first time.

We reach Rose’s room, raise our eyebrows at each other and open the door.
But we don’t go in.  There are several nurses standing around our patient’s bed.  What is going on here?  We are too nervous to move closer.
After a while, one of the nurses says, “Rose passed away a few minutes ago.”
Danielle and I look at one another, wide-eyed.  Our first patient is dead and we haven’t even touched her.  Is this some sort of cosmic warning?

We remain frozen in the doorway, like extra pieces of furniture.
After a few long minutes, one of the nurses motions us over.  “Have you ever done post-mortem care?” she says.
We’ve never done pre-mortem care.  We shake our heads “no” in unison.
“Come with me.”  The nurse motions with her hands.
We follow her to the bathroom.
“Fill this with warm, soapy water.”  She places a small pink bucket in the sink.  “Bring the lotion from the patient’s drawer.”
She rejoins the others, leaving us looking at each other in the bathroom.  This is all a bad dream.  Just a bad dream.  But it’s not going away.
We hurry and find the nurse alone, waiting next to the bed.  She holds a few folded wash towels.
She has a hardened face with dark eyes.  Without a word, she soaks and wrings her cloth in the bucket Danielle is holding.  She pulls the blankets off of Rose and begins cleaning her face.
We snap out of our daze and follow her lead.  I lift the woman’s arm and wash her shoulder.
Silently we work.  I feel my frustration level rising.  My first bed bath is on a dead person.  Does anything seem wrong with this picture?
With the three of us working, we finish the bath in only a few minutes.  But we’re not done.
The nurse holds out her hand.  “The lotion.”  Her tone isn’t bossy, but cool and efficient.
We both hold out bottles for her.  She takes Danielle’s, squeezes a drop on her palm, and returns it.  She uses her fingertips to rub the lotion on the patient’s face and neck.
I uncap my bottle and work on the woman’s shoulder and arm.  The lotion is sweet-smelling and cool, an eerie contrast to her fingers that are still surprisingly warm.  I hurry on to avoid thinking about it.
As I am rubbing the lotion into Rose’s hand, I feel a sensation that shakes me to my core.  Her finger twitches.
I scream.  I leap away from the bed and look down to see if I’ve peed myself.
Thankfully I have not, but when I look up, every eye in the room is locked on me.
“She moved.”  I point accusingly at the dead woman.
The nurse laughs.  “It was probably just a reflexive twitch, or you hit her tendon while you were rubbing her hand.”
I can feel my cheeks burning.  I want to throw my unused stethoscope at the nurse, storm out to my car, and stop at the nearest McDonalds for a job application.
But for some reason I don’t.  I clench my teeth and smile, squeezing out another line of lotion for the hopefully-dead woman.
I fume over how unfortunate Danielle and I are.  Why do we have to get the dead patient?  We are supposed to be learning important skills:  taking vital signs, giving injections, being good nurses.
Just keep working, Katie.
As we finish combing Rose’s hair, two men from the morgue enter the room.
“Not yet.”  The nurse waves them outside.
Now what do we have to do?  I can’t believe how much I am missing out on for this.

I roll my eyes and spot a small man entering the room. He concentrates on his steps.  When he pauses a few feet from the bed and looks up, I can see he’s well along, perhaps in his mid-90s. He says, “She looks beautiful.”
Slowly, he approaches Rose and takes her hand.  The nurse pulls up a chair for him.  He sits and pulls Rose’s hand to his cheek, holding it there a few moments.  His fingers run through her freshly combed hair.
“I love you with all my heart, my precious,” he says, kissing her hand, a slight tremble in his voice.

For a moment he is still, hunched over his beloved’s hand.  But then his frail form shakes, and sobs wrack his body.

The nurse springs to his side, hugging and supporting him with one of her arms.  With a familiarity that is instantly apparent, he curls into her shoulder, crying.

In a jagged voice he says, “She was my best friend for 90 years.  And my wonderful wife for 77. The best 77 years of my life.”

The pain in his face is unbearable to watch.  I wipe my eyes.

With clear eyes again, I see that the man is looking at us over the nurse’s shoulder.  Staring.  Silently he nods and mouths the words, “Thank you.”

Like a spark, it hits me:  I haven’t missed out on anything at all.  In spite of my impatience and pouting, I am witnessing and even playing a small part in something unfathomably important.  Here is a couple married for 77 years, I am watching their final good-bye.

I try to hide my own tears, but can’t.  I stare at the marks my tears are leaving on my scrub top.

Forget about vital signs and giving meds.  That is surface stuff, the superficial details.  Maybe nursing is really about the emotional support, being there when our patients experience the most dramatic changes in their lives:  birth, disease, healing, and even death.  I’ve always known that nurses were needed for the emotional side of patient care, but until today, I had no idea how significant that role really is.
I walk out of Room 616 humbled, with Danielle by my side.

As we walk down the long hallway in silence, I have a new understanding of my life’s work.

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Want to see how it all began?

On the right hand side of the page, under “Archives” click on Nov. 2005 & work your way up to follow my journey through nursing school!

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My accidental confession

My patient was an elderly woman with severe dementia. She had tried to punch my coworker the night before, and frequently refused letting anyone touch her.  I introduced myself as Katie, her nurse for the night. “Why I need a nurse?” she said, eyebrows furrowed.

“Because you are in the hospital, and I am here to take care of you.”

Her eyes got wide and she looked around the room.  “You think this is the hospital?  Girl, this is my home, what you talking about?”

I looked around the room and had a quick decision to make. I could argue with her and reorient her to her surroundings, which is the textbook correct thing to do, or I could make both of our lives easier.  “Oh, I’m so embarrassed.  I get confused sometimes. Yes, we are at your house. Your daughter asked me to come by to check on you. She must really love you!”

She nodded her head. “Yes, my mother does.”

“Well you have a good mother. Is it ok if I listen to you breathe?”

“Sure!”

I did a full assessment on the patient with her full cooperation.  As I finished, she asked, “How many blocks you cover?”

Blocks?  Hmm….  “Eight.”

“You cover eight blocks? Wow! You crazy!”

The next time I came into her room, the question was repeated.  My new answer was six blocks.  This was still too high.  The third time the question was asked, I said, “Four. How many do you cover?”

“Girl, I don’t get paid for that!”

But I do? What did I just tell my patient I do for a living?  I could feel myself blushing.

A few hours later, the question was repeated. “I don’t get paid for that!” I said.

“That’s good.”

While giving report to the day nurse, I made sure to tell her the correct answer to the blocks question was four.  ;)

 

 

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Just an average night shift….

I have a thing for old men.  Well, at least that’s what my coworkers say after one night I will never forget.

My patient, Louise, was an adorable 88-year-old who was recovering from cystocele sugery.  Her husband, Carl, was always by her side.

My shift started off busy, but I made sure to check on Louise frequently.  She had a catheter in and was on a PCA pump, which is a machine that allows the patient to receive narcotic pain medication by pushing a button.

The first inkling of trouble occurred around 3 am.   When I checked on Louise she was wide awake, her husband snoring in the recliner next to the bed. She gave me a strange look.  “Are you having any pain?” I asked.

“No! Why would I be in pain?”

“Because you just had surgery.”

“I’m fine. But I need to use the restroom.”

I checked her catheter, which was draining properly.  “You have a catheter, do you feel like you need to urinate?”

“Umm…  No, I need to have a bowel movement.”

I assisted Louise to the restroom.  The second she sat on the toilet, she snapped, “Get out!”

I understand wanting privacy, but leaving a wobbly 88-year-old on narcotics alone in the bathroom made me nervous. I put the emergency cord in her hand and left the door open a crack.  Her husband was awake and standing next to the bathroom door with me.

The IV pump, which I had disconnected from Louise, began beeping next to the bed. “I’ll keep an eye on her,” he said.

I walked to the bed to turn off the pump.  Suddenly, I heard the bathroom door slam. I turned towards her husband. “Did you do that?”

“No, it must have closed on its own!”

I ran to the door and tried to turn the handle. It was locked.  Our bathroom doors lock? “Louise, are you ok?”

No answer.

I knocked on the door. Pounded on the door.  Yelled her name.  Nothing.

I grabbed my phone and called my coworker Jackie.  We had eight patients on the floor and it was just the two of us.  “Jackie, where are the keys to our restrooms?”  I tried to keep my voice calm.

“Our bathrooms lock?”

This is when I began to panic.

I dropped to the floor and laid my face on the cold, germ-infested tile, trying to peer under the door at my patient.  I could see a gown on the floor, but not much else. Had she fallen?

I called the house supervisor and security.  “I need you right away, my patient is locked in the bathroom and is not responding.”

Minutes later, the house supervisor and two security guards arrived.  They also had no idea that our bathroom doors had locks.  Which meant that they had no keys.

I grabbed my scissors and handed them to the security guard. “Please get this door open now.”

As the guard tried to pick the lock, I continued pounding on the door and calling Louise’s name. She never responded.  I feared the worst.  If we ever got the door open, my patient would be laying on the floor dead.

While all of this was going on, call lights were going off, IV pumps were beeping, and patients were calling my phone.  This is what it feels like to suffocate.

I asked Jackie, the other RN, to do the most important things, and in an Acadamy Award-worthy performance, calmly told the patients who called with simple requests that I was in the middle of a procedure and would be in to assist them as soon as possible.  Once I was done doing CPR on my patient on the bathroom floor.

After what felt like an hour, but was probably more like two minutes of trying to pick the lock, the security guard looked up at me, helpless.  “I don’t care if you have to break it, please get this door open.”

He took the scissors and jammed them into the latch. The door popped open. The house supervisor Fred, the two security guards, Louise’s husband and I were all huddled together to look into the bathroom.

There stood Louise, butt-naked, holding both arms up in the air.  She had disconnected her catheter from its drainage bag (which she was holding up above her head with her left hand), so the catheter was hanging straight down from her, dripping urine. She had removed her IV and had a trail of blood running down her arm.

All of our mouths simultaneously dropped.  Louise slowly lowered her arms, and then raised the right one back up, index finger pointing straight at me.  “Get her away from me, she is trying to kill me.”

Huh?

I saw the security guards’ shoulders shaking as they were attempting to stifle their laughter.

“Please call the police, I would like to report an attempted murder,” she continued, glaring at me.

All eyes turned to me.  I could feel my cheeks burning and I didn’t know if I should laugh or cry.  “What?” is all I managed to say.

“You thought I was asleep.  But I was just pretending. I heard you and my husband plotting to kill me so you could run off together.”

The almost 90-year-old man whispered, “I’m so sorry,” to me.  I did my best to smile back at him.  I will never live this down.  But at least she is alive.

The house supervisor took over, getting her dressed, back in bed, inserting a new catheter, new IV, and removing the PCA.  I had the privilege of calling her doctor at 4 am and explaining the situation to the cranky man.

The next three hours were spent desperately trying to catch up. By 7:00, the woman was back to her friendly self, and she apologized for her accusation. We hugged and I told her to mention her reaction to narcotics if she ever has to have surgery again.

I was still charting when her doctor arrived at 9:00, and although he is a talented surgeon, he isn’t known for being friendly with the nurses, especially ones who wake him up at 4 am.   I was terrified.

He looked directly at me.  “I am so sorry,” I said before he had the chance to yell.

“What, that’s never happened to you before?” he said.

And for the first time ever, he smiled at me.

“Her husband failed to mention that she had sundowners or I never would have put her on narcotics,” he said.

“And Katie failed to mention that she has a thing for ninety-year-old men,” Jackie shouted from behind the nurses’ station.

And so it began…..

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Pharmacology site is up and running!

I was unable to find the pharmacology files my classmates and I made in nursing school, but did find my printed copies of those files. I have scanned them and they are posted for you nursing students here:

http://pharmacologyhelp.wordpress.com/

Now you guys will all buy my book if/when I get it published, right?!  ;)

 

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Whew!

I just realized that in the transfer of my blog when Windows Live shut down, over 400 of my guest book comments were lost! I was heartbroken until I found that I had saved some of them on my husband’s computer.  Now if only I could find those missing pharmacology tables…..

Lesson of the day:  back up your stuff!

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