Saturday, October 29, 2011

Top Five Things I Love as an ER Nurse



I love being an ER nurse. I got into Nursing because my family wanted me to. I was one of the lucky ones who actually learned to love being a nurse , and to love the profession even after 20 years of ER nursing. Nursing in the USA had given me great financial rewards and had allowed me to help my family at home.

But, I would not have remained a nurse if I was miserable in this job. So I find it annoying when I read about too many complaints and regrets about the profession. Whenever I read anybody bashing Nursing, my first question had always been: “Why stay any longer?”

Some nurses vent their frustrations (understandable) of not finding a job after nursing school and of their righteous indignation of being exploited as "paying" volunteers (total contraindications). Nurses in the Philippines deserve recognition for their service despite the "horrendous" situations in most of our hospitals.

Some nurses may actually find out that they don’t like being a nurse. That’s fine; that’s perfectly acceptable. Not everyone is suited to be a nurse. They may be a perfectly decent and compassionate people, but Nursing may not be for them, period.

But please do us a favor: just leave nursing to those of us who’ve found a niche in whatever field we’re at. Do not enumerate all the reasons of your disillusionment, because by doing so, you are merely mocking the profession that had actually brought happiness and fulfillment to most of us.

Have you finally realized that you'd rather be anyone else but a nurse? Then, just GO! Take a deep breath and move on to whatever your heart desires. Follow your non-nursing dreams. Make your choice and don’t drag down your fellow nurses with your negative vibes.




Life is challenging enough to be working alongside a person who does not share the passion. It is a disservice to the patient if we stay for the wrong reasons. The patients deserve nurses with service in their hearts; who care for them because they love to and not because they love the money or because they were “forced” to. If I were a patient, I would not want a nurse who think only of her overtime money and who could care less if I need any pain medication.

We’ve come into the Nursing with our eyes wide open. Our parents must have nudged us with visions of jobs abroad but I doubt it if they promised us a rose garden. Nursing is hard work and entails many sacrifices. It meant that my life would not be as glamorous like if in show business but I rolled up my sleeves, and got to work. I accepted that the uniform does not pave the way for a life in the limelight, of high fashion and easy money.

For once, I was too brusque to a nurse who whined about all sorts of things. I turned to her, and asked, “Then, why are you still here?”. I realized later that she was burned out, but I just did not want to be sucked into her miserable existence. The negativity was burning a hole in her personality that it was a torture to have her around.

After all these years as an ER nurse, one would expect a sense of disillusionment, or burn-out. But instead of waning, my passion for emergency nursing is burning in its intensity. When you find the nursing field that you’ve been looking for, any other department is inconceivable. And I realized, it is a double blessing when you enjoy the work you do. Nurses make a difference.

Here are top five things that I love as an ER nurse:


1. Variety is the spice of life- No two days are the same. There is no such thing as Ground Hog Day. But there are many instances of deja vu. It’s like a different flavored ice cream every day.

A staff nurse has different assignments and sometimes can be switched to different positions in a single shift. Every single day is an adventure, sometimes overwhelming but never boring.

You never know what will come through the ambulance doors. It is when it is too quiet that we scratch our heads and our hearts flutter because surely, something dramatic will come. We should always prepare for the unexpected. We should always be on our toes; this is not a place for the faint-hearted.

One day, a small dog wandered over to the ER with a splinter on his paw. Another day, a woman protested too much, “I’m not pregnant. I’m just fat.” Moments later, she squealed and out came a baby.

2. Organized Chaos – The ED is always overcrowded and it is gridlock time. Grand Central Parkway at 5pm. Stretchers next to each other. Any floor nurse who visits the ED would be horrified at what they perceive as a chaotic environment. An ER nurse knows that although the activity level is frantic, the staff knows what to do.

And there is organization amidst the din; there is controlled chaos. The adrenaline rush sustains the nurse as she flies from one patient to another; her focused and determined look means that she’s managing her time as best as she can, so please get out of her@%&*@ way.

3. Interesting Patients/ Funny moments- A nurse will never run out of amusing stories to tell.

After a snow blizzard, EMS transported a patient using a snow sled. An inebriated man pushed his compadre to the ED on a grocery shopping cart and told the nurse stoically, “my friend needs help.”

A trauma patient came in after a motorbike accident with a fractured leg; he was totally covered with tattoos. His eyebrows, nostrils and lips were pierced. His genitals were covered with his brand of art. But when he saw the 14 gauge angiocath, he screamed in fear.



A clergyman came after a freak accident with a cucumber lodged where it doesn’t shine. We keep a running tab on what’s the weirdest thing we found in any body cavity. Such is the life of an ER nurse. We live for the simple pleasures.

4. Inspiring people-
I get inspired by colleagues who lead by example: they spend their vacations on charity missions abroad. They spend their own money to go to Haiti or Guatemala. They come back with appreciation of their ability to touch lives.

And then there’s this nurse who worked cheerfully while struggling with a brain tumor. Her patients never knew that the nurse who comforted them needed comforting herself. But she persevered and gave her patients her very best.

There's another emergency nurse hero who continues to astound her army of supporters with her incredible determination as she fights for her life against the Big C.

Several of my fellow nurses were stuck inside the hospital when the blizzard rendered all roads impassable; they gamely took care of the patients. Some of us trudged through snow banks that were taller than us just so that we can relieve those who have worked before us. They’re our family.

5. Emotional rewards- It might sound too corny to some, but it is rejuvenating to see that you’ve made a difference.

Let me count the ways: you correctly triaged a patient with altered mental status as hypoglycemic; you assisted a battered woman find shelter away from her abusive husband; you monitored your stroke patient’s vital signs and now he thanks you for your help. You found the time to listen to your elderly patient who missed her loved ones who never visit. You helped deliver a baby.

We may not always get a Thank You, but when a patient gets better because of you, that’s good enough for me. That should earn us points in heaven.

I’m counting my blessings. I enjoy my work . I am an ER nurse.











Monday, August 8, 2011

The Great Escape





Tim slowly opened his eyes when he heard the door close. His pretend snores must have convinced the nurses to leave him be. He heard one nurse remind the other not to tie his wrist restraints to the bed side rails but to the metal support under the stretcher. This time, they left his boxers and socks on, and his feet unrestrained. Since he is an ER regular who loves his beer too much, he finally caught on to why the nurses always dressed him up with the "green gown". It was meant as a signal to all that he is an escape risk.

I need to leave. I need to escape, Tim muttered this to himself like a mantra.

Earlier, his cute nurse fiddled with the EKG leads on his chest and the heart monitor beeped with the now-familiar rhythm. She looked young and naive; her look of concentration as she applied the restraints belied her nervousness as she tried to imitate the confident efficiency of her preceptor.

"You must be new here, aren't you?" . Tim loved it when the newbies flinched as he growled and trashed in his bed. They quivered in fear, probably debating how long they would stay in the profession. Sometimes, when he is in the mood, Tim would put on a tantrum, his language as colorful as befitted the occasion (and most especially when the hospital police are nowhere to be seen). But there's another nurse named Josette who looks so sweet but could really shock you with her colorful string of curses.

Of course, he needs to maintain his reputation as the Obnoxious Drunk. The louder he is, the more the newbies scramble to give him extra helping of sandwiches and apple juice. On a really good day, he gets a hot meal during dinner time, then gets another one after a shift change.

Hahaha. This ER is so much fun. That's why he did not mind when the EMS used to bypass another private hospital to drop him off to his favorite city hospital. Here, everybody knows his name.

The senior nurses already know his modus operandi. While a junior nurse would try to cajole him into submission by giving him food, the senior nurses just raise their eyebrows at him, and quietly display the cloth restraints out. Those tough girls would not hesitate to slap a four-point restraints on him at a moment's notice. These nurses mean business, especially that night nurse named Tina. One look from her and he shuts up. They've come to an understanding: if he calms down and just sleep off his intoxication, she would leave him alone and she might even give him a cup of Colombian coffee that her Juan Valdez- look alike boyfriend brings her.

The "Banana bag" was infusing through his left arm vein. For some inexplicable reason, nurse Jackie (no, not that one on TV) had taken a liking on him. One night, while she was cleaning off a laceration on his hand, she started to educate him about the multivitamins in his intravenous. Now, he knows that the "banana bag" means he's well-nourished.

I got to go. My friend Dolly is waiting for me in the park with the Chivas Regal that she claimed that her boyfriend Frank gave her.

Tim looked up and found his salvation.

A hole in the ceiling. Yes!!! All that he had to do is get out of his restraints, retrieve the clothes bag under his stretcher and run for his freedom. But he needed to go up the ceiling because his jailor Tina would surely catch him if he tries to sneak out from the waiting room.

Tim flexed his hands. How smart of him to rub petroleum jelly on his hands just before the police picked him up from the street. He's not known as Houdini for nothing. Just a couple of tugs and he got out of his restraints. Next, he pulled out the intravenous on his arm just like how the nurses did.

Uh-oh, no time to dress up. He saw one of the doctors coming to his room, but thankfully, she was sidetracked in deep conversation with another nurse.

It's now or never. Tim stood up on the stretcher and started to climb up through the hole in the ceiling. Darkness awaited him but Freedom was within reach. He lifted himself up on shaky legs but he felt the green gown rip on a nail stud. Unbelievable, he was stuck! His legs were dangling in the air and his much-maligned derriere was in full display when Dr. S came through the door.

"Gotcha!"





* The names had been changed to protect the innocents (wink).

Tuesday, June 7, 2011

Till We Meet Again



What a journey it has been.

I said I will only be staying for two years. Like all others before me, I stayed longer and now it took twenty-one years for me to leave this place that I have grown to love. Elmhurst grabbed my heart and refused to let go.

It is a lifetime of memories. Through the years, we've created a kaleidoscope of special moments and bonded with a team of nurses, doctors, and support staff. Together, we've pulled through stressful times of overwhelming patient volume, poor staffing and personal differences.

I looked around the ED and marveled at the changes in the landscape, both in the physical environment and in the personnel who staff the ED day and night. The ED had changed but what remains true is that we are entrusted the responsibility of caring for others who are more vulnerable and unfortunate than us. To be able to spend your life in service of others is a blessing.

I started as a novice ED nurse who trembled every time I heard the red EMS notification phone ring and evolved to be a confident and knowledgeable nurse due to my multi-faceted Elmhurst experience. What's more important to me is the knowledge that I have made a difference.

Thank you for being a part of my journey. I will forever treasure the shared reminiscences and your kind words and expressions of support. It makes me happy to be appreciated by those who matter.

And now it is time to explore the world beyond these four walls and to create more memories in another hospital as their new clinical nurse specialist. Although I will be leaving a piece of my heart, I know that this new road will bring new opportunities for professional growth for me. If I made it here, I can make it anywhere.

To paraphrase Oprah, No sadness from me, I look forward to the next chapter in my life.

And when our paths will cross again, I expect to get a tight hug from you. Till we meet again.


Sunday, April 10, 2011

The Mule



Revised version as it appears in Nursing 2012, November 2012 edition.



1993, New York.

The elderly Filipino woman was shaking when she was brought by the EMS paramedic to Triage. She clutched my hand, pleading in silence.

The EMS paramedic bypassed the other triage nurse and zeroed in on me, correctly guessing that his patient and I share the same ethnicity.

“We picked her up at the airport,” he told me. “Her plane had just arrived fromBrazil. The flight attendants noticed that she was very agitated and crying uncontrollably. It seems she’s traveling alone, but she won’t talk to us.”

Anybody’s grandma

She was in her late 60s, with gray hair and a stooped posture; she looked like anybody’s grandma. In fact, she looked a lot like my own departed grandma. She held tightly to her purse and her eyes filled with tears. My initial reaction was to pat her shoulder in a gesture of comfort. As I rubbed her back, I felt her tremble.

At that moment, two men in suits appeared and handcuffed “Grandma” to the stretcher. The narcotics agents informed us that she was suspected of swallowing condoms of cocaine and she had to be isolated from the general population. They planned to wait for her to pass the condoms. I hoped that the cocaine packets would remain intact. Rupture of the packets would result in severe intoxication, seizures, and death.

Her story was all too familiar. She was a drug courier—or, in the colloquial term, a “drug mule.” But she was much older than the couriers who’d come to our ED in the past. None of the other couriers I’d seen looked like “Grandma.”

In my naiveté, I wasn’t prepared to think of the possibility of my patient as a drug mule. As I looked at her in disbelief and disappointment, she averted her eyes. Thrown off by my preconceived notions of what a drug mule should look like, I couldn’t help but ask, “Why?” She kept her eyes closed, but tears ran down her cheeks.

The agents were frustrated with the lack of information. “We need to find the people who contracted her to carry the drugs,” they told me. Their interviews with the patient were met with silence. She looked afraid; she provided all the demographic data for the registrar but refused to give any contact information. Maybe she didn’t want to give any information for fear of repercussions.

Taking a turn for the worse

Suddenly she grimaced in pain as she pressed on her stomach with her free hand. Alarmed, I yelled for the physician STAT. The patient’s BP was rising and her heart rate was racing. I was afraid that the cocaine packets had burst inside her.

“How many packets did you swallow? Tell us, please!” The patient hesitated, but as she squirmed in pain again, she mumbled, “Ten.”

The next few minutes were frantic as we prepared to send her to the OR for exploratory surgery. We were racing against time.

As she was wheeled out of the room, she turned to me and said, “I did it for my family.”

No room for preconceptions

“Grandma” didn’t survive the surgery. As we later learned, she died because she needed money to pay for her daughter’s cancer treatment back home.

Although we’d expected it, the news of her death affected the ED nurses who knew about her story. Our stereotypical image of a drug mule shattered, we were also touched by her sacrifice for her daughter.

To what extent would you go to help a loved one? we asked ourselves. How tragic that our patient felt trapped by her circumstances and fell prey to the drug lords who took advantage of her need.

I learned an important lesson that day: No patient is stereotypical; as unique as we all are, we respond differently to the chaos in our lives. There’s no place for preconceptions in nursing. We should be able to rise above our personal feelings and take care of each patient the best we know how, without passing judgment.



Sunday, April 3, 2011

My Favorite Things




I said I will only be staying for two years. Either I am a glutton for punishment, or just have an insatiable lust for adrenaline rush, or I really do love the ER. Twenty years later, the ER had taken a stronghold on me and I would never ever think of going anywhere else.


These are my favorite things:

1. EXCITEMENT GALORE- Nothing boring about ER. Every day offers something new and surprising, or out of this world. Days pass quickly, and however we try to manage our time, there's always something that needs to be done (including a bathroom break).



2. QUIET INTERLUDES, although infrequent, and temporary, are greatly appreciated and much-needed after a hectic day. Empty stretchers in the hallway are a welcome sight. This precious respite from the usual bombardment of patients allows time to sneak to the bathroom, catch up on each others' lives, and the chance to spend more time with our patients. Grab the moment to breathe because it means that a busload of patients are coming soon to break the peace.




3. HAPPY DRUNKS make up for the aggravation of having to fight off the nasty drunks. One day, a happy drunk masqueraded like a Luciano Pavarotti. His booming and impassioned O Sole Mio was surprisingly well-modulated and brought a smile to everyone, including our Alzheimer's patient, who stopped squirming in his stretcher. Somehow the familiar melody broke through the cobwebs of his mind, and he joined our happy drunk in total harmony.



4. LIVES SAVED We lose some, but most of the time we snatch patients from the brink of death. A 17-year old patient should have been a vegetable after a cardiac arrest, but we cooled him down and saved his brain. Five days later, he walked out of the hospital with full neurological functioning, ready to plan dates with his girlfriend again.



5. A SOILED METS CAP. A 9-year old boy felled by a direct blow on his chest from a baseball. He recovered from Commotio Cordis and came back to the ED to thank the staff. Pedro was in full Mets uniform, his blood-stained Mets baseball cap clutched in his tiny hands.



6. THANK YOUS.- A hurried discharge from a harried doctor left a patient and her family bewildered and frustrated. I spent just a few minutes to explain the discharge instructions. And I got a hug and a sincere thank you.



7. BULGING VEINS. Nurses always have a euphoric response to bulging veins, the ones which bulge before you even apply a tourniquet. No 22-gauge angiocathethers, no need for a vein probe, no need to call our vein expert. Just that quick pop, a gentle slide into a vein and Yes, you're home.




8. ELDERLY COUPLE HOLDING HANDS. The hopeless romantic in me triumphs at the sight of one elderly couple who held hands as they patiently waited for the ambulette we ordered to return them home. The husband comforted his wife with the sprained ankle. He catered to her unspoken needs. The wife soothed the husband who was getting impatient with the wait. I enjoyed watching them, even as I felt envious for the experience of spending a lifetime with a soulmate.



9. BABIES. Sometimes, babies are too eager to see the world and could not wait for the delivery room on the 5th floor . When the mother announces. "The baby is coming out!", the ED stops in anticipation and waits with bated breath. When the baby wails, the staff breaks into applause and coos as the baby is placed in incubator. Always a happy sight. We've seen enough deaths, so a new life reaffirms our purpose in being.



10. TEAMWORK. When the going gets rough, the ED staff gets going. Way past their scheduled off if the ED gets a call of a mass casualty. We trudged through several feet of snow, dodged drunks along the way, and stumbled through black-out streets. We held hands as we gasped in disbelief and watched helplessly at the horrifying scenes of 9/11 as played on tv. And then together as a team, we prepared the ER for the victims who never came. We hugged each other, and worked side by side to care for the rest of our patients.

Saturday, February 26, 2011

ED ODD



As if medical stories are not weird enough: Harlequin syndrome, asparagus pee smell, brain surgery via the eye socket, jeggings and yeast infection, coffee-induced strangling, steak-caused positive drug result, 'hormone of love' or 'cuddle chemical', and "sphenopalatine ganglioneuralgia" or brain freeze.

And now, Botox to cure vaginismus? I guess smoothing wrinkles takes a whole new dimension,huh?



Truth is stranger than fiction, and it has never become truer than in the ED.


Patient: "An animal went into my ear, it's now in my brain."
Doctor: "What kind of animal will go inside your brain?"
Patient: "You're rude. My left brain does not want to talk to you."
Doctor: "Can you tell your right brain to talk to me?"


At triage...
Patient: "I looked at the mirror and saw a blinking eye on my left butt."
The nurse thought the patient was crazy, but the patient insisted in being examined.

So the nurse and the intern took the patient to the room and looked at the patient's butt in question.

An eye blinked at them.


On a trip to South America, an insect had burrowed itself on the patient's butt.
(story by D. Dillon)



It's important to follow directions.

A patient bought an over-the-counter topical genital enhancement product from a neighborhood store. He did not follow directions. Instead of just rubbing the ointment, he ingested two doses in preparation for a date. He did not know that the Atropine effects would make him very, very sick.

He died the day after.



Toxic Sock Syndrome- when your patient's socks had melted into the skin, and the smell travels all the way to the hospital lobby. The patient is oblivious to the suffering around him. The staff tries to hold their breaths and waits anxiously for their shift to end.




Toxic Tampon syndrome- when a first-time user thought the tampon will absorb on its own.

Wednesday, February 2, 2011

SURPRISE!!!




Expect the unexpected. Brace yourself for a day of wonderment and what-the-hecks... of jaw-dropping and head-scratching incidents that defy explanations. You think you've seen it all?

Surprises abound in this place. And we love them. Not a 9-5 job where you can pretty much expect how you'll spend your day.

Huh, Welcome to our Emergency Department.


At triage...
Patient: "I swear I'm not pregnant. Shouldn't be. I'm on the pill. But my belly hurts soooooo much!"
Nurse: "Let me just put you on the stretcher."
Minutes later, the patient screams, the nurse lifts up the sheet, and finds a baby on the stretcher.
SURPRISE!!!


Nurse: "Miss, can you please give me some urine for a pregnancy test?"
Patient: (Giggles) "You're so kind. I'm really a man. "
SURPRISE!!!





Nurse: "Your son just went to x-ray, ma'am".
Woman: (outraged) "Excuse me, that's my husband."
SURPRISE!!! (awkward, too)


Undressing a homeless patient then finding wads of twenty-dollar bills tucked away in his underwear. Total amount = $10,000.
SURPRISE!!!


Foreign body in rectum, all types, all sizes.
SURPRISE!!!



December blizzard 2010... EMS brought a patient on a sled.
SURPRISE!!!



Patients help each other. An intoxicated patient was carried into the ER on a grocery cart by a similarly-ETOH intox friend.
SURPRISE!!!




The nurse heard grunting from the other cubicle. Thinking "Molly" (one of our ER alcoholic regulars) was in pain, she drew the curtain. Molly and her boyfriend were in a compromising situation. So much for privacy.
SURPRISE!!!


http://nurses.definitelyfilipino.com/index.php/2012/03/surprise/

Saturday, January 22, 2011

Goodbye, Kettly



Emergency Department... a place where we see deaths up close and personal. The ED staff who choose to stay do so because they love the rewards that come from saving lives. We are hardened (crazy) souls who have accepted life's realities. But it is difficult when you lose one of your own.

Today, we said goodbye to Kettly.

Through life’s ups and downs, Kettly managed to smile her way into her fellow nurses’ hearts. She reveled in the deep friendships that blossomed amidst stressful times in the ED. As she struggled with illness, she persevered and impressed her hospital family with her indomitable spirit of resilience and tenacity. Her easy wit and sense of humor brightened our days as we all commiserated with each other at the end of each day. Kettly cared for her patients, even as she needed caring herself. She offered hope.

It is difficult to imagine that the once-vibrant nurse who delegated cooking duties like a drill sergeant for the holiday party is no longer with us. Could she have been preparing us for her untimely passing by creating special memories of friendships and by showing us the value of team work? Did she realize that the new triage nurses would remember the words of encouragement she gave them on her last day in the unit?

As she held her family in her heart, she reserved a special place for her hospital family.

Last night, we gave Kettly a White Rose tribute and showed our appreciation by honoring her with our Nursing flag. The nurses, all dressed in white, stood en masse in solidarity with a few of our colleagues who struggled to read lines from a poem written by another nurse:

To witness humanity—its beauty, in good times and bad, without judgment,
She was there.
To embrace the woes of the world, willingly, and offer hope,
She was there.
(“She Was There” is copyrighted by D. Jaeger)


Kettly, we will miss your carrot cake, your de-boned turkey, and your words of wisdom. But most of all, we will miss the nurse who showed us quiet strength and resolve through adversity. We will miss your regal presence.