A Deep Cut

An ambulance brought in a man who had fallen through the glass window of a storm door. The sharp edges of the broken glass made a deep laceration in the crook of his right arm.

The ambulance packed the wound with several ten packs of 4 by 4 dressings. The bleeding slowed slightly, but kept pouring from the wound. They tried direct pressure, but couldn’t keep it constant. Instead, they applied a blood pressure cuff above the wound and like a tourniquet, they inflated it until the bleeding stopped. If they dropped pressure, the bleeding would start again.

The emergency room doctor asked that we slowly deflate the cuff. The bleeding started almost immediately, coming out through the multiple layers of the 4X4 dressings. We pumped the pressure back up to stop the hemorrhage.

 Because this incident happened on the daylight shift, the surgeon on call was in the hospital and was quickly summoned to the emergency department. He arrived in short order. He asked us to slowly deflate the blood pressure cuff. When we slowly released the pressure, the bleeding stared again. We pumped more pressure into the cuff.

We set up a surgical tray while the doctor gowned and gloved. He began to remove the packing from the wound, placing them in an emesis basin. The wound was very deep and wide. He removed five packages of the 4x4’s that the ambulance crew had stuffed inside the gaping laceration to control the bleeding. The cut was almost as wide as the man’s arm.

“Now,” he said. “Let off the pressure of the blood pressure cuff, slowly.”

I had just started to slowly release the pressure when a geyser of blood shot high into the air. It arched about two feet above the surgeon’s head, reached its apex, and started back down towards his upturned face. His eyes widened and he managed to step back out of the way just in time to dodge the descending fountain of blood.

I pumped the cuff’s pressure back up.

“Let’s try that again, but just let it out a bit and stop. Let’s do it in stages.”

I dropped the pressure just a bit and stopped; nothing. Again I eased out a bit more air. A vessel in the wound began to leak. Seeing the general area of the bleeding, he reached into the laceration and pressed on the vessel until he could clamp it with a hemostat.

“ Again.” He said. I eased the pressure a bit more.

We continued to slowly ease of the pressure off the cuff and the doctor applied hemostats until the wound only oozed blood and the surgeon was able to repair the deep laceration at his leisure.

Armed with a sling, a prescription for antibiotics and pain medications, the patient was discharged about an hour later.

Dr. Vandyk was on duty when a woman appeared at the triage area. She had wedged a folded towel between her legs, it was covered in blood. Immediately we thought that she was having a miscarriage and hurried her back to the gynecology examination room.

She was pale and looked like she’d lost a lot of blood. We started an infusion of fluids after we’d established an I.V. site. Another nurse got her into the stirrups waiting for the doctor to examine her.

As we worked, she started to tell her strange story. She said that she and her boyfriend were hiking and decided since the weather was so beautiful outside; they would have sex in the woods. Making a huge pile of leaves, they disrobed and quickly got down to business. When they had finished, for some unknown reason, the boyfriend slipped a knife into her vagina and cut her. They quickly dressed and left the woods. He became afraid when she started to bleed heavily and brought her to the emergency room for care.

 

Dr. Vandyk came in and examined her.  Her vagina was filled with blood, clots, dirt, leaves, and small twigs. The amount of debris inside her vagina required that she be taken to the operating room to do the extensive amount cleaning and debridement necessary before her laceration could be repaired.

After her surgery, she was admitted to our hospital for I.V. antibiotics to prevent an infection. She had a Foley catheter inserted to allow the area to stay dry, clean, and start to heal before she was discharged several days later.

We never learned whether or not she wanted to prosecute the boyfriend or whether stayed with him after she was discharged.

We had a nursing assistant named Kurt. He was a prankster with an extremely wicked and perverted sense of humor. Nothing was sacred to him and his quick mind would exploit any opportunity that appeared. He would go out of his way to play a joke on fellow employees.

Our head nurse on the med/ surg. floor was a short, full figured woman while the assistant head nurse was thin and tall.

When they stood near each other, they looked like Laurel and Hardy. They rarely stood beside each other. They had a mutual dislike for each other. It was only because they had to work together, that they tolerated the other. They worked on the same shift and Karl often played jokes on both of them. He would do something to one nurse that would upset her and made it look like the other nurse had done it. It spurred their rivalry.

The head nurse still wore garters and a rubber girdle. She kept a container of talcum powder in the restroom. She used it to powder herself so she could more easily squirm back into her girdle after using the toilet.

Kurt found out about it and Sara, the head nurse, became the target of his next prank. He pried the cap off her talc container and poured a layer of Ajax powdered cleanser onto the powder in the container. He popped the lid back on and set the talcum back in place on the restroom shelf. He did it on the afternoon shift when the head nurse was off duty.

The trap was set. It lay in wait for the head nurse to come in on the daylight shift the next day.  It waited for her to use it and she did. After she used the bathroom the next morning, she applied her “pussy powder.” That’s what she called it and a few minutes later, she began to squirm. It took the second run to the bathroom before the itching became a nuisance. She told one of the other nurses, “I don’t know what is wrong. Something is making me itch.” She never did find the reason for her itch or that she was again the butt of one of Kurt’s warped jokes.

Dr. Vandyk had developed a very bad habit, besides his constant smoking. In the event that he had to intubate a person, he would not wait to have an Ambu bag attached to see if the tube was correctly in place, he would use his mouth to blow into the tube to watch for the chest to rise. It was a very bad habit.

An elderly, obese woman arrested in the emergency department. She had presented with the complaint of chest tightness. We had started an I. V. and done an EKG when she gasped, clutched her chest, and her monitor went asystole. Asystole means her heart stopped. For whatever reason, the electrical impulses which cause the heart to beat weren’t being transmitted.

Her bed was right next to a crash cart. Dr. Vandyk yanked open the intubation drawer and pulled out a laryngoscope. He opened her mouth and asked for a 6.5 mm endo-tube. Dr. Vandyk slid the scope into her mouth and inserted the endotracheal tube. Not waiting for the balloon of the tube to be inflated, he leaned over and blew into the tube.

I thought I saw the woman’s abdomen move. If the tube is in the esophagus instead of the trachea, air will enter the stomach and not the lungs. The nurse listening shook her head. I placed my hand on her abdomen to see if I could feel her belly move as the doctor attempted to intubate a second time.

He slid the tube down her throat. Dr. Vandyk leaned over for a second breath, before he could blow the second time, I felt the abdomen move. I tried to warn the doctor, but all I could get out of my mouth was “Doc….” before an eruption of stomach contents poured out through the tube. It went right into the doctor’s open mouth. He leaned to the side of the bed and spat onto the floor the woman’s stomach contents.

He spat a few more times saying “Fish!” Pfttt! “Fish!”

You’d have thought this incident would have changed this habit, but it didn’t. Nasty as this incident was, it was not enough to change his habits.

Another incident happened in my days of student training and I have kept it a secret for all these years. It occurred while I was in my obstetrics rotation. One of the doctors decided to do a saddle block on a young woman in labor. The other student nurse who was with me was in her early forties while I was twenty-three.

The doctor eased a long metal tube into place inside the woman’s vaginal canal. Next, he picked up a syringe. Attached to the tip was a very long needle and when I say long, I mean at least ten inches. As he started to insert it into the tube, it made a rasping, grating sound of metal on metal.

I saw movement out of the corner of my eye. The sound was too much. It had caused the nurse beside me to start to faint. Fortunately, she was standing between me and a nearby wall. As her knees began to buckle, I leaned my weight against her pressing her tightly against the wall, keeping her upright. And let me add, I am no light weight person.

There is little more embarrassing than to faint as a student nurse. It is a bane to a student’s name to have “passed out’. It’s not a black mark against your training, but you can be certain you will be teased about it for a long, long time.

I turned my attention back to the procedure at hand and watched the doctor complete the block. He had just finished and had removed the needle and the metal tube, when I felt a stirring of the weight on my shoulder. The wilted nursing student began to rouse. She shook her head, once, twice and then reclaimed her weight. As she straightened up, I leaned away from her as she stood back onto her feet.

A few seconds later, she leaned close to me and whispered into my ear, “Thank you.”

It was something that I never shared until now.

During my internship at the same hospital, a rather slovenly woman came to be treated for a sore throat. She was obese and her clothing was filthy and stained. She smelled and needed a bath. The thing that made her stand out was her unusual appearance. Her neck was covered in “hickeys”, (“sucker bites/ hickeys are the bruised marks some people leave while kissing and making love.)

The doctor examined her throat and wrote a few prescriptions. When the woman left, he came over to us and asked. “What were those marks on her neck? I almost asked her what they were. Did someone hurt her?”

We had to smile. I tried to be delicate as I could when I explained what they were. “Sometime in the heights of passion, one of the lovers will suck on the neck of the other, leaving those marks.”

He looked puzzled for a second and said, “But who could have heights of passion with her?” So much for me trying to be delicate.

***<>***

Another incident happened in the same emergency department. Several ambulances came in, one after the other. They brought us three boys who had crashed while riding two motored mini-bikes in the middle of a large field. Even though they had wide open space to ride, they had somehow managed to wreck into each other. They didn’t present with any life threatening injuries, but the emergency room soon became very confused. You see, each boy had a first and last name that could have been a first name. Names like Thomas Harvey or David Paul, or Charles Scott. Keeping the names straight became a true nightmare, with some people using first names and others their last. Every order had to triple checked. When radiology came to do x-rays, we had to be absolutely sure they were taking the right person. It was the same with the laboratory and as well as when any of them needed medicated. All of them had minor injuries and were treated and released.

We were all very glad when the last one was treated and sent out the door.

Dr. Vandyk was on duty when a woman appeared at the triage area. She had wedged a folded towel between her legs, it was covered in blood. Immediately we thought that she was having a miscarriage and hurried her back to the gynecology examination room.

She was pale and looked like she’d lost a lot of blood. We started an infusion of fluids after we’d established an I.V. site. Another nurse got her into the stirrups waiting for the doctor to examine her.

As we worked, she started to tell her strange story. She said that she and her boyfriend were hiking and decided since the weather was so beautiful outside; they would have sex in the woods. Making a huge pile of leaves, they disrobed and quickly got down to business. When they had finished, for some unknown reason, the boyfriend slipped a knife into her vagina and cut her. They quickly dressed and left the woods. He became afraid when she started to bleed heavily and brought her to the emergency room for care.

Dr. Vandyk came in and examined her.  Her vagina was filled with blood, clots, dirt, leaves, and small twigs. The amount of debris inside her vagina required that she be taken to the operating room to do the extensive amount cleaning and debridement necessary before her laceration could be repaired.

After her surgery, she was admitted to our hospital for I.V. antibiotics to prevent an infection. She had a Foley catheter inserted to allow the area to stay dry, clean, and start to heal before she was discharged several days later.

We never learned whether or not she wanted to prosecute the boyfriend or whether stayed with him after she was discharged.

Retirement was not an easy decision to make. I had agonized over it for months before I finally chose to call it quits. I was almost thirty-seven years at the same place. I made tentative moves to retire about six months earlier. So many decisions had to be made. What type of health insurance? How much would it cost? I had tried to apply for Veteran’s health care, but was making too much money. Should I find private insurance or because of pre-existing health problems, should I continue under COBRA?

What should I do with my 403 B? When should I apply for my Social Security benefits? How should I select the payments for my retirement pension? It was a frustratingly slow process. If I had a question, I would ask human relations office. They answered my questions, but offered no real guidance.

           When you are driving, how do you know what direction to go? Either someone tells you or you have a map.  This is what I had been thinking as I went for my exit interview. Near the end of my interview, I was asked if I had any suggestions.

I said, “You now give new employees months of orientation and shadowing. You give employees who move from one area of the hospital to another and extended orientation period. Why doesn’t the hospital offer a day of “orientation” for employees who are nearing retirement age?”

“It would be optional. You could have representatives from the different health care companies, from Social Security office, Veteran’s Affairs, financial planners, legal advisers, retirement communities, activity groups, volunteer organizations, health clubs, etc. The representatives should be able to do or schedule appointments for one on one consultation.” (I specifically did not include A.A.R.P. They claim to look out for the well-being of the senior citizen population, but they whole heartedly supported national health care. I feel they did it to make millions more by selling supplemental health care insurance.)

I continued, “If management feels it is important and necessary for each employee to have a thorough and extensive orientation, shouldn’t they think it’s important to help their valued and often long time employees to make one of the most important choices in their lives? This will be the last orientation class that management would be giving us. Shouldn’t it be a good one? Shouldn’t the employee leave with a great perception of their work place?”

My interviewer agreed with me and wrote my comments for others to read.

If You can't Say Anything Nice

 I was working the daylight shift and I had just entered the emergency department. I couldn’t help but notice that the place was hopping. The night shift was often staffed with one doctor, one nurse, and one nursing assistant and they had their hands full.

It had been very busy all night and now, two patients were brought in by ambulance. I tossed my jacket and lunch in the break room and joined the melee. We no sooner had gotten them stabilized, when an overdose was delivered to us.

The rest of the daylight personnel filtered in to work.  The tempo never slowed. It seemed to pick up. Patients seemed to pour in. Some were routine visits and some actual emergencies, but they kept coming. Once a bed was emptied, it was almost immediately filled with another person seeking help for an illness or injury.

As I rushed past the desk, I saw the Directress of Nursing standing there, leaning on the ledge. I noticed that she was peering over and looking down at my shoes.

At that time all nurses, male and female, were required to wear all white shoes. I had white shoes, but I hadn’t had the time to change into them. They were still in my locker in the nursing lounge. What I was wearing was a pair of electric blue running shoes with white lightning type stripes on the sides.

It looked as though she was going to comment on my shoes. I stopped long enough to say, “If you’re not here to help us, don’t say anything.” And I hurried off.

“Oh, crap!” I thought after I blurted it out. “Me and my big mouth, I’ll be in her office tomorrow.”

Later when I passed the desk again, she had already left the area, but I had no time to worry about what I had said to her.

After lunch, the emergency department settled and I was able to change shoes. The dreaded phone call to visit the D.O.N. never came.

Gonna Wash That Man Outta My Hair

My first encounter with trauma in the emergency room came early in my student nursing rotation. I was on the afternoon shift, when a middle aged, big rig truck driver was brought to the Emergency department by ambulance. He had been involved in a vehicle accident, running off the road and into a large tree.

As we examined him, I knew that he had one of his fractured femurs because of the discoloration and distortion of his thighs. He also had facial trauma with distortion of cheek and nasal bones. There was a lot of bleeding from his nose.

He was strapped on a back board and was yelling “I’M DROWNING! I’M DROWNING!” And probably he was with the blood from his nose running down his throat.

Despite our frequent attempts to suction his mouth and throat, the blood would accumulate and he would forcefully spit the blood and clots out of his mouth. They would actually hit the lights and ceiling. Sometimes when it didn’t reach the ceiling it would rain down on the nurses and doctor gathered around him.

The doctor managed to get him intubated, after light sedation and the endotracheal tube prevented the blood from entering his lungs. It also made it easier to suction him. Shortly after that, he was flown to a hospital for a higher level of care.

 

I had stayed over longer than the end of the “class” because they needed help. I was a step and fetch it person most of the time, but it freed the others to do the things that needed done for the man.

Even though I wasn’t huddled around the trucker’s bed giving care, I had blood over my head, my shoulders, and my uniform. I washed off what I could from my hands and arms in a sink, but still had blood and clots on my uniform and in my hair.

I asked and took a bottle of hydrogen peroxide back to the dormitory to get the blood stains from my uniform.

I grabbed soap, shampoo, and a towel as soon as I got back to the dormitory. I ran cold water in the bathroom sink and began flick off the clots and work the blood stains out of my white top. I soaked my pants as well even though they were dark blue and couldn’t see any stains on them.

While they soaked, I went into the shower to get the blood out of my hair. Large clots of blood were dried and matted in my hair. I managed to pull a few small clots loose along with some of my hair. I tried soaking and scrubbing them out with water having limited success. They just weren’t budging and I was tired and getting frustrated. I was tired and  just wanted to be clean and get to bed.

A light bulb came on, a dim one for sure, now that I look back on it. The peroxide! It worked on my uniform. It should work on these clots too.”

I hopped out of the shower and snatched the peroxide bottle from the sink ledge. Hurrying back into the shower, I poured out some of the hydrogen peroxide on my hair. Then I squirted on some shampoo and scrubbed like crazy. After a few seconds, I rinsed the shampoo and peroxide out. I watched as the water became pink and some of the clots circled the drain and disappeared.

“Great! It‘s really working. The clots are coming loose.” I almost danced a jig, but I was too tired.

After repeating this about three times, my hair was clot free and clean. I collected my uniform, wrung out most of the water, and went back to my room. I hung my top and pants over the backs of chairs to dry and crawled into bed.

The next day as I walked to class, one of the student nurses said, “Boy you’re hair looks really red in the sun today.”

OOPS! It was the hydrogen peroxide. I had unintentionally lightened my hair. I didn’t know what to say and I didn’t want to look stupid, so I mumbled “It was a new shampoo.” and kept on walking.

Not a Leg to Stand on

The emergency room is always a good place for unusual things to happen. Much of the patient traffic is routine, but there are sometimes unique presentations.

Rosanne was a ward clerk who working the triage area as an elderly man was rolled into her cubicle in a wheelchair. He said he was short of breath. Rosanne initiated a chart, gathering the man’s name, birth date, and telephone number. At that time, patient information was typed and the care was hand written on multi–layered carbon charts.

The old man leaned over and grabbed his prosthetic leg with both hands. He started to shift it into a more comfortable position. As he did, the false leg became unattached and fell out of his pant leg landing on the floor at Rosanne’s feet. She paused, stared at it for a full five seconds, then leaped to her feet screaming, “E-E-E-E-K! E-E-E-E-K! E-E-E-E-K!” and danced around in a circle.

“Don’t worry, little lady, it happens all the time.” The old man started laughing. He leaned over and retrieved his leg, placing it across his lap.

By the time he was wheeled into his room in the emergency department, he was extremely short of breath from laughing and really needed placed on oxygen.

Such Language

Our hospital was still small enough and the core staff has been employed there long enough that we felt close-knit, like family; peoples of diverse cultures, religions, and nationalities all working together. Only by the people working together could we survive and provide the quality of care for our clients. We had to rely on each other to get the work done. For the most part, we all have become an integral part of the hospital’s daily function. Some of the stories have happened as one person tries to learn and to understand each other’s heritage and languages.

            One such incident occurred when a nurse of Polish heritage was trying to teach another nurse some Polish words. One of the words that she taught her protégé was chapka meaning hat. Several days later, they were working together when the “language student” saw a doctor walk in to the hospital wearing a new hat. She turned to her instructor and said, “Oh look, Doctor Hughes has a new chopek.”

            The instructor burst out laughing. She couldn’t speak for awhile because she was laughing so hard. Her student looked bewildered, until finally the teacher managed, “I haven’t taught you that word yet. The word you said was Chopek and that is the word for penis.”

            The “language student” turned red and said, “I knew I heard that word somewhere.”

            That ended the language lessons for several days.

Preceptorship

This incident occurred during my internship as a student nurse. We were alerted that two ambulances were in bound with two men who were injured in an industrial accident. They had been working in a scrap yard moving metals of old appliances and crushed cars and trucks, with a fork-lift. The machine upset while the scrap metal was the hoisted high in the air falling to pin them both.

The first man who was brought in had abdominal trauma. He was in shock and very pale. His blood pressure was thready and low. His abdomen was distended.  Marks of abrasions and small puncture wounds crisscrossed his abdomen. All of the personnel rushed to that end of the emergency department with the victim.

The doctor made the decision to open his abdomen and clamp off the major bleeders right there in the emergency room. It would give the man a fighting chance to survive until they could get the man into the operating room. Large bore I. V.s were started and the laboratory was called to have O negative blood brought to the emergency room immediately. O negative blood can be given to anybody without typing. It is the universal donor and this guy needed blood.

The second ambulance arrived hard on the heels of the first and I was the only one available to assess and treat the new patient until someone else could free themselves to help me. I was a senior in our nursing class doing my internship and had been a corpsman in the Navy, but this now was flying solo. My preceptor was at the other end of the room. This was something I’d never done as a nurse without a preceptor looking over my shoulder.

I helped the ambulance crew move the man from their stretcher onto ours. I transferred the oxygen from their portable to the hospital’s supply. I began cutting off the man’s shirt to apply patches for the cardiac monitor. I noticed that something with the chest wasn’t exactly right. I listened to his breath sounds with my stethoscope. While I bent closer to the man’s chest, I noticed his chest was deformed slightly and both sides didn’t rise simultaneously when he would take a breath. The center section of the chest sank down when the rest of the chest was rising.

BINGO!! He had a flail chest. My eyes bugged out. I called to the team with the other man, who were almost elbow deep, covered with blood. “This guy has a flail chest.”

“We can’t come yet. Turn the oxygen up and start an I. V. You know what to do. You learned it in classes. Keep track of his vital signs.”

I found a five pound sand bag and placed it across the section that had broken free and was “flailing”, turned the oxygen to ten liters, and started the I. V. The man was stable and I was relieved in more than one way. By that time the team had managed to clamp off the worst of the bleeders and send the man on his way to the operating room for the surgeons to finish the repair work.

The doctor came and evaluated my patient. He ordered x-rays and blood work. The man remained fairly stable, and without much ado, the doctor admitted the man to the intensive care unit to be watched.

My nurse preceptor told me later the man that they had previously opened up had a lot of abdominal trauma. The falling junk had lacerated his liver and damaged his spleen. “He wouldn’t have made it to the operating room without being opened up down here. His liver looked like hamburger.” Then she said, “Well, how does it feel to be a nurse?”

My first trauma patient as a nurse and he lived. I guess I passed the test.

All Hospitals Have Ghosts

All hospitals have ghost stories and our hospital is no exception. Some have more than others. It is rumored; although I’ve never seen it myself, that there is a pale white apparition that would walk from one side of a patient room to the other in our coronary care unit. The appearances would occur silently without any type of regularity. It only occurred when the room was empty, either late on the evening shift or early in the night shift. No lights would be on and the gauzy white form would slowly glide across the floor. At first the nurses would investigate, thinking that someone was there, but after several times, no one went in and would say, “Did you see that?” or “I just saw our friend.”

The next story occurred on one of our medical/surgical areas and I was witness to this frequent phenomenon. We would hear footsteps at the back end of the unit’s hallway. There was no way to gain access to that area without walking past the nursing station or entering through a thick metal fire door that made so much noise when it was opened or closed, we nurses would have heard it if it had moved.

The footsteps always started on the right side of the hallway and walked to the opposite side. The sound we would hear was steps of thick soled shoes or boots and not the shuffling sound made by patient in slippers.

We would check both hallways and patient rooms at that end of the unit when we would hear the footsteps, but never found someone who was up walking or even awake.

Another story occurred on the same med/surg. floor. It involved the bathroom of a patient room. The call light would go on. When we would check, everyone in the room would be asleep or the room would be empty. We had maintenance check the switch for a short. They even changed the switch and the light would still come on randomly.

Several years later, the administration changed the floor to a pediatric area. When the kids came, the “ghost” left and the call light didn’t come on unless it was actually pulled. I guess the ghost didn’t like kids.

 

Just Like a Ghost

This next story isn’t quite a ghost story, but it is in the same vein I will tell it anyway. I had just taken the body of a deceased person to the morgue, placed the cart in the cooler, and was doing the paper work in the log, when I heard voices in the storeroom through a connecting vent high on the wall. It was our maintenance man, Frank and Nicki, one of the female central supply techs. They were retrieving a bariatric bed. Bariatric beds are oversized beds for the larger patients. The bed was stored directly beneath the vent.

I moved across the morgue until I was underneath the vent. I cupped my hands around my mouth and making a funnel I moaned, “W-O-O-O-O-O-O! W-O-O-O-O-O!”

They immediately stopped talking. Then I heard Nicki ask, “Frank, did you hear that!”

When Frank didn’t answer right away, she persisted, “Did you hear that?”

Frank said “Yes! Yes I did.”

“What was that?” She asked.

I heard Frank shush her.

They were quiet and I could tell they were listening. So I waited. When I heard them start to move the bed in the next room, I again moaned, “W-O-O-O-O-O! W-O-O-O-O-O!”

Nicki said, “Let’s get out of here!” I heard the supply room door pop open and the bed rolled out of the room at a high rate of speed.

Later, I met Frank in the hallway and told him what I had done. He laughed and said, “I didn’t know what that noise was. I knew the morgue was next door, so I thought at first it could have been a ghost. The second time you moaned, Nicki’s eyes bugged out. She grabbed my arm and almost climbed up onto my shoulders. I think she would have if I would have let her.”

            We never told Nicki. Nicki, if you read this, I apologize.

Confused and Disoriented

Sometimes when an elderly person is taken out of their home environment and placed in a hospital setting, everything is new; smells, sounds, and furniture. They can become disoriented and should you add new medications, you only compound the problem.

In the intensive care areas, sensory deprivation also becomes another concern. They call it “Unit psychosis.”

I was supervising one busy night and the critical care unit was hopping with activity. We had just pulled one patient back form death’s door by our resuscitation efforts, when another patient tried to go down the tubes and coded. We drug the crash cart from an adjoining unit, because I hadn’t had time to replace the first one.

Both had been intubated and were on ventilators. Both had gotten central lines. The unit had been in turmoil for most of the night.

One of the other female patients in the unit had been alert at the beginning of the shift, but with the increased activity and noise, she had become disoriented. In her mind, she had confused the frantic comings and goings into a strange ideation.

She said to her nurse later. “I saw what went on!” She shook her finger at the nurse. “I saw that doctor and nurse getting married. He was Hawaiian and if I told you his name, you’d know him.”

“You were having a party. I saw them using an Ellis machine. “

The nurse tried to reorient her to time and place, but the woman’s conversation kept coming back to the Ellis machine.

“Well, what is an Ellis machine?” the nurse finally asked.

The woman explained, “The Ellis machine is big and red. It serves cold beer out of one side and French fries out of the other.” If someone could invent one, they’d be rich.

Our crash carts are large and red. They are similar to the tool chests sold commercially for mechanics.

I got a call from the nurse explaining what the patient had said and asked if she should fill out an incident form. I thought that anyone with half a brain would know that the woman was confused. Who would believe what she was saying?

I told the nurse that it wasn’t necessary, but to chart that the woman was confused and disoriented.

Of course that is not how the hospital hierarchy functions. When the patient satisfaction officer rounded, she heard the woman’s story. She called the nurse at home. The nurse had worked night shift and it was before noon. The satisfaction officer made the nurse come back in and do an incident sheet.

The patient satisfaction officer went to the Directress of Nursing and shared the patient’s complaint. She wanted me to be called in and explain why I had said not to fill out an incident sheet. The D. O. N. was intelligent enough to understand that something wasn’t right somewhere in the story. She went to speak to the woman herself.

Later when the D. O. N. saw me, she said “I spent only five minutes with the patient and knew why you said “it didn’t need to have an incident sheet completed.” She did not agree with the satisfaction officer’s interpretation and the whole incident was dropped.

How much unnecessary paperwork is done in our hospitals and out government because of some well-meaning but completely out-of-touch bureaucrat who pushes papers all day needs to feel important and to justify their job? How much extra paperwork is done because of “policy” not tempered with common sense and intelligence?

 

When the A Frame Falls Out

An ambulance delivered a twenty-seven year old female to us. She and her husband had just attended a funeral and were returning home when the A-frame fell out from under their car. The car lurched sideways, the passenger door kicked open, and she was thrown out onto the asphalt roadway. She skidded along the tarmac for several yards on her backside.

All that was left of her underwear and panty hose was the toes and the waist band. All else had been eaten away from the roughness of the pavement. The back and inner surface of her legs had a heavy case of “road rash” The dirty abrasions that occur from falling or sliding on a road’s surface or gravel.

After the doctor examined her, he was kind enough to have us medicate her for pain, before we began the daunting task of cleaning and dressing the expansive dirty wound.

As we cleaned her, picking pieces of gravel and dirt from her wounds, we noticed that the abrasions ran from her heels to her upper thighs and even up into her vagina.

Once her wounds were clean, we started to cover the abrasions with Silvadene cream and tried to apply the bandages. They were bulky, difficult to place, and would not cover those wounds inside of her vagina.

I began to think, “How is she going to keep the bandages clean when she has to go to the restroom?”

I told the other nurses to stop for a bit. “I need to talk to the doctor.”

“Doctor,” I said. “Did you notice that those abrasions went up inside her vagina?”

When he didn’t answer, I continued. “The first time that woman passes her urine, she’s going to come back in here and punch you right in the face.” Everyone knows what it’s like to get sweat into a scratch. This would be even worse. “You need to stick a Foley catheter into her for a few days until she has a chance to heal.”

Dr. Jaimie followed me as I went back to help with the bandaging. He re-evaluated the wound. He called her physician to get the okay for us to insert the catheter and have her admitted for pain control.

The Elephant That Sat on My Chest

I was supervising on an afternoon shift, when I heard an overhead page for a “Blue alert” on our obstetric and gynecology unit. It made the hair stand up on my arms. That was an occurrence that had never happened to me before and I hurried to see what was happening on the unit.

The patient was a middle aged woman who had delivered an infant girl earlier in the day. The woman’s heart had stopped. When I arrived, CPR was already started and I took over doing chest compressions to relieve the nurse who was tiring. The closed chest compressions were necessary to keep the woman alive. Apparently the stress of labor and delivery was too much for her and she had a heart attack.

With our compressions, the support of her breathing function, and medications we were able to get her heart going again. She was transferred to our coronary care unit for monitoring and recovery.

When I checked on her the next evening, I explained that I was one of the hospital’s nursing supervisors and that I had done compressions on her chest when she arrested downstairs in the O.B. unit the day before.

She said, “So, you’re the elephant who sat on my chest.”

I laughed and we talked a bit more before I left her room.

Her nurse came over to me when I walked into the nursing station and said, “I heard what she said to you and just wanted to show you something.” She opened the chart and pointed to what she had written while charting earlier. “Patient states ‘It feels as though an elephant sat on my chest.’”

I chuckled and left the unit feeling good that the woman was alive because "Me, the elephant” had done my job.

Many years later, a woman stopped me in the hallway of the hospital. She was with a beautiful teen aged girl. The woman turned to the girl and introduced me as “The elephant who sat on my chest when you were born.” Then she turned to me and said, “She’s graduating high school this year.”

I was awestruck. I am sure that my mouth was hanging open. This young lady was going to graduate this year and her mom was going to be around to see it. That was a great feeling to know that I had a part in keeping her mother alive for this milestone in the young girl’s life.

But the story doesn’t end there. A few years later, I heard my name being called. I turned and there was the same lady and her daughter.

            “We’re here for some blood tests.” She said. “My daughter is getting married this month.” and broke into a wide smile.

            I didn’t know what to say other than “Congratulations!” Such a feeling of wonderment and accomplishment flowed over me. Standing before me was this beautiful young woman about to be married and her mother was still living and able to see her walk down the aisle. What a rush of good feelings engulfed me.

Mistaken Identity

On one busy night, we were caring for a tall, gangly, older black man who had an unsteady gait and had almost fallen several times. When he wandered into another room with female patients, we decided to bring him to the nursing station for the night and put him in a geri-chair. They were legal then.

            A geri-chair is a padded, tall backed seat that had a tray fastened to it. The tray could be placed over the person’s lap, much like a child’s highchair. This kept the person seated and kept them from wandering, falling and being injured.

            We finally managed to get him to sit in the chair and fastened the tray over his lap. A few minutes later, he said, “I got to go to the bathroom.”

            Monica, a thin blonde nursing aide asked, “Do you have to pee?”

            “No. I got to poop.” He answered.

            Mona said, “We just got you into that chair. I’m going to get you a bed pan.”

            She moved the chair to his room which was directly across from the station, and pulled the curtain. She had him lift his butt and slid the pan between his legs. She stood outside the curtain. We could hear a “PFFART, PFFARTT!” sound.

            “Are you finished?” Mona asked.

            “I’m done.” the voice from behind the curtain said.

            Mona lifted the man’s gown and there was a dark blob on the bottom of the bedpan. Monica put on gloves, wrapped toilet tissue around her hand, and began the task of wiping the old man’s bottom.

            All of a sudden, he stiffened and sat straight up in the chair exclaiming, “White woman, leggo of my balls!!”

            Mona was so embarrassed. She had mistaken the man’s scrotum that was resting on the bottom of the pan for a bowel movement.

I am putting on the blog a few stories from the book that I am attempting to write about my career as a corpsman, student, and a nurse. These are already written and I need to take a break, but do not want to disappoint those who are reading my writings.

 

As a nursing supervisor, the tasks I was called on to do are many and varied. Because the supervisors are the resource persons for all the shifts, weekends, and holidays. Everyday problems with bed assignments and staffing always abound. They are challenging but often other problems arise when least expected. These unusual occurrences often appear out of left field with no warning at all.

These things can pop up and you stand amazed, wondering “What happened?” or they may fall into gray areas. These are areas that have no written policies about them, or they are problems that had never occurred before, or they were concerns that had ever been addressed formally. The supervisor then is “Going where no man (or woman) has gone before.” At those times, a supervisor must use past experiences, weigh their options, and make expected and reasonable judgment calls.

            Late one night, I received a telephone call from the critical care unit. A woman had shown up in the waiting area and wanted to come inside to pray for the patients that were there. They told me that the visitor had no relatives in the unit and to protect the clients’ privacy, they couldn’t let her come inside. Even then, it would have been highly irregular to permit her to do so.  Her intentions seemed good. Now, with HIPPA regulations, it would have been illegal for allow her to do so. The nurses were also concerned about the woman’s mental state. Although her intentions seemed harmless, was she?

            As I walked to the unit, I had time to collect my thoughts, sort them out, rearrange them, and try to come up with a solution. I wanted to satisfy the woman’s well-meaning desires and yet I still needed to protect the patients and the staff.

I approached the waiting area.

Through the window, I could see a middle-aged female sitting on the edge of one of the chairs, twisting a handkerchief in her hands. She looked up as I entered the waiting area. I smiled, introduced myself, taking a seat across from her, I asked. “What can I do you for you tonight?”

            She explained, “Today is the second anniversary of my mom’s death. She passed away exactly two years ago.” She nodded her head towards the unit. Tears glistened in her eyes. “I was at home alone tonight and felt the need to come here and pray for the patients inside the unit.”

            Now that I knew the reason for her being here, I understood it was an especially tender and as highly emotional moment for her. What could I do? My thoughts were still racing, trying to find an acceptable solution, one that would satisfy her needs and also our need to protect our clients’ privacy. As we talked, a vague idea started to form.

            I began by explaining why I couldn’t allow her to go inside the unit to pray. “Because the patients are very sick, I can’t allow you to disturb them. They need their rest and privacy, but (The light bulb came on.) I know a place and a way for you to pray for each and every person in the whole hospital. Can you come with me?”

She nodded.

            I stood and she started to follow. I noticed as I held the door open for her, the woman walked with a pronounced limp. I only hoped that I had really found a way to accommodate her wishes and that my proposed solution would satisfy her.

            We talked as I lead her through the hallways to the hospital’s chapel. I opened the door to allow her to enter. It was quiet there with the lights inside lowered and soft. The crimson colored padded pews filled the back of the chapel, and at the far end, was a stained glass window, an altar, and a thick oak and wine colored padded kneeler. On the altar sat a wooden Star of David, a polished brass cross, and an opened Bible.

            I placed my census list of the hospital’s patients that I always carried, face down, on the top rail of the kneeler. I turned to her and said, “This is a list of every patient in the hospital. Although I can’t show you their names, you can put your hands on these papers and pray for each one of them, not just the ones in the critical care unit. You can ask a blessing for them and all of the staff working here tonight, if you like.”

            She gave me a small smile and limped to the kneeler. She knelt and placed her hands on the top of my papers. She bowed her head. After about five minutes or so, she raised her head. There were tears in her eyes.

            I pulled a tissue from a box in the chapel and handed it to her.

“Thank you.” She said and rose to her feet.

I replied, “You’re quite welcome.” Then I added, “Now that you know where the chapel is located, anytime that you feel the need to pray you can come in here. The chapel is always open. If it is after visiting hours, just stop by the guards and let them know what you are doing and where you are going. Please feel free to come back anytime you feel the need.”

            As she limped off, down the hallway, I prayed that I had met her needs and made a difficult time for her, easier to bear.

The Trailer

My sister and her husband Douglas had a mobile home on some property that my mom and dad owned. The trailer was already set up and they had been living in it when they decided that it was too high and wanted to lower it to build porches.

Doug’s family and our family, including Uncle Dale gathered to do the work and to lower it. Jacks, blocks, and a come-along; chains and pry bars; roller pipes and ropes all were laid out to use as needed. The first task was to remove the under-skirting. It was a dirty, splinter producing job. When it was done, we started to lower the trailer one section at a time. Bit by bit, until we could go to the next section. It was tedious and time consuming.

Dale said, “We can lower one side at a time, with the jacks in place. Slowly let the trailer down onto the shorter cinder block pillars. It will save a lot of time and trouble.”

It did save time. We placed the jacks along one side. We jacked them up until we could remove one set of blocks. When they were removed, we slowly lowered the trailer until it settled on the supporting blocks. It went well for the first time. We needed to remove one more set of blocks to have the height where they wanted their mobile home. Lining the jacks up along the length of the trailer, we got ready to lift the weight of the trailer off the piers and remove another set of blocks. I was the one under the trailer, pulling out the blocks. The jacks lifted the trailer. I am scooting around under the floor of the mobile home when we noticed that the trailer was moving sideways. That was not in our plans. I tossed one of the blocks back onto the pier just in time. The trailer moved several feet to the side and dropped about ten inches. I thought, “Here we go. I’m dead meat.”

The trailer settled on the last block I threw up, but not before it had folded me double. I thought I was going to be smashed, but was able to slide my upper body to the side and work my way out.

My mom and Rosemary, Doug’s mom, were sitting in the yard watching. When the building shifter, they jumped out of their seats and rushed to the side of the trailer. Neither one knew who was underneath, but they were trying to help and keep the trailer from tumbling on its side. Rosemary grabbed and tried to lift it and my mom pushed against the side. If I hadn’t placed that last block, probably both would have been crushed. My sister, Kathy says that a miracle occurred and believes that Rosemary and Mom were given strength to stop the accident from being a tragedy. I can’t say. I was underneath wondering why my head hadn’t gone through the floor of the mobile home.

What had happened to cause the accident? One of the jacks had been placed on softer ground, and the jack started to sink, throwing all of the others off and allowed to trailer to list to the side.

Dale used the come-along to pull the errant end of the trailer back onto the piers. I wasn’t underneath this time. The trailer was the right height and that was all of the work we did that evening.

It was time for me to go home. My shoulder was hurting and I couldn’t raise it. When the trailer came down and partially pinned me, it dropped onto my right shoulder and pushed me to the side or I might have been crushed.

Cindy, my wife decided she would drive us home. She was so upset that she backed down the berm instead of the highway when we left. We managed to get home safely, but she was still shaken up.

I wasn’t sure what happened to my shoulder, but with the pain and limited mobility, I decided to shower, get into some clean clothing and head for the emergency department. It was the hospital where I worked. I wasn’t going in dirty.

I drove. I wanted to get to the hospital and Cindy was still shaken. X-rays revealed nothing, but I think my shoulder was dislocated and spontaneously was relocated. I still have some range of motion issues and pain with that arm.

 

Pros and Cons of Forgetting

When a loved one dies and passes to the great beyond,

sadness breaks like heavy rollers on a rocky shore.

Powerfully surging, it batters the heart and soul.

With tidal force, it runs its course through a dark bleak hole.

The pain and sorrow mounts with our grieving at its core

deeply hidden fierceness of our emotions respond.

 

When life fades, there’s a time of worrying and fretting

and death’s door is cracked open to take the person home.

We grieve because we are left with loss and emptiness.

Wide oceans of emotions shrink to become much less;

time slowly heals us and sadness dissipates like foam.

Sorrow runs its course and there’s comfort in forgetting.

 

Tears flow freely when the lights of a life are setting.

Time softens the sorrows and those loving memories.

The pain eases and the grief lessens from day to day.

Danger comes when those memories start to fade away.

Time allows deep and painful remembrances to ease

Yet we fear the dark, blurred emptiness of forgetting.