Not Just Another Nurse

I always wanted to become a teacher so when I completed year twelve of my schooling I was looking for courses available , but somehow I was advised to take nursing as a course of study as it was a faster option for becoming a teacher . However to cut the long story short and ten years down the line with five of them and still going on as a nurse I don't regret one bit about my decision. Anyhow recently my brother finished his schooling and so I was looking up colleges where he can study some Arts courses but he kept on insisting that he wanted to study nursing. At first, I was hesitant and I told him it's not easy being a nurse .It's not something you can do unless you like it and enjoy it. But he kept on insisting , so I finally gave in and enrolled him in a nursing college.It took me two of my four years in nursing school to accept my chosen vocation after the initial shock of having experienced the hospital firsthand in the first year of my training. If I knew then what I now know about nursing , I wouldn't have opted Nursing as a career choice but thank God I didn't know . Like me ,after high school , many people do not know what exactly a nurse does other than giving injections. So let me elucidate some of the things we do and what nursing is about.

1. The First and the Last : Being a nurse I realised that we are involved in many the firsts and lasts of people who come to the hospital. Nurses are the first people you encounter inside the Emergency and the last one to see when you go home on being discharged. It is the nurse who is the first point of contact when you come in.Also having delivered babies in the labour room and given multiple death cares I can say that nurses are the people you see but don't remember when you are born and the last people who respectfully deal with you when you die in the hospital before your family comes in . So yes we see you in your problems , we see you go home safely ,we help bring you into this world and see that you depart this world with dignity and respect.  
2. Hawk Eye :  Having worked in the emergency and ICU/ITU, I can say that when things go downhill it happens in the blink of an eye .Nurses are the ones that have a hawk eye over the sick patient that is in their care . Once all has been said and done and the doctors have decided what they want to do after changing their orders over a gazillion time and left , it's the nurse in the ICU/ITU that has to keep watch over the vital signs to ensure you see another day. In other words ,we make sure your condition doesn't deteriorate on our watch and if it does we do everything we've got to bring you back to see another fight.
3. Body Fluids: Anything said about nurses is incomplete without body fluids ..It's almost synonymous. We've had vomits ,poops , urine, amniotic fluid , saliva everything being splattered at us and each time we grimace and do what we have to do. I believe nothing can gross out a nurse ,having seen it all, they can carry out a perfectly normal conversation about poop at dinner time with you provided you don't gag . Yea you can call it code brown or whatever colour you want but it's what we do: clean you when you are unable to ,move you when you aren't moving and feed you when can't yourself.
4. People : Last but definitely not the least , it's the people that we meet daily.People is what makes nursing different from other professions and each one is to be treated  in the same way as the other with dignity and respect irrespective of their cast , colour , creed or gender. Every day at work we meet different people , each with his/her own story , their problems and troubles People come to us at their lowest , when they are dependent on us especially when all their life they were fiercely independent.So we meet people angry , frustrated anxious and vulnerable .It is then that this job tests your character , your patience .Someone once said the character of the nurse is as important as the knowledge they possess. 

Nursing is a combination of skills and knowledge and character .So finally to conclude I would say that nursing is easy as long as it remains in the books but add a little uncertainty of life and an eclectic mix of people and their emotions then it becomes a different ballgame altogether. 

Sleep and Night Duties !!!

It's night time and the first thing that comes to your mind is the sleep. Oh yea the irresistible urge to fall into the seductively waiting arms of sleep.Most of you if not all of you will understand this allure of sleep.
Right from the start sleep had always been my Achilles heel.Nothing could pull me away from my time with her. There were times when I had slept across my bed with shoes on just because I was too lazy or tired and didn't want to waste my time with sleep.
My upbringing was in a foster home with 35 other kids. So we had a daily timetable to follow. And everyday dinner was at 8pm which was followed by a study session for around two hours usually upto 11pm and as usual my head would be deeply buried in my books, fast asleep. Time and time again being caught sleeping head down I developed the art of sleeping while sitting without nodding off. With only one drawback, I left my jaws hanging wide open . And one day I found my mouth filled with a fistfull of salt as I was caught sleeping during the study hour. Since then I might have left many habits but the jaw opening remains.
So you can understand my state of panic when as a student nurse I was posted in night duties that too for a week. Which meant 12 hours of work while the world slept. I was not prepared for this but there was no way out. And to top that our hospital had this strict 'no sleeping on night duty 'policy. At first I did all the work that was assigned to me.Then came first onslaught of sleep I resisted , then the second,I maintained a stoic appearance. Then finally the on the third onslaught I was standing there like a zombie with bloodshot eyes. I was actually standing and sleeping. Thankfully the nurses were always there to help me out.One gave me a dark corner with a table to put my heavy head down which was getting heavier by the second. And this other time I was given an empty patients bed with curtains all around.Yea as a student nurse I somehow managed the night duties thanks to the nurses.
But then came the time when I started work as a Registered Nurses. I worked in the Emergency Room along with ICU for over two years. So as long as there was work to do in the ICU or a patient in the ER, I was wide awake. Sleep was no where near ,but dang,  on a slack night I would sit on a chair fast  asleep in my old position. Yea sitting in a chair with my jaws wide open. A couple of times I have found biscuits and gauze deposited in my mouth by my fellow nurses as I wake up with a start.
One good thing though, in the night duty is the potluck dinner. The nurses on duty bring an assortment of food as we all share a sumptuous dinner in the middle of the night. It's like a mini picnic ;only the eating part.
Anyhow I just had night shift last week in paediatric oncology. And as I was taking a round around 2am I realized how peaceful everyone looked while sleeping without a care in the world.Well that's what sleep does to us. It just lulls us into a world without care full of peace and rest.
But as for me and my struggles with sleep they will continue. Though thanks to the place where I now work, I get to sleep in between for two to three hours during the night that too lying down on a nice bed. Life couldn't be better !!! Eh!! What say!!

The Intensive Care Unit

                  PROLOGUE
Joe was running very late. He had promised his girlfriend of two years the surprise of her life. A well thought out plan to execute the perfect proposal. And with lots in his mind he was racing through the rush hour traffic at neck breaking speed nearly missing a car .

Mark was working as a nurse in the local hospital for over twelve years. Happily married with three children,Mark had chosen to settle in his hometown after marrying his childhood sweetheart,who is now a full time mother.And today just like any normal day Mark got ready to go to work the evening shift in the ICU. But today he was running slightly late and on the way he nearly had an accident as a maniac on a bike almost had a collision with his car.  
                       JOE
Where am I .And whats that beep beep sound. Why can't I move myself. Am I dead? No!!! that can't be. I can hear voices talking in hushed tones.The last thing I remember is the blinding glare of an oncoming vehicle as I was riding my bike.  And that jarring alarm again. What's that.....Am I floating....  
        
                    MARK
Patients assigned today bed 3&4. Ok let's see. Bed 4 , Joe a  25 year old male patient with history of road traffic accident on the ventilator. Oh oh a busy shift today then huh!!! There goes the ventilator alarm again. Seems the patient is awake. Inj. Midazolam 4mg stat.Sleep away...

                 JOE
What's that gurgling sound.Cough! Cough!! Oh what the hell!! What is going down my throat. Ssss!! What's that sound. Thank God it stopped. And as I  try to look at myself. Which is difficult as it is with this darn thing around my neck. I see tube coming from my nose another one in my chest and a tube for my pee.I see this machine right next to me making a slight huffing noise along with a hum as it tries to take air in and out my lungs , With tubes going from my mouth and into the machine. The gentle whirr of this thing next to my bed and the soft beep beep made me realize that I am in trouble ,deep trouble. Only the regular beat of my heart which the monitor showed in the form of sound gave me a reassurance albeit a weak one that for the time being I am alive.
                     
                       MARK
Well , let's see the orders. Hmm suction PRN(whenever necessary), sides q4h(four hourly I),IV fluids,ok on inotrops too. So blood pressure also to be maintained. I have to change his sides and giveback care too. It's definitely going to be a hectic shift. Time to  suction him. I hope this kid survives. If not hang in there my friend till my shift ends. Thankfully my other patient on bed no.3 Mr.Smith is stable. He is on some oral meds.So not much to worry about him. He will be shifted out of the ICU tomorrow anyway.

                      JOE
As I come slowly out of my drug induced slumber. I see this nurse talking softly to the patient next to my bed who seems to be in a much better shape. Oh oh there goes the alarm again from the machine which I think is the ventilator as I overheard while the nurses were talking.Darn there goes that thing down my throat.That was  uncomfortable,but I think the nurse knows what he is doing. Anyhow!! Where are my parents?How is my girlfriend taking all this in? I hope I get better. There's a lot left for me to do.

                  MARK
Another half an hour and my shift will end uneventfully . Hang in there Joe for a couple of days and you might even make it.Just then the alarm of the monitor that show  heart rate of bed 4 goes off. I think he is crashing. I see the on call doctor rushing to the bed along with a couple of other nurses. Immediately we disconnect the ventilator and connect the AMBU (it's a bag like structure which we connect to a tube that goes down a patient's throat and squeeze it as air goes in ). One of the nurse started a CPR (unlike in movies this one with both hands) . The doctor gave a series of stat orders . Inj atropine stat,inj adrenaline stat blah and blah which were immediately followed . As we all frantically made a joint effort to save the kid.One of the doctor said it's a VT (ventricular tachycardia- an abnormal heart rhythm which can be corrected by giving shock) on the ECG/EKG(It's a waveform representation of the heart beats). So we brought the paddles from the crash cart ,charged it ,shouted all clear and gave a shock of 300 joules.No effect,so the CPR continued.
 
                    JOE
What is happening ,I wondered as I saw a flurry of activity near my bedside. Doctors and nurses running around. Someone was loading injection into a syringe ,other was giving CPR,then there was someone I guess the doctor giving terse orders and finally the shock. It went for almost half an hour but it seemed a lifetime as I saw a bunch of people desperately trying to bring my heart back..... I stood over my lifeless body till I no longer could as I heard the doctor say 'time of death 8:15 pm' ....

                

       

OF VEINS and CANNULAS.......

 It been over two years since I've completed my nursing training and since then I have worked in the ER or the Emergency room for over more than a year and after puncturing numerous veins over a span of two years and finally learning to put in cannula without puncturing the vein( though I do have a bad I V  days from time to time) I have developed a sort of morbid fascination with the hands and the veins that courses through them. Many a times if not mostly during a conversation with  I find my eyes wandering towards people's hands and wondering how easy or tough it might be to put in a cannula. Though for records sake the toughest ones are the infants and toddlers (And I have a personal rule of not more than two stabs for kids.) Well some people have large veins and some have barely visible vein some straight and some convoluted ...oh oh there I go again. :) ;)

PAIN AND THE EMERGENCY ROOM

Being a nurse in the ER or the casualty or ED, I come across different patients in varying stages of pain. Some come clutching abdomen, bent over accompanied with 5 relatives literally picking the patient off the floor into the ER gurney, then there are people who come howling with pain literally screaming with anxious family members worrying their minds off along with ours and they have to be forcibly be evicted out. The other patients in the ER casting curious and worried glances wondering why we aren't doing anything for the poor patient in pain.
I often am amazed at the way some people come with stoic expression hardly showing any emotion or letting out any sound to show pain, its only after the examination; palpation to be precise that they evict some sort of a sound or expression to show pain though they might be in agony.
   Well pain is synonymous to the ER.  90% of the patients that come are in some sort of a pain be it a broken bone or a dog bite or abdominal pain or chest pain anything you can think of. And then of course you have some people fake severe pain for analgesia Its not always easy to tell but then someone who comes on a regular basis with the same pain with stable vitals and gets relieved with one particular analgesia .These are some of the signs  to watch out for.Then there are some who come in the middle of the night with headache and fever and want it to be taken as a life threatening emergency. Why dont they just take a paracetamol!!!!
But , at the end of the day its always a wonderful sight to see a patient leaving all smiles and thanks form the ER