MRSA Oh my!

For most people MRSA sounds like something out of a horror movie that recently invaded our society. For people who work in health care it's old news. Of course, I'm new to everything and I'm so becoming germaphobic!

My patient this week: 42 year old diabetic with end stage renal disease and a massive MRSA infection on contact isolation.

I was real paranoid at first but I had a suspicion I'd get a patient on contact isolation. I just knew it. Just ask Melissa, she'll tell you. I talked her head off about it the whole way to DeKalb LOL
Anyways, I need to shape up alot when it comes to my diabetes. I'm never exposed to anyone who has it so I don't really have a role model to learn from. And my doctors aren't too strict on me. I've really got to find an endocrinologist. I hear they'll kick my ass for my blood sugars. So I'm thinking that seeing this young patient in end stage renal failure will be an eye opening experience.

My first impression of her was ok. She just received a heafty dose of pain medicine a few hours earlier so she was practically comatose. She didn't have an easy morning. She was throwing up everything she ate. She also has a MRSA infection in one of her eyes. So she requires eye drops EVERY hour. And she has 4 of them, not to mention 2 insulins and about 10 oral meds. And it's up to ME to keep track of them and juggle their administration between AM care, vitals, blood sugar monitoring, and 30 pages of paper work. Not to mention having to complete a drug sheet for each med. On 2 hours of sleep.

But something really kicks in when I wear my uniform and assume the role of a "nurse". It's almost motherly. It's weird. I just feel this intense nurturing feeling. Protective even. Almost whatever I see becomes a non-issue to me. My patient was puking in a basin and it didn't matter to me. She has MRSA and it didn't prevent me from caring for her. I jumped right in.
Today she was much better. The doctor is just keeping her on Morphine for severe pain and she tolerates that better. She talked with me more, we even traded "diabetic stories" LOL What scares me though is she has severe kidney problems and receives dialysis 3 days a week and her diabetes is better controlled than mine! That really scares me. What kind of damage is occuring to my body even as I type this blog?! I'll get to my issues with the insurance company in a little bit.

The nurses I deal with have been excellent. They compliment me so much and believe me, they can be some bitter bitter people. So I really feel honored. I reported to the pts nurse at one point today and she's like "I love a nurse that's on her toes" LOL Then later on the pt asked the nurse and I how much nurses make. I was like "Well, I'm not a good one to ask because I don't make anything" LOL

Like my other patients, I really enjoyed taking care of her. She was a really great lady. She's been hospitalized for several weeks now and I told her to get better and when I come back in 2 weeks she "better not be here when I get back!" She really laughed about that. She wants out of there so bad. Just wants to get back to life again. That MRSA that you hear about is some ugly stuff. It's treatable, but it's still ugly. She got it in her eye and lost vision in that eye. And now she can't hear on that side either. Bad stuff.

Ok, the insurance company. I was using Accu-Chek but wasn't too happy with it. Bayer sent me a free Ascensia Contour and some strips. I love it! So I called my drs office to call in a prescription for more. These things are 50 for $49. Expensive, especially when the dr wants you to test 4 times a day. With insurance I can get 100 for $30. Good deal. Anyways, the dr calls in the prescription and I get to Kmart and they won't give them to me. Blue Cross had an underuse precaution on me. Apparently I don't test my blood sugar enough. Ugh. Ok don't complain that I don't test enough and then not let me get my strips.

So I go home, call the drs office, and tell the nurse what Kmart and Blue Cross is saying. She thinks it's insane. The next day the nurse calls me. Blue Cross faxed them a form about "will I use more than 100 a month?", "have I used this brand in the last 30 days", etc etc. Turns out BCBS has a contract with Accu Chek (Roche) and they really push Roche products. They don't have a contract with Bayer. It's not a "prefered brand". How much BS is that?! Just let me freaken treat my freaken diabetes before I end up in kidney failure and you have to pay much more for my freaken dialysis! Ass wipes.

Anyways, 3 days go by and I FINALLY get a call from the drs office. BCBS doesn't mind if I get that brand of strips. ARRRRRRRRRRRGH!

Almost done!

Let's see here... hmmm...

Oh yeah. I'm almost done with nursing this semester! Yay! Today I passed my IV checkoff. The only thing I messed up on was forgetting to close the clamp before I spiked the bag. But I realized I did it before it was too late and verbalized it. So she didn't count that against me. My infusion to give was 1000 ml of D5 1/2NS to be given at 140 ml/hr. My drop factor was 15 so that came out to be an even 35 gtt/min (I like NEVER end up with an even number). When she came over to count it she came out with 36 gtt/min, which is awesome because we had a +/- 4 gtts/min. YAY!

The only checkoff left is Foley Catheters! That'll be a toughie I'm sure. Maybe not. I just can't find any volunteers to let me practice with. Hmm... any volunteers? It's real simple, really. I'll just shove a tube into your bladder and then take it out.

I've passed all my exams and I only have 2 more left (I think) plus the final. I feel pretty good about it, but I don't want to get overconfident. I tend to overstress about things but that keeps me from getting lazy. Sometimes the overstressing is bad though, when I'm overstressing about too much at once it proves detrimental to my health LOL

Oh yeah, speaking of which, I got to talk to my dr about my stinkin blood pressure. I'm on Atenolol and my bp has been spiking alot lately. I'm so terrified of having a stroke or heart attack. My grandmother died of a stroke within a month of finding out she was a diabetic. I was so traumatized. So now here I am a diabetic for what? 6 years? My A1C's are decent (around 7) but my dailies are not. Plus the HBP doesn't help. And I could definitely stand to lose a few. And my dad had like a quadruple bypass earlier this year. Anything he gets physically, I tend to as well. He's diabetic with HPB with the same liver crap that I have. WAAAH! Ok Amy... chill tha hell out. Yer fine!

Ok everyone! I'm off to the land of sedation heaven! Muchos lovos and stuff.

Clinical Update

Well I'm officially half way through clinicals! Hell freaken yeah!

I went to the hospital Wednesday and picked up my patient assignment. Ok. She's on literally about 40 drugs. For each of those drugs I have to go home and research them and compile the data on a med sheet. So I'm thinking "Shit. And I have to be up at 4:00 am? I should just practice for MD residency now while I'm ahead. No sleep for at least 3 weeks eh?" Not to mention the pre-clinical paperwork I have to complete, including research on her condition and medical tests.

Bright and early Thursday morning... like 6:00 am. I check my patients chart to see how she did overnight. SHE GOT DISCHARGED!!!!!!!!!!!!!!!!!!! Son of a...

I have a new patient. I spend the next hour researching HIS condition and meds. Ok, it's pneumonia no biggie. I've learned alot about pneumonia. God blessed me cause this dude was awesome. He took care of himself, was very independent, and had to have a million diagnostic tests done. Thursday I accompanied him for a Persantine-Thallium Stress Test. Took 4 hours, but it allowed me to complete 10 pages of paperwork on him.

So last night my sleep deprived bootie goes home and researches all of HIS meds. I go to bed around 11:00 pm. BACK UP at 4:00 am I feel like I'm catching a cold. It's pitch black outside. And raining. And Atlanta peeps don't do rain. I'm heading up 285 and it's not even 6:00 am and I'm TIRED! And night blind. And sleep deprived. Ok.

I get there and my patient is going to the Cardiac Cath Lab. How cool? I go with him and watch his test and the guy ahead of him. That was the coolest thing watching the doctor shove a wire in his groin area up to his heart. And I got to watch the tube go into his heart and shoot dye into it and watch it pump away.

Next I figure, I'll go ahead and get my 17 page, once a semester detailed evaluation done with him. He's a very pleasant patient. An hour before quitting time I go in his room and he's starving, but still flat on his back from the cath. It's time to allow him to sit up but first we have to get a blood glucose on him. The techs stole all the freaken Accu-Cheks! So the nurse and I have to go hunt down an Accu-Chek before this dude grabs ahold of his food and starts chowing down.
Finally we get it done and he just wants to be alone with his food. I give him his privacy and get a head start on my other 10 pages of paperwork I have to do. With half an hour to go before post-conference I go back to his room. They FREAKEN TOOK HIM DOWN FOR A PULMONARY TEST! Fuggin A man.

So what's my impression of clinicals this week?

!!!AWESOME AS HELL!!!
!!!GIMME MORE I LOVE IT!!!
!!!!!!!AHHHHH HAAAA!!!!!!!

Almost Done!

Let's see here... hmmm...

Oh yeah. I'm almost done with nursing this semester! Yay! Today I passed my IV checkoff. The only thing I messed up on was forgetting to close the clamp before I spiked the bag. But I realized I did it before it was too late and verbalized it. So she didn't count that against me. My infusion to give was 1000 ml of D5 1/2NS to be given at 140 ml/hr. My drop factor was 15 so that came out to be an even 35 gtt/min (I like NEVER end up with an even number). When she came over to count it she came out with 36 gtt/min, which is awesome because we had a +/- 4 gtts/min. YAY!

The only checkoff left is Foley Catheters! That'll be a toughie I'm sure. Maybe not. I just can't find any volunteers to let me practice with. Hmm... any volunteers? It's real simple, really. I'll just shove a tube into your bladder and then take it out.

I've passed all my exams and I only have 2 more left (I think) plus the final. I feel pretty good about it, but I don't want to get overconfident. I tend to overstress about things but that keeps me from getting lazy. Sometimes the overstressing is bad though, when I'm overstressing about too much at once it proves detrimental to my health LOL

Oh yeah, speaking of which, I got to talk to my dr about my stinkin blood pressure. I'm on Atenolol and my bp has been spiking alot lately. I'm so terrified of having a stroke or heart attack. My grandmother died of a stroke within a month of finding out she was a diabetic. I was so traumatized. So now here I am a diabetic for what? 6 years? My A1C's are decent (around 7) but my dailies are not. Plus the HBP doesn't help. And I could definitely stand to lose a few. And my dad had like a quadruple bypass earlier this year. Anything he gets physically, I tend to as well. He's diabetic with HPB with the same liver crap that I have. WAAAH! Ok Amy... chill tha hell out. Yer fine!

Ok everyone! I'm off to the land of sedation heaven! Muchos lovos and stuff.

My First Patient

Ok, I'm working on the Cardiac Telemetry Unit. My patient on Friday will definitely leave an impression on me for the rest of my life, probably.

She's an 81 year old woman admitted for pneumonia sepsis. She isn't quite with it and is unable to talk. Her skin is paper thin and she develops blisters and bedsores very easily and non-stop it seems.

I did all sorts of stuff with her on Friday and even got to give her a sponge bath. I Got her some clean, fresh bedsheets and gown. She has a special lotion that needs to go on her skin and I put that on after her bath. Then I gave her a real gentle back rub. The tech that was keeping her on her side said that she really enjoyed it. I was like "Really? You think?" and she was like "Yes! Don't you hear her?" She was letting out these really soft moans like it felt good! Oh I felt good cause I knew she's been in so much pain.

A few times Respiratory Therapy had to come in and give her breathing treatments and suction her out. That was hard to watch. She had tons of stuff in her. And I knew it was painful for her. But the lady from Respiratory Therapy was absolutely fantastic. She really talked to her throughout the whole thing.

She had this little stuffed dog next to her bed and I asked her son about it. He said she used to have a dog at home, but he died. So this was her dog. After my shift was up I went to her room, got her comfortable, and tucked her in. I got down next to her and called out her name. She opened her eyes and looked at me. I spent probably 5 minutes smiling at her and talking to her about her day. I told her she had a bath, a new gown and sheets, a backrub... I told her she was treated like a queen! I told her about all her visitors, including her granddaughter from Michigan. Then I showed her her dog and she looked at it and I told her he was going to lay in her lap. Then I told her that she was a very sweet lady. She just looked in my eyes like she was really listening to me and enjoying me talking to her. This was probably the first time someone really paid this much attention to her in awhile. At one point it even looked like the corner of her mouth turned up like she wanted to smile. At least I hope she did. I couldn't believe how much she was paying attention to me. The previous few days she was getting more and more unresponsive.

I don't know what's going to happen to her for sure. She probably won't be there next time I come in. I know her family was trying to decide whether or not to send her to hospice. But regardless, even if she has a few days left, I hope I really touched her and gave her a few minutes of peace and relief. I wish I knew her before she got this sick.

It was definitely a spiritual experience. I felt that we looked into each other's souls just about. It was intense. I definitely found my calling. I've always known I wanted to be a nurse but I never realized how badly. I am definitely not an office person dealing with a bunch of ungrateful assholes that stab you in the back and treat you like shit. I know I'll have patients that are that way but knowing that I'm there to help them might make it easier.

Happy to report week 1 of clinicals was more than successful!

School Update

Well this has been quite the eventful week. Guess what? I survived front loading!!! WOOHOO! It all gets easier from here. My next two check offs? Oral meds and Subcutaneous Injections. I'm excited about subq's because I give myself 2 of them every day!!!

Monday: I went for my vital signs check off and passed it perfectly. All of my findings were well within the narrow range that they allow us (2-4 pts) and the lady doing my check off, Ms. Orlean, is beyond awesome. She's a midwife and I really look up to her. She's quiet but she's got a fantastic personality. I think she's my favorite out of all of them. I feel so at ease with her. During my check off I was a little nervous, but I had a thrill for a second. I felt like a nurse and it felt so natural. I hope I get that feeling more often. When I checked my email later that night I had an email from the coordinator about our clinical group. Our instructor never showed up and quit. So we didn't have a clinical instructor. But Mrs. Read was taking volunteers to do clinicals at Rockdale (the hospital 5 miles from my home and RIGHT next door to my sons daycare). I didn't sleep that night. I was so excited.

Tuesday: I spoke with Mrs. Read and she said she just had a few details to get settled but most likely I'll be at Rockdale. I'm really cautious and try not to think about it but for once I'm happy to be at school. After class I have a mandatory meeting with my Nursing Advisor. She reviews all my stuff (test grades, teacher notes, etc) and says that she's rather impressed. I'm glad she feels that way but I feel like I'm losing my everlasting mind! She explained that Nursing School is unlike any school you have ever experienced and it's VERY demanding and VERY stressful. There's alot riding on your success and they are very difficult on us (Remember! Didn't I tell you it's like bootcamp?!) But she said everything I'm feeling is very normal and actually I'm coping really well with school and it's demands. The only thing I need to work on is stress control. Stress has bad effects on my diabetes, HBP, and ulcer. She wants to see all that get under control. She's a fantastic woman and I'm glad she's my advisor.

Wednesday: I receive word that Rockdale isn't accepting anymore students. BIG let down. I'm back at DeKalb with an instructor from Lawrenceville. See? This has happened so much in school that I KNEW not to get my hopes up. I'm disappointed, but not suprised. Glad I didn't get too excited.

Thursday: I receive emails from my new clinical instructor. She has a reputation as being really cool and funny. That gives me alot of relief. She starts giving us the info everyone else has known about their group this whole time but our group was in the dark on. I'm scared of the unknown and not knowing ANYTHING has made the upcoming clinical experience even scarier. Finally I'm receiving "info" on my fear. I also find out I'm in group 1, which starts next Thursday. I was kinda hoping for group 2 so I wouldn't start so soon. Two of the guys I'm good friends with went to group 2. That sucks. But I found out that one of the girls in my group lives real close to me and her and I will carpool. That'll help so much. I'm not too familiar with that part of Atlanta. The good thing about being in group 1 though is I can face my fear of clinical and find out sooner that it's ok. Nothing to be afraid of. Plus I get it done and over with. We're also done with clinicals 2 weeks sooner (before Thanksgiving).

Friday: I attend clinical orientation. I still haven't met Mrs. Buchholz, my clinical instructor, but I'll meet her on the first day. We didn't actually go to the hospital, we sat in the auditorium at school and received lots of cool info about DeKalb Medical. We're going to be in the Cardiac Telemetry Unit. That sounds like it'll be ALOT of fun (ie interesting).

This Weekend: I'm going out to buy the supplies that I need for clinical (clipboard, pocket notebook, poclet nurses guide, etc) I feel like a kid starting school for the first time and having the honor of buying supplies. I also have to study for another Exam on Tuesday morning. Once again, Nursing tests aren't over what you know, it's "can you pick the best trick answer". Real frustrating. But my last 2 exam grades are 76 & 80... I have to score at least a 75 on all my test to pass Nursing school. So far so good. (I found out that they threw out one of the questions, one I just happened to get wrong, so my grade went from a 78 to an 80.)

Lord thank you for blessing me with the opportunity to become a nurse and help me to remember that this is a BLESSING and to stop whining because it can all be taken away in the blink of an eye. Amen.

My brother David... RIP

I don't know what my deal is this afternoon. Well, I think I know. I found an old CD of mine in the car with music I burned back after my brother died. When something as insane as my brother dying so tragically happens, I often feel my emotions through music. There's a few songs that I could feel. It's hard to explain. Anyways, on the way home this afternoon I listened to it. It brought back alot of emotions I felt after he died.

Those who know me real well know that he was a few weeks shy of his 24th birthday. He had a beautiful daughter who was 5 years old at the time. From what I understand his long time girlfriend, and the mother of their child, cheated on him that night. He was a paramedic and that night he broke into one of the ambulances and stole an IV kit and vials of Norcuron and Etomidate. Those are two drugs given when you need to paralyze someone and put them to sleep in an emergency when you need to intubate them. But you only have a few minutes to get a tube in them and give them oxygen. They're paralyzed and unable to breathe. He went home, put his daughter to bed, text'd his gf to come get their daughter (apparantly so she'd find him), started an IV and gave himself those drugs. He simply fell asleep, stopped breathing, and died within minutes. Problem was his gf was out doing her thing and didn't get the message. When his daughter woke up the next morning she tried waking her daddy up. When she couldn't she ran to the neighbor (they lived in a duplex). The neighbor came over, realized he was dead, took Lana back to her house and kept her occupied while the EMS arrived. Ironically the very same paramedics he worked with were the same ones who responded to the call. They had to work to bring back their friend and colleague who was beyond gone.

My dad was also a fireman/paramedic and heard over the radio about a suicide at such and such address. He knew that was David's address. Imagine how he must've felt. He rushed over there. My step mother was a nurse at the hospital he was taken to. In fact, I think she worked in the ER at the time. All these people knew my brother and, although they knew without a doubt he was gone (you're brain dead within a few minutes and this was a few hours later) they busted their ass to save him.

My mom was on the phone with David's gf's mother at the time. I think they called her before my mom for some reason. She clicked over to take the call and then clicked back over to my mom and said "Vicki, don't panic but David tried to commit suicide." My mom went hysterical. She actually called 911 because she felt she couldn't drive. Of course, there's nothing that they can do for her so she had to get in the car and drive into town. Ironically on the way she ran into my grandmother and cousin and honked her horn hysterically to get them to pull over. That's when she told them and they all drove to the hospital together.

Shit this is so hard to recall all this but I have to do it. If I don't just get it out it will stay with me and I'll dwell on it. Where's the vodka?

Anyways, they all got there and my mom ran into some of the paramedics. They were all so upset. They told my mom he was dead. She went in the room to see my brother and got hysterical. She totally lost it. So did my dad and step mother. Security actually had to come by because my mom knew his gf had something to do with it and she was threatening to kill his gf.

I was at work in Georgia when I received the call. I have the details in another blog posting. I just went numb all over but once I tried to walk I about passed out. I totally lost it. It took several supervisors and the head of HR to calm me down. They got me in touch with my family in Ohio and called my husband and told him to come get me. When I talked to my dad on the phone I was hoping he'd tell me that David only ATTEMPTED it but he told me David was gone. I think I said something along the lines of "Well tell them they need to go back in there and bring him back." I was so losing it.

When I got home I contacted my Pastor. He talked to me for awhile and told me to come in the next morning for prayer and communion. That night I made reservations for a larger vehicle to rent to take to Ohio. I think I drugged myself to sleep that night. When I woke up the next morning I went to the Church and received prayer and communion. You cannot believe how much that helped. Afterwards we drove up to Ohio. The whole way there I was so scared. I wanted to see my brother but I was scared to. I thought it would be way too hard to.

Needless to say I did it. I cried so hard for so long. He was in a sort of formal fireman's uniform. He looked amazing. It was too unreal. I don't know if he could hear me but I talked to him. I told him how much I loved him and how sorry I was for anything in my life that was wrong. My mom and dad, who have been divorced for over 10 years at this point, kept fighting left and right so I was the go-between and had to be the adult of a bunch of children. It really killed me and stressed me out, but in a way it was good because I could focus on something other than just my brother. But boy was it exhausting. I didn't really get to start grieving until I got back to Georgia.
Anyways, I had a hard time at first. I drank alot on the weekends but I gave that up after one particularly rough night. I went out for a drive and had a "talk" with my brother. I was so upset. I went to the liquor store, bought something, went home and got drunk as hell. I felt miserable. I just started crying and Marty asked me what was wrong. I said "I did this so I wouldn't feel anymore pain. Now I'm drunk as hell, but I still hurt." That's when I decided that alcohol wasn't worth anything. Don't get me wrong. I wasn't like drunk on my ass all the time. Just when Marty was home on the weekends I *would* get drunk on my ass after the kids were in bed. It was just my own little drunk and alone world.

Now here I am 2 1/2 years later not doing too bad relatively. I refuse to step one foot in the state of Ohio. I don't want to go anywhere near where we grew up. I guess it's my own avoidance. Before and during all my tests I say a silent prayer and I ask my brother to see me through the tests. I think about him every day. I just really hope he is at rest. That's all I ask for.

Ok, one shot of tequila and I'm ready to lay down and watch Gremlins 2. I feel better now. Thanks everyone for listening :-)