Sooner or later those with evil intentions show their true colors. Read the rest of this entry »

Wonder Years Part 3/ Heroin addiction can start slowly or it can overcome the human body in a matter of days. Some people can be addicted to it, yet work and carry on with their life like nothing is wrong. Read the rest of this entry »

Another weekend at work bytes the dust and it was relatively calm.

When I got to work Saturday morning I was struck by all the NOISE. Modern medicine provides us with so many devices to help keep people alive and healthy. And to alert nursing staff when things aren’t working right. We have call bells; feeding pump machines, IV pumps, ventilators, trach humidifier machines and heart monitors. 90% of our patients are hooked up to some sort of machine, or several. The machines have alarms on them, often two or more different alarms. One will tell us when a feeding bag is empty and the other might tell us the pump itself isn’t working. Another alarm tells us when the central line is occluded (clogged); yet another will tell us what each patients heart and respiratory rates are. It’s quite a feat to learn all the different sounds each machine can make, and even more difficult to remember what each sound means. Some of the alarms mean RUN. And fast. Heart monitors are hooked up to central system right at the nurses station, where (lazy) staff can watch what is happening.

One of the things we have to do, right away, is the head count. This involves taking a clipboard and going into each patient room, checking that the patient is in the right bed, has the right equipment, is safe and do a quick assessment of their condition. It doesn’t take long and for some reason no one likes to do it. So I always end up doing it. It’s routine for me.

As I went into each room, to check each patient, I got really annoyed at all the noises. I kept thinking about how hard it must be for these kids to sleep. But sleep they do. It amazes me how the human body will adapt to whatever is going on around it. I checked the pumps, the feeding and IV solution bags, made sure monitor probes were properly attached and fixed those that weren’t. Checking off each item on the list- I went about this drill like I always do.

When I got to the last room, it was strangely quiet. No machines, no pumps. It is the only room without that stuff. Looking at the patient, a little boy aged 12- immediately I knew something wasn’t right. He was shaking and thrashing about in his bed; blood and other fluids were frothing at his mouth. He was having a seizure. This little guy has been at my facility since he was 6 years old and is very fragile. He weighs all of 40 lbs. and has a G Tube. He is less than 3 feet tall. And he is absolutely adorable. He’s one of my favorites.

I turned him onto his side to enable some of that stuff to ooze out of his mouth instead of down into his lungs… and I pulled the emergency call bell to let them know-we need the nurse-stat. Within moments I heard feet running down the corridor. The nurse comes in and checks him out- it’s a bad seizure at this point. Who knows how long it had been going on for. Bloody froth coming out of the mouth usually means awhile. No one had checked on him since 5:15am; people having seizures can get into what it known as status epilepticus: A life threatening condition where the seizure doesn’t stop, heart rate goes up and then fails. Brain damage occurs quickly.

We hooked him up to pulse oximeter-which tells us his heart and respiratory rates, as well as how much oxygen is getting into his blood. I watched his heart rate climb from 146, to 178, to 204…and higher. While his 02 stats went down-88%, then 73%, then 54%… At this point his respiratory status began to be compromised. The boy has a history of severe seizures that often require life saving measures. As we watched him, he stopped moving and began vomiting. Within a minute we noted he wasn’t breathing. The nurse told me to suction him and start rescue breathing while she ran to call the MD. We need an MD order for emergency medications and EMT services. His heart rate now was at a stunning 276 beats per minute. The normal rate is anywhere from 90-140.

It’s a routine I have become very familiar with: Raise and lock the bed; pull it out into the middle of the room; move all equipment out of the way and get the headboard off and under the patient. The headboards are also what we call CPR boards. The mattresses are all specialized-they are run on yet another machine that keeps them soft and full of air. While they are great for sleeping in and preventing bed sores, they are not good when it comes to doing CPR: The darn things compress with the patients, making the effort useless.

He had no air exchange at all. There is fluid in his throat, that I could see. The poor little kid is turning dark blue at this point. I turned on the suction machine and placed the tubing down into his tiny throat, to get that crap out. And lots came out. But he still wasn’t breathing on his own. I climb into the bed and begin rescue breathing. My least favorite co worker comes into the room to see if I need anything. I told him to go get the crash cart for the nurse, because I knew where this situation was heading. Sure enough, after four minutes of rescue breathing, the boy’s heart stopped. Now I moved up to the next level of the CPR routine…1 rescue breath for every 5 compressions…for a minute. Then check for pulse and breathing…then give another rescue breath and another 5 compressions. The rate of this is one compression every three seconds or so. It’s fast and it is exhausting.

I didn’t hear the crash cart coming into the room. Nor was I aware that the nurse had come back in either. When you’re busy doing CPR, you tend to focus on that and nothing else. I only knew she was there when she pulled me back to take over. Thank God, I thought. She did another suction and then began CPR. An EMT came in with the nurse and he began his assessment and immediately intubated and bagged the boy. Then he set up an IV and got out some more equipment. A defillibrator and other things. I don’t like to watch this part of the routine. Fragile little bodies being shocked back to life. His little limbs moving like a ragged doll…They gave him three shocks and his heart started beating again. He coughs, chokes and vomits. Then he goes right back into the seizure. Its amazing. The rest of the EMS team arrives and they take over, totally. Meds are pushed through the IV and we learn the boy is being placed into a coma. To stop the seizure. He will be brouht to the local ER via ambulance and on total life support; there he will stabilized and then air flighted to Boston.

And then he is gone. I clean up his room-all the blood, the vomit, the empty packages that held tubing and gauze rolls. As I cleaned everything up, I thought about all this modern technology that saves lives. They have yet to come up with a device or machine that can tell us when the silence is an ominous sign. There are no machines to alert us when a seizure is occuring. Almost every patient I work with has some sort of seizure disorder-it comes with the territory of the population I serve. In my work, silence often equals deadly. It’s scary.

This is a typical thing to happen at work. Almost every weekend we have some sort of emergency, a crisis, that requires CPR or calling an ambulance. We also see death. I never get used to that. Although I hate that it happens, I guess it’s part of my world at work.

Hmm. I guess a rating of X could apply here, but it isn’t that bad. But it does have ADULT subject matter and is very graphic. Part Two of the Wonder Years. Consider yourself warned.

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Some people wonder why I’m crazy…I decided to write about it. It’s hard to bring these experiences to a keyboard. Tales from the other life. Long and probably very boring. Read the rest of this entry »

This is whine and bitch about work post. Long and boring. Read the rest of this entry »