mistakes happen

nobody is perfect; everyone makes mistakes. but obviously, some mistakes are more serious than others.

a secretary dials a wrong phone number - no big deal. a bus driver takes a wrong turn - oops, some people are a few minutes late. a barista uses whole milk instead of non-fat - oh well, a customer gets a rich treat!

but when an airline pilot falls asleep - hundreds of people are in danger. when a surgeon mistakes her left from her right - a person ends up losing the wrong limb.

unfortunately, nurses are always the last check when administering medications. it's a huge responsibility. a doctor prescribes a drug. a technician enters it into a computer system. a pharmacist mixes the med. there's room for all sorts of error. but in the end, it's the nurse who delivers the medication and is responsible for the famous five rights:

right patient
right medication
right dose
right time
right route

last night, i caught an error. it could have been hugely serious. a dose of immunoglobulin was ordered for a patient: 60 grams of IVIG diluted in 2 liters of normal saline. the doctor prescribed the right medication and the correct dose. the tech entered the information into the computer. the pharmacist mixed the right medication with some normal saline and filled a 2L bag. and finally, a sticker was printed with all of the correct info.

as the nurse, i received the medication, did my checks, and began infusing it into my sweet patient's central line. it's a serious medication, prescribed for a very serious illness. the medication costs several thousand dollars and is known to cause severe reactions. extra monitoring is required. the medication is started VERY slow and increased cautiously.

after 1 hour and only 62 of the 2000 mL were infused, i noticed something strange. the infusion pump notified me that 1938mL remained; but when i scanned the bag for verification, i noticed the bag did not contain 2L of fluid. i double checked the pump. had i infused the drug too fast? was there a leak? no, no. so, i called pharmacy. they insisted that there was a triple check; they could not have made a mistake. so i asked another RN to assess the bag. perhaps i was crazy and just missing something; perhaps the error was mine.

but then my phone rang; the pharmacist fessed up - there had been a mistake. instead of diluting the medication in 2L, they diluted the medication in 1L and placed it in a 2L bag. my patient had been receiving twice the concentration of the medication. and although the error was made by pharmacy, technically, the error is my fault. i should have noticed the volume; i should have called pharmacy before starting the medication. should my patient have had a serious reaction, it would have been my fault.

when nurses make mistakes, patients can die.

mistakes happen. thankfully this one ended okay.

my patient is safe...

for the time being.

broken heart

sometimes my patients break my heart.

because of my fantastic nursing care (!?!!), i have been requested by a patient's daughter to take care of her mom most of the days that i work. as great of an honor as that is, it can also be very challenging. you get to know your patient and their family well; the walls that you build up to prevent heart-ache and sadness start to crumble. and eventually, when the prognosis is bad and the patient miserable, you start to feel depressed and overwhelmed by the reality of your patient's life.

my 63 year old patient (the same one who had the seizure not too long ago and has been hospitalized for months) is having excruciating abdominal pain. i sent her down for a CT scan of her abdomen to assess her pain crisis and unfortunately, we created another one. the contrast that was injected into her IV extravasated (that's a big word for "leaked out of her veins"); she now has been visited by a plastic surgeon, as the contrast can cause serious damage to the surrounding tissue in her arm.

my patient just feels uncomfortable. she is sick of being in the hospital, sick of being in pain. as i watched her grimace and listened to her moans, she said to me, "i just want to cry." i replied with, "that would be okay marcia." then she said, "it's silly, but i just want my mom." marica is 63 years old. her mom is not here - not in the hospital, not on earth.

we always want what we can't have. and today, it's breaking my heart.

sometimes i want my mom and i am blessed to have her.

healthcare dilemmas

like the title of this blog states, nursing involves some of the strangest tasks and interesting predicaments. i just spent 90 minutes in a patient room with a gown, gloves, and mask on; i'm hot, sticky, and sick of smelling my own breath and recycling stale air. but that's not why i am writing. i am simply writing to say, health care is strange in general - not just nursing. are you familiar with HIPPA; it's a healthcare privacy act. so i'm probably breaking major rules. but we just admitted a prisoner to our unit for a stem cell transplant. interesting, huh? he has to wear his orange jumpsuit. and he has an armed guard with him at all times. honestly, i'm not sure how i feel about this... but just think to yourself, who is paying for this gentleman's care? our tax dollars are buying his chemotherapy, his stem cells, and a second chance at life (which typically results in a one million dollar bill). he may have simply gotten three speeding tickets (washington's three strikes and you're out law), but he could also have raped and/or killed people innocent people? hospitals are full of ethical dilemmas. what to do, what to do!

nursing gods

the nursing gods were good to me today. it's rare, but when it happens - what a gift! i was out late last night (reason not to be shared!) and felt exhausted when i woke up at 5:33. but, like the good girl that i am, i dragged myself to work. and although i had one total care patient, my other patient was incredibly sweet and self-sufficient! i had the opportunity to chat with my favorite PSS (patient service something/secretary) and share recipes. i folded some cranes. and i just plain enjoyed the nurses with whom i work. the day got even better when at 13:00, i won the coin toss that allowed me to go home at 15:30. woo hoo!!!

twelve hour shifts are SO long. and often times, SO hard. i always realize that when i have the opportunity to work a short day and see all of the other things i accomplish. i visited a friend i hadn't seen in a while. i ran 4.5 miles. and i even ate a relaxing dinner. currently, i am doing laundry and texting folks on the phone. might not sound like an ideal night, but it sure felt great. like i said, the nursing gods were on my side today. lord help me tomorrow!

little birds

i know today is not over, so anything is possible. but for now, i feel thankful for an easy day. the morning has been spent folding paper cranes! let me explain...

last year, i had a hard year personally and professionally. i was feeling extremely burnt out and disillusioned by cancer, chemotherapy, and stem cell transplants. so, to start out the new year right, and to encourage a more positive outlook on our unit, i decided to fold 1000 paper cranes while at work as a symbol of hope for our patients. ever read the children's books, "sadako and the thousand paper cranes?" well, it explains the significance of paper cranes and is a beautiful story about post-hiroshima japan and the aftermath of the atomic bomb.

anyway, i have inspired nurses and secretaries alike to use their free time (or to make free time) to fold little colorful birds. in less than two weeks, we have more than 300 of the little fellows. and soon, our unit will be more colorful and more hope-filled. it's strange, but there is something very cathartic about making things with your hands. and so, i find the activity a nice relief from nursing.

every now and then my manager walks by and stares at the group of us nurses who have collected to do artwork and i just smile. if i ever get fired for inspiring hope and unity on our unit, i'll just laugh and fly away with the birds!

CODE 199

why do they call it that? when "code blue, code 199" is frantically called on the overhead pager throughout the hospital, isn't it pretty obvious that someone is dying? silly numbers don't really sugar coat the message.

my patient had a seizure this morning at about 7:55. i hadn't even been in to see her yet. poor thing. i know her well. she has been in the hospital for at least two months. she got a stem cell transplant, but is now currently suffering from GVHD (graft versus host disease). the cells we transplanted into her body to cure her cancer are now attacking her GI tract (causing copious amounts of diarrhea and an inability to absorb medications and nutrients from food). she's miserable and grouchy and eager to get the hell out of here. and now she had a seizure... and we don't know why. sort of threw off my plans for the day. and hers.

i'm such a planner. i like organization and to follow a schedule. i make myself a list of all my tasks for the day and check them off as they are accomplished. i write down all of my medications for the entire day (often totally more than 30 meds in a shift). and something like a seizure really ruins the plan! there were blood gases drawn. stat portable chest xrays. a stat CT. incontinence of bowels and bladder. emergency platelets to hang. family members to keep calm. labs to be drawn. foley catheters to be inserted. none of these were on my list!

i'm nearing the end of my shift. my patient and i are tired. i get to go home. she doesn't.

death stinks

on new year's eve day, i got to work at 0645, like usual. at 0700, i sat through report, preparing for my day, barely listening to the ramblings of the night charge nurse recapping the previous 12 hours. but when i hear, "room 8232 expired at 0432," for some reason, i start to listen. as often as deaths occur on my unit, i continue to be saddened and the tiniest bit surprised. i often think to myself, "what a strange job. how many other folks can expect to witness and participate in death on a daily basis." well, i do. it's the reality of working as a nurse on an oncology unit. i am not assigned to room 8232; i do not know the woman who died. i never knew her and never will - or so i think.

my friend, courtney, is assigned to the woman's post-mortum care. and so, i become involved. hours after i've begun to care for my live patients, courtney asks for my assistance with her dead one; it's nearly lunch time. the family of the woman who has expired (what kind of word is that anyway) asked courtney to put in the 83 year old's dentures. so, we go in together. we kindly ask the family to leave the room. and then, we struggle to put stinky dentures into a dead, starting to stink mouth. death is not pretty. it does not smell good. rigor mortis has set in. the woman's jaw has drooped to the left. her tongue protrudes. how awkward. we have rubber gloves on. one of us is pulling down her jaw. the other is shoving uppers and lowers, trying to get them to click in place. i envision improper placement and teeth flying out as the family returns. after a tongue blade and some major force, we get them in. phew. job well done. time for lunch.