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With my nurse’s stethoscope (inspired by @lilredrooster)

I have:

Heard a collapsed lung.

Informed the doc my patient had symptoms of a pulmonary embolism, NOT pneumonia.

Heard fluid and asked for a chest xray to confirm pneumonia

Heard new onset afib before the EKG could get in the room.

Heard that terrible sound a heart makes when there is an incredibly high potassium level

Listened to bruits and thrills.

Heard crackles, rales, wheezes.. and that awful silence.

Confirmed the nasogastric tube I just placed was in the correct spot.

Recognized anaphylaxis and called the code, enabling anesthesia to get there in time

Listened to the racing hearts of newborns

Listened to the last beat of a woman’s heart as I held her hand, like I promised I would.
Caught a BP too low for a machine to catch.

 

With my nurse’s stethoscope I have saved lives.

I have never borrowed a doctor’s stethoscope because if I ever didn’t have my own, another NURSE lent me theirs.

Change the narrative. Learn what nurses DO.

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What About the: Respiratory Therapists?

Ready for a happy story?

Respiratory therapists are responsible for a lot of things all over the hospital. When they are on our floor, I can hear their phones ringing to call them to another floor. We see them doing treatments frequently, we call for help occasionally, and they are always included in a rapid response (a team effort to get to a deteriorating patient and avoid a code).

I am good with trachs, due to extensive training while I was a tech, and later homecare experience. So I am very comfortable with suctioning and trach care. Often, if the RT is very busy, I’ll do as much as possible to make their night smoother. I also volunteer to take the trach patients as often as I can because I know most of the nurses on my floor don’t like trachs. These patients often request for me to be their nurse again and again, and I do. It helps that I’m an excellent lip readers and intuitive. I rarely feel fear with a trach.. it’s a stable airway.

Recently at work, I felt helpless. It was a busy night, I had a 6 patient load with some really heavy patients.  My patient was deteriorating and a call to the resident was fruitless. I suctioned, but it was like tar. It was bad. My patient was grey. The oxygen level was okay so far but  could get worse at any moment.

For the next 1-1 1/2 hours, two incredibly knowledgeable  RTs worked over my patient, performing procedures I’d never even heard of. They told me what medications to get from the doctor. I phoned and phoned and phoned. I brought the meds in. I medicated the patient for pain. Other respiratory therapists in the hospital started to pick up their work, but I know they got behind.

It’s the middle of the night in the hospital. We ran out of suction catheters. The house supervisor went to central supply and when she couldn’t find what we needed, so she called floor after floor and suction catheters start to appear. We were good.

I was so impressed by the variety of the things they could do, and within that hour to hour and a half, my patient began to breath better. Partially from pain medication, but mostly from sheer force of will. We are all very bonded to this patient and he to us.

I was also impressed by the nurses and CNAs who left their floors running with the equipment we so desperately needed.

When I left that morning, the patient put out a hand. Thanked me for all I did. I said
You’re welcome, but it was a team effort and you are the most valuable player in the team.”

A lot of times, you’ll have a bad shift and you’ll feel you didn’t give the best care, and you’ll say to the oncoming nurse “well, they’re all breathing.” It’s nurse code for “I could only do the bare minimum, but we all survived, can I go home now please?

That night, I learned more about what respiratory therapists do. Like nurses, they run hard, unlike nurses, they are spread throughout the hospital covering several floors at a time. I knew they were smart, good in a crisis, but I am so moved by gratitude.

When I left work, everyone was breathing. And that is because the respiratory therapists I work with put their feet down and said “no.” It was a rough night, but we gave excellent care. And honestly, I don’t begrudge that patient my break (I did manage to eat). In a perfect world, nurses could get breaks everyday but medicine is by its own nature an imperfect science, and while I complain if I don’t consistently get breaks, it is absolutely worth missing a break to improve your patient’s health.

I plan on writing a series of blog entries about my interactions with other medical professionals. As with my patients, I will not name names or identifying features. The only person’s privacy I am giving up is my own.

 

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