I’m going to apologize ahead of time if this rant seems random – my thoughts are scattered, but I feel I need to get some of them down.

I also apologize if anything I say gets misconstrued.  Talking about race is always a dangerous subject, so let me say first and foremost that I am not at all racist and nothing that I say should be interpreted as such.  If it seems like I am saying something that would belittle anybody else because of their race, then please accept it as a poor communication because I do not harbor such feelings.  That said, here are my thoughts:

Martin Luther King day and the inauguration of our countries first minority president fall very nicely together.  As any regular reader of my blog is aware, I am fairly conservative and I have great reservations about President-elect Obama’s positions and viewpoints.  I didn’t vote for him, and given the chance, I’d go and not vote for him again.

http://www.theage.com.au/ffximage/2008/04/01/wbOBAMAKING_wideweb__470x326,0.jpgWhen it came time to select my President, skin color is not a part of the equation.  I live and work around blacks and whites and gays and straights and Latinos and Asians and men and women, and I love them all.  I try very hard not to stereotype anybody but instead to take them one at a time and give them the benefit of the doubt while I get to know them.  I think that a little bit of bias is built in to the human condition, but for the most part it is easy to overcome.  Certainly anybody who refuses to vote for somebody for political office, or who refuses to support them once elected based on race is somebody who needs to take a deep, long look into their conscience.

Senator Obama said many many times on the campaign trail that he was trying to stay away from race as an issue in the campaign, and despite a few obvious slip ups (“I may look different than the presidents on our dollar bills…”) it seems like he did so (of course, there is no way to know how much he had his hand in the mountains of race baiting that happened all around him, but I’ll take him at his word here).

But when you have the first seriously contending African American (yes, Nurse K, I know he is actually bi-racial, but I’m simplifying) running for president, it is not possible to escape the race issue.

On this day that we celebrate Martin Luther King’s dream of a nation where we will not be judged by the color of our skin but by the content of our character, I stand with great pride about how far we have come as a nation, where Colin Powel and Condeleeza Rice and Tiger Woods and Denzel Washington and so many others have paved the way for the great American dream to be open for all.  And yet, I stand with great fear for the future of race relations in our country when I watch television stations like BET further stereotypes of unlearned, immoral, womanizing criminals being the standard for blacks to look to, or when I see so-called leaders like Al Sharpton and Jesse Jackson, who jump on any chance to sensationalize and alienate and turn any situation into an us vs them, and in so doing keep race relations held back.  I feel great anxiety about where we are headed when I see the videos of Reverend Wright and those like him who would perpetuate the victim mentality, and rally the troops for a false war.

My nominee for hero of the black cause so far this century is Bill Cosby.  He has not been afraid to deal the hard love that needs to be dealt.  So much of cleaning up the problems that persist in black communities is to take personal responsibility for becoming a contributing and successful member of society.  These are principles that apply to every group of people, be they black or white, religious or atheist, nurse or doctor: learn everything you can, respect those around you, live morally, work hard, and eschew the title of victim.  What made this nation great to begin with was the mentality to stand up and do what is right and when life gives you a lemon, go find some sugar, butter, flour, and eggs, and make really good lemon bars.

That is why I respect Obama and have hope for what his Presidency can mean to race relations.  At least to this point, he has not tried to sensationalize race.  He has shown that a black man can be true to himself and be educated, well-spoken, and successful.  There is no need to try to be like P-diddy or Tupac in order to be true to your race.  We need to celebrate that.  We need to celebrate when a Tiger Woods can come along and make a big name for himself in a white-dominated sport.  We need to cheer when Condeleeza Rice can take on one of the most important jobs in the land and carry out the task with dignity and honor (partisanship aside).  I think having such a role model (partisanship aside) as Barack Obama in the most visible position in the entire world can take race relations forward by leaps and bounds.

And yet I’m scared.  I’m scared because all around in the background we have seen so much negative race baiting.  If we are to truly move forward in this country, then we need to put the charges of racism aside and work together.  It is an unfortunate reality that there are some people who would still judge a man based solely on the color of his skin and make assumptions and treat him as lesser.  That said, the overwhelmingly vast majority of people in this country are ready to accept that there is nothing about being black that makes a person less capable than a counterpart of any other race.

So in some roundabout way, this kind of gets me to the point that started this whole post in the first place: We will go backwards precipitously in this country if we continue to allow race to be used as a weapon.  I have seen throughout the campaign as charges of racism were leveled every time a major criticism of Obama was layed out.  This has to stop.  Period.  Vigorous debate is a fundamental part of the foundation of this country.  Principles such as freedom of the press and the first amendment are so important to us because it allows us to embrace conflicting viewpoints.  This is how we come together to share our differences and in so doing move toward common ground.  When this kind of free intercourse (stop giggling) of communication is allowed to thrive, then we thrive.  When it is stifled by wild acusations of racism, not only do we lose out on the discourse that could have been, but we devalue the true conflicts – the ones that actually have significance and impact.  Building straw men out of race and then tearing them down is a danger that should not be underestimated or pushed aside.  Cutting off debate with charges of racism halts the free distribution of ideas, and we are a nation powered by ideas.

Barack Obama is not the promised Messiah, but perhaps he can be, by nature of his office, the bridge that the civil rights movement needs to cross the trials that it faces.

Enjoy the historic day tomorrow as we see a symbolic step forward in equality for our nation and a giant leap toward Dr. King’s dream.  Then put race away on the shelf and move forward doing your part and your duty and continuing the honest and free debate that helps make this the greatest nation on earth.

I was at the nurse’s station enjoying just a moment to rest as all of my patients were in holding patterns and had nicely fluffed pillows when the triage tech came back announcing that they need a room now.  I go to help clean room 20, and since I wasn’t doing anything stayed to help with the patient, an elderly gentleman with a BP of 70 over crap who was diaphoretic and complaining of general malaise.  We got him hooked up to the monitor and got a line started and looked up to see a heart rate of 188 in clear SVT.  History revealed a pattern of this, worsening over the past few months.  According to the daughter, it had responded well to adenosine in the past, so we decided to do that again.  6 mg in, and we all waited and watched the monitor as the patient groaned and complained.  No appreciable change.  Try again with 12.  We all wait, holding our collective breath as the monitor does nothing nothing nothing, and suddenly flatline… and… return of normal sinus rhythm in the 60s.  We turn to the patient and ask how he is feeling and get a positive report.

http://www.ambulancetechnicianstudy.co.uk/images/SVT.gifGeneral relief is felt everywhere as we continue to watch the monitor and see the rate get irregular and start to fluxuate and move up to 80, 100, 130, 185, and from the bed we start hearing complaining again as the SVT sucks the oxygen right out of her.  I look over at the chart and realize that nobody has been charting and now the doctor is ordering for Cardizem.  I take pity on the primary nurse and grab the chart and start to try to catch up with charting everything that has been going on.  People are throwing times at me from every corner of the room: EKG done at this time, IV in at this time, meds given at this time, Obama inaugurated at this time.  I’m frantically trying to get it all down before my porous memory starts gushing, and if I do say so myself (I do), I do a mighty fine job.

A minute later my lunch breaker shows up and I leave to give him report.  From the room, I hear someone calling: “Braden, please get in here!”  The tone lets me know that I’m in trouble.  I can’t imagine what I did wrong, but in I come to find a chart shoved in my face.

“Care to change the medication?” asks the primary nurse.  Wondering what he means, I review what I wrote to find that I had charted that we gave 12 times the normal dose of atropine to an SVT patient, followed by 24 times the normal dose, just to make sure the rate hits 500.

Oops… perhaps I meant to write adenosine.

On an internet forum a while ago, I saw a post complaining about how hard it is to understand what people are trying to say because more and more colloquialisms are showing up where more formal writing would be more appropriate.  The poster goes on to lament the increasingly common uses of abbreviations and abuses of grammar and spelling.  Mentioning to/two/too and there/their/they’re and know/no as some examples of common mistakes that supposedly educated adults are using.

How about loose for lose?  There is a motivational poem up on the bulletin board at my work with the last two lines saying: “never loose faith/but mostly have fun”.

Don’t worry, I’ll hold my faith very tightly so that it doesn’t get all wobbly, and I’ll mostly have fun, but sometimes I’ll be grumpy.  Or perhaps they really meant: “never lose faith/but mostly, have fun,” which I guess would make more sense.

http://farm1.static.flickr.com/115/316524510_5abc69fad7.jpg?v=0I don’t mind so much the abbreviations for things as I do the lazy spellings.  We are raising a whole generation of kids who think that you is a one-letter word.  I don’t always use the Queen’s English, and I add plenty of slang into my conversations, (saying peeps for people brings joy and gladness to my day) but you can understand me when I speak and when I write, and I think that is basic communication.  The good news is that as more and more people get lazy with their communication, there are more and more resumes ending up in the trash and therefore more job opportunities available to me.

cuz if i right like most ppl u probly wont no what im sayin 2 much. thats cuz we r gettin real lazy bout learnin r kid’s. but aks an adult and they cant spel to. they get pwnd!!!!!

I guess, though, that in the end, I’m just grateful that I have yet to see a note on the medical record that says “OMG she b real phat, but dnt want pills til 2moro. i aks her if she b mental and say u noe u gots ta take it 2night cuz 2moro is majorly 4eva away. 😉 she say k thx and ate teh pill. thats gr8 innit?”

I worked triage again today, and the hands-down winner for best entry in the “reason for visit” line of the paper patients fill out when checking in:

my head poped

I hate it when that happens.  Luckily, a few royal men and horses were able to get together with a roll of duct tape and some crazy glue and solve the problem.

Runner-up:

emergency

Thanks – that’s really helpful.

Over at WhiteCoat Doesn’t Rant Anymore, we learn of a fascinating survey by the Kaiser Family Foundation that pretty much describes most liberal ideas: it sounds great until you inject reality.

It turns out that most Americans want universal coverage for health care that is paid for by thier employer or the rich, but support drops considerably if you mention that, oh by the way, you are going to have to pay for this.

WhiteCoat concludes:

In summary, it seems that most people in the survey want “The best health care someone else can pay for.”

Yup, and while you are at it, I want a pony.

Please.

Among a number of minor misspellings on a hand-written med list (including daly 4 times and dayly once) was:

hydrochorot

Hydrocodone?
Hydrochlorothiazide?
Hydrocortisone?
Hydro-Cobex?
Hydrochloric acid?

Courtesy of Cake Wrecks comes this, the greatest cake ever made.

[Monique+R+hrt+attack.jpg]

Somebody please tell my wife that this is the cake I want for my birthday.

By no means am I the most experienced nurse around.  I graduated in 2007 and I’ve only been an ER nurse for a year.

I’m certainly not the most knowledgable nurse I know.  In fact, I’ve tagged a few nurses in my ER that I can go to when I have a “what on earth was that” moment.  They usually know the answers and keep me in line.

I’m not the fastest nurse around.  In fact, sometimes I can be pretty slow because I still second-guess myself (was I supposed to mix that with bacteriostatic water or saline?) and when setting up for procedures I can never seem to remember all the supplies (oh yeah, I guess a speculum would have helped for the pelvic set up).  I’ve been making efforts to keep my secondary exams focused, but my OCD self just can’t leave that height and weight box empty even though my patient is here for a stubbed toe.

I really can’t say that I never make mistakes.  Sometimes I look at a chart after a patient has left and think, “I hope the lawyer doesn’t see that.”  I forget to go and get the cup of ice and the extra blanket that I promised.  I treat a patient for three hours before realizing that they don’t have a name band and I’ve given several medications.  I miss more than my share of IV sticks.  I almost always show up 1 minute late no matter what I do.  To save my life I can’t remember the name of the patient in room 23.  I had a nurse ask me if I had charted the black eye on that patient who just got shipped to the level 1 hospital… I hadn’t even noticed it.

So why is it, then, that I have had many patients say to me: “you are the best nurse I’ve ever had”?

http://i40.photobucket.com/albums/e202/Kat4779/supernurse.jpgI don’t say this to brag – if I wanted to brag I wouldn’t admit to all that stuff up above – but because I think that maybe I’ve found my nursing superpower: empathy.

I care about my patients.  Yes I get frustrated with the patient who is here for the third time this week for chronic back pain, but I can still go in the room, listen to their story, hold their hand, and be polite when I tell them that all they are getting is ibuprofen.

The other day I had a patient in for a migraine headache, so I went through the standard migraine fare: IV, Toradol, Benadryl, Compazine, lights off, rest for an hour.  Somewhere along the way a question I asked her raised a red flag so I dug deeper and found a history of drug problems and concerns about her children and problems with stress.  I sat at her bedside for a few minutes and offered some words of encouragement, I found the social worker and asked her to go talk to the patient, and I followed up a while later to make sure that everything was taken care of.  We talked for a little bit and hammered out a list of goals for the patient to work on to get life back on track.  When we were done she said, “every time I’ve ever come to the ER, everyone just rushes in and out like I don’t exist.  Thank you for treating me like a person.”  Another guy the same day came in with a University of Texas sweater on, so while I was starting the IV, I chatted with him about who would win the OSU-Texas game and what he thought of USC’s defense.  He thought I was an angel.  A few months ago I had a patient who was a little rude, but I did my best to treat her well and to carefully explain the doctor’s decision to not give her narcotics.  She got mad and came out of her room and started swearing and yelling and security was called.  Somehow I talked her down and managed to escort her and her threats of lawsuits out before security got there, but I felt like a failure to have had so angry and difficult of a patient.  When I got back, the charge nurse pulled me aside and told me that the patient was a very frequent flier (I hadn’t met her before) and this was the calmest and best behaved anyone had ever seen her.  No less than 4 nurses stopped to congratulate me on how well I had handled her.

I really didn’t do anything special.  I don’t have to.  I have found that when it all comes down to it, most of the patients I see don’t want a nurse who can recite the top ten side effects of venlafaxine.  They want a nurse who validates them as a human.

I’m not trying to belittle the technical skills and knowledge that are required to be a successful ER nurse.  A satisfied dead patient is still dead.  And I love the rush of working as a team to save a sinking patient, the satisfaction of getting a patient off to the cath lab to stop the heart attack, and the challenge of determining the correct rate of complicated medications.  I’m trying hard to become the best I can at starting IV lines, accessing ports, inserting catheters, remembering which medications are compatible, remembering to chart everything that the lawyers want me to write, and catching the subtle but important clues when assessing patients.  I have a long ways to go, and I get frustrated and anxious and overwhelmed and a little bit mad at the drunk who is running around in his underwear.  And if I could make an honest list from among the nurses in my ER of who I would want working on me when my heart stops beating, I’m not sure that I would be in the top 10.

I’m nowhere near a perfect nurse, but I am a good nurse, and my patients love me.  I certainly do not have the market cornered on being a “best nurse”, nor do I want to.  My point is not to lift myself up.  My point is to say that anybody can be a supernurse.  Next time you go to work, take just an extra minute to tell a joke, hold a hand, offer a hug, ask the kid when his birthday is, put that necklace in a baggie so it doesn’t get lost, and stop by the ICU after your shift to see how your patient is doing.  Not only will it make your patients much happier, it will reflect well on your facility, and it will make your job feel so much more rewarding when that patient looks at you and says, “You’re the best nurse I’ve ever had.”

The latest Change of Shift is up over at Crzegrl.  Emily has chosen a theme that I can certainly relate to: “If it isn’t late, I didn’t do it.”  She also has a whole host of links, including several first-time submitters. Oh, and a link to a post of mine.  Yay.

Go check it out for the links.
Go check it out for the sarcasm.
Go check it out for the introduction video.
Go check it out for old time’s sakes.

But whatever you do, go check it out.

From Happy:

“Doctors save lives.  Nurses save doctors and lives.”