Oh My

Rural ED: 1990's

How do I tell this??
Just how it happened.

Its a very busy day in the ED. Its summer. Its hot outside. This sierra gold country town is swollen with tourists. The local folks are out also,enjoying the lakes and mountains and the rivers.
Its a week-end. We have had multiple MVA's, (motor vehicle accidents) and one MCI (Multi-casualty incident) with fatality.

Its hot inside the ED. Its been a busy couple of days. Staff is tired. No lunch breaks for the past couple of days. We have had a record number of ambulance calls, ICU admits, and as always lately, there are more patients coming in than we can care for....Our Ed and crew has seen 60 plus patients everyday for the past 2-3 days. The ICU is full and we are holding patients in the ED, awaiting beds or transfer.

The vibe is very tense. We have a staff of 3 RNS on , 1 clerk and 1 ED Doc. The same Doc has been on for the past 3 days. He is tired...he is snappy and very demanding..he is done ...
The nurses have divided up the rooms..and the radio... and we are all running..Frustration is high. WE ARE ALMOST OUT OF CONTROL.

The clerk has her long hair up in a bun and every time I pass by the desk to give an order I see another pen sticking out of her hair....She is starting to look bizare

I walk out of a patient room..Just thinking where I must go next.All my tasks are outlined in my brain...and I keep track...until a new patient arrives with a medical issue that beats the last..
Then the mental task list spins and clicks and my brain re-posts. I would like to take a break and pee. I wonder what my kids are doing.

And I see ....

The Two nurses.

That I respect.

That I am working with them this shift.....

Counting on to come through..

Nurses that I have worked with for years.
We have weathered together:
Tough calls.. dying patients..bad managers... family issues...shitty husbands...
We all became flight nurses.... together..... Bonded.

I see them...

Standing in the middle of the ED..
With their hands
around each others throats....

Oh My...

What the hell did I miss.... what happened?? How did we get here..
And I know..
Without a word...
It does not matter..
We are here.. because of who we are .. and what we have done and what we have seen...And what this job extracts.
I step between them...
I embrace them both...
I pull their hands away...
I direct them to tasks...
They would do the same for me....
The momement is over.
The shift goes on...We pull through.

Stay close and follow me...

Rural Ed: 1989

My first day: As an ER nurse.

You never forget the ones who train you....it is a debt.... you are able to repay... if you are willing.......by passing it on....

The day started out quite calm. We went over equipment.... and forms and charting.... and drugs.. and the lay-out of the department....the roles....of the staff.... outside the ED and inside.

This was a ONE NURSE...ER..... a thing of the past now.... you needed to know a lot about everything..... You were it...you needed to be tough...

The crash cart...she had me crack it open and go over each item... and state its use... Things I had never seen...What the heck are Magil forceps??? Straight forward answers came....She expected me not to know things....

She talked about the med-net radio... and the classes I would be taking...to learn about pre-hospital care and my role...

She talked about the ED and how it was a catch all for the whole community...what should happen in the department and what shouldn't.

And she said..."I'll say nothing about the staff... you will have to make your own conclusions based on your relationships and experiences."...
That one statement became a corner stone of my nursing practice. We all develop our own bias....she was not going to pass hers on....

Then all hell broke loose...

A respiratory arrest...
followed by a patient in shock....
3 ambulances at once...
No beds in the ICU
A chest pain....

She flew...from room to room before and after the Doc.....They spoke very little....they JUST KNEW....

I watched as she started IV's and drew labs....directed lab personal and xray techs.....she orchestrated the flow..... I watched as she quickly assessed and determined who was sick and who was REALLY sick..... who got labs drawn first, and where the EKG needed to be done STAT....

She raised her voice, she stood her ground.... if someone got between her and what needed to be done for her patients.....NO... YOU ARE TAKING ROOM 3 FIRST !!!! NOW...she would firmly tell the xray tech.

Oh.... she pissed people off .... but I saw... It was not personal.....

Her blond hair flying in the wind she made...

She barked out orders... and they happened....and some how she handled it all.....I watched and learned.... and I did just what she said...I stayed close and followed. I didn't ask.. I didn't speak.

Just this ...drained me and at the same time filled me...

I don't think I ever thanked her....

She smiled when I came back the next day....

"You spent too much time in triage yesterday..no time for life stories here...just what's wrong today..I'm timing you...5 minutes....that's it.....in and out......I'm dragging you out of there if you go over."...she tapped her watch......

And I did not doubt her for a second.

I was hooked.

Prison Sounds

Level 4. State Prison :Infirmary:

The rattle of chains as inmates shuffle to the shower.

Muted fists pounding against the inside of cell doors.

The never ending slap/jangle of keys against walking legs and thighs.
In time with measured booted steps, announcing the passage of the free.

Heads banging against cell walls.

Booming commands shouted by guards:
TURN AROUND
CUFF UP

The screams from a tortured soul.

Metal cell doors slamming shut.

Toliets flushing.

Shrieks of anger. Profanity againist the world.

Metal keys grinding into locks.

Low mournful singing.

Loud voices that announce:
ESCORT COMING DOWN
the russle of staff as they clear the way...

Echos of high pitched laughter, meant for no one.

Deep silence...

Going to work

Level 4 State Prison: Northern California.......

The parking lot is just the same as any hospital....except....for

The guard towers.....

And the whole prison is surrounded by high fences... topped with razor wire . I have this insane desire ...to just touch the top.. with the tip of my finger... gently.... just to see....if they are real.....I know they are... They glisten....and look sharp.... but......

The towers are manned ....and the officers are armed......

You NEVER run in a prison. That's the first rule you learn.....

I enter a building that is called the "control" area. It is tree lined and has attractive, simple landscaping and it is staffed with 2-3 correctional officers.

In the parking lot..... I have donned my Kevlar vest...stab resistant.....It covers my front and back torso, the straps are Velcro and it stops just above the waist..It is military green and has a small tag that bears a brand name : SECOND CHANCE.

You must wear a WHISTLE. Pinned to your vest. You would blow this loudly if you were attacked by an inmate....I open the double doors....and walk a few steps.....

I come to a long counter... I place my lunch bag...on the counter and open it up for inspection. no cell phones , I-Pods, lap tops, books, newspapers, glass or metal objects are allowed....They are potential weapons and the correctional officer (CO) checks... I have my state ID..that I must show... coming and going.....they take it from your hand and read it front and back. You cannot enter or leave the prison without it. If you lose it on your shift, you must go back SEARCH and find it. If you cannot find it, it is considered stolen. You just don't lose it.

I wait... He says OK and I step through the metal detector..... and wait for him to BUZZ the door open....for the next step....

He buzzes me in..... and I step into a cage...and I wait ....The tower is above me..... The tower guard can look down and see who is there....8 employees are can enter into the prison at a time...

A metal door slides open and I enter into another holding cage. The door from the first cage slides close.........I walk into this caged area, exactly like the first.

This door slides opens and I step out.....When I leave I will go through the same process...through a set of identical steel cages ajoining the ones I entered through.

I am now inside the prison.....

I start to walk along the roadway..next to the electric fence that surrounds the prison......My work place is the the infirmary, or hospital. It also houses the UTA (URGENT TREATMENT AREA) The prisons ER.... This is only one of many places within the prison.....For now... it is the only place I know......As I walk I notice....

The redwoods.... That surround the prison....and press down upon it.....They are still giants... despite the gun towers.......Their presence..... is a reminder...of who was here first....

I can hear the ocean... just five miles away..... ..... I wonder as i walk... if there will ever be a time... .. that the forest will take back this place....and it will be gone... I think so....

I walk... about a quarter mile......To a gray building....that is my work place...
All the buildings are gray.. and flat...Un- marked...

Just in case.....of escape....

Hell.... My normal self says...if you could break out of this place... they should give you the grand canyon and ....a gazillion dollars......

But I remember that most prisoner escapes are out the front gate, in the clothes of staff and with a fake state ID. Assisted by staff.

Impossible I used to think.. Not so.. I have learned....That many of these prisoners are millionaires....Ofton they do not lose what they have earned illegally on the outside...also, high ranking gang leaders: "SHOCK COLLARS" continue to successfully communicate with the outside, run their operations, order murders, and collect monies. Inmates are allowed a Trust fund, that the prison manages, monies my deposited and withdrawn .

Many items are bought and sold here. Cigarette smoking is no longer allowed in California State institutions. Its bad for your health. So when you have a 20 year old inmate doing 3 life terms, without parole and he smokes 3 packs of UN filtered camels a day...the state will be footing the bill for his expensive health care as he dies from lung cancer or COPD. Multiple that by 100's of thousands.

As I Enter... the gray building.... I face 4 Correctional officers... Seated behind a desk.They are posted here and attend to all custody matters.They interact with us (MEDICAL STAFF) and also the rest of the prison. I sign in : A BIG BOOK..... They all know me... so I don't need to show my STATE ID....I found out just the other day the importance of this signing in.

If I were to GO MISSING..there would be a record of me...arriving at this unit and at what time.... Un- lucky staff in other prisons have been found..not alive.... in dumpters...

Through out the prison there are inmates working as porters, kitchen workers, lawn and ground maintenance, barbers, laundry services, auto mechanics, and in a optical factory where inmates makes eye glasses. So... these inmates are watched, and supervised, but they do have a degree of freedom and opportunity.

I'M here. I go through my mantra... Before I enter:

I WILL:
Be impeccable with my word.
I will not take anything personal.
I will Not make assumptions.
I will always do my best.

This is my prayer and supplication....It will help guide me...

I walk down the hall: and I enter the Nursing station.... I sign another book......My name and my assignment......

This is the infirmary...This is what is here:
10 cells of acute psych. care.
10 cells for medical care.

The ER...is just off the Infirmary.. Past the guard desk and through double doors that are locked. It consists of 2 gurneys a state of the art Cardiac Monitor, and crash cart, with suction machine, EKG machine, automatic BP machine.

I am the UTA nurse..... go figure..... that ED experience.... Tagged.....

So I see all the Inmates...(I/P ) Inmate/Patient.....

That are brought to the UTA with their complaints.....of:

To be continued.....

mommy burned me

Rural Ed 1998.

Night shift 6pm to 6am...I'm the RN

It started with a routine traffic stop.

S.O. brings into the ED a 30ish year old female who has been arrested for a DUI. Happens all the time. Except she has her 3 year old daughter with her...
So... along with the blood ETOH levels that the S.O. requires....we need to call CPS(child protective services) to find a safe haven for the child....

What a cruel trick of fate ..if you happen to believe in fate....I know this mother and I have cared for her and her.... child before....2 1/2 years earlier....I steel myself....and try to shut out our last encounter.....

Because ...Now

The mother is drunk. She is screaming and crying. She is trying to lash out at the officer....she is shouting profanities.....She is going to jail...She is taken to the ground and is cuffed.....snot running from her nose as she curses and thrashes on the floor....She has wet herself.....

Calls are made to find a emergency foster home for this young child.....She is beautiful..long black hair and a creamy flawless face...heart shaped lips...delicate fingers.. perfectly shaped oval fingernails...she is wearing PJs with feet... yellow or pink....and she smells like fresh laundry.. right from the dryer....I want to take her home.....I just know I can make it OK....

The doc instructs me to take her to a room and do VS and make sure she is OK to go to foster care....very routine....

I settle her on a gurney

and she tells me in a very matter of fact tone that

"mommy is sick again...."

yes I reply... and we will take good care of her...
don't worry...

"OKAY .....she replies....poor mommy...."

I explain to her that I want to make sure that she is not sick...
And I'm going to take her temperature.. and listen to her heart.....

OKAY.... she says....

I un-zip her PJS to listen to her heart....

and see.....

the scars... burns.... in various stages of healing.... up and down her chest and abdomen...the exact diameter of a cigarette tip.....

I knew just what they were.... and I ..well I can't quite describe how I felt....

But I said....

Oh... you have a boo-boo...

Yessss.....she says quietly and without emotion...her eyes are cast downward...tears cling to..her lashes that are not shed.....they are suspended....

I am suspended... holding my breathe and trying to freeze my face into a neutral position. I do not ask...how or why.....You can not.... That....could be considered leading the victim..... in a court of law....

However....

She states as a fact....without regret.. without fear...without emotion.... without blame or judgement.....Flat.....without tone.....without hope.....

Mommy burned me....

How in the world would that feel .... I think to myself........

I call to the Ed clerk to come and sit with the child......

I go to the next cubicle that holds the mother ..... the Doc is doing a medical clearance...a quick exam that assures that the mother is able to go to jail....

She remembers me...from the last time.....and I look her full in the face.... and I send to her...... with my eyes... the greatest measure of disgust and disdain that I can muster....I want to kill her with my eyes and my thoughts....I want to consign her to the outer....darkness...... .

She shrieks... YOU FUCKING BITCH..... YOU ARE STILL HERE!!!!!

I do not acknowledge her.....or speak to her

I will not give her that....she is now.... in the outer darkness.....

I speak to the Doc .

you need to come next door....we have another patient.... The Doc looks at me and he knows...He can read my eyes.... and through them....to my thoughts... ....He sees the worse.... he has a look of pain and dread.

As he examines her, he has a gentleness, and does not ask. Tears fill his eyes as he leaves the room, soon replaced with a mask.

Odd.... we never spoke of this... ever....We worked together for years.... We both went to court.. we both saw and knew....we never had to speak....It was what it was....

I step out of the room and .....Back.....I step....

Back in my memory....2 1/2 years ago... . in this very same ER.......another night shift.....

The same mother ... the same child... an infant then....6 months old ...in a car seat..... beautiful, dark, short curly hair...same lips.. shapes of hearts...

Both brought in by S.O.

This time mom was at a bar ....drinking.... in town.... and told the patrons she had taken a drug overdose and ....had given the same drugs to her baby ..both of them to die together....the baby left...in the car... outside... alone.....

That night they were both my patients..... the mother.. was close to death and ended up intubated.(breathing tube into the lungs)... I raced to save her.... with the doc leading the way.......IV's and meds... ordered swiftly....all the right things....

In the next room....

The infant was admitted after I passed a small catheter into her bladder....And her urine tested positive for narcotics.....She went into ICU.. where she was observed and monitored for 48 hours....for any ill events of the drug she was given. She was discharged into foster care..... And I thought that..... that was that..
You can't try to kill your child and get her back. Right?

After all was said and done.. months later...... I was distressed and angry to discover..that mother and child were re- united..... The infant went back into her mothers care.

An ER nurse knows no grey area.... Its black or white......right or wrong.......good or bad........one side or the other.....

I recall being up front .. with the unfortunate representative from CPS as she reported the outcome.....

I think I said........THAT'S BULLSHIT......YOU SCREWED UP.......AND DON'T EVEN KNOW IT........That baby should not be with that mother.....WHAT ARE YOU THINKING????

And.... Oh... I was given all the pat answers.....Its best to re-unite families.... and on and on....counseling and ....re-hab... and all.....and maybe that works.......sometimes..............................

but when it does not.....

here we are... now.....

To court I go to testify..... ..gladly.... I have a mission......And I am righteous....I want revenge...I want justice....

Mom receives a 7 year prison term.....The child is taken from her... permanently......

.the child was placed in a psych facility.........Unable to be adopted ..due to her psychological damage...

In my mind it is over.

However..... fate again ....would provide me with the opportunity..........

To confront my hate for the mother.....
regardless of my wishes... again and again and again......

After her sentence...she returned to her home town.....And

For the next few years she would become my patient......

time and time again. .....always on my shift... or so it seemed....because....

She had developed a chronic condition.....that would put her into medical crisis and acute pain..... that would cause her to seek care in the ED....

.... Drugs..... for her pain...... and care.... and tests....ordered by the same Doc who had treated her and her daughter.... years ago.....

and... provided by me... The nurse... The ER nurse... Her nurse....

We never spoke of the other times...

Our eyes met and locked..... there was no need to speak...
We both knew....It was what it was......So....

.... She did her time.....and was released.....

And I did mine....

word of prayer

Medical/Surgical Unit

1989

I'm an LVN working on the PM shift.

Our main focus on this shift is to prepare surgical patients for their upcoming procedures in the AM. This is the time before short stay surgical units. All patients requiring any procedure were admitted to the hospital the night before.

I am working with another LVN who has excellent skills. She is my senior and I learned many nursing tips from our time together. She was also a devout Christian. She had a close church family and her off work time was spent in service and worship.

I, at the time was a backslider, as she gently joked.. and she would kid me and invite me to church services. She had a nice way about it and it never made me mad or uncomfortable. It was done in such a way that I felt she truly cared for me....and she did...

We worked well together. She never tired, and if she did she never complained. We worked until all the work was done...

As this story unfolds, we are both working with our last patients of the shift. We are looking forward to sitting and doing some charting....this was the only time we weren't on our feet. The rest of the shift we could answer patient call lights and pass a few late shift medications if needed. The hard stuff was done. It had a been a busy shift.

I finish with my last patient and stick my head in the room she is working in..just to see if she needed any help.....

She is taking care of a 50'ish year old male who has recently been to her church a few times....She is doing his pre-op care. He is having a minor routine procedure in the AM.

I open the door in time to here her say to her patient...
" Well you are all already for tomorrow... would you like me to have a word of prayer with you before I go????

I heard him suck in this breathe....and exhale the alarmed words.
'WHY...DO YOU THINK I WON"T MAKE IT ??"
"WHAT DO YOU KNOW.. THAT I DON'T ??"
"OH MY GOD!!! I'M GETTING OUT OF HERE!!!! "
He starts to get out of bed, IV attached in his arm, suspended on the IV pole. His backside is fully exposed in his hospital gown. His spindly legs sport the white surgical hose (TEDS) she had just carefully applied.

She speaks.. her voice full of panic... "No don't.. I just thought...you would like a prayer of encouragement and hope. Stop... you can't.......goooo..."

"THE HELL I CAN'T!!! " He shouts.

I look as he tears the IV from his arm...needle and all.. blood dripping over his gown onto the floor....

He dashes to the closet and grabs his patient belonging bag which contains his cloths, wallet, and car keys.....blood dripping as he goes.

My friend is pale... and wordless....I think for a moment she may pass out....

He dashes past me and runs down the hall...towards... the front doors of the hospital....his blue and white gown flapping in the wind his hasty exit is creating...

He is gone.

OH MY...

I guide her by the elbow to the nursing station to sit..before she falls.
Her face shows her emotion.. she is overcome with guilt and regret....and concern...

I, the backslider am trying to suppress the insane laughter that is just about to erupt from my soul....and gush out my mouth.....I make it to the bathroom and howl into a towel until I think it is safe for me to be around others and act in a normal, professional manner... This is serious stuff.....

We called the nursing supervisor and report the event.. The surgeon was called... the patient taken off the am schedule.....

Our days off came and I did not see her for a few...

When work together again and she tells me that she had a chat with the Director Of Nursing ( DON) yeah....
She tells me she will no longer offer her patients a prayer.. unless they ask...

I think this is a good compromise....

Well, I tell her... God works in mysterious ways....

She lightly punches my shoulder and tells me to go to hell....

Back to work we go.......

the undertaker

Rural Hospital: 1990

Medical Surgical Unit.

I'm working as an LVN on the PM shift. 3pm-11pm.

This was the shift that prepared patients for their AM surgeries.

We gave enema's, shaved surgical sites, gave medications, obtained signed consents...and did a lot of pre-op (before operation) and post-op training(after surgery) teaching.


On the AM surgical schedule is a 85 year old male with a resent diagnosis of a cancerous rectal tumor... He is a local.. his family had been in this community for over a 1oo years.... This gentleman is a rancher, and very no-nonsense. He had not seen a doctor for 20 years and is very reluctant to have this surgery. Doctors are after his money.. and according to him: if there is nothing wrong with you, well they will poke and prod until they find something..... He is a character and I liked him...he is cantankerous...and complains about everyone and everything...

He is my patient this shift and I had completed all his pre-op orders, with much complaining and objecting on his part...Somewhere, he really gets it...he just needs to do this.. for some reason I understand. I connect.

Visiting hours are almost over.. I am at the nurses station.... and the surgeon is also there.. he is writing the last orders for all his pre-op patients.. and seeing them for last time before he takes them into the operating room...
We call him Nick the Knife. He is a good surgeon.... and a kind man.... He reminds me of a big bear as he lumbers down the hallways. He cares about what he does.. he also was born and raised here...

I sit at the desk.. charting.. the surgeon is at my back.. busy with his charts...We are alone...

A man approaches ... the desk... he is in his 60's.. tall , gray bearded, in a black suit.... from another era.... he has a somber manner....

He speaks: "I am here to see Frank Hornbrom, please. I am his undertaker, here at his request. " I look at him more closely and notice an aged cloth tape measure dangling from around his neck, tucked under his collar...."He has called me to measure him for a casket... "

The surgeon slowly turns and gazes at this man...He is listening.. attentive to his every word...

I am spell bound.. This is a once in a life time event...I know this...I will never see this again..

I direct the undertaker to the room and the patient he is seeking..

I sit .... amazed....

The surgeon turns ... to me ... .

"Well...now..." he says..".Looks like my patient has a lot of confidence in me.... "
And he smiles...A real smile.....he is also amazed.....

Later, I check in on my patient.

"You had an unusual visitor this evening. I remark. We don't see many undertakers here before the fact. "

"Bet you don't. I like things in order. Makes me feel better. He got my measurements.. and knows what I want. He'll see to things when the need arises. Somethings you don't leave to strangers. "

"His father buried my father, his grandfather buried my grandpa. "

"He'll bury me when my time comes. "

"No need acting like it a'nt goin happen. I'm standing as close as you can get. Got the cancer in me. Nothing is for sure. Except he'll build me one fine pine box if need be..."

"I can rest well.. knowing that".....he smiles...

"Turn down those lights now....on your way out..."