Wednesday, October 24, 2007
Saturday, August 25, 2007
* "Drop your pants here for best results." -sign at a dry cleaning store in Tokyo
Saturday, August 18, 2007
The next type is The Spoiled Slave Driver. These are usually women with maids. Now, don't be mistaken. They can also be of the male persuasion. Anyway, these patients are similar to the slave driver in that they are satisfied while you are in their room doing something for them. They become dissatisfied when you leave, though. As a consequence, they will call you back repeatedly so that you can do everything for them all over again.
Then there's The Push Button Player. These are often children or curious adults. They can't get over the amazing fact that if they press the call button, you (or your designee) will magically show up. They seem to think this is magic. They also drive stewardesses crazy, and they will even pull emergency cords on trains and buses to see if they'll stop.
Let's move on to The Guilt Specialist. This very special type of patient is bold as can be. They will try to do your job for you ... then try to make you feel incompetent. They say things like, "Oh, I took my own temperature and gave myself a bath. I didn't want to bother you."
Next, there's The Yenta. This kind of patient wants to know you personally, dear. They ask about your health, age, social life, sex life, etc. This concern seems to be touching. Then you realize that they are either buttering you up for special treatment, or they are gathering information for future blackmail attempts. Man!
How could we forget The Wanderer? They like to roam around. They can't stay in one place too long - especially bed! They "float" from unit to unit, and it's your job to find them and bring them back. Hooray for bed exit alarms!
Let's examine The Eccentric now. They like to sing at odd hours, or let out the occasional primal scream. Sometimes they like to "watch" the test pattern on TV (at full volume), or tell jokes - mainly dirty ones - and at particularly inopportune times. Sometimes they even perform pranks like putting apple juice in their specimen cups, then drinking it in front of you.
Oh, my gosh! How about The Playboy? He's more often than not a middle-aged, balding married man who has seen The Sensuous Nurse. He has all the lines you don't really want to hear. You see, he is looking for "special", very personal care. He often mistakes medical care for stimulation. But then, he mistakes eating, sleeping, and everything else for stimulation, doesn't he? He usually seems more than eager for a bedbath, even though he is fully capable of going into the shower alone.
Last, but not least, we have The Doctor's Helper. This patient assumes that the doctor knows everything, and nurses know nothing. They constantly question your authority and actions. Like ... "Why are you emptying my bedpan? Didn't the doctor tell you to do that, or aren't you supposed to measure it?". They'd probably like to bombard the doctor with all of these questions, but since the nurse is the one there, you guessed it! S/he is the target!
All joking aside, patients can also be wonderful and very appreciative. They are not all pains in the ass - not by a long shot! You'll all have your fair share of both types, believe me! Try your hardest to find the best in them and to realize that their bad behavior is often the result of some type of pathological process. If (and sometimes that's a huge "if"!!) you can do that, it'll likely make your shift - and their stay - a bit easier.
Hang in there!
Saturday, August 11, 2007
You can read more about it here.
Whether we agree with the war or not, how about we all stop and say a prayer for ALL of those serving overseas as well as stateside? My opinion ... we'd be nowhere without our military.
My condolences to Maria's family, and to all of the families who have lost a treasured member ...
Tuesday, August 7, 2007
12. List the first item on your shopping list.
11. Open a can of soda.
10. Dial the first digits of your home phone number to see how your kids are doing.
9. Plan the first 30 seconds of your day off.
8. Sneeze once.
7. Put lipstick on your upper lip.
5. Read the first two words of the newspaper headlines.
4. Put one quarter into the vending machine.
3. Bend your knees in an effort to sit.
2. Get a spoonful of yougurt halfway to your mouth.
And the #1 thing you'll have time to do during your free time ...
Do any of you have other things you can do during your "free time"? I seem to remember one time that I actually made it into the bathroom and was able to lock the door. Then my SpectraLink phone rang and I had to abort the mission at hand. Is it any wonder that nurses and teachers have the largest and least toned bladders around? Or that the same two groups seem to get more UTIs than anyone else? I, for one, am not surprised in the least! Now let me hear some of your ideas of how to spend all that free time!
The first topic I will tackle is that of "How to Tell Doctors From Nurses".
Seems pretty straightforward, but with more women in medicine and more men in nursing, it's not so easy anymore. The following guidelines should help you to "de-blur" the lines.
Docs: Show concern with your hospital insurance coverage.
Nurses: Show concern for your hospital comfort.
Docs: Will leave you a written note or prescription.
Nurses: Will decipher the doc’s hieroglyphics for you.
Docs: Admit patients to the hospital.
Nurses: Can actually find the patient once they are admitted.
Docs: Wear Rolex watches, and vacation in Europe and other exotic places.
Nurses: Wear Timex watches and vacation in the lower 48 (Alaska & Hawaii are too expensive).
Docs: Carry pagers so that if they’re needed, they’ll be present.
Nurses: Are omnipresent.
Docs: Are never in their office on Wednesdays.
Nurses: Explain to disgruntled patients why the doctor’s not in on Wednesdays.
Docs: Misplace charts.
Nurses: Take the blame.
Now, the disclaimer: This is all meant to be in fun. I hope it's taken that way! I'm sure that you can think of some other ways to tell the difference - feel free to leave them as comments!
The next lesson from The Handbook will be "What to do on Your Break". Be thinking about what you actually do on your breaks, so that you'll be able to compare with what's recommended in the lesson!
Have a great week!
Friday, August 3, 2007
Wednesday, July 25, 2007
What followed was no less than 2 full hours of abject misery. I trotted to the kitchen sink and got the water as hot as I could stand. I then proceeded to soak some lap sponges, which I plopped onto my eyes. I waited till they cooled, then tried to remove the tarantulas. They didn't budge ... not even a bit. Holy crap! This went on over and over for what seemed an eternity. So, y'all think plucking your eyebrows hurts? Hah! It's nothing compared to pulling out your eyelashes.
Thursday, June 21, 2007
|Your Brain is Blue|
You tend to spend a lot of time thinking about your friends, your surroundings, and your life.
Saturday, June 16, 2007
Look very closely ...
Is this stuff amazing, or what?
Anyway ... I hope you enjoyed looking at my mindless fluff. Have a great day, a great weekend, and a great Father's Day if applicable!
Sunday, May 20, 2007
The rules of the meme are as follows:
You simply list eight random facts/habits about yourself.
Feel free to write a little bit about those things if you'd like.
Don't forget to post these rules.
At the end of your posting, tag a bunch of people and leave a comment on their blogs to let them know they're tagged.
OK ... here goes!
1. When I was in tenth grade, I got caught shoplifting a pair of shoes from Target. I didn't think anyone would notice if I just exchanged my raggedy old shoes for a new pair. Was I ever wrong!
2. The same year, and before the shoplifting incident, I won a $10 bet at the same Target. All I had to do was sing something into the microphone at the checkout. I did a stirring rendition of "Strangers in The Night". It just hit me ... no wonder I have an aversion to Target and prefer WalMart!
3. About 7 years ago, I diagnosed myself with a pulmonary embolism. EMS laughed when I said I was in the midst of a P.E. I then informed them that I was an ICU nurse and an ACLS instructor, and I knew the signs & symptoms of a P.E. I had ruled out a CVA and an MI before I called. When I rolled into the ER (of the hospital where I work), I told them I needed a ventilator, and soon! I had a BP of 50/26, and an O2 sat of 80 on a NRB mask. I yelled at them to get me some Dopamine and some tPA. I was fixing to run my own code! Can you imagine the looks on their faces? Anyway, that's what happened. Ventilator for nearly a week, tPA, and dopamine. Once extubated, it was discovered that I had MRSA. Of course, I then got the "big gun" antibiotics. Was I ever pissed! Thanks to those multiple massive P.E.s, I now have an inferior vena cava filter and am on lifelong Coumadin. I hope I don't ever hit my head too hard!
4. I am so totally a "night person". I'm most productive after the sun goes down, and I hate, hate HATE the morning and people that are chipper when the sun comes up. I can't help it ... it's just the way I am!
5. I listen to music of all genres except rap (which isn't really music), but really am most drawn to rock and classic rock. I also love to sing classical choral music.
6. I got dumped for a man on Valentine's Day. It was a long time ago, and was a month after our first anniversary. He had brought home flowers, but they weren't for me. They were for him .... from HIS BOYFRIEND!! Yikes! This was back in the day when such things weren't on Oprah or Jerry Springer every damn day, so I was on my own to muddle through that disaster. The creep ran up $45,000 in cash advances on my credit cards before he left. The kicker is ... for whatever reason, I decided to Google him a few months back. That mofo is a doctor at freakin' Cornell!! He was a measley mall retail manager when we were together. Heh!
7. I am majorly obsessive-compulsive. My spices and albums/CDs are alphabetized. My linen closet has shelf dividers, and the cans in my pantry are all such that you can read every label. The clothes in my closet all face the same way on the hangers, and are sorted according to colors - dark shades to lighter. My shoes are all in plastic boxes and arranged the same way on the closet shelves. One more thing ... I count EVERYTHING, but you'd never know I'm doing it. Oh yeah ... I also check the alarm six times before I can actually go to bed. All I can say is "Thank God for Effexor"!
8. Now for the most personal thing. I am the textbook example of a "yo-yo" dieter. I have lost 100 lbs. three times in my 48 years. Thank God I have been at a healthy weight for the last several years, but it's definitely my cross to bear in this world.
Whew! That wasn't the easiest thing in the world. It was actually kind of hard to narrow it down to 8.
Since I am new to blogging, I only have a couple of people I can tag. One would have been Bo, who tagged me. I was also going to tag Medblog Addict, but she has already played, too. I hereby tag Student Nurse Jack and Third Degree Nurse. I hope you ladies participate!
Sunday, May 13, 2007
Happy Mother's Day to all of you Mothers out there! I can't think of a harder job, or one filled with more responsibility than that of being a parent. I don't mean just giving birth ... I mean being a parent. My hat's off to you! Enjoy your special day, you deserve it!
Tuesday, May 1, 2007
I solemnly pledge myself before God and
To pass my life in purity and to practice my profession faithfully.
I will abstain from whatever is deleterious and mischievous
and will not take or knowingly administer any harmful drug.
I will do all in my power to maintain and elevate the
standard of my profession and will hold in confidence
all personal matters committed to my keeping
and family affairs coming to my knowledge
With loyalty will I endeavor to aid the physician in his work,
and devote myself to the welfare of those
Contrary to what many believe, Florence Nightingale did not write this pledge. It was composed by Lystra Gretter, an instructor of nursing at the old Harper Hospital in Detroit, Michigan, and was first used by the hospital’s graduating class in the spring of 1893. It is an adaptation of the Hippocratic Oath taken by physicians.
Taken from the
"Schools in the Texas Gulf Coast Region turn away qualified applicants to initial RN licensure programs due to limited space within clinical sites and a shortage of clinical faculty. This grant, supported by a consortium of ADN and BSN nursing programs, hospitals, clinical agencies and community partners and funded through the University of Texas School of Nursing at Houston, demonstrates an alternative approach to nurse education. Designed as a preceptorship model, the project addresses a major limitation to increased student enrollment, constrained clinical education capacity. By increasing this capacity, student enrollment can expand and ultimately result in increased numbers of initial licensure programs graduates.
A second objective is to develop a pool of Preceptors for mentoring initial licensure ADRN and BSRN students in the clinical setting in the Texas Gulf Coast Region. Support of this program is expected to increase the collaboration among educational programs and between education and service for the benefit of the Gulf Coast nursing community and the population it serves."
There's one more semester of funding for the project. I really hope it continues beyond that, because this methodology is far superior to the traditional clinical education model where one instructor has 10 or 12 students. My little chickadees did more in this one semester than I did during my entire career as a student.
Let's see ... they started Foleys, NG and OG tubes, assisted with bedside procedures such as central line insertions and brace fittings for patients with neck fractures. They also drew blood from those central lines and arterial lines, learned about CVP, A-line, and ICP monitoring. They cared for dying patients, learned about the organ procurement protocol, and saw how to refer a case to the Medical Examiner. They even had a patient in DKA with a glucose of 1087. They administered meds orally, subcutaneously, via IV push and piggyback, IM, and via NG tube. They learned about heparin and insulin drip protocols, and had patients on both. They even did slush enemas on a vented stroke patient with a bowel obstruction. They also started to learn the invaluable skill (or is it an art?) of time management. They even gave change of shift report and made some calls to physicians, and we all know how hard that can be!
I'm very proud of my girls. They gained so much confidence in our 12 short weeks together. They were so scared and intimidated at first. By their last couple of weeks, they walked in acting like they owned the ICU.
Wednesday, April 18, 2007
Blessed be these hands that have felt pain.
Blessed be these hands that have embraced
Blessed be these hands that have been clenched
Blessed be these hands that have drawn blood
Blessed be these hands that have cleaned beds
Blessed be these hands that have anointed
Blessed be these hands that grow stiff with age.
Blessed be these hands that have comforted
Blessed be these hands, we hold
Blessed be our hands for they are the work
Sunday, April 8, 2007
Now this lady ... she's swimming in chocolate. I wonder what that's like? I'd imagine you'd need one masterful nuseplug and set of goggles!
Next, we have a couple of chocolate castles. I don't think I'd want to live in either one because I think they'd be hard to decorate, and 'll bet they're FULL of ants! Can you spot Dr. Seuss?
Some art deco and a white chocolate Matterhorn of sorts ...
What do you feed a chocolate horse, and what's the fuel for a chocolate train??
Sunday, April 1, 2007
-"Giving your cat the tablet ensures he gets the full dose at the prescribed time. It is easier if you have 2 people.
-Put the cat on a table and approach him from behind so that you encircle him in your arms.
-Hold the front legs with your hands, and keep the cat close to your body to limit wriggling.
-The person giving the tablet puts her thumb and second finger of her left hand over the cat’s head on either side of the jaw. As the head is lifted up, the cat’s mouth starts to open.
-Holding the tablet between your thumb and forefinger, use your second finger to open the jaw.
-Drop the tablet down the back of the throat, and if you are quick enough, follow it down with a push with your forefinger to ensure it has disappeared.
-Using a pill popper or pill applicator makes the process much easier.
-If your cat struggles, you can try wrapping him in a towel so that only the head is protruding. Remember the faster the process, the less stress to your cat, and the less he has time to struggle."
Yeah. Mmm hmm. Want to know how it REALLY goes?? Then read on ...
-Pick up cat and cradle it in the crook of your left arm as if holding a baby. Position right forefinger and thumb on either side of cat's mouth and gently apply pressure to cheeks while holding pill in right hand. As cat opens mouth, pop pill into mouth. Allow cat to close mouth and swallow.
-Retrieve pill from floor and cat from behind sofa. Cradle cat in left arm and repeat process. Retrieve cat from bedroom, and throw soggy pill away.
-Take new pill from foil wrap, cradle cat in left arm, holding rear paws tightly with left hand, Force jaws open and push pill to back of mouth with right forefinger. Hold mouth shut for a count of ten.
-Retrieve pill from goldfish bowl and cat from top of wardrobe. Call spouse from garden. Kneel on floor with cat wedged firmly between knees, hold front and rear paws. Ignore low growls emitted by cat. Get spouse to hold head firmly with one hand while forcing wooden ruler into mouth. Drop pill down ruler and rub cat's throat vigorously.
-Retrieve cat from curtain rod; get another pill from foil wrap. Make note to buy new ruler and repair curtains. Carefully sweep shattered figurines and vases from hearth and set to one side for gluing later.
-Wrap cat in large towel and get spouse to lie on cat with head just visible from below armpit. Put pill in end of drinking straw, force mouth open with pencil and blow down drinking straw.
-Check label to make sure pill not harmful to humans, drink one beer to take taste away. Apply Band-Aid to spouse's forearm and remove blood from carpet with cold water and soap. Retrieve cat from neighbor's shed. Get another pill. Open another beer.
-Place cat in cupboard, and close door onto neck, to leave head showing. Force mouth open with dessert spoon. Flick pill down throat with elastic band.
-Fetch screwdriver from garage and put cupboard door back on hinges. Drink beer. Fetch bottle of scotch. Pour shot, drink. Apply cold compress to cheek and check records for date of last tetanus shot. Apply whiskey compress to cheek to disinfect. Toss back another shot. Throw Tee shirt away and fetch new one from bedroom.
-Call fire department to retrieve the damn cat from across the road. Apologize to neighbor who crashed into fence while swerving to avoid cat.
-Take last pill from foil wrap. Tie the little bastard's front paws to rear paws with garden twine and bind tightly to leg of dining table, find heavy-duty pruning gloves from shed. Push pill into mouth followed by large piece of filet steak. Be rough about it. Hold head vertically and pour 2 pints of water down throat to wash pill down. Consume remainder of scotch.
-Get spouse to drive you to the emergency room, sit quietly while doctor stitches fingers and forearm and removes pill remnants from right eye.
-Call furniture shop on way home to order new table.
-Arrange for SPCA to collect mutant cat from Hell and call local pet shop to see if they have any hamsters.
You say you need to give your dog a pill? Wrap it in bacon and toss it up in the air. (Lucky bastards!)
Now ... before I get any hate mail, here's the disclaimer: No cats were harmed while trying to medicate them, nor were they given away when medicating them pretty closely resembled the above scenario. Actually, I love my girls. I just have to laugh, though, about trying to medicate them. I hope you laughed, too.
Tuesday, March 27, 2007
ST. M O M M A'S W O R T: Plant extract that treats mom's depression by rendering preschoolers unconscious for up to two days.
E M P T Y N E S T R O G E N: Suppository that eliminates melancholy and loneliness by reminding you of how awful they were as teenagers and how you couldn't wait till they moved out.
P E P T O B I M B O: Liquid silicone drink for single women. Two full cups swallowed before an evening out increases breast size, decreases intelligence, and prevents conception.
D U M B E R O L: When taken with Peptobimbo, can cause dangerously low IQ, resulting in enjoyment of country music and pickup trucks.
F L I P I T O R: Increases life expectancy of commuters by controlling road rage and the urge to flip off other drivers.
BUYAGRA: Injectable stimulant taken prior to shopping Increases potency, duration, and credit limit of spending spree.
N A G A M E N T: When administered to a boyfriend or husband, provides the same irritation level as nagging him.
Just take two and call me in the morning ...
Monday, March 26, 2007
This is who he killed, dismembered, then grilled.
Saturday, March 24, 2007
A PITA can be a coworker, a patient, a family, or Heaven forbid ... a doctor. We have had a gaggle of PITAs at Work this past week. Our biggest PITAs were family members. There were two patients in particular that had associated PITAs. The patients themselves weren't PITAs, but their families certainly were. PITA #1 was mild compared to PITA #2, but was a huge PITA nonetheless.
PITA #1 belonged to a 30-something patient who had a MAJOR surgery, but was very stable and not a problem in and of him/herself. Spouse, Mom, and Sister were another story, though. Patient needed a calm, quiet environment with minimal stimulation, but Family wasn't willing/able to provide this. They constantly hovered, talked to, and touched Patient. The end result? The most impressive projectile vomiting I have ever witnessed.
Also ... despite our rule of no overnight family, they demanded to spend the night with Patient. The stimulation and constant calls to the nurses continued. Fortunately, the projectile puking didn't persist. The minute Patient would wake up, Family called for pain or nausea medicine. Patient didn't want or need said medicine. They constantly spoke for Patient and made requests on Patient's behalf. Patient finally got the balls to tell them to knock it off. Thank God they (notice I said "they") went home while I was off. If I had to care for them one more day, I'd have probably poked myself in the eye with a pencil.
Carrying on the theme of asking from my previous post, I frequently ask myself:
-When did nursing get this way?
-Why do PITAS act the way they do?
-Didn't anyone ever tell them that the ruder they get, the less anyone wants to help them and the more people avoid them - not the other way around?
-Is this a hospital, or is it the Hilton?
-When did it become OK for PITAS to berate nurses?
-When did it become OK for administration to tell nurses to endure this abuse in the name of "customer service"?
-Maybe most importantly ... Why do I go back day after day for more? Sometimes I wonder, but deep down I know. It's for the Patient, not their PITA.
Wednesday, March 21, 2007
He says, "I was thinking. Maybe, as we do our time-outs and scrub our hands red, as we smile and get cups of ice and endure abuse with a smile, we could create our own ‘Ask Me’ buttons. But let’s ask some questions with a twist. How about some buttons that ask the things clinicians want to ask everyone else?" Almost all of these are his, but I've added some of my own.
Sooo .... Go ahead ... Ask Me ...
Ask me: How tired I am
Ask me: If I’m depressed
Ask me: How many holidays and birthdays I’ve missed with my family
Ask me: If I’m addicted to caffeine, or anything else
Ask me: If my hands ever bleed or crack from washing too often
Ask me: About the last time a physician belittled me on the phone or worse yet, in public
Ask me: If this is all that I hoped it would be
Ask me: If my opinion has ever been silenced with the threat of retribution
Ask me: What I’d do if I could do anything in the world … other than this
Ask me: How I feel when I do postmortem care
Ask me: How I feel when I am keeping a brain dead patient alive so his organs can be harvested for transplantation
Ask me: How I feel when I am taking that same patient to the OR for the harvesting after I've spent a very busy night keeping him alive
Ask me: If I’d recommend this job to anyone else
Ask me: If I ever fell asleep or ran red lights while driving home from nightshift
Ask me: How many times I do someone else’s job because they are lazy or stupid ... or because I am told that I have to
Ask me: About how compassionate I feel after several challenging shifts, or at the end of a double night shift
Ask me: If I feel like I'm a victim of slave labor sometimes
As me: If I think my employer REALLY cares about something other than money
Ask me: If anyone has lied to me today
Ask me: What it feels like to watch someone die and be helpless to stop it
Ask me: If I think patient satisfaction scores are really accurate ... or really matter
Ask me: What I think of the whole "customer service" approach to healthcare
Ask me: If my own pain is a zero … or a ten
Ask me: How it felt to be sued or deposed
Ask me: Anything except "Can you stay over and work tonight?"
Ask me: How it feels to be assaulted or verbally abused on a regular basis
Ask me: What I think about most doctors
Ask me: What I think of most of my nurse coworkers
Ask me: What a pain in the ass I think alot of families are
Ask me: For my views on the social welfare system
Ask me: How deeply I am moved by the suffering of my truly suffering patients
Ask me: How I feel about using my time and talent on someone who has tried to take his own life
Ask me: If I’m still able to cry
Ask me: How often I wonder when tragedy will strike my family
Ask me: How I could fix the broken system
Ask me: How many years, months, weeks, days and hours until I can retire
Ask me: If I’ve been treated fairly by my supervisor or employer
Ask me: When the last time was that I didn't have a UTI because there was actually time to go to the bathroom during a shift
Ask me: About the last time I had a 30 minute uninterrupted break
Ask me: What my dearest dream is
Ask me: What gives me hope
Ask me: Why I still do it
Ask me: If I ever allow myself to think I’m good enough
Ask me: What I use to determine my worth
Ask me: How my day is going, but mean it
Ask me: Anything … but be prepared for the truth, and only ask if you really want to know what I think.
Sunday, February 4, 2007
Friday, January 5, 2007
Like Joan Rivers, Rosie has made a career of being mean to people. If it weren't for insults, she'd have NOTHING. She has no talent and no appeal. Not that I was a big fan of The View before, but I think that a huge mistake was made by adding Rosie. She is a caustic entity. Wasn't there something or other in the past about Rosie and child abuse? Maybe I'm not remembering correctly.
And Donald ... ALL he has going for him is his money. Period. Does he REALLY think that his beautiful young wife is with him because of his wit, charm, and looks? Yeah ... and it'll be snowing in Miami tonight. The hair ... the beady eyes ... the puckered lips. He looks as if he has a stick shoved so far up his ass that he can't relax. Do you think he even has a Tshirt or a pair of sweats? I'd wager to say "no".
Tuesday, January 2, 2007
Let me give you a little background on B (not his real initial, of course). He was a vibrant, intelligent man of 51 years who never made it home from midnight mass on Christmas. He was pulled over for suspected drunk driving when, in fact, he was in the middle of a massive stroke. The police recognized this and immediately summoned EMS. But it was all for naught. He was well within the 3 hour limit for tPA when he arrived in the ER at Work. But nooooo. They were "too busy" with all the drunks to give him the attention that he needed. In fact, he didn't even get heparin (never mind tPA) until about 8 hours later. As a result, by the time he arrived in the ICU, he had complete left hemiparesis and aphasia. He could, however, communicate his needs pretty well. I wish there was a way that I could ethically and in good conscience tell B's family that they should file suit against Work, because I think that the ER was grossly negligent and his death could have been avoided.
When I cared for him 2 nights after his admission, he began the swift downward spiral. When I arrived for my shift , his GCS was 13. When I left at the end of my shift, it was 3 - the worst a person can have. We intubated him at the very end of my 16 hour overnight shift. About 2 hours after that, he was declared brain dead. As is Work's protocol, the bedside nurse calls our regional organ procurement organization, and they are the ones who approach the family about donation. It took B's family almost a whole day to decide to donate. For some families, it's an easy decision and for others, it's gut-wrenching. It wasn't easy for this family.
The care of donors is extremely involved. Placement of arterial and CVC lines if not already in place. Hourly vitals and suctioning. Chest Xray and hypo/hyperthermia blanket as indicated. STRICT hourly I & O, with cc for cc + 50 cc replacement IV fluids for urine output - e.g. 250 cc urine out = 300 cc IVF in the next hour. Initial set of labs (22 tubes PLUS 2 sets of blood cultures, sputum and urine cultures). Of course, pulling all that blood necessitated an increase in his Dopamine dose. Then, every 4 hour labs and ABG's. BP was maintained with Dopamine titrate and phenylephrine at a steady 25 mcg per minute. THEN .... any other meds or treatments as indicated by the q 4 hr labs ... like amps of bicarb here and there, mannitol here and there, insulin and calcium chloride now and then. It almost seems ridiculous to do all of this for a dead person. We needed to keep the organs as viable as possible. Intellectually, I understand the need for the rigamarole, but emotionally, it's hard.
It was with mixed emotions that I helped roll B to the OR for his organ harvesting. It felt like I was taking him to the gallows for an execution, and I had to keep reminding myself that he was already dead. I also had to keep reminding myself that many people would benefit from this tragedy. He had become a liver, kidney, pancreas, and heart valve donor. It is a very rewarding experience ... one that I hope all of you can experience at least once during your career.
I went home physically and emotionally exhausted, but after all was said and done, it would be a Merry Christmas for at least 5 families after all.