Nurse No-Life

I have been working A LOT lately. In order for me to go back to BC and visit my family, I switched a whack of shifts and I am currently being punished in the form of 72 hour work weeks. In my down time, I have been knitting, sleeping and trying to fit in yoga.

In preparation for this post, I made notes one night shift about what an average day in the ICU looks like. And in typical me fashion promptly lost said notes. So, this is a place holder until I wrangle the energy to do it again!

In other news, I finished a sweet pair of leg warmers I’ve been knitting for the last few months. Small yarn compared with small needles and a pattern that goes from mid-thigh to ankle equals the pattern from tedious hell. Once I weave in the ends I’ll post some pictures.

 

Back to Work

I have been back in the ICU for the last couple of days. Nothing really exciting. In fact, a lot of our patients are speaking (which means they’re not intubated nor sedated, which means they shouldn’t be in the ICU!)

I have been spending the last two days troubleshooting my patient’s fever of unknown origin… cultures all negative, WBC normal, meds changed around, CT of all his bits and pieces to eliminate lymphoma/abcesses… a strange clinical picture really. He does have an extensive psychiatric history but we’ve also eliminated Neuroleptic Malignant Syndrome…. We’re also investigating his apparent obtundedness, but in my opinion it is ‘selective hearing’ 🙂 He definitely chooses to whom and when he’ll respond to commands! As long as I don’t get in his bad books because his history says he has homicidal ideations. Yikes!

Tip of the day for my nursing folks: Put a disposable blue pad over the bedpan before you slide it under the patient. Best tip I have ever learned. Truly! No rinsing of the bedpan post-usage. Just fold it up and dispose! Try it, you’ll like it!

Occupy Wall Street: Workshop on Hypothermia

The Medic Tent at Occupy Toronto

So today at my local Occupy Movement, I gave a teaching session to the medics, safety folks and anyone else interested in learning about hypothermia. I was nervous to do a ‘Mic Check’ announcement, but was very fortunate to make a friend who had a megaphone! Sharing some really important information with the folks who are sleeping on location was super exciting, because our Canadian winters can be brutally cold, dropping into negative double digits. Plus, I’m kinda digging this new role as an ICU-nurse-turned-public health-nurse… You get to meet some really amazing people who have overcome a lot of adversity, and while they’re thanking you for dressing their wound, really you’re thanking them for sharing themselves with you and welcoming you into their environment and stories. Truly wonderful!

Here are some notes I typed up about what I taught, along with tips shared from the community about staying warm! These are specific to the needs of our Occupy community, so feel free to share and expand!

Hypothermia: Prevention, Recognition and Treatment

What is hypothermia?
Hypothermia is a lowering in normal core (vital organs in the torso) body temperature causing a decrease in the body’s ability to maintain normal metabolism and functions.

Signs and Symptoms of hypothermia:
Earliest signs are goosebumps and shivering. As the body gets colder and loses energy, the person’s ability to shiver disappears and more severe hypothermia rapidly progresses.

1. Central Nervous System: Slurred speech, decreased pain sensation (fingers and toes especially), decreased responsiveness to a person’s voice, drowsiness, poor coordination.
2. Cardiovascular System: Slow Pulse, blue lips and fingernails (because of decreased blood flow to limbs).
3. Respiratory System: Slower breathing.
4. Frostbite: Starts off as mild, yellow/gray patches on skin that become red and flaky when rewarmed. More severe frostbite develops blisters (high risk areas include nose, cheeks, fingers and toes).

Prevention of hypothermia:
Prevention is by far the best way to ‘treat’ hypothermia. Here are some tips…

• Many layers (base layer of longjohns, sweaters, windbreaker on the outside)
• Wool clothes (wool is especially good at capturing body heat, as well as keeping the body dry)
• Cover your head (a lot of the body’s warmth escapes from the head, armpits and groin)
• Wear thick socks and keep your feet dry
• Wear a scarf (keeping the back of your neck warm helps your brain perceive your body as warm.. seriously!)
• Wind and waterproof your tent (taping the silver emergency blankets to your tent ceiling is a good idea, as well as securing tarps as windbreakers and sealing all leaks in your tent with duct tape if necessary), make sure you have warm blankets/sleeping bags. Keep your bed raised off the ground with wooden pallets and cardboard
• Remember that alcohol will cool you down. It may make you feel warm, but really you are losing heat because your blood vessels are expanding, causing heat loss
• Keep each other accountable. Remind your community to dress warm! If you see someone underdressed for the weather, help them fix that!

How to treat hypothermia:
The most important thing to remember when treating hypothermia is to warm the core. A hypothermic body has lost it’s own ability to warm up so placing a blanket around someone will not help. We need to GIVE them warmth. There are two main techniques to do this:

1. Core rewarming: Once the person is in a warm location (indoors, in thick, dry layers of clothes)

• Encourage them to drink warm liquids.
• Place hot water bottles in their armpits and groin (these are places where major blood vessels run near the skin’s surface and thus are spots where heat escapes quickly

2. Inhalation rewarming:

• Encourage person to breathe the warm steam from a pot of freshly boiled water

*If the person is very confused, or has trouble staying awake or walking, has frostbite, or is no longer shivering consider seeking professional medical attention at a hospital*Sources:

http://en.wikipedia.org/wiki/Hypothermia
http://www.hypothermia.org/hypothermia3.htm
http://www.education.com/reference/article/Ref_Watch_signs/

Public Health Nursing at My Local Occupy Community

This afternoon I went down to the site of my local Occupy movement to get all ‘ICU nurse’ (read: tightassed organized) on the medic tent. I spent a little while taking inventory of the many generous gifts of first aid equipment and medications/vitamins. While I was in the tent mumbling to myself as I cleaned, I heard some voices approaching.

It was a street outreach RN and a mental health RN. They were curious about what sort of services we provided to the at-risk folks, as well as inquiring if the community was as troubled as the newspapers have been saying. (A lot of the media attention focused on our Occupy community has been about the substance addictions and occasional violent incident. As a result of the safe space the community provides and nutritious food supplied at the kitchen, many of the city’s disenfranchised folks spend time in the park. The community has always tried to deal with any issues of unsafe behaviour internally, or calling on support from volunteer social workers and on two occasions the police. While we don’t deny there are issues, they are not as immense as the media is making it sound.)

An interesting conversation followed with the nurses, myself and some of the core facilitators of the city’s movement around the delicate balance between keeping a space safe and not rejecting those who society have already cast out so unforgivingly. This movement is about community, creating change, and fighting for social justice. What sort of hypocrites would we be to deny haven and food to those who need it most? Luckily, we have had some support from volunteers trained in addictions and mental health counselling. We also have some wonderful local organizations that can help get people connected to shelter and food if necessary.

After this discussion, I spent some time just exploring the grounds and meeting some super inspiring people. Many people have been camped out since day one of our city’s Occupation. I shared some tea with another volunteer medic and chatted about what sort of issues have been cropping up for her. A significant one was hypothermia. Based on my nursing education, we thought it would be a great idea to have an education session for the other medics and anyone else who would find it interesting. So tomorrow this ICU nurse will be wearing the hat of a public health nurse! I have already designed some main teaching points, but hope to mostly facilitate a small discussion and idea sharing around issues like prevention, recognition and treatment of hypothermia.

I will type up my notes to share, perhaps with other medic teams at other Occupy movements. My friend who is deeply involved in the Occupy Montreal movement has already asked for information to share, so tomorrow will be my test run!

In other news, I successfully finished my ACLS course. Yay! By the end of the second day I was all “ugh, whatever” whenever I saw Vtach/Vfib on the monitor. We’ll see if I’m as cavalier when it happens in real life 🙂

Some little thoughts on Occupy Wall Street

A sign from OWS

For the last month and a half or thereabouts, I have been following the Occupy Wall Street movement very closely. When I first heard of it, it was on facebook from friend’s links as mainstream media was not yet covering it (for a variety of reasons, some more sinister than others I’m sure).

There are other blogs and news articles that very eloquently express their ideas and opinions on the movement, much better than I can, but I value writing as a way for me to process my own thoughts, so voila!

At first I thought ‘flash-in-a-pan’, but as the days went on and I discovered more about the motivating factors I realized the movement resonated. In fact, I now consider it one of the most inspiring social movements of my generation (I’m somewhere on the 20’s spectrum). I am shocked when people my age haven’t heard of it. This clearly implies they have no interest in politics, social justice or current events* (which is a complaint for another time). You can learn more about the OWS movement here.

*Side Note* Political activism is something I feel all nurses should be involved in. Whether for a specific cause (ie: my mom who is also an RN is crazy about asbestos), or for broader things such as voting for a political party with the best social/healthcare/education platform, nurses are in an incredible position to influence change for the good of the public. I mean, there are thousands of us, and for the most part we see what happens when cuts are made to healthcare for example…

Anyhow, more about the OWS movement… While Canada’s financial systems and policies differ from those of the USA, we are fast moving towards adopting ludicrous laws and bills (Omnibus Crime Bill anyone?!), and large financial institutions and corporations play a huge part in our political system in the form of lobbyists and party platform donations. I feel that radical change is needed, so when the OWS movement began spreading globally, I was thrilled when I discovered a branch in my city. So yesterday I hopped on my bike and went to check it out. I found a public kitchen feeding anyone who asked, tents set up amongst trees, people talking and laughing, inspirational signs all bringing attention to a variety of issues, from Palestine to climate change to the Tar Sands. Some people bemoan the fact that the movement has no ‘real direction’. I say those people are not paying close enough attention. The movement is about creating social change, and the uniting idea seems to be “People before Profits”. The rest is still falling into place. Relax, we’re working on it 🙂

At the volunteer station, I discovered they were in desperate need of medical staff. The nights are falling below zero now so hypothermia is a risk, and many of the city’s homeless have taken shelter in the park so along come some substance use and mental health issues often associated with that population of folks. I told them I was an ICU nurse and would love to volunteer some hours as a medic on my days off. They were thrilled and I was thrilled with the thought of reorganizing the medical tent  🙂 (and getting to know the passionate individuals involved with the movement, of course!)

So, my first shift is this Saturday. So exciting!

If you are curious how you can be involved, even just  a little bit, here are 11 Simple Ways to Support the Occupy Wall Street Movement Without Sleeping in a Park

Super inspiring!

PS, today and tomorrow I have been doing my ACLS (Advanced Cardiac Life Support). Whoa intense! I’ll write more on that when I’m done.

Pumpkin Pie = True Love.

I love the fall. There are many, many reasons why, but perhaps the most important reason is the food. It is harvest time and the markets are full of roots and squashes (which if you know me are some of my favorite foods!)

October has Thanksgiving and Hallowe’en which are some very awesome holidays in my opinion. One because it is a celebration based purely on gratitude and community. The other because it’s about costumes and the darker side of life. And what food epitomizes October better than the pumpkin!

Here is by far my favorite version of pumpkin pie. I have tested many in my life, and have tinkered and tweaked until I found the perfect balance between ‘good for you’ and friggin delicious. Healthy, potentially vegan if you so choose, and so flavourful you won’t even know you’re not eating conventional and crappy store-bought pie. This version includes how to use an actual pie pumpkin, but you can used canned in a pinch

PS, you’re welcome 🙂

Step 1: Preparing the pumpkin:

Make sure you have a pie pumpkin, which are smaller, sweeter, and smoother in texture than pumpkins meant for carving. A 6″-8″ pumpkin should do for one pie.

-Preheat oven at 350 F

-wash the exterior of the pumpkin, cut in half and scoop out the seeds (save them for roasting!) and ensure there is no stringy ‘guts’ left inside.

– Take a baking dish, put an inch of water in the bottom and place the pumpkins hollow side down in the dish.

-Bake for 45-60 minutes (until tender) (While it bakes, you can move on to Step 2: Making the Crust

-When the pumpkin is tender, remove from the oven and allow it to cool before you scoop all the ‘meat’ out into a medium bowl.

-Puree the pumpkin mush!

Step 2: Making the Crust

This is a recipe given to me by a dear friend. It is truly delicious and flaky. It makes enough for two crusts in a 9″ pie pan (you can freeze the other half of the dough and use it another time, or double the pumpkin filling recipe and make two pies!)

INGREDIENTS:

• 3 cups flour (spelt, or whole wheat or whatever you fancy)
• 1 cup ground flax
• 1 1/4 cup COLD butter, cut into small cubes (Or coconut oil for a vegan version
• zest of 1 lemon or lime
• plenty of cinnam0n
• 2 large eggs, beaten, with a splash of nut/soy/conventional milk

-Put a big bowl in the freezer
-Once cold, sift in about half of the flour and flax
-Using your hands, work the cubes of butter/coconut oil into the flour and flax by rubbing your thumbs against your fingers until you end up with a fine, crumbly mixture
-Add the rest of the flour and flax, lemon/lime zest, and cinnamon
-Add the eggs and milk to the mixture and gently work it together until you have a ball of dough (Don’t work the pastry too much or it will become chewy and elastic, not crumbly)
-then pat it into a flat round
-Flour it lightly, place it in a bowl, and keep in the fridge to cool for at least 30 minutes

After it has chilled:
-Split the dough in half
-Flour your workspace and roll half into a circle to fit your pie baking pan (an 8-9″ pie pan, deep dish preferably so you can fit a lot of filling!)
-Butter the pie baking pan, and then arrange the flattened dough onto it
-Put your filling into the centre of the dough (See Step 3: Pumpkin Pie Filling and Step 4: Bringing It All Together)
*NOTE: When making the pie crust, try to be as quick and confident as possible, so that the butter doesn’t melt, and you end up with a nice flaky crust. A good trick is to make sure your hands are cold by running them under cold water first*

Step 3: Pumpkin Pie Filling

• 2 cups pureed pumpkin (or one 15-oz can)
• 1 cup milk (unsweetened soy, almond, or coconut for vegan alternatives)
• 3/4 cup brown sugar, honey or maple syrup
• 1 egg (or 1 Tbsp psyllium husk, or 2 1/2 Tbsp cornstarch for vegan alternatives)
• 2 tsp cinnamon
• 1 tsp ground ginger
• 1/2 tsp salt
• 1/4 tsp ground cloves
• 1/2 tsp ground nutmeg

Step 4: Bringing It All Together

Pour the pumpkin filling into the pie crust, bake for 60 minutes at 350 F. Enjoy with whipped cream or ice cream and share the recipe!

 

 

How not to clean your bathroom, a PSA

Do NOT mix bleach and ammonia in the toilet bowl in an enclosed space. Bleach + ammonia = Chlorine gas = a weapon used in WWI and WWII as a chemical warfare agent causing chemical burns in the airway and lungs.

It will leave you intubated, ventilated,  and full of lines going in and out and pretty much wherever we can find space. When the swelling in your airway has finally gone down enough, your breathing muscles will be so weak you will need a  tracheostomy in order to wean off of the ventilator.

So please, Use vinegar, water, lemon juice and tea tree oil instead. No risk of toxic fumes, good for the environment, plus you avoid a ticket to the ICU. Win-win-win!

I’m all for optimism, but there comes a point…

“So how is he today?”

“Well, since yesterday, we’ve had to maximize the medication necessary to keep his blood pressure up. We have also had to increase the settings on the machine breathing for him.”

“Hm. He looks more swollen than yesterday. Are you giving him too much fluid? It looks like a lot of bags hanging up there. My friend’s aunt’s daughter used to be a nurse, and she said that too much fluid can cause swelling.”

“As I mentioned before, a few of those are critical for his bp. Some are to improve his heart’s contraction power, one is insulin to manage his out-of-control sugar levels from all the stress his body is under. He has an infection in his blood that is causing his blood vessels to all simultaneously dilate as well as cause fluid to shift from his circulatory system into his tissue, so he’s also on some antibiotics, as well blood products to try to pull some fluid back into his vasculature. He is very, very sick right now.

“So when do you think he’ll get out of here?”

“…as I just mentioned, he is extremely sick. He is still on a ventilator that is breathing for him. His kidneys have completely shut down and without the continuous dialysis he receives, his body would not be able to eliminate all the toxins building up. He will likely be here for weeks, and will require months of rehabilitation and convalescence.”

“Well, we have non-refundable tickets to go to Florida next week. We have already booked our rental condo with another couple. It won’t be anything really active, mostly just sitting around drinking cocktails. He should be able to do that, won’t he?”

 

How can I explain better this so you’ll take it seriously?!?

First day jitters

My first day in the ICU was nauseating. I hardly slept the night before, I had to run to the bathroom every hour, every beep, ping, and alarm I heard certainly meant imminent death. On the surface I tried to exude eager-to-learn confidence as I worked with my mentor, but inside I was a roiling disaster.

I was completely overwhelmed at the sight of my first patient. A mystifying tangle of lines, poles almost groaning with numerous IV bags as though they were overburdened apple trees. Tubes going in and out of all orifices, every fluid our human bodies produce being collected, measured and scrutinized. So many monitors displaying so many waveforms, each one telling a “live action” story of the various pressures and frequencies our bodies depend upon to maintain life.

Perhaps the most intimidating tube and machine to the ICU neophyte is the endotracheal tube and the ventilator. The endotracheal tube that protects the vulnerable airway of a person unable to maintain their own, attached to the machine that provides each breath to a specific volume, frequency or rate. All the sickest people have one, and my biggest fear was to dislodge it by accident! This tube and machine represent so much to families. It is the most obvious sign their loved one is ill: A big, plastic tube jutting out of their mouth that is attached to a giant machine at the bedside. When people hear the phrase ‘pulling the plug’ it is the ventilator plug they imagine being pulled out from the wall.

Anyhow, my first day in the ICU was intimidating, and yet amid all the loud noises, distracting tubesand monitors, there is a person who needs my help. My attentiveness, critical thinking, care and advocacy. That is what didn’t scare me off that first day. That and the adrenaline thrill of it all!

Sometimes I wonder...

 

New admission

I graduated in 2010 with a BScN and knew within 6 months of feeling like an underappreciated, stressed out waitress that the medical floor was not for me. (Mad respect to my brothers and sisters on the floors. Keep calm and carry on!) After moving across the country, a brief stint in endoscopy (you have an orifice, we’ll fill it!) and hospice palliative care, I scored a permanent full-time position in a major Canadian Med/Surg ICU.

It is often said that 20-30 years ago, most patients on the average medicine floor would have been in the ICU, and the average ICU patient would have been dead. I care for the sickest of the sick. People requiring 1:1 or even 2:1 nursing care, intubation and mechanical ventilation to maintain an airway and respiration, pressors and inotropes to maintain a blood pressure, amongst a myriad of other radical and extreme technologies and medications to keep you alive long enough for your body to heal itself from whatever major trauma or illness it is experiencing.

Now, I don’t profess to be a critical care expert. In fact, I’m still a fledgling nurse. However, I think reflection helps us learn and create connections so after much self-debate and intention-searching I have decided to give this a shot. Working in the ICU is simultaneously the most rewarding/upsetting/shocking/interesting job a person could have, and in order to process it all I figured why not share it with those who may find it as interesting as I do!