The Watchdog

Still at the subacute rehab center...
I took care of a serious character named Chuck.  His neighbors had called EMS because they hadn't seen Chuck in awhile and his house was kind of disaster.  He ended up being ok, but he was getting more confused and wasn't able to take care of the whole personal hygiene part of life, which is a pretty important part of life if you ask me.  He also had a little infection in his lower leg, so he came to kick it with us for awhile to figure out a better plan and get some antibiotics.  Chuck was awesome, he was completely mobile, which was a big switch from our usual wheelchair bound patients, or patients that needed help with transfers.  He was supposed to use his walker out in the hallway though.  Chuck probably only slept for about two hours a day, and he was always up to something.  Anytime he heard any kind of noise in the hall, Chuck bounded from his chair or bed to come see what was going on.  That's why I nicknamed him The Watchdog.  The Watchdog also looked EXACTLY like Jack Nicholson, he had crazy white hair and wore these glasses with big black frames which only added to his look.  Every time he came out to assess the situation he would always forget his walker, I would shout down the hall, "Watchdog, please grab your walker!"  He liked to shout back, "FUCK THE WALKER!"  I loved it, the sassier the better.  A few times he was in such a rush, he not only forgot his walker, but his pants too and would go sprinting out of his room with nothing but his whitey tighties on and black socks.  Pimpin'.

The Watchdog, but he had crazier white hair

More like this...

The Watchdog was tricky, right when you were wondering "what is this guy doing here, he doesn't really need our help.."  he would wander up to the nurses station at 11pm on a Sunday with his wallet out and ask me when we were leaving to go to the bank to deposit his work checks.  Or confuse me with one of his kids and tell me that he couldn't believe I put him in here.  That would quickly help us remember why he was there.  He had a roommate Buzz, and one of Buzz's TED hose (compression stocking) went missing shortly after Chuck moved in.  One day I noticed The Watchdog carrying something in his hand...it looked suspiciously like Buzz's missing TED hose.   I asked The Watchdog, and he denied it, saying that it was his personal book holder and he had brought it from home.  He had like 5 books shoved in this TED hose with the end tied off.  I asked him if I could see it and he said yes.  I asked him why his personal book holder had Buzz's name on it...(we labeled everyone's clothing) and The Watchdog smiled, snagged "his" book holder back and said that he put it on there "to confuse people."  Touché Watchdog, touché. 

The Real McCoy

Still in the subacute rehab center....

I took care of a lady named Lisa who had a developmental delay, as did her husband who came to visit everyday.  They were quite cute and you could tell they really loved each other.  Lisa, however didn't so much love to follow the rules, neither did her husband.  She had an issue with her stomach, if she ate junk food, or fatty food, she would almost always throw it up.  Her body just couldn't handle it.  Despite multiple requests from the staff to her husband to stop bringing her junk food, he would continue to bring it in.  Cheetos were Lisa's weakness and he always made sure she had a full supply.  Maybe we should have had him clean up the puke a time or two...just saying.  Lisa didn't seem to care, she would just laugh and ask to be cleaned up.  Cheeto & root beer puke is absolutely disgusting, in case you had any doubts.  She also knew what a big deal it was for the nurses to have a patient fall during your shift.  The state monitors falls and we go to great lengths to keep people from falling, from bed alarms, chair alarms, medication reviews, low beds, and mats on the floor next to the bed.  About once a week, after the CNA's put Lisa to bed...she would start rocking herself back and forth, back and forth, until eventually she would roll herself off the bed and onto the mats on the floor.  The nurses and CNA's would come running in hearing her bed alarm going off, and she would just laugh and laugh at all the paperwork we had to fill out, and she would cheer when we would use the mechanical lift to get her off the floor and back to bed.  I offered to put her in the lift almost every time I worked, just to let her have a ride, but she said, "no, it's more fun the way I do it."  I guess we all have to get our kicks somewhere.

There was one very unique patient that I will never forget.  Rikki lived directly across the nurses station and kept me more busy then any patient I've ever had.  She was bed bound, unless we used the lift to move from the bed to her chair.  She was a huge fan of her call light, and used it better than anyone I've ever known.  She had a friend who would come to visit almost daily, and finally I figured out that she was her partner & friend.   Rikki would not give anyone but her primary nurse the time of day, and eventually I became the primary nurse on her hall.  Things started off great, I learned how she liked her room and table set up, how she liked to take her meds in different ways depending on the time of day, how she liked the lotion put on her legs, the list goes on and on.  I knew she was a little confused at baseline, so I went along with it, but then things started getting a little weird.  She was always asking me questions about my personal life, and I was pretty good at deflecting them back to her, but one day I slipped up and mentioned I had a tail light out on my car and she wanted to know the make/model of my car.  I didn't think it was a big deal, so I told her.  The next day I find out she had been calling the Toyota dealership yelling at them for the poor service I received with my car.  I didn't even buy my car there.  I guess you could say this was the start of her "interest" in me.  As the summer went on, she would only refer to me as "her girl."  At first it was kind of nice, knowing that she really liked the care I gave her and that she trusted me so much.  But then she started refusing to take medications or dressing changes from anyone else, despite my best persuasion efforts.  She was starting to ask her CNA's if I had a boyfriend, and to pass little notes (that were barely legible) along to me, even though I was in her room about 100 times a day.  Over the months she would always mention that she had "the Real McCoy" and to stop by her room if I ever wanted any.  I never really knew what she meant and would usually laugh it off with a "the Real McCoy huh?  We'll see!"  But one day she was especially persistent and told me to come back to her room after my shift to see the "Real McCoy."  So I stopped by, and she starts digging around in her bed and around her tummy area (mind you, she never wore pants, only her t-shirt top and briefs in her bed) and she pulls out four mini vodka bottles....scoots over in her bed....taps the bed gesturing me to get in....and asks if I would like a shot of "the real McCoy to get rid of my nerves."  It took me a second to put it all together, an 80+ year old bed-bound woman, asking me to take shots so I can get into bed with her.  I turned beat red, said "sorry I have to get home." And peaced out.  There really are no words.

The Real McCoy

Still Tickin'

I worked through my second year of nursing school as an LPN at a subacute rehab/long term care center.  Now I know that a lot of these places have a bad rap, but this place was nice, very clean, and had staff that had been working there for years and years.  It was a pretty sweet gig.  I liked working evenings (2-10:30) because it was a little more mellow and it worked with my school schedule.  After finishing school I worked here until I got my "big break" at a hospital in a bigger city a couple hours away.  Here are some resident highlights...

We had a lady who was basically a hermit, she would rarely come out of her room and she hated most of the staff.  She would usually throw her pills on the floor when I set them in her room and tell me to get out.  She was pissed off at her daughter for putting her in there, can't really blame the lady.  My favorite memory of her was on a rare appearance when she ate dinner in the main dining room.  As she wheeled by after dinner, I told her I would bring her pills into her soon.  I was standing with another nurse passing our meds.  As she wheeled off I hear her down the hall say, "Bitches" (in her Spanish accent) followed by an evil cackle.  I'm not sure if I've ever been called a bitch by an 80 year old before.  First time for everything right?

Then there was Marianne who would come out of her room every morning with her lipstick painted on from her chin to her nostrils, and her eyebrows going in various directions.  She would come out of her room singing at the top of her lungs every day, only after using her rain stick to "calm her nerves."  A staff member who had worked there forever called Marianne "Lips."  I would loose it every time she called her that, it just seemed so wrong, but Marianne loved it and she was the only one who could call her that.  To my future children...please get my makeup tattooed if anyone starts calling me Lips.

A very special resident who had lived there for a long time, who had a developmental delay, could always find a way to make my day better.  He is about 6'5" and looks very young for his age because of his delay.  He would collect every aluminum can from staff and residents, then once a month he would take them to the recycling center to get a little money.  His friend that would pick him up would always take him to McDonalds afterward for a cheeseburger and a hamburger.  He would look forward to it all month.  He would also draw pictures from his coloring books for all the staff, I have a small pile of all the pictures he's given me over the year I worked there.  :)  Every morning he would go around the dining room and collect all the residents clothing protectors (I would watch him through the windows while I was passing meds).  Then he would sanitize his hands, and make his way with his walker over to my med cart.  He would pull up right next to me, sit on his walker, and grab the spare stethoscope I would keep for him on my cart.   I would put my stethoscope in my ears, and he would put his in his.  I would listen to my heart, and he would tap his stethoscope with his fingers.  Then we would smile at each other and say, "still tickin" :)

More to come... :)

I'm trying to stay professional but...

After Mari passed away I went back to work in the orchards counting bugs for the summer.  It was good to mix it up a little bit, I was feeling a little emotionally overwhelmed.  I got into nursing school that summer and couldn't wait to get started.  Honestly those two years are kind of a blur (I fell of the face of the earth for two years, sorry friends)...not many specific stories stick out until I got to do my last quarter of clinicals in the ER on night shift...all the crazies come out at night...

One night a man came in who was soaking wet, clothes and all.  Apparently he decided he was going to swim across the river.  Not a little river, a really big ass river.  Our friendly local police brought him to us to get checked out.  We got him hooked up to the monitor and his heart was racing.  We went through all the classic questions if someone has a funky heart rhythm and they can still talk to us.  Then I asked him, "sir, have you used any drugs tonight?"  He responds without missing a beat, "well yeah, but it was just two lines of coke."  Well, guess what...that still counts.  His heart eventually settled down, clothes dried out, and we called him a cab.  Adios River Man.

On a cuter note, we got a sweet little old guy (you will learn I have a huge soft spot for cute oldies, and even for sassy not-so-cute ones) with a GI bleed who had to wait in the ER for a bed to open up.  So we started his blood transfusion and let him hang out with us.  I went to talk with him and held his hand (hand holding is automatic with cute oldies) and his hands were really cold, so I said "oh, cold hands!"  He smiles at me and says "warm heart." :)  I hope I'm a cute oldie someday.

During this quarter was the first time I did CPR on a human, not a mannequin.  It's not for the faint of heart.  He had been coded for quite awhile in the ambulance and we kept at it for awhile in the ER then called it.  It's not Grey's Anatomy...ribs are broken, bodily fluids are everywhere...I'll just leave it at that.  So to all of you reading this...if you have an 90 year old grandparent or parent who is still a "full code" please talk this over with them.  Maybe give them some meds, a little shock to give them a chance....but please please, no chest compressions.  It is probably their time to go and letting us thump on their chest isn't the way to go out.  Sometimes we can do too much in healthcare, and coding a 90+ year old is the perfect example of TOO much.  (Alright I'm stepping off my soapbox)

We had a young homeless guy brought in by EMS who seemed either really drunk, or really high.  He couldn't get it together enough to do a breathalyzer, but the 10+ attempts were pretty entertaining.  We didn't know anything about the guy, and he definitely wasn't going to help us out, so we found his wallet and got his name.  Luckily he was in our system so we knew a little background.  He was a type one diabetic and an IV Meth user living on the streets.  I was assessing him with the ER doctor and the patient starts sticking his tongue, drooling, & grabbing his stomach and talking about "the baby."  The doctor asked me to check a blood sugar since this guy acting so out of it.  I checked it, and it was 19!!  (Normal is like 60-100)  I don't know how this guy was still functioning (well sort of functioning).  I grabbed my preceptor and she came right in and started trying to get an IV.  His veins were shot since he was an IV user, but eventually she found one up by his shoulder.  We gave him some IV dextrose and then the real fun began.  He started to perk up...then he stands up, and starts pulling down his pants.  I said, "I think he's gunna pee!"  Thankfully we had a urinal in the room and we shoved it down there and he fills the thing to the brim.  He sits back down, we ask him if he's hungry, he nods.  So we grab a few sandwiches and juice.  He eats these in about a minute, we ask if he wants more, he nods again.  We grab two more sandwiches and he eats those too.  We left him alone for a little bit & I hear the drawers in the room opening and closing.  We go back and he's stumbling around the room looking for needles.  We ask him to stop, and lock up all the needle drawers.  He still hasn't said a word to us, and he is still pretty out of it.  While we are locking the drawers, he starts farting.  Not your average fart.  This is what my older brother would call a "cosmic fart."  This thing went on for seriously 10 seconds.  It was insane.  I look at my preceptor, who is about to loose it too and I said, "I'm trying to stay professional, but..." and we just burst out laughing.  I don't think I've ever laughed like that in front of a patient, but it was 4am...and we just couldn't help ourselves.  The patient didn't seem to notice.  Then our friend (who still hasn't said a word) starts unpacking his backpack.  I seriously think they should have a show that reveals the contents of homeless people's back packs.  It was wild.  This guy had maps, needles, papers, books, hats, clothes, insulin, blankets, it just went on and on.  We stayed in the room just to see what he was going to do with all of it, but then he just loaded it all back up, held out his finger for us to re-check his blood sugar (it was normal) and he walked out.  So random.

Little Girl

After leaving my CNA job, I went to work for a home caregiver agency.  I was in school full time so I was paired up with Mari who needed me to come for an hour in the morning and a few hours in the evening.  I was so nervous my first day, going to some strangers house to take care of them.  I didn't know what to expect.  I had heard horror stories from other caregivers about houses being totally dirty and other family members expecting you do to all their dishes and cleaning.  You are there to care for one person, the person who needs help with their laundry, food and dishes.  You aren't expected to be the house maid.  Luckily I arrived at Mari's house and found that she lived alone in a very cute (and clean) house with her little dog Sugar.  She let me in & I fixed her breakfast and started a load of laundry.  She loved poached eggs with a piece of toast and a boost.  I was supposed to serve her meals on smaller plates to encourage her to eat more.  The big plates can be overwhelming.  When I first started I didn't really know what had happened to make Mari need my help, she seemed fairly able, but as the weeks ticked by I learned more and more.

Mari started showing me pictures of herself from a few years back.  She was curvy with big hair, big makeup and she still had the big personality.  She was without a doubt "fabulous" and she had all the clothes, products & pictures to prove it.  She told me she had been married, divorced the guy, then decided to remarry him!  She didn't care, and told me "it felt right."  When I met her, she was a skinny-mini and got tired very easily, but she still had the sparkle in her eye.  After a few weeks Mari told me she had cancer, but that's all she really said about it.  After talking to her niece, I found out that it was lung cancer that had started to spread over the last few months.

Every day I would come over, Mari would have QVC on the TV...and she had packages delivered almost daily.  Finally I spoke with her niece who asked me nicely to please change the channel from QVC because Mari was spending ridiculous amounts of money!  Her credit card was linked up and all she had to do was call and enter a code.  I asked her why she shopped so much and she said "well I'm bored."  We found a old western channel that she liked a lot and the shopping slowed down a little :)  She would buy the weirdest things.  One day a package of these wind spinner things that go in the yard arrived.  There were about four of them and they looked like roosters.  Mari wasn't feeling very good that day and she always kept the living room so dark...so I set up these wind spinner things in the yard in her line of sight from the couch and we opened the front door, let the sunshine in, and watched these ridiculous little things spin around in the yard for a couple of hours.  Mari smiled at me and said, "this was one of my best purchases."  :)

 Mari started needing radiation for a cancer lesion on her wrist that hurt.  You would think going to radiation wouldn't really be the time for a fashion show.  Guess again.  Mari made me show up two hours early to help her pick out her outfit which always had some sort of sparkle on it and was topped off with a fur coat.  Then there was hair and makeup which took about 45 minutes to an hour.  We would go to radiation, her little dog Sugar always came along, never without her bedazzled leash and collar.  I would usually pow wow with a dietician at the oncology center about ways to help Mari gain weight while she got her radiation.  Afterwards she always wanted me to stop at McDonalds for a cheeseburger and a vanilla shake, even if she only ate a few bites...Sugar got the rest :)

One day I came over and Mari was too weak to get up.  The hospice nurse came over and said that we were probably getting close to the end.  I remember I had checked her blood pressure and it was low, but I had called my mom and said "is this too low?"  It's crazy to think about working in the ICU now and how little I knew back then and how scared I was.  What a difference a few years make.  I was just starting my spring break so I stayed with Mari 24 hours a day.  The hospice group got her a hospital bed and oxygen, and I learned which medications to give and when, then kept Mari clean and turned her every few hours.  Lots of her friends were able to come and say goodbye...Mari and I spent about a week watching endless movies, taking naps, painting nails and talking about life.  She always referred to me as her "Little Girl."  She never had any kids, her niece tells me I helped fill that void even it was only for a short time.  Pretty amazing :)  I found out after Mari passed away that she had kicked out multiple caregivers until I came along, I would have never guessed...she and I hit it off from the start.  On the night she passed away, her best friends, her niece and I were all at the house.  We knew that she was getting close to leaving us, I had just given her feet a massage and she held out her hands and we all gathered around her.  She was hanging on for something, we weren't sure what...until Sugar jumped up onto her lap.  Mari passed away about a minute later.  It was, and still is one of the most moving moments of my life.  It's when I first realized that death can be beautiful, and peaceful.  I didn't know it at the time but Mari helped me discover my passion for end of life care.  What a gift to pass away at home surrounded by family and friends, and be so comfortable and calm.

Mari's manicure...there is a diamond on her thumb...she showed it to everyone who came over :)

I think about Mari often.  Her niece didn't know what to do with her belongings so I helped her take some of it to goodwill, and I ended up with a few special items.  My red couch is from Mari and it is my most treasured piece of furniture.  I also have these spoon holders that you put on your stove top (to place spoons and other utensils while you're cooking), there are four of them, one for each season.  Today I changed out spring for summer...thought of Mari and smiled :)  My crockpot is from Mari, so every batch of spaghetti is extra special.  So Mari, wherever you are out there....thank you for being my friend, and thank you for showing me that nursing was the perfect career choice & helping me find my passion.  I know you're breaking hearts up in there in heaven :)

xoxo, Your Little Girl

My utensil holder..summer :)

My favorite red couch :)

Who Pooped?!

So after passing my test, I headed out to find my first CNA job.  I interviewed at a skilled nursing facility in town.  The woman that interviewed me was really nice and she went on and on about what a "family" they were there.  They offered me the job on the spot & I accepted.  The woman who interviewed me quit a week later...that should have been my first clue.  It wasn't all bad, but it was and still is the hardest job I've ever had.  I usually took care of about 20-22 residents, by myself.  I never had a partner like I was supposed to.  I'll never forget trying to lift these big men and basically falling over them when I transferred them.  Here are a few of my favorite resident stories from my 5 months as a CNA in a nursing home...

There was a woman there who could just sense that I was new, young & naive.  The trifecta if you will.  I could never figure out why she was always asking me for water, and juice, and soda.  Like all the time.  I always gave it to her of course, who am I to dehydrate the woman?  Finally her nurse informed me that she was on dialysis and on a strict fluid restriction.  Lesson learned, always ask the nurse before giving patients food & drink....and never trust dialysis patients...

Then there was sweet Pam who would sit in the hall, day after day and say "help me, help me, help me please," in the sweetest little voice.  A sure-fire way to never be ignored.  Every single person who walked by would say "what can I help you with?"  Pam would always reply: "Well, I don't know." 

There was Beth who made me hand wash and hang dry all her undergarments every single fricken night.  I mean, I'm all for taking care of clothes, but lets get real...I had butts to wipe.  Then I would have to take her mini water bottles that her daughter supplied her with and I had to empty some of the water out of 5 of them, and funnel in the mini ice chips from the cafeteria.  It drove me a little crazy, but she gave me candy every night...only after the hand washing of undies and funneling of ice so I guess it was worth it.  She also called me her sunshine--that was nice :)

Last but certainly not least there was Ethel.  One evening before dinner another aide asked me to help her with a resident in the bathroom.  Little did I know the treat I was in for.  I go into the bathroom to find Ethel in her wheelchair, pants down, and poop evvverrryyywhere.  Literally everywhere.  Legs, arms, hair, face...you get the idea.  She was rolling back and forth & back and forth in the poop shouting "WHO POOPED?!  IT WASN'T ME!"  I kept quiet until she wheeled right up to me and shouts: "If you don't tell me who did this, my son will lynch you."  Really lady?  I had already tried unsuccessfully multiple times to remind her that she had pooped...to which she responded "there's no way, I'm a former nurse, the only way I poop is with an enema."  I still have never understood the connection on these two facts.  I'm now a nurse, and don't need an enema to poop, still fuzzy on her logic.  So I finally tell her, "You know what Ethel, I pooped.  It was me!"  She looks right at me, covered from head to toe in poop, wheelchair and all, and says, "you disgust me."  I spent the next hour cleaning the poop out of her chair.

From The Top

After a lot of careful consideration I've decided to start blogging about some of the craziness that goes on at my job.  I'm a Registered Nurse working at a downtown hospital.  I have been writing down stories and quotes for years in a journal, but lets face it...it's hard to keep up with that old school pen/paper business.  I have seen some intense things, met some amazing people, and met some crazzzyyy people.  I love my job...the good, the bad & the gross and I want to get all these stories written down before I get dementia and forget them.  So here we go...ALL the names used in this blog have been changed, HIPPA y'all.  They start when I first began my nursing journey, first stop....Certified Nursing Assistant class.

After spending a year at college thinking I wanted to be some sort of a business woman, I decided to move home to become a nurse.  I thought this was life changing news at the time, my parents weren't the least bit surprised.  First step was becoming a Certified Nursing Assistant (pretty fancy title for all the butt wiping that's involved) and I decided to do a three week crash-course with my older sister, instead of the quarter long class.  In the fall of '06 was the start of my nursing journey.  Our instructor was fabulous and opened my eyes to the world of nursing, and more importantly, the importance of higher education.  She was a shining star who truly believed in teaching CNA's the right way to do this difficult job.  For all the butt wiping, it is very rewarding, and is extremely physically and emotionally draining.  After a week or so in the classroom we were set free to work on "real patients."  We (my sister and I) were in charge of *Dale (all names have been changed remember?  The "*" makes it more legit), Dale was 103 and wearing a Mickey Mouse sweatshirt, a killer combo if you ask me.  We were also in charge of *Lucy (now you get it).  My sister and I had no idea what we were doing.  Dale, fortunately (amazingly) was able to walk.  He was my first ever attempt to put an adult diaper on someone while they are standing (it never works, first lesson learned).  A few lumpy adult diapers later, we were headed down the hall to check and change Lucy.  When we turned her over, I started gagging.  Second important lesson learned, always...always breathe through your mouth at work.  This is when I first learned that the smell of urine bothers me way more than the smell of poop, or stool if we are getting nursey with it.  We got Lucy cleaned and changed after a few 50 rolls over the pads trying to get it right on a bed about 6 inches off the ground (my sister and I are 5'9" and taller).  Other gems from this class that I'll never forget: always brush dentures with paper towels in the sink in case you drop them and they break (they are vedy expensive), never put someones glasses on their dinner tray (the kitchen will throw them away), don't assume every old person is hard of hearing (it can be embarrassing when you figure out they hear you just fine and you are yelling at them).  My sister and I made it through our clinicals without injuring anyone, and after the class was complete I signed up to take my CNA test.

The written test was no problem, I was much more nervous about the skills test.  I had to be watched washing my hands, measuring urine output, and applying Ted Hose (compression stockings).  No big deal right?  Wrong.  The Teds had to go on a mannequin with sticky rubbery legs.  I swear to God it took me close to 20 minutes to get those bad boys on, I even broke a sweat with my hands shaking the entire time.  But thankfully I passed and headed out to apply for my first CNA job...