Funny Dog

I found this lately on a day when I really needed to laugh.  Just thought I would share.

Maggie does run and bark in her sleep, but nothing like that!!!  So funny!  I wonder what he was chasing!

My Girl

We’ve had two seperate ultrasounds where the tech has been pretty sure it’s a girl.  The tech still hasn’t been able to get a view that told her 100% it’s a girl.  She will just not open her legs!

We were able to get the shots of everything she needed to see.  Last time we couldn’t get a good view of the heart of the cord.  But she got tons of shots of the heart today and what she needed of the cord.

We also got video of the entire ultrasound, which I’m sure I will watch over and over.

This girl is going to have my family’s long legs!  Each time her legs measure an entire week ahead of the rest of her body.  She weighed in at 1lb 3oz today.

I’m so excited to start getting the nursery painted and everthing ready.  And of course we can’t wait to meet her!

ACLS

This week I’ve spent my time studying in bed while fighting a nasty cold.  I had ACLS (learning to run a code) class all day yesterday and the test today.

The test includes being the team leader during a practice code, then taking a written test on reading EKG’s and another written test about what to do during codes.  It’s pretty stressful with a lot to learn, but thankfully it was some what of a review for me since I had a quicker version of this class back in Cincinnati.

Now, heaven forbid I ever find myself the only person who is ACLS certified at the scene of a code I will know what to do.  Hopefully, if I don’t forget it all!

I have a brother!

Angie got married on the 3rd.  I didn’t have time to take any pics, but we had a lot of fun.  Angie looked beautiful.

They look so happy together.

And Angie already has him in his place.

Congrats you two!!  We love you guys!

(All of these pics were by their photographer)

Dude, Share The Food!

This week was our church’s service Sunday.  We didn’t have a church service this week and instead spent the day serving.  We all headed to church somewhere else (where Eric, founder of Dude, Share the Food works).  After service our crew and about 10 people from the other church started making sack lunches.

Packing cookies into ziplock baggies

Packing chips (what the crew calls “salties” into baggies

Making sandwiches

Brewing hot coffee for the people outside on the cold, wet day.

Filling the brown paper bags with fruit, cookies, “salties” sandwiches, and condiments.

After getting what I guess to be around 200 sack lunches made up and everything packed into the trucks we headed to downtown Atlanta.  We spent the next three or four hours passing out lunches, hot coffee, and water at a few different locations and a few out of the cars windows as we saw people while driving.  I even jumped out of the car at a couple of red lights.

Eric hanging out with a guy he has been able to build a relationship with over the past year and a half since starting Dude, Share the Food.

Handing out some lunches and warm clothes to these guys.  What is amazing, we were in an older part of town with huge beautiful homes, probably worth 100’s of thousands of dollars, people walked on the sidewalks with bags from stores and went into the pub across the street for lunch.  But the streets were littered with homeless that with our self consuming vision we all fail to see every day.  I wouldn’t have seen them if I hadn’t been looking for them.

Enjoying their hot coffee and lunch.  The guy on the left was pretty much blind.  When he came over I offered him a sack lunch and handed it toward him.  He just stood there and didn’t take it.  He had no idea that I was talking to him, let a lone that there was a sack lunch being offered.  He depended completely on his buddy to guide him through life.

I’m so blessed and spoiled, and don’t appreciate it!  Today made me think of all of the times I’ve driven by a homeless person and kept my eyes purposefully fixed ahead, because I thought I “couldn’t” help.  Every day while I was in nursing school I drove past the same man, on the same corner asking for help.  How come I never thought to make up a sack lunch to hand him while I waited at a red light?  I know why, because as soon as I drove past him I never thought of him again until the next day.

When Brian and I lived in Cincinnati there was a homeless man who went through our trash every week on trash day.  He pulled out all of the metal he could find through the neighborhood then sold it to the scrap metal factory.  This man usually had several huge trash bags full of cans every week and had on nice new clothes and work boots.  But I NEVER, NEVER thought to offer him a cup of hot coffee or some food.  Yep, I’m a spoiled loser.

I know I’m not the only one.  It’s so easy to get out and help others, it usually doesn’t cost much, or take much time.  The hard part, is taking the focus off of ourselves and our busy schedules and seeing the people around us who are hurting.  Maybe you can start by doing one simple thing.  Make up a sack lunch.  Make it PB&J so it can sit in your car for a day or two.  When you see someone standing on the corner, pushing their shopping cart, where ever they are, just hand it to them.  How hard is that?

Matthew 25:35

I was hungry and you fed me,
I was thirsty and you gave me a drink,
I was homeless and you gave me a room,
I was shivering and you gave me clothes,
I was sick and you stopped to visit,
I was in prison and you came to me.

Oh, and check out Dude, Share the Food! If you click on “What Does It Mean” you can see a video.

My Overdose Patient

*WARNING* This story is kind of crude and talks about gross bodily issues.  Consider yourself warned.  Also, sorry it’s so long.

I originally started this blog as a way to remember my wildest patients in my nursing career.  This one is diffidently worth noting.  I was having a really good night.  I was in pod 3, which is my least favorite.  It gets the codes and mental health patients.  Plus it’s nurses station is smaller than all of the others, but there are twice as many people working in that area, so it feels cramped and every time I turn around someone is sitting in me seat and has their stuff all over my charts.  However, I had really good patients and none of my rooms had been full at once all night.  I had two mental health patients waiting for placement at another facility and all I needed to do with them was take their vital signs every two hours.  Security and our mental health people take care of everything else, unless they need meds, which mine did not.

At a little before midnight I got an EMS into my only empty room.  Lucky me, I had the only empty room in the entire ER at the time, well except for our trauma room that they leave empty in case we need it.  I grabbed a blank chart and waited outside of the room for the EMS crew to finish their work.  I already knew that she was an overdose on Lisinopril (a blood pressure pill), but knew nothing else.  I saw from watching while they talked that she would open her eyes and talk, but made no move what so ever to help move her 300 pound body over onto our stretcher.  After they finished one of them came out of the room to give me report.  She said the patient was groggy, but could answer their questions.  She had just been discharged from another ER the night before and had taken the entire months worth of Lisinopril in the past 45 minutes.  She was a frequent flier and had a long history of mental problems.  The EMS crew was planning on taking her to the ER she was discharged from the night before, but they were full and couldn’t take her.  Lucky me.  Apparently she had also been in our ER the week before as a psych patient, the mental health guys remembered her.

I could smell her before I even walked into the room.  I don’t even know how to describe the smell.  Not BO really.  Just stink.  This woman was only 33, but looked more like she was in her 50’s.  The sheet she was laying on top of was covered in dirt, was wet from where her wet socks touched it, and had bits of leaves and who knows what else.  She looked like a car crash patient who had lade on the ground before being brought in.  But, she had been brought in from her house.  She had lifted her shirt up to her chin and was scratching underneath her boobs that hung to either side and was also digging at her crotch.  Later, I would know why it itched so bad. YUCK.

She had her eyes closed and didn’t say anything to me while I worked on hooking her up to the monitor so I could get her vital signs.  She just kept singing for Charlie to come get her and take her home so she could play with his willy all night long.  Lovely.  The EMS got blood pressures on her of 105/60 and 100/50.  The first one I took…..70/32 and dropping quickly.  I believe the next one five minutes later was 60/20’s.  She got to us just in time.  I never did find out if she was the one to call 911 or not.  I quit getting information and hauled my butt to find a Dr.  I ended up triaging her as a level one, which is usually reserved for coding patients, but she was going to code any minute if we didn’t do something.

One of the other nurses came back in to help me get a second IV started and drawl blood while I hung a 2nd bag of saline and got the charcoal ready for her to drink.  YUMMY!  I still have remnants of it under my finger nails and it won’t come out.  At that point she was screaming for something to drink and swallowed all of the charcoal like it was the most refreshing lemonade ever.  At least I had no problems getting her to drink it and amazingly she didn’t puke it back up at me.

A few minutes later she was screaming that she wanted a drink and would not shut up.  Finally Jeff the tech walked in and screamed “MA’AM, You are not getting a drink right now!!”  The other nurse and I were outside of the room and just lost it laughing.  Jeff is usually the sweetest guy ever and can lay it on pretty thick for any patient who is upset.  When he walked out we were still laughing at how um, stern he was with her.  The other nurse said “well, I guess your customer service just went out the window with that comment.”  haha He was then upset that he was so mean.  We were like, don’t worry she won’t even remember.  Sure enough, 5 seconds later she was yelling for a drink again.

I spent the next two hours in her room trying to keep her covered since she seemed hell bent on being completely naked.  I was also taking her blood pressure every five minutes and trying to get caught up on my charting of everything we had done.  About an hour after she got there her grandma showed up.  Surprisingly, she was well dressed and looked normal.  She was a little too calmed considering the situation though.  She was probably used to seeing her granddaughter like that.  I also don’t think she really understood that she could possibly die, the pills still had hours before they hit their peek.

Her IV that the EMS has started eventually got ripped out and I was trying to draw some more blood because I needed one more tube to look for any other drugs that may be in her system.  As I was in the room the monitor took her blood pressure and it read 49/? meaning it was unable to detect the bottom number.  The prior reading had been decent still 70s/30s and holding steady.  I’m not sure why she dropped all of a sudden.  I poked my head out of the room and yelled for the other nurse to go find the Dr NOW.  We paged for the Dr and the other nurse quickly started helping me get yet another IV while I ran for more and got the patient basically standing on her head in the bed to get blood to her brain.  At this point she was pretty much non responsive and snoring away.  Later I learned that I liked her better that way.

We started her on a dopamine drip to help raise her pressure.  The bad part about it is, it also speeds up the heart rate and she was already pretty tachy.

Before she woke back up the tech (Jeff) and I put in a catheter so I could try to get a urine sample.  This would prove to be the most interesting part of the night.  Poor Jeff, I don’t think he’ll ever work with me again.  He handed me the scissors and I cut off her stretch pants.  As soon as I got half way up her leg Jeff pointed at the crotch of the pants and yelled “WHAT’S THAT??”  Her black pants were stained brown.  As soon as I got the pants cut off of her Jeff puked in his mouth and had to leave the room because of the smell.  I think I had been in the room for so long I was just used to it.  A couple of minutes later he came back with a bag full of coffee grounds for him to smell when needed.  I got everything set up and put on sterile gloves, I’m not sure what difference trying to be sterile made considering how dirty she was.  As soon as I was sterile I realized that I forgot to put the arm rail of the bed down and I couldn’t reach her well enough over it.  So, Jeff came around to put it down for me.  Small problem, her arm and large boob were in the way and he couldn’t hold them out of the way and put the railing down at the same time and I couldn’t touch anything to help.  Finally I was able to put my elbow against the arm rail to hold it while he moved her boob, the poor guy.  He was like “OHHHH, YOU OWE ME SO BIG!!!! Finally, I got her clean, not easy because she was full of yeast and all other kinds of stuff.  I can’t call it anything else but crotch rot.  Then for some reason he lifted up her belly to find even more yeast.  This girl needed some major anti fungal powder.

With in 10 minutes her pressures were around 100/40s.  She was awake and screaming every bad word in he book at her grandmother.  Her grandmother finally got up and walked out of the room.  We told her to go home, that she was going to be in the hospital for a long time and she didn’t need to sit and listen to that right now.

From then on her vital signs stayed pretty good.  Her pulse got pretty fast, so I had to slow the drip down.  She kept rolling over and getting tangled in all of the tubes and cables she was hooked to.  At one point she wanted me to turn her over.  I was like “I can’t pick you up, so if you want to turn over you’re going to have to do it yourself.”  Which she did.  Anyway, since she insisted on sleeping on her stomach we wouldn’t let her have a pillow, because we were afraid she would suffocate.  I think she had sleep apnea because every time she fell asleep her pulse ox would drop into the low 80’s despite her having oxygen on.  So, whenever she would wake up for a couple of minutes she would SCREAM for a pillow.  One time I happened to be in the room when she was doing this and tried to explain that if she would lay on her back she could have one, but not if she was on her stomach.  She informed me that Jesus would deal with me.  Because by me denying her a pillow I was denying my maker.  She sure liked to go back and forth from screaming obscenities and talking about Charlie’s willy to talking about Jesus and Heaven.  Oh, at least I had something to laugh about from the situation.

There’s a bun in the oven!

That’s right! We’re expecting an addition to the family next June 21st! We found out almost a month ago when I took a pregnancy test.

Our first positive test. October 14, 2008

Our second positive test! October 15, 2008

I had an ultrasound today and everything looked good, so we’re finally sharing the news with the world. My due date is June 21, 2009.

The 3D ultrasound picture. November 10, 2008. It’s in position to get it’s butt wiped already!

So, now everyone knows!! Ugh, it feels so good to finally spill the beans! And I can post on here with out feeling like everything is so fake because I have a HUGE secret to hide. We feel totally blessed and lucky, especially since we hadn’t even started trying to get pregnant yet. We had some scares at the beginning because of my gallbladder problems. They did an ultrasound a month ago when I was in the ER and they couldn’t see anything yet. My lab numbers were also low at the that time. But, that all makes since now because we know from my ultrasound today that I wasn’t as far along as we thought a month ago. So, ready or not, here it comes!

Some Pics!

I know, I know.  I’ve been a bad blogger lately.  Today I emptied out the camera’s memory card.  Something I haven’t done in months.  I still have pics on the Nikon to empty, but I at least got the point and shoot empty.  Here’s what we’ve been up to.

Velocity’s first practice service.

Chase playing during encounter time yesterday.

My cousin Damon’s little boy Camron had his 4th birthday and got his first bike.

I went home for my friend Erin’s wedding.

Saturday Brian and I went to Helen, GA for their Oktoberfest.  Unfortunatly, my camera was on some weird setting the entire time, so every picture came out blue.  This is Brian by the Chattahoochee river while we were waiting to be seated at the restaurant on the river.

That’s pretty much it.  We’ll be flying home again in December for my sister’s graduation and then again in January for her wedding.  Today is my first day of work out of orientation.  Hopefully I survive and all of my patient’s do as well!

A Bump in the Night

Around 1AM last night Brian and I heard a very loud bang.  I’ve never seen Maggie move so fast!  She went from under the blankets by my feet to on the floor barking in less than a second.  I think it took about 10 years off of my life.  We both jumped out of bed to try to figure out what it was.  I thought it came from outside since our bedroom windows were open.  I went to the window and looked out, but couldn’t see anything.  Brian thought maybe something fell in the laundry room, so I went in there and looked and checked all of the upstairs bedrooms while Brian and Maggie went downstairs to look around.  Neither one of us found anything out of place.  I went down to the basement and looked around and we flipped the outside lights on.  Nothing…..It was starting to freak me out that maybe someone had been outside or maybe it was a neighbor shooting or something across the woods.  It was defidently loud enough to be a gun going off.

Thirty minutes later after we had walked upstairs and given up on finding the cause of the loud noise I walked into our bathroom and suddenly knew what it was.  I looked into the shower and sure enough that was it.  Our metal shower caddie full of all of our bottles had fallen to the floor of the shower.

It took me about an hour to finally fall back to sleep.  Fun excitement in the Brunke household.

What is it like working in the ER??

1. You are assisting a primary nurse with charcoal administration down an orogastric tube. The room measures eight feet by twelve feet. The patient starts to retch before the tube is pulled. Knowing that charcoal can spew out of a tube in a five foot radius (even with a thumb over the opening) and the stretcher is two feet wide, how many feet per second do you have to back up to get less charcoal on you than the primary nurse?

2. Doctor A picks up a chart out of the rack. S/he finds that it is a repeat patient with abdominal pain. Doctor A puts the chart back. Doctor B picks up the chart five minutes later and also returns it to the rack. Doctor A leaves the nurses’ station heading south at three miles per hour. Doctor B leaves the nurses station for the doctors’ lounge at five miles per hour. How long before the patient is at equal distance from Doctor A and Doctor B?

3. You were assigned two large treatment rooms and the gynecologic room. By the end of the day you have cared for ten patients. Four patients were female over the age of 80, all complaining of weakness. Two patients were male, ages 72 and 50. The last four were female, between the ages of 24 and 40, all complaining of abdominal pain. It is 3:00 p.m. and time to restock the rooms. How many bedpans will you need?

4. You are the primary nurse for an elderly patient with congestive heart failure. The IV stick was exceptionally difficult, but you are able to start an 18 gauge catheter on the second attempt. You leave the room to check on another patient. A relative thinks that the IV has stopped dripping and opens the clamp. How much IV fluid will infuse before you return?

5. You are sent for your morning coffee break. You need to use the restroom but can’t find one unoccupied and have to walk down to the lobby. The coffee pot is dry and you have to make more. When you get to the cafeteria, the line extends ten feet into the hallway. You can’t remember exactly when your break began. How much time do you have left?

6. You are the primary nurse taking care of a particularly shy female in the gynecology room. Her private physician arrives to see her, but you can see that he is not in a particularly good mood. After much coaxing, the patient agrees to a pelvic exam. How many people will open the door during the exam?

7. An elderly man arrives in the Emergency Department by rescue squad. Twenty minutes later his wife arrives and registers him. She is shown the entrance to the department and slowly shuffles in. How many rooms will she walk into before she finds him?

8. You are assigned to the EENT room. You have a patient to be checked for a peritonsillar abscess. The ENT physician has been paged and expects to arrive in 45 minutes. Three hours later, he arrives and is at the patient’s side, asking for a flashlight. Lightly jogging at 22 miles per hour, how many rooms will you have to search before you find one?

9. You have been asked to cover a coworker’s rooms during her break. One of her patients is an elderly, confused male with an enlarged prostate. A catheter has been inserted and his physician is coming to see him. Somehow he manages to get off the stretcher. The drainage bag is firmly hooked to the side rail. Knowing that the catheter is 16 inches long and the drainage tubing is three feet long, will he be able to reach the door before pulling out the catheter?

10. A college student named Muffy is brought to the Emergency Department with a sore throat. She has no relatives in the area. Will there be enough chairs in the waiting room for deeply concerned significant others?

I’m not sure where I originally read this, but I thought it was a good indication of the craziness in the ER.  I do love it though.  I love never knowing what is going to walk through the door next.  I love the turn over of patients, 3 or more through each room per shift.