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All that really matters.

There are only two things that really matter to me right now.  1. Making sure that my partner and children know that I love them, and  2. Te...

Saturday

Second Victim

I'm at a nursing conference.  There was a lecture option called "The Second Victim of Infusion Therapy- Related Adverse Events", basically "Guilt from Making Medical Mistakes".
I couldn't even walk into the conference hall.

Twenty years after It happened, I still feel such shame, fear, and guilt about that shift that I cannot discuss it except among my closest confidants.  Those few discussions have been opportunities to teach other nurses about the dangers of infusing even the simplest of meds to patients in our care.

My family does not know.  The family of that patient does not know.   The only other person outside of my own medical community that has heard this story is my therapist.   I told him about it as I opened up about the most shameful events in my life.  (Besides the story I will share, he heard about childhood molestation and the divorce of my parents.  A shame spiral can be born of varied ingredients to be sure!)

Realizing that many of you reading this may not be nurses I will tell it as clearly as possible without: A.) making the medical jargon confusing B.) revealing any identifying details of the patient or her family or C.) attempting to persuade you of my own guilt or innocence.
Many reading MAY actually be nurses.  We tend to be a very caring community and some of you encouraged me here at this very conference.   Those that regularly read this blog are friends, family, and past members of our support group (many of YOU were nurses and other caring professionals).
Also taken into account is the fact that some of you (though not medically trained)  have watched Gray's Anatomy or Code Black.  In that case, keep up!

This event happened more than 20 years ago.  Technology and safety measures have improved and systems put in place to prevent this sort of incident from happening today.  Events that DO occur are handled much differently today as well.  Even so, my heart is racing and hands are shaking even as I type...

Fresh out of nursing school I was hired in the ED of a large Level I Trauma Center in a Teaching Hospital.  This was not common practice but I had worked in this ED as a student and the staff was pleased with my performance.  My preceptor was a former Army Captain and a real no-nonsense, authoritative, high expectation kind of woman.  (Translate: a real bitch).  She grilled me mercilessly and forced me to Be All I Could Be whether I had enlisted or not; she was an excellent motivator to know my shit.  Embarrassing me in front of other staff did not seem the least bit out of line to her.  Even Residents on their Trauma rotations sympathized with me when she demanded answers, calculations, and algorithms at the bedside of critically ill patients.  Several months into my first year she deemed me capable of caring for patients independently.  Midshift and after work she would ask me for report on all I'd done and advance my knowledge further with a battery of questions, comments, and even demonstrations of techniques or equipment I hadn't had the opportunity to use in the day's practice.

Because this particular day was busy and staff was short we were separated.  I was working independently.  In this ED we used one side of the department for Critical Care and Trauma and the other side for more minor illnesses and injuries.  We called it Trauma Side/Clinic Side.  Though all nurses on duty cared for all patients, we assigned a room or a block of rooms to each nurse to assure none were left unattended.  I was working Clinic Side.  Army Charlie, my preceptor, was Trauma Side.  There were about 5 rooms along the front hall that would be under my charge for 12 hours.  I took report at 7am and began caring for half a dozen patients; my rooms plus an extra few on the back orthopaedic hall.
     In one of the front rooms, directly across from the Nurses Station was a Sickle Cell patient.  She was resting fairly comfortably and had received about a liter of D5W/IV fluid.  Typically Sickle Cell patients came in because they were in a pain crisis; excruciating pain requiring narcotic pain relief and, often, a hefty amount of hydration.  This Dear Lady was on the stretcher with her IV in place and fluid running at about a liter/hour.  She needed lots of fluid today and would likely be with me for most of my 12 hours.  I greeted her, checked her IV site and drip rate (in those days we simply counted the drops per minute in the drip chamber and controlled the rate with a roller clamp).  She smiled and thanked me right off for being so nice.  "That last nurse was so mean and rough", she complained.  Indeed, her night nurse who had just given me report had complained that this patient was a "frequent flier that needed juicing up".  She was a harsh old trauma nurse that didn't like being assigned to clinic side doing "the easy stuff".  Though she was skilled, she wasn't kind.  I assured my Dear Lady that I would be with her through the day and was happy to give extra TLC as needed.  I went to read her chart and see what she'd need.  (Again, the ancient day of paper charts piled on a desk. Doctors could write orders on the front page.  Nurses turned to the next section to hand write notes and Assistants added vital signs and lab results as they were obtained.  All pen on paper and photocopied pages.)  She'd received her narcotic and only needed fluids while lab results were pending.  I got a dose of antidote to her narcotic and put it in my pocket with her name on it.  (Again, that's how it was done "back in the day".)

"Clinic" got busy in a hurry.  I checked in on my patients and flew about from task to task for about 8 hours.  My Dear Lady was still in the room up front.  I'd given her a dose or two of pain reliever through the shift and kept her comfortable but awake.   I shouted across the desk to the Attending to see if he wanted me to change her to a different solution.  "Give her another round of D5" he'd replied.  I did.  This bag was slowed so that it wouldn't need to be changed again in the last 4 hours of my shift.  I saw kids with asthma, pulled a roach out of someones ear, and helped a doctor put a cast on a fractured humerus.  When I next checked through my charts the Dear Lady had an Xray ordered.  I went into her room to wheel her down the hall myself.  She seemed drowsy, but spoke to me.  Half way to the Radiology Suite in the ED I had a sick feeling in the pit of my stomach.  I stopped and looked her in the eyes and asked a few questions to check her mental status.  She groaned and lost consciousness.  I'd seen this happen a few times with Sickle Cell patients.  Often another nurse may have given a dose, or even several doses, of narcotic without my knowledge.  It would be written on the chart.  I checked.   Indeed, the doctor had ordered and the charge nurse had given a dose while I had been wrangling roaches and slinging cast supplies.  Though it didn't seem to be an unusual amount of narcotic, the first and best response is to reverse it when a patient's mental status suddenly changes.  This antidote causes and quick and dramatic reversal of the narcotic's effects.  Frankly, the administration of this drug is very satisfying to administer.  The patient arouses immediately and, though the pain returns as well, stopping the effect of the narcotic brings the patient right back to "reality".  Like a slap in the face it brings them back from the brink of overdose.  I called out loudly for help and notified everyone around me what I was doing.  "Narcan in!"  is something of a battle cry.  Other staff might stop and watch your patient wake with the same satisfaction you feel as you administer the life-saving dose.  Indeed, I felt a surge of satisfaction that I had been well prepared with her dose in my pocket.  Army Charlie had trained me well so that others would be alerted to both my dilemma and the imminent return of Dear Lady's consciousness.

But she didn't regain consciousness.  She lay there unresponsive despite my intervention.  I switched sides of the Stryker frame and began pushing her toward the Critical Care side.  As I passed back by the Nurses Station the charge nurse called out to me, "hey, I need to chart on her- I hung another bag of D5W for you".  I looked at her with horror.  "Help me".  Was all I could say.  She joined me in heading to a telemetry room as I told her of the events of the past few seconds.  I checked the syringe in my pocket.  I'd given the right dose to the right patient.  She pushed on- I went back to the patient's room.  I thought I was going to tell a family member that we were moving her, but the bucket trash can caught my eye.  There were several empty fluid bags in the trash can.  I don't remember if I even spoke to the man that sat next to where my Dear Lady's bed had just been.  I examined each bag and ran for the Critical Care room.  In the hallway before I reached it stood Army Charlie.  "What the hell have you done?"

I don't know if that is really even what she said to me.  But that is what I remember hearing.

There had been at least three other nurses "helping me" care for this Dear Lady.  All totaled she had received at least 5 liters of D5W.   There were so many mistakes made in the care of this patient.  The fact remains, she was MY patient and I assured her that I would care for her.  She died the next day in the ICU.  There have been very few days that have gone by since then that I haven't thought of that dear lady... or my preceptor's question.  "What have you done?"



Tuesday

A Better Story

Rarely does a song hit on all cylinders and tell a story exactly as I would.  This one does.
First, a little background.  Then, have a listen.

Moving furniture around is a hobby of mine.  It drives my family crazy.  I call it changing scenery.  Change is FUN to me.  Can't explain it... just a "me thing".  Maybe it's you too?  Do things need to change for you to be happy?
There is a time in every marriage, even the very best and happiest, that it's time to make a decision.  Same with friendships, jobs, and all relationships.  There is a time to decide, "Will I keep on the way we always have? ...or is it time for a change?"
Sometimes we don't decide to make the change as much as we back into it.  Sometimes we change the way we work by accident. Sometimes that's a blessing in disguise.

There are so many people ready for a change that just don't know how to make it happen.  Here's your encouragement.  A small change can change everything.  Just not "playing along" as we always have is enough to throw a wrench in the works.
On the other end of the spectrum, how much change can any relationship survive?  It's a little scary to think we might be throwing it all away when we start making changes.

Listen and trust that there IS a better story...

https://www.youtube.com/watch?v=PIOwzq2MiQ4

Listen with good speakers or earphones.  There is magic in every beat of this one.  Each cymbal crash is well placed.  Percussion is perfect, from the first rattle of the egg shaker (the ONLY instrument I'm proficient at playing) all the way through the last crash of the high hat; it's wonderful.  There's an Eric Clapton-esque bluesy riff in the final minute or so; after the lyrics finish.

Even more important, there's a better story...

Stretch

It occurred during my morning workout that I can't really know how flexible I am until I stretch. Stretching increases flexibility.  Flexibility is measured by stretching.
So why do I expect this to be painless?

I want to grow, to reach farther, to be able to do more. To do those things, I must be flexible.
I want to be more flexible. Therefore, I must be stretched. I must reach farther. I must grow.
Stretching involves reaching as far as one can, and then reaching further.
    It requires effort combined with relaxation.
There is a pulling or pushing and then relaxing- leaning into the pain until it eases. It is staying with a position, just being still while it hurts; and then backing away.
 A rest- and repeat.
Push.
 Lean.
 Ache.
 Breathe- stay with it.
 Become comfortable with it.
The use of force alone results in injury. Failure to exercise the stretching at all leads to a lack of range of motion, decrease in performance, and risk of injury.


Soon the places that used to be painful are not anymore.
 I'm able to go easily where I was not able to go at all before.
 If I continue, I'm able to go to places I've never been able to reach.

Yes, it hurts- at least it's uncomfortable. But it's necessary if I'm going to get any better at what I'm doing.
 If I want to stay healthy I need to do it.
And so I stretch myself.     I go farther than I've gone before.       I try to reach places I haven't been able to reach before... stay with it... breathe through it... stay there for just a while longer- even when it hurts.
That is how I get better.

This is now Blog

http://girlinjams.blogspot.com/2016/10/monster-mom.html

Monday

Back Again

So, despite myself, here I am again.
I've found my tribe here in webberspace and I feel the love tonight.  
I've started myriad blogs, written notebooks full of stories, and had the best conversations with the best people- but I think this is my favorite.  And I think I will keep coming back.

There's something soothing and settling about knowing you can write the deepest darkest crap swirling in your psyche.  You can send it out into the bloggosphere where it will be largely ignored, but then, ah then... someone happens upon it, gets it, laughs/cries/squirms uncomfortably and writes back to tell you they are your soul mate, you are their spirit animal, they are coming to visit and never leaving your side.  That last part is the main reason the innnernet is the only place to blast emotionally loaded pieces.  When Sally Sobby wants to hear the sad sad story of how Daddy left you in your footie jammies but you are in a "Let's go to the Lake in Jammies" mood- her shit doesn't bring you down.  And neither does your own.  There's nothing to ruin a good Misdemeanor Mood quite like your own memories of abandonment.  And when the Party Girl takes of her lampshade and settles in to talk seriously about how the Dog in her life is more significant than any other Significant Other can be right now, nobody is disappointed, or worried about bringing the vibe down, or afraid she's not living up to being the life that others are living vicariously through her.
Or something like that.
What I mean is, when I write I can be me.  All of me.  I can bounce through emotions a mile a minute and change my mind about anything and not leave anyone wondering where I went.
I'm right here.  All of me.
I need a bit of editing.  I need to get it all out, I need to get out more.  I want to get out some things that we have been talking about and things we haven't been able to talk about.  I want to hang out here with you.  I'll be back.  Like to join me?

Tuesday

All that really matters.

There are only two things that really matter to me right now.  1. Making sure that my partner and children know that I love them, and  2. Telling the story only I can tell for the benefit of others who have the same story but cannot tell it.
The reason these are important is because 1. I am the only one who can give this love and it is essential to who they are, and 2. I have to get it out, I'm the only one who can tell mine, and too many people can't tell their own but maybe they can use mine to express what they each desperately need to tell too.

Both objectives apply to both needs.  There are so many partners and parents who aren't able to love their "loved ones" well.  My heart breaks for those on BOTH ends of this broken connection.
Listen, if you believe you are unlovable because your parents or your partner didn't love you like they should, please know...
it's not you, it's them.
How do I know?  Because I am them.
I am a parent who desperately loves her children- but I have a hard time trying to show it in ways that they are able to perceive it.
I love my husband with my whole heart and soul- but I struggle to make him feel or know that.

It's not them,
  it's me.
They are not broken or unlovable.  I am broken and unloving.

"It's not YOU.... it's them."

I say again, if you believe you are unlovable; you are wrong.  You have received bad information.
This is the kind of thing that gets passed down, spreads like cancer, infects entire families and generations.  Because I am busted- they believe they are.  When they believe it- they don't love themselves or believe they are lovable.  Unless something big happens this cycle continues.

The other chain that will continue to be unbroken unless drastic measures are taken is the silence. Others who know they are the same as me are unable to speak up.  They can't tell the stories and so they hide.  They don't have the words and when they do have the words -they cannot speak them.
Shame, anger, guilt, and fear keep us silent.
Well, not anymore.
This is about to get real.

I am telling the truth- from every side of the story that I can.  I have tales to tell and I'm spilling them here.  I can speak to the child who felt unloved because dad wasn't there.  I can talk about the pain of knowing I was unloved and unwanted.  Injury, Abuse, Illness- I got it covered.
I'm not covering up any more.
And it's because of you.  There are just too many of you out there suffering in silence.
There are too many people that whisper to me, "I've never told anybody this before..." then tell the same stories I've heard a thousand times- of childhood abuse, or family trauma, or secret addiction.

So here is where I will tell a thousand stories.  I've been afraid and too lazy and had excuses until now.  Now I will tell my stories; for my kids, my husband, and for you.
Because I have realized this is all that really matters.





Sunday

Imperfect


I've been reading The Gifts of Imperfection again.  Whenever I read or watch Brene Brown I'm inspired... to think, to try at relationships, to write, and to sit in the closet and eat cookies until the feelings go away.
http://brenebrown.com/
She gets me into trouble every time, so I don't know why I keep picking up her books.  Maybe it's because she occasionally slips in a curse word.  (I fucking LOVE cursing, but it's frowned upon by almost every establishment to which I am associated.)  Her writing wouldn't be what I would call my favorite.  As she says in Gifts, "I'll tell the story of how a cynical , smart-ass academic became every bit of the stereotype that she spent her entire adult life ridiculing....who spends days contemplating things like grace, love, gratitude, creativity, authenticity...".  The subject matter makes me simultaneously want to wretch and share her level of expertise.  Her books sit on my nightstand and collect dust because I hit a chapter and put them down with intentions of never thinking on the subject matter again.  I hate it.   But I love her.
That's probably how she gets me into trouble.  She has that rare quality of likability despite my lack of adoration for her life's work.  My desire is to know what she knows without having to study, experience, or sully my current pathologies with her experiential wisdom.  It's somehow akin to wanting to know the details of the car wreck without having to experience it or even pull over and help.  She is one of my "Imaginary Friends"- she is real but our friendship isn't.

So there's my Authenticity.  I am a shitty person who thinks awful things and doesn't really even WANT to be connected... but then I sulk and hate myself because I haven't many friends.  (Except imaginary ones.  I have tons of those.)  I'm the worst kind of friend; there for a while and then gone forever... unless I need a favor or finally feel the guilt of having abandoned all of my friends who have been so there for me and loving even while I've been unlovable.

Instead of calling all sorts of long lost friends and trying to make connections that I will only let fall by the wayside within a week I have decided to piddle at this blog.  Maybe I'll invite all of the friends who have been my everything for a season to come read how much they mean to me here.  That would save me the whole messy connection bit.  I really want to love others well... it's just the bit of having to actually spend time with others that stops me.  I feel completely overwhelmed by the idea of making plans and following through with them.  Shooting a blog post once every several months is much more my speed.  So that is where I'm starting. This is my cast into the river.... I'll throw out my line this one time and then just sit here until I summon the courage to try again.