I went through some old journal stuff and started looking at the things 20 some years ago when I was first a nurse (an LPN) Its scary to see some of these patient stories in print, still all this freaking time later.

Back in the dark ages when I first became an LPN (this was when giant nurses roamed the earth, oh wait they still do). I was assigned to work a transitional care unit (TCU), which is essentially when a hospital has a ward that is just like a nursing home and it is Medicare billable like a nursing home for skilled care (Medicare lesson, forthcoming the story is more interesting than me explaining government rules). I was working with another nurse who I still swear to this day is gay, although he never made a pass at me, I digest. I am still swallowing…okay lousy choice of words, I think it is super important to turn off your “desires” at work. I have worked since I was 16, and I have never even seen a work fling or relationship end well.

Anyhow, back to TCU, I was excited and new to everything, sure I had been a nursing student in this hospital even on this ward and worked for 3 months with another nurse, but it was finally my time to shine and do my own thing without the watchful eye of someone trying to decide if I was doing it right.

One thing that I should point out is that nurses tend to be the most hateful creatures you will ever know, to each other (and unfortunately to patients behind their backs). I see this all too much, and it is unfortunate since that kind of treatment of other front line healthcare workers is the worst form of moral injury. It also reflects on patient care.

Anyway, with all this in mind, I headed to report and out to my first shift. The first day on the job is like any first day, stuff happens, and you try to deal with it and remember where everything is. I was told by a friend that if you can remember where the bathroom is after the first day you are doing good.

Man, I am all over the damn place on this. I was on the evening shift. Now being on a ten-bed TCU, we had only two nurses, and we were busy. I mean flying down the floor and on top of that we had this mysterious patient on my side of the hall that kept his door closed and had at least one person with him all the time. As a new nurse, I didn’t enter the room as much as I should. I was busy, but I should have been in the room more. We ran so much, both of us nurses, and as I recall I ended up with the heavier patients (those are the patients that require the most work).
This patient called like clockwork to get his Vicodin or Darvocet (See how freaking old this is? We even had Percodan look that shit up.) every 2 hours. I did in fact set my watch by it. Every time I went in there the patient and his “friend” (a pretty skanky looking girl and folks I can be pretty skanky, so when I say skanky, she took skank to whole new levels) (last sentence had skank 4 times in it…wow). She would act like everything was reasonable, and it was. This patient had a central sub-clavian catheter (IV access that goes directly into the heart), so I checked it and left. Now IV pumps are connected to central lines; they monitor line pressure. Any pressure change in the line causes an alarm and stops the infusion. Well as I was walking down the hall later about 2100 hrs just trying to stay awake, I hear the alarm chime. I just zipped in the room thinking I was going to reset the pump and that was it. Well, what I found was bizarre beyond anything and I watched Ishtar (google it). The patient had a needle in his hand and was injecting heroin into his central line through the iv port on the central line (back then we still had injectable hubs). Thus the alarm was functioning and detected a pressure change. I knew it was heroin cuz face it I have been around the block. The spoon with the melted liquid, the cotton ball, the brownish powder and skankarella with a tourniquet in her hand. My guess is she was next. The house nursing supervisor (a good catholic woman who acted as she had never heard of such a thing) questioned me at length, wanting to know how I knew this type of thing. After five years in EMS, I think I’ve got it. It made for an exciting call to the doctor (who was none too pleased either) and a lot of paperwork.

Moral learned here is that no matter closed door or not you always go in a room with only the briefest of knocks and periodically unannounced after that. An old nun once told me, they are here to be treated, not for sleep or privacy. Have you seen the gowns? We had some of the funniest freaking nuns in the house that always said the most off-color things. I also hear the best priest and rabbi jokes from Father O’Malley, our house chaplain.

An interesting entry, but not quite as interesting as what I found on ortho one time.

Please remember to be the person your dog thinks you are.