registered nurse

The louder you are in the ER waiting room, the more the staff is convinced that you are not having an emergency.

I mean it. You’re getting the attention you think you want, all eyes on you. Except ours.
“Isn’t there anything you can do?” Your fellow waiters ask us, concerned. Behind the triage window, you can’t hear our teeth grinding.
You’re in pain, i understand that. This might even be the worst pain you’ve ever felt.
But you’re probably not dying.

Dying isn’t loud.
A patient having a heart attack does not scream and thrash and gasp for air. It’s a whisper, a tightness, with slow flexing fingers.
A stroke happens in a fraction of an instant, and never makes any sound. More whispers, halves of sentences and muscles that don’t quite match up anymore, a puppet with a few of the strings cut. Alarmed and wandering eyes, maybe, but never yelling.
Or the more common killers, infections that shut down organs or the pipes of blood that sever. Cardiac or respiratory failure. If a person can talk they are, in fact, breathing just fine.

Remember this, the next time you come to an emergency department. Remember this when you’re sitting in the waiting room, while a sleepy-looking person in a wheelchair is whisked away without a word.

What I've Learned After 3 Months of Being a Nurse

What I’ve Learned after 3 months of being a nurse

  1. There is no pressure like being in the code of a 23 year old you were talking to 20 minutes ago while their mother stands in the door way begging you to save them.
  2. There is no silence like the one at the nurse’s station while everyone is gloved up and waiting for the arrival of the fire department that just called to report they’re on the way with someone in full cardiac arrest. 
  3. It’s easier to tell your friends about the funny stories and the funny patients. You keep the sad ones to yourself. 
  4. It’s hard to get someone to care about following up with a primary care physician to get further care and medication refills when they don’t know where their next meal is coming from.
  5. Psych patients make thanking God for waking you up in your right mind a completely different thing. 
  6. Other peoples struggles can make yours seem so small.
  7. The screams of the family who just lost their loved one will ring in your ears for hours…sometimes days. 
  8. Nursing is NOT passing meds and listening to heart beats, its giving your all during a code and still pulling something out of yourself to hold a grieving family member and understanding your emptiness does not compare to theirs.
  9. I’ve learned to stop praying for things to go right but instead to pray for the strength to handle anything that may come way.
  10. Some patients will make it hard to care about them, others will make it hard to let them go. 
  11. I haven’t learned this yet but I’m practicing leaving all of these things at the exit door of the emergency room. So that I can exist outside of work.
  12. I love nursing and there’s nothing I’d rather do.
FATRAT - Resp. Distress Acronym

There are a few signs you’ll see when it comes to sever respiratory distress. This is an acronym I use to know what to look for and I will help you by showing what this just might look like to!

F - Flaring (Nasal)

A - Anxiety

T - Tachypnea

R - Retractions

A - Accessory Muscles

T - Tracheal Tugging

These are a few signs of severe respiratory distress. If you have a patient with any of these, you might want to pay attention to them. This means they need help NOW.

One more time the acronym is:

F- flaring nasal

A - anxiety

T - tachypnea

R - retraction

A - accessory muscles

T - tracheal tugging

Betrayal.

But their existence will float away
And just like every word they say
And we will hold hands as they fade

- Avett Brothers


The day I let you down, should have been like every other day.  Should have been straight forward and we should have done what you needed.  We should have done what you wanted.  Instead I let you down.


We had known each other for a while.  You were the sweet lady that huffed and puffed to breathe after a lung transplant that left you with really only one viable lung. You had a sweet smile and you knew me on sight.  I would come by your room when you weren’t my patient and say hi and chat for a moment.  You were a tiny lady with a big beautiful heart.  


Two days ago I was assigned to you.
You called me by name and we spent the day arguing about whether you would get to drink or not.  You couldn’t so I put a feeding tube in and tears formed in your eyes as I did. I apologized profusely and you smiled weakly at me.  Half way through my shift you called me into your room and gripped my hand.


“I’m not.. gonna… make it.” You said between breaths.  You stared at my face as you said the words. I looked at you in surprise and quickly reassured you a best I could.  Your numbers all looked good.  Stable.  You looked at me resigned and nodded as I told you that you were improving.  You asked to go on the bipap so you could rest and I tucked you in.  


The next shift- you told me you wanted to be done.  You told me to turn everything off and take all your tubes out.  There was no mistaking what you were asking.  I talked to you at length about it. I asked if you knew what taking all of that away meant- you nodded and asked me to help you.  I squeezed your hand and told her I would talk to the doctors and your family.  
Hours later- your daughter, despite hearing your pleas that you are tired and wanted to rest and be done, told the doctors to do everything. Despite the fact that your head shook a violent “NO” when asked if you wanted intubated if need be- your daughter said yes.  Despite my telling the doctor that you had appeared to be in your right mind for me, they labeled you confused.  I hung my head when they told me what they decided.  I avoided the room for a few hours because what could I possibly tell this sweet soul that I had promised to help?


I snuck in as you rested, your breathing labored and the bipap obstructing most of your face.  I turned around and your eyes opened.  You waved me over to you and I hesitantly walked to your side.  You mumbled something through the bipap and I leaned closer to hear you.  You tried again and I apologized for not understanding.  You shook your head in frustration and I popped the bipap off so you could tell me.
When are you going to release me from all this?  When are you going to let me go?” You said in between your labored breaths, your hand gripping mine.  “When are you taking the tubes away?”  
I stared at you and squeezed your hand.  I didn’t know what to say to you other than the truth.
I can’t…” I said my voice on the verge of breaking.  “Your daughter… your family…They want you to keep fighting.  They want everything done. The tubes have to stay.”


The look on your face when I spoke those words to you made my heart physically hurt.  I didn’t know how else to tell you that you had been betrayed.  By your family… By your doctors…By me.  

You shut your eyes and laid back on the pillow.  The family members that had been left to “encourage” you, stood awkwardly to the side.  I straightened your lines, pulled your blankets up and was about to go when you raised your hand.  You set it gently on my arm and looked at me.
“Thank you.” You said loud enough that the bipap didn’t smother it.
I squeezed your hand and we shared a moment.  I didn’t look at your family.  I looked at you, my eyes glistening with the same frustrated tears that mirrored in yours.  I nodded and you closed your eyes.  
The day I let you down, should have been like every other day.  Should have been straight forward and we should have done what you needed.  We should have done what you wanted.  Instead I let you down.

NCLEX Pharmacology Medical Suffixes

  • -amil = calcium channel blockers
  • -caine = local anesthetics
  • -dine = anti-ulcer agents (H2 histamine blockers)
  • -done = opioid analgesics
  • -ide = oral hypoglycemics
  • -lam = anti-anxiety agents
  • -oxacin = broad spectrum antibiotics
  • -micin = antibiotics
  • -mide = diuretics
  • -mycin = antibiotics
  • -nuim = neuromuscular blockers
  • -olol = beta blockers
  • -pam = anti-anxiety agents
  • -pine = calcium channel blockers
  • -pril = ace inhibitors
  • -sone = steroids
  • -statin =antihyperlipidemics
  • -vir = anti-virais
  • -zide = diuretics
Dear visitors and hospital personnel

If you are going to use the patient elevators and you are not currently a patient, there are a few things I’d like to ask you to keep in mind:

1. If you are waiting for an elevator and nurse arrives transporting a patient, the nurse and patient get the next elevator. I don’t give a shit how long you’ve been waiting. They are patient elevators. For patients.

2. If a patient is in an elevator on a gurney please do NOT attempt to squeeze yourself in there with them. If you are not currently taking care of said patient or you have no familial relationship with them YOU SHOULD NOT BE IN THE ELEVATOR WITH THEM. Imagine what it must feel like to be in that bed. Imagine what it would feel like to have a stranger stare at you, guessing who you are and why you’re there. Please give them their privacy and give the nurses and RTs and transporters the space they need to transport the patient safely.

For fuck’s sake.

Because you’re more than your disease.

Chad is only 25. He is gay, and has been with his partner for 15 months. 

He was last tested for HIV a year ago, and the results were negative. 

He came to my ER last Thursday with back pain - but the back pain didn’t concern the physician. The red plaques on his body did. He reported having them for 5 months or more.

These red plaques are tell tale signs of Kaposi Sarcoma, tumors that themselves are telltale signs of AIDS and a severely throttled immune system. 

Chad admitted to knowing this, but not seeking help. 

His back pain came from meningitis. He had fungus in his blood, in his spinal cord, and in his brain. He had to be placed on extreme forms of anti-fungals. We had to medicate him for the fevers, chills, and spasms the treatment caused. He had panic attacks.

And his nurses, myself included, were angry to some extent. Who would let this happen to themselves? We said in the hallways. Who grows red scales on their bodies, has every warning sign of HIV, but doesn’t seek help?

I got my answer that day. His mother came to visit as I was calming him from a panic attack. He couldn’t stand the thought of another round of amphotericin B that night. After a small dose of ativan, I plunked him in a wheelchair, and we made a point to get out of the unit for a bit. He’d been in that room for 7 days straight, growing weaker. He hadn’t seen or heard from his partner since his diagnosis. 

His mother asked me why he was so weak and he pulled me down before I could answer. “I don’t want her to know what I have,” he whispered in my ear. 

And it hit me. He is all alone. 

He is an island in the middle of nurses and doctors who are fighting hard for him, but who do not - can not - truly understand what he is going through, or why he made the choices he did in delaying treatment. 

I told his mother he has an infection in his blood and spine. I carefully avoided words that could hint at HIV; but in truth, if she had wanted to really know, less than 5 seconds googling the rash on her son’s body would have lead her to an answer. 

After she left and we returned inside, I helped him into bed. 

“Why didn’t you find help earlier?” I asked as I helped him get his weakened legs onto the mattress. 

“I didn’t think anyone would care. I thought I’d have to beg for help, and…I don’t know. I didn’t think I’d get the help. I’d be shunned.”

I was speechless for a moment. I hate that, in 2015, someone would avoid life saving treatment because of the shame society places on diseases. 

He continued “My boyfriend is the best thing that’s happened to me in years, and I knew he’d leave. My mom knows I’m gay but doesn’t ever talk about it. My dad hasn’t talked to me in years. I saw the signs and I felt like…well, my life is over. I only came in because the pain got so bad.”

I hate to think of how many more days you will spend in that room, listening to us badger you into eating hospital food, into just one more dose of amphotericin, just one more lap around the unit. I hate to think that those days may only stop because we lose the battle against the raging infection in your immunosuppressed body.

I hate to think that you may not live to see the year 2016.

You are so much more than your disease, Chad. You are more than your sexual orientation. You are more than your mother’s opinions and your fathers silence. 

I hope you’ll see it before it’s too late.