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Tuesday, April 26, 2005

Have you ever saved someone's life?

It's a strange feeling to save a life. Each time is different. I work as a nurse in a local hospital, and over the years I have saved, or have taken part in saving, many lives. How many, I don't know. Over a hundred anyway. I guess it's possible to save a life and never know it. Picking up subtle clues that someone is in some sort of trouble, and then finding a way to keep them from "going bad" would probably count as saving their life. Although not everyone who "goes bad" will die. So it's hard to know if you saved their life or just "prevented complications".
Most of the time, you are part of a team that responds when a "code blue" is called. That is, if a patient in the hospital quits breathing, or their heart stops, or goes into a funny rhythm that's not pumping blood out to the body, they will begin to die. Without oxygen, their brain can only go a matter of minutes. Within four to six minutes, brain damage begins. After ten minutes or so, they are in big trouble. Anything more than that, it's pretty much all over with. When a member of the hospital staff observes that a person is either not breathing, or that their heart is not pumping, they set off an alarm called a "code blue". That will call the "code team" to come assist in either making the person breath again, or helping their heart to begin pumping blood. Most often, it is the heart, at least in my hospital.
The code team is made up of key people throughout the hospital. Usually, a doctor, a cardiology resident, one or more nurses probably from the icu, somebody from the pharmacy, lab, ekg, and hospital administration. Also, the chaplain's service, respiratory therapy, and any available staff from the floor where the patient currently is.
Every floor in the hospital has a "crash cart" which is a bright red toolbox (or blue if it is for use in children) that is full of the equipment most often needed when trying to save someone who is near death. Ours has a heart monitor/defibrillator, for shocking the heart. Also, the most common drugs that are needed for assisting the heart to beat properly (speed it up, increase the effectiveness of the heartbeats, increase the blood pressure, or whatever the problem happens to be) Also needed are kits for putting in a breathing tube (called intubating a person) and kits for putting great big iv lines into the deepest veins. Then you also need oxygen and different kinds of oxygen tubing, as well as a bag for pumping the oxygen (they do this instead of mouth-to-mouth) Then for good measure, there is a suction machine in case the person has something blocking the airway (could be blood or vomit or something else, which is another reason why you don't really want to do mouth-to-mouth)
Another thing on the crash cart is the backboard, which is just a flat piece of board to put under the patients back so that when you do chest compressions, the mattress doesn't bounce them and use up all of the force of you pressing down. In a pinch, the foot of the bed will disconnect and can be used as a backboard.
It's really something to see a "code" take place. At first glance it seems to be the most chaotic thing you've ever seen. They try to copy this in movies sometimes, but it never comes across the same. I think the coolest part is how everyone talks over each other, but everyone can hear each other at the same time.

"What is the o2 sat?"
"Can you hand me a flush"
"Give another epi"
"It's 92%"
"Hold compressions for a minute"
"Here you go"
"Still V-tach"
"Did someone take the abg's down?"
"Ok, go ahead"
"Epi's in"
"What labs you want?"
"Do you got a bed in CVICU?"

It's like a well-oiled machine...sometimes. There always seems to be one glitch per code. Usually something small. Sometimes big. I hope not this time though.
The worst glitch I ever saw was when we opened the crash cart up and it was completely empty. People got fired over that one.
Most often you are able to get a breathing tube in so they can be hooked up to a respirator and you get the heart going and then wheel them, bed and all, to the icu. Then they hook them up to the respirator (which is what most people think of when they talk about life support) and get the heart beating more normally by using drugs.

As a nurse, when I help with a code, then I can say that I helped save a person's life. Now sometimes my help could have been done by any other nurse in the hospital and then I could have been off that day and it wouldn't have made a difference in the long run. But there are other times when my being there made all the difference in the world. That's when I would say that I actually saved the person's life myself. In other words, if I had the day off and a different nurse had been there, the person probably would not have made it. Those are the ones that are the most memorable.

Today was one of those times.

I saved a person's life today.

I am a nurse.

Monday, April 04, 2005

Texas. It's like a whole other country

Ok, so I am proud of my state. But I would say it is with good reason. The day after Easter, out came the BBQ pit. It never fails. I know that in a lot of places, Easter is a good marker to tell you when to start planting. Doesn't work here. Around here, I put the melons in the ground in February, the tomatoes in early March, and everything else goes in when i have the time. Easter is when the pit comes out.
Now you can tell a lot about a man by his BBQ pit. At least in Texas you can. On TV you may see someone with an apron on, holding a big fork, standing over a grill. That doesn't happen around here. Nope, not in the whole state of Texas. For one thing, no real Texan would be caught dead wearing an apron. My mother had an apron. I think the purpose of an apron is supposed to be if the thing starts to sizzle and spits on you, it wont burn you. It just seems kinda sissy to me. Another thing is, you never, ever use a fork on the meat. If you stick the meat with a fork, all the juice is going to come out. No piercing. And then of course, Texans don't use grills, they use pits. Grills are for yankees. And let me tell you, they take a lot of pride in their pits. I've even seen an old train engine converted over to a BBQ pit. It can, presumably, do a whole cow at once.
So anyway, out came the pit.
After it started cooling off outside, we piped it up and fired it up hot enough to burn out anything growin' in there. That's one of the important parts there. You see, a real Texan will never clean the grill part of the pit. you just take it off and bang it a few times to knock off any of the food that might be still stuck on there from the last time. Then, after using it a couple of dozen times, the grill becomes "seasoned" and you no longer have to use any spices in your cooking.
I've had neighbors come over to see what smelled so good cooking in there, and it was nothing but the pit itself. That's the main reason why you never use aluminum foil or a wire brush.
Unsanitary? not at all. before you cook on it next time, fire it up hot enough and kill everything off.

Overall, Texas is a great place to live. Especially in be spring time. Right now it's been "a/c in the day, heat at night" kind of weather. Gets up to about the mid-eighties and down to around 60. Yes, that's right, I run the heat if it goes down to the 60's. Actually, I run it in the 70's as well. But that's ok, because in Texas, energy is cheap. In the house I live in now, I almost never have an electric bill over a hundred dollars. Except in August, of course. But that's the dog days, and those are bad anywhere.

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