Saturday, October 05, 2013

Ohai. September was sort of busy.

A few folks have asked for updates on our Fantastic Integrated Computer System and about the woman who went to the non-accredited nursing school. Herewith:

The FICS is. . . .well, most of the functionality has been turned off. Which is nice, as it doesn't feel like Big Brother is right over your shoulder all the time. Basically, none of the tracking features worked right. Hell, the call lights and information boards in the rooms didn't even work right, so away they went, to be replaced with the old setups. Nobody is crying.

As for the tech who went to the wrong school: Somebody asked why accreditation makes a difference, if her grades were good and she'd had previous floor experience. It makes a difference because accreditation is the way that hospitals and clinics know that a particular school is teaching material that's up-to-date and useful. It's based, as far as I know, on things like NCLEX passing rates and the qualifications of the teaching staff as well as the course requirements. Whether or not it's one more bit of Press-Ganeyesque BS I don't know; all I know is that you simply won't get hired if you don't have a degree from a school with accreditation.

And yeah, she and I talked about it; she's going to work where she can until she gets enough experience that it won't matter where she went to school. I don't know if that'll work or not, but here's luck to her.

In other news, it's been a while since I gave y'all a good, old-fashioned, gross nursing story. Here you go:

The patient was a woman in her fifties or early sixties. She was obese, had alcohol and opiate dependency, and was diabetic. She was in the preop area of another hospital, prior to getting some toes snipped off, when she started complaining of a headache and then fell over and seized.

Big aneurysm. Big, big blown aneurysm. The hospital, having no flies on its collective self, transferred her to Sunnydale to have that aneurysm clipped, even though it wouldn't make much of a difference to her functionality. So she showed up at Sunnydale NCCU intubated and sedated, got her clipping done, and stayed intubated and sedated for about twenty-four hours (the usual routine).

Except that about six hours after surgery, both of her legs got all swollen and funky. Oops. That's not a part of the usual routine. Turns out she'd somehow clotted off her IVC filter. That's a doohickey that looks a little like a miniature colander--you get one in your inferior vena cava if you have large or repeated clots in your leg veins. It's supposed to strain out any clots that might go to your lungs or head and hurt you. Anyhow, hers got all full of clots, which basically means you lose the blood flow back to your heart from your lower body. If you're thinking that's not good, you'd be right.

Out comes the heparin drip. More clots, more problems. Eventually, she managed to sustain pretty substantial damage to both kidneys, which required pressor support (drugs that go through your IV line to help your body maintain a livable blood pressure) and continuous renal dialysis (which is a big blood-scrubbing machine that we only use when things are Indeed Dire). We cut off the heparin and started using leech spit (yes, really) to anti-coagulate her, but the damage was done. She had some clotting disorder that's rare enough in women (why do we always seem to find those?) that nobody had tested her for it until she came to us.

Here's where things get interesting. Patient had two sons, one of whom was beyond batshit on the crazy scale. Mama made one good decision in a rare moment of sobriety and made Sane Son her power of attorney and medical liason. He was all for stopping the heroic measures. Beyond Batshit Son, however, was still part of the family, and used his time in the NCCU to cause problems, raise hell, and generally put up such a fuss about continuing life support that the docs felt hogtied by family drama.

Meanwhile, the patient had infarcted her bowels, meaning she had a belly full of dead intestine. She'd put on about forty pounds of water weight and looked like an enormous balloon person in the bed. Her skin was weeping excess fluid all the time, to the point that we put super-absorbent pads all over the bed and hoped for the best. The only things keeping her alive at that point were nine different drips (I counted), a ventilator, a dialysis machine, and sheer dumb bad luck. Her hands and feet were gangrenous. She no longer responded even to pain. Her reflexes were gone.

Beyond Batshit Son, despite being told that her chances for recovery were nil, continued to insist that Mama be kept on life support. He even called Adult Protective Services to tell them that his brother was abusing Mama--imagine APS's surprise when they investigated and found a Mama-Lump in a bed in a critical-care unit. This continued for a couple of weeks, until I degloved one of Mama's legs by accident.

"Degloving" is a nice word for what happens when you're so sick, or so burned, or so generally unlucky that your skin simply comes off. We were turning her, using the pads we'd put under her to absorb fluid, when I felt something mushy in the pad under her thigh. I figured it was just the super-absorbent gel in the thing and shifted my grip. . .which was when the nurse across from me blanched and shuddered.

The skin on the back of Mama's left thigh had sloughed off her leg. You could see layers of fascia and muscle underneath, and the lump of shed skin and fat was hanging off in a flap. There wasn't any blood; even with multiple drugs to keep her blood pressure up, she wasn't pushing enough of the red stuff to bleed when that happened. She leaked clear fluid.

Shudder.

With that, the docs on the case sat down in a meeting, collectively sacked up, and turned off the ventilator. The patient, grateful for the relief, died without fuss four minutes later. Given that the accidental skinning happened over a weekend, it took 'em all a couple of days to get together, but they did it. Beyond Batshit Son was never on board with the decision and had to be escorted off the premises by a couple of no-nonsense cops.

And that, my friends, is your Requisite Gross Nursing Story for the month. Sweet dreams!


14 comments:

jimbo26 said...

Ah FICS . In the UK , they decided to install a £25Bn ( $18Bn ) computer system to link every hospital . ( This was before they decided to close and closing hospitals down ) . Anyway , after all that money , they couldn't decide what software to use , so they decided not to use it .£25B down the drain .

messymimi said...

These are the stories that make me crazy, the people who won't let go.

Hope everything else is going well for you.

Penny Mitchell said...

Yay! I get a gold star for knowing enough to ask if it was a bad burn when I heard the words "degloved a leg". Yay for me! I am so smart. S-M-R-T. I'm going to go back to my non-medical profession now.

The grossest thing I encountered this week was a coffee mug someone had left in one cubicles. It had An Interesting Life Form growing in it. That's about the limit of gross that I see on my job, and I will never again have the temerity to complain about it. Amen and amen.

DollsInDystopia said...

Promise me you will NEVER let any batshit members of my family do that to me. Okay?

bobbie said...

Great to see you posting again!

Loved the story! I took off a foot dressing one day, and found I'd also 'won' a pair of toes, too. That doesn't EVEN come close to your lady, I know, but it was bad enough, as it was at the beginning of my career.

Peace ~

Anonymous said...

Was an ethics consult involved or did they get batshit son to agree?

Stories like these make me happy to work in a military hospital where security forces will haul any disruptive family member who so much as raises a fuss about anything!!

Eileen said...

Personally - abandon heroic measures at the clipping aneurysm stage...

I assume she wasn't really going to ever recover much function?

Patients with toes dropping off used to happen to OH when he had Buergers disease cases - but at least they tended to be sort of dessicated and dry.

Heidi said...

I think I just became a vegetarian.

Bryan Training said...

Yeah, it's gross. But still interesting to know.

Is not the usual scenario. Sad for all of them. But needs to get it out of our mind and next patient please.

That's our life.

Erica MacDonald said...

Sad to think of your end of life happening like that.I do feel very sorry for the woman....But, you have a great writing style! Have you written any books?

Anonymous said...

At "degloved her leg by accident" I let out an audible "Oh sh*t!!" startling my cat as I pictured a gooshy skin flap hanging from a weeping, edematous lower limb... Have a patient at present who's headed that way if she doesn't get with the program (CHF, lymphedema, renal insufficiency, everything BUT diabetes!)

I've missed your sense of humor! Hoping things are going well and that we'll hear more from you sooner than later :-)

Nichole Brock said...

Shudder, indeed! The grossest thing that happened to me this week was seeing a worm on the road. Can't help but sympathize with that woman's condition, though.

Ninjanurse said...

Sounds like a typical day in the ICU.

KATRINA DEGELER said...

My nursg program became accredited during my final semester there. When doing my clinical rotations hospital nurses gladly let us in on a secret... My 2 yr community program students were better students then the 4 yr private accreditated students that came thru there any day. In many ways according to them they would rather have my schools 2nd semester students than the private colleges final semester students. I imagine there r non accredited programs out there that don't turn out to be as well educated students as accredited program students but mine was a fantastic program apparently. When we received accreditation apparently our staff was the most impressive they've seen for a 2 yr program.