LJIDOL SEASON I PROMPT 20 BRIDGE AND STRAW
Apr. 2nd, 2012 05:30 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
basricWARNING: TRAUMA CONCERNING DROWNINGS VICTIMS INCLUDING A PREGNANT WOMAN.
It's May and graduation at Vanderbilt. It also meant the nurses graduating from the Master’s Degree program were being hired. Though they were technically called ‘Nurse Practitioners,’ they were just considered the same as any other registered nurse.
Vanderbilt has a bridge program. This means if you have an Associate’s Degree in anything you can take six semesters costing $30,000 each, not including rooming or books, and graduate with a Master’s Degree in Nursing.
I came into work Friday and discovered three files and a note from my new manager. She had hired three of these nurses, I’m sure she thought she was doing the unit a favor.
The first folder introduced me to Polly; I skimmed her ‘wonderful’ academic record to find her Associate Degree was in Agriculture.
Second was Susan. Her Associate Degree was in business.
Lastly, we had Julie whose Associate Degree was in psychology.
All three graduated at the top of their class. The problem with the Bridge Program for us is clinicals are done in the Associate and Bachelor Nursing Programs. Research and management are the basic curriculum of the Master’s. They do have a period of time in the hospital where they work as an extern (like the doctor’s intern). The difference is, they are not allowed to assess or give medications so basically they are used as CarePartners.
These three new nurses had spent three weeks on the day shift working triage. My new boss wanted me to train them to work the night weekend shift, eventually allowing each to take the lead when I felt they were ready.
In the conference room before shift I sat with the three new nurses and Paula. “First, weekend nights are very different from the day shift.”
Polly, who apparently was the alpha of the group and with just a few words I knew she thought she was me or rather knew everything I knew so she could just take over triage, “We know how to do the job. You are not our boss. See this,” she pointed to the named emblazoned in red on her lab coat and her Nurse Practitioner beneath her name.
Paula who rarely gets angry sat forward, “Honey you don’t even want to play the initial game with her. She got her degree the hard way; she worked for it ending with a PA and a PhD. So if I were you, I’d sit back and listen.”
“Paula,” I warned her.
Polly turned red, Susan made a pretty pout, but Julie sat forward with a pad and pencil at the ready.
“The regular resident was in a car accident and will be okay but he is in the SIC-U. The Attending will take lead tonight.”
Polly and Susan sat forward twittering with excitement.
“The Attending just loves me," Polly preened.
“Uh huh, I will assess as victims arrive and I have assigned Paula Bay One, Julie Bay Two and Susan Bay Three and Polly Bay Four.
“FOUR. I want the main arena. I am working to lead trauma and you give me Bay Four. I know the manager told you to let me take lead. My Aunt said you would be jealous of me. Men call me gorgeous. I have a perfect figure,” Polly stood and ran hands over her hourglass figure.
I stepped into her personal space, “First, you put on a lemon yellow shapeless gown, gloves, booties a cap covering your hair, a blue mask and goggles so we all look alike. By the end of the night your makeup is gone and your hair is limp or sticking straight up in the air.”
“A for the main arena, that is my domain, when you have proven yourself to me you will be allowed to work lead with me observing. You'll work where I tell you in the meantime -- how I tell you. Every patient deserves the best care you can give. Whatever Bay you are working is a going to have a major trauma.”
“I want the main arena and the Attending. You are not my boss. My Aunt is the new manager and she says I will lead triage within three months then I will be your boss. Then you will pay for this insult.”
“We walk through those triage doors this night, I am the boss.”
They filed out. Paula leaned in and whispered, “She makes her lead and I’ll quit along with half the staff.”
“Three months is a long time. I’m just sending a prayer out into the ether that she doesn’t kill someone tonight or the Attending doesn’t kill her."
Susan spoke to me in private a while later trying to explain that Polly's aunt had great expectations from her. That everything always came easy to Polly, but she was a good nurse. Polly had learned if she made a scene she always got what she wanted.
"Not when lives are at stake. I don't care if her father's the President, in trauma our patients come first, always."
And so the night began.
Our first three victims of the night were GSWs—to the spine, the chest, and the head. I gave Julie the head wound with Paula overseeing, the other two nurses I gave the spine. “Make sure you have everything set up for the resident to intubate and place the line.”
“We know how to do our job.”
“Then I don’t have to remind you not to remove the neck brace or back board until after the scans."
I went to assist Dr. A. with the chest wound, “Pulling a double shift?”
He looked up from his assessment, “Just don’t put that man-eater, Polly with me tonight. I’m irritable enough.”
“You know I never share you when you’re working.”
He grinned, “You’re the straw in my glass.”
“I know for a fact you’re a single malt scotch man. A straw won’t sit in a shot glass.”
He sighed and moved so I could draw labs from the line he’d placed, “Just as well, Grace (his wife) would shoot us both.”
“Not if my husband finds out first.”
Paula’s patient was wheeled by us on his way to surgery. The spinal followed. Our victim crashed as the door shut and the electrodes showed him go straight to asystole. Dr. A. was handed the scans as we started CPR.
“Stop, it shredded the ventricles. He’s bled out internally. TOD 19:55."
In our waiting area Paula and I listened to the whispered complaints of the newbies. The radio static blasted followed by a request for three of the LifeFlights. The new bridge they were building over the Tennessee River in Clinton had buckled and collapsed onto the old bridge. There were automobiles, a bus and an eighteen-wheeler in the river with concrete and steel that followed to crush and mangle. The water was icy so they had been able to rescue and resuscitate many of the victims. Five would need our Trauma One Center. Apparently they had maxed out the Trauma One in Knoxville, which was closer.
We heard the boots of the flight crew as they slapped the floor at a run and shortly thereafter the whirr of the blades and growl of liftoff.
We had ninety minutes, give or take. I tried to prepare them, but Polly and Susan whispered between themselves.
“Ladies," I tried for attention, "Keep in mind that these are drowning victims with catastrophic wounds. In caring for the wounds, don’t forget drowning victims tend to have cervical fractures. A great deal of the water the EMS get out is from the stomach so there may still be river water in the lungs, use your stethoscope often to assess breath sounds."
We had a knifing victim brought in and the Attending watched over his resident and I watched over Susan.
Everything flowed smoothly; I listened while the Attending took the call from the radio as the Flight Resident gave him brief, medical shorthand of the five victims coming to us from the scene.
Most were without oxygen for at least twenty minutes before they were recovered by the divers and resuscitated by EMS.
First, a twenty-four year old male had been impaled through the abdomen by metal rod from the bridge. On site they had cut through so one inch came out his back and eight inches from his abdomen.
The second victim was a fifty year old female with a crushing injury to her chest, concrete slivers had embedded in her chest from the concrete block that punctured her car’s roof and windshield then settled on her chest.
The third was a twenty year old female in her second trimester with obvious cervical fractures (meaning they found her head at an unnatural angle).
The fourth victim had open fractures in all four extremities. This one had a major beam crush her vehicle and they had to wait for a crane to move it and get her to land. She was dead thirty minutes before resuscitated. She was awake, alert and talking.
The fifth victim’s vehicle was crushed by concrete debris that did not penetrate the vehicle. It appeared he had a crushed pelvis.
They were forty minutes from touch down.
We had just sent a head trauma to surgery when the first copter settled on its pad.
The open fracture came in first. Having discussed the victims with the Attending I gave Paula this patient in Bay One.
The crushed pelvis I gave to Julie in Bay Two with orders for a full body scan before they began. “Watch the neuro checks in the feet. Call for help if the pedal pulses are lost.”
The next copter brought the pregnant victim. I sent her, as per his request, to the Attending in the main arena.
The next two victims arrived I gave Susan in Bay three with a reminder to stabilize the rod in her victim first, watch the neuro checks for signs of shock or stroke and look for bleeders.
I sent the paramedic to Bay 4 as I looked for Polly. I found her as she tried to assist the Attending. I watched her reach across his sterile field to hand him something and recognized the thunderous expression on his face. I saw him snatch his line out, wad it up and throw it away along with his gloves. I moved fast and forced Polly toward Bay 4.
“You have a female with a crushed chest embedded with slivers and chunks of concrete. If the charge nurse wasn’t in a code I would relieve you. No, you have nothing to say. Go and do your job. You missed report so just wait for the resident or Paula or Rene or I come to assist. Understand me, Polly; what you have done has pissed off the Attending and me. You are unprepared to care for your patient and keeping me from mine. So, two patients could die because of desire to have your own way. Get in there with YOUR patient and do your job if you capable. Watch the patient. Call for help if she gets in distress and remember what I told you about drowning victims.”
The Attending gave me a fuming look. “Can’t handle your nurses anymore?”
That stung. I knew he was furious, but he was right, I had known Polly was a loose cannon.
I placed the leads to the EKG and thankfully she was in sinus rhythm. We had anticipated, so had called for an OB nurse. She wheeled her cart in and placed the leads on the victim’s swollen abdomen.
She looked up at the Attending and shook her head. He borrowed my stethoscope since I’d shelled out the $400 for the super-sensitive one. He stood back, “I’m getting something faint could be an echo, maybe the child. Husband?”
Rene, our Charge Nurse, shook her head, “Was taken to Knoxville, DOA.”
“Any other family, parents, sister, brothers, in-laws?’
“What are you thinking, to take the baby and use the Ped Paddles?” the Ob nurse made it more a musing than a question, “I see you put a trach in beneath a neck brace. Cervical damage?”
“The cord is intact, disks are out of alignment. Ortho is just waiting for us to stabilize.”
The OB nurse nodded and used my stethoscope, “I hear it, too. We’d need to do the C-section before the other surgery, may be an echo. We won’t know until we get in there.”
Rene ran, yelling back, “I’ll find family.”
We left the OB nurse with the patient; I followed the Attending into Bay 4. Polly had tweezers and had pulled out concrete fragments from the patient’s crushed chest. She pulled one and a small geyser of blood rose and fell in rhythm with the victim’s heart.
“Polly! I told you not to touch, just assess.”
I bumped her with my hip and reached for a hemostat and handed it to the doctor. His silence was chilling.
“The resident never came,” she whined, “I had to do something.” I wasn't sure it was because she wanted to help the patient or was just bored.
Dr. A. clamped the leak, intubated and had the line placed in minutes. I drew tubes of blood and handed them to Polly, “See if you can get these to the lab without causing another major incident.”
I turned my attention back to the patient, he had no breath sounds on the right side and red bubbles on his lips.
“His lung is probably punctured. I don’t have viable spots to place leads and can’t use his back since I can’t turn him, Doctor.”
“Call surgery, we’ve done all we can, send him down,” he removed his gloves and stepped out. I made the call. Paula had sent her patient stabilized to surgery as had Julie. Now Bay 4’s patient was pushed out of triage by surgical techs.
The resident was with the patient with the rod. Susan had it well stabilized.”
I doubled checked her work, "Well done, Susan."
That patient was sent down to the surgical floor. I sent Julie and Susan to the break room to decompress and returned to our pregnant victim.
Rene came in followed by nosy Polly. “I have a phone order from the patient’s mother to perform the C-Section.”
There was a flurry of activity by the OB nurse and five minutes later our patient was on her way to surgery.
The night rolled into morning and we had the run of the mill knifings, two GSW’s, a couple of whacked heads and three MVA’s.
06:00 Things had been settled for over an hour. I went looking for Polly. I found her in triage flirting with the Resident. Dr. A. startled me by whispering beside my ear, “She looking for a doctor?” Meaning had she become a nurse to marry a doctor.
“No, she wants my job.”
“Never happen.”
“The new manager is her aunt.”
”Never happen.”
I stepped into triage and interrupted her flirtation which earned me a killer glare.
“Polly, I need to speak with you in the conference room; NOW.” When she turned back to the resident intent on ignoring me, I barely restrained my temper, “Don’t make me send someone for you, Polly. And Dr. B. this is something you want to walk away from, especially with your Attending on the warpath.”
She flounced into the conference room. I had Paula sit in on this meeting as a witness. “Polly, if you behave the way you have tonight on the day shift I do not know how you are still working here.”
“How dare you,” she dropped into a chair, “I did nothing wrong, you were the one lording over everyone.”
“Let’s start with you not being there to take report after I had given you a patient.”
“I belong in the arena with the Attending.”
“Then let’s move on to your contaminating a sterile field for the Attending's central line placement. . .”
“I’ll take it from here,” the deep voice of the Attending came from the door. The man was gone and the God blocked the doorway and he was furious.
I’ve seen him like this with residents, but I’d never been a witness the full force of the storm he raged over Polly. I was surprised the wallpaper didn’t curl off the wall though he never raised his voice. When he finished the little ding bat actually challenged him.
“You are not the boss of the nurses. My aunt is manager of Trauma. She says who works where. You can’t keep me out of Triage.”
Dr. A. is a big man. I know he was exhausted having worked over twenty-four hours but he raised weary shoulders and head to his full height of six feet five and in a voice just above a whisper that if pointed at me would have scared the hell out of me said, “I AM TRAUMA. This is my unit. MINE. If I want you gone, you are gone, whether resident, nurse, CarePartner or manager. Somehow I don’t think your aunt will throw herself on her sword for you. You can stay on in trauma but where I can’t see you, regular rooms or Step Down. You will never again work a shift in triage or TIC-U. Now, if I were you I’d go call your aunt because I still may yet file charges with the Nursing Board if the patient you were responsible for dies.”
He turned and walked out. She looked at me then Paula and burst into tears, then had the audacity to beg us to help her.
“Honey, if you think I’d go up against that man for you, you are crazy.”
Paula looked at me, "Thanks ever so much for including me in watching Dr. A dress down someone. It was on my bucket list."
"Shut up. What are friends for but to share the fallout. And this is not over."
Polly did not come back to Trauma and our Manager blamed me. Seems my teaching skills were poor or perhaps I was just jealous of watching a younger, prettier nurse being prepared to take my place so I sabotaged her.
If not for Paula and Rene’s intervention I would have quit right then.
All five patients survived, the mother ended up on a ventilator for life and her baby did not survive.
I hate May graduation at Vanderbilt and I hate nepotism.
Definitions :
Asystole: Flat Line—no electrical activity in the heart
Cervical: Neck Spinal Disks
GSW: gunshot wound
Ped. Paddles: Neonatal Pediatric defibrillator
Pedal Pulses: Pulse felt from the vein on top of the foot
SIC-U: Surgical Intensive Care Unit
TIC-U: Trauma Intensive Care Unit
TOD: Time of Death
Ventricles lower large chambers of the heart
We are in the midst of a intersection. My fabulous partner is the talented whipchick. Find her entry HERE
It's May and graduation at Vanderbilt. It also meant the nurses graduating from the Master’s Degree program were being hired. Though they were technically called ‘Nurse Practitioners,’ they were just considered the same as any other registered nurse.
Vanderbilt has a bridge program. This means if you have an Associate’s Degree in anything you can take six semesters costing $30,000 each, not including rooming or books, and graduate with a Master’s Degree in Nursing.
I came into work Friday and discovered three files and a note from my new manager. She had hired three of these nurses, I’m sure she thought she was doing the unit a favor.
The first folder introduced me to Polly; I skimmed her ‘wonderful’ academic record to find her Associate Degree was in Agriculture.
Second was Susan. Her Associate Degree was in business.
Lastly, we had Julie whose Associate Degree was in psychology.
All three graduated at the top of their class. The problem with the Bridge Program for us is clinicals are done in the Associate and Bachelor Nursing Programs. Research and management are the basic curriculum of the Master’s. They do have a period of time in the hospital where they work as an extern (like the doctor’s intern). The difference is, they are not allowed to assess or give medications so basically they are used as CarePartners.
These three new nurses had spent three weeks on the day shift working triage. My new boss wanted me to train them to work the night weekend shift, eventually allowing each to take the lead when I felt they were ready.
In the conference room before shift I sat with the three new nurses and Paula. “First, weekend nights are very different from the day shift.”
Polly, who apparently was the alpha of the group and with just a few words I knew she thought she was me or rather knew everything I knew so she could just take over triage, “We know how to do the job. You are not our boss. See this,” she pointed to the named emblazoned in red on her lab coat and her Nurse Practitioner beneath her name.
Paula who rarely gets angry sat forward, “Honey you don’t even want to play the initial game with her. She got her degree the hard way; she worked for it ending with a PA and a PhD. So if I were you, I’d sit back and listen.”
“Paula,” I warned her.
Polly turned red, Susan made a pretty pout, but Julie sat forward with a pad and pencil at the ready.
“The regular resident was in a car accident and will be okay but he is in the SIC-U. The Attending will take lead tonight.”
Polly and Susan sat forward twittering with excitement.
“The Attending just loves me," Polly preened.
“Uh huh, I will assess as victims arrive and I have assigned Paula Bay One, Julie Bay Two and Susan Bay Three and Polly Bay Four.
“FOUR. I want the main arena. I am working to lead trauma and you give me Bay Four. I know the manager told you to let me take lead. My Aunt said you would be jealous of me. Men call me gorgeous. I have a perfect figure,” Polly stood and ran hands over her hourglass figure.
I stepped into her personal space, “First, you put on a lemon yellow shapeless gown, gloves, booties a cap covering your hair, a blue mask and goggles so we all look alike. By the end of the night your makeup is gone and your hair is limp or sticking straight up in the air.”
“A for the main arena, that is my domain, when you have proven yourself to me you will be allowed to work lead with me observing. You'll work where I tell you in the meantime -- how I tell you. Every patient deserves the best care you can give. Whatever Bay you are working is a going to have a major trauma.”
“I want the main arena and the Attending. You are not my boss. My Aunt is the new manager and she says I will lead triage within three months then I will be your boss. Then you will pay for this insult.”
“We walk through those triage doors this night, I am the boss.”
They filed out. Paula leaned in and whispered, “She makes her lead and I’ll quit along with half the staff.”
“Three months is a long time. I’m just sending a prayer out into the ether that she doesn’t kill someone tonight or the Attending doesn’t kill her."
Susan spoke to me in private a while later trying to explain that Polly's aunt had great expectations from her. That everything always came easy to Polly, but she was a good nurse. Polly had learned if she made a scene she always got what she wanted.
"Not when lives are at stake. I don't care if her father's the President, in trauma our patients come first, always."
And so the night began.
Our first three victims of the night were GSWs—to the spine, the chest, and the head. I gave Julie the head wound with Paula overseeing, the other two nurses I gave the spine. “Make sure you have everything set up for the resident to intubate and place the line.”
“We know how to do our job.”
“Then I don’t have to remind you not to remove the neck brace or back board until after the scans."
I went to assist Dr. A. with the chest wound, “Pulling a double shift?”
He looked up from his assessment, “Just don’t put that man-eater, Polly with me tonight. I’m irritable enough.”
“You know I never share you when you’re working.”
He grinned, “You’re the straw in my glass.”
“I know for a fact you’re a single malt scotch man. A straw won’t sit in a shot glass.”
He sighed and moved so I could draw labs from the line he’d placed, “Just as well, Grace (his wife) would shoot us both.”
“Not if my husband finds out first.”
Paula’s patient was wheeled by us on his way to surgery. The spinal followed. Our victim crashed as the door shut and the electrodes showed him go straight to asystole. Dr. A. was handed the scans as we started CPR.
“Stop, it shredded the ventricles. He’s bled out internally. TOD 19:55."
In our waiting area Paula and I listened to the whispered complaints of the newbies. The radio static blasted followed by a request for three of the LifeFlights. The new bridge they were building over the Tennessee River in Clinton had buckled and collapsed onto the old bridge. There were automobiles, a bus and an eighteen-wheeler in the river with concrete and steel that followed to crush and mangle. The water was icy so they had been able to rescue and resuscitate many of the victims. Five would need our Trauma One Center. Apparently they had maxed out the Trauma One in Knoxville, which was closer.
We heard the boots of the flight crew as they slapped the floor at a run and shortly thereafter the whirr of the blades and growl of liftoff.
We had ninety minutes, give or take. I tried to prepare them, but Polly and Susan whispered between themselves.
“Ladies," I tried for attention, "Keep in mind that these are drowning victims with catastrophic wounds. In caring for the wounds, don’t forget drowning victims tend to have cervical fractures. A great deal of the water the EMS get out is from the stomach so there may still be river water in the lungs, use your stethoscope often to assess breath sounds."
We had a knifing victim brought in and the Attending watched over his resident and I watched over Susan.
Everything flowed smoothly; I listened while the Attending took the call from the radio as the Flight Resident gave him brief, medical shorthand of the five victims coming to us from the scene.
Most were without oxygen for at least twenty minutes before they were recovered by the divers and resuscitated by EMS.
First, a twenty-four year old male had been impaled through the abdomen by metal rod from the bridge. On site they had cut through so one inch came out his back and eight inches from his abdomen.
The second victim was a fifty year old female with a crushing injury to her chest, concrete slivers had embedded in her chest from the concrete block that punctured her car’s roof and windshield then settled on her chest.
The third was a twenty year old female in her second trimester with obvious cervical fractures (meaning they found her head at an unnatural angle).
The fourth victim had open fractures in all four extremities. This one had a major beam crush her vehicle and they had to wait for a crane to move it and get her to land. She was dead thirty minutes before resuscitated. She was awake, alert and talking.
The fifth victim’s vehicle was crushed by concrete debris that did not penetrate the vehicle. It appeared he had a crushed pelvis.
They were forty minutes from touch down.
We had just sent a head trauma to surgery when the first copter settled on its pad.
The open fracture came in first. Having discussed the victims with the Attending I gave Paula this patient in Bay One.
The crushed pelvis I gave to Julie in Bay Two with orders for a full body scan before they began. “Watch the neuro checks in the feet. Call for help if the pedal pulses are lost.”
The next copter brought the pregnant victim. I sent her, as per his request, to the Attending in the main arena.
The next two victims arrived I gave Susan in Bay three with a reminder to stabilize the rod in her victim first, watch the neuro checks for signs of shock or stroke and look for bleeders.
I sent the paramedic to Bay 4 as I looked for Polly. I found her as she tried to assist the Attending. I watched her reach across his sterile field to hand him something and recognized the thunderous expression on his face. I saw him snatch his line out, wad it up and throw it away along with his gloves. I moved fast and forced Polly toward Bay 4.
“You have a female with a crushed chest embedded with slivers and chunks of concrete. If the charge nurse wasn’t in a code I would relieve you. No, you have nothing to say. Go and do your job. You missed report so just wait for the resident or Paula or Rene or I come to assist. Understand me, Polly; what you have done has pissed off the Attending and me. You are unprepared to care for your patient and keeping me from mine. So, two patients could die because of desire to have your own way. Get in there with YOUR patient and do your job if you capable. Watch the patient. Call for help if she gets in distress and remember what I told you about drowning victims.”
The Attending gave me a fuming look. “Can’t handle your nurses anymore?”
That stung. I knew he was furious, but he was right, I had known Polly was a loose cannon.
I placed the leads to the EKG and thankfully she was in sinus rhythm. We had anticipated, so had called for an OB nurse. She wheeled her cart in and placed the leads on the victim’s swollen abdomen.
She looked up at the Attending and shook her head. He borrowed my stethoscope since I’d shelled out the $400 for the super-sensitive one. He stood back, “I’m getting something faint could be an echo, maybe the child. Husband?”
Rene, our Charge Nurse, shook her head, “Was taken to Knoxville, DOA.”
“Any other family, parents, sister, brothers, in-laws?’
“What are you thinking, to take the baby and use the Ped Paddles?” the Ob nurse made it more a musing than a question, “I see you put a trach in beneath a neck brace. Cervical damage?”
“The cord is intact, disks are out of alignment. Ortho is just waiting for us to stabilize.”
The OB nurse nodded and used my stethoscope, “I hear it, too. We’d need to do the C-section before the other surgery, may be an echo. We won’t know until we get in there.”
Rene ran, yelling back, “I’ll find family.”
We left the OB nurse with the patient; I followed the Attending into Bay 4. Polly had tweezers and had pulled out concrete fragments from the patient’s crushed chest. She pulled one and a small geyser of blood rose and fell in rhythm with the victim’s heart.
“Polly! I told you not to touch, just assess.”
I bumped her with my hip and reached for a hemostat and handed it to the doctor. His silence was chilling.
“The resident never came,” she whined, “I had to do something.” I wasn't sure it was because she wanted to help the patient or was just bored.
Dr. A. clamped the leak, intubated and had the line placed in minutes. I drew tubes of blood and handed them to Polly, “See if you can get these to the lab without causing another major incident.”
I turned my attention back to the patient, he had no breath sounds on the right side and red bubbles on his lips.
“His lung is probably punctured. I don’t have viable spots to place leads and can’t use his back since I can’t turn him, Doctor.”
“Call surgery, we’ve done all we can, send him down,” he removed his gloves and stepped out. I made the call. Paula had sent her patient stabilized to surgery as had Julie. Now Bay 4’s patient was pushed out of triage by surgical techs.
The resident was with the patient with the rod. Susan had it well stabilized.”
I doubled checked her work, "Well done, Susan."
That patient was sent down to the surgical floor. I sent Julie and Susan to the break room to decompress and returned to our pregnant victim.
Rene came in followed by nosy Polly. “I have a phone order from the patient’s mother to perform the C-Section.”
There was a flurry of activity by the OB nurse and five minutes later our patient was on her way to surgery.
The night rolled into morning and we had the run of the mill knifings, two GSW’s, a couple of whacked heads and three MVA’s.
06:00 Things had been settled for over an hour. I went looking for Polly. I found her in triage flirting with the Resident. Dr. A. startled me by whispering beside my ear, “She looking for a doctor?” Meaning had she become a nurse to marry a doctor.
“No, she wants my job.”
“Never happen.”
“The new manager is her aunt.”
”Never happen.”
I stepped into triage and interrupted her flirtation which earned me a killer glare.
“Polly, I need to speak with you in the conference room; NOW.” When she turned back to the resident intent on ignoring me, I barely restrained my temper, “Don’t make me send someone for you, Polly. And Dr. B. this is something you want to walk away from, especially with your Attending on the warpath.”
She flounced into the conference room. I had Paula sit in on this meeting as a witness. “Polly, if you behave the way you have tonight on the day shift I do not know how you are still working here.”
“How dare you,” she dropped into a chair, “I did nothing wrong, you were the one lording over everyone.”
“Let’s start with you not being there to take report after I had given you a patient.”
“I belong in the arena with the Attending.”
“Then let’s move on to your contaminating a sterile field for the Attending's central line placement. . .”
“I’ll take it from here,” the deep voice of the Attending came from the door. The man was gone and the God blocked the doorway and he was furious.
I’ve seen him like this with residents, but I’d never been a witness the full force of the storm he raged over Polly. I was surprised the wallpaper didn’t curl off the wall though he never raised his voice. When he finished the little ding bat actually challenged him.
“You are not the boss of the nurses. My aunt is manager of Trauma. She says who works where. You can’t keep me out of Triage.”
Dr. A. is a big man. I know he was exhausted having worked over twenty-four hours but he raised weary shoulders and head to his full height of six feet five and in a voice just above a whisper that if pointed at me would have scared the hell out of me said, “I AM TRAUMA. This is my unit. MINE. If I want you gone, you are gone, whether resident, nurse, CarePartner or manager. Somehow I don’t think your aunt will throw herself on her sword for you. You can stay on in trauma but where I can’t see you, regular rooms or Step Down. You will never again work a shift in triage or TIC-U. Now, if I were you I’d go call your aunt because I still may yet file charges with the Nursing Board if the patient you were responsible for dies.”
He turned and walked out. She looked at me then Paula and burst into tears, then had the audacity to beg us to help her.
“Honey, if you think I’d go up against that man for you, you are crazy.”
Paula looked at me, "Thanks ever so much for including me in watching Dr. A dress down someone. It was on my bucket list."
"Shut up. What are friends for but to share the fallout. And this is not over."
Polly did not come back to Trauma and our Manager blamed me. Seems my teaching skills were poor or perhaps I was just jealous of watching a younger, prettier nurse being prepared to take my place so I sabotaged her.
If not for Paula and Rene’s intervention I would have quit right then.
All five patients survived, the mother ended up on a ventilator for life and her baby did not survive.
I hate May graduation at Vanderbilt and I hate nepotism.
Definitions :
Asystole: Flat Line—no electrical activity in the heart
Cervical: Neck Spinal Disks
GSW: gunshot wound
Ped. Paddles: Neonatal Pediatric defibrillator
Pedal Pulses: Pulse felt from the vein on top of the foot
SIC-U: Surgical Intensive Care Unit
TIC-U: Trauma Intensive Care Unit
TOD: Time of Death
Ventricles lower large chambers of the heart
We are in the midst of a intersection. My fabulous partner is the talented whipchick. Find her entry HERE
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no subject
Date: 2012-04-03 11:48 am (UTC)no subject
Date: 2012-04-03 10:43 pm (UTC)no subject
Date: 2012-04-03 10:28 pm (UTC)no subject
Date: 2012-04-03 01:28 pm (UTC)no subject
Date: 2012-04-03 10:31 pm (UTC)no subject
Date: 2012-04-03 05:45 pm (UTC)no subject
Date: 2012-04-03 10:23 pm (UTC)But you are right, we should have a mental health screening like the police recruits and military have.
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Date: 2012-04-03 06:08 pm (UTC)no subject
Date: 2012-04-03 10:21 pm (UTC)There are a lot of good nurses and doctors, I write about the ones I've dealt with in my career that are not so much. Otherwise what you'd just get is the trauma and I'm afraid that would be too much.
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Date: 2012-04-03 06:20 pm (UTC)You keep talking about placing central lines and a sterile field in many of your entries. I know this is technical, but could you explain more about why this is done and how it works?
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Date: 2012-04-03 10:09 pm (UTC)Anytime during the procedure if anyone reaches across this square of sterile field bacteria can fall and travel along the catheter to the heart and the patient gets a hospital infection in their blood and heart.
That's why some hospital infections occur, sloppy or careless insertion or care of the central line.
Is it clearer or TMI do I need to put it in simpler terms, I never know being hardened and assuming everyone understands.
'
I write without verbs because when we speak to each other we don't use them so I have to go back and put them in. So if you see a sentence without a verb give me a yell, I just misses it.
Hope I answered your questions.
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Date: 2012-04-03 08:02 pm (UTC)You have written some awesome and terrifying things in your amazing writing, but that might be the single scariest :P
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Date: 2012-04-03 09:55 pm (UTC)And if you can't find the financial aide, the Veteran's Hospital will sign a contract with you to work where ever they need you for 1 year for 1 each semester so six years in Alaska or Hawaii, and move it they need you to move.
Now I have seen some of these nurses that made friends with their nurses doing their extern that helped them get experience so not all are ding bats.
Vanderbilt was not the only nursing school doing this.
I protested because I had to have a cadaver to dissect. They don't even do cats or fetal pigs like most associate & bachelors do.
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Date: 2012-04-03 10:45 pm (UTC)no subject
Date: 2012-04-03 10:54 pm (UTC)But there is hope, terrifying as it is...the healthcare motto
keep doing it until you kill your quota then make changes. That includes the drug industry, too.
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Date: 2012-04-04 05:17 am (UTC)Wow. I would not have thought that was possible!
"Thanks ever so much for including me in watching Dr. A dress down someone. It was on my bucket list."
Hahahaha! I can well believe it!
I like how the bridge accident worked into this story-- that very much would create trauma victims.
And the Vanderbilt program sounds like a nightmare for whoever winds up with those nurses. It's criminal, really-- they're overpaying to be undertrained, and probably have no idea. Ugh.
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Date: 2012-04-04 11:23 pm (UTC)(no subject)
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Date: 2012-04-04 07:53 am (UTC)I've heard of horror stories like Polly... but I'm *DAMNED* glad I never had to deal with one.
As always, potent and moving. Thanks for sharing.
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Date: 2012-04-04 11:20 pm (UTC)Thanks as always for your support. I thought whipchick and I complimented one another, me blunt and she refined in our writing styles.
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Date: 2012-04-04 08:03 pm (UTC)I think that some producers should nab up your stories and make a series for television!
Your last line was priceless! :)
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Date: 2012-04-04 11:16 pm (UTC)(no subject)
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Date: 2012-04-04 09:44 pm (UTC)no subject
Date: 2012-04-04 11:07 pm (UTC)I could do a story with a Susan or a Julie but I've found comments are not as forthcoming or the votes so I assume people want the worst. I could try it again and see. If I do just a regular day in trauma, it ends up just trauma and I think that is too much for most readers.
What do you think?
I look through my journals and find the most unusual and controversial.
There is not a kinder gentler Trauma night, just slower.
This does stir a memory of a nurse who had a special touch, I will go see if I can find it.
Thanks for commenting.
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Date: 2012-04-04 10:54 pm (UTC)I agree completely. This was a great piece, as always.
Dan
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Date: 2012-04-04 11:09 pm (UTC)(no subject)
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Date: 2012-04-05 12:30 am (UTC)no subject
Date: 2012-04-05 06:19 am (UTC)no subject
Date: 2012-04-05 01:34 am (UTC)Out of all your trauma stories, this one IMO is one of your strongest :)
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Date: 2012-04-05 06:09 am (UTC)no subject
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Date: 2012-04-05 03:44 am (UTC)no subject
Date: 2012-04-05 06:04 am (UTC)no subject
Date: 2012-04-05 04:33 pm (UTC)*shakes her head*
Captivating as always. Brava!
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Date: 2012-04-05 05:52 pm (UTC)no subject
Date: 2012-04-05 07:00 pm (UTC)no subject
Date: 2012-04-05 10:26 pm (UTC)Not that I don't get frustrated especially in May and January.
Thanks for reading and commenting.
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Date: 2012-04-06 12:27 am (UTC)no subject
Date: 2012-04-06 01:52 am (UTC)