I have a strange job.

Happy 2009, everyone! First off, I would like to apologize to my thousands of loyal followers for my lack of posting in the last several weeks. I am very sorry to let you down. With the holidays and finishing up my critical care nursing residency program, I have been very busy. But now I am DONE! With the residency, that is. Beginning tomorrow evening, I will have my first shift without having someone hovering over me, watching my every move. I am excited, but very nervous at the same time. Now if I make a mistake, there is no one to catch it. It's all on me. Needless to say, I will only be taking care of the most stable of patients in the ICU, if I can help it!

My last shift in residency was on Sunday, and it seemed only fitting that I had my first patient death. That may sound kind of grim to some people, but it was like a natural transgression. I started off taking care of very stable patients and gradually transitioned onto sicker and sicker patients, to finally one that was so sick that there was nothing left that could be done.

He already looked like a dead man from the moment I started that shift. His skin was mottled, extremities were cold. You couldn't feel any of his pulses. Pulse oximetry monitoring wouldn't work on him since his peripheral blood circulation was non-existent.He was on three different vasoactive drips to keep his blood pressure up. He was maxed out on two of the medications, and so our only option was to gradually go up on the third until that one was maxed out. And from there, we just waited for him to go.

It was a bit tense, standing in the room with the family members, all staring at the monitor, watching his heart go into arrythmias. Brief runs of ventricular tachycardia. Blood pressure kept dropping. I had to just turn off all the alarms on the monitor because the constant blaring was just a reminder of how quickly this man was going down.

Onces the blood pressure dropped into the 30s and 40s, my preceptor and I attempted to find either a carotid or femoral pulse. Nothing. Decided to page the on-call doc to examine the patient, because at this point, he probably really was dead. On-call doc was just an intern. Idiot intern. He didn't show up for nearly 20 minutes. He couldn't feel any pulses either and decided to call it. "So, is there like a form or something I need to sign?" he asked me. "I don't know. You're the doctor," I replied.

The respiratory therapist came in and disconnected him from the ventilator, while me and my preceptor turned off the numerous IV pumps, turned off the monitor. I'm not sure why I expected the man to move or breathe or anything like that, but of course he didn't. Everything was still, quiet. He was dead.

After all the necessary paperwork was completed, I went to get the keys to the morgue and a gurney on which to put the body. By the time we zipped him into the body bag, it had been almost three hours since he was officially declared dead. I was surprised that his body was stiff. Weird.

But it got even weirder. After unlocking the door to the morgue, there was yet another door to unlock, which was the door to the cooler. Yes, it was about the size of a walk-in refrigerator at a restaurant. Not nearly as big as you would expect for a hospital as large as the one at which I work. Four or five other gurneys with adult-sized bodies were in there. To the right, there were shelves with plastic storage containers that had tiny, baby-sized body bags. And there was a big red barrel that said "Placentas Only."

The third key was to open up the box where my dead patient's chart would go. And then I had to sign him into the morgue; much like you would sign someone into a doctor's office or a meeting.

So there you have it. My job, my work as a nurse. Well, only a small part of it. A small, strange part of it.

Observations from the E.R.

As part of my orientation, I got paid to spend the day (a.k.a. sort of work and observe) in my hospital’s E.R. I had a really good time when I rotated through there during nursing school, and this time was no exception. There were several things that I noticed during that day:

1. As much as I enjoy working with the unconscious or intubated patients who cannot talk to me up in the ICU, I also really enjoy working with the “crazies.” At the county hospital, there is definitely no shortage of those. Take, for example, the old prostitute (so insist the ER nurses) with a walker who demanded to speak with the head of the hospital because we would not prescribe her narcotics. Or, the older African American gentleman who suffered a minor burn to his face after lighting a cigarette while on his oxygen tank. He was there so we could “get this black stuff off of his face.”

He couldn’t even tell us why he needed to be on oxygen in the first place. I must be a bit of a risk taker, because as agitated as he was getting, I still dared to put a catheter in him since he wasn’t able to “go” and we needed to get a urine sample to do a drug screen. He had initially flat out refused to get a catheter put in, but I was able to sweet-talk him into it. For that, I earned the nickname of “Angelina Jolie.”

2. I am getting better at putting in IVs. I was batting 1000 that day. Three for three, baby! I’ll be honest though; every person I stuck had veins fat enough that you’d have to be blind not to get one in. But whatever.

3. The ER nurses are a lot nicer than the SICU nurses. Don’t get me wrong, I do like (most) of the people I work with. However, as talented as they are, there is some serious attitude that gets thrown around, and it’s something I didn’t quite fully realize until I went to the ER. As much as I love my coworkers’ sick sense of humor and can relate to them on many levels, I just hope I don’t get fully sucked into their cult of superiority. I’m telling you, the nurses in my unit have a reputation around the hospital, and now I can see why!

4. Docs are around constantly. I thought we saw them a lot in the ICU, but they are literally there all the time in the ER. That is where they live. And all the hot ones are married.

5. If you are a trauma patient (car accident, fall, shooting, stabbing, etc.), expect a doctor to put his finger in your rear. The trauma hall was very busy that day, and on every admit that I saw, the same doctor was always sticking his finger up the patient’s butt. Yes, yes, there is a totally valid reason for it (to check for bleeding and rectal tone; no tone can mean a spinal cord injury), but the juvenile side of me smiled. I secretly wondered exactly how many butts had this doctor stuck his finger inside of during his tenure in the world of medicine? I was also amused by the male patient who screamed expletives while getting his special exam, as if the doctor was taking his manhood away from him . . .

6. There is nothing like getting to meet a patient up on the helipad. Okay, so I’m sure by the hundredth or even tenth time you get to do it, it would get old, but I was absolutely giddy inside when I learned that I would get to watch the CareFlite helicopter land and help wheel the patient on a gurney all the way back to the trauma hall. The warm wind, the setting sun, and the Dallas skyline in the background made for a perfectly surreal experience. You couldn’t pay me enough to be a flight nurse, but I’d love to take over once the copter lands! In a word: awesome.