The Greatest Wound I Ever Saw

How exciting. This is for the one or two people who accidentally end up here from the nurse blog. .

Patient was an 82 year old female, very active, didn't look 82. From South Carolina, visiting family. Taking coumadin for irregular heartbeat. (thins blood so that if heart beats irregular big clot doesn't float in there and gum up the works real bad leading to ischemia of the heart tissue and possibly anoxia of brain, leading to Terri Schiavo type situation. Or death. ) Anyway, my nice little lady banged her leg on the stair. Right leg, mid calf, outside. Lateral I think we call it. Turned into big bruise, about 14 inches long and three or four inches wide. Then the entire thing fucking liquified. Seriously. Bruise turned to mush and she came in with GIANT open wound on lower leg and lots of pain. Lovely lady. Dressing like 5 inches thick.

This is the dressing change. Say I decide I'm gonna do it at 8:45 pm. I go in at 8:15 and give her 50 mg of Demerol and take the ACE bandage off that covers the kerlix bandage that covers kerlix sponges, ABD pads (5" x 9" thick absorby pad that soaks up lots of gicky stuff) and Regranex, a gel that comes from the pharmacy with a note that says "Do not lose- Costs lots of $$$ each tube $450" taped to it. So, ACE bandage off. Kerlix bandage remains. I then take some normal saline NaCl .9% and saturate dressing so that when I come back in 30 minutes and rip it off the pain is not excruciating.


My little lady was awesome. The first time I took the rest of the bandages off and saw the wound, my exact words were, (and I apologized right afterwards) "Holy Shit!" I remember thinking "what's that white shiny thing?" and then realizing that it was a tendon. Shudder. So, visible tendon, muscle, fascia, blood vessels, a little bit of necrosis and just general huge gaping wound. Ok, I just spent 15 minutes trying to find a link to a photo that gives an idea of what this wound looked like but coudn't find anything. She just chuckled and said "I know, it's really quite something, isn't it?" She was a doll. And she could hold up her leg up in the air for 20 minutes at a time. I tried doing that at home and lasted about 20 seconds before muscle twinges set in.

And now for the crucial difference between nurses and physicians. (other than the $ and respect)

I came in one afternoon and went to ask her what time she wanted me to do the dressing change for her and she immediately began crying. Now, this lady was my patient for about 10 days by then, and hadn't cried at all. I asked her what had happened, had I somehow upset her? And she told me that the physician, we will call Dr. Safari Browser, came in earlier, and changed the dressing on the day shift. Without medicating her first. Or soaking the gauze. You know how it feels when you rip a bandaid off? That's intact skin. Now imagine ripping layers and layers of blood caked and dried gauze off your actual muscle tissue. Mmm good, huh? She was sobbing throughout and the bastard just kept going. I reassured her she would absolutely get her Demerol shot first and that if she needed painkillers afterwards I would call the doctor right now and make sure there was an order for something extra if she needed it. Jerkhead doctor.

She spent the last 10 days of her stay with her the foot of her bed elevated and both legs up on pillows. She had an incision and drainage and skin graft performed and was able to go back down south with a much smaller calf.

I glare at the doctor when he's not looking.

I used to think House Arrest would be cool

But now I know better. Since Tuesday the 15th, I have left the house 3 times. The first time was to go have surgery.

Monday night- midnight (ok it's Tuesday am)- no more food or drink. Considering I have a little "problem" with Diet Pepsi and the need to imbibe at least 16 oz an hour, this was difficult. So thirsty. Gah. Wake up at 11, watch tv and smoke cigarettes in preparation for the big 'no more smoking' movement expected to begin later in the day. Go to hospital with Bug. In elevator, run into 2 nurses from day shift who I literally shudder to see. "What are you doing here?" they say. "Having surgery on ankle to fix ligaments." I say. Blank stares. 15 awkward seconds later they mumble "good luck' as Bug and I run out of elevator. Bitches.

Get admitted, which means fill out paperwork and get IV started. The nurse who did it is way better than me at doing it. I would like to say that all of the patients at Sweet Valley Hospital (heh) get treated equally, but when I told them I was RN upstairs, smiles abounded and people wanted to make my stay more pleasant. Supposed to go in for surgery at 2. Then it gets moved to 3. Starving and thirsty and really grumpy now. Oh, and I got my period early that morning and have brutal cramps.

Finally go to OR at 3:15. Talk to orthopedist. So far 5 people have checked with me that it is in fact the left ankle that the operation is to be on. Anesthesia- goes in IV. 2 seconds later I wake up in recovery with unbelievable pain in left ankle. Also gigantic cast. Lovely nurse, who I know from when she brings patients up to my floor, says "Hi! Need some Demerol for the pain?" I nod. 25 mg IV push . Does NOTHING. They give me more. It helps.

Go back to recovery where mom and Bug are waiting. They bring me food. YAY! Toast which tastes fantastic and ginger ale. MMm good. Finally get to leave hospital- driving home I immediately light cigarette which makes me feel really nauseous. Open window and breathe deep. Like in college when you'd drink too much and it would turn into Operation Don't Puke.

Home. 10 minutes of huffing and puffing and ok a little crying, and I am up driveway with crutches. Then to stairs, where I crawl on hands and knees up to couch.

And there I remain. Left house briefly on Saturday the 19th, to go to wedding in Brooklyn. Puerto Rican food is GOOD. Bug and I got lost for two hours in car and it got annoying and Bug was getting annoyed so I just took more Darvocet and dozed.

On Monday I went to pathmark to deposit disability check. Bank of America in store. 15 minutes from car to store. They have the little carts you can drive but I couldn't figure out how to get it to work so I just crutched over to the bank. Got bank guy to go pick me up fake nails cause I couldn't fathom making the trek the additional 15 feet. Finally got home, horrifically sweaty and exhausted. Collapsed on couch.

And there I remain.

The Ankle Strikes Back

Tomorrow. Surgery. . Yippee. Four weeks on crutches. Considering when the original injury occured they gave me a cane because I am so not graceful, I am somewhat fearful. So. While I am recovering I plan to:

read a bunch of books I got from the library.

Watch more Deadwood. . I heart this show so much. It takes historical and fictional figures and throws them all together. I think it's super. I like Sol Star and Dan Dority and of course, Al Swearengen. . Alma sucks. Trixie rocks. Seth needs to relax. Charlie's awesome and the Doc is great. I'm not wild about Adams.

Browse the internet. This is where I need you to send in links to check out.

I also plan to somehow quit smoking, on the theory that I will feel like crap anyway, so I might as well feel like crap and go through nicotine withdrawal at the same time. I have Nicorette gum and a fake cigarette that has a mint cartridge inside. So. Hopefully four weeks from now I will be able to walk, not smoking, and not weigh 400 lbs.

Some Nursing Related Things

Today I was wondering if "nurse" would get changed to something like "Bedside Health Care Professional". Along the lines of "custodial engineer", if you will.

Since the accidental URL posting incident, I realized I haven't actually written much that's even remotely nursey. And I don't want the nurse blog people thinking....something....?

Oh, and did I mention that my mom also got that email from my brother and thus the link to this site? Fanfuckingtastic! And if you read comments from previous post, you can see that my dad has it too! Hi Dad!

So. Nurse stuff. Nursing school- you start patient care at nursing homes, because, presumably they don't care if you fuck up old people. Actually it's cause there's no IVs, lots of bed baths and cleaning of perianal areas (to give you the appropriate respect for the CNAs) and very little medication. There is also feeding. Every other student nurse with me would chant this at me as I gaped openmouthed at the tray and spoons and tried to figure out how to get the food from point A to point B:

"It's just like feeding a baby!' And when helping the residents to dress- "It's just like dressing a baby!" To which I would have to remind the fuckers that I DON'T HAVE CHILDREN. I was unaware that having children was a prereq for nursing. I knew the others, anatomy and physiology, chem, microbiology, , etc. etc. When I first enrolled, the registrar's office made a big stink because I didn't have entry level sociology. I had 300 level, but not intro. They also wanted me to take a Mandatory Writing class. I explained that I had written a 97 page thesis on The Medical Management of Intersexed Individuals and there was no way in fuck I was taking this class. They continued to make a stink.

So I sicced my mom on them. They took the 300 level and shut up about the writing class. When my mom gets on the warpath, people will do almost anything she wants, simply so she will leave them alone. I suck at that.

Ok back to nursing. Classes were fairly easy, as I have the Multiple Choice Test Gene and am able to get an above average to high pass with minimal effort. (I study 2 hours day before, then maybe 4 hours day of test, rarely do reading ahead of time and somehow manage to wing it) This earned me the resentment of a bunch of people in my class. Some of the tests had questions that my dog would be able to answer so when those people failed out, I sighed in relief for the patients who might have suffered at their hands.

Ok. Clinical. Clinical made me cry. Literally. Every time. Terrified I would kill someone accidentally. I had no hands on patient care experience- I had worked for over a year in a hospital but in a psychiatric unit where physical contact was limited to vital sign assessment ( I was the only person besides the nurses who knew how to take a manual blood pressure so I got to do it Every Single Day) imagine a psychiatric unit with 22-24 Acutely Psychiatrically Ill Adults. Do you think this is a quiet place where it is easy to hear the sounds of the systolic blood pressure coming in? No. It's not. The other physical contact would be the 'take downs' or "Dr. Strong" call, where some patient was acutely agitated and actively violent. That involves all strong men from surrounding units coming up to help us feeble women pull the screaming, kicking, wicked strong, and oh yeah, ACUTELY PSYCHOTIC patient into the time out room where they were placed in 4 point restraints and administered the 5-2-1. (5mg Haldol, 2mg Ativan, and 1mg cogentin) IM injection.

Not at all like the gentle assessment and patient care I was now expected to provide.

Later:

The 92 year lady who RIPPED OUT HER PICC line , the elderly gentleman who knocked the side-rail off the bed, and the nice man with the broken femur who kept telling me to sit down "because I hate seeing you limp like that! You should go home! "

I don't think I want to be a medical/surgical nurse

Cause it makes me crazy. There are lots of people who thrive on adrenalin pumping situations or in high stress environments. I am not one of them. Every time I am at work- I get there at 2:45, and my 4:15 I am profusely sweating and my heart rate is up to 115 and I am dizzy with anxiety- I just can't wait to leave. I love my patients, I do. But I'm not cut out for this. I want to go back to psychiatry, possibly because I fit in better with that population. I hate my job. My left ankle/foot- the one of the notorious lame-ass injury is not getting any better because I am running around on it for 8+ hours. My right foot- the previously "good foot" is now the lucky recipient of pain that shoots from the outside of the foot halfway up my leg. Love it. I have two braces- one for each ankle. I limp all night. My patients ask me "Are you ok? Should you be here with that limp? Why don't you sit down in here for a little while?" My patients are trying to cover for me and trying to get me to sit down because they can tell my feet are all fucked. Somehow I think that maybe they are trying to tell me something. Like this is the wrong job for me.

Thank You

I just wanted to thank everyone who has taken the time to leave some words of sympathy about the loss of my Milo. It means a lot to know that people care- and it reassures me that as long as there are still people out there that love animals like I do (and not in a Catherine the Great way) that the world might not be too fucked up. Just remember, in Dog Heaven people food is good for dogs. Milo is at the table right now, gobbling away and then he'll go run and run and run. And it'll be great.

Thanks again.