The Rhythm of Life

 I have always had a fascination for EKG tracings. My desire to know what the little scribbles on graph paper meant led me to take a critical care certification class at my hospital so I could work in CCU if needed, and the step down unit Telemetry so I could play with these fascinating items at work. I learned a lot in that course but it was  dry and I did more memorizing than actual learning. I got signed off to take Advanced Cardiac Life Support after this and I decided to take it with an outside company rather than in the hospital. The in-house instructor had the reputation of failing everyone during the “mega code” including doctors.  At that time, ACLS was extremely difficult and a feather in the hat of anyone who could pass it.

I took the course under Dr. David Doernbach, a fascinating and funny man who had the knack of making the technical funny and a discerning that clinicians who understood what they were doing and why made for much better patient outcomes than patients who were treated with memorized algorithms and protocols.

I sat with my mouth hanging open as Dr. Dave presented a slide show that showed some of the first EKG machines, monstrous contraptions that took up entire rooms with the patients sitting with their feet in buckets of salt water and nurses with bat wing starched hats rolled out soot tracings onto paper so the scribbles could be studied.

But if you think that is archaic, consider this: In 1838 Carlo Matteucci, a professor of Physics at Pisa University invented what was called a “rehoscopic frog” where the nerve of a dead frog was used as the electrical sensor, causing the dead muscle to twitch to show electrical activity! How gross! Don’t you appreciate your cardiologists nice clean office now?

That was it for me, thanks to Dr. Dave, I will forever be hooked on graph paper with scribbles on it. And we have come such a long way from the 1788 report of the Humane Society: ” An Essay on the Recovery of the Apparently Dead” in London, to Augustus Waller demonstrating EKG’s on his dog, Jimmy, standing in four jars of saline for the show at St. Mary’s Medical School in 1889. The first portable EKG, a “Holter Monitor”, was a 75 pound backpack invented by Dr. Norman Holter in 1949. I mean seriously, if you can handle trudging around with a 75 pound backpack your heart is probably fine. At least for now!

So that brings us to a modern EKG– this is a normal rhythm strip.

You have your first little “bump” called a “p-wave”  is the electrical activity going down the heart muscle to stimulate the heart to action, the large “wave” after that is the “QRS” that shows the ventricles contracting to pump blood out of the heart. The last little bump is your t-wave as the heart depolarizes to perform this miracle all over again. The boxes on the graph paper show time, going horizontally, and measures voltage, or strength of action, horizontally. This is an extremely SIMPLIFIED explanation but to me it speaks to much more than the cardiac cycle. We have an idea, a thought, that leads to an action then a resting period, and we get ready to do it again. impulse- action- rest -repeat-impulse-action-rest-repeat…

This is the rhythm of LIFE.

What can happen when your rhythm is off?

Well on an EKG if you have no p-wave, you have atrial fibrillation and your ventricular action is often rapid and irregular. In your life if you have no plan your actions are thoughtless and often irregular…

Think about it!

And there are so many variations to consider, apply them to your life by name: premature atrial contractions= premature thoughts we may react to with unplanned actions OR premature ventricular contractions, an action with no thought to guide it. These can become more frequent and lead to very dangerous rhythms/actions. If you have a proper p-wave then too much time before action from the ventricle you have a heart block. Depending on how long the interval is between p-wave and action shows the severity of your heart block.  Are you blocking an action you need to take in life? Consider and treat this now before it ends you. Bradycardia or tachycardia describes a heart rate that is either to slow or to fast, either one can decrease cardiac output, or measurable action in your life. Is your life moving along at the correct pace? Why or why not? What is causing the slow down or acceleration? Better get with your cardiologist and find out.

This one is familiar to anyone who has ever seen a medical drama on TV.   V-TACH! or “V-TACH! Charge the paddles!” and the gorgeous TV doctors and model nurses slap the defibrillator on the patient, yell, “CLEAR” and the patient dramatically arches off the gurney, everyone looks at the monitor and see’s a perfect sinus rhythm, everyone smiles and the patient smiles too. Especially if the patient is a female and the TV doc is VERY cute! This never fails to make me laugh!

In real life, this is an extremely serious situation with scant minutes for correction. The heart muscle is “fibrillating”, in other words it is moving, but the action is not producing any cardiac output. The heart is “quivering” but not pumping blood, there is no life-sustaining action here at all. This often has tragic outcomes…

Socrates stated, “The unexamined life is not worth living.” We can look at our lives like an EKG tracing, do we have a p-wave, a plan, take only the correct amount of time and have appropriate actions? Then do we rest and repolarize so we can do it again?

I like to sit down with my journal and think on paper. This helps me focus and see what is going on in my life, what is working, what is not, what I think should be going on and what I think I should be doing. In this way I can follow the advice of the Apostle Peter: “Seeing that ye look for such things, be diligent that ye may be found of Him in peace” 2 Peter 3:14. My way may not work for you but I encourage you to find a way that does. Then do it!

Take good care of your heart and it will take care of you.

 

*** Nothing in this post is intended to replace medical advice from a doctor! Educate yourself on the signs and symptoms of a heart attack or stroke  http://www.heart.org/HEARTORG/Conditions/911-Warnings-Signs-of-a-Heart-Attack_UCM_305346_SubHomePage.jsp       IF you even think you are having a problem– call FIRST, call FAST, call 911!  (line stolen from Dr. Dave!) Believe me the ER is full of doctors and nurses who can’t wait to take care of you. It’s what we do– even if our doctors are not that cute or the nurses don’t look like models at the end of a 12+ hour shift! ***

If you are a medical professional who is tired of boring ACLS classes or dry EKG lectures I can not recommend Dr. Dave’s programs highly enough. He is simply the best, and funniest! http://www.vsu.com/

You could also work through this book and really show out at work parties! Just don’t forget the real life mantra, “treat your pt. NOT the monitor!”

https://www.amazon.com/Ecg-Workout-Exercises-Arrhythmia-Interpretation/dp/0397550553/ref=sr_1_1?ie=UTF8&qid=1491774961&sr=8-1&keywords=DAvid+Doernbach

(comment if you know this one)

xx00- Alana

 

A young nurses’s Christmas

I would rather eat nails than try to put together a holiday schedule for a group of crabby nurses….

Those of you who work traditional non-shift work type jobs may have never considered this, but hospitals must stay open 24-7/365. And someone has to work each and every one of those shifts.

Even Christmas day.

The scheduling requests can start rolling in on the nurse managers desk in the beginning of October. Of course who got what, is based on seniority, timing of request, what holidays you previously worked and so on.

So when the schedule was posted for December that year, it was an immediate flurry of activity as though a farmer had just spread corn outside a chicken house.

This did not affect me much. I was staffed through our in house agency. I was “float pool” so I got to pick and choose shifts, based on the needs. I didn’t join the hen party around the newly posted schedule.

Later that shift I found one of my co-workers in the bathroom crying. She tried to wave me off but I got some cheap scratchy tissues and demanded she tell me what was wrong.

Tabitha was only a couple of years older than me. We were just kids really, but our lives were on different tracks. Tabby was already married and had three young children. I was not, and still enjoying being my parent’s spoiled “baby girl”.  Tabby’s husband had walked out on her three months ago and this was going to be her first Christmas as a single mother. And because she had used all her PTO and sick time during this crisis, she was scheduled to work 7-3 on Christmas day.

It was her first Christmas alone, she had no family in town to help her and three young children.

I sat there in horror as she cried.

And before I could even think, I hear the words fall right of my mouth, “I’ll cover your shift for you Christmas day.”

Tabby looked at me with her brown eyes as big as saucers. “what?”

“You heard me, I’ll take your shift. You need to be home with your kiddo’s. I don’t have any kids. I can work.”

She finally stopped crying and we wondered if the Nurse Manager would allow us to make the trade. We trudged down the hall to her office and it was a done deal, except I got roped into pulling a double since I was the house “good Samaritan” and another single mom who was scheduled 3-11 had asked off too. I groaned, but I was now trapped I had to do it. Tabby’s relief and joy were almost enough to make me not feel so sick to my stomach.

Christmas Day was sacred at our house. It was my parents favorite holiday. We had traditions! Rituals! We sat up half the night to call family members across the world to wish them Merry Christmas in their time zones.  Now I had ruined Christmas for my own family. I avoided my parents like the plague for several days.

When I finally went over to my parents house, my mom took one look at me and said, “what have you done?” When I confessed my crime of ruining Christmas and why I did it.  my parents just smiled.  I was not disowned.  “We will be fine.” my dad said, “We can bring you dinner to the hospital.” My mom added.

Christmas morning arrived to find me getting report in the conference room with the night shift who could not wait to get out of there and the day shift who did not want to be here. But there were patients to care for and only the sickest of the sick had not been discharged for the holiday.

At around eleven AM my mother called and wanted to know if it was okay for them to head my way with food. I thought it was a little early but they were driving forty minutes across town to the hospital where I worked so I told her to come on. I still had one patient to get ready for the day and I thought I had plenty of time. This elderly lady had been with us for days. She had come out of the Cardiac Care Unit to our telemetry floor after a massive heart attack. She was very weak and still having irregularities on the monitor and remained on strict bedrest. She begged me to help her put on her own pretty robe over her hospital gown. I smiled and ran her IV lines through the sleeves and combed her hair. Her family had not been to see her since she got out of the unit. I shook my head thinking of that and got her lipstick out at her request. I prayed that her family would show up today. Or at least call her! This sweet lady thanked me profusely for getting her dressed and said with a voice full of hope, “I’m sure my son will be here soon!” I hoped she was right. I could not imagine her disappointment if no one showed up.

I left her room feeling sad again and heard a clatter coming down the hall. I looked up and what to my wondering eyes did appear but my father!  Wearing a Santa hat and pushing a cart loaded down with food! I laughed and laughed and thought of the little Tupperware dish I had envisioned. I should have known better! My mother was giggling and appeared to be his designer elf in  her perfectly matched silk outfit and shoes. She had adorned her perfectly set hair with a poinsettia flower for this occasion. And of course her nail polish and lipstick matched that poinsettia perfectly!

I could not stop laughing and directed them to our nurses conference room. What had been a chamber of doom just a few hours ago was transformed now into a holiday buffet of joy as my mother spread out a table cloth and set up dessert’s while my father prepared to carve an entire turkey.

My Dad was in his element carving the bird expertly for a crowd of adoring nurses and I noticed my mother had disappeared. I slipped out to find her.

In my elderly patients room I found my mom. She was sitting on the side of the bed holding the hand of a lonely old woman. She had a basket with her full of little crocheted stockings she had made and stuffed with nice soap and matching lotions she was giving out along with a dose of her Christmas love and joy.

My mom had experienced several major illness’ during her life and knew all to well how sick you had to be to get stuck in the hospital on Christmas.

My elderly patient had a death grip on my mother’s hand and would not let go. My mom sat there patiently, quietly reassuring her that it was ok.

Finally the elder said, “But who are you and why did you come see me?”

My mom smiled and said, “My daughter is your nurse today. She told me you would enjoy a visit. My name is Connie.”

“You did a good job with that girl.”

My mother kept smiling and her face just beamed with pride.

I slipped away because I was afraid to spoil this moment for them, plus I was about to cry. My heart was full of conflicting emotions: joy at feeling loved and appreciated, anger at this poor ladies absentee family, sorrow for her loneliness, pride that the stranger bringing her such comfort was my own dear sweet mother…My mother, whose life dream was to be a nurse, but she never got the opportunity to go to college or nurses training. My mother, who had glowed during my graduation and cried through my nurses pinning ceremony.

I wandered back towards the conference room towards laughter and wonderful aroma’s of food when I noticed my charge nurse sitting alone manning the desk. “Marge, go fix a plate and enjoy my crazy parents! I’ll watch the desk for a minute” Marge bolted. I sat down. I didn’t think a single call light would go off. Not with the well dressed elf of joy out there spreading her light and magic around.

I sat there listening to the laughter and my favorite line from the Grinch popped into my head, “Perhaps Christmas does not come from a store, perhaps Christmas is a little bit more…”

And perhaps Christmas is more than family traditions, or even special meals.

Perhaps Christmas is bringing the Joy of the Season to who ever needs it most and where ever they are.

 

I dedicate this post to my Mom and Dad,  Edgar and Connie Haase. There are nurses from MMC, who still remember you and the joy you brought to us and our patients as we worked on Christmas Day.

 

 

 

Life, Death and Chickenpox.

chickenpoxChickenpox under a microscope.

We don’t see chickenpox much anymore, thanks to the varicella vaccine. Chickenpox is highly contagious, airborne and can also spread through contact with infected blisters before they crust over. For most patients it is an itchy annoyance. For other’s, chickenpox is anything but…

When I was a child my older brother brought home the pox. My mom quarantined him to bed with his door shut until he was on the downside of his very high fevers. Then she sighed and told me to take him his dinner tray and “rub his arms and get it over with.” My brother  got very angry when I told him I had been instructed to rub his rash, but we complied and sure enough, in three days I had chickenpox too.

For me, it was just the itchy rash and not being allowed to play outside. The death penalty for a kid who played outside, all day, everyday. A very serious annoyance.

For a patient I received out of the Intensive Care Unit to my Med-Surg ward in 1990 it was far more.

In my shift report I was receiving a patient who was being discharged from ICU to our unit with a diagnosis of Chickenpox! This patient was a 32 year-old male who had been in the unit for three weeks on a ventilator.

The lesions in his lungs had finally cleared up, he was off the vent and breathing on his own, but still very weak and in need of supportive nursing care and medications.

I got him settled in to his room, checked that IV site was fine, marked when it would need a site rotation, put his fluids back on a pump all the while chatting with this nice young man.

I was absolutely shocked to find out that he had simply gone to work one day and a co-worker with a sick kid had brought that child to work with her instead of calling out sick.

You guessed it, the kid had chickenpox and this young man never had. Varicella is much worse in an adult than in kids and this man soon had varicella lesions not just in his mouth, but in his lungs, got pneumonia and almost died. The three weeks in ICU and ventilator support had saved his life.

Well, nurses talk. And this good-looking young man who was almost killed by an inconsiderate co-worker was the talk of our nurses station. Unless you work in orthopedic/sports medicine having  attractive young men as patients is the exception, not the norm, and we went wild spoiling him during his stay on our floor.

I might know of a few nurses who snuck down the stairs to the pediatric ward to “swipe” ice cream sandwiches out of the freezer for him! But I admit to NOTHING!

We talked. And we judged. How DARE this woman take a kid with an infectious disease to work with her? didn’t she KNOW she may have KILLED someone? How could she have been so STUPID? Or was she just an IDIOT?

We absolutely trashed this woman not a one of us knew.

I regret those foolish words now. As an older woman who now has children I feel terrible for that unknown woman. Now I know what it’s like to be put in an impossible situations.

Why did she take that sick kid to work?

Is it possible that she was a single mother who had been told that one more call-out would cost her job?

Is it possible that her paycheck was the only thing standing between her kids and hunger or homelessness?

Is it possible that she didn’t know her child was still infectious?

Is it possible she simply had no idea how serious chickenpox could actually be? After all, her kid just had an itchy annoying rash.

And it is highly unlikely that as a co-worker she was unaware of what had happened as a result of her bad decision. She had to know how sick this man was after he was hospitalized and missed well over a month of work. I can not imagine her personal guilt and self-condemnation.

It is possible that the boss made the connection between her child and her co-worker and she paid consequences for that action.

And it is possible that other co-workers treated her in person, the same way a floor of nurses did, with judgment and condemnation.

Now interestingly enough, this young man never did. I was changing out his IV one afternoon and asked him if he was angry at this woman. I was expecting a juicy rant but what I got was, “No, why? It was not her fault. How was she supposed to know I had never had chickenpox? Sh*t happens!”

That was all he had to say about the matter.

As I’ve grown over the years from a know-it-all 20 year old, into a woman, a mother, a person who has had to choose between very bad options I remember that nice young man and his attitude.

Yes, STUFF HAPPENS! And it happens to everyone, all the time. Sometimes there is no good choice, sometimes the actions of other people will determine a bad road you get to drive no matter how much you try to steer towards an exit.

But we get to choose our attitude and words. We get to choose to either blame and condemn or not. We get to choose to wallow in misery or “blow it off” with a phrase as this man did.

And I believe this young man’s refusal to give in to blame and bitterness, to shrug off a brush with death and laugh and say, “Sh*t happens!” is why he survived and recovered.

And not just for this situation. I guarantee you that man has survived and thrived! And he probably continues to set a good example for those around him of a positive attitude and good choices.

 

Blessed are the merciful, for they shall obtain mercy.    Matthew 5:7

For if you forgive men their trespasses, your heavenly Father will also forgive you.           Mathew 6:14