On The Move. Again.

Well, it’s here.

It seemed like we were just back in Missouri, all excited about packing up for our new adventure in Mississippi…and here we are again, getting ready to move again, this time to Vero Beach, Florida.

Someone needs to tell my husband that if we move any farther south we’ll end up in Puerto Rico.

This is my last week in H’burg, finishing out my work schedule and making sure the movers get all our stuff.

Matt has already moved. He called yesterday to say he was on the golf course. The day before that he was in Jupiter watching the Card’s minor leaguers…

…while I was getting my oil changed and tires rotated and boxes packed and dogs walked and apartment cleaned.

Something just doesn’t seem right about this situation.

We’re sad to be leaving some great friends, some great co-workers and a great church – the Vero area is lacking a little on the Southern Baptist options and we’re praying we find a great place to get plugged in.

Either that or convert to Catholicism. Not that there’s anything wrong with that.

I went down to FL earlier this past week for a job interview at one of the three local hospitals. This particular facility was recommended to us by Matt’s new principal and the athletic director – I thought it a great sign from people who had been patients there to really talk up the place.

It’s not just a hospital – it’s also connected to a heart institute, which will make several people who read this blog laugh and wonder if I’ve lost my mind.

Bless my heart, y’all.

Back in nursing school at good ‘ole SLU I had regular panic attacks and nervous breakdowns any time I encountered anything that even remotely hinted at cardiac anything.

Before really digging into EKGs, the only heart rhythm I was remotely familiar with was normal sinus, and even then I would second-guess myself at P-wave placement and freak. And cry.

My cousins that I lived with during nursing school got to witness this on a regular basis. Tom, my cousin-who-happens-to-be-a-doctor, patiently sat down with me one afternoon to go over QRST segments and how different rhythms affect different places of the heart. We talked about CHF, mitral valve regurg, aortic stenosis…all the stuff that can come from having a bad ticker.

I still would have my own episodes of RVR (AKA: rapid ventricular rate) when sitting down to a cardiac exam, and I vowed to never have anything to ever do with telemetry or heart stuff. Ever.

Enter Forrest General Hospital here in Hattiesburg.

After working on a surgery floor for six months, our sister floor – a telemetry floor – had an opening. I had floated up there once or twice before, and it literally scared the bejeezus out of me.

Give me a hernia repair or a gallbladder removal or a mastectomy and I can take care of you with my eyes shut. But a patient with chest pain? A patient in AFib?

See that Addie-shaped hole in the wall? Yeah. That’s me running. Screaming. Crying.

But I thought that telemetry  (for those who keep asking, telemetry is simply monitoring the patients via remotes and wires connected to the pt’s chest with sticky pads that show up on the telemetry monitors at the nurse’s station…we can see your heart rate and rhythm all the time. I know when you get up to pee because your heart rate jumps, by the way. Good times.) would be a good challenge, the chance to learn something new.

And what do you know? I fell in love with my heart patients.

Chest pain doesn’t freak me out anymore. Give me some aspirin and morphine and some nitro, and we got this under control, baby!

Heart caths, stress tests and echos are routine to me now. I know! Shocker!

I saw Tom at my uncle’s funeral two weeks ago and he got the biggest kick out of hearing where I was applying in Florida. And of course he had to joke about my panic in nursing school over everything cardiac. Thanks, Doctor. J

So what will I be doing?

Cardiovascular Step-Down.

Very, very excited about this.

I will get to combine my background with post-surgery patients with my ever-increasing knowledge of heart patients. These people will be coming out of the CCU/ICU after having open-heart surgery. We’ll have cath patients, chest pain patients…even overflow during the winter months with all the sweet little retirees that come down from the north.

Speaking of the sweet little retirees…my new uniform colors are WHITE. All white. Why? Because the hospital did a survey and found that those sweet little retirees recognize nurses best in white.

Like in the 1920’s.

But patient satisfaction is important…so I’m off to buy white uniforms and the white underwear it will require.

So as of now, I arrive in Florida on August 15^th, start orientation on August 21, and our furniture is supposed to arrive at our new house August 20. We're very glad we decided to rent in MS - so we don't have to worry about selling a house - but now we're trying to close on a house with me still in Hattiesburg and Matt already down in FL. 

I feel the heart palpitations starting up again. It’s either stress or I’ve had waaaayyyy too many cups of coffee this morning.

Today I love: Extra-wide Rubbermaid tubs for packing and the clean feeling that comes from throwing a way/donating things we really don't use or need. 

The Big 200

Let's do some math.

I know. You're in shock. Me? Math? I'm the girl who runs screaming from numbers and those evil operations that make them multiply or divide.

I'm the girl who to this day, cannot balance a checkbook.

But I promise. This math will be fun. 

Let's start by taking a barely-turned-33-year-old.

Add in 11 years of high school varsity baseball seasons.

Subtract the blood (literally), sweat and tears that have gone into all 11 of those seasons.

Add in a cross-country move to the deep south where baseball starts in February and lasts until someone forces you off the field by turning off the lights.

Combine that with this past Saturday's baseball game against Prentiss with North Forrest winning 16-3, and what do you have?

A 200th career win for MW.

He hates to make a big deal about things, hates taking credit, hates having the spotlight on him.

But 200 wins under your belt? It's something to be proud about.

So, in keeping with the fabulous tradition of wives embarrassing their husbands, I had a little award made that now sits proudly on our kitchen table.

Buried in junk mail. Dog treats. To-do lists. Newspapers. Three purses.

I obviously need to clean the kitchen table. And possibly get rid of some purses.

In any case, Saturday was a day for celebration. The team needed the boost of a win, and we needed an excuse to go out with friends.

Bops and laser tag were included in the celebration. Not kidding.

(Sugar hangover and sore calves from crouching behind walls so I could shoot my husband - this 30-something had a hard time getting up for church the next morning.)

Congrats, Coach Walters on your 200 milestone. It's been an adventuresome 11 years by your side, first as a Baseball Girlfriend, now as a Baseball Wife.

That being said, as a Baseball Wife, I've gleaned several tidbits of knowledge over the years:

• There will always be cleat marks in the carpet.
• Dirt clumps tracked through the kitchen.
• Red dirt and green grass...whoever thought white baseball pants were a good idea needs to have their head examined. Good thing MW does all the laundry.
• Nights where you don't get home from coaching a game until after midnight and still managed to get up at 6am to go teach young (hyper, hormonal) minds.
• Baseball widowhood from February until May. Or June. Or July, depending on your summer baseball plans. 
• Vacations revolve around Omaha and the College World Series.
• Watching "The Sandlot" over and over and over. And over.
• A line-drive to the thigh will leave baseball stitch impressions on your leg for weeks.
• Doing my own thing so I don't turn into one of those whiny, dependent wives who always asks, "When are you going to be hoooommmmeeee??? Don't you miiiiissssss meeeeeee??" 
• Weekend tournament sunburns are a given. So are flip-flop tan lines.
• More baseball team t-shirts than I know what to do with.
• Sunday afternoons are for mowing the baseball field. And dragging the baseball field. And stats. Lots and lots of stats.
• Staying up doing team laundry in hotel rooms during away tournaments. Never underestimate the power of multiple bottles of Spray n' Wash.
• Knowing that as of the first day of baseball season (and quite possibly the weeks leading up to it), any time I try to talk to you you will have a glazed look in your eyes...and I will know you are secretly running baseball stats and plays through your head as we carry on a conversation.

"The road to 300 starts now!" was heard as we pulled out of the laser tag parking lot Saturday night.

Glad to be along for the ride.

Observing Patients, Eleven at a Time

I keep having family and friends ask me what unit I work on at the hospital and what we do. As a brand-new, career-changing nurse, it's been a little hard to explain, even to myself. Now that I'm officially out of orientation and some (just some) of my naivety is gone, I figured I better know where I am and what I'm doing.

I didn't have the slightest clue as to what a hospital observation unit was when FGH hired me. I was just grateful for a job offer in a city that has one major university and several community colleges, all whom had just graduated their own gazillion nursing students who were looking for jobs in the Hattiesburg area at the same time I was. That, and I could finally move out of my parent's guest room and join my husband who had moved down to our new digs several weeks earlier.

No offense to mom and dad. It was a great time having mommy do my laundry again, but this 30-year-old was ready to move out of the proverbial basement and get on with her life.

Honestly, I was so proud of my title as "RN-Medical Oncology" back in Missouri. Caring for cancer patients? Totally worthy occupation. Outpatient Observation? It sounded weak at first, like I would be putting band-aids on boo-boos and sending my patients home with a lollipop.

Some days, I wish that's all I did.

I didn't really know what an observation unit was. I was like, do I just watch the patients and make sure they don't get worse? What are we observing for? Am I going to be bored to tears?

Today's Hospitalist explains observation units like this: "As Emergency Departments are increasingly stretched by capacity constraints and lack of specialist support, hospitals are turning to observation units, also known as clinical decision units, to fill those gaps without taking up inpatient beds. Patients admitted to observation units are expected to be evaluated and treated and rapidly improve within 24 hours."

“The setting is geared toward patients who require more management or attention than can be given in the traditional ED, but do not need the length or level of services provided in the inpatient setting,” says Russell Holman, M.D., senior vice president of Cogent Healthcare, a national hospitalist firm based in Irvine, Calif.

“Placing one patient in the observation unit frees up about three beds in the ED,” says Sandra Sieck, R.N., president of Sieck HealthCare Consulting, Mobile, Ala. "Observation units can help avoid unnecessary and costly inpatient admissions by aggressively diagnosing and treating patients’ symptoms, allowing them to go home in a timely manner."

Our unit works closely with the ER doctors - but when emergency department orders run out after eight hours, care is usually handed over to one of the on-call Hospitalists...which means a whole new set of orders to implement. In the meantime, the physicians and case managers are trying to determine - in less than 23 hours - whether the patient needs to be converted to inpatient status.

So it's very true we move at a rapid pace.

Yesterday alone, between transfers, discharges and admissions, I had 11 patients.

To give you a bigger picture, our unit is only 14 beds. I take seven, the other nurse on shift takes seven.

Seven beds. 11 patients.

Lots of coffee. And aspirin. And charting.

Our floor sees everything from sickle-cell crisis to cellulitis, COPD exacerbations to dehydration. Patients come from outside clinics for blood transfusions. We see a lot of patients with renal failure - I've gotten to know our nephrologists really well. We get a lot of funky wounds, and we also serve as a recovery floor for patients coming out of surgery.

PACU delivers us lap-chole patients, (seems like everyone and their second cousin has had their gallbladder removed lately) hernia repairs, thyroidectomies...just about any same-day surgery where the patient just needs to stay the night and be discharged in the morning. I call those my "eat solid food and drink with out throwing up, pee, walk the halls without passing out and be cleared to go home" patients. We've also had a run of PEG placements lately, and I feel like I can do tube feedings with my eyes closed.

(Which I once said to a co-worker, who told me she would hope I wouldn't. Southern people still don't get that when I say things like that, it's called sarcasm.)

A typical 12-hour patient rotation can look like this: a patient is admitted to the floor from post-surgery around noon, only to be discharged four hours later...who's room was rapidly cleaned and assigned to a new patient who arrives no less than 20 minutes after the previous patient was wheeled out the door.

Or a patient gets to the floor from the ER, and ten minutes later surgery is calling for them (no joke...this happened to me this week). To get a patient to surgery, you have to complete a whole checklist of items, have surgery consents signed - which you can't have the patient sign if they've taken narcotics (morphine, dilauded), which of course the ER gave them just ten minutes earlier - draw labs, make sure the patient has removed dentures/jewelry/glasses/clothes off/gown on, plus call surgery to give report on the patient you're sending them.

Giving report on a patient you've seen for a total of five seconds to the same-day surgery nurse who's been around the block a time or two is nuts. You better have your stuff together. Or at least make it sound like you have your stuff together.

And speaking of drawing labs, PCRMC spoiled me. We had phlebotomists who would come and do a simple stick for an H&H. Not so here. We grab our trays and tubes and trot off down the hall to play vampire.

PS: I love central lines and chest ports. The end.

It can get exhausting. Halfway through orientation I decided I didn't like the floor, it was too fast-paced and that I just couldn't get my day organized with all of the admission orders, discharge orders and general care orders going on in between. One patient coming in while another is going out...I seriously felt I was drowning trying to keep on top of everything. People wanting to be discharged want to go home NOW, not in 30 minutes...at the exact same time the PACU nurses are calling you into the room of the patient they just brought up because they need to hand off the chart and have lifting help from the stretcher to the bed. And then that new patient wants something to drink and their family is hovering and their IV is beeping and....

And people wonder why I'm still broken out in stress-related hives.

(Sarcasm again, my southern friends. But not really.)

Now that I've been on my own for two weeks, I'm realizing that I'm not as incapable as I first felt. I can do this.Yes, it's incredibly stressful. Yes, it's rapid work. But I feel like I know this floor now, I know where things are, and I know who to ask if I don't know something. I'm getting to know the doctors - most of whom are fairly approachable and easy to talk to.

I really like my co-workers and feel that we all work well together. They bring cake to celebrate birthdays, and I like cake.

This floor is growing on me. Once in awhile I still miss my cancer patients and the five-patient, steady, unchanging workload in Missouri, but honestly, this is now starting to feel like home. I don't want to bail ship and leave this unit anymore.

I get it now. I get the point and purpose of observation, and I'm proud to be an RN in the middle of it.

Oh, and my scrubs are cute too.

Sunday, Sunday...

I did something today that I've never done before.

I wore shorts and a t-shirt in mid-October.

And went to the beach.*

This is about as far out as I'll go.

Things-in-the-ocean-that-will-eat-my-legs-phobia and all that.

"A message in a bottle!" I said.

"Nope," said M. "Just somebody's fo'ty."

So sorry, Missouri...I just didn't miss you that much today.

*I've actually been to the beach before, just not in mid-October. And just to clarify, we went after church. And lunch. And walking the apartment dogs who, we discovered, shredded a newspaper and some of M's student's homework while we were at church. Fabulous.

Road Trip Weekend #1

Drive south 90 miles. Then you're in the land of debauchery and weird people and beautiful architecture and puffy little sugary pillows that I had been deprived of for 30 years.

New Orleans.

Yes, it's true. I've never been there. Unless you count the time my church youth group stopped on the way home from a mission trip in Texas just to get Hard Rock Cafe t-shirts while my youth pastor told of the evils of Bourbon Street.

Walking around the French Quarter on a 99 degree Saturday afternoon is quite a different experience. The place was packed. I'm the kind of person who likes to stop and look in store windows, take in the scenery and just take my time looking around. I quickly found out that that is next to impossible in the Big Easy. If you stop to look, you get trampled from the masses of people behind you on the sidewalk. Being short in a large, moving crowd isn't the best.

I lovelovelove the buildings. The balconies. The history.

But then we found it. The oasis in the middle of all of the hot, sticky, stinky inebriated bodies. It's green awning waving hello in the breeze. Powdered sugar dust coating the sidewalk in all four directions.

That's right. Cafe du Monde. Home of ridiculously thick black coffee and fried dough covered in powdered sugar.

Heaven.

Totally worth whatever time I will have to spend on the elliptical to minimize the damage.

I did the entire experience. The tiny little table crammed next to other tiny tables that can barely seat one person. The coffee that I could barely drink because, as my sister told me, it will put hair on my chest by morning, and the beignets. Oh, the beignets. Sigh.

Yes. I'm a naive little Midwestern girl, transplanted in the Deep South, enjoying every minute of it and not worrying if I look like a complete idiot tourist.

I need to quickly remind myself to say "ya'll" though. Every time I say "you guys" I get someone who asks me what part of the Yankee North I'm from. Fabulous.

Today I love: Fresh cut pineapple and Chocolate Truffle coffee.