Our cath lab shared leadership (shared governance) team decided that we’d like to help our hospital staff better understand what goes on in the cardiac catheterization lab which will lead to better patient education and care. So, we have broken the cath lab procedures into 3 basic categories: diagnostic, interventional, and EP studies/device implants. We will be putting on 3 different presentations to cover these topics.

Last week, we started with our first of the presentations (on diagnostic caths). We used one of our cath labs and set up a “sterile” tray, brought in a mannequin, and turned on our equipment. We presented 30-minute mock caths, where we talked about topics like pre-procedural prep, sterile fields, coronary anatomy, and closure devices. We had about 60 staff members come through the lab in just a few hours and received positive feedback from the staff who attended.

I’m honestly really proud of what our team put together – I think programs like these do nothing but help the staff to care for our patients.

I had my first grad school class 2 weeks ago (I started a Family Nurse Practitioner program for those who may not be caught up with my educational adventures). The FNP (family nurse practitioner) program starts with a few classes on theory & ethics which meet in person every other week and the rest of the course work is done online.

So, the big story… 4 days after I attended my first class I received a phone call from my academic advisor telling me that she does not see a statistics course on my undergrad transcripts. I confirm with her that I never took a stats course in undergrad. She proceeds to tell me that a stats course is required to be a nurse… yeah, right. Then she tells me that it’s at least required to be a nurse in the state of Arizona… again, yeah right. So, she tells me that unless I can show proof of completing a stats course (which I cant because I never took one), I am being dropped from the nurse practitioner program. Whaaaaaat?

So, after a not-so-mild freak out, I make a phone call to my enrollment advisor who was unable to give me any answers except for saying “We will not drop you from your current class, but you’ve been dropped from all further classes unless you can show proof that you have completed stats in the next 5 weeks.” So, I had a stress-filled evening trying to search the community colleges for an online stats class with no luck (all online classes were 8 weeks long). I woke up the next morning to talk to the academic advisor again only to find out that the school had a 5-week stats course that started just a few days later. So, I am now concurrently enrolled in stats as well as a nursing theory course, which is fine because I’ll be able to continue in the nurse practitioner program but is less than ideally financially. Apparently, since I am not currently in the “nurse practitioner program” because I do not have the pre-reqs, I am not eligible for student loans, so I now have to pay out of pocket for the 2 classes I’m currently taking.

So, I guess in the end everything is okay – just 5 weeks of extra stress (taking 2 classes at once along with working full-time), and a good chunk of money drained out of my bank account that I wasn’t planning on. I just still cannot believe that I have been accepted into this nurse practitioner program for over a year and they don’t notify me of a missing pre-req until AFTER i start the program!  They’ve had my transcripts in hand for 14 months – that’s a pretty long time. Ah, well… it’s about the end product in this case, right?

Working in the ICU totally fostered every aspect of my type A personality. I was able to spend the first few minutes of my shift organizing all of the IV tubing, monitoring lines, medical equipment, and linens just the way I liked them before the family came in. I made a mental list each morning of all of the things I wanted to accomplish for my patient and I had 12 hours to work with the other members of the medical team to achieve them. Everything was so organized… and more importantly they were organized MY way.

This also fit in with the midwestern lifestyle I grew up in – everyone was in a hurry for everything. Driving downtown Chicago is an experience all in itself; whew. But the west coast lifestyle is something totally different. I’ve found that people don’t really make plans in advance out here. If you ask someone to take a weekend trip with you in 2 months, it’s sometimes hard to get a definite answer until a week or so prior. That’s just the way things are.

With the change to the cath lab (a MUCH more laid back environment), I’ve been trying my best to work on my “it’s no big deal” attitude. I have a friend in town from another west coast city who definitely has that laid back attitude that I’m searching to have. She’s staying with other friends here in Phoenix and hasn’t let me know what any of her plans are for the trip. So, I’m sitting at home on a Thursday night not knowing any of my plans for the next two days and I’m trying my best to go with the flow and not worry about it.

It’s not a big deal. This is nothing to stress out over. The world will keep spinning even though I don’t know what my plans are for tomorrow.

If I keep saying it over and over, it’ll all come true, right? :)

I had the pleasure last night of watching Barbara Walters’ special “A Matter of Life and Death” on ABC. It spoke about how heart disease kills twice as many people each year as all cancers combined and the events surrounding several celebrities having open heart surgery. Barbara spoke about her experiences with her aortic valve replacement and interviewed David Lettermen, Bill Clinton, Robin Williams, Charlie Rose, and Regis Philbin.

The special worked to expose heart disease for what it is- a killer that doesn’t discriminate between women and men. It also helped to demystify the events surrounding open heart surgery and show “real people” (celebrities) who have gone through this invasive surgery and survived, still looking as strong and successful as ever. One of my personal favorite parts of the special was when Barbara Walters was interviewing her surgeon and the surgeon mentioned that  Barbara had pulled through some of the most common setbacks following surgery and Barbara was genuinely surprised and had no idea that she had any complications. The surgeon told us that Barbara was anemic and required blood transfusions and went into atrial fibrillation (an irregular heart rhythm) which was controlled with medications. They also talked about complications that Charlie Rose experienced which were more severe. He developed an infection which required him to have a repeat operation to replace two of his valves, went into shock and was in a medically induced coma for several days. But, they talk about how his determination and medical care helped him overcome his diagnosis and get strong enough to get back to work.

I’ve been searching the internet and haven’t had any luck finding a full-length video. I’ll keep my eyes peeled though.

As I was checking out my favorite bloggers on my Google Reader feed, I came across this post by ImpactEDnurse (Ian Miller) about a patient setting the new standard in thank you cards in his long career in the ED. This post got me thinking about my favorite “thank you” that I’d received from a patient.

I remember him well, he was admitted to the CVICU after an acute MI (heart attack). He was taken straight to the cath lab from the emergency room and the occluded artery in his heart was opened up. He was feeling better physically, but he was pretty freaked out by the whole situation. He was a young guy… in his 40s. He was active – he played softball and bowled frequently. It was one of those “how the heck did this happen” kind of situations. I took care of him for 2 days in the ICU and we spent a lot of time talking; both about patient education issues as well as about his life and his family. I felt like I knew him pretty well after 2 days. At the end of day 2, he was transferred out of the CVICU to the step-down unit and I knew he would be scheduled to go home the following day if all went well.

So, the next day, I went down to his room to check in and see when he would be going home. As I peaked around the curtain in his room, he motioned me in. He was watching the Cubs vs Dbacks game on TV and everyone was silently watching the screen. It was between plays and we were listening to Mark Grace announce the game when Mark Grace himself said, “and I want to send get well wishes to Mr. ____ _____  who is in the hospital today.” WHAT?

As a die hard Cubs fan from Chicago, I was dumbfounded. “Mark Grace knows you? You know Mark Grace?” Well, apparently they play softball together and go bowling at the same place every week. He must have seen the shock on my face.

The next week, I came into work and found a manilla envelope  at the nurse’s station- It just said “Amy Sellers, Cardiovascular ICU” on it. I opened it, and saw this….

…a picture of Mark Grace from his glory days with the Cubs, autographed for me. Nothing else. No other words from the patient. He knew how much this would mean to me and it now hangs in the office in my home and is a daily reminder of the kind heart this patient had and his very special way of saying thanks.

We were taking care of a patient who had multiple medical issues. He was a bilateral leg amputee, diabetic, hypertensive patient with an acute exacerbation of congestive heart failure which brought upon him new onset renal failure. When he was initially admitted, we were running him on aquaphoresis (pulling fluid out from his blood without actually dialyzing). Then, his kidneys were looking a little worse, so we did run him on dialysis for a few days. Everything was looking better and be left the ICU for a room on the medical telemetry floor.

Later that evening, he respiratory arrested, was intubated and returned to the ICU. His son came in the next morning with the legal paperwork showing that he was his father’s medical power of attorney and wanted to “pull the plug” and let his father go peacefully. This is a very hard situation to be in for us as well as the family member. Even though his father is laying in the bed, very still, it is only because we have sedatives going through his IV to keep him asleep. We cannot legally take out the breathing tube with the sedatives going (Dr Kevorkian, much?) and if we turn off the sedatives, he will wake up and breathe on his own… not well, but he will breathe enough to keep himself alive for awhile. We understand that his dad has a lot of medical issues and has been through a lot in his life, especially the last few years after his amputations, but he is not in a state in which we can withdraw care and let him pass on peacefully. Just another difficult day in the ICU trying to explain situations like these to families who are losing hope.

I had never heard of dentists checking blood pressures and heart rates… who would have thought?? Well, apparently many dentist offices realize the impact that they can have on the health of their patients. I recently asked my personal dentist if this was something that they did at their office and he replied that if a patient had a relevant medical history or had advanced age without regular medical checkups, he would check a blood pressure before performing any procedure on the patient. Interesting.

This all came to light after we had a patient present to our hospital for a diagnostic cardiac catheterization. He had originally gone to his dentist where they had checked his blood pressure and found that it was very high. They referred him to a cardiologist who started a work-up to find if there were any other medical conditions and found that he had a positive stress test and a CT scan showed that he had a large aneurism in his abdominal aorta. So, he was referred to a vascular surgeon to fix his aneurism, but since he had a positive stress test, the surgeon insisted that he get cardiac clearance from a cardiologist before surgery. His cardiologist then brings him to the hospital for a cardiac catheterization, which showed severe disease in multiple coronary arteries and a need for a coronary bypass (open heart surgery). So, he was placed in the ICU for a few days while the vascular surgeon and the cardiac surgeon ran tests and discussed which was better for the patient: to fix the aneurism or fix his blocked coronary arteries first. And this is where the patient sits at this point, it’s been two days and we’re waiting for a set of test results.

If the patient’s dentist didn’t find the high blood pressure and recommend that the patient get it checked out, then the aneurism could have very easily ruptured, probably causing sudden death, or he could have had a massive heart attack from the blockage in his coronary arteries. The more that we can do to make patients fully aware of medical conditions they have, or might have, the more informed decisions they are able to make about their health. We see patients all the time who come in as smokers, drinkers, and/or children of people who died of heart disease saying “I was totally healthy before this heart attack” only because they hadn’t seen a physician in 15 years. If they had known that their cholesterol level was over 300, they could have been placed on a daily pill to help decrease their risk of this huge heart attack they just had.

Today I had an extremely satisfying day at work. I wouldn’t say that it’s rare for me, but it’s nice to come home after 12 hours and not have a single thing to complain about.

Today I had the pleasure of taking care of a 37 year old man immediately after 5-vessel coronary bypass surgery. Upon getting report from the nurse in the operating room and hearing his age, the fact that he was overweight, and an uncontrolled diabetic, I have to admit that I was nervous. Generally, these patients are a pain in the butt. Judging by the facts that I had laid out on paper, I was imaging a rough day.

But, it was just the opposite – the guy woke up from anesthesia very calmly, required absolutely no vasoactive medications, was extubated quickly, and worked on his breathing exercises and got out of bed without complaint. He asked me lots of questions, which is not something many people have interest in within 6 hours of open heart surgery  - how long have i been at the hospital, am i married, how far do i have to drive home after work, etc. I had plenty of time through the afternoon to talk to his wife and his 14 year old daughter, and really enjoyed my day with them and being able to get a glimpse into their life together as a family. At the end of the day, the patient’s wife teared up, gave me a hug and thanked me for taking good care of her husband.

My perception of my day was totally wrong and I was pleasantly surprised. I went home with a smile on my face and I felt like I made a difference in someone’s life and really… isn’t that why we all wanted to become a nurse?

We had a 50-something year old man who was admitted to the ICU after a vascular bypass surgery in his left leg. When reading through his history, we found that he was in our hospital just 2 weeks prior and had a stent placed in that same artery. He was a heavy smoker at 2 packs per day and made the decision that purchasing his cigarettes was more important than purchasing his Plavix (a medication that reduces the effect of platelets, thereby reducing the chance of a clot forming in the newly placed stent, which would re-occlude the artery causing a lack of blood flow to the leg and foot).

This guy was a little rough around the edges… he was not the kind to say thank you to the nurses or doctors (but he looked appreciative after his massive, hourly dose of dilauded). When we helped him get in or out of the bed, he would scream and swear, and even reach to pull out his IVs or EKG leads out of aggression/pain. Its tough for many nurses (myself included) to have a lot of empathy for a person like this. When someone doesn’t take care of themselves, or have concern about their own health, it makes it difficult for the healthcare providers to have as much compassion, but we do take care of them. We do make sure that they get the attention that they need no matter how much energy it takes, but it is definitely easier mentally when you do have that connection.