Pulmonary embolism & deep vein thrombosis

In recent weeks I've had new encounters with pulmonary embolisms (PEs). So, this post is to explore the origin of this condition and what it looks like.

First off, deep vein thrombosis (DVT) refers to clots that form in the veins of the legs. DVTs are often the cause of the pulmonary embolisms. Normally, the blood in the veins is pumped back to the heart by the leg muscles that 'milk' the veins through contraction. However, clot formation occurs when a person is on bed rest or is inactive (like mentioned above - long car trips or long hours at a desk). In the hospital a lot of attention is paid to preventing DVTs; patients that are in the hospital post surgery or are on bed rest for more than 24 hours are automatically given heparin, an anticoagulant, that prevents clotting.

These clots when they do happen can break off from where they have built up within the leg veins. The clots then travel to the heart and get pumped out to the lungs - getting lodged and causing a pulmonary embolism.

Again, pictures are worth much more than my words so here is a quick video that illustrates the phenomena of DVTs and PEs:

It's also worth noting, this can occur in any age group. In March 2011, the athlete Serena Williams had a foot surgery in New York and then traveled to Los Angeles, where shortly afterward she had to be rushed to the hospital for a PE (Serena William Hospitalized for Pulmonary Embolism). 

So remember to get up and move around to keep your legs and lungs lively!

Bedside manners matter

Today was my turn to be the patient. I went to a routine OB/GYN appointment only to be horrified at how unkind the doctor I had was. I really shouldn't be surprised, I see doctors misbehave all the time. However, since I was the patient, I really took it personally this time. I left the appointment nearly in tears at how cruel this MD was. And in clinics you don't even have a nurse to back you up!

Everything I said was interrupted and worse was that my doctor argued with me. There is a difference between educating a patient and dismissing a patient. Unfortunately I got the latter treatment because my doctor couldn't keep their mouth shut long enough to listen to my actual concerns and to find out why I had these concerns.

After a long drive home and a nap it really just reminded me how thankful I am that I get to be in my patient's rooms when the MD comes in. Often I do the emotional clean up post doctor visit such as when they deliver frightening news that a patient has to have a critical surgery or a patient will have to have dialysis for the rest of their life. My patient's often end up in tears too and it's unfortunate it has to be this way.

There is no doubt that MDs are the harbinger of bad news in most cases, but there are those who succeed in their communication. They grab a chair and sit eye to eye with a patient. They are comfortable around emotion and tears. And they shut up and listen. These are the doctors that succeed in bridging the gap between medicine and humanity. These are the doctors that patient trust.

Now I just need to find myself one of those....

A blissful week - I'll take it!

"Gifts have ribbons, not strings" ~Vanna Bonta

This week was gift-like. I am doing my first 3 on/1off/3 on run of work days. I don't know if it's the seasonal change, but my first 3 nights thus far have been delightful patients. On my third night I had one patient all night and reveled in doing a lot of teaching and putting together an informational packet in Spanish for them to better understand their new condition.

Meanwhile, my coworker and I were spying on the ER waiting room (we can see the waiting room from our patient rooms) and it was packed. We savored the quiet we were enjoying, but also anticipating getting slammed with admits. Somehow, not one patient came to the IMCU - and we did a dance for joy to be skipped over this week.

Now onto the next set of 3 days!

Nights like the Exorcist

The last few weeks have been fast paced with lots of cardiac patients and renal patients, and a handful of some crazy patients that require the whole nine yards of 1:1 sitters, restraints (had my first experience with leather restraints recently), and anti psychotic meds that really sometimes don't seem to do anything initially. To top it off somehow these wild patients always end up in the same room number and now I shudder at group report when I get that room number!

I had a 2 night stretch recently with the a patient where the 1st night sounded like scenes of the Exorcist movie were emanating from within the room and by the second night the medications had caught up to my patient and calmed them down beautifully. By the end of that week I was exhausted - mentally, emotionally, psychologically. It's traumatizing to use restraints for everyone involved. I feel like it took several weeks to recover from that patient particularly.

At the end of the 12 hour shift I really struggle to clear my mind enough from an experience like that so I can sleep and do it all over again that night. I maintain my compassion with these patients, however, it's sometimes hard to do when ducking flying limbs or more recently had a patient grab my stethoscope that was hanging around my neck and being called every name under the sun. My heart breaks for these people - what a frightening experience - and yet it is simply exhausting. That's why days off are necessary for this job - so I can recharge my batteries and my compassion and remain a good, caring nurse.