Nurses and doctors have to be quick on their feet and know how to prioritize––they never know what's going to come through the hospital doors. You'd think that'd keep them on edge, but the best medical professionals are skilled at keeping cool under pressure. People's lives depend on them after all.
Still, there are plenty of times when they are surprised or taken aback by what they've encountered. They don't teach you everything in school.
This one was fun:
Patient in ER gets a standard urine drug screen. Positive for ethanol (alcohol.) Patient insists he does not drink alcohol. Test is repeated. Positive. Patient is very upset. He does not drink alcohol. Blood test is drawn. It's negative.
We checked everything we could think of. Did we have the right urine? The right blood? It should be impossible to test positive on urine and negative on blood.
Meanwhile, I finish his regular urinalysis. High white blood cell count, and really high glucose. Elevated white cells means you need to look at it under the microscope because they probably have an infection. It's loaded with yeast.
The man was diabetic, (obviously,) and had high glucose (sugar) in his urine, along with a yeast infection of the bladder. The yeast was fermenting the glucose to ethanol within his bladder. He was The Man Who Peed Beer.
I was in my first year out of family practice residency.
The specialists like to sneeringly refer to us as jack-of-all-trades/master of none.
I was on call from the ER. A normally unshakable ER doc was beside himself. Had a very preterm mom in active labor. And fog wouldn't let us fly her out. He was the only ER doc and the transferring facility wouldn't take her in transport without a physician on board (probably not legal but we needed her to be at a hospital with a NICU and L&D so they called me).
In route I was trying to coach her to breath through the contractions. But she felt something coming out. I looked and saw a foot.
So we're in the back of an ambulance delivering a footlong breech preemie. We delivered about a minute or two out of the hospital.
They were expecting a mom in preterm labor. Not a micro preemie. We were met in the ambulance bay by one nurse. She took a look at me holding the baby with a blanket and oxygen and said follow me.
We ran through the hospital to L&D and turned on an incubator. Peds wasn't in house and the baby's heart rate was low. So I proceeded to intubate her.
That was 12 years ago. She survived and is doing great.
I wrote my program director at 4 am that morning when I got back home thanking him for all the training. I think I used 100% of my training that night.
A patient being treated for HIV purposefully tried exposing staff members to his fluids. That was a sobering experience.
A very panicked nursing assistant came running to the desk one day saying, "you have to come see this! I don't know what this is!"
The NA brought me into a patient's room where she was giving a bath and points to an area on the patient's buttocks. "What is that?"
I lean in for a closer inspection, when the patient starts to turn back around and says, "IS THAT MY EYE?!"
Sure enough, I didn't receive in report that my patient had a prosthetic eye which at some point came out of the socket and became suction cupped to her buttock.
I left the room and had never laughed so hard in my life.
Nurse here, they never taught me to cover up someone's butt with a bed pad as you give an enema. Sh*t can sometimes explode out while you hold the tube in place. The first time I ever gave one my whole arm was covered in sh*t by the time it was over.
Took care of a young man with a gunshot wound to the abdomen. He had many complications. He was in the hospital for over a year. He had an ostomy bag for a while, but when they finally removed it he was so nervous because he hadn't pooped in so long. His call light goes off and he says "Go look in the toilet, you're never going to believe this!" I go in there and there is poop in the toilet!! His first solid poop I had seen in over a year! I walked out and gave him the biggest hug. He was so proud of his poop. I walked out of his room with tears in my eyes. Nursing school never prepared me for crying outside of a patient's room because I was so happy they had pooped.
It warms my heart to know this comment made you smile and was relatable to some of you. Good luck to those who are on their own ostomy journey! It stinks (literally) but always keep hope. And always remember: it's the little things. -a grateful peds nurse
How to put a fake eye back in. A patient came in from a a not-so-nice nursing home with a multitude of problems, one of which was a disgusting, draining fake eye that had to be removed for treatment. Upon discharge, we had to put it back in. Simple enough we thought. But we had no idea how and struggled to figure it out. I suppose that is why the nursing home staff never took it out to clean it. This was decades ago. Fake eye technology is probably much better today.
How to react when a patients bowels pop out of their incision. This happened when I was a brand new nurse, but off orientation. Quite a learning experience but came in handy because a few years later it happened to a different patient and I knew what to do.
(You have to keep the bowels very moist, cover with sterile gauze, and patient is rushed to the OR)
Wow. So many things. I think one important thing that was never taught is how to deal with a patient dying for the first time. I couldn't stop picturing his last breaths, the yelling of his family. All of it played through over and over. Hospice is tough, but it still is one of my favorite jobs I've ever done.
When I was a student I accidentally degloved a patient from the elbow down. They were incredibly sick, probably already brain dead, and had one of the worst case of TEN/Toxic Epidermal Necrolysis I've ever seen.
Any way I'm in there holding this ladies inside out arm skin like an idiot, with the family standing in the corner horrified, and I just froze.
My first thought was to kind of slide it back on, but thankfully one of the senior nurses rescued me and snipped that shit off.
One of my first dressing changes as a new burn RN involved removing the dressings from a guy's hand. While I am unwinding the dressing, the tips of his fingers crumbled away. I thought I had done something horribly wrong and just froze. THEN my preceptor decides to pipe in "we were thinking that might happen." Like, thanks for the heads up??
The first time I had to tell someone their loved one didn't make it.
Though they address it, no one *really* tells you how to break bad news to someone, how shitty and impotent you'll feel doing it, the fact that you won't be able to answer their panicked questions, what it's like to realize that there's nothing you can say to family members that will truly bring comfort, how shocked or even angry you'll be when some people don't really care about Mom going downhill, how ashamed you might feel when you look back and realize that you're becoming numb to it all after a while. Yeah, you probably had to click through some presentation on the 5 stages of grief at some point and maybe a generic lecture on what NOT to say, but until you've stumbled through it a few times, you're winging it, and probably poorly.
Respiratory Therapist here!
How to act when we unplug the ventilator to let go a patient. Especially when the family is around.
To their defense they do warn us it's going to happen, but it's never until you actually do it that you realize the weight.
I like to talk to my patients even if most are already brain dead at this point (although I did have to unplug conscious patients, that was hardcore to say the least). This gives me a sense that at least if even a small part of their consciousness is still alive at this point, they know they're not alone. I tell myself that at least from now on they won't be suffering anymore.
Student nurse here... How to hide looks of shock when something very surprising or awkward occurs. I remember one time a doctor grabbed me when I was in the hall to hold something for him while he was putting a patient's prolapsed rectum back in. Awkward...
Digital disimpaction. I can only imagine the partnering instructions for that. No one poop for 2 weeks then come to class and buckle up
How to sit in bed and hold your patient as she profusely vomits and delivers her 16 week old dead fetus.
Yes they teach you that compassion and empathy are the backbone of nursing, but absolutely nothing can prepare you for this type of situation.
They never really tell you how to cope with being berated by family members, patients, and even co workers. Part of being a nurse means that you realize you are dealing with people at their most vulnerable, at the worst time in their lives. And you know this in the back of your head. But being an emotional (and sometimes physical) punching bag for days at a time requires a certain mental toughness that you can never really prepare for.
All those things you encourage your patients to do (eat well, exercise, get enough sleep, etc) also apply to you. I know too many nurses who don't take care of themselves mentally, physically or emotionally in a very draining environment. Self care is incredibly important and sometimes we'll lose sight of ourselves in trying to take care of others, but we're of no use to anyone if we're running ourselves ragged.
Edit: First, thanks for my first gold stranger!!! I didn't expect that at all, especially on a comment about how we're not taking care of ourselves. And second, please please please try to take care of yourselves!! I know it's hard. I know we've all seen some shit and have all probably had nightmares from it so it's probably not high on our list of priorities to make sure we're okay. But you're no good to yourself, your loved ones or your patients if you don't. If anyone ever needs to just vent about anything please feel free to just message me!!
As a sonographer, I have to keep a poker face a lot of times when I am seeing something very alarming or sad on the screen. Luckily, most people have no idea what I am looking at so that's a plus. I'm not allowed to give any results to patients (doctors deliver the bad news) so I have to stay neutral. It's really hard.
That dead people can still fart. Middle of the night, all alone with the body and you hear that. Scared the hell out of me!
Hospitals/health care facilities are emotional places, and there are a surprising number of murder/suicides at healthcare facilities. Side product of this is a large number of healthcare professionals who've been in active shooter circumstances. I bring this up first because it's becoming more common around the world in general and we should be better trained and also to bring up that PTSD is already prevalent and under reported in our field and this would certainly be another cause of it.
Take care of yourselves out there.
Nursing school did not prepare me for how decomposed a person can get before they are actually dead. Work in the ICU and patients have horrible bed sores or weeping open skin that just sloughs off their body while we are pumping them with vasopressors and what not to keep them alive. We all have moral issues with this ... It's a terrible part of nursing.
Working as a nurse on an oncology unit, I will never get used to the number of patients that don't make it and we have had 5 deaths in the last month. Cancer sucks.
Pain control related to the specific cancer is something I definitely didn't learn in my one lecture on oncologic care in school. The patients gain tolerance to the drugs and require more and more to keep them comfortable, and you can't think of it as drug seeking or addiction because their tumor burden is just that painful.
Caring for family members at the end of their loved one's life is definitely not something I was prepared for. They will ask you how much time they have left when there is no real way to predict that, they will beg and plead to bring a do not resuscitate patient back, and then there are the ones who show no emotion and it just seems worse.
Compassion fatigue wasn't a topic in school for me. You hear about burnout more often, but compassion fatigue on a total care/difficult to care for patient is important to recognize too.
When you have to euthanize a 91-year old woman's ancient cat who belonged to her husband and when you set the cat on the hospital blanket, you ask the sweet old woman who lost her husband and daughter in the same month, "Would you like your blanket back?" And she answers with tears in her eyes, "I just want my family back."
No, it doesn't get easier.
Registered Nurse here. Nothing in nursing school really prepared me for comfort care patients. Comfort care patients are those that we have stopped all life saving measures on per the patient/family wishes and they are basically just there to have a comfortable death with the help of morphine/Ativan.
Never knew that it was going to be my call when to give patient more morphine, knowing that it may be the dose that makes them pass. Never knew that I'm the one who turns off the oxygen that's keeping the patient alive because the family is ready to say goodbye. What's crazy is that I've come to see it as truly providing comfort. Giving the ultimate comfort sometimes is death.