My coworker said this after a patient threw a full urinal at her because his meal tray hadn’t arrived yet. He ate dinner at 5 every day and it was 5:15. Never mind that she had no control over meal tray delivery and had spent the better part of an hour giving multiple units of blood. He was also angry because he’d spent over a day in the ER because there were no beds upstairs. 

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Even more Cassie ;) —

In going back and rereading the question that the subscriber asked (but after having already made my LOVELY PLANTS POST, because I love my plant-children) — I kinda missed their point, so here goes on that — let me quote KB here:

Cassie again!

Awhile back we asked paid subscribers if there were any questions in particular they wanted answered, and someone asked how we got back to normal after shifts, and I thought I’d use this slot here to talk about how I do that that with y’all.

(TL:DR, scroll down to see photos of my garden that I’m inordinately proud of)

Ok, so if you follow me on Twitter you might know my most famous tweet ever was about butt stuff. 

Yes, people put stuff in their butt and lose it. No, we don’t really care that you do it anymore that we care that you put a ladder on top of a lawnmower to reach a chandelier and fell off it. People do dumb shit. They end up in emergency rooms. 

Ok, so you already knew about that? Cool, let’s talk about other weird shit.

Hey peeps, Cassie again!

I just finished off a 12 hr shift (although I’m pushing this post out into the future some for HIPAA-adjacent reasons) and I thought I’d give y’all a summary(ish) of what went down while it’s fresh in my mind

So, first off, my patient was a 1:1 patient, which meant that I was their only RN (although I happened to have a new-hire/gopher that day, which was great.)

The reason they were a 1:1 was because they were actively dying with covid.

Ok, so the ERs are overwhelmed, right? You’d have to live under a rock to not see images of ambulances waiting to unload and patients in hallways and hear about record wait times and how people are being sent home on oxygen because in some areas there are no rooms, right?  

Yeah. It’s real. Everything sucks right now. November/December was really fucking awful in the Midwest—January has not been as awful, though we are still at 90%+ capacity in most facilities and ICU beds are pretty hard to come by. It’s the “new normal”, a phrase I first encountered after my son passed away, and this is the second time I keep hearing it used regularly. I can interpret that as this is just how it is, it’s gonna suck forever, so get used to it.  

A few days ago one of my coworkers said “remember how pissed we used to get when we came in if there were ANY inpatient holds and now you’re just like “YAY THERE ARE ONLY TWENTY” and I was like YES THOSE DAYS WERE THE BEST. The BEST. I wanna go back.  

Hey there, it’s Cassie again!

Thought I’d take a moment to go through and explain what ‘life support’ really means, since it’s a term that gets tossed around a lot but if you’re not a medical person you might not have a great context for it.

At its broadest, life support is anything that you require to survive — makes sense, right? It’s any therapy that if you didn’t have — you would die.

Before I get into the explanatory weeds here — sometimes we’re taking care of people’s grandmothers, who’re writing them notes on facetime or sending texts, and they’ve got breathing tubes in or they’re on 3-4 pressors (blood pressure medication, more later) to keep their BP up, and they are very much alive!

“You signed up for this.”

“Well, you’re getting paid a lot.”

That’s just some of the things people have said to medical professionals who have voiced how difficult healthcare is during this pandemic.

COVID-19 really has done quite a number on our headspace, especially in the ER. We’re not only treating acutely ill patients with a highly contagious virus, we’re holding record numbers of admitted patients, and while most of the public is pretty chill about wait times and hallway beds, some are definitely not. 

Sometimes I’m like why am I still doing this?

And then I have to remind myself. 

Head on collisions and partial amputations, 

Hey there, it’s Cassie, sorry it has been a bit between posts! Both L’Erin and I were swamped with work and general malaise.

I got my second vaccine shot last weekend. Felt out of sorts for a few days, unsure whether that was my shot, work, my mother's continuing poor health (due to her having covid), or being an American, heh.

My mom went back to the hospital a few days ago and they X-rayed her, found out she'd gotten pneumonia and a UTI. They've blasted her with antibiotics since, and she feels better again. I hope it sticks. (For the record she's been fighting this since Christmas...and I can't say I TOLD YOU SO until she's all the way better, heh.)

So about a month ago, an Oregon nurse was put in leave, then fired after she posted a TikTok video about traveling maskless, encouraging play dates, etc. There was a tremendous backlash from Twitter users and the Internet sleuths found her real name and her job, and she was subsequently dismissed from her hospital. Also, she was an oncology nurse, which is just....so fucked.

Right after that this other idiot in Florida did the same thing, and get this, she was a PEDIATRIC nurse who worked with special needs and immunocompromised children. Same outcome. 

We’re going to talk about some recent racist incidents in medicine today and what I’m going to say is important.

The first one I want to talk about is FarmerNurse. FarmerNurse aka Wee Key aka some chick in one of the Carolinas, a Registered Nurse, flashed the “ok” symbol affiliated with white power while fully gowned in PPE on TikTok. She was promptly fired after multiple people reported her, even though she shut down TikTok and other social medias. But there’s a lot to unpack here.

I was scrolling through Facebook when I caught a glimpse of a photo from my friend Sara. It was Sara holding her son’s hand., with an ambulance cot behind the bed. That wasn’t what caught my attention. The picture didn’t show his face, just their hands and a small glance at his chest—where I saw what looked exactly like a Ballard closed suction catheter. 

My heart stopped for a second. He’s intubated? How did this happen?

(This is going to be long, bear with me and settle in.)

As a lifelong nerd with a writer’s morbid side-interest in all the ways people can die and a habit of following all sorts of people on twitter, I started seeing the news about covid out of Italy, straight from Italy, at the end of Feb, and very early March.

I couldn’t tell what the Italian broadcast I was watching said, but I didn’t need too — they were inside an ICU, I could tell from the ventilators and the pumps. And the second I saw multiple people flipped over on their bellies, I thought, “Oh, no. This — this is bad.”

This is our first ‘subscribers only!’ post! (Mostly, because we believe in large part that information, especially on health-care related things, should be free right now.)

But we very much appreciate your support (and in fact you’ve already funded a purchase of brand new nursing shoes for me, thanks! ;))

I’ve just finished lining up this upcoming week’s posts for us, but I’m too brain dead from working back to back 16s to be otherwise functional right now. (I’ve worked 104 hrs this pay period, that includes five 16 hr shifts and two holidays. I remember my name, and that’s about it.)

I still thought I’d reach out and check in though, as we enter the new year — do you have any questions or thoughts, no matter how random, weird, or mundane — that we could answer for you about nurse stuff, hospital things, or covid madness? Or just something you want to get off of your chest and have us amplify?

Just don’t.

I’m putting this placeholder post in here now, and we’ll see if I get a chance to change it between now and the 31st.

I have every intention of coming back here and writing something moving and thrilling that makes you totally reconceptualize your view point and gives you the munition you need to explain to everyone else in your life why you’re staying home as much as possible — and not only that — but something SO MAGICAL it CONVINCES THEM TOO to stay home, like some ‘I clap for fairies!’ fever dream that flows outwards from all of our well-meaning hearts to somehow inspire and heal our nation and get everyone who is currently a dickwad to stay home and not breathe on anyone else in the new year.

Let’s talk about what happens when hospitals begin to reach capacity! High bed occupancy is defined by some as reaching 85% capacity. This is significant for mortality rates increasing in the neighborhood of 9% according to a 2014 study.

But why, you ask, would being at 85% capacity mean increases in mortality?

Because capacity takes a whole lot of things into account. For example, “ghost beds”. There are hospitals that utilize semi private rooms. Due to COVID-19, these have been made private for infectious disease control purposes. But that bed still counts towards capacity.

How to behave in a pandemic when your local hospitals are at and over capacity in order to decrease the strain on the healthcare system and workers.

1)      Utilize the emergency rooms for emergencies. If you’re calling to ask if the ER is busy, if we’re full, or what the wait time is, your needs can probably be met by an urgent care.

2)      Insert photo of things for urgent care cause ER

3)      Don’t call to ask if we have COVID patients. Everyone has COVID patients. Sorry.

I hope everyone had a safe holiday at home with a minimal amount of people and no one outside your pod!

Work’s cray. Some of you all follow me on twitter, so you’ve seen my ongoing messages from the staffing office, but if you haven’t, here was my weekend:

Today I'm going to explain oxygenation and ventilation in layman's terms, so y'all can play the home game! (This is a recap of a prior post based off a viral tweet I had in spring. I sent it to my author mailing list a bit ago, so if you’re on both lists and this feels familiar, that’s why!)

At the time I wrote it it was more to explain why NYC needed so many vents so quickly — I’ve tweaked it now to explain more about why people with covid might be on a vent.