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Two incredible amazing people.

 

It was May of 1991 and I had been a burn nurse for nineteen months when Gary was found in a car that was on fire after the fire had been put out. The fire department did not think anyone was inside. His burns were extensive and he had breathed in a ton of smoke so Dr. Ayvazian told his fiancé Linda that he would not survive. Gary and Linda had both worked on the movie White Palace which was filmed in St. Louis about a year prior to his burn. I have never seen the movie but always remembered this fun fact.

Anyhow Gary was with us for a few months  and then he was discharged home. The thing I remember most about him was the day they were making the mold of his face for his pressure mask. They inserted straws into his nose for him to breath through and then pretty much covered his head. I was his nurse that day and had to think hard about other things as I was having a claustrophobic panic attack for him. I am pretty sure I gave him extra Valium, Versed or something to make it more tolerable for me. Hee hee

     It wasn’t too long before we started seeing him again. There was a Burns Recovered Support Group that was run by a guy who was before my time. It wasn’t long until he passed away and Gary and Linda stepped up to take over the group. I believe they met once a month and Gary would come visit patients once or twice a week during the day time.
     After seeing an article in People magazine about a burn camp in Texas, Linda felt called that  Missouri needed a children’s burn camp. After doing research she discovered we had none so she and Gary decided to start their own. The first year (1997) they had 17 campers and no child has ever paid for camp. The camp is located at the Lake of the Ozarks. Brian’s parents have a house at the lake so one summer Emily, Kayla and I made a visit to burn camp. Either Linda gave me bad directions or my lack of GPS skills were showing because I somehow managed to miss the turn and ended up driving to Jefferson City. I turned around and went back to the lake. Brian got his map out and gave me new directions. We found it the second time around. Although we didn’t stay long, I immediately knew it was a wonderful place for the kids. A week where they can be just kids and not burn survivors.
     I have had so many burn unit memories over the past couple of weeks. Linda shared my blog and I heard from a nurse friend I have always remembered and wondered what happened to her. Back in the day people would ask how I could work there. And my answer was pretty much everyone got better and went home. I never really knew how most of them did after they left. There were certainly days when I left wondering if all the torture I and the team inflicted on these patients was worth it.
     So on Friday I went and spent the evening with Gary and Linda. I had such a wonderful time that I ended up staying past eleven and the next day went to Universal Studios on four hours of sleep. I would have done it on no sleep! They are both two amazing selfless giving people. They took the support group to an amazing place and they started the camp from the ground up. I am sure at the time of the accident if you would have asked if this would have been their path in life they would have said no way. I can’t help but think God had this planned all along. I use to see Gary in the cafeteria on Tuesdays from time to time. It was always an exciting day for me. I cannot remember (even though we just talked about this) if they retired and moved four or six years ago. I do know it took me close to two years to stop looking for Gary in the cafeteria.

 

     I’ve never felt that were truly recognized nor appreciated for all they have done, especially by the hospital. However it’s as if God purposefully put these words of Jesus in my head (yes I had to look up exactly where they are located. Bible bees locations are much like patients names. I know their story but not their names)
 Matthew “Be careful not to practice your righteousness in front of others to be seen by them. If you do, you will have no reward from your Father in heaven. 

“So when you give to the needy, do not announce it with trumpets, as the hypocrites do in the synagogues and on the streets, to be honored by others. Truly I tell you, they have received their reward in full.But when you give to the needy, do not let your left hand know what your right hand is doing, so that your giving may be in secret. Then your Father, who sees what is done in secret, will reward you 

These two live this every day. I’m so thankful that I decided to share my Dr. Ayvazian blog with Linda. She responded with an invitation if you are ever in the area please come see us. She was probably blown away when I said I will actually be there in three days, free on Friday. Originally Emily and I were both coming on Saturday and starting trip on Sunday. Since I’m a theme park nazi I decided we should start on Saturday and fly in Friday. She took a red-eye so she could work on Friday and the rest is history.

Mole Moral ~ Gary and Linda are my providential people. (Another church term). Meeting them changed the direction of my life and so many, many more and for the better!

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The Greatest Doctor I ever worked with

This week I went to “don’t call us St. Anthony’s, we’re Mercy South now” to visit a childhood friend’s father who is in intensive care. While in the lobby looking for directions I saw this on the wall.

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Since I was curious about what sort of propaganda was on display, I walked over to take a closer look. When I saw this picture on Mercy’s timeline I stopped rolling my eyes and was flooded with so many memories.

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It’s not easy to read so under the picture reads Dr. Vatche Ayvazian leads the expansion of the burn unit designed to treat patients of all ages.

New research is conducted in the burn unit at St. John’s Hospital, which cares for hundreds of patients each year. Highly specialized treatment protocols draw patients from throughout Missouri and Illinois for treatment of severe burns, and the center becomes the largest of its kind for the state.

I have thought about Dr. Ayvazian over the years. He retired from the burn unit not too long before I left in 2000. His leaving was one of the reasons I left, because although his replacement is a good doctor he was not even comparable to Dr. Ayvazian.

The man was not only a genius but the most compassionate doctor I have ever worked with. He had a choice of becoming a doctor or a concert pianist. Lucky for Mercy he chose surgery. I never heard him play but I’m sure he was incredible. He was also fluent in seven languages. One time we had a patient that only spoke French. He went in and had a conversation like he spoke French as his primary language. It was so mind-blowing to me, I can still see the patients face and which room he was in. Dr. Ayvazian treated everyone the same and he never cared if the patient had insurance or could pay. It was completely irrelevant. He was upfront and told everyone exactly how the patient really was and what the odds were for survival. He never sugar-coated or gave false hope but it was done in such a caring and compassionate way. And when he lost a patient (this happened a lot) he took it personally and although he didn’t say much, I could tell it really bothered him.

He treated not only adults but children as well. I have never met another physician that could treat both as the difference is like vanilla and chocolate ice cream. Nurses usually either take care of adults or kids but not both. Although in the burn unit we did take care of both.  However, almost every single nurse that left went on to a job that was adults and not kids. There was nothing that outraged Dr. Ayvazian more than child abuse and it was the only times I witnessed him lose his temper. He let a couple of parents really have it.

There is no way to describe the stress and adrenaline surge that would run through the burn unit when we got the call a big burn was coming in. The teamwork was phenomenal among everyone to pull this off. This left me with a life long friend and fond memories of so many others that also went elsewhere in Mercy with their careers. Dr. Ayvazian always came in to evaluate and if they had circumferential third degree burns escharatomies or fasciotomies would have to be performed. This was done with the Bovie machine and would effectively cut through the skin and cauterize at the same time. If you have ever singed your hair, this is what it smells like times ten. Often there would almost be a visible cloud of smoke hanging in the burn unit. Dr. Ayvazian would yell “follow me with the light” when doing this and if you got behind he would really start yelling. However, after everything was done and settled he always apologized. Maybe he was a little like me, the more excited or nervous I get the louder I yell.

The first two to three days after skin grafts we would give Ketamine during the dressing changes because the donor sites were so painful. One of the first times I was the nurse in charge of donor site changes I did something wrong. Dr. Ayvazian yelled at me but then afterwards pulled me aside and told me that I would be a great nurse and he didn’t mean to yell. I still can remember this patient, how he was burned and what room he was in.

Its been almost twenty-six years since we had a patient with ninety-three percent burns. We actually had a layer of his non burned area removed and sent to a lab. They grew his skin in the size of saltine crackers and we used it on his arms. This probably saved his life but they were such a pain because we couldn’t move his arms much for I swear six weeks or they wouldn’t take. It seems like the cost was forty-seven thousand an arm or something outrageous. We did attempt to use it on another patient but aborted it for reasons I cannot remember.

I googled Dr. Ayvazian and found all his research papers. I had no idea he did research because the internet was just coming to light when I left and I had zero desire to go to a library. We would soak the skin grafts in CeN04 for the first twenty-four hours. I cannot remember if it’s spelled Cerrous Nitrate (this is crazy because it was never approved by FDA so we always had to get a consent signed for it) but I did find the articles he and the other burn unit director published on the research. The burn techs that had been there for twenty years would tell us about how they had to mix it in the burn unit back in the day and if they spilled it on themselves it would stain. When I worked there the pharmacy mixed it and it came in big brown jugs. When Dr. Ayvazian retired so did it. I am sure there was a party in the pharmacy.

According to google Dr. Ayvazian is eighty-three years old at the time of this blog. This does not seem possible. However, it also doesn’t seem possible it’s been over eighteen years since I worked there. It was the hardest job of my life but the teamwork and comrodary is unexplainable and made it the best job of my life. I am so thankful for Dr. Ayvazian and all the people he helped. God made a true one of a kind gem with him.

 

Mole moral ~ Till the day I die my favorite line will be “when I worked in the burn unit……”

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Nursing Boards

Brian has been laying hardwood in the bedrooms. He has finished Kayla’s and Allyson’s room and is currently working on ours. This requires everything to be moved out and going through everything. I refuse to discuss how much stuff I have either given or thrown away. I still have more than enough junk and I can’t help but wonder where it comes from.

Yesterday I was cleaning out my night stand when I found this gem.

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It has been in the same place well protected for THIRTY years now. I still remember this like it was yesterday. Back in the day, NCLEX was a class you could take to help you study for boards. I am thinking it was a couple of hundred bucks to which Gena and I said nope not taking it. It was optional and the acutal test was just called  boards. Now the test is called NCLEX which is very confusing for me.

Back in 1988 it was a two-day test given in Springfield Missouri, The test was in four parts, two each morning and two in the afternoon. Gena, Katie and I all drove down together. I borrowed my moms car because it had air conditioning and my personalized plates had already arrived RACH-RN. I figured it would be bad karma to drive mine to the test as if I had already passed. We shared a hotel room as well. I can’t remember which night we went to the mall and had this done but we each received a copy.

The test was awful. For starters people walked around the entire time staring at you making sure you didn’t cheat. If you had to use the restroom, you had to raise your hand and be escorted to the bathroom like a three-year old. I remember the room was filled with long cafeteria like tables. It seems like we had two hours for each portion. This led to once everyone was finished, we would all start comparing answers and be convinced we had all failed. I had smoked during nursing school but quit when I graduated. Over those two days I easily smoked over a pack of cigs by myself. I remember throwing what I had left out the window on the way home.

I think it was a good six weeks before our results arrived in the mail. I was so thankful to see a small envelope because that meant I had passed. I swore if I failed, I was working at Hardees for the rest of my life because I wasn’t going through that again in December. Boards were only offered twice a year back then. Gena and Katie also passed as well, although by the time we had arrived home we just knew we had failed. Katie and I worked together at Deaconess until I left for St. Johns burn unit. I must really be getting old because all of these memories just keep flooding back and I am starting to feel like an old person with all my “back in my day” stories!

 

Mole Moral ~ You never know what I am going to find in my house when I actually go through stuff. This was a true gem and put back where it has always been kept!

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Monday Night Golf League

Brian has been in the Monday night golf league for what seems like forever. He has no idea when he joined and neither do I. This past Monday he came home early and totally freaked out. I thought for sure he got his first speeding ticket of his life but his evening was way more traumatic.

Golf was finished for the night and some of the guys were sitting outside drinking beer and doing whatever it is guys do when all of a sudden Dave falls out of his chair. He lands on the ground and is unresponsive. Brian springs to action to see if he’s breathing. His chest is not moving so he tells one guy to check for a pulse and barks at the others to call 911. The other guy can’t find a pulse (I’m really not sure if I could find a carotid pulse either in that situation) so Brian says to him you are going to have to start chest compressions. The guy is like I don’t know how to do that. Just then Dave wakes up and says he is fine except his neck hurts. No one had managed to call 911 so they skip calling them. Brian drives Dave home from golf and stays with him until his wife gets home. The next day after work I make Brian text Dave to make sure he is still alive. A person usually doesn’t go unresponsive, apneic and potentially pulseless for no reason. Dave answers right away that he is fine but his neck still hurts. Sometime later that evening Brian’s text message buzzer goes off and the next words out of his mouth are something to the effect of holy shit. Well I have a nose problem and ask him what is up. The text is from Dave.

Dave decided to go to urgent care because his neck was hurting so bad. They did a CT scan and determined he broke his neck and they were sending him by ambulance to Barnes. So the paranoid nurse in me was like, he was walking around with an unstable neck fracture for 24 hours, he’s lucky it didn’t extend into his spine and paralyze him. How crazy is that a fall out of a chair can lead to a broken neck. I am also secretly thinking they will check out his heart to see what caused the episode leading up to the broken neck.

Brian heard back the next day and after 2 CT scans, 15 x-rays and an MRI they determine surgery wasn’t needed but he will be in a brace for two weeks. I of course ask what about his heart. “I don’t know” was Brian’s response. Trying to get information out of dudes is almost impossible. I do know Dave won’t be finishing out the golf season except for maybe the after golf drinking and doing whatever it is dude’s do.

I was super impressed with Brian’s take charge attitude of the situation. He has taken CPR at least three times that I can remember. It’s probably because he has lived with bossy pants me for 28 years. Also so caring of him to drive Dave home as well. I really do have an awesome husband!

 

Mole Moral ~ Guys never stop thinking they are invincible even when they are all over the age of 50!

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The Bleeing Edge

This Netflix documentary was released the week I was at Big Stuf camp. I had quite a few people ask me if I had watched it yet. I finally sat down and watched it two days ago. I wish I could say I was shocked but I wasn’t, as most of it I already knew.

It’s been almost four years since I was a work and someone said Rachel Dr. Veronikis is calling from the OR and wants to talk to you. First of all Dr. V rarely calls anyone, much less from the OR so I went totally paranoid and figured he was going to yell at me. Instead he said I want you to go in and talk to my patient in 16. We had just moved to our new unit and I had to figure out where that room was. So I walked into Melynda’s room and said something like hi I’m Rachel and Dr. V told me to come talk to you. She had mesh removed by a doctor in California and was here for reconstruction with Dr. V. She shared her story with me.

I must say not only was she super nice but she was super smart. She had one of the Johnson and Johnson mesh put in. It wasn’t the small piece that supports the urethra but an entire thing that lifted the bladder up and had arms. She told me they knew when it was brought on the market their would be some lawsuits so they set aside a slush fund to cover them. There were no trials or studies on living women. The mesh had gotten approval through the 510k process. If a new product is similar to one currently on the market it is approved without trials or research. Physicians were trained over a weekend using cadavers. That’s dead women. Some physicians were also given kickbacks for every sling they placed. I have seen enough of Dr. V patients that had mesh placed that never needed it, to know this is truth. I am sure everyone involved would deny it but actions speak louder than words. Melynda added me to a Facebook group with all kinds of links to mesh articles. I read as much as I could and joined a few of the public groups to stay informed and keep up with what is going on.

So I started the show knowing full well I would be furious, but it was way worse than I imagined. It started with essure, the coils placed in tubes to prevent pregnancy   Again very little training and doctors were told if you missed the tube just put in another one. One lady had five of them floating in her uterus. These are made of metal so it only seems logical people would react to these. The trials they did were rigged. Some of the gals responses were changed right in front of them to make it say they had zero complications and one hundred percent satisfied only because they weren’t pregnant. It was taken off the market in every country except for the United States. However, right before the documentary aired it was announced it would be pulled from the market at the end of this year. I guess the greedy company wants to get a little more money while turning a blind eye to all the people they have harmed.

I have never been a fan of the daVinci (robot) machine. After watching this I would not ever encourage anyone to use it. They state it’s less invasive for hysterectomy. However the least invasive is the vaginal approach. The robot makes a blind stab for the first incision and most of the time that works out fine. However when it was developed an eight month training period was recommended. However again greed knew no one would buy it or invest so it was cut to a much shorter time period. And the show says a doctor practices and then had another physician watch him for two or three times and then he can perform on his own. This is accurate in my world. They had four different women end up with their intestines falling out of their vagina. I say no thanks.

So many people have been injured, maimed and have had their life ruined and yet the greed continues. Profit before people seems to be the motto these days. The FDA 501k process is broken and the loophole needs to be closed. When some of the FDA scientist attempted to be whistleblowers they were either terminated or had their job eliminated.

I don’t have the answers except to do your homework and don’t let anyone implant anything in you without extensive research on your part. The latest greatest doesn’t always mean safest or best.

 

Mole Moral ~ Melynda found her mesh on eBay, purchased it and gave it to Dr. V at her six-week check up. It makes you wonder just how easily any untrained physician can get their hands on it and implant it into unsuspecting people.

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Own it, don’t dismiss it.

A few weeks back my music switched to cycling through everything on iTunes, instead of just my play list. I usually tolerate this until one of the kids nasty worded rap songs comes on and I switch it back to my Christian music. After I saw Rob Bell two years ago I downloaded some of his first pod casts and it so happened number seven popped on. I had heard it before but I had a feeling I should listen again. I believe he called it the tapes in your head. The word tape kind of shows our age since I’m pretty sure they no longer exist.

He was talking about the way you talk about yourself in your head. So he launches into a scenario where he is playing kickball with you and you catch his ball but you trip and fall and run a spike through your chest. So he cuts the spike loose and halls you to ER. I had a hard time getting past playing kickball with Rob and not calling 911. Anyway you arrive to ER and they stat page a doctor to your room. Do you want your doctor to play this in her head? I’m not really sure about this. I graduated last in my class. There are so many doctors that are better than me. Or would you want her tape to say I’ve got this. I know exactly what needs to be done. I have the skills and the team to accomplish this. Another thing he spoke about is not owning compliments but rather dismissing them or downplaying them.
Three hours after I listened to this I walked into work and my boss was talking with another gal I had never met. The unknown called me high energy and my first thought was no I’m not. And then it was if my head shook and cleared my brain and I was like I think she’s right. So I’ve been thinking about how my life does indeed reflect high energy.
For starters my job reflects this. I am scheduled eleven am until seven-thirty pm to come in and take all the new admits. They include surgeries, direct admits (straight from home or doctors office) ER patients and moms who just had a baby that ends up in NICU. This shift originally started because for a few years the hospital did away with having people on call and we were not allowed to staff for patients who weren’t there at the start of the day. On big surgery days (10 or more) this could be a nightmare with every nurse being at max capacity and yet more surgeries needing to come. I worked three to eleven back then so a lot of times they would call me to work early. So anyway I now come in at whatever time they need me. This may be as early as eight thirty or as late as three. I sometimes have all five patients within three hours. The recovery room loves me because I almost always take report when they call and have taken back to back and say send at same time I’ll make it work. The only time this is a nightmare for me is when the patients were not given adequate pain medicine during surgery and are out of control upon arrival. This keeps me running for the first few hours. Our unit is huge and really spread out so on a crazy day I can easily hit ten thousand steps in eight hours. And to think my husband likes to harass me and say all nurses do is sit around and eat chips and dip.
My activity level screams high energy too. I walk almost three miles every day for my coffee and then around the back neighborhood. It’s also my time to play Pokémon. I’m still running and always training for something. Last years fifty mile runalone says either high energy or belongs in an insane asylum.
At the end of the same day I had a patient and her husband thank me for being the kindest nurse and person they ever met. My first reaction was to dismiss the entire compliment and then Rob popped into my head and the love dare. I remembered one of the three things Brian said he admired about me was my willingness to do whatever I could to help others. And I must admit they were right. They were of a different culture and I respected that and incorporated it into my plan of care. Plus they were Heartprint patients which will always have a special place in my heart.
So over the past three weeks I’ve been trying to own it, instead of dismissing it. I must say this is a lot harder than I thought it would be. My head tape likes to go immediately to the negative and the worst case scenario. I guess I have something to work on.
Mole Moral ~ If the tape is negative, eject it, and replace with a positive one, you deserve it!
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Time Really Does Fly!

On this day thirty years ago I graduated from Deaconess College of Nursing with my diploma in nursing. So much has changed since then that it is almost impossible to believe. For starters there is only one diploma school left in the area and that is Lutheran School of Nursing. Every other program is either associate or bachelors in nursing. The diploma schools had the most clinical hours back in the day and were usually associated with hospitals. In other words free labor.

I recently looked at my scrapbook to figure out which day I graduated on. I was very surprised to discover I graduated on Uncle Larry’s birthday. I would have thought I would have remembered this but I guess this is why I scrapbook. Things you think you will remember forever you quickly forget.

I must say nursing school has not changed at all during this time. It is still the most stressful time in a person’s life. I swear they do everything they think of to get people to quit and weed out the weak. I mean if you even think about applying they start quoting wait lists and GPA’s and drop out rates. It is just ridiculous. I can honestly say I would never go through it again. One and done.

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I thought I would list some of the changes over time. Please feel free to comment any others.

  1. All white with a nursing cap. Scrubs started around 1989 and the caps were gone by the time I started working at Deaconess
  2. No computers at all. All charts were paper and kept at the  nurses station.
  3. Medication carts with narcotics on them. Now my friend Gena who works at a small hospital still has them. I haven’t carted one up and down the hall since 1990 when I went to the burn unit.
  4. Gloves were only for sterile procedures. You carefully cleaned up people and emptied foley catheters.
  5. It cost money to watch TV and there were only seven channels.
  6. Smoking occurred anywhere in the hospital. Patients were placed in rooms based on smoking preference.
  7. No scanning medications or automatic times placed in charts. Also the medication records were hand copied by night shift every four days.
  8. All pain medications were given IM. There was no IV push pain medication.
  9. Darvocet was not a narcotic. It no longer exits as it was taken off the market years ago.
  10. Two nurses had to count narcotics at shift change. No one could leave until the count was right. If you forgot to sign out a narcotic it held up everything.
  11. LPN’s were phased out of mercy at least five or more years ago.
  12. There were no twelve-hour shifts.
  13. There was no straight day shift. You could work straight evenings or straight nights but days were rotated with either evenings or nights.
  14. People were admitted the night before for tests now done outpatient such as cardiac cath, upper and lower gi, stress test, etc.
  15. Nursing boards were a two-day event with a six-week wait for results. Small envelope you passed, big envelope you failed and they were only offered two times a year.

I know I am forgetting so many things but there are many others I will always remember.

  1. My first patient that passed away.
  2. My preceptor, Lisa from my first job.
  3. My ten years in the burn unit including my first really critical burn.
  4. How hard nursing school was.
  5. How I learned to never date a patient the scary hard way.
  6. Why I transferred to Women’s Health.
  7. Being pregnant and vomiting in the trash can during a feeding tube insertion.
  8. Taking care of my first Christmas Angel.
  9. Leaving a code to go the bathroom to avoid peeing in my pants.
  10. The class I had to take to learn how to use a computer mouse.

 

Mole Moral ~ As I look at my picture I think dang I had a nice figure and yet if you would have asked me back then I would have told you I was fat. My body image disturbance isn’t just a nursing diagnosis, it’s a reality!