CODE BLUE – TOWER 5!

April, 1977 – Midwest, USA – Orientation

I had just completed my class on handling emergencies including cardiac arrest when I heard the overhead page, “Code Blue, Tower 502, Code Blue, Tower 502, Code Blue, Tower 502!” I was standing in the nurse’s station, so I grabbed the Code Cart and pushed it as fast as I could to Room 502.

Running with the Code Cart!

Running with the Code Cart!

Ann, another nurse on our unit had started to give respirations to Eleanor, a small gray skinned elderly lady I had just talked with the hour before. The doctor and nursing supervisor ran into the room behind me. Miss S., the supervisor, quickly told me to give the medications while she recorded everything the doctor ordered. We grabbed the board off the back of the cart, lifted the patient and put it under her back. Debbie, RN started compressions while Ann grabbed the Ambu bag, hooked it up to the wall oxygen, and placed it over the patient’s face.

Dr B barked at me, “Give 50 cc of Sodium Bicarbonate!” I grabbed the box with the large syringe, tore it open, screwed the plunger on to the syringe, pointed it toward the ceiling, and pushed hard on the plunger to clear the air bubble out of the syringe. Oh, No! I realized that I forgot to remove the needle cap as I saw it go sailing across the room! Dr. B glared at me. My hands started to shake as I grabbed the port of the patient’s intravenous line, pierced it with the needle of the syringe, and began to push the fluid with both thumbs on the plunger as hard as I could through her line. Her body quickly was becoming acidic, so the bicarbonate would counteract this. The Doctor continued to give orders and I pushed the medications through the IV while Ann and Debbie continued respirations and compressions. After 30 minutes, Dr. B. said, “Stop…we lost her.” He turned and left the room.

Everything became quiet. Miss S said, “I’ll call the family while you and the aide wash her body, put a clean gown on her, and clean up the room. Ann removed the code cart from the room and took it down the elevator to the supply department to exchange it for a new cart.

After the aide and I cleaned up Eleanor’s body, I stood alone beside her bed gazing at her. Her face looked relaxed. Her body was still warm. This was the first time I ever saw anyone die. I didn’t know her well, so I don’t know if she had a personal relationship with Christ or not. Silently I prayed, Dear Lord, Use me for your glory and honor. I don’t know how many days I have left here on earth, but You do. Help me to always be ready to meet You. Thank You for saving my soul by your precious blood. Amen

June, 1977 – Evening Charge Nurse

I have now completed orientation and feel like the biggest adjustment is over. It  came to the point where I was daily dreading when the time arrived for me to leave for work. The pressures and responsibilities almost overwhelmed me because all I could hear in my dreams at night was, “Code Blue, Tower 5, Code Blue, Tower 5…” I was so fearful of resuscitating anyone because of the havoc and chaos at my first Code Blue.

I poured out my heart to God and realized I must trust Him, because He is the one who controls life and death, not me! As it says in II Timothy 2:4-5, Who will have all men to be saved, and to come unto the knowledge of the the truth. For there is one God , and one mediator between God and men, the man, Christ Jesus. How God longs for each person to receive Him as their Savior, but He will not force Himself upon anyone.

Now I enjoy going to work every evening, and rest in the Lord to give me the wisdom and strength in every emergency, allowing Him handle it through me! I am just the glove on His hand. How delightful to rest in Him!

And now, the exciting part… the Lord has opened the door for me to teach a Bible class with one of my former patients! One day when I was teaching the class about diabetes, I was able to share the gospel with the patients. Mary listened attentively and asked me to come to her room after class. She shared with me that she also is a Christian and was longing to learn more about the Bible. She lives close to the hospital, so I offered to teach her, and she eagerly said, “Yes!” So every Tuesday morning I go to her home before I go to work and we have the most wonderful time together in the Word.

I was preparing for tomorrow and studying Genesis 22, where Abraham was willing to offer up his only son, Isaac, in obedience to God. He believed that God could resurrect Isaac and was willing to totally obey God in simple faith. I so desire to always obey God like that!

Reflection – 2014

Since those days, I have been involved in many Codes for cardiac arrest including infants in labor and delivery and adults when I worked in dialysis and the nursing home. Some nurses enjoy emergencies, but I never have. I am more comfortable having the difficult conversation with elderly terminal patients about their choice of whether or not they want to be resuscitated, and when to choose hospice care. It is a sobering thing to watch someone pass into eternity. But it is truly delightful when I know the person has received Christ as their Savior, and he is welcomed home into heaven above! What grace of our dear Savior to save sinners like us!

Precious in the sight of the Lord is the death of His saints.

Psalm 116:15

 

 

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Graduate Nurse Orientation

April, 1977 – Midwest, USA

After one week of vacation visiting friends, I began orientation on the diabetes unit on day shift. The nurses have been very friendly and encouraging as they teach me about diabetes and how to care for the patients. This new hospital is a circular tower with 10 floors of 30 private patient rooms on each floor. It was designed with nurses in mind since the nurse’s station and elevators are in the center. This way, each patient room is equally close to the nurse’s station. Since no one has a roommate, it also eliminates roommate problems, and it is easy to put someone in isolation when they have an infection.

I stand in front of the new hospital tower where I worked as a new graduate nurse.

I stand in front of the new hospital tower where I worked as a new graduate nurse.

I quickly learned the day shift routine. After clocking in with our badge, we began by listening to the cassette taped report from the night shift nurse in the conference room. Then we made walking rounds with the night shift nurse and checked how much fluid was remaining in each IV (intravenous) glass bottle and marked the tape on the side of the bottle with the hour. Next we counted narcotics with the night shift nurse, both signed the book, and she handed me the keys. Then I mixed all my IV antibiotics for my shift in 50 cc bottles of normal saline. This could be quite time consuming if I had to mix 10 to 15 bottles. First I wrote out all the labels with the patient’s name, medication, time, date, and my initials. Then I gathered the glass bottles of dry medication from their tray in the medication cart and  enough 10 cc syringes from the supply cart. Next I withdrew 10 cc of saline, injected it into the bottle with powdered medication, rolled it between my hands until it dissolved, withdrew it from the small bottle, injected it into the 50 cc bottle of normal saline, and pasted on the label.

By that time it was breakfast. The aides checked each patient’s urine sample for sugar and handed us the list of results: negative, trace, 1+, 2+, 3+, or 4+.  Then I checked he patient’s insulin dose, drew up NPH or Lente, and added enough Regular Insulin (short acting insulin) to cover the amount of sugar the patient spilled in his urine. Then I went to the patient’s room and watched him inject himself while giving him further instruction.

After the patients finished breakfast, the aides started baths and bed changes while the nurses passed the 9 a.m. meds. After meds, we did treatments such as dressing changes. In between all this, we made rounds with the chart rack whenever the doctors appeared, and then processed the orders. After the MD wrote the orders on carbon paper, the unit clerk tore off the extra copies and sent them in the pneumatic tube to the correct department (lab, pharmacy, dietary, etc.) Then the nurse cosigned the order after checking their work for accuracy.

On day shift, there are 3 nurses, so each cares for 10 patients and there is one nursing assistant for each block of patients. On evenings, there are only 2 nurses so each cares for 15 patients with 1 nursing assistant on each block. On night shift, there is usually only 1 RN and 1 nursing assistant for the entire floor. This is really challenging trying to manage 15-20 IVs alone with antibiotics, hypoglycemia, etc.  It is quite a shock to me to take care of so many patients after only having 2 patients in nursing school! Probably my best preparation was the summer I worked as a nursing assistant on night shift in the nursing home and was in charge of 50 patients at night. But the nursing home patients only needed custodial care; they were not acutely ill such as these complex diabetic patients.

All patients who are diagnosed with diabetes come to our floor whether they have a medical or surgical problem. We can closely monitor their blood sugars and adjust their insulin or tablets appropriately. We also are taught to quickly recognize and treat low blood sugar with 50 cc intravenous injection of glucose if they are unconscious.

When a patient is newly diagnosed with diabetes, they are admitted to the hospital for an entire week of classes. We have a new diabetes classroom and have class every day after lunch. On Monday, we teach them about diabetes in general by showing a short 8 track film and using posters. On Tuesdays, the dietician teaches them about the diabetic diet and counting exchanges of the different food groups. Wednesdays, we teach them about the 3 different oral medications (Diabenese, Orinase, Tolinase) and the 4 types on insulin (Regular, NPH, Lente, Ultralente) and they learn how to inject insulin into a sponge for practice. Thursdays we review exercise and how to travel with diabetes. Fridays we teach them about foot care and skin care since they are prone to ulcers on their feet, and what to do when they become sick. We also encourage them to walk around the unit to get their exercise. I really enjoy teaching the classes!

I have completed 4 weeks of orientation on day shift. Next week I go to evening shift for 2 more weeks of orientation, and then I’m in charge of the whole unit. I have to admit, it sounds rather scary… Every day before I go to work, I ask the Lord to give me wisdom in making the right decision and to help me learn all this new information. I am definitely on information overload!

If any of you lack wisdom, let him ask of God, who giveth to all men liberally, and upbraideth not, and it shall be given him. James 1:5

Reflection – 2014

As I think back over the workload on that very busy diabetes unit, I can recall so vividly my feelings of inadequacy and struggles with time management and making the right decisions, especially in emergencies as a new graduate. I quickly became much more comfortable with patients with diabetes which had been a weak area for me in nursing school. There are now so many medications available to treat diabetes, that it is hard to keep up with them!

I am so thankful we now have plastic IV bags and that the antibiotics are mixed in pharmacy before they are delivered to the floor. I recall dropping a glass bottle on occasion which shattered and made a big mess!

The advent of the blood glucometer so each patient can check their own blood sugar numerous times daily has made patient management much easier. As a result, the urine dipsticks for sugar have become obsolete. Our unit piloted one of the first glucometers which cost $500, needed to be plugged into an electrical outlet, and was about 4 inches by 6 inches in size. But it was much better than calling the lab for a stat blood sugar before giving the patient orange juice loaded with 3 packets of sugar while we waited for the results.

 

Graduation from College of Nursing!

March, 1977 – Winter Quarter – College of Nursing

The final few weeks in nursing school have been so busy between clinicals, sending out resumes, and interviewing for jobs. My first job choice was to work in home care because that was my favorite quarter. I met with the director of nursing at the county board of health where I had my clinical last fall. She said they would be very interested in having me work for them after I gain at least one year of experience on a medical or surgical hospital floor. Because it is such an independent position alone in the patient’s home, they do not hire new graduates.

I also interviewed on a medical unit for evening shift at University Hospital where I have had many of my clinical sites. My third interview was at a 300 bed community hospital located downtown in a low income neighborhood. The head nurse on the diabetes unit seems very friendly, efficient, and has developed an impressive diabetes program.

I was offered both hospital positions, so after praying about it, the Lord gave me peace about accepting the evening shift position on the diabetes unit. Since I am rather weary of the huge 1000 bed busy University Hospital, I am ready for a smaller quieter place.  I hope the hours will be a good fit for me since I am not a morning person. Like all hospital nurses, I am required to work every other weekend and every other holiday. I will be able to attend morning worship at church every Sunday, but I am sorry I will miss every other evening worship and most prayer meetings on Wednesday nights. After I have some experience, I hope the Lord opens the door for me to work more regular hours.

I guess it paid off to go to summer school and graduate 3 months before the majority of my nursing class. I am very blessed to have had 2 good job offers since there is an overabundance of new nursing graduates presently.

My graduation was held inside at the 10,000 seat basketball arena. The graduates sat in rows on the basketball floor while our families and friends sat in the stands. It was a happy thrilling moment when they asked the 20 of us in the College of Nursing to approach the table where we were each handed our degree! I was so thankful all my family could attend! We had a nice dinner afterward and I showed them the hospital where I will be working.

Pamela Receives Her Bachelor of Science in Nursing Degree!

Pamela Receives Her Bachelor of Science in Nursing Degree!

My Brother tries on my Cap for size! He graduated 2 years later.

My Brother tries on my Cap for size! He graduated 2 years later.

Grad family

My family rejoiced with me!

Dear Lord, Thank you so much for your grace and strength these past four years of college. I know I could not have completed my degree without your help! Thank You for the times of sweet fellowship with the brethren, and for the trials that pressed me closer to You. I pray for all the students from around the world who heard the gospel, and pray they would receive You as their personal Savior. I commit my nursing career to You and pray You will use me for Your glory and honor! In Jesus’ Name I pray, Amen.

Thou wilt show me the path of life. In Thy presence is fullness of joy; at Thy right hand there are pleasures for evermore. Psalm 16:11

Reflection – 2014

The Lord has been so faithful to me these past 37 years. I am amazed that I am still able to work full time in nursing despite the number of health problems over the years. He has always wonderfully provided for me and given me so many opportunities to share the gospel around the world during my various travels.

My first pastor always taught us to record the number of gospel tracts we handed out and the books we read on the home Bible study program. As I was rereading my college journals, I was curious to total them. I was totally amazed that by God’s grace, He allowed me to hand out 2381 gospel tracts on campus and read 45 books in the home Bible study program during the four years I was also studying nursing. It was such a privilege to meet students from all over the world! I am so thankful I was taught early in my Christian life to always put God first (Matthew 6:33) and to be “redeeming the time, because the days are evil.” Ephesians 5:16

 

Graduate Nurse Banding Ceremony

Febuary, 1977 – Senior in College of Nursing

It is hard to believe I am in my last quarter of nursing school before I graduate in March. This quarter my clinical site is the Intensive Care Unit (ICU) at University Hospital. I truly thank God that everything I learned the past 4 years is finally coming together! I am receiving a good review of anatomy and physiology as I spend many long exhausting hours making my care plans for these complex patients. I go to bed at 1 a.m. after finishing the care plan, and arise at 5 a.m. in order to get to ICU ready for report at 7 a.m.

I have a very nice instructor, Miss B. She corrected me last week after I gave a medicine Intravenous (IV) push without her or my preceptor being present. Earlier in the quarter she told me to work as independently as possible, but I guess that does not apply to IV meds yet! Thankfully, no harm came to the patient.

At the third week, I became filled with anxiety that I would not make it through the quarter because it was so difficult. I pleaded with the brethren to pray for me and claimed Isaiah 40:29.

He giveth power to the faint; and to those who have no might He increaseth strength.

The Lord gave me victory and lifted the horrible depression and sense of defeat. From then on the quarter was fine!

The end of January, my class had our ceremony where we received our black velvet band to attach to our nursing cap! It was such a proud moment of accomplishment to come this far and pin that black band on that only graduate nurses are permitted to wear on their caps. My family traveled 2 hours so they could share this special time with me.

Approaching the podium to receive my band.

Approaching the podium to receive my band.

banding 2

Pinning on my new black velvet band.

banding 3

I almost feel like Cherry Ames with my black band!

Reflection – 2014

Nurses no longer wear caps in the clinical setting. It was optional to wear mine in the hospital where I first worked after graduating. I wore it very proudly at first, but as I bent over a patient to do his dressing change, it fell into the middle of my sterile field and I had to start over. I also knocked it off sometimes on the over-bed trapeze bar. There was no good way to clean it since it was made of starched almost cardboard like material.

But there were some advantages in wearing it. I could easily identify which nursing school the person had attended. I still am fascinated when I look at old pictures of the wide variety of nursing caps! It also set us apart from the nursing assistants so the patient knew at once that I was a nurse when I entered the room. During a code for a patient emergency, it was easy to recognize who the nurse was because of the cap.

A variety of nursing caps!

A variety of nursing caps!

I still have my slightly yellowed cap tucked away in my bottom bureau drawer. Occasionally, I gaze at it fondly and recall that proud moment when I received my black band!