Ebola: From Eyes of an Emergency Nurse

It's Tuesday night, my bladder is full, and the emergency department is poppin'. 11.5 hour into a 12 hour shift that consisted of multiple heart attacks, strokes, and a motor vehicle accident, just to name a few patients seen tonight... When a patient with nausea, vomiting, and abdominal pain is triaged into my care, the first question I immediately asked is, "Have you made any recent travels within the last 21 days?" Of course the patient rudely snaps, "I don't have Ebola; I just ate something bad."

As an emergency room nurse, my primary focus is on the immediate safety, whether that be for patients, the community, or on a good day, caring for myself. Nursing is a selfless job, and it is very bothersome when patients are rude to the person who is caring for them, essentially saving their life. But, that's human nature, I guess, and nurses have learned to deal with it.

I'm sure many of you have heard about the Ebola outbreak in Dallas, and if you haven't, you probably live under a rock. If that's the case, stay under the rock, it's most likely safer. With recent media coverage, the infected nurses from Dallas are receiving a lot of backlash for improper technique. However, the truth is that a majority of us are not equipped to care for Ebola. According to the Centers for Disease Control and Prevention (CDC), personal protective equipment (PPE) should suffice against the spread of the virus. However, Ebola is a creature in itself.

Lets put this into prospective. The CDC precautions for the Ebola virus are contact and droplet, which consist of the following PPE: gloves, a disposable gown, mask, and goggles. I agree with the CDC that this is the normal protection against contact and droplet illnesses, but my question is... 

Is the Ebola virus normal? 

I mean the virus ONLY kills 50% of it's victims compared to the 1-2% influenza (flu) does. Oh, and by the way, Ebola and the flu are spread the same way--surprise! However, non-like the flu, Ebola has no FDA-approved vaccination or medication; care is focused more on symptom management rather than treating the disease (e.g. intravenous fluid resuscitation, electrolyte balance, oxygen preservation, and hemodynamic stability). Recovery relies on supportive care and the patient's immune system. With a virus of this magnitude, so easily spread, and no cure, why are nurses risking their lives being equipped with only standard PPE. And, why does the CDC get to wear the full Hazmat suits? But, of course then when a nurse contracts Ebola, it's their fault--no ifs, ands, or buts about it.

Hazmat

Healthcare professionals care for many patients each day, several with curable illnesses and some that are not treatable. Ebola is unpredictable, and many of us are ill-prepared and not equipped to care for the virus. Believe it or now, healthcare professionals are humans too; we are not perfect. I'll be the first to admit that I make mistakes. But, with that said, we are doing everything we can do to be near perfect, including staying up to date on our skills and on illnesses such as Ebola. As the Ebola virus continues to spread and affect more lives--and it will--it is going to be a challenge for nurses and patients. However, the care and treatment development will only continue to evolve. In the meantime, please have faith in us, nurses. We really do know more than you think we do. We are not as incompetent as the CDC or the news anchor--reading cue cards--would like you to think. 

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Signs and Symptoms of Ebola:

• Fever (greater than 38.6 degrees C or 101.5 degrees F)
• Severe headache
• Muscle pain
• Weakness
• Diarrhea
• Vomiting
• Abdominal (stomach) pain
• Unexplained hemorrhaging (bleeding or bruising)

For more information visit the CDC website.

Six Months

"You have six months to live..." The words linger in the doctor's month. 
"No, take that back; this has to be a dream." The patient pinched himself. Nothing. The words punch him in the chest, knocking him to the ground in tears as reality sinks in.

It's hard to do, but close your eyes and imagine yourself in that situation... Now open them, and continue reading--pretty please.

You can really learn a lot from someone who is very ill or dying. I'm starting to think that nursing is not about caring or healing the patient as much as it is about just being there for them... Learning about life... Changing the way we think. And, it's about teaching other who are still living the things we've learned from the dying. I feel rather selfish because I teach my patients so much everyday, but I think my job has taught me so much more about life and living. Don't get me wrong... I do heal my patients, making sure their care is the best enhancement for their quality of life. But, some patients are terminal--they cannot be healed [physically]. I find this is where my job takes a turn... I'm no longer the teacher. I'm no longer the caregiver. I'm not a nurse. But... I'm a friend. A listener. The learner.

Death:  it's a powerful teaching tool for life and living.

However, I don't know why it takes death and dying to show people things about life. Maybe it's because everything else become irrelevant--nothing matters anymore... But the time you have left with family and friends... But living... And love... It all boils down to love.

I can't even imagine how it must feel to know you are about to die--six months to live. Though, I imagine all other life's problems are much inferior. A lot of us, most of us, go about life all wrong... At least until it's too late.

Ryan Gosling

Who cares about the latest gossip column on Ryan Gosling? Who cares about the football game on Sunday? Who cares about the new Halo game... A shiny new car? The newest trends? The next iPhone [that is exactly the same as the previous model with the headphone jack on the opposite end].

We all do... But should we?

I can only express what I know and have learned. I know there is much more to life, but it is taken for granted. We tend to rob ourselves of happiness by not doing the things we love and care about the most. We put so much hard work towards the things that, in the end, don't matter at all. I think we can all agree that life is about living... Being with the people we care about... And loving. 

Why not do just that?

Today, I challenge you to sit down and to think about life. Write down what really matters to you--what you value and cannot live without. What keeps you living? What keeps you optimistic? Whatever that is... I challenge you to do everything you can today in order to do it. If it's your mom, call her; tell her you love her. If it's food, eat! Give up your diet for the day. Enjoy whatever it is while you still can. 

You just never know when you'll only have six months to live. Welp, that is unless you're a Mayan. According to them, we all have less than six months to live.

Might as well enjoy it!

Live. Love... While you still can.

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Update: 

Life is going really well in Washington. It rains more than every now and then, but I don't mind it one bit. The people here are really open-minded and receptive--like that a lot. I have met some new people, along with enjoying the time with my friends already here. The worst thing so far is having a full bladder and cold hands. Or, having a cold toilet seat and having to... Well, you know... Though, I have noticed an increase in suicidal and depression rates here. But, that is not me! I can't believe I have been in Washington for almost two months already. I miss my friends and family from back home a lot. I can't wait to visit home again. I was hoping to for the holidays, but I'm the lowest man on the totem pole at work again. Grrr... That's okay... Soon! My mom did come visit me, however. It was funny. I was joking with her on a Thursday to come visit for the weekend and before I knew it, I was buying her a plane ticket that flew to Seattle the following morning. Talk about spontaneous and living life. I love her very much. 

Welp, I think that's all for now. I truly am bless to have a great job and a lot of great people in my life.

Rankin Out.

Dying Young

Life, whether you believe it or not, is precious. But... Life, regardless if you mean to or not, is taken for granted and mistreated everyday. And yes... I, too, am guilty of this heinous act. However... Today, here and now, is the time to change that!

Whole milk dairy products, ice cream, butter, eggs, shrimp, and liver are only a few food high in cholesterol.

Chad, why are you talking about high cholesterol? 

Well, my friends, 25% of Americans in the United States die of  heart disease each year; that's a 1 to 4 ratio.¹ BUT... The real reason is, I was recently diagnosed with high cholesterol, and it scares the poop out of me. 

Life is ironic.

A guy who has never touched a cigarette in his life. A skinny twig. An active jump roper. High cholesterol? Ironic.

The doctor determined it was hereditary, and I was started on medication--Simvastatin 40 mg PO hs. The funny thing is, I have given several of my 60+ year old patients lower doses of this same medication. Ironic!

With all ironic-ness set aside, I want to bring awareness of heart disease prevention. Everyone, young and old, should be proactive in their healthcare. I'd first like to start off by giving my definition of what cholesterol is. If you would like a more professional definition or more information, I would encourage looking at American Heart Association [AHA], Center for Disease Control and Prevention [CDC], MayoClinic, or WebMD.

Cholesterol [a waxy, fat-like substance that the body needs] is similar to hair in a bathtub drain. Though, your body does need cholesterol, too much can be detrimental to your health. Like hair in a bathtub, if you have too much of it, it's harder for the water to drain. Too much wax build-up in the arteries can harden and form plaque, making it harder to perfuse vital organs, such as the heart and brain. This sometimes can lead to a complete blockage--myocardial infarction/stroke. 


Do you see why this issue is so important? 

Risk factors and prevention according to the CDC ¹:

• Hereditary: Inevitable
• Age: Inevitable [greater than 25 years]
• Diabetes: Maintaining blood sugars levels between 70-110 is optimal.
• Diet: Avoid saturated fats, trans fats, and triglycerides. Increase monounsaturated and polyunsaturated fats.
• Weight: Lose weight and maintain a health body mass index [BMI].
• Physical Inactivity: Adhere to a moderate-intense exercise regimen for a least 30 mins [most days of the week]. 
• Smoking: This is a nasty habit and no one should do it. You're not only increasing your chances of heart disease, but you're also harming the innocent with second-hand smoke.

I never thought I would have health issues at such a young age with the level of activity in my life. But... I do. Life, so crazy and unpredictable, can be taken away at any moment. And... Life, not promised to anyone, will go on with or without us. So... Today is the day to make a healthier change. Because... There is no sense in dying young.

... Here's to a healthier, longer life!

¹ CDC. (2010). Cholesterol. Retrieved August 28, 2012, from http://www.cdc.gov/cholesterol.

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Update:
Where do I start? You already know about the cholesterol, so yesterday's Facebook status can pretty much sums it all up in a nutshell.

Sh-long for now.

Rankin Out!

Healthy Mind; Healthy Body...

... Healthy Life!

In recent years, the most common trend sweeping the nation seems to be healthy living. If one hasn't said the following, chances are they know someone who has: "For my new year's resolution, I want to lose weight." However, wanting and doing are two different things.

Time after time, I see people fall short and lose site of their goal. Thus, I want to share my Tips on healthy living. I also want to add that this is my opinion and not medical or evidenced basic practice. It's simply from my heart and brain, which works for me.

My morning nursing assessment:

When I walk into a patient's room, I first observe the surrounding area. I look for clues to one's lifestyle, one's culture, one's health, and potential hazards to one's health. The lifestyle I live is that of my own, but the cultures I share are that of many. Though I'm Italian, I strive to be culturally competent. My health might be described as controlled chaos with potential hazards that could ultimately destroy my soul. However, the thing about health care is that we are always weighing our options--the risks versus the benefits. Sometimes it's beneficial to take a risk. Some call it careless, but I call it living.

Tip # 1: Focus on you; your soul. Care about yourself while caring for other. It's worth taking risk for the people you care for. This is good for your psyche.

Once I introduce myself, I then ask the patient the following four questions:

Can you tell me who you are?

Do you know where you are? 

Tell me what today is.

Are you in any pain?

I find these questions deceiving because I don't even know who I am nowadays. I don't know where I am or where I'm going. Life is unpredictable. However, today is a new day. Find something worthy living for. Everyday is an adventure--a new paragraph in the story call Life. It's an opportunity to do something epic. Pain... It comes and goes, but pain is what makes us feel. It makes us strong. It helps us understand pleasure better. "If you're going through hell, keep going." - Winston Churchhill

Tip # 2: Find something worth living for. Even if it hurts, don't give up. It's healthy to stay strong.

I then look at the eyes for the pupils to be equal, round, reactive to light, and accommodation. I see a world lacking equality and more narrow-mind than well-rounded. The world is dark and cold. War is all around us. It's up to present to change the perception of the future. It only takes one person to lead an army--to change the perception of many. Why not raise the youth to love, to care, and to treat everyone equally?

Tip # 3: Be a good role model. Someone looks up to you. Create a healthy future.

As I place my stethoscope on the apex of the lungs, I tell the patient to take a deep breath in and out, listening to the air fill the lungs and escape again. My lungs fill with air. I breathe, but my breath is easily taken away by the right person. Everyday I wake up breathing, I am thankful because I have another chance at life. 

Tip # 4: Relax and breathe. Take time each day to focus on your breathing, but don't be afraid to let someone take your breath away every now and then. Unneeded stress in your life is draining and unhealthy. 

My stethoscope is then place anteriorly on the chest to auscultate the heart. My heart tells the truth. It knows my feelings before my brain can even comprehend what's going on. It becomes tachy [beats fast]. It loves strong. A picture is worth a thousand words [my friend posted the picture to the right on Facebook today]. "I took a deep breath and listened to the old bray of my heart: I am, I am, I am." - Sylvia Plath

Tip # 5: Love. Listen to your heart, express your feelings, and don't hold back. Everyday is full of missed opportunities, so don't miss out on something that's right in front of you. It's important to have intimacy and solidarity rather than isolation [Erik Erikson].

As I place my stethoscope on the abdomen, I auscultate the bowel sounds and ask, "when was your last bowel moment?" Life is full of crap, but I either take some toilet paper and clean it up... Or I plug my nose and ignore. Besides one glance from that special someone can cause your belly to tingle and make you forget all about the smelly crap. Haha!

Tip # 6: Laugh and ignored the "bull shit." Laughter, in my opinion, is a natural cure and main ingredient in health promotion. 

Finally, the skins is palpated. One touch can cause my arrector pili muscle to contract, sending chill bump down my spine. 

Tip # 7: Touch. It's a necessity to living.

When two heart beat as one, breathing synchronizes, and the warmth from the closeness of two bodies is felt, nothing else in the world matter. It's the feeling of being safe. The two bodies work perfectly together. It's perfect. It's healthy to focus on you, be strong, create a healthy future, relax, love, laugh, and touch.