As The Pump Turns

Me walking through the side door from the parking lot, carrying a grin and a purple pharma bag filled with pens.

Nurse R: What is that?

Me: Pharma bag and pens, (pharma rep) stopped me in the parking lot and gave me some.

Nurse R: (raising eyebrow) Kim’s having an affair with the drug rep.

Tech: Pen whore!

(everyone laughs)

Me: yes that’s right I am a prostitute and my johns pay me in pharmacutical pens.

Nurse R: Ohhhh….the blood cell pen, sweet.

If you haven’t noticed we love pharma pens.  My favorite is this one:

Oh and if I was having an affair with the drug rep I would so tell everyone, he is a beautiful man.

So, in finding out more info about my dialysis job I was informed it was in a hospital.  Cool, I thought, acutes!  Then my new manager said something to the effect of “children’s…”  

Oh shit!

I have never dialyzed a child or adolescent, however, I feel this is basically fate.  I have always thought I’d end up somewhere in nursing with children.  I never thought peds nephrology, but it works.

I guess I need learn what a normal pediatric kidney patient blood pressure is….oh crap.

There was this day about eight months ago, I was working at 48 chair dialysis clinic.  My area was in the back against the windows and in the “isolation” pod.  Where we keep our Hep B patients, they can not dialyze with the rest of the population due to the fact that hep B is highly contagious.  Anywho, the isolation room is a big 10 by 10 room with glass walls.

We had this traveling patient that was for lack of a better word, a total dick, he yelled at us, tried to spit, cursed and tried to hit me while I attempted to put in his needles.  Eventually his treatment was initiated and I left him alone and he fell asleep.  About two hours pass and all of a sudden he bolted from his chair, stood straight up and started screaming.  I walked towards the door and asked him to sit down, I needed to glove up and gown up before I could get him anything he needed.

He’s cursing and screaming and basically throwing a fit, I summoned the nurse and a few burly techs show up right when he pulls out his venous needle.  I mean like takes off the tape and pulls it out.  Then he began to wave it around the room, making hep B blood waves on the glass walls, blood is pouring from his fistula, squirting out of his sharp needle and he’s painting the walls.  Painting the freakin glass walls with his blood. 

Zack, a quick thinking newbie nurse shut the glass door and told us to wait.  We basically have to wait it out.  And we waited until his eyes rolled in the back of his head and he hit the floor covered in his own blood.  Then we started the rescue protocol.    The police were never called, no report was ever made.

He lived, I am sure he is inflicting his anger upon some other dialysis clinic somewhere in the great states. 

The four of us who were involved in this little fiasco got called on the carpet for it.  We were asked why we waited for him to basically pass out due to blood loss before we did anything.  My answer basically was because it was not worth it to rush in there with a man who was waving a sharp 15 guage dialysis needle around who had hep B and whatever else he failed to tell us.

We all got written up, the manager agreed we made the right choice but if the man were ever to sue us he had to show disciplinary action. 

I know in my heart I made the right decision, the man did not die, he did stay in the hospital for a few days, but he survived. 

In dialysis there seems to be a gray area when it comes to patients behaviors.  They are allowed to yell, scream, spit and make rude comments to us without a blink of an eye from administration.  They are our customers, the patient is always right, jack up the heat to 85 degrees for the patient because they forgot their blanket.

Yes, we are here to take care of the patients, to offer them compassion and care.  But we have to protect ourselves too and the other patients.  The Hep B man was angry and we felt he would probably try to cut us with his needle.  Our health was at stake.  I don’t regret doing what I did, it was his choice to remove the dialysis needle, he received care once he was no longer a threat. 

EMTs and paramedics are not allowed to go into a situation where their lives are at risk, they are to wait for police.  Why is it that dialysis clinics are different?

Any disgruntled patient can walk into any dialysis clinic across the United States with a handgun and take out the tech who hurt him the day before.  There is nothing to protect us. 

Last week a patient was taking out his stuff from his backpack and mace fell out if it.  He brought a weapon to dialysis.  Yes, mace is a weapon, okay, a weapon.  What happened to him?  Nothing.  Sure, he didn’t try to use it, it just fell from his backpack, but not one administrative person came to talk to him, even though the two techs who witnessed it went and complained. 

Has healthcare gotten to the point where we have to risk our lives to make the patient happy?  Does the welfare of the staff mean nothing?

I have landed myself a job.  Right smack in the middle of Seattle, with apparently a great view.  I don’t know what that means but it was thrown in with the deal.  Having the BONENT has paid off considerably.

I am on the waitlist for a few apartments.

I have kindly suggested to my cat that we will be moving, he meowed and sat by his food bowl. 

Things are coming together.

….what kind of craziness is this?

So someone once asked me…okay, no one actually asked me, but I assume someone must have wondered at one point or another why I named my blog what I did.

“As the pump turns” actually came from a conversation I had at work with Texting Nurse and a few techs.  My clinic has the nurses station in the exact middle of the unit, the dialysis machines and chairs skirt around the edge, hugging the wall.  When things have slowed down, all the patients are on and we have a few minutes to breathe we usually gather in a semi circle and gossip talk. 

As almost anyone in dialysis knows the patients have to do but watch TV or watch US.  That seems to be the case most of the time.  It’s like a fish bowl and the workers are the fish.   You’ll catch one in the corner of your eye, a patient with a grin after you said something you thought was a whisper.  Busted. 

We are basically the patients daily soap.  I swear we could do an hour dramedy on dialysis, the things that occur in the dialysis clinic are classic and priceless. 

It’s like As The World Turns only with more blood.

This is why I love Postsecret because sometimes it’s nice to know someone else out there felt the same way at some point.

A collection of things I have noticed from my years as a dialysis tech.

• When you first start at a outpatient clinic get a ride to and from dialysis for the first few weeks, so you can stabalize and see if driving is an option. 
• Until you know what your body does on dialysis don’t bring a big meal, some crackers or a small snack should be okay.  Big meals can cause big problems while on treatment, all the blood rushes to your gut to help digest food, which could lead to nausea, dizziness and a crash in blood pressure.  So ease into the big meals to see if you can handle it.
• Come in at least 20 minutes before your scheduled “on-time”, the staff appreciate it and it’s not as rushed as when you come in late.  You can schedule many impromptu things in those twenty minutes, a private talk with the RN, social worker or dietician.
• Know and remember the seven signs of grief.  Consider this a loss, a big loss.  Treat it as one and mourn, there is nothing wrong with doing that, it is expected and healthy.
• Remember that more in likely this will be a long term condition, at least a few years before a transplant can become available.  Make choices that will help you in the long run.
• Family members have to grieve too, anger may be a big one.  As things start stabalizing for you remember that there are times you won’t be able to do what you used to do, so take your time, take time to rest, stress to them how tired it makes you.
• Use our resources.  Money can be tight with all the meds and the lack of work some dialysis patients experience.  So USE our resources, we have them.  In our community we have a Kidney Crisis fund that is run by dialysis staff and patients.  We give an allotted amount to every dialysis patient in our county based upon need.  Water heater breaks in the middle of winter, who do you call?  KCF!!!  It’s all voluntary and we get our money from fund-raising.  So use us.
• Communicate with the Nurses and techs at the clinic.  If you fall, bleed after dialysis, have dizziness or cramps at home, let us know.  We can help you!
• Take your binders.  I can not stress this enough, take them!!!
• Frustrated by those Doctor drive-bys while in the chair, call their offices and request an appointment.  Your insurance is paying for it in full every month, Doctor’s have to see you every month.  Get your monies worth!
• I am a firm believer in Home Dialysis, whether it be Hemo or PD, it doesn’t really matter to me, find what’s best for you.  Talk to the nurses and techs, even if your dialysis center doesn’t have a home dialysis program you can usually find one in your area.
• Travel.  Yes you can travel.  Many dialysis patients are scared to travel.  They don’t want to visit other clinics, don’t want other people sticking them, but yet miss going on a cruise or just enjoying a few days away from home.  Social workers can plan for vacations, always ask you never know what you will get.

Things don’t bother me as much as they used too.

My nose has come gotten used to the sterilent smell of the clinic in the mornings when things are shut tight.  When I walk into reuse I don’t retch at the smell of congealed blood. 

I don’t bat an eyelash when a patient tells me about his urinary tract.  It doesn’t bother me that every third week of the month I will be measuring urine volume and suctioning it into test tubes. 

I’ve seen toes fall off, I’ve seen aneurysms the size of tennis balls, I half expected them to explode.  I’ve seen people go downhill, I’ve seen people we’ve thought wouldn’t make it one more day last three years. 

But in the end, some days you feel like you haven’t accomplished much, you can’t cure kidney failure. This is the thing that bothers us.  You can raise all the money, you can dialyze as many people in twelve hours, but in the end, it feels like you haven’t done much.

That is why the Dialysis nurse and tech burn out rate is so high.  There are only two ways out of kidney failure. 

You can live a very happy life on dialysis, you can dialyze at home and do all the things you did before.  You can get a transplant and pee to your hearts content. 

But this isn’t always possible. 

So if I look a little sad today it will pass, we take it hard to, you know.

Author’s note:I love my dialysis patients, I really do.  I couldn’t do what you do every other day.  I’d be a whiny baby, really I would.  But there are somethings I don’t understand, so you know, if you are a patient and reading this, so don’t take it personally.  Mmkay?

I really don’t understand some things.  I understand that you have every right to refuse some part of your treatment, I will give you that.  But refusing a graft or fistula because and I quote, “it might hurt”, makes me a tad irritated.  These aren’t extremely old, frail people who would suffer or perhaps die from the effects of surgery.  These are people in their mid-thirties and forties. 

There are lots of things in this world that “might” hurt.  But tell me how bad it hurts when your CVC catheter is infected or because you’ve had so many catheters placed in your chest the only other place is in your femoral vein…yeah sexy, thigh cath.

Yes the surgery will produce a little pain, and the needles may or may not bother you (we have lidocain).  But in the long run you’ll feel better and be happier and shower without having to change the bandage!

Shower!  People, you can shower!  Or swim…or, have your cat lick your chest to its ultimate pleasure, all things that you can do with a fistula or graft.  So if not for your health, do it for your cat people.

Oh and by the way, “special brownies” not an appropriate food gift for dialysis staff.  Thanks.

Normally I am a very calm, rational person, not much really irks me or gets me too riled up.

But I am having one those days…

I am freaking out because I am moving to Seattle in 53 days…Fifty-three days.  Like it’s official.  Put in my 53 days notice, my last day of work is August 28th, my landlord knows I am leaving my apartment.  AHHHH.

But I don’t have a job, I don’t have an apartment.  I have nowhere to live and no job.  The one place I want to work (I check there website for job openings everyday, it’s a sickness), only has one position open for a part-time tech…

So are there like tons and tons of Dialysis Technicians moving to Seattle?  Or am I just, you know, bad luck?

My other question…do I live in Seattle and live a very pedestrian lifetsyle (the thought scares me, I love my car and basically live in) or do I live in the outskirts and save money on rent but spend it on gas?

Okay enough of that silliness.  In other news, the ex-ex boyfriend came from Humboldt county to visit.  He was a paramedic with the local Paramedic Ambulance but went up to Humboldt State to get his nursing degree. 

We’ve been talking and seems we both have kind of grown up since our last little debacle.  I promised myself I would never date him or anyone else in the “business” again.  So, it’s nice just to have my friend back.

(He’s the blonde boy, I am the blonde girl)