On death and dying

Sometimes it's depressing for me to work around so much death and decay. It's hard on the mind, body, and soul. One of worst feelings for me is having to take care of a patient everyone knows is actively dying except for his/her family. Money and denial are strong motivators. 

Working in the ICU, I see a lot of things happen on a daily basis to the human body that really shouldn't be happening. It's my personal belief that some of the things we do to our patients for the sake of "doing everything we can" fall into the category of cruelty. I believe in protecting human dignity and that is a difference between saving a life and prolonging suffering. Here's my thoughts on dying patients:

1. People die, it's a part of life. 
2. But if you fuck up, you just killed someone.
3. You have a job because someone is trying to die; your job is to not let them.

Remember this line from the ANA Code of Ethics: "The nurse should provide interventions to relieve pain and other symptoms in the dying patient even when those interventions entail risks of hastening death. However, nurses may not act with the sole intent of ending a patient's life even though such action may be motivated by compassion, respect for patient autonomy and quality of life considerations."

What we can and can't, should and shouldn't do is so contradictory. 

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On a related note, I've learned a couple things that aren't in the books in regards to keeping your dying patients alive or recognizing that they're about to crash on you. There's no evidence based practice behind these, they're just things I've noticed. 

1. The less you touch your patients, the less likely they are to die. Yes, I know you're supposed to turn your patients often to prevent pressure ulcers and skin breakdowns. But when you see a patient desaturate for 15 minutes or go bradycardic and see rhythm changes from being turned 30 degrees, its time to stop touching them for a while if you want them to live until your shift ends. 
2. The poop of death. The final release. The phenomena of terminal defecation. Excreta ultima. If you've seen it, you know it happens. That massive dump that happens right before a patient codes. I think it has to do with massive K+ loss followed by sine waves and fibrillation, but what do I know. 
3. Patients on long-term vasopressors are going to feel cold. Don't warm them up. The cold is from the vasoconstriction in their periphery, which will eventually lead to tissue breakdown. But if you warm them up, you'll cause vasodilation which is going to drop their blood pressure. Take your pick. 

The prerequisites

Most schools I've looked into have the same basic prerequisite requirements. If you've been working as an RN in the ICU, most of this stuff you should have already.

• Bachelor's degree. Usually BS in Nursing, but some are ok with a related or science field.
• GPA of 3.0 or higher. Keep in mind that this is a minimum requirement. I've seen GPA requirements as low as 2.75 but in reality a competitive GPA is probably around 3.75.
• Most programs will require one or more of the following: 
• Statistics 
• General Chemistry
• Organic Chemistry 
• Biochemistry
• Physics
• Anatomy and Physiology 

• Minimum GRE scores (2012+) of 297 to 300. 
• RN licensure. This should be unrestricted and have a spotless history.  
• Between 1 to 3 years of experience in critical care. Some places will consider ER, PACU, and OR.
• CCRN and/or other additional professional certifications
• BLS, ACLS, and PALS Certification
• A rich sugar mama to support you through 24-28 months of schooling cause you won't be able to work. 

So where do I stand in all this? 

• Bachelor of Science in Nursing, from a state college
• Undergrad GPA = 3.27. Hardly competitive for most programs, but I've taken graduate level nursing courses in pharmacology, pathophysiology and a couple others with a GPA of 4.0. 
• The only other extra courses I've taken are statistics and general chemistry. I also have a introductory general general/organic/biochemistry course. Anatomy and physiology were done as preqs for my BSN program. 
• GRE scores: Verbal=157, Quantitative=153. Waiting on my analytical writing scores. 
• About 3 years of experience in critical care
• CCRN is completed. Also have TNCC in addition.
• BLS, ACLS, and PALS under my belt. In addition, I'm also a BLS Instructor and working towards becoming an ACLS instructor. 

Good news today from Kaiser!

I got this email from the Kaiser Permenante School of Anesthesia earlier today. 

When I applied for shits and giggles back in 2011, I got a phone call and was rejected outright. An email saying "...you meet our minimum requirements..." is a step up. Yeaaa buddy.

Introduction

I know what this blog sounds like. It sounds like a blog about farts. My girlfriend claims that the flatus produced by my bowels is some of the most rancid she's ever smelled. It's safe to say I that is one part of my life I've mastered.

This blog is here so I can vent about being an ICU nurse. I'm not really the politically correct type, so you'll find some pretty blunt and uncensored "confessions of an ICU nurse" type things on here. Like how if I'm gassy at work, I go into my demented C.Diff positive patient's room to crop dust.

It's also here because I'm trying to become a Certified Registered Nurse Anesthetist, or CRNA to those unfamiliar. This blog is to help me keep track of what I've actually done and my progress.

If you're reading this, you're probably a nurse or looking towards becoming CRNA too. Hopefully you can give or get a little insight along the way.