Ramblings By Rhianna

September 14, 2008

Kathy Russell Passed This Way

Filed under: My Life, ER nurse — Administrator @ 3:38 am

Every once in a while something happens that causes you to pause a moment and see where you are, how you are and what you are. That happened this week. One of the girls at work didn’t show up on Monday, and after many worried phone calls the police were sent to her home and discovered she had died over the weekend sometime.


 It stops you in your tracks and makes you ask…” what is the purpose of it all”. What is our purpose in it all?  
That personal theory that I’ve held on to says, there is no reason in death, only purpose in life. How does it fare when it takes on the reflection of someone else’s lifetime?  I only know her from the stand point of where Kathy’s life intersected with mine. She was strong and fierce and like all of us, a pain in the ass sometimes. She was a presence to contend with, one who was felt when ever she was around.  She made me laugh and often had insightful comments to share. She wanted better things from her life and was not quite satisfied. Like every one else I know, she was frustrated with how things were and impatient for how things should be.  And in those ways she was very much like me.


 So, what is the meaning or purpose? In her role as an ER nurse she saved many lives and lessened the mark of pain or injury for thousands of individuals over the years, was one of those people someone who will change the world? Did she create someone from her body that has ensured her immortality though her daughters?  Was her presence as part of her family, job or friendships enough to make our world somewhat better? Was there something she said or did that has become the place mark of her presence on this world?


 Yes.


 Kathy Russell passed this way. She shared her talents, her sense of humor, her skills as a nurse, her love as a mother, daughter, sister and friend.  Her life may seem to be lost in the communal energy of what makes us grow as people, but it does not diminish what she contributed. I wish I had known her better, but I do know that I am a better person for knowing Kathy.  
 

Rhianna Samuels

May 21, 2008

Drilling

Filed under: ER nurse — Administrator @ 12:19 am

Today was one of those days that drain you, despite how interesting it played out. I’m on the disaster committee team and twice a year we plan a big disaster drill for the hospital. Sometimes it includes the entire community, sometimes it just the hospital. We spend weeks and months planning this exercise in pushing the limits of our capabilities to prepare for the disasters that nature inevitably visits upon the world.

 
It’s only been two and half years since a tornado tore through our city and killed twenty-five. We learned then what happens in reality and what happen in a drill are quite different things. You might be surprised when I qualify that statement to mean it works better in reality than in a drill…at least short term. The hospital staff hates the drills; it’s just another pain in their fanny’s. In reality people pour in to help when a disaster happens.

 
To help make it seem more real, we go the route of moulage. We go to great lengths to have our volunteers looking injured and even encourage a bit of acting for the talented. I had to keep the smile off my face when one of them came off the ambulance crying out. “Where’s my baby, bring me my baby!” An Emmy winning daytime performance.

 
I went to work yesterday and realized the drill was today. I also remembered that my niece’s bf was in town this week and I called to see if he wanted to participate. He is a charming young man, in his last year of nursing school. So, I swung by a little after six am and picked him up and hoped they could use him. As luck would have it, a couple of volunteers did not make it. 

 
Initially he was going to be a jet fuel induced asthma victim, but one of the moulage victims fell out and I used my minimal power to slide him in as a substitute. We headed to the make up room and were soon surrounded by twelve other victims, all part of the OB ward. Beach balls were being taped to abdomens, soot to faces and gashes glued to foreheads. I learned the technique of using tissue paper (the kind you use to wrap your gifts) and vasoline applied to skin. It looks like pealing burnt skin, especially after you add black and gray makeup to give it even more reality. My favorite was the nurse victim with a piece of glass jutting out of her chest. She was so disappointed when they declared her dead. The gray, white makeup was used for the morgue victims. There was even blood along legs as the pregnant gave birth to beach balls.

 
John managed to be a hospital worker who rushed in to help pull victims from the fire-balled hallway and both hands were tissued, vasolined and blackened. Add the sooty face and we were off. Somehow I doubt he felt jealous of the others that were evacuated down stairwells in a paraslyde. Not my cup of tea, but it works.

 
I spent my time on the loading dock to evaluate triage, at least until the decontamination tents went up. As you can see we pushed the system, the staff and hospital and all in less than three hours. Everyone did their jobs and it went well. The police, ambulance services and fire department all participated to make it as real as possible.

 
When I thought to write about this, I considered it an amusing piece and there was humor along the way. I fuss about how it’s always the emergency department that gets stressed, but this time we hit the OB floor with a helicopter and we learned some new things about how to respond to something that would be horrific if it happened in real life. The way our world has been jumbled by nature and man anything can happen and most likely will. Aren’t you glad we keep trying to prepare for it.

 
Rhianna

May 18, 2008

Just a thought.

Filed under: The writer, ER nurse — Administrator @ 8:37 pm

I like complex stories. I hear many people complain that, as writers, we should explore one theme and do it well, rather than pull in many different ideas. Now, this is not about any one book that I have written, but more on how the process is when writing. My day job requires that I do a bit of quality work on processes that are not going well. It’s a standard process improvement dynamic. As you break down each step of the problem, you discover that there are many stumbling blocks along the way to the ultimate goal. The first thing that you do is decide what needs improvement, who can bring about improvement and what is the ultimate measurable goal.

 
In writing a HEA, you pretty much know your goal. Setting up who you want involved in the process, determines the dynamics, but the end goal is always before you and it must be measurable. Is the HEA moving forward, or has it moved backwards and how do you move it forward. The stumbling blocks are your conflict. As one process block is solved, I find that two or three others may pop up as a consequence. The people outside our core team impact the direction of that team and will often change how we approach the process or bring in detail or minutiae. There are some things that only take a few changes and by exploring it well, you have reached the goal.  As a person that seldom gets to work on the simple problems, I enjoy solving all the issues along the way.

 
The big push in quality is evidenced based research. We are creating, measuring and evaluating research to make decisions on what works to ensure the best outcomes. I like the analogy of the formula romance novel as evidence based. Yes, we can improve quality of care for the heart attack, because after years we’ve accumulated enough evidence to prove that if we get them to the hospital, give them aspirin, beta blockers, have a positive ST elevation and to cath lab or thrombolytic interventions fast enough we can save them.  Our Romance formula story gives us the perfect example of this; you meet the beautiful female or plain Jane; A world weary alpha hero; throw in questionable heart pains and mild discomfort that eventually leads to severe discomfort, breaking heart pains and send them to the best cardiac center in the country and it’s all good.

 
I have a lot of respect for the best. I also have a great regard for the firsts. Those individuals that come up with the question of how can we do this better, even if it’s different that how we have always done it. The original great paranormal romance writers, the non-formulaic romance writer or the subtle suspense writers and totally off the wall heroes and heroines who populate some amazing books.  

I see so much of the absurd in life, even life and death. So when I find it in a book, I’m completely pulled in.  When I write, I always know where I’m going, but I don’t always know how I’m getting there, it’s a process and I let the next stumbling block determine the next scene. Although, I write paranormal, I use parallels in the amazing real lives of the normal to build something believable. 

 
Like I said, it’s just a thought.

 
Rhianna

April 7, 2008

I love it when a story comes together

Filed under: The writer, ER nurse — Administrator @ 12:34 am

I love it when a plan comes together.  That was one of my favorite lines from the A team TV series, in the way back when. It works for the writing process also. I love it when you decide on the threads that will intertwine through out your plot. Then you begin to weave with all the threads to create something unique and perhaps poignant.  I have two stories that have now reached that point in my mind and on the page.

 

When I start a story, it generally begins as a simple beginning and ending. There is one event that defines the middle. I lean towards being a panster for dialogue, but I usually have the image for action and characteration. As I consider the story and often before I actually start to write, I have to build the mythology, the details that color the world. I like the imagery of a tapestry. The first step is the story in outline form, or the simple design.

 

The mythology/details are when I decide on the colors. Do I want vivid or murky for this section, should I choose forest browns and greens or bright yellows, pale greens or reds. Will there be birds and angels in the sky or an austere church. It has to be read enough to fall into.

 

More then the skies, the back round of the characters are for texture, bringing them to the forefront, so our eyes are drawn to them. Should this story be made from a hand made loom or manufactured. My preference is hand made with yarn and thread of many thicknesses. There are so many choices to make.

 

I realized yesterday as I wrote on my current wip, that it was suddenly forming a picture that I had not fully realized. Threads that I believed were there for their bulky texture would now become more prominent and extend further, even beyond this story. I love it when a story comes together.

 

On a completely different topic, this last week we had a toddler come in to the ED, who was resuscitated on the scene and survived long enough to spend a day or two in the hospital before his death.  It was child abuse and neglect. The other children had already been removed from this family. The last custody hearing for this child, the judge was recommended to not return him by the social worker and child protective services, but the child was placed back into this home.  HIs death is now on that judge, who I suspect will now carry the burden of his judgement upon his soul.

 

We see child abuse from neglect, physical to sexual abuse come through our doors. Not every day, but enough to have very strong opinions about people who preform cruel acts upon the innocent. I don’t think there is a person male or female, amoung our staff that would consider the death penalty too extreme for any one who kills a child through abuse. The two nurses that performed his SANE came away in tears.  

 

This topic is a well developed discussion among the nurses, doctors and law enforcement officers. I can recall some years ago the 18 month old who came to us with a cervical 2 fracture. One that made her a quadraplegic for life. I was all for the death sentence for that, breaking the neck of a baby. Perhaps it is why in my writing I found some justice along the way for those who could not demand it or make it happen. If you have read Shaking Off the Dust, then you’ll know exactly what I am referring to.

 

Perhpas the oddest thing that you might not know about me is that I still tend to trust people, despite the unsafe world we live in, I still want to believe there are good people, willing to make our lives better.

 

Rhianna

 

 

March 15, 2008

Wearing the nurses scrubs

Filed under: ER nurse — Administrator @ 11:24 pm

This week seemed extraordinarily long to me. It’s a work thing. I usually have my Wednesday’s off and in the last month I’ve worked three out of four of them. Being the supreme candy ass that I am, I start dragging my fanny around, much like the old dog who you forced to go for a walk after years of sleeping at your feet.

 
 I enjoy my day job, for the most part. It is primarily as an educator for my ER, but I do a day at the patient care side every couple of weeks. It keeps me cognizant of the many issues that the bedside nurse must deal with and this year our ER has been exceptionally busy.  Monday is one of those days. My ritual is to wait until I get to the premises to take the 800mg or ibuprofen. If I take it when I get up at 5am, then it wears off half through the shift. I would recommend it for all our nurses, because you work your fanny off. (That’s metaphorically speaking, though I would wish it were literally speaking, because my fanny needs it.)

 
 The last day I worked was quite busy and I had an orientee. I schedule them, so when I’m on the floor it is a good time for me to see how they are progressing. In this instance he was spanking brand new to the floor and supposed to be with someone else who called in sick, so he tagged along with me. I won’t say his head was spinning, but it did get twisted around once or twice as the day progressed.

 

The usual came in for the morning, a diabetic with a blood sugar of over 600, bless her heart she’s been diabetic since she was a child; An abdominal pain; a chest pain; and a couple of flu patients. Then the unusual came into our trauma/critical care room.  It was a woman, who was limp and fairly out of it. She’d been sick with the flu for a week, and had a significant history so she was not brought in until she was bad. Her blood pressure was 51/palp.  Any thing under 90/ is a concern. This was of great concern, but even with this BP she mumbled and followed some commands. Oh, I didn’t mention her significant history. She had some level of amputation on all four of her extremities. Her right arm above the wrist, the left at the knuckles, both legs below the knee. That made finding an IV site extremely difficult. Our life flight nurse was helping with that, but in the end our physician put in a femoral line.  So, my new ER nurse was holding on to his head, to stop it from spinning.

 
 After a liter or two of fluid her BP boomed up to the seventies (Yes, that’s a joke. I wanted 90’s) But she perked right up. And her companion told us her story and how in ’92 she became ill and that is when she had her original problems. I realized that I had taken care of her when she came in back then.

 
I tell people that I can walk through the mall and feel like I recognize most of the faces, and yet I cannot remember them. What does that say about me?

 
I read an article, nursing of course, that within the next 12 years the nursing shortage will increase by 33%.  In my job I am trying to teach the future and what I have discovered the last five years or so, is that the young men and woman coming out of colleges and universities are not willing to work as hard as those before them.  That is not a bad thing. I wish my generation had felt the same way. Nursing is one job that is hard work. The average time that a nurse spends in critical care areas, like the ER or ICU is three to four years because of the stress level of those jobs.  Things will change or we are all in for a very scary time. Who will be taking care of you and me?  Not me, I hope.
 Okay, rambling again.

Rhianna

February 9, 2008

Humor and Light

Filed under: My Life, The writer, ER nurse — Administrator @ 6:05 pm

For some reason I can’t seem to be one of those daily bloggers. I’m really not that interesting. My life has required so many compromises along that way, that I don’t often get bent over the small stuff, so there’s no hot tempered or snarky response rolling off my tongue every time I read the paper or watch the tv.  Now, that’s not to say that I’m never that way. I have my moments.

 
I can’t resist the pun or humorous comeback. It’s really an illness. Mary, the wonderful woman I share an office with, has to deal with my PUNishing wit and just shakes her head. I know, don’t bother to insult me with the famous quote that puns are the lowest form of humor. That was written by someone who had no talent for it.

 
Puns are only funny when they are a spontaneous part of a conversation and instantly given. If you have that pause to think about it, then it is a groaner. I find humor so attractive. I love the hero’s especially if they are funny, but most of the time, I want the side kick, who has all the best lines in the movies or books. When I write I try to infuse humor where ever possible. And we all know that the funny heroines are in.

 
Where I have worked the day job for the last 16 years, the humor can be dark. To often the situations we deal with are tragedies. You can be overwhelmed by the bad and having a cockeyed view of things makes it better. I did an entire blog on my face last year, because my niece tells me I can have a scary face. It’s the one that is weary and bland, the one you wear to not show your emotions. I’ve tried hard, now that I work in the office more, to relearn how to wear my face.

 
I want to wear a mischievous face that I had as a child. The one when they are bound to get in trouble. I want that face on this old mug. Since, I know all the terrible things that happen to people when they are being naughty, I wear my humor armor. It shields me from the worst of life’s drama, breaks it up and makes it bearable. Reality is just that way. It’s not a joy ride with no consequences. It’s a little bit of joy, a lot of boring and large patches of drama. It’s PUNishing, hence my reaction to most of it is filled with a knowing smile, not a tear.

 
My favorite books have some funny in them. I used to read Georgette Heyer’s historical books in my teens. I would recommend them to anyone, my favorites are Devils Cub, The Unknown Ajax, Reluctant Widow (love this, but it’s hard to find) and Toll Gate. What I loved about her books- she wrote them from the fifties to the seventies- was the slow build up of learning about the characters and describing the clothes and times. Yea, all that was great, but no that wasn’t what I loved so much as the set pieces. At some point in her books, she builds to a scene that is so funny. It’s like she’s playing a chess game and has built everything to that moment of sheer excitement or humor.

 
As a writer in today’s market we’ve all been brought up with instant gratification from TV and movies. We’ve cut out the character building to a degree that it’s difficult to believe a character could be found in reality. We like them because they are alpha’s, larger than life and over the top. As adults we come as we are, but the building of the relationship between the characters is what grounds the reader to fall into the world they are reading.
I’ve been doing another stream of consciousness blog, sorry. It’s like a long dinner conversation that starts on being late and ends with you favorite recipes.

 
I like to always end with a question, hoping for comments and suggestions from those poor wondering souls that have found their way to my blog. How important is humor in your life? What percentage of your life is filled with amusement and joy? I think a strong 15-19% of my daily life ends in a smile or a laugh. It’s one of the reasons my tag line, such as it is reads…”Let your laughter be bright and you love incandescent.”  Laughter is a close second to love, they both LIGHTen our lives burdens.

Rhianna

November 28, 2007

A sense of humor

Filed under: The writer, ER nurse — Administrator @ 5:05 am

I’m in that time right before my book comes out in e-print. I should be doing every thing to promote “Shaking off the Dust”, and in small ways I am. My day job is a nurse educator, and it doesn’t require PR. However, new authors need as much publicity as they can get.
 I want to believe that I wrote a novel so fast paced and interesting that it will find an audience based solely on the story. Perhaps, if I were being published by one of the massive publishing houses, who were spending many thousands of dollars to promote the book and have it placed at the check out in every Borders, Books-a-Million and Barnes and Nobles in the united states my chances of having a ground swell of readers would be better.


 My dream is that it is such a different take on life and death, as we know it,  that the reader will be drawn into the lives of these characters. I’d love to have a best seller–big surprise, huh?–  So I want to start introducing you to my novel. There are some excerpts at Samhain Publishing, here’s the link
 http://samhainpublishing.com/coming/shaking-off-the-dust

In the end, it’s all about the story, so let me tell you a little about my herione.

What I loved about writing this story was that although there are some very serious themes involved- a terrorist plane bombing for one—Hannah’s voice is full of self depreciating humor. She recovered from a near death car accident and is living with the after effects.  Although, it is the same old routine, her life works and she functions well in how she defines it. When she’s literally thrown to the ground by fate and begins her odd alliance with the dead neurosurgeon, Tom Mecurio and his best friend, Takeshi Shimodo, her life strays far from normal.  She just wants to get it done and return to her real life, that’s the nurse in her. Do your job and be quick about it because someone’s life my hang in the balance.


 Working in an ER is part of my professional life, I know first hand the kind of jaded wit that doctors and nurses use and the teasing  that keeps the weariness of life smacking you up side the head on a regular basis at bay. Some people think it’s black humor, but it’s not. It’s the one thing that can keep you sane. So you look for what is absurd and find a way to express that with an amusing twist. You are never more alive than when you are laughing.  She’s a cry baby at heart, the humor is a brave front. Although, I think she is genuinely funny. 

 Cover Art
Come on back soon.  Next blog is about Tom, the arrogant ghost.

June 30, 2007

Today I did both of my jobs…

Filed under: My Life, The writer, ER nurse — Administrator @ 4:37 pm

Some days I love my job. Yes, I tell myself that everyday, just as a reminder. And if you think about it I have two jobs. One is the day job, the one everyone tells you not to give up until you have at least three best sellers. The other is the one where I write and wait impatiently to see it published.

 

Today, almost as soon as I reached my office, the night charge nurse came in smiling and content with life. He has several new nurses on his shift and was bragging about them. (The new nurses fall under my job description.) For half an hour and within just an hour of the day shift crowd being there, it all went to hell. He had four patients suddenly going critical at the same time.

 

One was crashing as his blood pressure tried to reach zero, one having an allergic reaction that tried very hard to close off his throat, one rushing to surgery. 

 

The fourth was a young girl, who when she entered the ED was complaining of abdominal pain and missed her period a month before. Trouble was when the nurse examined her she was as near to crowning as you can get without the head popping out. (You know the scene in Knocked Up.)

 

The doctor came and did a quick exam and sent three nurses up with her to reach L&D while the doc stayed with the other patients in the ED. They called to warn L&D(labor and delievery) and rushed to get her there in time. Trouble was there was not an obstetrician on the floor. He said he could hear the page over head. Three ER nurses and a couple of L&D nurses delivered this little girl.

 

He was feeling pretty good. Saved some lives and brought a new one into the world. He was smiling as he told me that he had so wanted to simple push aside the L&D nurse and deliver the baby himself. It was a tantalizing idea to be the first to hold her as she was born. The baby was early, but not that early. The other patients all made it without complications and all was right with his world.

 

I wasn’t with them while they showed the gold. After more than 15 years in the emergency room it was a thrill to see the nurses that I helped orient and encourage, gain the knowledge and skill to shine when it all seemed dark for a time.  

 

I know how he felt. We bear witness to tragedy so much of the time in the emergency room. We see the miscarriages, not the deliveries. We see the first golden hour of traumatic events when everything you do can make a difference, not the day they walk home. We hear the death wails of family members as they are allowed in the room to watch as we try to save their husband, wife, brother or father, not the sweet remembrances.

 

It requires a very special individual to do that job. We don’t have the hours or days of getting to know our patients, instead we a short window of time save the emergent patient or diagnose and treat the less emergent. We are the way station on their way home, the hospital room upstairs or to their maker. There’s always someone else waiting for us to get to them. So this nurse would go home today weary from life, with the knowledge he and five other nurses made a difference in the lives of everyone they cared for that night. Some days at the end of your shift that feeling is not there, because you feel only the weary. It was a good day for him and I was glad.

 

So today I did both my jobs. I bore witness to his story and then I wrote about it. In my life I don’t have to come up with outrageous tales, I can just tell you about my day or one of the many I remember.  When I write I always see the happy ending, even if it is not part of the real story. That’s why I write fiction.

 

Rhianna Samuels/story teller/ER nurse

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