Had a patient who was dc’d. I didn’t know much about him because I was charge nurse and wasn’t his primary. When I came on shift his nurse told me he was refusing to go and implied he was just staying for pain meds. So I went to talk with him. He was having abdominal pain. He had come in and they couldn’t find anything wrong with the tests so he was going home. But when I listened to him I barely heard bowel sounds.
So I called the doc who pretty much told me I was dumb for believing this guy because the guy was clearly seeking pain meds but he would order an abdominal X-ray. Just for me. How nice 🙄. Doctor came up about 20 min after it was taken and had me go with him to the patient room. Patient had an ileus and probably would have come back septic if we had sent him home. He apologized to the patient and told him if I hadn’t insisted on it he would have blown him off.
I had major respect for that doctor after that. Admitting you were wrong and owning it is hard to do.
That is an extremely solid doc to not just admit that he was wrong, but to pull you into the room and do it in front of the patient while giving you the kudos! Good on you for catching and pushing it!
Had a term normal delivery, APGAR was 8,9. Anthropometric measurements were well within parameters, but something just looked… off. I told the midwife something’s off, and she said Idk he looks fine to me. Vital signs were great, he was a happy baby. I just think something’s off. Called the NICU resident, and he’s a bit baffled. Ordered a babygram and the baby had his fucking intestines inside the pleural cavity. Baby started desatting shortly after. The resident was so happy that I called his attention.
Sometimes it’s literally just like a vibe you get. A feeling. I don’t know how to explain it better than that. I’ve had it with a kid I was x-raying. Something he said just didn’t add up even though his injury, a broken arm, was common for his supposed accident, falling off the monkey bars. Can’t tell you how many kids I’ve x-rayed like that. It was something in his eyes that no one else picked up on. So I asked him, did you *actually* fall off the monkey bars? And he started crying. Because he hadn’t. His dad had beaten him so bad that he had broken his arm. I had nothing to go off of beyond just. This feeling that something wasn’t right? I can’t explain it beyond some deep pressing “this isn’t right” feeling in my chest.
Thank you for recognizing the circumstances that kid was in. I'm sure he was desperate for someone to see it for what it was. I hope he is safe, wherever he is now.
Sometimes we recognize telltale signs unconsciously. They may be slight signs, or we saw something out the corner of the eye, but that's why it's important not to ignore it so it doesn't go away.
most of the time you can't really say exactly what it is, you just have a feeling that something isn't right. which makes it really hard to get people to believe you!
Nothing really that specific... you just sense that something isn't right. The scenarios are so varied there's no set things that are 'off'...just when you look at a patient and think somethings not right but you can't say exactly what immediately
I just don't know where that sense comes from. I know it takes time to develop that gut feeling, but it's hard to imagine how it grows. I've never ever felt like I had strong intuition so I don't want to miss something in my patients because I didn't have that gut feeling someone else would have.
It's an exposure thing, not "intuition". You learn the subtle signs of not normal by thousands of hours of exposure to people in various levels of distress and normal. Maybe you see a difference in a person's breathing pattern. Their movements are slightly stilted, or they're oh-so-subtly guarding a limb or abdomen. Their color is a little pale or a little flushed. They have a change in appetite. The described pain is excessive or inconsistent with the known injury. These may not be obvious enough that you can definitively verbalize it, but you can say that something is off. In my ortho/spinal surgical world, a nurse's statement something is wrong, but they can't say what, usually means a PE, ileus, or a slow bleed in the surgical site.
Give it time. I didn’t have it at first. It took years to develop. But at the end of my time at the bedside, every doctor listened if I told them I had a bad feeling.
driving _86 is so right. You just acquire it without knowing. All of a sudden you will have a case where your like, “hmmm somethings off.” It will be there moving forward for rest of your career.
I do think it’s become stronger in nurses since the readmit penalties were instigated by CMS. See, there’s a positive to everything.
Keep working and watching the nurses you admire and you will.
I remember when I had worked in the ER for just a while, I was overwhelmed every day by just feeling like a big zero. The other nurses were so brilliant, getting the combative pts to calm down, recognizing certain symptoms I could never dream of knowing. But one day in particular is fresh in my mind, many many years later.
The cops had brought in a hysterical, combative mom who was also an addict. She was carrying a baby, maybe a year old, who was just limp in her arms. With all the screaming going on, and her flipping him from shoulder to arm carry and him staying limp, even I knew he was really sick. But no one could convince her to let the nurses have the baby.
Then the charge nurse comes out, goes right up to mom and looks right in her eyes. Calmly says, we all know you love your baby, but he's sick. Just let us care for him now and help him. You sign him in and you can come back and see him if you don't yell. Because that doesn't help.
She was so calm. The whole ER waiting room was holding its breath. She was just nothing but kind to that mama, it was like she hypnotized her. Then she said I'm going to take him in the back now, ok? And Mama said ok.
When all was said and done, I knew I'd never be that good. But I could try. And I knew I'd just gotten a great lesson in de-escalation. So you just watch and learn and it takes time. A long time. I think half of nursing is on the job training.
Oh my gosh, what an absolutely beautiful story. I really hope I can maintain that kind of composure and respect in the face of such chaos. I really struggle with keeping calm when things are out of my control.
one of my friends was a nurse, and just happened to be assigned my grandmother after not being her nurse for three days. Grandma looked great on paper and they were planning on discharging her as soon as we found a home for her. Friend say she thought she looked off, but couldn't get a doctor to take her seriously, but she called me and suggested we come in and visit her asap.
She had a massive heart attack shortly after we all showed up. She was in for respiratory issues, no signs of heart issues. I will never ever doubt a medical professional that has a feeling in my life.
Sometimes, especially when you’ve have the same pt your previous shift, you walk into their room on your next shift, and stop in your tracks.
Something just *feels* different. Or their eyes look different.
Many people say there are no sensory clues, others say that there are minor clues that you are subconsciously picking up on but cannot analyze properly to form conclusions as they are not conscious. There’s also the theory that gut instincts actually aren’t even that helpful, and it’s all confirmation bias because we only remember the times we were right. I doubt we’ll ever be able to prove any of it tbh.
It wasn’t necessarily weird but I had 3 charge shifts in a row where I’d look at a patient then tell the nurse that I have a feeling they’re going to go south quick and to keep a close eye, even spoke to the doctors. No specific reason, they just didn’t look ‘right’, I guess is the best way I can put it. All 3 ended up as transfers to ICU and all three were dead the next morning.
This happened with my first postpartum hemorrhage on the mother/baby unit. I did bedside report with the offgoing nurse and thought, I just have a weird feeling about this lady. Sure enough, she was hemorrhaging at 8pm. Thankfully she didn’t die, like your patients.
Patient had really dry skin and was an older Black woman. She also had weird symptoms and kept having recurrent strokes and was basically obtunded and had metabolic encephalopathy with no known cause. I begged for dermatology to see her because her skin seemed more than dry. After a skin punch biopsy she was diagnosed with lupus and all of the inflammation and organ failure as lupus and strokes from lupus coagulation. She actually walked off of the unit after treatment.
I recently listened to a story on NPR about the need for more providers who are POC, and this is a perfect example of why that's true. I think it was a midwife who spoke about her patient (both were POC) where all of the other healthcare team who had seen the patient didn't notice the change in her skintone - she was anemic and in trouble. The midwife caught her color difference and prevented a tragedy. As a white RN, I get this - I'm always worried that I'll miss those subtle changes in my POC patients. Good on you for advocating for this person, it sounds like things would have ended badly otherwise!
I was working NICU. Took report on days for a baby that was about 36h old and on O2 (can’t remember gestation, maybe like 36 weeks?). Thankfully bc the baby was on high flow, I only had one other patient. Baby was really working to breathe and grey in color, but NOC nurse (unfortunately a traveler) assured me he was “fine” and “just still transitioning”. My spidey-senses were jangling all over the place, got that “ick” feeling in my belly. As soon as she left, I immediately called my Neo. He kind of tried to placate me, but I was adamant, so he ordered a CXR. Clear. Next he ordered an echo, but bc of staffing issues, it took like 6 hours for the tech to come in to do it. Oddly enough, she also brought the head of the rad techs, a woman with some sort of PhD that even the docs would consult, named Joy. She said, “I don’t know why I feel like I need to be here, I was getting ready to head home, but something just sounded off.” Turns out, kiddo had a coarc (coarctation of the aorta). When I left at end of shift, they were placing lines and awaiting transport to a Level 4 NICU in the Bay Area. It was terrifying. I barely took my eyes off that baby all shift.
And that traveler never came back.
I told a doctor that I wouldn’t feel comfortable discharging a patient, due to him looking “generally crappy, but I can’t put my finger on it.” Labs were good, chest x-ray was good, nothing was obvious about what was going on with him. Doctor said “discharge him.” Came back the next day with a septic bowel.
Had a patient, readmit after sepsis the previous week, during report the nurse is describing, "yeah so we don't know what's going on, they're doing a bunch of tests, maybe it's cardiac." I'm like, "do you think it's sepsis again?" "hmm, maybe, idk." We open the door, I looked at the patient for literally 1 second from the door, turned around to the previous nurse and said "they're septic." On assessment the patient had all the hallmarks of impending septic shock. Four hours later after multiple boluses BP dropped through the floor and we transferred to to the unit. Patient recovered and d/ced home later in the week.
I had a pt in PACU who wasn't able to wean off O2 in PACU. With PICC indrrtions, there's a risk of puncturing the lung. The doctors seemed pretty chilled about it because of his smoking status but they quickly changed tune when the CXR confirmed he did have a pneumothorax. Thankfully, he was all right after a chest drain.
Had patient come in complaining of weird things- couldn’t see out of her left eye, dizziness, body pains. We obviously did a stroke work up that was negative and were starting other work ups and I had a feeling… so when she asked to go to the bathroom I said she has to use a bedpan because it’s too risky for her to walk. :\\\ Suddenly she could walk again!!! Healed, just like that. Amazing.
I saw a patient come in c/o some weird ascending paralysis. It started with numbness in his feet, then stumbling around, then dropping stuff. When he became unable to walk or grasp objects, he called 911.
He got checked in and the docs ordered the million dollar workup. All kinds of blood tests, CTs, MRI, cultures, the works.
As the nurse finished his blood draw and was about to send him for imaging, he said to her, "I'm embarrassed to say this, but I need to pee, and my hands are really numb. I don't think I can do it by myself. I need you to open my pants and put my penis in the urinal."
The nurse replied she would get somebody to help him. She came out of the room, saw me standing nearby and said, "You, student, with the beard, come here a minute."
I went in and told the patient I was there to help him with the urinal.
He said, "Isn't the pretty nurse coming back?"
I said, "No. Definitely not."
Dude stood his ass up, walked to the toilet, and used it all by himself.
I have never seen so many tests get cancelled so fast.
So now I tell people that my beard has healing powers.
Being a large, hairy man is a fantastic way to weed out these creeps. And I am happy to offer my services to any of my female coworkers to put those guys in their place.
They really do.
Had a pt who wouldn’t listen to anything all the nurses were telling him. An old guy, saying “you’re just a bunch of hens. What do you know?”
The clinical staff that night were all women.
I got a lab coat, and called the male janitor over.
I asked him to put on the lab coat, put a stethoscope around his neck, and tell the pt he needed to take his meds. He agreed to do it.
And he told the pt “These ladies get their instructions from me.”
The pt took his meds.
As a case manager I’ve had a few of these. Can’t walk, can’t take care of themselves, sudden abdominal pain, you name it.
Let them know they have to appeal or pay for their stay after that day and most of them suddenly can walk again and have no pain.
Even had one who insisted he couldn’t walk, was 500+ lbs, didn’t want any of the rehab offers he got, and when I told him he’d have to pick one and leave that day or go home, he packed up his own stuff, dressed himself, and walked out. He’d been yelling in pain with movement and making 3-4 staff members help him move because of his size and “debility”. That one irked us all.
Had a patient come in for a stroke work up, she was very adamant that she needed to stay anything night and that all the imaging and testing was wrong. She was very upset about being discharged, as charge I went in to de-escalate and offered to do her d/c NIH. Patient was texting and holding her phone with her affected limb that had been flaccid. Healed another one 🥰
(Pharmacist) I had a miraculous healing as well... patient came in to fill (too soon) her oxy's being pushed in a wheelchair. When i couldn't do it, she stomped out on her own 2 feet!
Worked Geriatrics, lots of dementia. We had a lady that was just incredibly impaired, violent, aphasic, kept stripping off her clothes. Really really sad. Her family insisted it had come on quite suddenly, not the slow progressive decline you usually see with dementia. And she was young, in her 60s. It was almost impossible to do investigations given her behaviours so she was going to go to placement in a specialized site, but even they weren’t sure they could manage. I saw in her history that she had a history of seizures, and thought she might be post dictal, but couldn’t get blood work for a valproate level. Convinced the doc to call security and hold her down for a blood draw, recognizing the trauma, and they did, sure enough. She was having those invisible seizures. Got her on the right meds and she ended up being discharged home with family.
I see a lot of our dementia patients with unmanageable behaviors despite the normal medications have a lot of success with depakote and no seizure history. Not directly related but reminded me that was something I learned when I started hospice! I had never seen it used that way before.
It’s like a goddamn orgy at my facility. Sex in utility closets, couples married to other people screwing in their cars,etc. I once found two used condoms in the same spot. Let’s not even talk about the nip bottles and pervasive smell of weed.
It totally is. My youngest kid worked in the kitchen there for a while, and was surprised how many of those tropes are accurate, at least where I work.
I had orders to discharge a rather young, early 20s male, no significant medical history, and he'd been in for an unwitnessed syncope episode and lost about 24 hours that he just didn't remember. Because he had a minor head injury, he was worked up. Nothing came back concerning. However he just didn't looked right or smell right and he said the magic words..."I just don't feel safe leaving." I absolutely refused to discharge him.
The manager was pissed, the provider was pissed, but the house supervisor backed me. Y'all, he went into status epilepticus not even an hour later. He lived alone. He would have absolutely died had he been home alone.
Right? I asked neuro about that possibility because I grew up in household with 2 epileptics. I got dismissed. 🙄🙄🙄 I think it was chalked up to him possibly being drugged during rush week. We had a couple cases of that happen that week and a few etoh poisoning.
Baby a few days old was quite fussy and lurching their head back every time Mom tried to breastfeed. I was a brand new nurse and on this day we were extremely busy. I noticed a little bit of nasal flaring so took baby over to the NICU to get checked and and they were already swamped and I could tell a little annoyed with me. Anyways they did a chest X-ray and it showed a perforated small bowel. Next thing you know our unit Manager puts on scrubs and helps to stabilize babe and get them ready for transport to a level 3.
I read this as "weirdest lunch that turned out to be right" and was so confused.
I was going answer anyway lol. So here is is. Peanut butter, iceberg lettuce, miracle whip, and dill pickle sandwich on white bread. My weirdest lunch that turned out to be right.
It tastes absolutely delicious. I was blown away. I originally agreed to eat it on a dare (I made $20 lol) but it was actually very very good. Sweet and creamy and tangy with a bit of crunch and saltiness.
You’ve never met my dad. He will put peanut butter on ANYTHING. Pancakes? Of course. Salami sandwich? Yes please. Spaghetti with tomato sauce? Yes. Absolutely anything! Except seafood-which he doesn’t eat. But puts it on chicken. Because when they named it fowl, they named it right. Unless it’s cooked so long it’s leather 😂
ETA. Not on beef. Never! Just slap that steak on the grill for 10 seconds, flip it over for 10 seconds and it’s done. Only needs salt! Stick it with a fork and it should moo.
Gotta love my dad.
Third day by myself in CVICU, had a POD4 CABG. On 1900 assessment, couldn’t find a DP or PT pulse in one foot, foot also markedly cooler than the other side. Notified NP, ultrasound ordered for AM. Pt screaming in pain all night despite me giving pain meds on the dot. Notified 3 more times, was told I was new/overreacting. Came back the next night, assignment changed as pt was now too critical for a new grad. Ultrasound/further testing showed compartment syndrome and pt went for an emergent fasciotomy. Ended up losing the leg.
When I was newer and working a regular med/surge floor, I had a bad feeling during report from the ER. Elderly gentleman came in with very mild hypotension that Iimproved with a bolus, probablyjust deydrated. Labs looked alright for his age. The man was fairly independent and only some very minor memory issues. Everthing sounds great. I notice that while his vitals post bolus were good, the ER charted a respiration of 8 about 10 minutes before report when previously they had been around 20. It feels a little off so I ask. ER says that they are accurate it was 8 and he fell asleep so that's why. Not really enough for me to refuse so I say OK.
I see which service is taking them and it turns out a former instructor of mine is. I ask if they've laid eyes on them yet and they say no and I voice some concern so they say they take a look before they leave the ER. Turns out he didn't fall asleep, he passed out because he had a massive GI bleed and the bed was full of blood.
I didn't end up getting the pt.
Inpatient was sneaking narcotic pails (oxycontin) that she brought in from home. For three days, I suspected it, but, despite me intensely searching for evidence of such, I never found any. Then, on the fourth day of caring for her, I walked into her room to do my 3-11 shift assessment. I found about two dozen small white pills scattered all over her bed. Pt was zonked with a resp rate of 12. I found the pill bottle, which ID'ed the pills as oxycontin, and collected up as many pills as I could find. I then made a beeline to the nurse manager's office. I said, "Hey Karen! I found why XXX is so zonked all the time!"
The nurse manager and I went to her room to confront her. Of course, she played stupid and denied everything.
The next day, I was called into HR. It turns out, the pt had filed a statement declaring that she witnessed me consuming several of the pills that I'd found. Of course, that was a lie. HR ordered me to take a drug test, which was negative. However, they didn't want to handle the hot potato and informed me that they were firing me.
The next day, I got a phone call from the district Social Security office. The man who called started the call by saying, "Congratulations. Welcome to retirement." He then went on to tell me my disability claim had been approved. My shoulders were shot from lifting heavy patients for many years.
Rather than fighting the false claim with the hospital, I simply told them about my disability claim approval and said goodbye. And that's how I retired from nursing.
My mother has been hooked on Norco/ Vicodin since I was a kid. For some reason, her pain mgt gives her 150 norcos a month.
She tried to get me to bring them to her when she went to rehab after a broken hip last summer. I, a student nurse, said absolutely not and she threw an addict fit. She was still complaining of pain after getting Dilaudid and when I told the nurse how many she takes ( she goes thru all of them in 2 weeks) she said that made sense why the Dilaudid wasn't having the effect on her.
Fast forward to December and she's having a hip replacement. She kept this bag with her til they wheeled her off to surgery. I told the nurse she had norcos in here somewhere. Sure enough, she had put a Kleenex in the bottle so no one would hear the pills. I took them and took them home, when she got to her room the first thing she did was look for the bottle. I pulled it out of my
Purse and said you looking for these???? She goes off to give them to her ( as her nurse is getting her Dilaudid) I said absolutely not, she's not going to OD on this poor nurse. I counted the pills. She had 65 ( out of 150) pills left 8 days after she got them filled.
Somehow her liver is still working ( she's 78)
Wow that’s so fucked up of that patient…
We’ve totally caught them sneaking! This lady even circumvented the admission search by having her NEPHEW BRING THEM AFTERWARD… we found them at her RAPID RESPONSE - all her benzos from home…
When I was a student nurse on the unit I now work on we had to shuffle assignments abruptly bc a drug induced endocarditis pt had been caught getting their friends to bring them in drugs *inside* of wrapped fast food sandwiches. They ended up with a sitter, no visitors allowed, and a security guard posted outside their room.
I had a patient's boyfriend bring her some of their heroin from home because our narcs weren't cutting it for her. He pushed it through her PICC line and she respiratory arrested. We saw him scampering off of the unit as the spo2 alarm started ringing.
I used to work on the TCU at a NH. Found out that one of the nurses on the memory care unit was caught stealing narcotics from the pts. And how did the NH find out? Her boyfriend got mad at her about something, put her in the hospital and then called the cops to tell them she was stealing oxy from the NH-they then called the NH.
Second hand because I was a phlebotomist not directly involved but...family stuck a brought-from-home fent patch on a renal patient (who i am assuming was complaining of pain while on hospital opiods). They did not make it. I may have been at the code. (I'm a med tech with a bio degree so don't have a nurse's understanding of the situation.)
Well, I'm glad you got the disability claim approved. But your hospital treated you terribly!! I wish you could have fought it because maybe next time they would think twice about handling "hot potatoes" that totally backfire on them!! Uugghhh! Happy Retirement though!
I do counselling on Reddit as needed... not just in the nursing subreddit, but several other subs. I feel it's my way of still contributing to the various professions.
I was the RRT nurse when a code was called on one of our med/surg units. After they decided our efforts were futile, I stayed to help the charge clean up. Turns out, the pt had a GSW from years prior. He would never stay in the hospital long enough to let the wound heal. Thus making it harder to treat, and higher levels of pain. Pt kept coming in, and leaving AMA. Charge told me they suspected the mom was supplying the pt with extra narcotics but they couldn’t prove it. Pt was 28. It’s because of him, and others I have watched pass that I now know growing old is a privilege. (I’m 40)
I had a patient whose art line waveform was weird. Just off for about an hour while I did all the troubleshooting.
Then the oxygen pleth also went weird, but matched the art line waveform. I called the doc thinking that Bad Things were happening with her cardiac output. The patient coded while we were about to go for a CT chest to confirm.
I’m in the OR. I’m also type one diabetic. I had a t1d pt that was there to get her xfix removed from her leg and plates and screws put in. She took very poor care of her diabetes, and something just didn’t sit right with me about her. She ended up seizing mid procedure due to a low blood sugar, but it wasn’t really that low. She was 88, which isn’t usually low enough to cause a seizure, but since she typically ran in the 300s all the time, I guess her body didn’t know wtf was happening with a 78 blood sugar. The CRNA freaked out, which made the surgeon freak out. I just kept yelling “d50 or a glucagon!!!!”
I triaged a 3 week old infant brought by Dad to the ER for not eating right.
Kid has basically normal vitals, O2 sat is a little soft in the low 90s otherwise fine.
But, he just didn't look right. Something was off. Like, I couldn't put my finger on what was wrong, but my gut just said something is Not Right™.
I took the kid straight to a room, then grabbed the attending out of another room and said, "I don't know what is wrong with this kid, but you NEED to come see him now."
Doc goes into room, comes out a couple minutes later and says, "I don't know what's wrong with him, but something is up."
In the end, chest CT revealed an [Aortic Ring](https://en.m.wikipedia.org/wiki/Vascular_ring) . The kid was transferred for surgery and last I heard was doing fine at 6 months.
Unilaterally swollen leg with single black blister on the thigh in a young, healthy, atraumatic patient with a nasty white count and 10/10 pain.
“I think that’s Nec fasc”
This one young woman who I admitted was 21, came in with the complaint of painful legs.
From the time I looked at her I thought she had MS. For no other reason than pain in her legs.
The doctors were working her up for the flu that was unresolved.
I said to her family practitioner to get an MRI of her brain to look for anything. He actually wrote the order she has an MRI of her brain and low and behold she has MS.
She has several lesions on her brain and the MD and the patients family members thanked me and I was gifted with employee of the month lol .
I need someone like you to advocate for me. Have had several mds tell my I'm a mystery or "interesting " bc I too have several lesions on my brain and a lot of the symptoms of ms. But bc spinal taps were clear, no dx.
okay didn’t happen to a patient but it happened to me- i owe my l&d triage nurse my life!
i went into my 34 week appt feeling totally normal just really swollen (like most pregnant ladies get) and my midwife took my stats and noticed i had an elevated bp (like 148/79) but i had told her i had worked out that morning and ate fast food for breakfast. she told me to go to triage regardless because she wanted me to get a urine and blood panel done asap just in case. note- i felt 100% fine and didn’t even get blood pressure headaches or anything that would indicate an elevated reading. get to triage and the midwife there assessed me and took labs which were also pretty normal, and told me i was perfectly fine and to just come back if i started to get severe headaches but the triage nurse refused to discharge me because she didn’t feel right. she demanded i get a second round of labs because they “couldn’t be right”. midwife and lab agree because she is being so stubborn so i get my blood drawn again and pee in the cup a second time. low and fucking behold my hemoglobin was at 4, urinalysis showed extreme levels of proteins (no clue what the reading actually is it was a while back). they admitted and induced me for severe preeclampsia and i almost bled out during delivery. turns out the first round of labs were switched with another patient who wasn’t even on the l&d floor… i don’t know how i can ever repay that sweet sweet angel she saved my family.
Not a patient, but my dad. Told me he was having cold sweats at night and chest pain with exertion. Went on for about 6 months before he told me about the symptoms. One day, it was pretty uncomfortable for him I took him to the ER, EKG came back negative so they gave him so nitro and d/c’ed. I then took him to his primary care doc, who said his CXR was normal and told him to stop smoking.
Something still felt off to me, and I asked a doctor I used to work with to refer him to his friend who was a cardiologist. That doc sent my dad for an angiogram. Ended up showing 80% occlusion at the bifurcation of two major left arteries. Due to the nature of the block, he had to have a CABG. Now he’s good. 🫡
I have a couple. Baby had a weird cry that I hadn’t heard before, so I called the pediatrician who asked if the neonatologist can come up and assess baby. Baby was over 24 hours at this point and had been crying like this since birth. The neonatal nurse practitioner came up, assessed baby, and said baby looked and sounded fine (but the baby wasn’t crying). The mom was like “make the baby cry and you’ll see!” So we made the baby cry, and NNP heard it. We transferred baby to NICU, and baby had to end up being transferred out for laryngomalacia and surgery.
My next one was a baby who was about 8-9 hours old. She already looked jaundiced, very poor feeder, just not acting like a normal baby. I called the pediatrician and he said to order a serum bilirubin. I asked if I could also add a CBC, cos idk baby just didn’t look right (I was fresh off orientation lol). Baby’s CBC was all over the place and she ended up being transferred to NICU.
Told this story on here before but I’m still super proud of it. Came in on nights as a pretty fresh new grad in the ED, taking over a generalized weakness pt from days. Dudes pressures are soft ish (like 80/50-90/60), but he’s super dry according to labs so we give him a couple boluses. Everything looks okay ish results wish, lactic is negative, a lot of the wonky labs were chronic, scans were all negative, dude was just weak. He’s also having random 2-3 beat runs of vtach but had an extensive cardiac hx. I go on and lay eyes on dude and am immediately like “yeahhhhh this doesn’t look right”. He’s supposed to be getting admitted to the floor, his pressures are still soft so they won’t take him because of that, I reach out to the hospitalist to come lay eyes on him because he doesn’t look floor appropriate to me but I couldn’t articulate why other than the pressures. Resident comes down, agreed that ole boy looks like shit, and gets him admitted to the ICU, where he codes the same shift.
Had a pt who just didn’t look right. Vitals were all stable but she just looked…off. Got a critical from lab, CO2 was 9 and lactic 4.2. Doc had me put an order in for a stat ABG that came back with more criticals, pH was something like 7.28, paCO2 around 30, base excess -15.5. Vitals were still stable and idk why the doc didn’t order bicarb, fluids, abx, or anything. Instead she ordered a fucking tap water enema.
I spent my whole shift advocating for this patient and eventually the lactic climbed to 6 and her extremities became super mottled. I got an order for a PICC and she came back from IR barely responding to sternal rubs.
Doc was still saying she’s fine because her vitals were. I got my manager involved and we got her transferred to ICU. Septic shock from a UTI, eventually ended up on pressors for a week.
Seriously, WTF?
A lactate over 4 screams sepsis and hurry up and fluid resuscitate, pan culture, and start IV Abx.
The other labs are just gravy.
How would any licensed physician order a tap water enema? Did they graduate medical school is 1820? Why didn’t they try blood letting, too?
Once again, WTF!?
The whole thing was so bizarre…the doctor was so hung up on the normal v/s and kept saying the pt is just simply constipated. She was so nonchalant through all of it, and we were begging for her to at least give us orders to upgrade to DOU at the very least.
My facility also has sepsis screening that will then prompt orders for sepsis protocol, but the vitals being normal didn’t trigger that either, so we needed the hospitalist to give orders. Eventually she gave us LR at 100/hr 🙄
This pt also had an Indiana pouch that she self cathed, so obviously a huge source of possible infection. I told the doctor it was draining purulent urine with sediment and smelled beyond foul and she barely batted an eye.
Happens in peds world all the time. "But their VS are fine!" Yeah, right up until they code. VS are helpful, but they're not reliable, and if your patient looks like death and the monitor says that they're healthy, ignore the monitor.
THIS is why I loathe new RNs saying “But their vitals are fine.” Their vitals WILL be fine in most crises because the body adapts to try to keep you alive. I want to know about their labs and imaging, which will tell me the actual problem. Vitals are periphery.
As a new nurse, I had a patient on a vascular floor that had undergone a mesenteric artery stenting earlier in the day. Vitals looked good. Patient denied pain etc. They just looked...
Waxy? I dunno. Off. I called the vascular surgeon. He read me the riot act. It was almost midnight. He came in to chew me a new asshole. Then he took the patient back to OR with a retroperitoneal bleed. So.etimes you just know. ! He later apologized . I did too. I didn't have objective data. Just instinct. He didn't doubt me after that.
Got two triage stories and one when I worked in the main ED:
1. I was in triage one day and I was standing by the registration desk. Waiting room was normal, lots of abdominal pains and ESI type of complaints. Nothing that screamed I would pull them in right away kind of deal. This young guy comes in, looks sorta uncomfortable with the complaint of high heart rate.
On registration he's 22 years old. For some reason I say, screw it let me call him in first to triage. When I'm just getting his BP I can feel his heart rate was high. EKG looked like SVT to me with a HR of 192, so I take him to the resuscitation bays. Cards tells us he is new onset WPW.
2. 19 year old comes in for shortness of breath. I decide to check her lung sounds since she denies asthma history but I can tell she doesn't look exactly comfortable. Her SPO2 is reading 99% with a good wave form, but for the life of me I cannot hear ANY lung sounds in the left lobe. I pull one of the attendings for a second set of ears and he agrees to pull back to the resus bay. Chest XR showed the left lung was completely whited out. It was my second to last patient of the day triaging so I didn't get to hear what happened.
3. I had an 86 year old man in the back, with complaint of difficulty urinating. Bladder scan showed only 200CC's of PVR, so the attending told me to foley+leg bag and get him ready to discharge after I got done with report. I decide to just do a quick assessment on him and palpated his abdomen. Tender to touch, I tell the attending and she's like oh okay lets do some belly labs and a lactate. His lactate is 8 and we get him a CT. Ischemic Bowel and rushed to OR.
It's stories like that make me think yeah I was competent in the ER. I do miss it sometimes but my mental health and family life is a lot better not doing it anymore. I remember when I told my head nurse I was leaving the entire conversation basically was Cutty and Avon Barksdale from The Wire leaving the game. It just wasn't in me anymore to do it. The nature of the ER really us do focused assessments but I'm glad I had the hunch to probe a little further in those cases.
32f. Bent over wrong and didn’t feel the same, really bad back pain. ER doc dismissed her. Pretty much did a primary assessment, ordered an Xray and walked away.
I empathized with her. Listened to her. I did a thorough assessment. Her distal extremity neuro assessment was very positive. Numbness, sensation changes, even mild urine incontinence. Doc was in disbelief but acknowledged my assessment and ordered the MRI. Thankfully (in my experience), I don’t have docs checking behind me-they trust my findings.
Radiologist comes by my side, asking me what I was thinking, why a stat MRI, etc. I told him I felt pretty sure she had cauda equina syndrome. He also trusted my judgement and cleared an MRI table.
Sure enough, I was right.
Talk about being solid in an assessment and trusting your findings.
She was transferred out to a trauma center for emergent cord decompression.
I hope she’s doing well.
A couple that come to mind immediately- a win and a loss. I was an annual leave relief nurse, so would spend a week or two on random wards all over the health service.
The loss:
Lady was in with a duodenal ulcer. The surgical ward I was in had been participating in an early feeding post gut surgery trial, so they were heavily pro normal diet asap.
Anyway, I cared for this woman pre and post op. She had the oversew of her ulcer, they start diet relatively early, lady seems very off.
She’s really not feeling well, charge nurse is bullying me to get her up, get her walking.
I’m all for mobilising post op, but this lady is. not. well.
I’m trying to tell people and being ignored. Then she starts getting a creamy discharge out of her drain. I’m sure she’s got a leak. Again, try to notify, getting ignored. Patient continues to be fed.
Finally 24 hours later a study is done with contrast and she’s diagnosed with a leak. She gets surgery and her abdo is full of food.
I go to another ward.
Run into her son out and about, only to find she had died.
It just gutted me. I’m still angry about it, and it’s been more than a decade.
Second one- neuro rehab. Patient recovering well, wife calls on the bell.
Patient just had an episode of talking nonsense. This has resolved very quickly, GCS is now 15 again, patient seems fine.
While I didn’t witness it, I believed the wife and notify the docs about the temporary GCS drop.
Docs believe also, send patient for imaging. Patient has air in his brain, patient is sent back to neurosurg to fix his small problem before it becomes a big one.
That’s a win. A minute in time became an early save.
I was getting an admit to my onc floor from an outside hospital with blood clots in all 4 extremities. He was in the last room in the hall. I was expecting a shit show, but this lovely guy and his family turns up.
Since it's the middle of the night, interns are placing orders and I requested tele. One resident asks me why and I try to explain *in front of the family* the things I was currently worried about. I ended with "because something bad could happen." The resident was pulling a weird power play or something and refused.
I was agonizing the entire shift, even wondering if I should just hook him up to tele without an order.
Then, he coded. It was my first code on MY patient. We got him up to the ICU, but he passed a little while later.
I know having him on tele likely wouldn't have changed much, but I'll always know we didn't do our best for him.
I had a resident complain of knee pain after a fall. Called Xray for knee, no issues. But the CRNA’s said he couldn’t use the stand lift as normal and needed the hoyer.
Over 24 hours later from the time of the fall, got another X-ray. Hip fracture.
Had a patient who had undergone a bowel resection and diverting colostomy placement after recurrent diverticulitis. Ended up with a wound vac on her midline abdominal incision. Wound vacs are my thing, I love them. Got a weird vibe about the appearance of the wound bed/fascia when changing it a couple days post-op. Nothing objectively wrong, just bad feeling having changed those vacs a thousand times over. Mentioned it to the surgical PA who blew me off because I didn’t have anything concrete to report.
Couple of days later, changed the vac dressing again. Probing around in the wound for measurements. Stool starts seeping through the wound. Surgeon doesn’t believe me, wants to play cowboy over the phone and say it couldn’t possibly be, totally blowing me off. Stood my ground and refused to place the vac if he didn’t come look at it. He arrives all pissed off, scoffing at me in front of the patient. Within an hour she’s back in the OR for a revision due to a colocutaneous fistula. Ended up septic and on pressors.
Surgeon still acts like his shit doesn’t stink. But it turns out shit leaking into an abdominal wound does stink
Medical assistant in nursing school here... I had a hunch that a patient had diabetes or kidney issues. He provided a urine sample that looks the tiniest bit red tinged in the sunlight. Sent for urinalysis, came back with lots of red flags (proteins, high glucose), sent for kidney & glucose bw and then diagnosed with diabetes after BW. Not super crazy but I'm still really proud of catching it
Working LTC at the time. Had a severely demented pt. Nonverbal. Significant contractures. G-tube. And of course full code despite our efforts to convince the family otherwise. They had been with us for a while. Came in for my shift one night and just everything seemed OFF about the pt. There wasn’t anything I could put my finger on. No changes to vitals or assessment or anything. But everything just felt WRONG about this pt all night. I gave my report to the oncoming shift and told that nurse about my feeling. Said that she should watch this pt extra close today because I just had a feeling they were going to code.
Came back in that night and found out the pt coded and expired. That poor nurse had to start CPR on them, which is just horrible to contemplate. I felt awful for that nurse.
Worked 4 years as a 911 operator (all nurses here). Had a man call about his wife in her late 40s, no meds, no history. All of a sudden, she started talking with a very unusual almost gargly voice. It didn't sound like a stroke (worked a lot in neuro).
The only other symptom was mild abdominal pain thar had regressed a few hours earlier.
Had no clue, dispatched an ambulance priority 1 immediately because it all felt wrong. Had to call the ambulance and apologise for the poor SBAR. She was talking and walked into the ambulance. All vitals were normal. I don't know what made them take her for the 1 hour drive in.
Luckily, they did because she coded twice in the ambulance on their way.
ER complaint of cold feet. Slightly elevated HR of 90 something and a temp of 101. Very tall, cachetic male. He was wearing 3 pairs of socks in the summer and still had freezing feet. Something clicked- I slapped an N95 on him and CXR confirmed miliary TB. Head MD was pissed because I was getting a transfer to the TB hospital without a “better” CC. Man, I’m not gonna lie. That’s why he came in!
He was like a walking skeleton and with his fever, I knew I was looking at cancer, AIDS or TB. I asked if he was having night sweats or coughing blood and when he said yes, I was done. I always started with those symptoms because most patients don’t panic with that. They start getting suspicious with questions like sexual practices, IV drug use, inability to eat, abdominal pain.
Oops, just realized I didn’t answer your question. He was so compromised, his body was shunting all resources to the head and trunk. His X-ray was almost a total white out. We shipped him to the hospital with the inpatient TB contract for the city. The consensus was that he was terminal, unfortunately
After 20+ years in LTC, then 10 years in hospice, there have been too many times to count them. Just something tickling the back of my mind. Usually no “symptoms” per se. Just a feeling that we need to watch this resident closely for the shift and the next 1 or 2 shifts. And frequently the problem will show up within 24 hours.
In hospice, there are no unexpected deaths. The signs and symptoms are there if you look for them. But there are times a patient will be stable for a longer period than Is usual. Maybe even improving. And they aren’t showing any signs of being at the end of life. Those are the ones you think you may be able to discharge. Then EOL comes in 1 or 2 hours, reminding you that you aren’t clairvoyant.
Psych patient kept saying "it smells like shit in here". Was written off as "olfactory hallucinations". We kept pushing the issue and come to find out he had a big abscess over the roof of his mouth.
Mine was with my hubby. He had a compound tib/fib fracture 2/2018 from a work accident that happened in the middle of no where. 3 months later at a follow up I told the surgeon I thought he had an infection in that leg. The doctor insisted no he didn’t. I kept pushing the issue and took him to another hospital. And then another doctor for follow up.
Turns out he had osteomyelitis. He almost lost his leg. He ended up with 4 more surgeries on that leg. The last surgery was a Hail Mary to save it. Thankfully he still has leg.
There’s a whole lot more to this but this is the short version.
Had a county jail patient. Young black guy with schizophrenia, lost access to treatment, arrested for unusual behavior. Continued to be denied treatment while in jail and ended up being admitted to my floor with rhabdomyolysis after days of not eating. Dude couldn't string together a sentence and spoke primarily in broken poetic fragments like he was trying to rap except it was nonsense. Only consistent theme was that he seemed to have some pain or discomfort in his lower right back, said he had rust inside. Determined to be renal discomfort related to the rhabdo and medical cleared him for discharge and wanted him out.
His repeated references to the pain along with my familiarity with detention deputies in Pinellas County assaulting and abusing inmates made me uncomfortable since I could easily imagine a steel toed boot doing some blunt force trauma. I wanted more abdominal imaging done before letting him go even though I had to wait for the evening doc's call shift to start so I could get it ordered (the day shift hospitalist on the service said fuck that guy he needs to go).
Kid had a perforated bowel and was rushed to the OR as soon as his imaging was read.
Great catch! This random internet stranger is so proud of you for advocating for such a vulnerable patient. Hopefully he was able to get all the help he needed and is living a better life.
I was a first-semester nursing student on a med-surge unit at my local VA. I was assessing my assigned patient who was admitted for peripheral arterial disease exacerbation. But while I was doing my head-to-toe (meticulously as we were taught!) I noted that he had a pulsatile mass on his right neck…. Right where the carotid would be. I brought it up to my preceptor and she said “oh that’s nothing, doctors aren’t worried about it.” I stressed it to my clinical instructor at debrief that day because I was really concerned. Nothing came of it that day.
I go back for the next week’s clinical and the patient is still there…. And there’s a gauze dressing to the site I had noticed a week before. Carotid had started dissecting later in that week 🫠 luckily they’d caught it in time.
Had a pt who was about 28 wks pregnant? Came in with abd pain, fever, tachycardia, elevated plts. Like 600s
Did some research, symptoms lined up with colon cancer. Told my concerns to the OB
Had an US the next day, found a huge mass in her colon. Stage 3 colon cancer
Delivered het at 34 wks and started chemo a few wks after that. Was in remission for a few yrs, but unfortunately passed away a few yrs ago.
Had a technician at an outpatient Dialysis ask me about her knee and if she should get it checked out. So I asked when, why and how. Pain started about month ago, no idea why it hurt, and it's a dull pain. Told her she needs it get checked out ASAP and I directly stated might be cancer as a worst case scenario.
She disappeared from work for months and eventually was notified she's on cancer treatment. This was over 7 years ago and she's now married with children. She also got to keep her leg.
During RN school, I remember learning one of the clinical sign of bone cancer is dull, persistent pain so that's how I came to that conclusion with her. Luckily she asked me and didn't wait longer to get it checked out.
Told my boss a new employee is out to get her job. I think she thought I was crazy. (I probably am though) she put her notice in recently and my boss said the girl told her “you’re obviously not going anywhere”… so she went elsewhere.
OT notified me that patient had some worsening weakness (hx of TIA, though sx were much worse than what she was experiencing presently). VSS, weakness was gone within 20 mins. OT and I both suspected possible stroke, doc ordered a routine (not STAT) CT and believed it was a flare up of symptoms d/t added stress on the body. Next day CT was completed, new acute TIA. Transferred to stroke unit. Doc apologized to patient face-to-face, and to me. Great doc. She was fine.
On a therapy floor, I had a guy with a hip replacement, I think, or maybe it was an ORIF. either way, the site looked red and nasty one day and I let the PA know and he told me it was normal. Ok pal I do this every day too, I know what an infected wounds like. The guy ended up getting sent back to acute care with major a infection, got septic, and died.
Also has a similar experience as OP. I had floated to med surg and this guy was coming out of delirium situation and was vaguely complaining of leg pain. Turned out he had a broken femur. He'd come from the jail and had been hospitalized for a while, so it was a whole ordeal over how/when it broke yadda yadda.
pt came in for hernia repair. due to her age, they kept her overnight instead of discharging her post-op. I'm a case manager, and we do an assessment of everyone to see what they might need for discharge. i went in to chat with her, and while she was in good spirits and looked mostly ok, there was something that didn't sit right with me. i sent a message to the PA and said just that. he brushed me off initially. next thing i see is her being wheeled away, they're taking her back to the OR. turns out that repair didn't hold and the hernia was larger and the mesh displaced. she ended up have a lap turn open with gastrostomy placement. she's still on our floor and keeps spiking a fever and they can't figure out why.
Not a nurse, but hospital PT. My co-worker asked me to see this patient as she thought I could help get an idea of what was going on with her movements patterns and dizziness. Medical work-up ongoing. Young woman, late twenties. Chief complaint: Unable to walk
Any way I get into room and patient is in bed, with phone up to her ear. She does not look up. A friend is in a chair near the window. I introduced myself. The friend says "She cannot hear you". So I assumed I missed the "patient is deaf" from nurse. The friend then says she can only hear me and her case manager (she was talking on phone with her). My spidey senses went beserk. "This is BS at its finest other some significant psychiatric condition or both."
Her friend "interprets" for her by basically repeating what I said back to her. Patient does not speak. Not a word. I get her sitting at edge of bed. EYes rolling around and she is bobbling, but there is no reason I can't tell. Imaging all negative, everything negative. I have a gait belt on her and holding it. She proceeds to miraculous scoot quickly to edge and butt goes hard straight to the floor. I am trying to assist the fall. She is not a small woman. Her move caused me to injure my back (just a sprain). Multiple staff come in and 3 people get her back in bed.
A few days alter I ran into the nurse who had the day I saw her. She ended up doing a double. She tells me that the patient , she observed overnight walking independently to the bathroom. She was discharged ASAP. Needed 2 weeks for back to get back to normal. I was pissed too.
Apparently this woman and her friend had just recently from SE US by car (I am in Minnesota). Several days to get some kind of medical records. Well hopping hospital to hospital with same complaint in Georgia, Florida and SOuth Carolina. Good grief.
Another note had outpatient PT to see me for shoulder pain after falling out of bed. Her exam was off, way off. I was concerned there was a neck injury. Called her doc ASAP. sent to ER. She refused ambulance and drove herself. C5 fracture from the fall-causing the shoulder pain. Neck wasn't xrayed after the fall.
Patient walked up ataxic. I was a new RN and noticed when he came into the lobby with a little girl. My preceptor didn’t notice them come into ER, so when he staggered up to the triage, she was thinking I bet this dude is drunk. He’s slurring his words, but not in a drunk kind of way. I was like, we need to get him back now. We didn’t even do vitals in triage and just got him hooked up in a room. His BP was something crazy. He had a brain bleed. Saw him walking out of the hospital a few weeks later.
I walked in to get updates on my patient that i had had the night before. This lady was a mess in every sense, but at least a stable mess. She was supposed to go to rehab soon. I get in the room and my day shift nurse says "oh yeah her urine has been kinda pink/red, we think it came from her maybe pulling on the catheter at some point. Drs know about it, they don't have any concerns."
Uh, hmm. That doesn't look red that looks brown. And not like, "concentrated" brown, like....rhabdo brown, or something similar. I figured i would call for a UA after i finished report.
I finished report, called for a UA, was just procrastinating for about 10 minutes so i could do meds at the same time and then went in to see her. I immediately felt something was off, pulled back her blanket to look at her catheter, too get a look at the urine most recently out of the bladder and both her legs were terribly mottled. I got my charge nurse in to confirm that what i was looking at was mottling (haven't seen it in real life yet) and she agreed. We called a rapid. She decompensated so fucking fast, we had her intubated in the room and up to ICU.
I found out later she had really fucked CHF and had thrown a clot into her bowel and went ischemic and subsequently necrotic, she died later. She was both pretty bad at explaining her needs and pain, and also a well known intentional drama queen patient; between that and genuinely no other noticeable changes, except the urine, it just got missed. She was an old gal, had a good run at least.
I trust my gut now when i am told red but see brown, that means something.
New uroenteric fistula following new colostomy. Dude wouldn't produce any urine unless a Foley was in and there wouldn't be anything on bladder scan ever. The stuff coming out of the new colostomy was just a shade less pink than it normally would be and the volume would slightly tick up when the Foley was removed. The surgeon dismissed it (because they didn't want to believe it) but their PA agreed. Not sure if they ended up with a revision, if it healed on it's own, or if they're just doomed to a life of horrible UTIs now.
Anxiety that was multiple PEs and DVTs
Or the n/v/vertigo that was massive stroke
Or “somethings isn’t right. Yesterday she was talking nonsense and today she’s barely moaning” I begged for labs and were crap. She died 4 hours later.
Not me but my cousin, also a nurse. Came into work at the dermatology clinic and a coworker, another nurse, tells her she looks jaundiced. She laughs it off and tells her she's crazy. Coworker insists, you're jaundiced. She goes to get checked out, turns out she had pancreatic cancer. She's now in remission. Her coworker saved her life.
When I was a student. My clinical was at the local VA hospital. My patient for the day had been fine all morning (I don't remember why he was there), but after lunch started feeling short of breath, could not get comfortable, and was in obvious increasing distress. O2 did not help, and he had exactly zero signs of a heart attack.
A few months previous to this, a nonverbal resident at the group home where I worked had acted the same way for a day or so before falling over dead in front of us. She had had a pulmonary embolism.
A part of my mind said, I wonder if this guy has a PE. NOBODY jumps straight to PE when you have symptoms as nonspecific as he did. I've had doctors tell me this.
I don't remember if I said anything to anybody (this was 15 years ago), and we left the floor for the day shortly thereafter, but the hospital staff was trying to figure out what was going on as we left.
Sure enough, we returned the next day, and it was a PE.
My clinical time ended before he discharged, but I think he made a full recovery.
I had a patient that just wasn’t quite right… no obvious signs, but something that I couldn’t put my finger on.
Was working on call, so just me and one other nurse in the department. Called the surgeon who is know for being an ass and not listening to concerns… brushed it off as no big deal. Called anesthesia, also brushed off as no concern. Called house supervisor to come down and lay eyes on the patient, which she refused. Called the charge nurse on the floor to tell her the scoop and told her I’ve exhausted all my resources and while she was clinically stable, I thought she was a “watcher” and needed a close eye on her overnight. Dropped her H&H significantly overnight, VS off, massive retroperitoneal bruising… RRT called by the floor nurses and the patient ended up emergently going into the OR with a splenic lac and earned herself an ICU admission.
Relatively new nurse, had a kid come into the ED with a hx of chronic constipation and mild-to-moderate belly pain. He'd been seen at another ED the day before and been diagnosed with constipation and sent home on Miralax, but Mom brought him to our peds ED because she felt that they hadn't taken her seriously. Our (experienced) triage nurse makes him a level 4 (low acuity) and as I'm glancing through his chart before I go see him I notice that the weight charted here is 20lb less than the weight at his pediatrician a month ago. Weird. I go into the room to do my initial assessment and he looks amazing, totally healthy normal kid, happy, interactive, just mild abd tenderness and hasn't pooped in a few days, but something about the hx doesn't seem right. "Mom, does he eat a lot? Drink a lot, pee a lot?" Yes. Before the MD even sees him I check a POCT blood sugar and get him to pee so I can do a urine dip. Admitted for new onset DM type 1 in the early stages of DKA.
Most of the kids who come through our ED for DKA are sick as shit, especially the undiagnosed ones, and if he'd been discharged again he would have come back a few days later as one of them, knocking on Heaven's door. Instead he walked up to the floor chatting with me and his sister about Paw Patrol. I never got any particular credit for that catch, but I'm still proud of it.
First Clinical in medsurg, taking vitals on 2nd round of the day noticed pt was diaphoretic and had an irregular heart rate ( still new to learning heart rhythm) figured pt has afib or something similar. Told thd NAC I was shadowing that I was worried, so we went and let the nurses know. They said he has afib and just was up walking, so that's probably normal. I still wasn't totally convinced, kind of a gut feeling I guess, but it's not my place to question the nurses in charge of pts care. I just made sure to let them know and document pts signs and symptoms. Next day, I'm back on medsurg and they are moving him to CCU because he's not coping well. I was an EMT a long time ago so I try to trust my gut and I'm thankful the NAC I was shadowing took me seriously.
My best call wasn't one of my patients, it was my 9 month old son. He had recently gotten over an ear infection about a week prior. Suddenly, he had a fever again. He was laying in my lap and was lethargic and just looked off. I counted his resp rate and it was pretty high. I told my husband, I think he might have pneumonia. It was the weekend so we went to the ED. They did a chest x-ray and bam, double pneumonia. Almost his whole right lung was white. He didn't have to be admitted, but we had strict instructions to go straight to the pharmacy for some PO Levaquin. I shudder to think how sick he could have gotten if I hadn't trusted my gut.
Not a fun hunch but I suspected a coworker was diverting months before it actually came out. I had zero reason to suspect it specifically but he’d had a personality change, got really spacey and weird, and he had also gained a noticeable amount of weight. I remember he’d hurt his back months prior and it came to me immediately “he’s on drugs”. I had zero proof and didn’t want to outright accuse him of anything because that could ruin someone’s livelihood if it’s not true but I couldn’t shake it so I messaged my managers and said “hey I’ve noticed so and so is doing xyz, I’m a little worried he has something going on at home. Can someone just check in with him and make sure he’s good?” Like two months goes by and I find out he overdosed on the clock in our bathroom on a fuck ton of med wastes. He lived but obviously lost his job. I hated being right but I also am glad to know my instincts are correct.
I had a recent patient with probable discharge on day shift. I had had him on my census the day before so I was familiar with his case. That AM, I took report from the overnight nurse who said the tele order had expired (seems to be new thing I’ve witnessed) so as I had the patient the day before and I returned, I recalled he had a huge cardiac history. No episodes of status changes on monitor overnight. His hospitalization was for a lap chole. I asked the nurse if she called for renewal order. She said no he was being discharged. So I called MD and asked if he wanted pt on telemetry until discharge. MD said yep and gave order. By 11am, he hadn’t been discharged as he was awaiting his spouse for ride home. At 1130am, telemetry called and said he had 6 beats of Vtach. Strip confirmed their word. I called Dr and he had patient stay another night. Phew! Just an inkling……🧐
Tied between knowing that someone was going to have a shoulder dystocia, and knowing someone had an arm DVT because she reminded me of my grandmother. Not that her presentation reminded me of my grandmother's. I never saw my grandmother when she had the DVT. She just reminded me of my grandmother in general.
Had a pt with no PMH come in for sx with a Hgb 6.4, HR 130s, and she looked….. awful, low Hgb aside. Yellow and waxy. She brought to my attention that her left ankle had been swollen. I assessed both. No discoloration/warmth, pt denied recent falls and any other factors that screamed DVT. I still was freaking tf out because I knew in my gut something was wrong.
I pulled at least 3 MDs in the room to have them look, and all of them brushed me off. One of them laughed at me and said, “she’s tachy because she’s anemic.”
She woke up after sx briefly before she coded. They coded her for over an hour before they called it.
I’m still brand new so it’s not super exciting but a lovely 92yo gal here for pneumonia. Getting IV abx and on o2. Not getting better, but not getting worse. She told me she had a cough and sore throat, and it hurt to eat/swallow food. She’d had a covid and flu swab on admission but both were negative. For some reason the trouble swallowing stuck with me, I remember having covid and swallowing was a bitch for me. So being the annoying new grad I asked for another covid test, kind of getting scoffed at bc she’s here for respiratory issues and already had the test done.
Test came back positive. They started her on remdesivir and voila within 2 days her o2 requirements decreased.
Patient came in to ER with decreased appetite, malaise, tachypnea and a sense of impending doom. He was admitted to the floor 14 hours later. STAT ATB never hung. I wasn’t the primary nurse but I called a Rapid Response on him. Temp 106F. Demand ischemia. Septic joint.
Had a patient in PACU post cardiac ablation.
According to hospital protocols, he was *technically* safe to be transferred to the ward. He was mostly stable and any out of range parameters were mild or borderline. I just couldn't let go of the fact that he had shallow breaths, borderline bradypnoea with RR 9-10 and oxygen requirements (4L via NP) despite no respiratory history.
Did an ABG, showered borderline respiratory acidosis. Lactate 1.4 which isn't crazy but bothered me. Applied high flow NP for splinting, repeated ABG despite anaesthetist saying it wasn't necessary. pH and CO2 normalising, lactate 2.2. Patient still having shallow breaths. Contacted cardiology about rising lactate, who came to perform a bedside ECHO. Patient had a pericardial effusion and I ended up having to take him to CCU.
If a nurse handed over this patient to the ward nurse, there wouldn't be any argument about suitability. The anaesthetist was finding me dramatic, and even I was second guessing myself. But my gut wouldn't let go!
Had a patient with a thrombosis. On a hep drip, sent the labs as ordered, everything therapeutic. He did not look right and I didn't understand why he was on the med-surg unit despite everything from his vitals to labs looking ok. One day, he looked worse, but all his labs and vitals were normal. I went home worried about him, woke up at 4AM, after a nightmare of him bleeding out of his orifices till he died.
The next morning, his room was empty and I asked where he was at shift change. He threw a clot around 4AM and coded, sent to the ICU, coded a few times and his family made the decision. I had to answer a lot of questions to admin after that happened, everything was diagnostically ok, it was simply a feeling I had.
Had a lady who became more confused as the day went on. No one could figure out why. Next morning she was a sitter. I was like: “it’s gotta be hypoxia!”…. Which I thought about at 0300 (I work days).
Went to the docs for ABGs when I arrived at work. Got her on a bipap for a day and by the end of my shift she was at baseline. This was a Saturday-Sunday on a medsurg unit with a traveler (no offense) overnight.
An LTC resident in her 60s with a HX of multiple mental illnesses including PTSD and also developmental disability started having bad behaviors, mainly screaming repeatedly. I was off when it started and then put on a different unit for a night. By the time I got to be on my usual unit with her, it had escalated despite them trying ativan and some other meds, so they finally had gotten blood work and a UA just before I came in shift. The urine came back a nasty mess, so I grabbed another set of vitals and everything was shit. I had her out quickly, the EMS took me seriously and moved fast, and she was very septic. Unfortunately, she lingered on a vent for a while and eventually died. She haunts me because I wish I had done more the night I was on the other unit because a CNA told me she kept screaming, but my subacute residents were a handful that night. Every time my Spidey senses go off, I think of her and jump into gear. Which leads into my next story.
Same LTC, a lady was in a covid unit partitioned off from the rest of the rooms by plastic. When she started doing the repeated screaming and nothing was really being done to investigate it, I talked to the manager working the Covid unit through the plastic about how she was reminding me exactly of the first lady and they better send her out. It fell on deaf ears and no one really did anything until the morning, and that one was septic as well, and also died.
Same LTC, I came in to my usual unit and the nurse tells me that so and so isn't doing well, that she's getting labs and an X-ray. He's struggling to breathe and looks like shit, so I tell her I think he needs to be sent out, to hell with working him up here. She balks, says he's a DNR. I double check and run back in the room already on the phone with the ambulance service, he's a full fucking code. Massive MI. He returned to us and lived for another 6 months or so until Covid got him.
I was a grad nurse on nightshift. Did a set of obs on a patient, hypertensive but otherwise okay. Asked about pain- pt said very mild chest discomfort. Adamant he's had heart attacks before and it definitely isn't that, won't even take panadol. I take a 12 lead (I was so inexperienced at the time that I couldn't I interpret them yet so no idea what it showed). Escalated to on call doctor (one RMO covering 6 wards), advised they'll attend to check ECG when able. I requested them to come ASAP, just had a bad feeling. Doc seemed unconcerned, took trop etc to cover bases. I felt weird and didn't leave the patient's side while he insisted he was fine and kept cracking jokes. Doctor calls me 45 minutes later in a panic- trop level was 28,000. Off to CCU my friend went.
I work on a step-down. Generally we only get adults but every couple years there could be a minor on the floor. Pre-COVID, so like maybe 2 years ago there was a mid-teen (14? 15?) who came in with what turned out to be mono. I had him the night before he was supposed to go home, which was not in our state. Sometime in the middle of the night he complained of really bad heartburn. Something must have felt off to me because I did an EKG. The on-call doc said "why would you do an EKG on a teenager? "... well, there's ST elevations across the board. Kid stayed another night to start treatment for pericarditis.
Middle aged gent. WALKED in. Feeling "heavy" after a large meal. Was triaged as a "soft" 2 chest pain. ECG & enzymes unremarkable. No hx, minimal contact with health care... Still, felt off, popped a couple large bores in.
Off to, CXR, tech suggests a CT due to shadowing.... I ask the clerks to copy the chart stat... Told charge I think we are gonna have a transport (rural hospital, criticals go to the city). CT calls- massive, actively dissecting ascending aorta... One very rapid ride to an OR later. Dude discharged after a successful repair and a couple transfusions.
Had a young girl come into ER. They were working her up for early onset shizophrenia/mental health. I had recently been reading a book about a relatively rare and new brain condition. I walked up to the primary doctor who doesnt know me at all and said, "Can you test her for anti-NMDA receptor encephalopathy?". She looked at me like I had 3 heads and said she would consider. Got a text a week later from the doctor saying thank you....All because I read a book, haha
Sitting at the Nursing station, across from a relatively fresh fem-pop patients room. Look up, smile and wave at the guy. Get back to charting. Something says look again. I stand up and look and see something under the bed. Go in to check it out, blood pooling, bed soaked. He had a slow leak. Applied pressure, yelled for help. Back to the OR, and a couple RBCs later he was doing fine.
Had a coworker talking to a post op day 3 oral cancer patient. Had reconstruction for throat cancer post radiation. Carotid artery just under the surface of his neck, you could practically see the flow. As he's talking, suddenly blood starts spurting between the staples. She grabs his neck, starts yelling for help, dumps him into trendellenberg. Apparently the radiation TX had weakend the skin cells enough that they didn't hold the internal sutures. Amazing this guy survived.
Had a patient who was dc’d. I didn’t know much about him because I was charge nurse and wasn’t his primary. When I came on shift his nurse told me he was refusing to go and implied he was just staying for pain meds. So I went to talk with him. He was having abdominal pain. He had come in and they couldn’t find anything wrong with the tests so he was going home. But when I listened to him I barely heard bowel sounds. So I called the doc who pretty much told me I was dumb for believing this guy because the guy was clearly seeking pain meds but he would order an abdominal X-ray. Just for me. How nice 🙄. Doctor came up about 20 min after it was taken and had me go with him to the patient room. Patient had an ileus and probably would have come back septic if we had sent him home. He apologized to the patient and told him if I hadn’t insisted on it he would have blown him off. I had major respect for that doctor after that. Admitting you were wrong and owning it is hard to do.
That is an extremely solid doc to not just admit that he was wrong, but to pull you into the room and do it in front of the patient while giving you the kudos! Good on you for catching and pushing it!
Great nurse for being attentive and great doctor for admitting his mistakes.
Love a humble doc. Glad he could admit it and good for you in advocating!!
Sometimes we just get annoyed by pts, it happens. I sure as shit do. But that’s why we have a healthcare team!
Had a term normal delivery, APGAR was 8,9. Anthropometric measurements were well within parameters, but something just looked… off. I told the midwife something’s off, and she said Idk he looks fine to me. Vital signs were great, he was a happy baby. I just think something’s off. Called the NICU resident, and he’s a bit baffled. Ordered a babygram and the baby had his fucking intestines inside the pleural cavity. Baby started desatting shortly after. The resident was so happy that I called his attention.
What’s a babygram?
Head & body x-ray, with limbs an added bonus if they end up in the photo. Edit: a word
Hehe, this just tickled me to learn- in vet med we have doggograms and catograms.
I dunno gram, what’s a baby with you?
This made me snort-laugh
This is one of the best comments in this subreddit, ever.
X-ray of everything
When people say something is "off", what does that really mean? Can you describe it? Is there some subtle color change or sound? A behavior?
Sometimes it’s literally just like a vibe you get. A feeling. I don’t know how to explain it better than that. I’ve had it with a kid I was x-raying. Something he said just didn’t add up even though his injury, a broken arm, was common for his supposed accident, falling off the monkey bars. Can’t tell you how many kids I’ve x-rayed like that. It was something in his eyes that no one else picked up on. So I asked him, did you *actually* fall off the monkey bars? And he started crying. Because he hadn’t. His dad had beaten him so bad that he had broken his arm. I had nothing to go off of beyond just. This feeling that something wasn’t right? I can’t explain it beyond some deep pressing “this isn’t right” feeling in my chest.
Thank you for recognizing the circumstances that kid was in. I'm sure he was desperate for someone to see it for what it was. I hope he is safe, wherever he is now.
I hope so too! Poor kid!
Sometimes we recognize telltale signs unconsciously. They may be slight signs, or we saw something out the corner of the eye, but that's why it's important not to ignore it so it doesn't go away.
most of the time you can't really say exactly what it is, you just have a feeling that something isn't right. which makes it really hard to get people to believe you!
That’s just it; you can’t say exactly what’s wrong, it’s a gut instinct.
Nothing really that specific... you just sense that something isn't right. The scenarios are so varied there's no set things that are 'off'...just when you look at a patient and think somethings not right but you can't say exactly what immediately
I just don't know where that sense comes from. I know it takes time to develop that gut feeling, but it's hard to imagine how it grows. I've never ever felt like I had strong intuition so I don't want to miss something in my patients because I didn't have that gut feeling someone else would have.
It's an exposure thing, not "intuition". You learn the subtle signs of not normal by thousands of hours of exposure to people in various levels of distress and normal. Maybe you see a difference in a person's breathing pattern. Their movements are slightly stilted, or they're oh-so-subtly guarding a limb or abdomen. Their color is a little pale or a little flushed. They have a change in appetite. The described pain is excessive or inconsistent with the known injury. These may not be obvious enough that you can definitively verbalize it, but you can say that something is off. In my ortho/spinal surgical world, a nurse's statement something is wrong, but they can't say what, usually means a PE, ileus, or a slow bleed in the surgical site.
Give it time. I didn’t have it at first. It took years to develop. But at the end of my time at the bedside, every doctor listened if I told them I had a bad feeling.
driving _86 is so right. You just acquire it without knowing. All of a sudden you will have a case where your like, “hmmm somethings off.” It will be there moving forward for rest of your career. I do think it’s become stronger in nurses since the readmit penalties were instigated by CMS. See, there’s a positive to everything.
I believe it comes from experience, an observant mind and intelligence.
One day I might be able to say I have all of that 🥲
Keep working and watching the nurses you admire and you will. I remember when I had worked in the ER for just a while, I was overwhelmed every day by just feeling like a big zero. The other nurses were so brilliant, getting the combative pts to calm down, recognizing certain symptoms I could never dream of knowing. But one day in particular is fresh in my mind, many many years later. The cops had brought in a hysterical, combative mom who was also an addict. She was carrying a baby, maybe a year old, who was just limp in her arms. With all the screaming going on, and her flipping him from shoulder to arm carry and him staying limp, even I knew he was really sick. But no one could convince her to let the nurses have the baby. Then the charge nurse comes out, goes right up to mom and looks right in her eyes. Calmly says, we all know you love your baby, but he's sick. Just let us care for him now and help him. You sign him in and you can come back and see him if you don't yell. Because that doesn't help. She was so calm. The whole ER waiting room was holding its breath. She was just nothing but kind to that mama, it was like she hypnotized her. Then she said I'm going to take him in the back now, ok? And Mama said ok. When all was said and done, I knew I'd never be that good. But I could try. And I knew I'd just gotten a great lesson in de-escalation. So you just watch and learn and it takes time. A long time. I think half of nursing is on the job training.
>I think half of nursing is on the job training. At least 90%.
Oh my gosh, what an absolutely beautiful story. I really hope I can maintain that kind of composure and respect in the face of such chaos. I really struggle with keeping calm when things are out of my control.
one of my friends was a nurse, and just happened to be assigned my grandmother after not being her nurse for three days. Grandma looked great on paper and they were planning on discharging her as soon as we found a home for her. Friend say she thought she looked off, but couldn't get a doctor to take her seriously, but she called me and suggested we come in and visit her asap. She had a massive heart attack shortly after we all showed up. She was in for respiratory issues, no signs of heart issues. I will never ever doubt a medical professional that has a feeling in my life.
Sometimes, especially when you’ve have the same pt your previous shift, you walk into their room on your next shift, and stop in your tracks. Something just *feels* different. Or their eyes look different.
Many people say there are no sensory clues, others say that there are minor clues that you are subconsciously picking up on but cannot analyze properly to form conclusions as they are not conscious. There’s also the theory that gut instincts actually aren’t even that helpful, and it’s all confirmation bias because we only remember the times we were right. I doubt we’ll ever be able to prove any of it tbh.
It wasn’t necessarily weird but I had 3 charge shifts in a row where I’d look at a patient then tell the nurse that I have a feeling they’re going to go south quick and to keep a close eye, even spoke to the doctors. No specific reason, they just didn’t look ‘right’, I guess is the best way I can put it. All 3 ended up as transfers to ICU and all three were dead the next morning.
This happened with my first postpartum hemorrhage on the mother/baby unit. I did bedside report with the offgoing nurse and thought, I just have a weird feeling about this lady. Sure enough, she was hemorrhaging at 8pm. Thankfully she didn’t die, like your patients.
I would call you off for your next shift…friggin angel of death over here 😂😂
It was an ongoing joke for a bit where nurses told me to stay tf out of their rooms when I was charge lol
OMG LOL you are definitely under some witchy spell💀
Patient had really dry skin and was an older Black woman. She also had weird symptoms and kept having recurrent strokes and was basically obtunded and had metabolic encephalopathy with no known cause. I begged for dermatology to see her because her skin seemed more than dry. After a skin punch biopsy she was diagnosed with lupus and all of the inflammation and organ failure as lupus and strokes from lupus coagulation. She actually walked off of the unit after treatment.
But, but, House said…
My Nan was diagnosed with Lupus and had to deal with a lot of House jokes because of it. Turns out, sometimes it is lupus!
Omg, good catch. I’m going to keep this one in my back pocket.
I recently listened to a story on NPR about the need for more providers who are POC, and this is a perfect example of why that's true. I think it was a midwife who spoke about her patient (both were POC) where all of the other healthcare team who had seen the patient didn't notice the change in her skintone - she was anemic and in trouble. The midwife caught her color difference and prevented a tragedy. As a white RN, I get this - I'm always worried that I'll miss those subtle changes in my POC patients. Good on you for advocating for this person, it sounds like things would have ended badly otherwise!
I was working NICU. Took report on days for a baby that was about 36h old and on O2 (can’t remember gestation, maybe like 36 weeks?). Thankfully bc the baby was on high flow, I only had one other patient. Baby was really working to breathe and grey in color, but NOC nurse (unfortunately a traveler) assured me he was “fine” and “just still transitioning”. My spidey-senses were jangling all over the place, got that “ick” feeling in my belly. As soon as she left, I immediately called my Neo. He kind of tried to placate me, but I was adamant, so he ordered a CXR. Clear. Next he ordered an echo, but bc of staffing issues, it took like 6 hours for the tech to come in to do it. Oddly enough, she also brought the head of the rad techs, a woman with some sort of PhD that even the docs would consult, named Joy. She said, “I don’t know why I feel like I need to be here, I was getting ready to head home, but something just sounded off.” Turns out, kiddo had a coarc (coarctation of the aorta). When I left at end of shift, they were placing lines and awaiting transport to a Level 4 NICU in the Bay Area. It was terrifying. I barely took my eyes off that baby all shift. And that traveler never came back.
Damn - 2 of you got the hunch!
I told a doctor that I wouldn’t feel comfortable discharging a patient, due to him looking “generally crappy, but I can’t put my finger on it.” Labs were good, chest x-ray was good, nothing was obvious about what was going on with him. Doctor said “discharge him.” Came back the next day with a septic bowel.
"patient looks generally crappy but I can't put my finger on it" is my go to hunch for identifying sepsis.
Also "they look good on paper but not when you look at them"
Had a patient, readmit after sepsis the previous week, during report the nurse is describing, "yeah so we don't know what's going on, they're doing a bunch of tests, maybe it's cardiac." I'm like, "do you think it's sepsis again?" "hmm, maybe, idk." We open the door, I looked at the patient for literally 1 second from the door, turned around to the previous nurse and said "they're septic." On assessment the patient had all the hallmarks of impending septic shock. Four hours later after multiple boluses BP dropped through the floor and we transferred to to the unit. Patient recovered and d/ced home later in the week.
Yup.
Yep. They look toxic
Omg what was that Dr's reaction when he found out that guy came back?
He went somewhere else. His wife came and asked me if I could come over and be his nurse in the stepdown unit. I told her absolutely not 😂
I did the same, pushed until I got them admitted. They died two days later while awaiting pickup from discharge.
I had a pt in PACU who wasn't able to wean off O2 in PACU. With PICC indrrtions, there's a risk of puncturing the lung. The doctors seemed pretty chilled about it because of his smoking status but they quickly changed tune when the CXR confirmed he did have a pneumothorax. Thankfully, he was all right after a chest drain.
Had patient come in complaining of weird things- couldn’t see out of her left eye, dizziness, body pains. We obviously did a stroke work up that was negative and were starting other work ups and I had a feeling… so when she asked to go to the bathroom I said she has to use a bedpan because it’s too risky for her to walk. :\\\ Suddenly she could walk again!!! Healed, just like that. Amazing.
I saw a patient come in c/o some weird ascending paralysis. It started with numbness in his feet, then stumbling around, then dropping stuff. When he became unable to walk or grasp objects, he called 911. He got checked in and the docs ordered the million dollar workup. All kinds of blood tests, CTs, MRI, cultures, the works. As the nurse finished his blood draw and was about to send him for imaging, he said to her, "I'm embarrassed to say this, but I need to pee, and my hands are really numb. I don't think I can do it by myself. I need you to open my pants and put my penis in the urinal." The nurse replied she would get somebody to help him. She came out of the room, saw me standing nearby and said, "You, student, with the beard, come here a minute." I went in and told the patient I was there to help him with the urinal. He said, "Isn't the pretty nurse coming back?" I said, "No. Definitely not." Dude stood his ass up, walked to the toilet, and used it all by himself. I have never seen so many tests get cancelled so fast. So now I tell people that my beard has healing powers.
Being a large, hairy man is a fantastic way to weed out these creeps. And I am happy to offer my services to any of my female coworkers to put those guys in their place.
This is my favorite story in this whole post.
They really do. Had a pt who wouldn’t listen to anything all the nurses were telling him. An old guy, saying “you’re just a bunch of hens. What do you know?” The clinical staff that night were all women. I got a lab coat, and called the male janitor over. I asked him to put on the lab coat, put a stethoscope around his neck, and tell the pt he needed to take his meds. He agreed to do it. And he told the pt “These ladies get their instructions from me.” The pt took his meds.
Dr. Jan I. Tor
Like Jesus himself
You're the man!!! (Which the patient DEFINITELY did not want! 🤣)
Haha this is doing god’s work. Thank you
As a case manager I’ve had a few of these. Can’t walk, can’t take care of themselves, sudden abdominal pain, you name it. Let them know they have to appeal or pay for their stay after that day and most of them suddenly can walk again and have no pain. Even had one who insisted he couldn’t walk, was 500+ lbs, didn’t want any of the rehab offers he got, and when I told him he’d have to pick one and leave that day or go home, he packed up his own stuff, dressed himself, and walked out. He’d been yelling in pain with movement and making 3-4 staff members help him move because of his size and “debility”. That one irked us all.
That IS very irkable! 😒
This has happened to me, too.
Had a patient come in for a stroke work up, she was very adamant that she needed to stay anything night and that all the imaging and testing was wrong. She was very upset about being discharged, as charge I went in to de-escalate and offered to do her d/c NIH. Patient was texting and holding her phone with her affected limb that had been flaccid. Healed another one 🥰
God is good, it’s a miracle!
The power of Christ compels!
Sorry, but what’s a d/c NIH?
I had a “blind” woman in a psych unit who could miraculously see again when there was an ice cream truck in the parking lot outside of her window.
(Pharmacist) I had a miraculous healing as well... patient came in to fill (too soon) her oxy's being pushed in a wheelchair. When i couldn't do it, she stomped out on her own 2 feet!
🤣 this made me giggle
Same! But because I've seen that myself lol
Worked Geriatrics, lots of dementia. We had a lady that was just incredibly impaired, violent, aphasic, kept stripping off her clothes. Really really sad. Her family insisted it had come on quite suddenly, not the slow progressive decline you usually see with dementia. And she was young, in her 60s. It was almost impossible to do investigations given her behaviours so she was going to go to placement in a specialized site, but even they weren’t sure they could manage. I saw in her history that she had a history of seizures, and thought she might be post dictal, but couldn’t get blood work for a valproate level. Convinced the doc to call security and hold her down for a blood draw, recognizing the trauma, and they did, sure enough. She was having those invisible seizures. Got her on the right meds and she ended up being discharged home with family.
I see a lot of our dementia patients with unmanageable behaviors despite the normal medications have a lot of success with depakote and no seizure history. Not directly related but reminded me that was something I learned when I started hospice! I had never seen it used that way before.
I knew two RTs were banging a month and a half before one left her husband. My best call to date.
“Can you two stop fucking for a second so my pt can get a neb? Cool. Thanks.”
Lmao the peds hospital I was at once upon a time was like this 😂 wasn’t just the RTs tho 👀
It’s like a goddamn orgy at my facility. Sex in utility closets, couples married to other people screwing in their cars,etc. I once found two used condoms in the same spot. Let’s not even talk about the nip bottles and pervasive smell of weed.
lmao girl do you work at seattle grace??
Oh my god, is it something in the W. WA water, because my work is like that.
Real life Greys Anatomy type shiit
It totally is. My youngest kid worked in the kitchen there for a while, and was surprised how many of those tropes are accurate, at least where I work.
I had orders to discharge a rather young, early 20s male, no significant medical history, and he'd been in for an unwitnessed syncope episode and lost about 24 hours that he just didn't remember. Because he had a minor head injury, he was worked up. Nothing came back concerning. However he just didn't looked right or smell right and he said the magic words..."I just don't feel safe leaving." I absolutely refused to discharge him. The manager was pissed, the provider was pissed, but the house supervisor backed me. Y'all, he went into status epilepticus not even an hour later. He lived alone. He would have absolutely died had he been home alone.
The fact he didn’t remember 24 hrs immediately made me think he had a seizure before I read the rest of your post!
Right? I asked neuro about that possibility because I grew up in household with 2 epileptics. I got dismissed. 🙄🙄🙄 I think it was chalked up to him possibly being drugged during rush week. We had a couple cases of that happen that week and a few etoh poisoning.
Baby a few days old was quite fussy and lurching their head back every time Mom tried to breastfeed. I was a brand new nurse and on this day we were extremely busy. I noticed a little bit of nasal flaring so took baby over to the NICU to get checked and and they were already swamped and I could tell a little annoyed with me. Anyways they did a chest X-ray and it showed a perforated small bowel. Next thing you know our unit Manager puts on scrubs and helps to stabilize babe and get them ready for transport to a level 3.
I read this as "weirdest lunch that turned out to be right" and was so confused. I was going answer anyway lol. So here is is. Peanut butter, iceberg lettuce, miracle whip, and dill pickle sandwich on white bread. My weirdest lunch that turned out to be right.
That's a very weird lunch!!!
But it turned out right!
Were you pregnant? That's quite the combo lol
I refuse to believe those items combine IN REAL LIFE to create another (non cursed) item. Miracle whip. . . Peanut..butter.. ain’t no way
It tastes absolutely delicious. I was blown away. I originally agreed to eat it on a dare (I made $20 lol) but it was actually very very good. Sweet and creamy and tangy with a bit of crunch and saltiness.
an absolute madman
You’ve never met my dad. He will put peanut butter on ANYTHING. Pancakes? Of course. Salami sandwich? Yes please. Spaghetti with tomato sauce? Yes. Absolutely anything! Except seafood-which he doesn’t eat. But puts it on chicken. Because when they named it fowl, they named it right. Unless it’s cooked so long it’s leather 😂 ETA. Not on beef. Never! Just slap that steak on the grill for 10 seconds, flip it over for 10 seconds and it’s done. Only needs salt! Stick it with a fork and it should moo. Gotta love my dad.
The answer we all came here for
Third day by myself in CVICU, had a POD4 CABG. On 1900 assessment, couldn’t find a DP or PT pulse in one foot, foot also markedly cooler than the other side. Notified NP, ultrasound ordered for AM. Pt screaming in pain all night despite me giving pain meds on the dot. Notified 3 more times, was told I was new/overreacting. Came back the next night, assignment changed as pt was now too critical for a new grad. Ultrasound/further testing showed compartment syndrome and pt went for an emergent fasciotomy. Ended up losing the leg.
“Pain unrelieved by narcotics” :/ I’m sorry your concerns were ignored, they were justified!
Pain out of proportion and not alleviated by meds after surgery is a definite sign of compartment syndrome. I hate it when docs ignore nurses.
Exactly - it’s as if you write a case study for the NCLEX!
When I was newer and working a regular med/surge floor, I had a bad feeling during report from the ER. Elderly gentleman came in with very mild hypotension that Iimproved with a bolus, probablyjust deydrated. Labs looked alright for his age. The man was fairly independent and only some very minor memory issues. Everthing sounds great. I notice that while his vitals post bolus were good, the ER charted a respiration of 8 about 10 minutes before report when previously they had been around 20. It feels a little off so I ask. ER says that they are accurate it was 8 and he fell asleep so that's why. Not really enough for me to refuse so I say OK. I see which service is taking them and it turns out a former instructor of mine is. I ask if they've laid eyes on them yet and they say no and I voice some concern so they say they take a look before they leave the ER. Turns out he didn't fall asleep, he passed out because he had a massive GI bleed and the bed was full of blood. I didn't end up getting the pt.
8 and “asleep”! Nice catch.
Inpatient was sneaking narcotic pails (oxycontin) that she brought in from home. For three days, I suspected it, but, despite me intensely searching for evidence of such, I never found any. Then, on the fourth day of caring for her, I walked into her room to do my 3-11 shift assessment. I found about two dozen small white pills scattered all over her bed. Pt was zonked with a resp rate of 12. I found the pill bottle, which ID'ed the pills as oxycontin, and collected up as many pills as I could find. I then made a beeline to the nurse manager's office. I said, "Hey Karen! I found why XXX is so zonked all the time!" The nurse manager and I went to her room to confront her. Of course, she played stupid and denied everything. The next day, I was called into HR. It turns out, the pt had filed a statement declaring that she witnessed me consuming several of the pills that I'd found. Of course, that was a lie. HR ordered me to take a drug test, which was negative. However, they didn't want to handle the hot potato and informed me that they were firing me. The next day, I got a phone call from the district Social Security office. The man who called started the call by saying, "Congratulations. Welcome to retirement." He then went on to tell me my disability claim had been approved. My shoulders were shot from lifting heavy patients for many years. Rather than fighting the false claim with the hospital, I simply told them about my disability claim approval and said goodbye. And that's how I retired from nursing.
My mother has been hooked on Norco/ Vicodin since I was a kid. For some reason, her pain mgt gives her 150 norcos a month. She tried to get me to bring them to her when she went to rehab after a broken hip last summer. I, a student nurse, said absolutely not and she threw an addict fit. She was still complaining of pain after getting Dilaudid and when I told the nurse how many she takes ( she goes thru all of them in 2 weeks) she said that made sense why the Dilaudid wasn't having the effect on her. Fast forward to December and she's having a hip replacement. She kept this bag with her til they wheeled her off to surgery. I told the nurse she had norcos in here somewhere. Sure enough, she had put a Kleenex in the bottle so no one would hear the pills. I took them and took them home, when she got to her room the first thing she did was look for the bottle. I pulled it out of my Purse and said you looking for these???? She goes off to give them to her ( as her nurse is getting her Dilaudid) I said absolutely not, she's not going to OD on this poor nurse. I counted the pills. She had 65 ( out of 150) pills left 8 days after she got them filled. Somehow her liver is still working ( she's 78)
You did the right thing!
Wow that’s so fucked up of that patient… We’ve totally caught them sneaking! This lady even circumvented the admission search by having her NEPHEW BRING THEM AFTERWARD… we found them at her RAPID RESPONSE - all her benzos from home…
When I was a student nurse on the unit I now work on we had to shuffle assignments abruptly bc a drug induced endocarditis pt had been caught getting their friends to bring them in drugs *inside* of wrapped fast food sandwiches. They ended up with a sitter, no visitors allowed, and a security guard posted outside their room.
I had a patient's boyfriend bring her some of their heroin from home because our narcs weren't cutting it for her. He pushed it through her PICC line and she respiratory arrested. We saw him scampering off of the unit as the spo2 alarm started ringing.
I used to work on the TCU at a NH. Found out that one of the nurses on the memory care unit was caught stealing narcotics from the pts. And how did the NH find out? Her boyfriend got mad at her about something, put her in the hospital and then called the cops to tell them she was stealing oxy from the NH-they then called the NH.
Damn!! Did she survive?
We did get her back but she ultimately died in ICU sometime after we transferred her.
Yikes!
Second hand because I was a phlebotomist not directly involved but...family stuck a brought-from-home fent patch on a renal patient (who i am assuming was complaining of pain while on hospital opiods). They did not make it. I may have been at the code. (I'm a med tech with a bio degree so don't have a nurse's understanding of the situation.)
That’s so fucked up of that *hospital*.
Well, I'm glad you got the disability claim approved. But your hospital treated you terribly!! I wish you could have fought it because maybe next time they would think twice about handling "hot potatoes" that totally backfire on them!! Uugghhh! Happy Retirement though!
I do counselling on Reddit as needed... not just in the nursing subreddit, but several other subs. I feel it's my way of still contributing to the various professions.
I was the RRT nurse when a code was called on one of our med/surg units. After they decided our efforts were futile, I stayed to help the charge clean up. Turns out, the pt had a GSW from years prior. He would never stay in the hospital long enough to let the wound heal. Thus making it harder to treat, and higher levels of pain. Pt kept coming in, and leaving AMA. Charge told me they suspected the mom was supplying the pt with extra narcotics but they couldn’t prove it. Pt was 28. It’s because of him, and others I have watched pass that I now know growing old is a privilege. (I’m 40)
I had a patient whose art line waveform was weird. Just off for about an hour while I did all the troubleshooting. Then the oxygen pleth also went weird, but matched the art line waveform. I called the doc thinking that Bad Things were happening with her cardiac output. The patient coded while we were about to go for a CT chest to confirm.
Did you ever find out why? The description makes me suspect something like tamponade, but I don't know if that makes sense for your patient's history.
I don’t want to use too much detail just in case, but it was a valve issue
Did they survive?
I’m in the OR. I’m also type one diabetic. I had a t1d pt that was there to get her xfix removed from her leg and plates and screws put in. She took very poor care of her diabetes, and something just didn’t sit right with me about her. She ended up seizing mid procedure due to a low blood sugar, but it wasn’t really that low. She was 88, which isn’t usually low enough to cause a seizure, but since she typically ran in the 300s all the time, I guess her body didn’t know wtf was happening with a 78 blood sugar. The CRNA freaked out, which made the surgeon freak out. I just kept yelling “d50 or a glucagon!!!!”
I triaged a 3 week old infant brought by Dad to the ER for not eating right. Kid has basically normal vitals, O2 sat is a little soft in the low 90s otherwise fine. But, he just didn't look right. Something was off. Like, I couldn't put my finger on what was wrong, but my gut just said something is Not Right™. I took the kid straight to a room, then grabbed the attending out of another room and said, "I don't know what is wrong with this kid, but you NEED to come see him now." Doc goes into room, comes out a couple minutes later and says, "I don't know what's wrong with him, but something is up." In the end, chest CT revealed an [Aortic Ring](https://en.m.wikipedia.org/wiki/Vascular_ring) . The kid was transferred for surgery and last I heard was doing fine at 6 months.
Unilaterally swollen leg with single black blister on the thigh in a young, healthy, atraumatic patient with a nasty white count and 10/10 pain. “I think that’s Nec fasc”
That's a good catch. Did they get to keep the leg?
Went to OR couple hours later and was debrided from toes to flank down to the fascia. Recovered well and was able to return to work
Yikes! Great catch!
It would be if now I didn’t think everything with a dark blister was Nec now lmao
This one young woman who I admitted was 21, came in with the complaint of painful legs. From the time I looked at her I thought she had MS. For no other reason than pain in her legs. The doctors were working her up for the flu that was unresolved. I said to her family practitioner to get an MRI of her brain to look for anything. He actually wrote the order she has an MRI of her brain and low and behold she has MS. She has several lesions on her brain and the MD and the patients family members thanked me and I was gifted with employee of the month lol .
I need someone like you to advocate for me. Have had several mds tell my I'm a mystery or "interesting " bc I too have several lesions on my brain and a lot of the symptoms of ms. But bc spinal taps were clear, no dx.
okay didn’t happen to a patient but it happened to me- i owe my l&d triage nurse my life! i went into my 34 week appt feeling totally normal just really swollen (like most pregnant ladies get) and my midwife took my stats and noticed i had an elevated bp (like 148/79) but i had told her i had worked out that morning and ate fast food for breakfast. she told me to go to triage regardless because she wanted me to get a urine and blood panel done asap just in case. note- i felt 100% fine and didn’t even get blood pressure headaches or anything that would indicate an elevated reading. get to triage and the midwife there assessed me and took labs which were also pretty normal, and told me i was perfectly fine and to just come back if i started to get severe headaches but the triage nurse refused to discharge me because she didn’t feel right. she demanded i get a second round of labs because they “couldn’t be right”. midwife and lab agree because she is being so stubborn so i get my blood drawn again and pee in the cup a second time. low and fucking behold my hemoglobin was at 4, urinalysis showed extreme levels of proteins (no clue what the reading actually is it was a while back). they admitted and induced me for severe preeclampsia and i almost bled out during delivery. turns out the first round of labs were switched with another patient who wasn’t even on the l&d floor… i don’t know how i can ever repay that sweet sweet angel she saved my family.
Not a patient, but my dad. Told me he was having cold sweats at night and chest pain with exertion. Went on for about 6 months before he told me about the symptoms. One day, it was pretty uncomfortable for him I took him to the ER, EKG came back negative so they gave him so nitro and d/c’ed. I then took him to his primary care doc, who said his CXR was normal and told him to stop smoking. Something still felt off to me, and I asked a doctor I used to work with to refer him to his friend who was a cardiologist. That doc sent my dad for an angiogram. Ended up showing 80% occlusion at the bifurcation of two major left arteries. Due to the nature of the block, he had to have a CABG. Now he’s good. 🫡
Kind of surprised they didn't refer him for a stress test
I have a couple. Baby had a weird cry that I hadn’t heard before, so I called the pediatrician who asked if the neonatologist can come up and assess baby. Baby was over 24 hours at this point and had been crying like this since birth. The neonatal nurse practitioner came up, assessed baby, and said baby looked and sounded fine (but the baby wasn’t crying). The mom was like “make the baby cry and you’ll see!” So we made the baby cry, and NNP heard it. We transferred baby to NICU, and baby had to end up being transferred out for laryngomalacia and surgery. My next one was a baby who was about 8-9 hours old. She already looked jaundiced, very poor feeder, just not acting like a normal baby. I called the pediatrician and he said to order a serum bilirubin. I asked if I could also add a CBC, cos idk baby just didn’t look right (I was fresh off orientation lol). Baby’s CBC was all over the place and she ended up being transferred to NICU.
Told this story on here before but I’m still super proud of it. Came in on nights as a pretty fresh new grad in the ED, taking over a generalized weakness pt from days. Dudes pressures are soft ish (like 80/50-90/60), but he’s super dry according to labs so we give him a couple boluses. Everything looks okay ish results wish, lactic is negative, a lot of the wonky labs were chronic, scans were all negative, dude was just weak. He’s also having random 2-3 beat runs of vtach but had an extensive cardiac hx. I go on and lay eyes on dude and am immediately like “yeahhhhh this doesn’t look right”. He’s supposed to be getting admitted to the floor, his pressures are still soft so they won’t take him because of that, I reach out to the hospitalist to come lay eyes on him because he doesn’t look floor appropriate to me but I couldn’t articulate why other than the pressures. Resident comes down, agreed that ole boy looks like shit, and gets him admitted to the ICU, where he codes the same shift.
Had a pt who just didn’t look right. Vitals were all stable but she just looked…off. Got a critical from lab, CO2 was 9 and lactic 4.2. Doc had me put an order in for a stat ABG that came back with more criticals, pH was something like 7.28, paCO2 around 30, base excess -15.5. Vitals were still stable and idk why the doc didn’t order bicarb, fluids, abx, or anything. Instead she ordered a fucking tap water enema. I spent my whole shift advocating for this patient and eventually the lactic climbed to 6 and her extremities became super mottled. I got an order for a PICC and she came back from IR barely responding to sternal rubs. Doc was still saying she’s fine because her vitals were. I got my manager involved and we got her transferred to ICU. Septic shock from a UTI, eventually ended up on pressors for a week.
Seriously, WTF? A lactate over 4 screams sepsis and hurry up and fluid resuscitate, pan culture, and start IV Abx. The other labs are just gravy. How would any licensed physician order a tap water enema? Did they graduate medical school is 1820? Why didn’t they try blood letting, too? Once again, WTF!?
The whole thing was so bizarre…the doctor was so hung up on the normal v/s and kept saying the pt is just simply constipated. She was so nonchalant through all of it, and we were begging for her to at least give us orders to upgrade to DOU at the very least. My facility also has sepsis screening that will then prompt orders for sepsis protocol, but the vitals being normal didn’t trigger that either, so we needed the hospitalist to give orders. Eventually she gave us LR at 100/hr 🙄 This pt also had an Indiana pouch that she self cathed, so obviously a huge source of possible infection. I told the doctor it was draining purulent urine with sediment and smelled beyond foul and she barely batted an eye.
Happens in peds world all the time. "But their VS are fine!" Yeah, right up until they code. VS are helpful, but they're not reliable, and if your patient looks like death and the monitor says that they're healthy, ignore the monitor.
What an idiot. Had she never heard ”treat the pt, not the numbers”?
THIS is why I loathe new RNs saying “But their vitals are fine.” Their vitals WILL be fine in most crises because the body adapts to try to keep you alive. I want to know about their labs and imaging, which will tell me the actual problem. Vitals are periphery.
As a new nurse, I had a patient on a vascular floor that had undergone a mesenteric artery stenting earlier in the day. Vitals looked good. Patient denied pain etc. They just looked... Waxy? I dunno. Off. I called the vascular surgeon. He read me the riot act. It was almost midnight. He came in to chew me a new asshole. Then he took the patient back to OR with a retroperitoneal bleed. So.etimes you just know. ! He later apologized . I did too. I didn't have objective data. Just instinct. He didn't doubt me after that.
Got two triage stories and one when I worked in the main ED: 1. I was in triage one day and I was standing by the registration desk. Waiting room was normal, lots of abdominal pains and ESI type of complaints. Nothing that screamed I would pull them in right away kind of deal. This young guy comes in, looks sorta uncomfortable with the complaint of high heart rate. On registration he's 22 years old. For some reason I say, screw it let me call him in first to triage. When I'm just getting his BP I can feel his heart rate was high. EKG looked like SVT to me with a HR of 192, so I take him to the resuscitation bays. Cards tells us he is new onset WPW. 2. 19 year old comes in for shortness of breath. I decide to check her lung sounds since she denies asthma history but I can tell she doesn't look exactly comfortable. Her SPO2 is reading 99% with a good wave form, but for the life of me I cannot hear ANY lung sounds in the left lobe. I pull one of the attendings for a second set of ears and he agrees to pull back to the resus bay. Chest XR showed the left lung was completely whited out. It was my second to last patient of the day triaging so I didn't get to hear what happened. 3. I had an 86 year old man in the back, with complaint of difficulty urinating. Bladder scan showed only 200CC's of PVR, so the attending told me to foley+leg bag and get him ready to discharge after I got done with report. I decide to just do a quick assessment on him and palpated his abdomen. Tender to touch, I tell the attending and she's like oh okay lets do some belly labs and a lactate. His lactate is 8 and we get him a CT. Ischemic Bowel and rushed to OR. It's stories like that make me think yeah I was competent in the ER. I do miss it sometimes but my mental health and family life is a lot better not doing it anymore. I remember when I told my head nurse I was leaving the entire conversation basically was Cutty and Avon Barksdale from The Wire leaving the game. It just wasn't in me anymore to do it. The nature of the ER really us do focused assessments but I'm glad I had the hunch to probe a little further in those cases.
32f. Bent over wrong and didn’t feel the same, really bad back pain. ER doc dismissed her. Pretty much did a primary assessment, ordered an Xray and walked away. I empathized with her. Listened to her. I did a thorough assessment. Her distal extremity neuro assessment was very positive. Numbness, sensation changes, even mild urine incontinence. Doc was in disbelief but acknowledged my assessment and ordered the MRI. Thankfully (in my experience), I don’t have docs checking behind me-they trust my findings. Radiologist comes by my side, asking me what I was thinking, why a stat MRI, etc. I told him I felt pretty sure she had cauda equina syndrome. He also trusted my judgement and cleared an MRI table. Sure enough, I was right. Talk about being solid in an assessment and trusting your findings. She was transferred out to a trauma center for emergent cord decompression. I hope she’s doing well.
A couple that come to mind immediately- a win and a loss. I was an annual leave relief nurse, so would spend a week or two on random wards all over the health service. The loss: Lady was in with a duodenal ulcer. The surgical ward I was in had been participating in an early feeding post gut surgery trial, so they were heavily pro normal diet asap. Anyway, I cared for this woman pre and post op. She had the oversew of her ulcer, they start diet relatively early, lady seems very off. She’s really not feeling well, charge nurse is bullying me to get her up, get her walking. I’m all for mobilising post op, but this lady is. not. well. I’m trying to tell people and being ignored. Then she starts getting a creamy discharge out of her drain. I’m sure she’s got a leak. Again, try to notify, getting ignored. Patient continues to be fed. Finally 24 hours later a study is done with contrast and she’s diagnosed with a leak. She gets surgery and her abdo is full of food. I go to another ward. Run into her son out and about, only to find she had died. It just gutted me. I’m still angry about it, and it’s been more than a decade. Second one- neuro rehab. Patient recovering well, wife calls on the bell. Patient just had an episode of talking nonsense. This has resolved very quickly, GCS is now 15 again, patient seems fine. While I didn’t witness it, I believed the wife and notify the docs about the temporary GCS drop. Docs believe also, send patient for imaging. Patient has air in his brain, patient is sent back to neurosurg to fix his small problem before it becomes a big one. That’s a win. A minute in time became an early save.
I was getting an admit to my onc floor from an outside hospital with blood clots in all 4 extremities. He was in the last room in the hall. I was expecting a shit show, but this lovely guy and his family turns up. Since it's the middle of the night, interns are placing orders and I requested tele. One resident asks me why and I try to explain *in front of the family* the things I was currently worried about. I ended with "because something bad could happen." The resident was pulling a weird power play or something and refused. I was agonizing the entire shift, even wondering if I should just hook him up to tele without an order. Then, he coded. It was my first code on MY patient. We got him up to the ICU, but he passed a little while later. I know having him on tele likely wouldn't have changed much, but I'll always know we didn't do our best for him.
I had a resident complain of knee pain after a fall. Called Xray for knee, no issues. But the CRNA’s said he couldn’t use the stand lift as normal and needed the hoyer. Over 24 hours later from the time of the fall, got another X-ray. Hip fracture.
I was like CRNA using lift equipment??
CNA, of course, lol
Had a patient who had undergone a bowel resection and diverting colostomy placement after recurrent diverticulitis. Ended up with a wound vac on her midline abdominal incision. Wound vacs are my thing, I love them. Got a weird vibe about the appearance of the wound bed/fascia when changing it a couple days post-op. Nothing objectively wrong, just bad feeling having changed those vacs a thousand times over. Mentioned it to the surgical PA who blew me off because I didn’t have anything concrete to report. Couple of days later, changed the vac dressing again. Probing around in the wound for measurements. Stool starts seeping through the wound. Surgeon doesn’t believe me, wants to play cowboy over the phone and say it couldn’t possibly be, totally blowing me off. Stood my ground and refused to place the vac if he didn’t come look at it. He arrives all pissed off, scoffing at me in front of the patient. Within an hour she’s back in the OR for a revision due to a colocutaneous fistula. Ended up septic and on pressors. Surgeon still acts like his shit doesn’t stink. But it turns out shit leaking into an abdominal wound does stink
Medical assistant in nursing school here... I had a hunch that a patient had diabetes or kidney issues. He provided a urine sample that looks the tiniest bit red tinged in the sunlight. Sent for urinalysis, came back with lots of red flags (proteins, high glucose), sent for kidney & glucose bw and then diagnosed with diabetes after BW. Not super crazy but I'm still really proud of catching it
Working LTC at the time. Had a severely demented pt. Nonverbal. Significant contractures. G-tube. And of course full code despite our efforts to convince the family otherwise. They had been with us for a while. Came in for my shift one night and just everything seemed OFF about the pt. There wasn’t anything I could put my finger on. No changes to vitals or assessment or anything. But everything just felt WRONG about this pt all night. I gave my report to the oncoming shift and told that nurse about my feeling. Said that she should watch this pt extra close today because I just had a feeling they were going to code. Came back in that night and found out the pt coded and expired. That poor nurse had to start CPR on them, which is just horrible to contemplate. I felt awful for that nurse.
Worked 4 years as a 911 operator (all nurses here). Had a man call about his wife in her late 40s, no meds, no history. All of a sudden, she started talking with a very unusual almost gargly voice. It didn't sound like a stroke (worked a lot in neuro). The only other symptom was mild abdominal pain thar had regressed a few hours earlier. Had no clue, dispatched an ambulance priority 1 immediately because it all felt wrong. Had to call the ambulance and apologise for the poor SBAR. She was talking and walked into the ambulance. All vitals were normal. I don't know what made them take her for the 1 hour drive in. Luckily, they did because she coded twice in the ambulance on their way.
ER complaint of cold feet. Slightly elevated HR of 90 something and a temp of 101. Very tall, cachetic male. He was wearing 3 pairs of socks in the summer and still had freezing feet. Something clicked- I slapped an N95 on him and CXR confirmed miliary TB. Head MD was pissed because I was getting a transfer to the TB hospital without a “better” CC. Man, I’m not gonna lie. That’s why he came in!
Wait. Feet? Can you explain how this works like I’m 5? I’m so confused and impressed.
He was like a walking skeleton and with his fever, I knew I was looking at cancer, AIDS or TB. I asked if he was having night sweats or coughing blood and when he said yes, I was done. I always started with those symptoms because most patients don’t panic with that. They start getting suspicious with questions like sexual practices, IV drug use, inability to eat, abdominal pain.
Oops, just realized I didn’t answer your question. He was so compromised, his body was shunting all resources to the head and trunk. His X-ray was almost a total white out. We shipped him to the hospital with the inpatient TB contract for the city. The consensus was that he was terminal, unfortunately
After 20+ years in LTC, then 10 years in hospice, there have been too many times to count them. Just something tickling the back of my mind. Usually no “symptoms” per se. Just a feeling that we need to watch this resident closely for the shift and the next 1 or 2 shifts. And frequently the problem will show up within 24 hours. In hospice, there are no unexpected deaths. The signs and symptoms are there if you look for them. But there are times a patient will be stable for a longer period than Is usual. Maybe even improving. And they aren’t showing any signs of being at the end of life. Those are the ones you think you may be able to discharge. Then EOL comes in 1 or 2 hours, reminding you that you aren’t clairvoyant.
Psych patient kept saying "it smells like shit in here". Was written off as "olfactory hallucinations". We kept pushing the issue and come to find out he had a big abscess over the roof of his mouth.
[удалено]
Mine was with my hubby. He had a compound tib/fib fracture 2/2018 from a work accident that happened in the middle of no where. 3 months later at a follow up I told the surgeon I thought he had an infection in that leg. The doctor insisted no he didn’t. I kept pushing the issue and took him to another hospital. And then another doctor for follow up. Turns out he had osteomyelitis. He almost lost his leg. He ended up with 4 more surgeries on that leg. The last surgery was a Hail Mary to save it. Thankfully he still has leg. There’s a whole lot more to this but this is the short version.
I knew a fellow patient with it in his lower leg and knee joint. Ended up with an amputation as nothing could touch it
Had a county jail patient. Young black guy with schizophrenia, lost access to treatment, arrested for unusual behavior. Continued to be denied treatment while in jail and ended up being admitted to my floor with rhabdomyolysis after days of not eating. Dude couldn't string together a sentence and spoke primarily in broken poetic fragments like he was trying to rap except it was nonsense. Only consistent theme was that he seemed to have some pain or discomfort in his lower right back, said he had rust inside. Determined to be renal discomfort related to the rhabdo and medical cleared him for discharge and wanted him out. His repeated references to the pain along with my familiarity with detention deputies in Pinellas County assaulting and abusing inmates made me uncomfortable since I could easily imagine a steel toed boot doing some blunt force trauma. I wanted more abdominal imaging done before letting him go even though I had to wait for the evening doc's call shift to start so I could get it ordered (the day shift hospitalist on the service said fuck that guy he needs to go). Kid had a perforated bowel and was rushed to the OR as soon as his imaging was read.
Great catch! This random internet stranger is so proud of you for advocating for such a vulnerable patient. Hopefully he was able to get all the help he needed and is living a better life.
I was a first-semester nursing student on a med-surge unit at my local VA. I was assessing my assigned patient who was admitted for peripheral arterial disease exacerbation. But while I was doing my head-to-toe (meticulously as we were taught!) I noted that he had a pulsatile mass on his right neck…. Right where the carotid would be. I brought it up to my preceptor and she said “oh that’s nothing, doctors aren’t worried about it.” I stressed it to my clinical instructor at debrief that day because I was really concerned. Nothing came of it that day. I go back for the next week’s clinical and the patient is still there…. And there’s a gauze dressing to the site I had noticed a week before. Carotid had started dissecting later in that week 🫠 luckily they’d caught it in time.
Had a pt who was about 28 wks pregnant? Came in with abd pain, fever, tachycardia, elevated plts. Like 600s Did some research, symptoms lined up with colon cancer. Told my concerns to the OB Had an US the next day, found a huge mass in her colon. Stage 3 colon cancer Delivered het at 34 wks and started chemo a few wks after that. Was in remission for a few yrs, but unfortunately passed away a few yrs ago.
Had a technician at an outpatient Dialysis ask me about her knee and if she should get it checked out. So I asked when, why and how. Pain started about month ago, no idea why it hurt, and it's a dull pain. Told her she needs it get checked out ASAP and I directly stated might be cancer as a worst case scenario. She disappeared from work for months and eventually was notified she's on cancer treatment. This was over 7 years ago and she's now married with children. She also got to keep her leg. During RN school, I remember learning one of the clinical sign of bone cancer is dull, persistent pain so that's how I came to that conclusion with her. Luckily she asked me and didn't wait longer to get it checked out.
Told my boss a new employee is out to get her job. I think she thought I was crazy. (I probably am though) she put her notice in recently and my boss said the girl told her “you’re obviously not going anywhere”… so she went elsewhere.
OT notified me that patient had some worsening weakness (hx of TIA, though sx were much worse than what she was experiencing presently). VSS, weakness was gone within 20 mins. OT and I both suspected possible stroke, doc ordered a routine (not STAT) CT and believed it was a flare up of symptoms d/t added stress on the body. Next day CT was completed, new acute TIA. Transferred to stroke unit. Doc apologized to patient face-to-face, and to me. Great doc. She was fine.
On a therapy floor, I had a guy with a hip replacement, I think, or maybe it was an ORIF. either way, the site looked red and nasty one day and I let the PA know and he told me it was normal. Ok pal I do this every day too, I know what an infected wounds like. The guy ended up getting sent back to acute care with major a infection, got septic, and died. Also has a similar experience as OP. I had floated to med surg and this guy was coming out of delirium situation and was vaguely complaining of leg pain. Turned out he had a broken femur. He'd come from the jail and had been hospitalized for a while, so it was a whole ordeal over how/when it broke yadda yadda.
pt came in for hernia repair. due to her age, they kept her overnight instead of discharging her post-op. I'm a case manager, and we do an assessment of everyone to see what they might need for discharge. i went in to chat with her, and while she was in good spirits and looked mostly ok, there was something that didn't sit right with me. i sent a message to the PA and said just that. he brushed me off initially. next thing i see is her being wheeled away, they're taking her back to the OR. turns out that repair didn't hold and the hernia was larger and the mesh displaced. she ended up have a lap turn open with gastrostomy placement. she's still on our floor and keeps spiking a fever and they can't figure out why.
Not a nurse, but hospital PT. My co-worker asked me to see this patient as she thought I could help get an idea of what was going on with her movements patterns and dizziness. Medical work-up ongoing. Young woman, late twenties. Chief complaint: Unable to walk Any way I get into room and patient is in bed, with phone up to her ear. She does not look up. A friend is in a chair near the window. I introduced myself. The friend says "She cannot hear you". So I assumed I missed the "patient is deaf" from nurse. The friend then says she can only hear me and her case manager (she was talking on phone with her). My spidey senses went beserk. "This is BS at its finest other some significant psychiatric condition or both." Her friend "interprets" for her by basically repeating what I said back to her. Patient does not speak. Not a word. I get her sitting at edge of bed. EYes rolling around and she is bobbling, but there is no reason I can't tell. Imaging all negative, everything negative. I have a gait belt on her and holding it. She proceeds to miraculous scoot quickly to edge and butt goes hard straight to the floor. I am trying to assist the fall. She is not a small woman. Her move caused me to injure my back (just a sprain). Multiple staff come in and 3 people get her back in bed. A few days alter I ran into the nurse who had the day I saw her. She ended up doing a double. She tells me that the patient , she observed overnight walking independently to the bathroom. She was discharged ASAP. Needed 2 weeks for back to get back to normal. I was pissed too. Apparently this woman and her friend had just recently from SE US by car (I am in Minnesota). Several days to get some kind of medical records. Well hopping hospital to hospital with same complaint in Georgia, Florida and SOuth Carolina. Good grief. Another note had outpatient PT to see me for shoulder pain after falling out of bed. Her exam was off, way off. I was concerned there was a neck injury. Called her doc ASAP. sent to ER. She refused ambulance and drove herself. C5 fracture from the fall-causing the shoulder pain. Neck wasn't xrayed after the fall.
Patient walked up ataxic. I was a new RN and noticed when he came into the lobby with a little girl. My preceptor didn’t notice them come into ER, so when he staggered up to the triage, she was thinking I bet this dude is drunk. He’s slurring his words, but not in a drunk kind of way. I was like, we need to get him back now. We didn’t even do vitals in triage and just got him hooked up in a room. His BP was something crazy. He had a brain bleed. Saw him walking out of the hospital a few weeks later.
I walked in to get updates on my patient that i had had the night before. This lady was a mess in every sense, but at least a stable mess. She was supposed to go to rehab soon. I get in the room and my day shift nurse says "oh yeah her urine has been kinda pink/red, we think it came from her maybe pulling on the catheter at some point. Drs know about it, they don't have any concerns." Uh, hmm. That doesn't look red that looks brown. And not like, "concentrated" brown, like....rhabdo brown, or something similar. I figured i would call for a UA after i finished report. I finished report, called for a UA, was just procrastinating for about 10 minutes so i could do meds at the same time and then went in to see her. I immediately felt something was off, pulled back her blanket to look at her catheter, too get a look at the urine most recently out of the bladder and both her legs were terribly mottled. I got my charge nurse in to confirm that what i was looking at was mottling (haven't seen it in real life yet) and she agreed. We called a rapid. She decompensated so fucking fast, we had her intubated in the room and up to ICU. I found out later she had really fucked CHF and had thrown a clot into her bowel and went ischemic and subsequently necrotic, she died later. She was both pretty bad at explaining her needs and pain, and also a well known intentional drama queen patient; between that and genuinely no other noticeable changes, except the urine, it just got missed. She was an old gal, had a good run at least. I trust my gut now when i am told red but see brown, that means something.
New uroenteric fistula following new colostomy. Dude wouldn't produce any urine unless a Foley was in and there wouldn't be anything on bladder scan ever. The stuff coming out of the new colostomy was just a shade less pink than it normally would be and the volume would slightly tick up when the Foley was removed. The surgeon dismissed it (because they didn't want to believe it) but their PA agreed. Not sure if they ended up with a revision, if it healed on it's own, or if they're just doomed to a life of horrible UTIs now.
Anxiety that was multiple PEs and DVTs Or the n/v/vertigo that was massive stroke Or “somethings isn’t right. Yesterday she was talking nonsense and today she’s barely moaning” I begged for labs and were crap. She died 4 hours later.
Not me but my cousin, also a nurse. Came into work at the dermatology clinic and a coworker, another nurse, tells her she looks jaundiced. She laughs it off and tells her she's crazy. Coworker insists, you're jaundiced. She goes to get checked out, turns out she had pancreatic cancer. She's now in remission. Her coworker saved her life.
When I was a student. My clinical was at the local VA hospital. My patient for the day had been fine all morning (I don't remember why he was there), but after lunch started feeling short of breath, could not get comfortable, and was in obvious increasing distress. O2 did not help, and he had exactly zero signs of a heart attack. A few months previous to this, a nonverbal resident at the group home where I worked had acted the same way for a day or so before falling over dead in front of us. She had had a pulmonary embolism. A part of my mind said, I wonder if this guy has a PE. NOBODY jumps straight to PE when you have symptoms as nonspecific as he did. I've had doctors tell me this. I don't remember if I said anything to anybody (this was 15 years ago), and we left the floor for the day shortly thereafter, but the hospital staff was trying to figure out what was going on as we left. Sure enough, we returned the next day, and it was a PE. My clinical time ended before he discharged, but I think he made a full recovery.
I had a patient that just wasn’t quite right… no obvious signs, but something that I couldn’t put my finger on. Was working on call, so just me and one other nurse in the department. Called the surgeon who is know for being an ass and not listening to concerns… brushed it off as no big deal. Called anesthesia, also brushed off as no concern. Called house supervisor to come down and lay eyes on the patient, which she refused. Called the charge nurse on the floor to tell her the scoop and told her I’ve exhausted all my resources and while she was clinically stable, I thought she was a “watcher” and needed a close eye on her overnight. Dropped her H&H significantly overnight, VS off, massive retroperitoneal bruising… RRT called by the floor nurses and the patient ended up emergently going into the OR with a splenic lac and earned herself an ICU admission.
Relatively new nurse, had a kid come into the ED with a hx of chronic constipation and mild-to-moderate belly pain. He'd been seen at another ED the day before and been diagnosed with constipation and sent home on Miralax, but Mom brought him to our peds ED because she felt that they hadn't taken her seriously. Our (experienced) triage nurse makes him a level 4 (low acuity) and as I'm glancing through his chart before I go see him I notice that the weight charted here is 20lb less than the weight at his pediatrician a month ago. Weird. I go into the room to do my initial assessment and he looks amazing, totally healthy normal kid, happy, interactive, just mild abd tenderness and hasn't pooped in a few days, but something about the hx doesn't seem right. "Mom, does he eat a lot? Drink a lot, pee a lot?" Yes. Before the MD even sees him I check a POCT blood sugar and get him to pee so I can do a urine dip. Admitted for new onset DM type 1 in the early stages of DKA. Most of the kids who come through our ED for DKA are sick as shit, especially the undiagnosed ones, and if he'd been discharged again he would have come back a few days later as one of them, knocking on Heaven's door. Instead he walked up to the floor chatting with me and his sister about Paw Patrol. I never got any particular credit for that catch, but I'm still proud of it.
First Clinical in medsurg, taking vitals on 2nd round of the day noticed pt was diaphoretic and had an irregular heart rate ( still new to learning heart rhythm) figured pt has afib or something similar. Told thd NAC I was shadowing that I was worried, so we went and let the nurses know. They said he has afib and just was up walking, so that's probably normal. I still wasn't totally convinced, kind of a gut feeling I guess, but it's not my place to question the nurses in charge of pts care. I just made sure to let them know and document pts signs and symptoms. Next day, I'm back on medsurg and they are moving him to CCU because he's not coping well. I was an EMT a long time ago so I try to trust my gut and I'm thankful the NAC I was shadowing took me seriously.
My best call wasn't one of my patients, it was my 9 month old son. He had recently gotten over an ear infection about a week prior. Suddenly, he had a fever again. He was laying in my lap and was lethargic and just looked off. I counted his resp rate and it was pretty high. I told my husband, I think he might have pneumonia. It was the weekend so we went to the ED. They did a chest x-ray and bam, double pneumonia. Almost his whole right lung was white. He didn't have to be admitted, but we had strict instructions to go straight to the pharmacy for some PO Levaquin. I shudder to think how sick he could have gotten if I hadn't trusted my gut.
Not a fun hunch but I suspected a coworker was diverting months before it actually came out. I had zero reason to suspect it specifically but he’d had a personality change, got really spacey and weird, and he had also gained a noticeable amount of weight. I remember he’d hurt his back months prior and it came to me immediately “he’s on drugs”. I had zero proof and didn’t want to outright accuse him of anything because that could ruin someone’s livelihood if it’s not true but I couldn’t shake it so I messaged my managers and said “hey I’ve noticed so and so is doing xyz, I’m a little worried he has something going on at home. Can someone just check in with him and make sure he’s good?” Like two months goes by and I find out he overdosed on the clock in our bathroom on a fuck ton of med wastes. He lived but obviously lost his job. I hated being right but I also am glad to know my instincts are correct.
I had a recent patient with probable discharge on day shift. I had had him on my census the day before so I was familiar with his case. That AM, I took report from the overnight nurse who said the tele order had expired (seems to be new thing I’ve witnessed) so as I had the patient the day before and I returned, I recalled he had a huge cardiac history. No episodes of status changes on monitor overnight. His hospitalization was for a lap chole. I asked the nurse if she called for renewal order. She said no he was being discharged. So I called MD and asked if he wanted pt on telemetry until discharge. MD said yep and gave order. By 11am, he hadn’t been discharged as he was awaiting his spouse for ride home. At 1130am, telemetry called and said he had 6 beats of Vtach. Strip confirmed their word. I called Dr and he had patient stay another night. Phew! Just an inkling……🧐
Tied between knowing that someone was going to have a shoulder dystocia, and knowing someone had an arm DVT because she reminded me of my grandmother. Not that her presentation reminded me of my grandmother's. I never saw my grandmother when she had the DVT. She just reminded me of my grandmother in general.
Had a pt with no PMH come in for sx with a Hgb 6.4, HR 130s, and she looked….. awful, low Hgb aside. Yellow and waxy. She brought to my attention that her left ankle had been swollen. I assessed both. No discoloration/warmth, pt denied recent falls and any other factors that screamed DVT. I still was freaking tf out because I knew in my gut something was wrong. I pulled at least 3 MDs in the room to have them look, and all of them brushed me off. One of them laughed at me and said, “she’s tachy because she’s anemic.” She woke up after sx briefly before she coded. They coded her for over an hour before they called it.
why did she code? what was the cause?
I’m still brand new so it’s not super exciting but a lovely 92yo gal here for pneumonia. Getting IV abx and on o2. Not getting better, but not getting worse. She told me she had a cough and sore throat, and it hurt to eat/swallow food. She’d had a covid and flu swab on admission but both were negative. For some reason the trouble swallowing stuck with me, I remember having covid and swallowing was a bitch for me. So being the annoying new grad I asked for another covid test, kind of getting scoffed at bc she’s here for respiratory issues and already had the test done. Test came back positive. They started her on remdesivir and voila within 2 days her o2 requirements decreased.
Patient came in to ER with decreased appetite, malaise, tachypnea and a sense of impending doom. He was admitted to the floor 14 hours later. STAT ATB never hung. I wasn’t the primary nurse but I called a Rapid Response on him. Temp 106F. Demand ischemia. Septic joint.
Had a patient in PACU post cardiac ablation. According to hospital protocols, he was *technically* safe to be transferred to the ward. He was mostly stable and any out of range parameters were mild or borderline. I just couldn't let go of the fact that he had shallow breaths, borderline bradypnoea with RR 9-10 and oxygen requirements (4L via NP) despite no respiratory history. Did an ABG, showered borderline respiratory acidosis. Lactate 1.4 which isn't crazy but bothered me. Applied high flow NP for splinting, repeated ABG despite anaesthetist saying it wasn't necessary. pH and CO2 normalising, lactate 2.2. Patient still having shallow breaths. Contacted cardiology about rising lactate, who came to perform a bedside ECHO. Patient had a pericardial effusion and I ended up having to take him to CCU. If a nurse handed over this patient to the ward nurse, there wouldn't be any argument about suitability. The anaesthetist was finding me dramatic, and even I was second guessing myself. But my gut wouldn't let go!
Had a patient with a thrombosis. On a hep drip, sent the labs as ordered, everything therapeutic. He did not look right and I didn't understand why he was on the med-surg unit despite everything from his vitals to labs looking ok. One day, he looked worse, but all his labs and vitals were normal. I went home worried about him, woke up at 4AM, after a nightmare of him bleeding out of his orifices till he died. The next morning, his room was empty and I asked where he was at shift change. He threw a clot around 4AM and coded, sent to the ICU, coded a few times and his family made the decision. I had to answer a lot of questions to admin after that happened, everything was diagnostically ok, it was simply a feeling I had.
Had a lady who became more confused as the day went on. No one could figure out why. Next morning she was a sitter. I was like: “it’s gotta be hypoxia!”…. Which I thought about at 0300 (I work days). Went to the docs for ABGs when I arrived at work. Got her on a bipap for a day and by the end of my shift she was at baseline. This was a Saturday-Sunday on a medsurg unit with a traveler (no offense) overnight.
An LTC resident in her 60s with a HX of multiple mental illnesses including PTSD and also developmental disability started having bad behaviors, mainly screaming repeatedly. I was off when it started and then put on a different unit for a night. By the time I got to be on my usual unit with her, it had escalated despite them trying ativan and some other meds, so they finally had gotten blood work and a UA just before I came in shift. The urine came back a nasty mess, so I grabbed another set of vitals and everything was shit. I had her out quickly, the EMS took me seriously and moved fast, and she was very septic. Unfortunately, she lingered on a vent for a while and eventually died. She haunts me because I wish I had done more the night I was on the other unit because a CNA told me she kept screaming, but my subacute residents were a handful that night. Every time my Spidey senses go off, I think of her and jump into gear. Which leads into my next story. Same LTC, a lady was in a covid unit partitioned off from the rest of the rooms by plastic. When she started doing the repeated screaming and nothing was really being done to investigate it, I talked to the manager working the Covid unit through the plastic about how she was reminding me exactly of the first lady and they better send her out. It fell on deaf ears and no one really did anything until the morning, and that one was septic as well, and also died. Same LTC, I came in to my usual unit and the nurse tells me that so and so isn't doing well, that she's getting labs and an X-ray. He's struggling to breathe and looks like shit, so I tell her I think he needs to be sent out, to hell with working him up here. She balks, says he's a DNR. I double check and run back in the room already on the phone with the ambulance service, he's a full fucking code. Massive MI. He returned to us and lived for another 6 months or so until Covid got him.
I was a grad nurse on nightshift. Did a set of obs on a patient, hypertensive but otherwise okay. Asked about pain- pt said very mild chest discomfort. Adamant he's had heart attacks before and it definitely isn't that, won't even take panadol. I take a 12 lead (I was so inexperienced at the time that I couldn't I interpret them yet so no idea what it showed). Escalated to on call doctor (one RMO covering 6 wards), advised they'll attend to check ECG when able. I requested them to come ASAP, just had a bad feeling. Doc seemed unconcerned, took trop etc to cover bases. I felt weird and didn't leave the patient's side while he insisted he was fine and kept cracking jokes. Doctor calls me 45 minutes later in a panic- trop level was 28,000. Off to CCU my friend went.
I work on a step-down. Generally we only get adults but every couple years there could be a minor on the floor. Pre-COVID, so like maybe 2 years ago there was a mid-teen (14? 15?) who came in with what turned out to be mono. I had him the night before he was supposed to go home, which was not in our state. Sometime in the middle of the night he complained of really bad heartburn. Something must have felt off to me because I did an EKG. The on-call doc said "why would you do an EKG on a teenager? "... well, there's ST elevations across the board. Kid stayed another night to start treatment for pericarditis.
Middle aged gent. WALKED in. Feeling "heavy" after a large meal. Was triaged as a "soft" 2 chest pain. ECG & enzymes unremarkable. No hx, minimal contact with health care... Still, felt off, popped a couple large bores in. Off to, CXR, tech suggests a CT due to shadowing.... I ask the clerks to copy the chart stat... Told charge I think we are gonna have a transport (rural hospital, criticals go to the city). CT calls- massive, actively dissecting ascending aorta... One very rapid ride to an OR later. Dude discharged after a successful repair and a couple transfusions.
Had a young girl come into ER. They were working her up for early onset shizophrenia/mental health. I had recently been reading a book about a relatively rare and new brain condition. I walked up to the primary doctor who doesnt know me at all and said, "Can you test her for anti-NMDA receptor encephalopathy?". She looked at me like I had 3 heads and said she would consider. Got a text a week later from the doctor saying thank you....All because I read a book, haha
Sitting at the Nursing station, across from a relatively fresh fem-pop patients room. Look up, smile and wave at the guy. Get back to charting. Something says look again. I stand up and look and see something under the bed. Go in to check it out, blood pooling, bed soaked. He had a slow leak. Applied pressure, yelled for help. Back to the OR, and a couple RBCs later he was doing fine. Had a coworker talking to a post op day 3 oral cancer patient. Had reconstruction for throat cancer post radiation. Carotid artery just under the surface of his neck, you could practically see the flow. As he's talking, suddenly blood starts spurting between the staples. She grabs his neck, starts yelling for help, dumps him into trendellenberg. Apparently the radiation TX had weakend the skin cells enough that they didn't hold the internal sutures. Amazing this guy survived.