Me

The hospital where I work has a money issue. That is, our department was more than a thousand hours over budget on staffing. As a result, the ED director was fired last year, and the new director has been swinging the budget axe. She laid off 25 nurses as her first official act a year ago, and we have been running understaff since. They took us from 3:1 patient to nurse ratios to 4:1. They also eliminated most of the nurse assistant positions. As a result, we usually don’t get lunches on our shift, nor do we get off work on time. This results in a 12 hour shift usually stretching out to 13 or 14.

Still, our department saw more than 150,000 patients last year, so we are raking in the money. My recent visit to the emergency room was billed at over $40,000, so do the math. Even if they only collect a quarter of what they are charging, they made billions from the ED alone.

On top of all of this, they don’t let us do required trainings during our shift, we are required to do them on our days off. This training is required by our employer, and is over and above the continuing education that we do on our own to maintain licensure. They tell you that annual NIH stroke scale certification is required, and you are subject to discipline if it isn’t completed, for example. So you do it on your days off.

In the past year, more than a quarter of our nurses have left. They are desperately trying to hire replacements, but the word has gotten out, and the only nurses applying for jobs are brand new ones out of school with no experience, because they are hungry for a job that isn’t med-surg.

Admin then tells you that they will pay for a maximum of 2 hours per week of training. The only problem is that they assign far more than that. This two week pay period alone, I have done 8 hours of mandatory training on my days off: a 3 hour class on NIH stroke scale, a 3 hour class on IV insulin, and a 2 hour class on ESI triage policy.

They are only going to pay for 4 hours of it, if they keep up their policy. In the past year, they have denied paying me for about 100 hours of mandatory training. I’m tired of it. I have screen shots of emails telling me the training is mandatory, screenshots of my online time card, and emails of the policy saying they will only pay for 2 hours per week.

I am turning them in to the state department of labor. I’m going to get my money. If they take any action against me, that is illegal and I will sue their ass. I am tired of being made to work for free because they have a “budget.” Well, I have a budget, too, and I expect to be paid for my work so I can make my budget.

I will admit that I have been a bit MIA around here lately. That’s because of the pool project. We contracted the building of the pool, deck, and birdcage to a company. The landscaping and irrigation were our responsibility. We went through a 57 day delay because we had problems getting a building permit.

Once we finally got our permit, the pool company was here the next day, and the pool was complete 57 days later. We couldn’t be happier with the progress. There is a 30 day wait between getting the pool done and the final inspection. What we didn’t know was that irrigation, grading, and landscaping is part of that inspection. That means we are in a bit of a crunch to get it all done.

I rented a trencher and dug trenches for drainage and irrigation. That was the part that put me in the hospital because I tried to do it all in a single day to save some cash on the renal charges. I learned my lesson there. When we get hot, we take a break and sit in the pool for an hour or so.

Then I installed underground drainage lines to direct rain runoff from the gutters away from the house. I really like those, because they run about 30 feet away from the house to an automatic valve that opens when it’s raining.

Then I ran 4 zones of irrigation lines, planting 40 sprinkler heads so that everything within 35 feet of the house and pool gets irrigated, especially the plants we are putting around the pool.

Then the barrier lines for the robotic lawnmower went in around the edges of the back of the property. I don’t like mowing the backyard because it’s so large, so it was that or a riding mower. The cost was the same, only I don’t have to mow now.

Once those were in, I put edgers around the house to create a 2 foot barrier between the lawn and the house, so that the weedeater won’t damage the paint. Then the plants got put in, with some of them being large enough to keep nosy people from seeing us in the pool.

I also had to replace the tree in the front of the house, a 12 foot tall Crepe Myrtle.

After all of that was done, we put down 2200 pounds of mulch in all of the planter beds. We finally finished all of that today. Now we are waiting on sod.

I am paying a crew to come in and lay the sod, because that is hot, backbreaking labor, and it wasn’t that much more money than buying the sod and doing it ourselves.

While all of this was going on, I attended 3 days of classes, worked three days a week, and interviewed for two different jobs, as my contract with my current employer is ending soon, making me an at will employee.

All in all, it was a harder project than I thought, but it did save us quite a bit of money. It would have cost us about $10,000. All of that wound up costing about $4,000, with the biggest two expenses being 2,200 pounds of mulch and having 4 pallets of sod laid.

One of the things that makes the heat so dangerous here in Florida is the humidity. The dew point temperature is the temperature at which the air can no longer hold all of its water vapor, and some of the water vapor must condense into liquid water. At 100% relative humidity, the dew point temperature and the air temperature are the same, and clouds or fog can begin to form. While relative humidity is a relative measure of how humid it is, the dew point temperature is an absolute measure of how much water vapor is in the air (how humid it is). In very warm, humid conditions, the dew point temperature can reach 75 to 77 degrees F, but rarely exceeds 80 degrees.

The dewpoint for the afternoon that caused my heatstroke was between 71f and 74f. The temperature for that 4 hour period was between 91f and 94f. That results in a heat index of between 100f and 103f.

High dewpoints are dangerous because it is a limit on how well your sweat can evaporate and cool your body. Heat can build up to dangerous levels.

Combined with that, it was a bright, sunny day with almost no wind. The Navy actually has tables for permissible heat exposure. Under those conditions, Navy regulations say that acclimatized personnel shouldn’t perform heavy work for more than 15 minutes per hour. I far exceeded that for more than 4 continuous hours.

Even worse, I am now 35 years older than I was when I was in the Navy. I am also about 40 pounds heavier. All of that makes my susceptibility to heat stress more pronounced.

As I said, I know better. Let my experience in this case serve as a warning to others as we enter the hot summer months here in the South.

It’s been several days since my last post. There is a good reason for that. As my readers know, I am installing a pool in the backyard. It’s almost done, and I decided that this was the best time to install the landscape sprinklers. I rented a gas powered trencher and spent a day pushing that thing around the yard as it dug a few hundred feet of foot-deep trenching.

I thought the trencher would make the job easy, and it didn’t. It made the job easier and faster, but it was still a chore trying to maneuver that thing all over the yard. It was hot, and by hot, I mean 95f with dew points around 70f. That’s a heat index of about 102f. I drank four quart sized bottles of Gatoraid during the six hours I was working. When it was time to return the trencher, my wife came with me and we went to dinner afterwards.

At dinner, I began losing my words. It started when I tried to say “skin in the game” and what came out was entirely different. Then I couldn’t really hold a train of thought long enough to continue our conversation. When we tried to leave, I was walking like I was drunk. My wife drove us home. When I got home, I was feeling confused, my pulse was 125, and temperature was 101.9f. I asked her to take me to the ED.

When we got there, the staff thought the same thing that I did- they put me under the sepsis protocol. Another oddity was that my right ankle was swollen to twice its normal size and extremely painful. My vital signs were odd:

Pulse 120, respirations 28, Oxygen Saturation 98%, BP 145/110, temp 99.8f

They also tested my heart, did a CT scan of my brain, and a bunch of other tests. The results that were abnormal was my D-dimer, which was critically high at 1.02, as well as my creatinine levels and liver enzymes were elevated. It looked like my kidneys and liver were being damaged somehow.

For those who don’t know, d-dimer is a protein that is found in the blood of someone after the breakdown of widespread blood clots. Elevated D-dimer levels suggest increased fibrinolysis, which can be a sign of either clotting or bleeding.  Now they got really concerned that I had blood clots, which can cause swelling legs, strokes, heart attacks, and other problems. The decision was made to admit me at that point. I went back to CT for an angio scan.

All of the tests of my heart, brain, and other systems came back normal. That d-dimer still bothered everyone. Finally, the hospitalist came to see me the next morning with what we all agreed was the answer. The combination of fluid loss due to my large amount of sweating, as well as the elevated core temperature from strenuous outdoors work cause a severe case of heat stroke, which activates your body’s clotting mechanisms, causing widespread micro blood clots.

Studies have shown a correlation between elevated D-dimer levels and the severity of heatstroke, as well as with the development of complications like AKI (acute kidney injury). In patients with exertional heatstroke, high D-dimer levels are associated with an increased risk of acute kidney injury. This in turn causes hyperinflammation (hence, the swollen ankle).

The danger here is that I was on the verge of developing disseminated intravascular coagulation (DIC) and multiorgan failure, which would have killed me. I didn’t even feel bad while I was working, and I thought that drinking large amounts of fluids would keep me from being dehydrated. I was wrong. I lost 12 pounds in that six hour period when I was working. When you consider that I drank about 12 pounds of Gatoraid, that means I lost about 12 liters of sweat in those six hours. Sweating out 24 pounds of fluid in an afternoon is potentially deadly. I am fortunate to be alive.

In short, I had an extremely severe case of heat stroke, and it damned near killed me. I wound up being in the hospital for several days. It was stupid of me not to recognize the signs and symptoms, especially as a nurse, a paramedic, and as someone who has lived in the Florida heat nearly his entire life. I was supposed to work today. I called off. I still feel a bit weak and under the weather, and my ankle still hurts.

I passed my boards this morning. I can now add some more letters behind my name. Now to take a nap.