The Restaurant

Thanks to the drug company I was allowed in one of the better restaurants in my town. And let me say, I do thank them. The thing is, the owner of the restaurant grows the greens for his salads. What I don't understand is, why do we now leave the stems on the ends of the green things? And why am I eating stuff that reminds me of what I used to throw away out of the garden and eat out of the yard (haven't mentioned my fixation on imitating the horse, have I??) It was rather embarassing having the green stems hang out of my mouth while sipping on the very fine wine. And I wonder why my boss rarely takes me anywhere!!

It was fun, I appreciated learning the differences between cardene and nipride, both of which I am very comfortable with. But remember, I'm the one that thrives on adrenaline. I do enjoy these dinners the speaker though made one false statement that all the ICU nurses corrected him on: patients can live forever in the ICU, we all know the stories.

On that note, my "friend" that I also precepted in the unit was delighting the aides today with stories of my disasters. I had forgotten some of them, but it was fun hearing her perspective on those things. Okay, a quickie: one of her first days in the unit, code was called, doc was in the room with our pt (we hadn't even seen the pt yet - first thing in the morning), we go to the code...... as we are bringing the code pt down to the unit they call a code in our unit. I walk in, it's MY patient. Seems the doc let him get up to go to the bathroom and he suddenly didn't feel well, they got him back in bed and that was pretty much all hey could do. The family had all gone home, they had been there all night and he was fine. Rather awkward moment explaining that one.

Another day tomorrow.........

Ode to Movie Popcorn

Disclaimer: I am NOT a poet, my favourite poet is Ogden Nash. Please lower your expectations here.

Ode to Movie Popcorn

How I love you,
dare I say, let me count the ways.
You bid to me as I dream of the movie
You call out to me as none at home can do.

You are drenched in petroleum products
called "butter"
You harden my arteries as you encircle
my circulatory system.

Yet I cannot resist,
at times I flock to the cinema
only for you do I seek.
Nay, not the flick.

You say, why oh why do you partake?
Heck if I know, but I must.
Even now, I am not sated (hope this is the right use of the word??)
You call, you call, you call.


*this is probably going to be revisited, but I had to start somewhere.

Friday the 13th

Okay, anyone that works in an ER or area like that knows that we are a superstitous lot. You never erase the last name on the board, you NEVER say "it's quite in here", in fact we get worried and call it the "q" word, lots of things like that. In my unit, in fact lots of people at this hospital (we have around 700 beds) they know me as the"angel". I have never done anything to cause it, it's just there are some people that seem to be the one that is there when things go badly. I'm always cautious about it lest people misunderstand.

Today, I was charge. We have a 20 bed unit, I had two patients (our normal load per nurse). The charge nurse is also lead on the code team for the hospital. Everything was somewhat decent this morning, I even got LUNCH!! Then, well, CODE BLUE so I ran to it. Took awhile to deal with it, transferred the pt to another unit, went back to mine. While I was out they filled my empty bed with a "great charge nurse patient." Pt in their 30's had some heart valve issues, just here to be watched a little closer. You know, just in case. While I was gone they even bathed her (my unit is awesome - I will brag on them anytime, anyplace). So anyway..... my perfect charge nurse patient didn't understand the rules, my rules...... she came down on 1.5 liters O2, decompensated over about 30-45 minutes, was intubated, PEA (ran a code), we placed an art line, neo, dopamine, NS bolus, then the big one, a balloon pump!

I'm still in shock. One of the nurses today is an instructor, she and I reviewed what had happened. Had I missed something? Should I have intubated sooner? We intubated before she gave out, I had drugs being mixed from pharmacy before I had orders so when the doc called back I could be ready right then, I was trying to beat the bad stuff..... I even had the crash cart next to her room to ward off the evil spirits..... No one felt like I missed anything and I really don't either. It's just reviewing how fast our patients can go bad. Had she remained on the floor I really think she would have died. Those nurses are good, but it happened too fast for them to be able to do everything we did. Again, and none of them will read this, well one will, the nurses around me were doing all the work, I was directing some and pacing a lot (phone calls to docs), running and fetching, scribbling notes so I could remember what in the heck happened.

I left work at 8:50, I was supposed to be off at 7p. The patient was stable when I left, the other code patient was alive as well. Maybe it wasn't a bad day after all.

Kindness

Funny, I just read what I wrote about the ER, how nervous I was. It went fine by the way. But it has brought to mind how much culture difference between ER and the unit I work in. I hope that it's more the whole rest of the hospital, but anyway, you'll see what I mean.

Monday was a very rainy day.... accidents happen. A family was traveling through our town from out of state, no family here. They were involved in an accident, I don't know who's fault, I heard hydroplaning, but it's not important to the story. There were four people in the car: dad, mom, two kids. Dad was seriously injured, difficult extracation, head injury, at some point was intubated. Mom and kids were brought out my hospital, dad to another. For those that don't work in ER, the decision was based this way: dad needed serious care, we could provide that but we could only take so many victims at once. Mom and kids needed to be seen, there was great potential for serious injury. Normally kids would have gone to the local childrens hospital, but mom couldn't be treated there and they didn't want to split mom and kids up. The place dad was taken would have probably sent kids to children's, so mom and kids to us, we can do care for all.

Now, mom and kids turned out fine. Picture yourself in mom's place. One kid, the youngest was placed in the same bay as mom, the older taken to a different room. She knew spouse was hurt, but not with us. She couldn't see older kid. She was stressed. It was difficult. We were able to work them through at a decent time (even with me being slow).

I called the other hospital to see how dad was, it wasn't good: that was when I got the story about head injiury, nonresponsive, on vent with chest tubes, broken bones, etc. I went to mom, told her that he was in good hands, but very serious. I called the chaplain and had him come. We arranged for cabfare to the other hospital and chaplain called over to their chaplain for follow up. So far, not bad. Here's the rub.

Mom had glass all over her, mom had all the luggage. She asked if there was a place where she could shower. There was in the main part of the hospital. The ER charge nurse had a fit about me wanting to let her do it, even though I could "free" up the room she was in and it would require nothing of staff. We allow families to use these facilities for people that have to stay in the critical care waiting areas. I was horrified by the reaction I got. I had no idea if mom could do that at the other place, I don't know what they offer. I have no clue what kind of finances they had.

Maybe it's the thought, "what if it were me?" This is beginning to be a real source of action for me. Today I was trying to catch up on stuff, people needed me here and there. A call light was going off and the pt kept saying, "nurse, nurse, something is wrong here." I wanted to blow it off so bad, find HER nurse and let them deal with it. Finally I went in, and her IV had horribly infiltrated and the meds were burning her skin. I felt maybe an inch tall, I know that hurt her. What if I was the one needing the pain medicine or the drink or whatever..... I fail so often, yet when I want something I want others to do it NOW.

So I listen to others (and myself too often) joke and carry on, or make fun of things, or say: they really don't need that. Then I wonder, what if it were me in there.... I hope I don't get paid back for all the stuff I've done. I really hope that I become the person that responds rightly to others. But then too often I'm more like today when I suggested if only we could get the guy in the room with a fly (yes, a fly) to think he was hallucinating the fly, then he would shut up.......

Isn't it interesting what your children think of you. The other night my oldest called me as I was about to leave work. A 12 year old son of someone from the church had been skateboarding down a hill, fell and was coming to the ER at my hospital. Could I go check on him?

Got to the ER, they were just checking in, dad, kid and another teen that drove them. Kid looked bad, no kidding. My thoughts had been I would go down there, kid would have a "pumpknot" and overreacting parents. Kid was pale, had been combative, said over and over he couldn't see, bucket in lap (he was about to barf) and again, he looked bad.

I went to the back, asked the charge nurse if they were going to get him back soon, that he didn't look good (please note, I work some in this ER, I know them and knew he would be upfront with me). Seems they had just gotten multiple ambulances in and there were no open rooms. I offered that maybe we should take kid to the children's hospital that was about 10 minutes away, charge nurse thought that would be a good idea.

Normally I would not like this, kid is here, needs to be seen soon. However our children's hospital is top notch and I felt like he would be more appropriately treated there (more than likely in hindsight - my hospital would have diagnosed him and transferred to the kid's hospital anyway). I rode with the kid to the other hospital, I was quite worried about him and hoped that if something happened maybe I could be useful.

We got to the ER, kid started vomiting as soon as we rolled in. You look at lay people in these situations and how they react and how we react. Dad had kid in the men's bathroom before I could stop him, he suddenly ran out and told me kid was barfing...... okay, I ran in and was like, get him in the wheelchair. Dad told me we needed to clean up the mess, I went out and told security that I needed towels, methinks dad probably couldn't carry kid over it without falling. I thew towels down, kid in wheelchair and got out of there.

While they were triaging kid, dad kept getting flustered and I would answer.... I noticed then that there were several notations "mom states...." I figured it was easier to let it go than to clarify. The staff there was wonderful, I was quite proud of them.

As it turns out, kid fractured his skull and was admitted to ICU. This was Thursday, today I heard he is still in the hospital, having trouble keeping food down.

I told my son that I appreciated him calling me, I think they would have stayed at my hospital until seen and it was better that I pushed to move him. While there were downsides to moving him (again, normally I would not do that) it was better for this situation. My son also went to the hospital to see them and be available if needed to help. It's interesting to see how compassionate he is towards others. I wish I could say that my hospital is always the best, but I do so appreciate knowing that they will tell me when I need other help. Oh, and I work in that ER Monday.