Psych? Am I crazy?

So some exciting news from work. Well, first some unexciting news. I was helping a patient get out of a stretcher and I pinched a nerve or something in my left wrist. It didn't seem that big of a deal, but it was still sore several hours later so my charge nurse sent me to the ER to get it looked at. FOUR HOURS (and a few xrays) later I was sent home in a splint with a prescription for ice packs and lots of ibuprofen. So I've been wearing this splint at work for the past two days, mostly just to remind me not to lift anything, which is super annoying, although it did have the perk of getting me out of some poop cleaning, and I can't deny that was a win situation. But still. This morning I had to go to employee health to make sure all the paperwork was in order in case I have to file for workman's comp or something, but I'm not really expecting it to go that far. I'm off the next week for vacation, and I intend to be in 100% by the time we get back.

OK, now for the exciting news. Starting in mid-December I'm going to start orienting on the psych unit at the hospital. I'll keep working my current floor on weekends, and will pick up 12 or 16 hours a week learning psych. I'm pretty excited about it, it will be a very different and new slice of nursing to learn. And, considering that at this point I've had this job longer than any other job I've ever had (excepting my two years at Mega Video in high school), mixing things up a little is a good thing for a change junkie like me. The only thing is they don't wear scrubs on psych, meaning I'm going to have to go out and buy some new khakis and polos to wear. (I'm not wearing my regular clothes into the hospital. Hospitals are gross. Really. Tangent, but if you must bring your children in to visit someone, make sure they don't touch anything. Seriously.)

Last night I took care of this lady whose doctors didn't want her to eat or drink anything as they were afraid something was up with her pancreas and wanted to give it a little rest. She wasn't so much confused as just she could care less what the doctors wanted. I walked into her room and she was on the phone apparently talking to 411 saying "Can you connect me to the Hospital Cafeteria please?" Twice I came into her room and she had rummaged through the garbage can and found a paper cup and was drinking from it at the sink. GROSS!! Don't drink out of cups that have been in the garbage!! I thought she was going to try and leave when I took the second glass away from her, but luckily she decided it was time to go to sleep, so I dodged that bullet. I feel very sorry for the day nurse taking care of her today though, I'm sure she is busy being a handful at this very moment.

[title of show] is the best thing since laughing

David and I took a very quick run up to NYC this weekend. The goal: see the Broadway production of [title of show]. David saw the show in 2004 at the then brand new NY Musical Theatre Festival, and since then this company of four have taken their destiny in their own hands and through a genius combination of talent and self-promotion managed to find Broadway producers. I am in awe of them. The show was supes fun, full of laughs and inside jokes, but at its most powerful as a mirror saying "Yes, you can!".

For more insidery fun, who sits in front of us but Jen Cody and Hunter Foster (it was funny watching him not react when the show starts talking about his sister Sutton), and in front of them was John Patrick Shanley. Behind us somewhere was Mamie Duncan-Gibbs, who must have been there with a few friends because they all hooted when she was mentioned.

I'll admit it made me really miss the Broadway community. I'm quite confident that we made the right decision in leaving NY when we did, it was far too much of a sacrifice to have continued. But at its best, it was pretty darn awesome, and these [tos] kids are awesome for making their dreams come true.

We'd sort of planned on seeing a matinee, but nothing at TKTS really caught our imagination. We'd wanted to see "Billy Elliot", which is still in previews, but we balked at the $136 ticket. $136!! We were staying with our good friend Tommy, and instead e decided to slum it at the movies instead, and saw Bill Maher's "Religulous". I always take these kinds of one-sided "documentaries" with a grain of salt, as he "interviews" ordinary people who have no chance of debating someone as smart as him, or, in some cases, as even coming across as half-intelligent. But, in its best moments, he makes a compelling argument for the virtues of doubt. In a world where we have psuedo-religious political leaders who campaign on "never blinking" and are incapable of ever admitting to a mistake, I find the argument powerful and comforting. (I'm sure Maher is super disappointed that he finished shooting the movie before Sarah Palin entered the stage, because I'm sure he'd have plenty to say about her religious views.) But still, the movie isn't for anyone.

The trip was too fast to plan any time to see any of our other NY friends. Next time we come back we'll have to have a little par-tay somewhere. We had a way too fast breakfast with Tiffany Sunday morning before catching our bus back to DC, but it was just that, way too fast. I miss you Tiffany!!

So I worked last night and I found out that a 26 year old patient we've been seeing on our floor on and off for several months finally passed away on Sunday. She was very sick and in lots of pain, and I'm relieved that she isn't suffering like that anymore. But still it is so sad, no one that young should be that sick. It had been a week since I'd seen her last, just poking my head in her room when I was leaving. I sometimes try and say goodbye to people I know even if I'm not taking care of them that shift. I'm not always very good at it, but in this case I'm glad I did, because the last thing I will remember about her is a smile.

My parents and Uncle Rod are coming for the week to hang out. We're headed to Gettysberg this weekend which will be fun. I don't really know what we will do until then, but those things have a way of working out. And, no pressure guys, but it had better be fun because we've had to say "no" to no less than four couchsurfers, whom all seemed really fun and interesting. ::grin::

Gill slits

Last week I was taking care of this guy who had lung cancer. There were lots of things going on with the poor guy, and I don't think he slept for more than maybe 30 minutes over the two nights that I had him. But he had family there around the clock, and while he was obviously pretty sick, I was very unprepared to come back to work this week and find out that a few hours after I left he died.

Then Monday night I was given what everyone told me was a "difficult" patient. He had a GI bleed, so had blood coming out at both ends and kept me busy all night cleaning things up. But other than his overall discomfort, he was pretty calm and stable all night long. At change of shift I went in to say goodbye, and he was breathing a bit fast, which he did often when he would try and get up and move around. The tech was there to get his vitals, so I told him to take some deep breaths and try and relax, and to have a good day. He thanked me for a good night and I left. Five minutes later as I'm giving report to the day nurse, the tech calls from the room and even before I can get across the floor they've called a code. Doctors and pharmacists and whomever they all are pour into the unit, get him stabilized and whisk him off (freshly intubated) over to the ICU. I haven't heard a full report of how he'd doing (his heart never stopped but he just wasn't breathing), but as far as I know he hasn't died.

Codes on our floor are relatively rare, but this is the fourth we've had in a month, and I have to say I'm not a fan. I've spent so much time going over everything I did for both of these guys, trying to figure out if I missed anything, or if there was anything I could have done better, or seen earlier, or done differently. Fortunately for my sanity I can't think of anything, and both of these events surprised the doctors as much as they did me. But still it wears on you. If there was a way to call in sick from work that didn't mean leaving the shift understaffed, I totally would have called in the next day, I was just mentally exhausted. Catherine, I just don't know how you survive in the ER. All that adrenaline would be fun for a while, but I would just be dead afterwards.

Last night, despite my weariness, was a pretty good shift. I took care of this guy who has a leak somewhere in his lung, and his upper body is filling with air. Yes, you heard me right, he is a human balloon! Across his chest, down both of his arms, and up into his face, his skin feels like rice crispies breaking when you push on it as the air bubbles move around. Totally weird! His voice sounds thin and nasally, both because his throat is constricted a bit from the air in his skin, but also because the whole resonance of his head is off. They even made these cuts in his chest which we can kind of massage around them to squeeze some of the air out. They called them "gill slits". It was very weird. But weird in a kind of awesome way, I bet it is a very long time before I see anything like that again.

On a sadder note, one of my favorite people at work confided to me that she interviewed for another job. Selfishly I'm devastated, because I love working with her. But on the other hand I want her to do what makes her happiest. She hasn't been offered anything yet, and she is totally underplaying it, but I can't imagine she won't get the offer, so I'm counting down my few last shifts with her. ::sad face::

Oh, and now for something TOTALLY WEIRD AND UNEXPECTED. Even weirder than a man balloon. One of the other nurses brought in chicken curry last night. I was all, "I don't like curry", because, I don't. But unless it is made of spiders, I will try almost anything, so I took a bite. And it was the most delicious thing ever! It was totally mild, not spicy at all, and it didn't have that curry smell that I often find overpowering. It was just delicious. It was like the day I took a bite of a tomato and my whole life changed because it wasn't gross like my dad told me it would be. What is funny is I've actually had good curry before, I love chicken korma, which I assume is some kind of curry, but I never really thought about it before. Anyways, I came home and raved to David, who also hates curry, and he seemed open to the idea of trying it. So now I have to figure out how to make something with the good curry. I love expanding my palate!

I'm so excited and I just can't hide it!

After a very busy weekend, I just had one of the slowest night shifts ever. All four of my patients wanted to be left alone to sleep which, hey, is totally reasonable (but very unusual). I gave one guy a sandwich at 1am and basically did nothing but paperwork until I drew some blood at 4 and then passed some meds at 6. A nice break I guess, but for a second-in-a-row night shift, it meant I was struggling a bit. One of my 93 year-old lady patients at least gave me something to think about by setting off the alarms every five seconds with her crazy bradycardia. Her baseline is about 50, so we had the alarm set at 45, but as she slept she kept dropping, and by morning the alarm was set at 39 and she was still setting it off every few minutes. Kind of scary, but the docs were aware and when I'd check on her I would be the one in distress, not her. At one point we had to straight cath her for a urine sample, and though she was resistant and restless, her heart rate spiked to an incredible - 55.

I had another patient all weekend, a guy who was hoping for a liver transplant, but his kidneys started shutting down as well. The transplant team finally denied him, so he decided just to go home. His family was all there and very supportive, but with liver and renal failure, he probably won't live but another few days. He was a great guy, only in his 50s, and though his family was being strong for him if I'd get them out of the room they would start to break down. For whatever reason they all got along with me very well and I'm glad I was able to help them through what was a very rough few days (lots of pain, blood and albumin transfusions, EKGs, etc). Don't forget to enjoy the time that you have, because you just never know.

But enough of work. Tonight our super-friend from Albu-q-q Erin is coming for a visit, and I am ridiculously excited. Kyle and Liz arrive on Friday, and then my Dad will get here Tuesday. Better yet, I don't have to go back to work until next Thursday! So let the partay-ing begin! I just hope all the expected rain gives us a break because we have lots of fun outdoorsy stuff planned, and I will be very bummed if we can't take our company to Six Flags because of stupid weather.

A weekend of work

Hoo-boy. Saturday was a pretty busy shift for me at work.

- one patient had a heparin drip and needed blood draws every six hours,
- one patient had an external fixator to his leg and required "meticulous pin care",
- one patient had a wound vac to wall suction,
- one patient had feedings via his Pegtube (plus I had to crush all of his meds),
- one patient was starting to have hallucinations,
- two patients were on anti-nausea drugs around the clock,
- one patient vomited an entire liter,
- two patients received blood transfusions,
- all four patients received insulin with each meal,
- all four patients needed pain meds every two or three hours,
- one patient had a PCA started,
- all four were on telemetry, and one was on continuous pulse ox,
- two were on lasix and voided almost six liters between them.

At the end of the day, I walked into the room of the guy I'd been crushing his pills for his pegtube all day, and found him eating pizza he had ordered. You can eat a pizza but you can't swallow your pills? ::sigh::

The good news is - my day was actually ok. I was running around like crazy, things were obviously very busy with call lights going off all the time ("I need pain meds!!"). But at least I've gotten to the point where everything I had to do was firmly within my knowledge base. So maybe I didn't have time to stop to eat even my granola bar, but on the other hand I felt like I blinked and suddenly the day was over. Also, I had some great backup help from my charge nurse and our techs. Yesterday was a lot more under control without having to repeat the blood transfusions and the heparin drip reached therapeutic levels so I only had to draw his blood once. But I'm getting a grip on all this stuff that nurses do, and that is a good feeling.

I still learn new things every shift though. Like I'd never given nitro paste before, and this weekend two of my patients were on it, so now I'm good with that. (And boy does it work for bringing blood pressure down!) Vaseline gauze to external fixator pin sites? Check. I remember the first time I had to give a blood transfusion, and how overwhelming it all seemed, all the double checks, all the paperwork, all the vital sign checks. Now it is just a straightforward task, even if it is time consuming.

Under the category of something you would only hear in a hospital, I heard this being asked from across the entire unit "Hey, can you tell me about that bowel movement?" I won't get graphic, but the response included the phrase "banana-sausage sized". Seriously.

So I'm back to work tonight, and I think I will be getting all four patients back. Except for the guy with the hallucinations, I think night shift will be a bit easier for them. I doubt any of them will actually sleep much, but people still tend to quiet down at night. And I'll only have to give insulin once! Then I'm off until Saturday. Which is great, because I need some time to do some Mother's Day shopping. At least I have a good idea of what I want to do, I just hope the mail gets it there in time.

Now I have to go take a nap. I'm not tired, but I know I'll do better if at work if I get some sleep today.

Pick your fluid, I saw it

For the record, our days in DC are limited. This is the first time I've ever loved spring so much, DC really blossoms and the weather has been fantastic the last week or so. Unfortunately David is allergic to it, forcing him to hide indoors at times where I desperately want to go out for walks. We'll see how long it lasts. But we won't survive long in a city where David can't go outdoors on the most beautiful days of the year. Apparently it is a tree of some sort. Hope it drops its flowers soon whatever it is.

This weekend at work: a big, tall, burly guy walks out of his room and yells at me "It is cold in my room! I'm calling the police!". A little later a white lady doctor tries to talk to him and he shouts at her "Get out of my room white woman!". She came out and jokingly asked me if I thought this would be a good time to talk to him about stopping his drug use. Heh. Happily I only had to deal with him for one shift. He was definitely a guy nurse patient though, all the girls were scared of him. He snuck through his shared bathroom and totally freaked out the woman in the next room. He retreated, but then started asking what her name was. We moved him across the hall pretty quickly.

I also took care of another gentleman who has been on our floor for week, very confused following a stroke. He talks a lot, but very little of what he says makes any sense. We'd had a pretty good weekend, but then he got it in his head he wanted to leave. The more agitated he got, the more we had to stop him from leaving, and the more we held him back the more combative he got until he started hitting, kicking, and spitting. He's been on so much Valium and Benadryl and Seroquel that the drugs hardly touch him, and even after some Haldol he was screaming and fighting us, so we had to put him in four point restraints. It was very clear we were doing it for his own safety, but still it has been haunting me, I hate having to tie someone down. In his head, all his talking must make sense, and it must be terribly frustrating for him. I had him again last night, and he was a bit calmer (he wasn't violent) but still very agitated and wanting to leave. Fortunately his IV is the only thing left that he could pull out (the feeding tube and foley are gone), so I was at least able to release one of his hands, which calmed him down. As soon as I released his other hand though he started trying to get out of bed to head for the door, so we had to keep that one. Poor guy.

Otherwise it was the weekend of bodily fluids. One guy throwing up. A lot. One guy with pins in his leg that were bleeding all over the place. Two guys with tracheostomies coughing up lots of boogers. The confused guy was pooping. Another with a PEG tube into his stomach that came open and leaked the chocolate shake I'd given him a few hours earlier all over his bed. None of it is fun, but somehow it is always the boogers that gross me out the most.

The weird thing, is that other than the restraints, which really bothered me, I am really liking my job. It is tiring, and can be stressful, and sometimes I don't eat for 12 hours and sometimes my legs hurt from never sitting down, and there is always another piece of paperwork to fill out. But I have to say it feels pretty good when people say thank you after a long day.

Quick note...

After two night shifts, I'm jet-lagged and am trying to get re-oriented for my day shifts this weekend. Tues night among my four patients I got to give Golightly which you nurses know results in some very sad "South Park" type humor (if you find poop dripping onto the floor funny), plus I had two Heparin drips, sacral ulcer dressings, contact isolation, aspiration precautions, a cortisol test (which required three blood draws over the course of an hour and a half), I gave two units of blood, I prepared two of them for dialysis...it was extraordinarily busy for a night shift. Luckily the night crew is the best and I got plenty of help.

I had to get the Survivor post done with before my memories started to fade, but we just had some most excellent company that I will talk about soon. Complete with photos! But I have to force myself to sleep for now. Wish me luck.

80 degrees is on the near horizon...I hope

Spring is imminent, and I couldn't be happier about it. Technically, spring is well on its way, trees and flowers are blooming and David has started taking his allergy medicine again. There is one of those great trees behind our house that has all the tiny purple flowers, a Japanese something-or-other I think, and it is gorgeous. The cherry blossoms are starting to fade already. But for me spring means warm weather, and we are still having a few chilly and damp days, but these are becoming fewer. We took a four mile walk yesterday over to the Bed Bath & Beyond to look for a new mixing bowl yesterday (I cracked my favorite orange bowl making cookies a while back), and it was great until about the last mile home when a cool wind picked up. We didn't actually get a new bowl, but we did get a pepper grinder, so David was happy.

Taking walks with David are probably my most favorite thing to do. I don't even care where we go. As long as it is warm out, we are great at just walking randomly and always seem to find interesting things along the way, cool architecture or plants or people or something. Last night we walked by this lady listening to an iPod, and her favorite song must have come on because all of the sudden she started shaking her formidable booty right in the middle of the sidewalk. If she hadn't been big enough to beat me up I might have laughed out loud in enjoyment. I wish more people were brave enough to dance in public. Well, she also seemed crazy, I have to admit. But still, props to her.

In a related thought, one of my other most favorite things happens at the gym. Almost everyone, myself included, works out with their iPod blaring. Every once in a while, someone on the treadmill will forget themselves for a second and sing along with music only they can hear. It never lasts more than a phrase or two, but my feelings towards singing are well documented on this blog and it always makes me happy. I don't think I've ever done it at the gym (though there was that incident as a boy scout camping in the wilderness listening to "The Wind Beneath My Wings" on my walkman...)

I just found out that we are getting five new grads this summer from the "new grad" day I helped host. That should be fun. My hospital is currently playing chicken with our travel nurses, trying to make them join the in-house agency. Dunno what is going to happen, but we might be losing a handful of extremely experienced nurses. I understand the hospitals reluctance to allow travel nurses to work indefinitely (while earning so much more than the rest of us), but at the same time losing five experienced nurses, just to replace them with five new travel nurses, seems like cutting off your nose to spite your face.

Jeffrey and Rick are coming a week from today! Hooray!

A few thoughts

A strange thought came over me last night as I toiled through my second night shift in a row since coming back: April Fools Day passed without a single fool. Now, I for one hate tricks (shut up David, I'm talking here!), so I guess it just shows to go you how sleep addled I can get with multiple night shifts that I actually had a moment of sadness over the quiet passing of a super weird holiday. (When I was a kid my mom used to put green food coloring in the milk, which I always assumed meant I had to dump extra sugar into my cereal to balance it out. The thought of green milk still makes me shudder.)

Other passing thoughts:

1. Southland Tales is a WEIRD movie. We Netflixed it I think only because Fletch of Blog Cabins said it was weird, although now I can't find his review on his site anymore. But while I still have very little idea what the movie was, er, about, I love the movies where the casting director was allowed to, say, populate half his cast with Saturday Night Live alum. I don't know how well it helps the movie, but it can be fun when every other face you see, you are like "Hey, it's THAT guy!". And of course it is always a coup to have the smarts to hire Zelda Rubenstein. My only wish is that the Rock could act, because he actually makes some very interesting choices when he chooses his roles, and like the American Pie guy, he is just so darn likable. But I guess everyone can't be another Beth Grant.

2. As for Idol last week, I'm getting a little tired of rocker David making me like him with awesome performances, when it is clear that I can't like anyone with hair that ugly. On the other hair hand, Brooke finally straightened out that 70's mess on her head and I thought she looked fabulous. But neither of them are making me question my inclination to adopt Archuleta. Yet. However Syesha totally rocked it out, and though I never saw her winning, color me surprised that Ramiele is lasting so long. As for the country chick who never seems to live up to her potential, I mean, what can you say when someone is so calculating that they sing the unimpeachable "Proud To Be An American"? You say, "Well-played, and welcome back next week!" If this were Survivor she would now be my favorite. Heh.

3. In nursing school you hear a lot about "nursing intuition", those times when nothing is obviously wrong with a patient, but you just have a feeling something is wrong. I had that patient the Monday night. He was very lethargic, and would only answer focused direct questions. He respiratory rate at one point climbed to 40 until we lifted the head of his bed to about 55 degrees (he was a very big guy who refused his BiPap). But all his other vitals were in range and the questions he did answer indicated he was oriented and aware. I had the docs come and look at him, and we fiddled a bit but there just wasn't anything concrete to go on. Anyway, last night I came back and they had just finished sending him to the ICU. I didn't get the whole story, but they had finally done an ABG and his pH was 7.25, so I think he is intubated now.

4. I still have a post coming about our vacation, which was awesome. I'll get to it tomorrow, unless Survivor is on tonight again.

All this March sunshine is making me happy

My dad came to town for business, and stayed with us last night. He has 20-year old memories of some amazing Mexican restaurant which we tried - and failed - to find. However the place where we did end up was having burrito special night, and I had a rather delicious BBQ chicken burrito that gave me Happy Tummy. Also they had cinnamon ice-cream for dessert, and as everyone knows, cinnamon ice-cream is corporeal joy.

Dad drove the rental car, and quietly showed off his mad driving skills with a deft job of parallel parking. He even apologized that he was maybe two inches away from the curb. But here is one reason my dad is awesome - before I could get my compliment out, he started telling this 30-year old story about this one time when my mom was driving and, the way he tells it, made parallel parking history neatly fitting in her 40 foot long car in a 40.2 foot space. My dad is totally crushing on my mom because she once parked a car. I think it is adorable.

I worked three nights in a row this weekend. Physically it was tough, I tried all week to stay up late and sleep during the day, but besides feeling jet-lagged all the time, my body fought back and I got sick. I hardly ever get sick, and it totally annoys me. Of course I was able to ignore it while I was working, but within a half hour of leaving work on my last shift I could barely speak. Sometimes I don't know where I get my jock-adrenaline from, but it sure comes in handy. The good part is that I have a few days off to recover, and David has two weeks to get it and get over it before we go on vacation to Florida.

Oh, my favorite part of the weekend, was this little old lady who was sharing a room with a patient of mine. She was very confused, and while I was checking some equipment on my patient I could hear her nurse trying to assess her orientation. She couldn't remember what year it was, or where she was, or pretty much anything. Finally the nurse asked her if she knew who the president was.

"Well," she replied carefully, "it isn't Clinton anymore."
"You are right about that." the nurse said, "But can you remember who it is?"
She thought a few moments, and finally exclaimed "Oh, yes, it is President Obama!"

Well, at least we know she has been paying some attention to current events. Or she is psychic, who knows? lol

Yesterdays primary decided little, as I suppose was expected. I keep hearing all this chatter, mostly from Fox News (hey, my dad was here, so I let him watch, though I did force him to change to CNN when Karl Rove came on, even I have limits), about how the Democrats are going to destroy themselves choosing between Clinton and Obama. But I just don't get it. While I am certainly suffering from primary fatigue and would love it to be over, I don't really see why people think this it is so terrible that we have two great candidates to choose from. Yeah, they are going to play every advantage, and they are going to fight a little. But so far the only time I've been upset is over Hillary trying to change the rules in the middle of the game to allow the Michigan and Florida elections to count after the other candidates agreed not to campaign there. That's lame. But otherwise all it shows is, again, that we have two great candidates and are having a tough time choosing which one would be "best". That is a choice I can live with. I find Obama inspiring, something I never thought I'd find in a politician, so he remains my choice. But either one will appoint the right supreme court judges.

I finished that Stephen King novel about cell phones killing off mankind. Or whatever it was about, I don't know, it was so poorly written that I'd go paragraphs without remembering anything. And even when I'd realize I'd done it, I'd rarely go back to catch up. I did read another book called "Hero", about a teenage boy who is coming out as gay and as a superhero at the same time, which was kind of interesting if a bit simple. I'm thinking of grabbing something like "Treasure Island", which I've never read. I'm just afraid it is going to make me start fantasizing about living on a deserted island again, and I've already been down that road. We also just Netflixed "Oliver Twist", the Polanski version, and it was so boring that I'm not convinced reading a classic is really what I want either. I mean, really, does Oliver actually DO anything? He is worse than Harry Potter, just reacting to everything around him rather than actually accomplishing anything himself.

Special note to Rick, Jeffrey and Erin - we are going to have super fun when you come visit! And now I know a great place to get burritos!

A busy night at work

So last night did not begin auspiciously. I began my shift with two patients asking for pain meds while a third was just being admitted from the PACU with some huge bloody dressings and two JP drains. The day nurse was nice enough to get the new admission settled while I was madly drawing up percoset and dilauted. My one guy had a chest tube following a partial lung resection, and they had just dc'd his epidural that afternoon, so he was really hurting, and my lady was recovering from sickle cell crisis. My fourth patient is a regular on our floor, an older lady with afib and rotating infections (including, of course, MRSA isolation) and issues with a big dose of dementia who enjoys putting on her "coat" (a gown) and walking off the floor. The day nurse told me she was more oriented than usual, but that she had stepped on her foley tube and her urine had since turned to a nice shade of cranberry.

OK, I can do this, right? My charge nurse was extra awesome and helped set up my continuous pulse ox while I was dealing with my poor lady whose heart rate had been in the 130s since early afternoon. She had been given a few meds, but nothing had really worked, and, well, I don't know what people were thinking, but it was making me very uncomfortable. So after the hydralazine, po metoprolol and then an IV push of another 5mg of metoprolol, I called the cover docs and said, listen, can we do something here? They said give her another 5mg. I did, and though it was difficult to get a very accurate assessment of her (at one point when I was asking her if her chest hurt she said simply "I'm just going to agree with anything you say") she finally started breathing 40/min and was clutching her chest. Out came the EKG, and a third dose of IV metoprolol. Still her rate was in the 130s/Afib, so we started her on a Cardizem drip, and FINALLY she calmed down into a more comfortable 80s-90s range.

Just as she is getting settled, my chest tube dude calls me. I've been giving him rotating doses of oxycodone (q4) and dilauted (q3) and oxycontin (q12), but suddenly his heart rate is in the 150s. I guess it was a lesson the health care gods wanted me to learn tonight. So on came another round of 3 IV pushes of metoprolol and an EKG, portable chest xray, and lots of meds including ativan, ambien and more dilauted to calm him down. (I thought giving him ambien at 3:30 in the morning was kind of mean, but he was anxious and sweaty and he did finally fall asleep after that, even though his heart didn't slow at all.) Just as I was leaving he went off to get a CT scan to eval for a pulmonary embolism.

Things were crazy, but all my night shift peeps totally stepped up to help me out, drawing labs and giving pain meds and just helping out wherever they could. My charting probably left a bit to be desired, but everything got done and at least all my meds and vital signs were well documented. It made me very aware of how glad I am where I am, where there is a real sense of a team and I wasn't just left to flounder, or given reluctant help or an attitude. I'm definitely baking for next week, because they totally rock and deserve to be fat and happy.

I'm at that stage with nursing where for the most part I am holding my own, but still I learn something every single shift. I really feel like I learned practically nothing in school, not because the schooling was bad, but because when I was busy learning how to do an assessment I wasn't really able to absorb many of the practical details of what I was really assessing. Now that I'm comfortable in the setting, all the details are finally making sense. Or to put it another way, all the stuff I memorized without necessarily understanding is now starting to make practical sense. I'm absolutely tired of often feeling just a little bit lost at work. But with every new experience I get that much more, well, experienced. And I am sure glad that it just keeps getting better and better.

Thoughts from the first week of February

I worked on Tuesday night, so yesterday I was just pretty tired and headachey, but when David got home from school the weather was just so nice that we went for a walk and only wore sweatshirts, and I was in heaven. It has been weeks since we've really been able to go on a walk of decent length, and it reminded me that taking those walks every day is a huge part of the reason I love this city, and is when I am at my happiest. Exploring a city on foot with David is one of my most treasured activities, even when we are walking up streets we've been on dozens of times before. We talk, we plan, we catch new details of the landscape we'd not noticed before. More confirmation that I have to live in an environment that is warm enough for comfortable outdoor activities all year round.

I had a patient this week that, long story short, had an operation for a bowel obstruction. They pulled out all of his intestines and started looking for the obstruction (which ultimately wasn't there), but before they could put him back together his blood pressure dropped to zero. It them took them three days to stabilize him enough to put his intestines back inside of him, and another week before they could completely sew his belly back up. Can you imagine having your intestines spread out on the bed with you for three days? Some of this medical stuff is craaaazy. (He still has major health issues, but other than a nasty scar his intestines are all working the same as they did before.)

My birthday was fun, thanks to everyone for all the cards and emails. We'd been thinking of where to go for dinner, and suddenly I realized I just wanted fondue. So we did that. It is such a simple thing, yet was better than anything I'd have found in a restaurant. David made cupcakes just to be different, and they were, of course, good too. Almost anything edible is made better by being bite-sized.

We tried getting into watching "Dance Wars: Bruno VS Carrie Ann", but in the end it just was too...boring. I loved watching cruise ship performers when I was on a cruise ship, but on TV it just comes across as being silly. Plus, having never watched Dancing With The Stars, I could care less about Bruno or Carrie Ann and get majorly bored by their antics. Besides, the show has been on how many weeks now, and I still don't really understand how the show is going to end, and who it is that will get a recording contract, a person, a team? What if one team gets decimated in six weeks? I think the kids on Bruno's team are a tad better, but Bruno annoys the heck out of me, and it is unclear if I'd be voting for his team or for him. Anyway, I imagine this is one of the last-minute attempts at filling a slot the writers strike opened up, and it shows. Instead, we saw a commercial for some Randy Jackson dance team show on MTV which seems similar but much more interesting. Of course, Survivor starts tonight, so between that and Project Runway my TV viewing is doing just fine at the moment.

Radha, check out Blog Cabins, Fletch has a great post on some ideas for future seasons of Survivor. My favorite: no tribes, with everybody together competing individually the entire time.

I really need to post on politics, but I don't have the time right now. I'm very excited about Obama, but realize it could still go either way. Today at the grocery store we saw an older woman in a wheelchair, to which she had affixed a big sign that said "Mama for Obama". I wanted to hug her. lol

Romney, well, I should save the thought, because it is a more nuanced argument, but I was at the gym watching TV today when he "suspended" his campaign, whatever that means. I'll always think of him as the candidate that might have been. Had he run on his strengths, he might have had more appeal. Instead he decided to pander to the new base of the Republican party, the Christianists, and in doing so made a fool out himself over and over again. He has Rove and Bush to thank for that. But today when he said a vote for a Democrat is a "surrender to terror", he really pissed me off. If that kind of taunting fear garbage is the best he can do, then he hardly deserves to be president. I just read some excerpts from McCain's speech from today, and he makes a similar argument that he will be better at security, but does so in a way that isn't just insulting to people who might disagree with him. There are no absolutes in politics, and anytime a candidate says "Vote for me or die", well to me it only makes you look desperate, stupid, or perhaps just an incredibly sore loser. As lame as it is, I get pandering when you are trying to get votes, but why be so divisive if you are dropping out?

Also, we had some company the other day, but I will post on them as soon as I get the photos uploaded to the computer, because they have a super cute baby.

If this is winter I might like it here after all

Well, I made it. In the end I was more mentally exhausted than physically. In fact I'm pretty amazed at how well my body held up. I remember not too long ago where I was afraid I'd never be able to stay up for night shifts, much less one that had a day shift on either side of it. I have no plans to try six in a row again, but at least I know that if push came to shove I can do it.

My favorite patient of the adventure cracked me up the last night. On a fellow nurse "That one is very pretty. She is a piece of cake." On Ellen Degeneres "I don't like that woman. She scares me." She kept saying that to thank me for taking care of her she wanted to make me dinner. Later a commercial came on her TV for a hot tub, and she told me she would buy me one. (I got the distinct impression she's bought gifts like that before for people.) I just have this image of her in her youth, a high society free spirit. People are just awesome.

Then there was the other patient who was watching coverage of the primaries, who said he was for Huckabee. When I said I liked Obama, he said incredulously "But he is a Muslim!". ::head in hands:: We kept the tone light, but then later he offered "Well, I hate Guiliani for two reasons. One, he likes abortion. Two, he wants to let the gays get married." I wanted to say, well, this gay is about to give you a blood transfusion, so perhaps you shouldn't be so rude. lol Other than that he was a good patient though, a very spry 80 years old. Plus he was pooping blood, so I gave him a pass.

Tonight BFF Tiffany arrives from NY for a few days. Tomorrow we are going to another friends house to see his new baby and have fondue. But this guy is going to make the fondue cheese from scratch, which excites me to no end. I'm always excited when I have extreme culinary delight in my near future.

Is anyone watching Project Runway? I love that show. And this season everyone is so ridiculously *nice* to each other, all helpful and encouraging. I love it. Who says you can't be a diva without being a total bitch? However I'm starting to feel the pain of the writers strike. I need my Pushing Daisies!!

David is experimenting and is making gnocci for dinner tonight, which I'm looking forward to, so I should probably get back downstairs and offer my help, even though I'm rather pathetic in the anything but washing dishes department in the kitchen. (Except for baking of course.) We're also hoping to take down the Christmas tree tonight, and that is going to be a mess.

Oh, and just for grins, here is another reason why the 70's were super-bitchin'. The longer you watch, the more it hypnotizes you until by the end you wonder how you've survived all these years without this particular piece of joy in your lives. Also, Karen Carpenter is flawless. It's a fact. It's indisputable.

my ongoing slaving for the machine, political intrigue and a dog even I enjoy

Five down, tonight left to go. Glad it is a night shift, because it gives me nap time today plus it should be slower paced tonight. The last two days have been good overall, but I got the inevitable 6:30 new admission both days, which always sucks. But hey, the husband of one of my patients gave me a small box of fancy chocolates, so that was fun. I'd rather he spent his time talking her into not refusing 99% of the things we want to do for her, but what can you do. Every time she refuses, she always says "Let's not make a big deal about this" in her cute accent, and despite myself I can't help but to find her totally adorable. They were going to put in a central line at the bedside, which would have been awesome to watch, but she was too agitated so they decided to send her down to get a new PICC put in under anesthesia. Sad for me, but so, so much better for her.

A big yay for McCain. I wouldn't count Plasticman out yet, but I really don't see how Guiliani is going to recover thank goodness. Huckabee still freaks me out though, and I bet he wins South Carolina. I couldn't be happier that Obama won Iowa, but I'm actually glad Clinton pulled it out in New Hampshire. I want Obama to win ultimately, but I want him to win it, not just walk away with it. This is turning into a much more interesting primary season than I ever expected (remember when Clinton and Guiliani were both expected to win hands down?), so that is good at least.

Well I'm gonna go take a nap. But I'll leave you with a cute video. As you probably know, about the only thing I appreciate less in life than a hyper dog is snow, but even I can't deny that this is adorable (and looks way fun.)

How far you can walk into a forest? Halfway.

Three down, three to go.

The good news is that my body, unbelievably, seems to have little problem at all staying up for night shifts. I just finished my second in a row, and while there were definitely some yawns of gargantuan proportion, I wasn't ever fighting sleepiness or anything. Also, I love night shifts. It is all so much quieter, I love tucking a patient into bed and then not really doing more than peeking in to make sure they are still asleep and breathing every few hours.

The bad news is that, come end of shift, my body loses its sweet survival mode protections, and I come home and feel like I spent the night partying with Paris Hilton. Dang I'm wiped out. And now I have to go back and work two more busy weekdays. ::sigh::

Other fun events: cleaning actively bleeding wounds so bad the patient started sobbing on eye contact. (We love you dilauted!) A French woman who enjoyed refusing to let anyone but me touch her. Actually she didn't really like me touching her either, but she couldn't resist flirting a bit and I took the opening and ran with it. Distraction can be a great tool. Another guy who only spoke Spanish, again reminding me how badly I want to speak Spanish. At least I could say "tiene dolor?" or "esta bien?" every so often. The best part with him was drawing some blood, and one of the caps came off the tube and I spilled blood all down my pants and on my shoe, which isn't nearly as funny as it sounds. David saved the day with that one with some expert use of hydrogen peroxide and saved my favorite scrubs, but I still had to walk around for about three hours with blood on me, like, gross. Oh, and how can we forget the lovely doctor who started a patient on a heparin drip who is such an impossible stick that her "daily" labs had to be rewritten to be done only on days she has dialysis. The night doc finally had to come and do an arterial stick on her, but used a heparinized tube so the results were all skewed and useless. I had to leave that mess for the poor day shift. I hope they figure that one out before tomorrow.

So despite the headache, I'm halfway through my six day marathon. It hasn't really been that bad, I just wonder when the mental fatigue is going to really hit me. Because it will.

Better news for the future though, BFF Tiffany is coming to visit next weekend. Woo hoo! I hope the weather cooperates so we can get out of the house for some adventuring.

I think I should go sweet talk David into making me some waffles, I need some comfort food.

One awesome lady moves on to bigger things

One of my favorite patients passed away yesterday. She had been in the hospital for several months floating around to various floors depending on which organ system was acting up at the time, but one of our nurses was floating to the ICU where she was and got to be with her. I'd spent a lot of time talking with her and her husband, holding her hand, and getting completely wrapped around her finger. She was pretty sick though, and her death wasn't a huge surprise nor do I find it as depressing as I was afraid I might. I'm pretty darn sure she is in a better place and feeling a lot better than she has been. I wish I'd been able to see her husband one last time, but he was a good guy and I'm sure he'd prepared himself for this.

I'm not sure if it is just my acceptance of death as a semi-usual event in a hospital setting, or my comfort with the idea that death is not the final event of our existence that is keeping me from getting too sad about it. Still, I'll miss her wry smile.

Christmas fun and more love of Kathy Griffin

I'm sitting here making some of the finishing touches on my Christmas present to my family, which is at such a level of awesomeness it will make them all weep and and be amazed that they have never received a gift that was so spectacular and wonderful and they will realize I am forever their favorite and they love me more than they ever have and all other gifts they receive will pale in comparison to my excellent taste and creativity. So if you are giving a gift to someone I am closely related to, then all I can say is, SUCKER! Too bad for you that they are going to like my present way better than yours! Neener neener!!! Bwa-ha-ha!!!

Other than being awesome, I am just being tired, because I've spent every waking moment of every day off I've had in the past two weeks working on, er, stuff, and now I've got four days of work in front of me and I'm a little pooped. We are having some fabulous Albuquerque company on Friday night, and I'm going to barely be able to say hello before running off to bed again after work which is totally crappy. Ah, well. Yesterday was actually a great day at work, despite having two patients break down in tears. One guy said "I really hope I just die tonight. I believe in God, and I know suicide is the worst sin, and I can't wash away all the good I've done in my life with that, so I just hope I die in my sleep. Tonight." I didn't say much, because, what DO you say, but also he didn't want me to say anything, he just needed someone to listen. But other than the abject depression, I'm getting much better with my actual work load and don't feel so incompetent anymore, which you might realize is a huge plus in my overall sense of happiness.

Other nurses, how many times have you done this: After work, just as I was about to start eating dinner, I suddenly realized that in my long note I wrote that I had a patient on Aspiration Precautions, when she was really on Airborne Precautions (to rule out TB). It is a dumb mistake, I don't even know how I remembered that I'd done it. But now I'm all annoyed with myself. Stupid! Stupid!

We just got some cookies in the mail from my parents-in-law, and also some honeycomb candy which is one of my favorite things ever. When I lived in Singapore they had it in candybar form, called a Violet Crumble, but I've only found them here on rare occasions in specialty stores. Of course, thanks to all the work I've been putting in on my sweet Christmas gifts, I haven't been to the gym in almost two weeks and now I'm eating Christmas cookies, it is all a bad scene at my house. Come January I'm going to be eating better and gymming more often, I swear. Well, maybe not eating better, but I do like the gym. I have a sick gym, so it is actually fun to go. Plus if I go at the right time I get curious VH-1 reality TV to watch while I'm kicking butt on the elliptical or treadmill, which is sometimes painful but other times delicious. Once Kathy Griffin was co-hosting "The View", and that was like Christmas had come early. If I ever win the lottery, I will totally use my winnings to arrange a dinner date with her, I think she is just crazy-awesome-funny. I don't get all fanboy crazy over many celebrities, like any of the celebrities I met after Boheme usually sent me into a spiral of awkward silliness (I just smiled sheepishly at Nicole Kidman, couldn't even approach Placido Domingo, and I totally insulted Dame Maggie Smith, but by accident I swear!) But Kathy Griffin seems like she would be just a normal person, not a star you had to watch out for. Besides, if I said something stupid or insulting to her she might make fun of me in her act and what could possibly be better than that?! My friend Susie is friends with Chloe Webb who is also someone I would die of embarrassed happiness if I got to meet, but I think I missed my chance with that one by moving to DC. ::sigh:: I'm not even going to discuss my friend who was tragically killed in a blog duel recently, who at one time was allegedly given heartfelt love by a somewhat tipsy Allison Janney. She is probably just a liar anyway. (My friend, not Allison Janney.)

I'm definitely watching Survivor tonight, but I probably won't get to blog about it until Tuesday, when I will also watch Sunday night's finale. Sorry to be so late with everything, especially with the finale and all, but work is work. I think most of you mock me for it anyway, but I know I can't expect all of my friends to be as enlightened as me on every subject, especially when it comes to areas of my most excellent taste. Enjoy watching Law and Order spin-off #4, or whatever it is you silly anti-reality watchers enjoy.

The post that is all about me trying to stay awake

Tomorrow night I work my first night shift, so I'm trying to stay up late tonight to get myself ready. It is only 12:30 and I'm barely making it. I suspect I will like the slower pace of the night shift, at least the part with the fewer demands on how much I need to get done. On the other hand, I really do like being so busy I can't take lunch, because the day just goes by so much faster. I'm a little afraid tomorrow night is going to be LONG, and I'm going to resort to drastic measures such as drinking Coke or something nasty like that. (I know, you thought I was going to say coffee, but I only drink fresh coffee brewed for me by the owner of the Vietnamese coffee plantation, and even he had to douse it with half cream, I have standards you know.)

Today was a good day. I flicked urine red with blood clots at my nurse educator. Not on purpose or anything, my nurse educator is pretty rad. But I was flushing a foley catheter and it spurted when I disconnected it. Luckily she was holding a collection cup at just the right spot and it hit that instead. This is merely one example of why I wear my glasses instead of my contacts at work. You never know when a shield is going to come in handy.

It snowed today. As much as I hate everything that snow represents (i.e. coldness), I have to say that from the windows of the hospital it was really, really pretty. Then walking out to the bus it was warmer than you would have thought and again, really pretty. I think it is that I love falling snow, and snow that collects in places other than where i have to walk, as long as I'm never cold. We almost went for a walk when I got home, but it was getting mushy and that is no fun to walk around in. David got to go see the lighting of the Capitol Christmas Tree tonight while I was at work, lucky dog. He said it is pretty amazing. I'll go check it out this weekend I imagine.

Dang, 12:42, I wish I typed slower. I was hoping to make it to 1am at least, but I am currently dying inside, so of to bed with me. I just hope I'm able to sleep in, because if I still wake up at 5:15, which is quite possible, then I'm really going to be messed up tomorrow night. lol

an update and a thank you

So I think I finally passed that threshold at work, where even though I am still learning lots every day, I finally had a full load this weekend and felt comfortable with that. I didn't have to hang any blood or anything terribly time consuming like that, but I still had two PEG tubes (with feedings and water boluses), a PCA, an ostomy bag, a foley that needed flushing, two bedside commodes, one who needed pain meds every two hours, one on contact isolation...well, you know how it is. But I was ok. I mean, thankfully it was a weekend so it was quieter without lots of new orders and tests and stuff. But I'm finally getting comfortable, and I like that. At one point the commode fell on the floor and made a mess, and my preceptor (who is getting bored now that I'm doing almost everything) sighed, then turned to me and said "well at least that gives you something for your blog." It always comes back to poop, doesn't it?

Thursday night I work my first night shift, and I'm looking forward to trying that out. I'm a little worried at how my body will react, especially the next day, but there is only one way to find out.

David had a great birthday on Friday. I gave him presents and we went out for Italian (his favorite) on Thursday night, and thanks to all of you who responded to my email and gave him a call or email while I was at work. He got over 60 messages, some from some very old and distant friends, from all over the country and even one from New Zealand, which was totally awesome. At one point he started singing from that Bill Finn song, "(S)He was incredibly loved, and he knew it." So kudos to all of you.

It is supposed to snow tomorrow. Not sure how I feel about that. I wish it wasn't on a work day. Also I am missing the Capitol Christmas tree lighting, which totally sucks, even though it would probably be too cold to enjoy anyway. It just gets harder to enjoy the things in this city when it gets cold. We went on a very short walk last night to look at the neighborhood Christmas decorations, which was fun but we didn't last long against that wind.

I guess this is purely an update post, instead of the more fun adventure or just funny posts. But there it is.

Also, I had a weird dream last night where I was me but also sort of Harry Potter, because there was a huge snake in the walls of my very French Quarter mansion and it was coming after us (I was with the Dursleys) and we were trying to escape and then I was hiding on the roof and was going to slice open its belly when it slithered over where I was hiding, but I woke up before that part. I have no idea where that came from.

One way to turn spare time into something freakishly delicious

Catherine, consider yourself double dog dared.