Sunday, December 23, 2007

The 12 Pains of Work

**In the Burn Unit, At Christmas Time**


The 1st thing at work, that's such a pain to me...
Is not having time to pee

The 2nd thing at work, that's such a pain to me...
Answering the call bell,
and not having time to pee..

The 3rd thing at work, that's such a pain to me...
Signing out narcotics,
Answering the call bell,
and not having time to pee

The 4th thing at work that's such a pain to me...
Dealing with the residents,
Signing out narcotics,
Answering the call bell,
and not having time to pee

The 5th thing at work that's such a pain to me...
Five beeping pumps,
Dealing with residents,
Signing out narcotics,
Answering the call bell,
and not having time to pee

The 6th thing at work that's such a pain to me...
Q 1 hour finger sticks,
Five beeping pumps,
Dealing with residents,
Signing out narcotics,
Answering the call bell ,
and not having time to pee

The 7th thing at work that's such a pain to me...
Central line changes,
Q 1 hour finger sticks,
Five beeping pumps,
Dealing with residents,
Signing out narcotics,
Answering the call bell ,
and not having time to pee

The 8th thing at work that's such a pain to me...
Multiple intubated patients,
Central line changes,
Q 1 hour finger sticks,
Five beeping pumps,
Dealing with residents,
Signing out narcotics,
Answering the call bell ,
and not having time to pee

The 9th thing at work that's such a pain to me...
No meal breaks,
Multiple intubated patients,
Central line changes,
Q 1 hour finger sticks,
Five beeping pumps,
Dealing with residents,
Signing out narcotics,
Answering the call bell ,
and not having time to pee

The 10th thing at work that's such a pain to me...
The computer system,
No meal breaks,
Multiple intubated patients,
Central line changes,
Q 1 hour finger sticks,
Five beeping pumps,
Dealing with residents,
Signing out narcotics,
Answering the call bell ,
and not having time to pee

The 11th thing at work that's such a pain to me...
annoying family members,
The computer system,
No meal breaks,
Multiple intubated patients,
Central line changes,
Q 1 hour finger sticks,
Five beeping pumps,
Dealing with residents,
Signing out narcotics,
Answering the call bell ,
and not having time to pee

The 12th thing at work that's such a pain to me...
Codes at change of shift,
annoying family members,
The computer system,
No meal breaks,
Multiple intubated patients,
Central line changes,
Q 1 hour finger sticks,
Five beeping pumps,
Dealing with residents,
Signing out narcotics,
Answering the call bell ,
and not having time to pee

May you all have a very Merry Christmas and Happy New Year.
2008 is looking GREAT!!

Thursday, December 20, 2007

How to Host A Cookie Party: Manhattan Style

In case you were wondering how my Cookie Party went last Sunday....

1. Send out a survey via email of potential dates at least a month in advance to gauge availability on certain dates

2. Follow-up that email, requesting that people actually respond

3. Send out a "Save the Date" email with a note-"details to follow"

4. Expect that 1/3 of the people who said they were available, will bail on the actual party

5. Request that guests arrive at 1:30 if you want them to show up by 2:30

6. Don't put an end time, otherwise you kill the spontaneity of city living

7. As the party gets closer, start inviting people who aren't "cookie swap type" people...

8. Tell the people from #7 that there will be alcohol, lots and lots of alcohol

9. Request that guests bring 3 dozen cookies, if you only want them to bring 2 dozen...no one reads carefully

10. Expect that 3/4 of the people will show up with STORE BOUGHT cookies, when the whole idea is to bring homemade cookies/the recipe/and their special story

11. Laugh hysterically when one of the guests honestly tries to pawn off Entemanns chocolate chip cookies as "homemade"...NO home made cookies are THAT perfect

12. Don't be shocked that all the people from #7 are the first to arrive, and make an immediate b-line for the bar set-up

13. Know that your mimosas will be the hit of the party but that none of the guests really care that you spent an hour making the fresh squeezed OJ...in the future, unless Martha Stewart is on the guest list, screw the fresh-squeezed and grab the Tropicana

14. a) if you want to stay true to the idea of the party-Have the actual cookie/recipe swap BEFORE your guests get drunk
b) if you want to be a laid back hostess and enjoy the party, have the swap AFTER the bar runs dry...the stories are MUCH better

15. Don't forget to leave extra rolls of toilet paper in the bathroom, otherwise one poor guest will have to shout out from the bathroom for some ...

16. Don't stress that you only have official seating for 8. People WILL sit on the floor cushions that your mom so fabulously made you

17. Don't be shocked that your friends mesh fabulously with your roommates friends

18. Consider inviting boys...it's a great way to show off your domestic skills

19. Figure that your guests will take the party to the local pub for an "after cookie" party and yes they WILL get looks when they stroll in with Tupperware full of sweet treats

20. Smile, as you let out a sigh, while wiping up the last crumb and putting away the last dish at midnight

Sunday, December 16, 2007

Up, Down, All Around

What have I been doing?
Better question: What haven't I been doing?

Well for starters, last weekend my little sister and her friend Alex were here for avisit. My dad drove them in on Saturday. We spent the morning exploring Central Park, my dad took us out to lunch, he drove home, the girls and I went shopping, I took them out to dinner in Little Italy with my friends, they shopped on Canal Street, we shopped more and more on Sunday, and then I took them to the Amtrak station and sent them on their merry little way. It was the first time I had seen my dad and sister in over 5 months! I savored every moment of that weekend and I didn't want it to end.

I worked Monday and Tuesday and picked up OT shifts on Wednesday and Thursday. Friday was my first day off, but I babysat, I worked Saturday, and Sunday I met with my trainer, ran errands, did laundry, and hosted a holiday cookie party.

I guess it doesn't sound like much, but working four 13 + hour days in a row is hard. Did I mention that Winter is the burn unit's "busy" season?? We were VERY short staffed. I did not get lunch ANY day this week, and on Thursday the first time I was able to use the restroom was 5pm. (Yes, I do get to work at 7:15 a.m.).

I'd like to give you a summary of my patients this week...

Pt # 1- a 260+ pound man with scald burns to his lower legs as a result of testing hot bath water and having diabetic neuropathy. This man is intubated, sedated, has a history of 3 heart attacks, 3 strokes, diabetes, uses cocaine, and who has been having serious cardiovascular issues. In a healthy person, we like to see a blood pressure of 120/80, MAP's of 80, and heart rates in the 70's-80's. Well this man goes from having BP's of 220/190 to 56/30, HR's ranging from 55-120, and no matter what we do medically, he continues to have these episodes. The real issue? We are drying to dieures this man, he's retaining over 20 water, but whenever we pull fluid off of him with a diuretic, he drops his BP, we have to bolus his with fluid and he ends up being more overloaded than the day before....

Pt #2- a 57 year old woman with diffuse burns over her body after she lit her house on fire. She's got a history of IV drug use who gets ENORMOUSLY high doses of methadone every morning. She is so out of it, that there is no reasoning with her. Despite the fact that she is in post operative splints from her skin grafting, she tries to get out of bed, and karate chops at your head with the splints when you even attempt to get near her. Oh yeah, she says very UNKIND things. Let's just say that her favorite term for me begins with a "C" and rhymes with "punt"...yeah, I know.

Pt #3- a 79 year old man with Alzheimer's who burned himself while smoking. Best part of the story? This is his 2nd! time admitted to our floor for smoking burns. Honestly, what is a man who cannot perform his own ADL's doing smoking anyway?
So this patient also has a very diry mouth. However, he prefers to use the above mentioned name with tha adjective "f*ck*ng"...he tries to bite, pinches breasts, and spits. Because of that he's in 2 point wrist restrains, and soft mitten restraints. What a pleasant, pleasant man.

Pt #4- the 67 year old new admission with 65% burns after she set her bathrobe on fire in an attempt to kill herself. Even sadder? This was her 3rd attempt at suicide.

Any one of these patients alone, wouldn't be that bad, but we were short staffed with 5 sicks calls leaving 7 vented patients and 12 non vented patients for only 7 nurses.

Here is how ONE DAY of my week went down...

While dealing with one of pt #1 BP episodes, the cardiology fellow came down to consult on the patient. The cardiology fellow got into a verbal argument with the burn fellow outside the patients room, leaving me to deal with BP issue. During the 45 minutes that this was going on, pt # 3 managed to free himself from the restraints and rip out his central line (a type of IV surgically inserted into a great vein, in his case, the subclavian. When I went in to check on him (thankfully after stabilizing pt #1), he was half way out of bed with his post operative splint hanging over the bed... on the verge of falling. When I called for someone to come help, he started with the dirty mouth, pinching, and spitting. I no sooner got him back to bed, when I hear pt #3 screaming at the top of her lungs that she needs to get out of this "F*ck*ng $hit h@ll hole to get to the Western Union to get some money to save the men from the things who get that stuff done". (I mean, you know those people, right?) When I try and calm her down, she starts with the karate chopping.
saving myself from the karate chops, I get paged overhead to the phone to deal with the irate wife of pt #3 because she doesn't agree with the patients medication regime (honesly, not much IC an do about that...I'm not writing the med orders.). I calmly explain to her that when the doctors round at 3:30 I will address this issue with them. She isn't satisfied, demands that it be dealt with immediately, and I tell her that the doctors are in the OR but that the issue WILL get addressed.
I no sooner hang up, but then nuclear medicine calls up to ask me why pt #1 isn't down there for his V/Q scan. V/Q scan what?!?!?! I know nothing about this supposed scan, but I do that he WILL NOT be going b/c it's at least a 2 hour ordeal where myself, the fellow, and a resident need to leave the floor to transport the patient and then stay for the entire test. Right, and my other patients will just take care of themselves.
I page the fellow, have him d/c the scan,and also let him know that pt #3 took out his line. He requests that I stick this man for his noontime labs. Now there is nothing I love more than poking a man who can't sit still and screams bloody murder. Thankfully, I got it on the first shot.
Now back to dealing with pt #2. She needs to have her dressings taken down, but we are too short staffed to take her to the tank. And so begins to dressing change at tbe bedside. 2 hours later....
As if all of this isn't bad enough, at 5:30pm, I get a call from the ER that I'm getting an admission. To add to the mass confusion, I pass off my patients and prep for the new admission. I won't bore you with the details, but I'll sum it up as TRAIN WRECK. The circumferential burns required emergent escharatomies of the abdomen/chest/arms. Nothing the like the smell of freshly cauterized flesh.
As sh*te proceeded to hit the fan, I plugged on.

I clocked out of work at 9:45 pm. 2 hours and 15 minutes after my shift ended.

And that, folks, is what I have been doing.

Saturday, December 15, 2007

when it rains, it pours

wow, I certainly have been MIA. I have a large post in the works, but for the same reasons that I have been mia, my post isn't done. stay tuned.

Monday, December 03, 2007

Double Take

I feel as though, lately, I have seen a few things that I would like to comment on...

I was caring for a 20-year old newly diagnosed insulin dependent diabetic who was extremely non compliant with blood sugars ranging from 50-700. Trying my best to illustrate what sort of complications can arise from uncontrolled blood sugars, I listed some potential complications via case scenario.. blindness, kidney failure leading to dialysis, testicle removal, and foot amputation....Do you know what is reaction was??? "How can you live without testicles?"
*no words, sheer pity

At the gym, at the little counter behind the stair climbers, sat a man delicately slurping his split pea soup, gently crumbling saltine crackers into, reading the paper, and oh yeah- he had a placement. This man does not work there, nor was he working out.
*are you kidding me? I hope all those sweaty germs taste delicious...no salt needed

Ina Garden on her cooking show commenting that even the kids would lover her spinach casserole? What where the ingredients? sour cream, mayonnaise, butter, cheese, fried onions, and oh yeah spinach.
*Umm, two things. 1) can one even taste the spinach in that dish? 2) Don't kid yourself people, 15 pounds of spinach wouldn't cancel out all those *other* artery clogging ingredients

The people working at Dunkin Donuts who did not get any one of the five orders ahead of me correctly. (I.E. regular tea instead of a vanilla chai, Salmon Cream cheese instead of Lite Veggie, a dozen munchkins instead of a dozen donuts, a large hot chocolate filled half way, instead of a medium cup, and an untoasted plain bagel with onion cream cheese instead of a toasted onion bagel
*I went safe and ordered a medium decaf coffee BLACK

The traffic cop who was talking on his phone while directing traffic. The light actually changed 4 times before he turned around to let the other side of the traffic pass by
*if I weren't in a hurry, I would have called his supervisor

The enormous Christmas tree in one of the apartment buildings lobby...decorated with menorah ornaments and blue lights
*oh come on people, do we have to be SO politically correct?

Enough of that. I'm done. Just thought I'd let you in on some of the sight and sounds of life in the Big Apple

Saturday, December 01, 2007

I'll Rub Your back, If You Rub Mine

Hi my name is Kelly and I am perfectionist. (Admitting you have an ‘problem’ is the first step, right?) Don’t get me wrong, this trait has been beneficial, but I do see where it has been a problem. Gee, I sure wish I had a Venn diagram right now.

I have a drive to succeed: leading me to graduate #5 in my class and onto a Ivy League College gradating with Magna Cum Laude honors; however, many nights (more than I care admit) I missed out on fun things because I was on a different one-track. I pay meticulous attention to detail: I always cover all my bases; nevertheless, painstaking amounts of time have been lost when it really wasn’t necessary. I don’t shy away from a challenge: I swam competitively for 13 years, never once being the best, but I got so much satisfaction from giving it my all; I’m stubborn and won’t back down, even if it is a hopeless cause. I aim to please: I can work a crowd and talk to most anybody; I hate confrontation and will often not speak up with my opinion for the sake of avoiding an argument.

I think you get my point. I’m not really sure why I am writing this post, but I guess lately I have been giving my habits a lot of thought.

At the beginning of my orientation for work, I was precepted by a nurse “the bi*itch” who was so demeaning and belittling to me that I almost quit (eating their young, anyone?). She called me useless, yelled at me in front of a patient, and told me to get it together. So now, now that I am a real nurse, all on my own, I do everything with this nurse in mind. I write detailed anecdotal notes, I clean and organize my patient’s rooms, I keep them [patients] clean, I label and note everything, I write report before giving it verbally, I do everything like I am preparing to handoff my patients to the b*tch. I guess I have her to thank for this, as everyone is impressed with my organization and efficiency, convinced that I have worked before, astounded that I am a new grad.

Not going to lie, I get that warm and tingly feeling inside when people pay me such a compliment, but I sort of feel guilty. I’m not acting in such a way for other people, I do it out of my insecurities. I’m afraid of looking weak and vulnerable, of looking incompetent. Over the years, I have learned that it’s OKAY to ask for help, especially when charting unknown territory, but when I can figure something out on my own, I find it more satisfying.

More than being a perfectionist, I am extremely independent. For this, I can thank my parents. They provided a warm, loving, and pleasant environment, but they taught us how to be self sufficient. For example: In the 4th grade, I simply refused to put away clean clothes and would just toss them back n the dirty clothes piles after I decided not to wear them. My mom kindly gave me 3 warnings. Then she took me to the store, asked me what detergent I best liked the smell of, brought me home, took out the stool, and said, “Kelly, this is how you do laundry. I am sick and tired of putting all that effort into your laundry and having you be that disrespectful of my time. From now on, you will do your own laundry.” I’ve been doing laundry 12 years.

Or when I was complaining about what we were having for dinner, my mom took out the cookbooks and let me pick the sides (yes, there were nights when we ate salmon with carrots and stuffing or lasagna with cranberry-walnut rice) but she kept me involved in the process and allowed me to feel included.

I always ended up doing the work for the entire group project when others slacked, I was the first to volunteer for tasks others didn’t want to do, I would give anything a shot before I asked for help-sometimes proving disastrous i.e. rake the lawn (only to learn that my dad had fertilized and that I had raked up the strategically placed leaves to protect the grass).
This independence and perfection has played out into my dating life as well. My first boyfriend treated me like a princess, and I liked it- to an extent. But I got annoyed when he wouldn’t think of letting me get my own glass of water, put on my own jacket, etc. I loved the chivalry of opening the doors and pulling out chairs, but I hated feeling like I was smothered. I need a little space. However, I also don’t need to take on another project. I’m not looking for some schlepy guy who couldn’t be bothered with anyone but himself. I feel like I’m a good catch (god this always sounds so conceited) but I’m fun, funny, driven, compassionate, organized, smart, love adventure, and can cook. I’ve been told numerous times, that maybe I just intimidate guys, but why?

At a carnival I had my fortune told. She said that, “Someday you will meet a man who you don’t overpower.” At the time, I laughed it off, but it’s looking more and more like this is the case. My perfectionism is making my pickings too slim and my independence is preventing me from being swept off my feet.

In a day and age where women are out in the workforce, proving their equality, and not settling for less than the best, I find myself torn between giving it my all, and letting someone give me a little.