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.

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