in need of a good read

I'm a bit stingy when it comes to spending money on things like books. It kills me to pay $25.00 for a hardcover when I know in 3 months that it will go to paperback and only cost between $9-$14. If the wait list for the new books at the library wasn't months long, I'd march right over to the New York public library and check the books out there.

Over the last few years I've taken to going to the "bargain book" section at Barnes&Noble and picking up a few seemingly good reads. It's largely hit or miss, but I have managed to snag a few good ones. For all you history buffs, I highly recommends "On Hitler's Mountain" by Irmgard Hunt. The beginning is slow, but the overall concept and insight into Nazi Germany is intriguing.

So, now, I'm asking a favor...

Does anyone have any good suggestions on some good reads? And/or how I can get exposed to some books aside from the best sellers that are a drain on my bank account?

thankyouverymuch

All About Potatoes

Here are this week’s four questions. They’re about potatoes. Check out the FFOF Meme

#1. Potato Chips. What kind of chips are your favorite?
I'm not much of chip girl, butif forced to choose, I'd say baked lays BBQ

#2. What’s your favorite thing to dip chips in?
All about the spinach and artichoke dip- I love it on fresh veggies

#3. What’s your favorite way to eat a baked potato?
With a very crispy skin and salsa

#4. How do you make mashed potatoes?

boiled, cubed yukon gold potatoes
skim milk
lowfat cream cheese
salt, pepper, garlic salt, fresh chives

to sleep per chance to dream

it's 4:49 in the AM, I'm not at work, and I'm WIDE awake. I went out with G, we came back home, he left, I went to bed, and I tossed and turned and tossed and turned and tossed and turned. This saga began at 12:50. In the last 4 hours I've...
*watched 2 episodes of without a trace,
*self medicated with benadryl
*read the last 2 issues of Bon Appetit Magazine,
*worked out my budget for the upcoming months without a calculator,
*drank 3 bottles of water,
*ate 5 almonds,
*got up to pee 3 times (maybe I shouldn't have had the water?),
*turned my AC down to 67,
*counted backwards from 100 (5) times,
*organized my bookshelf,
and,
*text messaged my friends that i was annoyed to be wide awake (payback for all their phone calls when I'm trying to sleep during the day).

Ugh. If I don't fall asleep in the next 11 minutes, I say screw it. I'm getting up, getting dressed, and going to the gym.

So just in case you see me out, I'm not ignoring you, I'm just exhausted.

with grace

my arms hurt.
my back hurts.
my neck is cricked.
I had a long night.
no! Get your mind out of the gutter.
we coded a patient (for an hour) twice.
i may be small, but i'm certainly mighty.
i broke ribs.

maxed out on levo, dopa, dobutamine,and epi, we never got her back from asystole.
she didn't make it.

RIP

hip hip horray (literally)

It's been 13 weeks since the injury occurred. I've been going crazy. Even though I've been allowed to resume my usual activities, the running wasn' happening. It was painful. It's been 2 weeks since I was cleared, and I've only logged 4 miles. Ehhh.
However, today I had a surprise brunch with GI Greg (my trainer) who's home for the weekend from training. We were talking and I just had a good feeling. So after our brunch, I laced up my sneakers and hit the gym to run. And run I did. 5 1/2 miles @ an 8:15 pace. Far from my previous pace, but still not awful. When my workout was over I felt like a wight had been lifted off my shoulders. I hope today wasn't just a fluke, and that I'm finally on my way.

Olympic Edition FFOF

Valmg's FFOF questions were inspired by the Olympics this week. See what everyone is blogging about here:

#1. What do you drink to rehydrate in the heat or after working out?
When working out I drink water. Post workout I drink Powerade ZERO and/or crystal light.

#2. What do you eat to help boost or create energy?
Before my runs I eat 1/2 banana with 1 TB Better'n'Peanut Butter

#3. What’s the healthiest snack you eat?
I love carrots and hummus or an apple with almond butter.

#4. Share a recipe or instructions for your ideal three course meal.
Normally I would insert a very detailed descritpion here, but since I'm on my 3rd overtime shift this week, my brain isn't up to par. Here's my suggestion: menupages.com.

I Should Get Paid for This

Even before I knew ANYTHING about being a nurse (i.e. NSO during freshman orientation) I got asked silly nurse questions. Not going to lie, I had no clue when I answered these questions...

"Am I going to die from drinking this Jungle Juice?"
IF you die, so will the thousand other people drinking from this barrel. Fill 'er up

"Can I drink and take Tylenol/antibiotics/birth control"
I'd skip the Tylenol, but if you are going to drink and want to avoid an "accident" I'd go with the birth control

"Will I get herpes from sitting on the toilet in the dorms?".
No greater chance of getting it from the toilet seat than from that sketchy frat boy you hooked up with last night.

As the years passed, I grew more knowledgeable and was able to actually give some helpful advice. I have no problem when my friends come to me with "health questions", I always just hope I have an answer. I guess in a way it makes them feel better, even if I just tell them what they already know (i.e. "I'd say you need to go to the ER for an x-ray, the bone IS sticking out.")

Last week, Craig approached me with a nurse question. He pulled up his pant leg and said, "Do you think these are infected?" I swallowed hard as I looked at the welts on his legs, covered in green scabs with blanching red rings around them. Did I mention the edema in his leg and ankle.
(original image from wikipedia)
ME: "Craig! You are on your way to nasty case of cellulits. You need to go the doctor and get some antibiotics. We admit patients for cellulitis, you don't want it to go systemic."

Craig: "You mean I can't just take some Tylenol and put on some cream?"

ME: "Uh, has it worked yet?"

Craig: "No. Oh I guess you're right. I'll go to the doctor. Wait, I don't have a doctor here. Am I going to die?"

ME: "No, you just need to See a doctor. So go to the ER"

Craig: "But isn't that going to be a long wait?"

ME: "Well it's going to be a lot longer if you don't get it treated and have to get admitted to the hospital for a course of IV antibiotics."

Craig: "Okay, thanks nurse Kelly.I'll go"

ME: "Call me if you need anything. I'll check in with you later."

4 hours later

Craig: "Nurse Kelly. You were right. They checked me all out and gave me some antibiotics. Thanks."

ME: "No problem Craig. Feel better. See you tomorrow."

36 hours later, 8am
MY cell phone goes off, it rings again, and again. I hop out of bed, thinking something is truly wrong. It's Craig. I call him back.
"Hi Nurse Kelly. Did I wake you?"

ME: "Uhhm, well I guess I had to get up anyways."

Craig:"Good. Well, okay, so yeah like I started the antibiotics and my legs are looking better but now I have this hard lump under my belly button and it's red and kinda sore."

ME: "Is it itchy?"

Craig: "No, just hurts and looks gross. Do I have skin cancer?"

ME: "Take some benadryl, and Tylenol, and put a cool compress on it. If it's not better in the morning or is getting worse, go to the doctor."

Craig: "But Nurse Kelly, I don't have a doctor."

ME: "Well then, I guess you'll have to go to the ER (again). Have you thought about getting a doctor in the area? What is your insurance, I'll look into it for you."

Craig: "Do you think I can get in and out quick because I was just seen there? Like a preferred patient?"

ME: "Craig, we aren't talking about some luxury hotel chain, we are talking about a hospital. You (and your belly button ailments) will have to wait like everyone else. haha"

Craig: "Okay, guess you are right. I'll call you later."

ME: "Sounds good. Feel better and keep me updated."

I managed to dose back off for an hour or two, but it wasn't quite the restful sleep I was longing for. I kept dreaming about Craig's weird belly button issue. Just another day in the life of Nurse Kelly.

I made his day

Last night I had plans to go and see Pineapple Express with G, J, M, E, and others at 9 p.m. G was going to meet me before hand at 7:15 and then head out for drinks and meet up with the rest of the crew to see the movie. G's express train got stuck on the tracks, so he didn't get here until 8. No biggie.

We went to the Stumble Inn and got a quick drink. Of course, it was raining cats and dogs, so we copped out and took a cab to the theater. The cab ride was quick (from 76th to 32nd) and cheap ($7.10). I whipped out my wallet and handed the cabby a $10 and asked for a $1.00 back. G and I walked into the theater but didn't see any of our friends. G called them; they were already inside. Oh well, we waited in line to get tickets. Just as we were about to walk up to the counter, I looked up and saw SOLD OUT SHOWS: Pineapple Express 9:00. Ugh, okay. Now what? Oh well, could have been worse,. G called J and told him the situation, I think J felt bad, but we made the best of it. We bought tickets to the 10:15 show, went around the corner, got a few more drinks, and then came back to see the movie. I'm not complaining...after the last month of G's traveling and my work schedule, a little extra 1 on 1 time was fine with me.

The 10:15 show wasn't crowded at all, I guess everyone opted for the earlier viewing. We settled in and the movie rolled. Don't get me wring, there were a few good one liners, but for the most part the movie was a lot of violence and monotonous antics surrounding getting high and smoking weed pineapple express. The movie was LONG, well over 2 hours, but the company was good, so it all worked out. G and I came home, watched the Olympics and fell asleep only to be woken up by the alarm at 6:45 so G could make his early morning T time with the boys.

After he left, I fell back asleep until 10:30. After an amazing workout, I headed to St@rbucks for a soy milk latte (yum!). I pulled out my wallet to pay and did a double take. Where is the $20 that I took out of the ATM the day before? I see the $10, but the 20 is gonzo. Oh no I can't believe it. Yup, in my haste to pay the cabbie the night before, in the dark no less, I handed him the $20, for a $7.10 fare and only asked for $1.00 back. No wonder he pulled away so fast. Oh well, guess I made his day.

All about Appetizers

Here are this week’s four questions. This week they’re about appetizers. See what others are salivating over writing about here

#1. What is your favorite appetizer?
I love spinach and artichoke dip.

#2. Do you eat enough appetizers that you get full and can’t eat your meal?
No, we always get one to share with the table

#3. Do you usually make frozen or fresh appetizers?
I make them. I love the convenience of the premade or frozen, but they are so high in sodium and fat that I prefer to make my own.

#4. Share a recipe or instructions for an appetizer.
Yet again, from my wholefoods recipe stash...

Dried Fig, Brie and Rosemary Bites
Serves 4 to 6

8-12 large plump dried figs
2-3 ounces Brie, cut into small pieces
2 teaspoons extra virgin olive oil
1 tablespoon fresh rosemary leaves
sea salt, to taste
ground pepper, to taste
If the figs are very dry, plump them in boiling water for 5 to 10 minutes. Drain and cool them. Trim the stems and make a slit in the side of each fig. Push a piece of Brie into each fig. Place in a bowl and toss gently with olive oil, rosemary, salt and pepper. Serve at room temperature or heat in a 350°F oven until warm and cheese melts, about 8 minutes.

Metamorphosis

While working out in the gym today, I overheard a conversation that got me thinking. The conversation was about keeping a diary. Did/do you keep a diary? Growing up, I had a diary (yes one of those girlie ones with a "lock and key" that could easily be picked with a bobby pin). I wrote about lots of things, but I'm pretty sure most of it related to things about my friends, boys that I liked, things I maybe regretted doing, and/or things that I wanted to do. The preteen years were perfect for a dairy, a place to write about stuff and then guard it under lock and key.

As I got older, it sort of fell by the wayside, but I started scrap booking. My teenage years were captured on film and then later digital memory cards, but either way I had pictures to look back upon and recollect what was going on in my life. My teenage years were marked by milestones and things perfect for images (dances, proms, beach trips, vacations, cars/driving, parties, college visits, etc.) When it comes to socializing in the teenage years, a picture (for better or worse) really does say a thousand words.

When I arrived at college, I entered a whole new world. It was a time of firsts and milestones (much like my teen years) but similar to my preteen years, I was full of hopes and dreams and crushes on boys. (Oh how much I loved when the crew team ate in my building's dining hall and when the frat boys sat on their leathers couches along locust walk). Before I left for school, I bought a journal to write about my college years; however, I was so busy with school work socializing that I didn't have much time to write about anything [fun] (espescailly with my writing seminar from hell!) I took lots of pictures and they were plastered on Websh0ts and Faceb00k. Even more than being a way to capture memories they were a way to fill in the blackouts nights that lasted into the dawn.

As I began my senior year of college, this blog was born. I started feeling nostalgic and wanted to keep track of my thoughts and of things that couldn't be captured on film (mainly work and clinical experiences...HIPPA anyone?). However, I didn't dig that dusty journal out of storage, I chose to start blogging. I spent so much time on the computer, anyways, it just seemed like a practical idea...plus I was enamored with the idea of an audience. Like I've blogged about before, the content I blog about is varied, but I like it that way. I can talk about my hobbies, my personal life, my job, my friends, etc...the possibilities are endless.

I have but a few regrets with my choices over the years..
*I wish that I had more pictures from my preteen years because like Dan was just sooooo dreamy in the 6th grade
*I wish I had taken the time to write about some personal things in my late teens and early twenties because let's face it, some thigs weren't meant for public viewing and certainly weren't appropriate to be captured on film (the closet incident, the whip cream fiasco, the first time I had sex, the infamous taxi cab ride, etc). Okay, now that I've given you all TMI...
*I wish that I wasn't leery of sending this link to all of my friends. As much as I love them, there is a part of me who wants to keep this mine, or maybe I'm afraid of what they'd say.

But in the end, when I'm old and gray and my memory isn't what it is now, I'll have something to look back upon and remember who I was, what I did, and all that I aspire to do.

What about you? what made you start blogging? did it stem from a lifelong passion for writing or was it something that just seemed like a good idea at the time and now you're hooked?

what happens when you get septic

this is night #5 of a 7 consecutive shift stint with the sickest patient i've ever taken care of (I think).

some highlights of the clinical situation thus far:
*maxed out on dopamine, added levophed drip
*H/H =7.0 / 21.2...2 units PRBC transfused
*gram negative sepsis as seen in the blood stream and BAL...Aztreozam Abx therapy
*pre-renal failure (>10cc/hr for 15 hours) despite fluids going at 1000cc/hr
*patient CXR showing patchy infiltrates and fluid: patient not oxygenating or ventilating well
*SWAN Ganz inserted. Cardiac output > 13, Wedge high 20's, CVP 28-34.
*septic shock
*started on Xigris
*PTT > 150...xigris stopped...4 units FFP transfused
*ABG: 7.22/55/67/18...FiO2 on 100%...8 sets of ventialtor changes made
*8 liters of bed drainage per shift
*1 liter of diarrhea in 3 hours, C.Diff samples sent~positive growth...rectal tube inserted

stay tuned. 2 more nights to go.

My Road to Recovery

6/14: 13 mile run, followed by left groin pain. Iced it and popped an anti-inflammatory
6/15: Tried to run. OUT OF CONTROL pain. Cross trained instead. Taking Aleve RTC (round-the-clock)
6/16: Still couldn’t run. Decided to switch up my marathon training schedule and take off the week of 6/15-6/21 instead of 6/22-6/28
6/18: Now having pain without activity. Decide to try acupuncture-minor relief noted.
6/20: Acupuncture session #2. Again, short lasting relief.
6/22: Attempt to run. MISSION FAILED, the pain is excruciating. Cross training is boring as all hell. Emotionally distressed. Leave for Philly for a few days.
6/23: Cross train in the AM, minor discomfort. Go to playground with the boys and make the mistake of chasing after them. (Hey, what fun is hide-n-seek if you don’t chase them??). Pain sets in and doesn’t leave.
6/24: Wake up really stiff, unable to bend/squat to put on my sneakers. Cross training is now downgraded to Yoga and Pilates. Ugh! Decide that I need to be seen for this pain. I start a frantic search to find an sports medicine orthopedist who takes my insurance. By some miracle of god, I get an appointment with the guru on running injuries for the following day. Sad that my trip to Philly is over, but relieved to be getting my pain checked out.
6/25: Appointment Day! Before the MD even sees me, I’m sent for x-rays. Within 5 minutes of speaking to the MD, he’s 99% sure it’s a stress fracture on the neck of my femur, but only an MRI will confirm. Must get that scheduled. In the meantime, no running, no strenuous activity, “nothing that causes pain” (direct quote), and need to get fitted for orthodics.
6/26: Sweet! Get an MRI for 7pm tonight! Wow, that was a long 90 minutes.
6/27: Call to speak to the “Guru.” He can’t see me and he’s going away for the entire upcoming week. Next appointment I can get? 7/10.
6/27-7/10: Agony (emotional and physical). Waiting. Bitchyness.
7/10: Follow-up appointment. So the diagnosis surprises the doc and myself…it’s not a femur fracture, it’s a pelvic fracture! Which means: another month of no running, no cycling, no stairs, minimal extra walking; swimming pool here I come; PT 3x/week; a bone scan; and Tylenol (yup, Tylenol. Did you know that anti-inflammatories slow bone regeneration.)
7/11: Start PT. It’s brutal. Let my bosses know the test results and find out that I don’t qualify for medical leave because I haven’t been employed for a year (2 weeks short).
7/12: Make the emotional plunge back into the pool. Not as bad as I thought.
7/14: Start my 2 weeks of “desk duty” at work. ( QA , chart review, and protocol compliance)
7/17: Bone scan day.
7/18: Day without pain. WOW.
7/19: Climbed stairs without pain. Able to bridge on left leg (5 PT sessions in the making!)
7/20: No pain medication! Making progress.
7/21: Finally seeing definition in my quads and hammies again. Still really tight. Finding alternate ways to stetch, haha. No comment. Marks 5 weeks since initial injury.
7/25: Desk work completed. Will resume patient care next week.
7/26: No pain today. 70 minutes of cardio! Getting strong one day at a time.
7/28: Wore heels ALL day. First time out of flats in 6 weeks! No pain.
7/30: Fist night back at work taking care of patients.
8/2: Sqautted to check a foley catheter...ouch, that hurt.
8/3:Ran across the street to make a red light, NO PAIN! Alleluia!
8/4: Crossed my leg (horrible habit, I know). Holy moly! I've got a decent range of motion!
8/6: Begin my 7 night straight stretch.
8/8: 8 Week Follow Up! Bad News: I've got osteopenia. Good News: I'm CLEARED TO RUN AGAIN! PHILADELPHIA MARATHON 2K8 HERE I COME!

If I Could Tell You

Dear Family of Patient X,

I will not say that I know how you feel, because I don't.
I will not say that everything will be fine, because it won't.
I cannot promise anything,
I cannot control the actions of others.

I come here to do my job, and take the best care possible of your loved one. Please let me do that.

I know the beeping and chirping of the the monitors, ventilators, and pumps is bothersome, but they are they for the patients safety...please don't take it upon yourself to silence them. They go off for a reason.

When I explain that I need to step out of the room to get a 2nd RN to check the blood that needs to be transfused, that is not the time to scold me for a missing blanket. Your loved one has a 103 degree fever and surrounded by ice packs, a blanket is contraindicated. I've made sure that they are covered, discretion and modesty of course.

I know it's hard to digest all that is going on with your loved one, but they really are getting fed. They can't eat through their mouth, they are on a ventilator and sedated. See that little tube in their nose, connected to that pump with the hanging bag of that creamy liquid? That's their food, I promise. Please don't berate the dietary worker who delivers food when she skips your room. It's not her choosing.

My age really isn't important. I am fully capable of taking care of your loved one. If anything, the fact that I am new(er) makes me pay even more attention to detail because I'm still "by-the book". But if it gives you a piece of mind, I have a BSN from an Ivy League school where I graduated Magna Cum Laude. All of my ICU credentials and certifications are adequate and up to date and because I know you are still wondering, Reagan was president when I was born.

Yes, we do take a lot of xrays. No, we aren't trying to give your loved one cancer. They have fluid in their lungs and we need to see if our methods to remove it are working.

I know it seems like I'm sitting at the computer a lot, but Im completing all my charting and documentation. There's a lot of information that needs to be charted hourly (175 items, actaully). I swear I'm not checking out YouTube,

Visiting hours are 11am-7pm. I have alredy bent the rules by allowing you to be here until 8pm, please stop begging and pleading with me to let you stay longer. You know that you can call at any time, give me the password, and I'll update you. Yes, I still have your home number, cell number, work number, beeper number on the whiteboard, in the patient's chart, and on the computer system . I know how to use a phone, I'll get in contact with you if anything happens.

Like I said before, I come here to do my job and provide the best possible care. Monitors will alarm, pumps will beep, xrays will be taken, charting will be done.....

But here are some things that you may not be aware of:
I treat all my patients the way I would want my loved on treated. I talk to my patients, letting them know what I'm doing and/or what will happen, even when they are unconscious. I gently bathe them and perform hygenic care. I comb their hair and clean in their ears. I cream and powder them up so they smell fresh and clean and then when it's all said and done, I take their hand in mine, give it a little squeeze and tell them, "I'll pulling for ya. Don't put those boxing gloves away, the fights not over yet." I place their hand back at their side and continue about my night.

So now, dear family, as I send you on your way, please know that I may not have the same relationship with the patient as you do, but that's okay. You are their past and future, but I'm in on their present. I'm here for them, just like you. So let's work together to get them through this....one day, one minute, one breath at a time.

Sincerely,

Nurse Kelly

Banumpkins

(Banana Pumpkin Muffins) I just created them and they are so good.

1 ripe banana mashed
1/2 can pumpkin
1/4 c. applesauce
1/2 vanilla soymilk
1/2 c. packed brown sugar (I used turbinado)
1 egg

1 3/4 c. whole wheat flour
1 tsp baking powder
1 tsp baking soda
1/4 tsp salt
1 tsp cinnamon
1 tsp pumpkin pie spice

1 banana, quartered and chopped


mix all the wet ingredient together, sift in dry ingredients, add in banana chunks.

preheat oven to 375. Prepare a 12 muffin pan with non stick cooking spray. Fill cups 2/3 of the way. Bake 20 minutes. Enjoy!


chopped walnuts or pecans would be great in this recipe too. the natural sugars of the mashed ripe banana really mellow the strong pumpkin flavor.

Fly On the Wall

Going to the pool and gym yesterday was the first time I had left my apartment since arriving home from work Sunday morning. After my workout, I came home, showered, and put my pajamas back on. In dire need of doing laundry, I put on sweat pants (it was only 70 degrees but I had my AC cranked) and a big baggy t-shirt from college. Still exhausted from my 52+ hours of working in 4 days, I lounged around my apartment all afternoon. However ,around 9pm I suddenly foudn myself craving seltzer water. I gave up soda over a year ago and never crave it, but occasionally long for some fizz. I couldn't fight the urge, so I put down my book, got up off the couch, laced up my sneakers, and grabbed my purse. IT wasn't until I was outside and walked by a window that I stopped, checked myself out top tobottom, and burst out laughing. I looked absurd.
Bandanna headband with wildy curly hair
Baggy gray t-shirt (Penn Soccer), no bra of course!
Baggy gray sweatpants (not the same shade as tshirt) with SWIM on the butt (left overs from high school)
Fleece socks (I wear them as slippers)
My running sneakers
and one of my "going out" Kate Spade handbags (really cute, got this last week)

I whipped out my phone and called N to leave her a pictoral description of what her best friend was currently sporting out in public!

I prayed the the store wouldn't be crowded and that I wouldn't get picked up by some homeless bum thinking that he just found his sugar mama.

Oh well, that's what exhaustion will do to you.

Top Dog

"Charge nurse pick on 6xxxx"
"Can I speak to the charge nurse?"
"Have the charge nurse call the nursing supervisor."
"Ask the charge nurse if she can help you."
"See if the charge nurse will go speak to the disgruntled family in room X"
"Ask the charge nurse where XYZ is located."
"Tell the charge nurse that you found a discrepancy in the pixus system."
"If you don't like your assignment, speak to the charge nurse."
"Didn't get a meal break? Tell the charge nurse"
"Not enough nurses to take care of all the patients? Tell the charge nurse."
"Resident is MIA/not returning pages/being a jack ass! Tell the charge nurse"
"Couldn't obtain the blood work for labs that the docs ordered....tell the charge nurse"
"Patient just spiked a fever/vomited/pulled out central line/fell out of bed/stopped peeing/dropped his blood pressure... Tell the charge nurse"
"Patients trash needs to be emptied...tell the charge nurse housekeeping staff

Get a sense of where I am going with this entry?

It's a rule in the ICU that you can't be the charge nurse until you have been working on the unit at least a year, have all of your additional ICU credentials (ACLS/PALS), and aren't a complete pompous asshole, arrogant bitch unapproachable.

It's always suspenseful to come on shift and see the name of who will be charge. Some are FABULOUS and some are completely awful, unhelpful, lazy, and rude less than fabulous.

I never hesitate to ask the charge nurse a question and I always keep them updated on my patients conditions. AFter all, they can be a huge help if when shit hits the fan and/or you feel overwhelmed or frustrated. I'll admit it, I've asked a series of assaine questions; however, for the most part I try not to abuse the charge nurse...they have enough to handle.

So how surprised was I when my nurse manager approached me Friday night and told me that I would be orienting to charge nurse? Very surprised, especially since this was my first week back taking care of patients since fracturing my pelvis plus Friday was night #3 of a 4 night stretch.

When orienting to charge nurse, they pair you with a senior nurse who gives guidance and explains the ins and outs of the job. However, they largely let you fumble through the night and get your feet wet. I lucked out because my senior nurse was very experienced and helped me anticipate what might happen, but I still worked myself to the bone. During report from day shift, we were told that there was a pending transfer from an OSH of a circumferential arm burn. The resident still needed to sign off on the acceptance and decide what patient we could move off the unit to accept it, but the ball was in motion. Our night began when we got a call from the transfer center that we needed to accept a pediatric patient with bilateral palm scald burns from a hot iron. (That's 2 beds we need to free up). To accept the circumferential burn we needed to move someone out of the ICU onto step down. To accept the pediatric patient, we needed to transfer out an adult step down patient. Confused yet? Try being the one to coordinate all of this.

Just when I thought I had worked all of this out with the resident and admitting bed officer, a stretcher rolls onto the floor. WTF? Who is this patient? Oh, well this is the adult transfer....who we haven't accepted yet! We don't have a bed! Neither the resident or the nurse received report on this patient! this is going to get ugly. Not sure what to do, the patient was admitted into the system and kept in holding (sort of like an ER patient) until we could open up a bed. Eventually (3 hours later), crisis averted.
THEN
Patient in room XYZ decides to plug his ET tube and is sating 88%....STAT page respiratory and the resident,disconnect ventilator, bag the patient, deep lavage suction..............where is the resident? where is respiratory...........suction........bag patient.....suction.......COUGH!! Patient breathing again. Settle patient, reconnect ventilator, monitor vigilantly, send ABG in 30 minutes.
THEN
Patient in room ABC looses A-line (this is a problem as the patent's blood pressure is dependant on dopamine ). Page resident, take cuff pressures every 2 minutes, set up for new A-line. Anticipate that resident will fail miserably at inserting this Aline into this 3rd spacing fluid overloaded patient and page the night fellow. 15 minutes and 2 attempts later, fellow manages to inert a new line.
THEN
Patient in room EFG drops blood pressure and stops urinating. Reassure the bewildered resident, suggest it's time for a fluid bolus!
THEN
Nurse for patient 123 gets into argument with the pharmacy over dispensing a new ativan drip. Get on phone with the devil pharmacy tech and explain that the patient had line changes and all new drips must be hung, so even though a new drip had been hung at 8pmfriday and didn't expire until 8pm on Saturday, we needed a new drip STAT. You can't stop sedating a patient on a ventilator. dumnbass!?!?
THEN
Staffing office calls to tell us they are sending 2 nurses for day shift. We should be overjoycing, right? WRONG. We need at least 16 nurses to "safely" staff the unti, the 2 nurses they're sending us, only puts us at 13.
THEN
The mother of the 34 year old patient in room MNO calls for the 5th time in 7 hours "to check up." OK lady, here's a little insight for you.... your kid 34 year old son burned his peni$ 2 days ago and made it clear at that time that we are not to give our any information over the phone to anyone except for his wife (who we assigned a password to for obtaining info). It's 3am and he's sound asleep. Like we explained before, we don't connect calls into the rooms after 10pm, it's disruptufl. you need to get the # from the patient and call them directly. Please don't send him flowers because flowers aren't allowed on the unit .And lastly, stop trying to bribe me with coffee and a muffin if I'll let you come in before visiting hours begin at 11am. thankyouverymuch
THEN
Receive phone call from the ER attending that there is a 40%er in the ED who needs to be admitted.
THEN
Patient in room QRS shits himself for the 8th time requiring the nurse to change his sterile dressings on his back and legs for the 7th time. Time to make sure that the 3rd CDiff specimen has been sent and then insert a rectal tube. If the devil created diarrhea, then God created the Zassi.

A whole lot more happened that night, but I won't bore you with details. I was in charge again Saturday night and didn't get out of work until 9:30am Sunday morning. I went to bed at 6pm and slept until 11 am today. I'm all recharged and it's a beautiful thing....that is until I go back to work on Wednesday.

dominos

Last night was my first night back at work, actually taking care of patients, after almost 3 weeks of time off to heal my little injury (which is getting better every day, thankyouverymuch).

My boss had called earlier in the day, as in 8am (like that the heck would I be doing at that time of day? Sleep?!?! Apparently not). He called to make sure that I was coming in because staffing is atrocious "see how I was feeling". I assured him that I'd be in and would see how I felt. I did make one request. I told him that I would prefer one very sick, preferable vented patient, over a few "walkie talkie" step-down patients. Have I ever mentioned that I loathe the call bell and think it was possibly invented for the sole reason of tormenting overworked staff??

I arrived at work early (after a year I still overestimate the amount of time it will take me to walk 5 blocks) and am surprised to find that my assignment is actually a "sickie". Oh wait, he's sick, but he's also a bariatric patient (a mere 206 kilos). Um yeah, so like how am I going to maneuver this man? With help, of course. My coworkers were great with lending a hand (or two, or three, or four) but my adventures didn't end with his size. All those with weak stomachs and/or those who want to eat in the next hour, don't read on. During the course of the night he started to blow snot bubbles-one popped in my face (amen to face shields). He projective vomited (did I mention he also has a tracheostomy), that was delicious. Despite giving pharmacy a 2 hour heads up that I needed a new ativan drip, they were 45 minutes late in supplying me a new one. You know how it goes from here...Patient sedation lessons, patient pulls out NG tube that the attending had placed. While I was replacing the NGT tube, the patients A-line pressure bag malfunctioned and I lost the waveform. After 2 attempts the NGT goes in but the patient just coughed off his trach cap and goo flies everywhere. I attempt to prop him on his side and what to do you know? Oh yes, some of the worst smelling farts ever. Only good thing is that there was none of that brown delight, to accompany the odor. That's when my foot skid on the floor. Oh yes, I had just stepped into a the pile of puke that I missed when cleaning up the vomit with cl0r0x wipes (remind me again why we pay a housekeeping staff?) I squatted down to examine the problem. WHOOPS, OUCH, F@c^! That didn't feel good. Now, stuck in a squat, I just started to laugh and laugh and laugh. What else could I do? I pulled myself up and just started to fix all my messes.

Clean puke: check

Get new pressure bag for A-line: check

Reinsert feeding tube: check

Suction out patients mouth and nose and tube for any residual vomit: check, check, check

Completely change patients linens and bed (2nd time in less than 2 hours): check

Wash patients face: check

Take off gloves; Rremove mask; Wash hands; Sit in chair; Pray that 8am isn't really still 5 hours away

I'm back tonight for #2 of 4. Stay tuned, it's always an adventure when nurse Kelly is around.