Sunday, December 21, 2008

the final countdown

Christmas is in less than four days It's three days, fourteen hours, and two minutes to be exact, but who's counting, right?

Per usual, there has been no rest for the weary. I worked four days this past week and they were no less exciting than my previous post. Also, I made a mad dash from work on Thursday night to get across town to babysit. That was fun in rushhour, not! Thankfully the R's were home before midnight, so getting up at 4:44a.m. for the gym and work on Friday wasn't impossible. Friday night was our Christmas party. Now it's a well known fact that us nurses love to party and have a good time...sometimes just a wee bit too much. That's what happens your life is more work than play -the play is way overdone.

Our party was nothing fancy, nor was it free. It was at a local bar that many of us go to frequently. For $30 we had 4 hours of open bar from 8-12. I was determined to get there early this year because last year I missed most of the party while waiting for N to dilly dally getting ready. Too bad my plan wasn't quite in line with the hospital gods. I had to work Friday day but I figured I'd be out by 7:50ish. Or not!?!?. Brief recap of what happened between 4:30 p.m. and 8:45 p.m. when I finally left work.

-Four patients came back from the OR
-One patient got discharged
-Two patients arrived from outside hospitals as transfers that were so not necessary
-A patient needed to be transferred to the pediatric floor but had no family at the bedside to travel with them
-A patient was extremely hypotensive and had a critically low Hemoglobin and Hematocrit (5.5, 15.5!!!). Said patient needed to be transferred from a stepdown room into an ICU room and get two units of blood rapidly transfused. But first needed to have a type and screen sent because the initial one expired. The type and screen was sent but one line of the sheet wasn't signed so the lab rejected and threw out the sample and another one had to be sent (have you ever tried to get blood from an exceptionally hypovolumic person?) I'm still in shock that I go an IV into their arm. Additionally the cardiac monitor was not working in the patients room so they had to be on a portable monitor.
And the most exciting, although rather traumatic...
-A patient blew their anatomises and ruptured their carotid artery. You know those scenes on TV where blood is squirting out everywhere? Real life is way more intense! After that patient got rushed to the OR, and I settled the patient with the low H&H into the room, and I transferred the patient to the pediatric floor, and I did the admission history and assessment on one of my new admissions, and gave report to the night staff on my other patients, I rushed home, took a 49 second shower, put on my new party dress, straightened my hair, and hopped in a cab to my party. I arrived at 9:20 p.m. Now that people is a speedy party prep!

I was barely in the door and someone put a drink in my hand, followed by another and another and another. I'm a two drink drunk on a good day, so four drinks on an empty stomach meant the super chatty, quick witted,flirty, confident Kelly was out in full force. I don't know where the night went. Before I knew it, the party was coming to a close and it was close to 2am. As I left, I think I hugged and kissed on the cheek every firefighter that was there, plus all my coworkers-even the ones who I only sorta like, haha. Two, very nice, older, as in could be my father old, firefighters walked me out and got me a cab home. My party dress was barely off (that sounds so dirty) and I passed out. I didn't wake up until 10:30 Saturday morning and, to be quite honest, I wished I had just kept sleeping. My head was pounding, my throat was killing me, and my eyes were crusty with Friday night's makeup.

I managed to rally after a multivitamin and two cups of tea. And by rally I mean go to the gym for a jog, shower, and attempt to Christmas shop;however, he latter was a huge failure because with every store I walked into and saw a line, I turned on my heels and walked out. Which brings us to the present.. T-minus three days, fourteen hours, and two minutes until Christmas.

What do I have to do before then?
1. Buy gifts for: my cousin, one of our fellows, my roommate, my dad, my mom, my trainer, my grandfather, my cleaning lady, my water delivery man.

2. Mail the already stamped and addressed holiday cards (hey, the post office is 2 blocks away)

3. Bake Christmas cookies

4. Wrap the few gifts that I have purchased

5. Do laundry so I have clothes to bring home

6. Find a Christmas Eve mass AFTER I get out of work, but BEFORE midnight

7. Get in touch with the L's so I can finally give them their Christmas AND Birthday

8. Book a train ticket home for the day after Christmas

9. Work Tuesday, Wednesday, and Thursday

Wow, I've got a lot to do and not much time. On that note, I'm out. Wishing you all a happy, healthy holiday and new year!

Sunday, December 14, 2008


Holy Moly, I’ve been MIA and I have lots of catch you all up on. First, the entire month of November I was feeling really down. Some days it took all the energy I had just to get out of bed. I wasn’t excited about anything, nor did I want to do anything. I even hated going to the gym or running (yes, you read that correctly). I was rather concerned. I knew it wasn’t normal to feel that way; however, I didn’t care much about anything.

When my family saw me at Thanksgiving, they thought I looked bad. My schedule wasn’t helping my case. I was working 5 nights a week, 12+ hours a night, and not sleeping more than 3 or 4 hours in between shifts. I don’t care what you say, sleeping during the day does not even compare to sleeping at night. Plus, all this exhaustion was wreaking havoc on my body.

I’m very conscientious about what I eat, how my clothes fit, my weight etc. So when my pants started getting tighter ,and I knew I hadn’t changed my eating habits or how much I exercised, my stress only increased. I finally reached my breaking point when N called, asking me to dinner, and I broke down and cried. I told her that I’m just miserable. I hate working nights. It’s lonely. It’s isolating. I can go an entire week without seeing my roommate. I don’t do that much for myself and the few things that I do (i.e. working out, running, cooking) I no longer enjoy. After an hour of her listening to me sob and sob and sob, she convinced me to go out for sushi in the Village. It was freezing cold outside, but I needed the fresh air. After another restless night’s sleep (that’s the other problem, now that I’m used to staying up at night, I can’t sleep on my days off) I called my doctor. Not being one who EVER takes medication, I now have lovely prescription for some @mbien. Magic.Little.Pill.

Even better than the fake sleep that I’ve been getting is the fact that I’m doing a month long rotation on days. It’s heaven. They’ve also been giving me a lot more responsibility at work. In addition to acting as charge nurse, I’m also precepting some of our new nurses. It’s extremely flattering to be given so much responsibility after only working in the BICU for 16 months.

My transition from nights to days was a little hairy. I worked Thursday and Friday nights, had Saturday off, then worked Sunday, Monday, Tuesday days. Despite the fact that I hadn’t worked a day shift in a year, I was in charge on Sunday, Monday, and Tuesday. Let the games begin!

I won’t bore you with the details but we were slammed with boarder patients from the PACU, two of which were extremely unstable and ended up getting emergently intubated and rushed back to the OR. One patient died. One patient coded six times over 48 hours. The repeat coder also ended up swanned (twice, after the first one was defective), had a transvenous pacer placed by cardiology, then had a GI bleed, then stopped oxygenating his body as indicated by his PO2 of 45 from his ABG.

On top of all this activity, we had another patient who came in intubated with an unknown medical history; she was found down in a house fire after smoking and drinking in bed. Turns out this lady had quite a history with IV drug use and alcohol abuse, so she was damn near impossible to sedate due to her high tolerance of narcotics. Her magic cocktail turned out to be 150mcg of Fentanyl and 50mcg of Propofol.

The above situations kept all of us doctors and nurses very busy, but I had a very emotional experience on Monday. I can’t remember if I ever posted about this patient, but back in July I admitted a five year-old boy started a house fire and ended up with 65% total body surface area full thickness burns. He was intaubted and sedated, teetering the line between life and death.

The night I admitted him, I thought-on more than one occasion- that we were going to loose him. His mother was the first parent I had to address regarding life and death. I took off all my surgical garb, took her by the hand, and walked her into her son’s hospital room. I explained, in lay man’s terms, the physiology of burns. My knees knocked, but my voice never faltered, as I told her that the first 72 hours were the most critical. I caught her in my arms as she broke down; she wept on my shoulder like baby.

I took care of this boy four nights in a row and countless times over the next few months. His hospital stay was complicated by infections, sloughed graphs, respiratory and neurological issues, but every time I took care of him I felt a sense of pride and hope. I was there the afternoon they extuabted him; I watched him take his first non- ventilator assisted breath; I teared up.

This little guy became a fixture on our unit. Everyone knew him, and he knew everyone. Two weeks ago he celebrated his 6th birthday, it was a 24-hour, non-stop party. Everyone from the attending physicians to the house keeping staff joined in the celebration. I knew he was getting better, but the idea of him leaving never crossed my mind. So when I found out that he would be discharged to rehab on Monday, my stomach knotted.

Monday morning I went into his room and had a long talk with him. I told him that although I was very sad to see him go, it was a very special day for us both. For him it marked astounding progress, for me it was a happy ending to a six month journey. I can’t begin to express how meaningful it was for me to discharge the very patient who I thought I would loose.

As I reviewed the mounds of paperwork with his mother, she looked up at me and started to cry. Much like the first night I met her, I caught her in my arms and she wept on my shoulder. However, this time her tears were that of joy not fear. She looked at me, as I wiped away her tears, and mouthed “thank you.” And it was that moment that reminded me why I do what I do. It makes the long hours, the back-breaking work, the stress, and the frustration all worth it. I must have some angels up in heaven, because this reminder couldn’t have come at a better time. Once again, I feel at peace, ready to take on whatever comes my way.

Friday, December 05, 2008

Week 58: Four Foods on Friday

I'm back this week. Check out everyone else's meme entry here.

#1. Does your family usually eat meals in the kitchen or somewhere else?
Well, we eat in the living room around the coffee table. Hey, it's city apartment living!

#2. Who usually does the dishes in your house?
Me, I'm OCD about dirty dishes in the sink.

#3. What’s your favorite small appliance or tool in the kitchen?
Blender. With limied space, I use it to chop, puree, mix, and of course blend

#4. This one’s for my son. Share a recipe for chili.
Can't take credit for this one, it's from 28cooks

Tempeh Chili

1 (8 oz) pkg tempeh

2 tbsp soy sauce
2 tbsp water
1 tbsp Lousiana-style hot sauce
1/4 tsp garlic powder
1/4 tsp onion powder
1 tbsp sesame oil

4 tbsp oil
4 cloves garlic
1 cup onion, chopped
1 tsp Italian seasoning
1 tsp mustard powder
1 tsp cumin
1 tbsp chili powder
1 tsp salt
1/4 tsp freshly cracked pepper
2 (14.5 oz) cans diced tomatoes with green chilies
1 (15 oz) can black beans
1/2 c water

In large ziploc bag, combine all marinade ingredients. Add tempeh, seal bag, and refrigerate for 1-8 hours (or longer). Grate tempeh with large grater and place into medium bowl with remaining marinade. Heat olive oil over medium-high in large pot. Add garlic and onion, and saute until almost tender, about 5 minutes. Add Italian seasoning, mustard, cumin, chili powder, salt, and pepper, and stir for 30 seconds. Add tomatoes, beans, tempeh, and water. Stir well, bring to a boil, then lower heat. Simmer, uncovered, stirring frequently, for 30-45 minutes, until chili is thickened. Serve and enjoy!