No big surprise, our ICU census was full last night- all 20 beds occupied. Our step-down unit was only 3/4 full- 15 beds occupied. So when we got the EMS phone call at 3 am that we were getting three smoke inhalations, guess what?!?!, our three "stable" ICU patients (non vented/demented/etc) needed to head to the step-down unit.
Our prospcects were grim..
- two vneted patients over the age of 90
-two patients on CCVHD, also vented-duh!
-one fresh 30% degloving injury with history of dementia
-one 60% deglving injury, vented, in DIC
-new purpura syndrome admission with GI bleed
-fresh post op of STSG to bilateral legs on heparin gtt for a PE
-fresh extubation with signs of anoxic brain injury from initial carboxy hemoglobin > 50
-quadriplegic wound management patient with a 12% ejection fraction (systolic heart failure, ya think?!?!?)
-etc, etc,
And just who were the lucky three???
1. Thitry something year old man who refused to leave his room stating that it was Passover and that he had hired a cleaning service to come in and purify the room and it's air. Nope, under no circumstance would he leave his room to be sent to a "dirty and unholy hell hole" -direct quote.
2. Middle aged man with severe MR that likes to streak in the hallways and jump up and down naked when moaning and screaming when we do his burn care. Oh yeah, you can forget going near him with a needle for labs, let alone for IV placement...too bad he is going to the OR today for surgery.
3. Older woman with extensive history of ETOH, only 6 hours past the threshold for severe DT's. Did I mention she's obese and refuses to wear bipap so she essentially goes apnec every two minutes.
So glad that shift is over! Never a dull moment.
Wednesday, April 08, 2009
Tuesday, March 31, 2009
update
Update on this post....
The dumb shit resident that I saw never called back with my lab results. I got annoyed after trying to call her back for a week and just looked them up myself. Maybe I wasn't supposed to do that? eh, oh well.
Called 11 times to get an appointment with an attending: hold, transfer, hold, hold, ANSWER, nope transfer, click.......fuck!
Called on the 12th time this past Friday from work in the same hospital where the practice is located:
One ring....
Secretary: Hello? what department are you calling from? What can I do for you?
Me: Hi this is Nurse Miss Kelly from the burn unit, I'm a former patient of Dr. W's, I need to make an appointment with Dr. C?
Secretary: Oh do you work here in the hospital?
Me: Umm, yes?
Secretary: Marvelous. How's this Tuesday at 10:30am?
Me: Seriously? That's great.
Secretary: Would you like us to call you if we can an earlier cancellation?
Me: I'd love that! (thinking am I dreaming?)
Secretary: Okay, I can reach you at this number?
Me: Actually my cell is better xxx-xxx-xxxx. thanks.
Secretary: Oh, okay. Well then I'll note that. Bye bye.
lesson learned: make an internal phone call, work the system!
The dumb shit resident that I saw never called back with my lab results. I got annoyed after trying to call her back for a week and just looked them up myself. Maybe I wasn't supposed to do that? eh, oh well.
Called 11 times to get an appointment with an attending: hold, transfer, hold, hold, ANSWER, nope transfer, click.......fuck!
Called on the 12th time this past Friday from work in the same hospital where the practice is located:
One ring....
Secretary: Hello? what department are you calling from? What can I do for you?
Me: Hi this is Nurse Miss Kelly from the burn unit, I'm a former patient of Dr. W's, I need to make an appointment with Dr. C?
Secretary: Oh do you work here in the hospital?
Me: Umm, yes?
Secretary: Marvelous. How's this Tuesday at 10:30am?
Me: Seriously? That's great.
Secretary: Would you like us to call you if we can an earlier cancellation?
Me: I'd love that! (thinking am I dreaming?)
Secretary: Okay, I can reach you at this number?
Me: Actually my cell is better xxx-xxx-xxxx. thanks.
Secretary: Oh, okay. Well then I'll note that. Bye bye.
lesson learned: make an internal phone call, work the system!
Monday, March 30, 2009
FFoF #72
#1. Suggest a question for FFOF. Something fun is in store for the one whose question is chosen.
What is your favorite memory associated with the smell of a certain food? As in, you smell it, close your eyes and are instantly drawn back to a magical moment in time....
#2. Share instructions on how to make your favorite smoothee or shake.
Breakfast in a Glass~my banana mango smoothie
2 frozen, ripe bananas (freeze WITHOUT the peel!!)
1 mango, peeled and sliced
1 cup orange juice (any kind will do- I prefer tropicana light plus calcium or fresh squuezed)
1 cup fat free vanilla yogurt
*1 tsp of vaniila extract and a dash of cinamon can be added to enhance the flavors*
Cut banana into chunks. In a blender, combine all ingredients and blend until smooth.
If the smoothie is too thick, thin with a little more orange juice. Pour into 4 glasses.
#3. What’s in your favorite panini?
Eggplant, portabella, zucchini, roasted red pepper, and goat cheese
image
#4. Share a recipe for potato salad.
For all those of us who aren't big on mayo!
Roasted New Potato Salad
Ingredients
2 pounds new potatoes, cut into chunks
6 tablespoons plus 1 teaspoon extra virgin olive oil
Salt and pepper to taste
1/4 pound green beans, stemmed and sliced
2 tablespoons red wine vinegar
1/2 cup basil
1 garlic clove, finely chopped
2 medium tomatoes, chopped
1 cup salad greens
12 pitted Kalamata olives
Method
Preheat oven to 400°F. Toss potatoes with 1 teaspoon of the oil, salt and pepper and transfer to a roasting pan. Cover and roast until tender, 35 to 40 minutes. Set aside to let cool.
Meanwhile, bring a large pot of water to a boil. Add green beans and cook until just tender, 3 to 4 minutes. Rinse in cold water and set aside.
Put vinegar, remaining 6 tablespoons oil, basil, salt, and garlic into a blender and purée until smooth to make a vinaigrette. Toss potatoes, beans, tomatoes with vinaigrette together in a large bowl, then spoon mixture onto a plate arranged with salad greens. Garnish with olives and serve.
What is your favorite memory associated with the smell of a certain food? As in, you smell it, close your eyes and are instantly drawn back to a magical moment in time....
#2. Share instructions on how to make your favorite smoothee or shake.
Breakfast in a Glass~my banana mango smoothie
2 frozen, ripe bananas (freeze WITHOUT the peel!!)
1 mango, peeled and sliced
1 cup orange juice (any kind will do- I prefer tropicana light plus calcium or fresh squuezed)
1 cup fat free vanilla yogurt
*1 tsp of vaniila extract and a dash of cinamon can be added to enhance the flavors*
Cut banana into chunks. In a blender, combine all ingredients and blend until smooth.
If the smoothie is too thick, thin with a little more orange juice. Pour into 4 glasses.
#3. What’s in your favorite panini?
Eggplant, portabella, zucchini, roasted red pepper, and goat cheese
image
#4. Share a recipe for potato salad.
For all those of us who aren't big on mayo!
Roasted New Potato Salad
Ingredients
2 pounds new potatoes, cut into chunks
6 tablespoons plus 1 teaspoon extra virgin olive oil
Salt and pepper to taste
1/4 pound green beans, stemmed and sliced
2 tablespoons red wine vinegar
1/2 cup basil
1 garlic clove, finely chopped
2 medium tomatoes, chopped
1 cup salad greens
12 pitted Kalamata olives
Method
Preheat oven to 400°F. Toss potatoes with 1 teaspoon of the oil, salt and pepper and transfer to a roasting pan. Cover and roast until tender, 35 to 40 minutes. Set aside to let cool.
Meanwhile, bring a large pot of water to a boil. Add green beans and cook until just tender, 3 to 4 minutes. Rinse in cold water and set aside.
Put vinegar, remaining 6 tablespoons oil, basil, salt, and garlic into a blender and purée until smooth to make a vinaigrette. Toss potatoes, beans, tomatoes with vinaigrette together in a large bowl, then spoon mixture onto a plate arranged with salad greens. Garnish with olives and serve.
Monday, March 23, 2009
tah dah!
I must make this quick, I'm on my way to work (night 4 of 5), but I just got the final word.....
Grad School Acceptance:
YALE: yes
HARVARD: yes
COLUMBIA: yes
EMORY: yes
Now onto the million dollar question: Where do I want to go?
Grad School Acceptance:
YALE: yes
HARVARD: yes
COLUMBIA: yes
EMORY: yes
Now onto the million dollar question: Where do I want to go?
Thursday, March 12, 2009
Four Foods 69
#1. Olive oil. What kind do you prefer to use?
Extra Virgin. I don't use much oil., so I splurge and buy the expensive aged stuff. You use less, when it's more flavorful!
#2. Meatballs. Do you make them from scratch, buy premade cooked or buy premade frozen?
I make meatballs from scratch for others and use frozen "meat-less ball" for myself
#3. Do you use napkins at home? Paper or cloth?
I use papertowels. I know, please don't send the green police after me.
#4. Share a recipe for a white sauce.
Heat 3 TB milk in a saucepan, add 8 oz of cream cheese. Stir, stir, stir, add seasonings to taste, stir, stir, stir. As soon as smooth, turn heat down to lowest setting.
*add in seasoned and cooked chicken or fish
* toss with pasta
Go here to join in on this meme.
Extra Virgin. I don't use much oil., so I splurge and buy the expensive aged stuff. You use less, when it's more flavorful!
#2. Meatballs. Do you make them from scratch, buy premade cooked or buy premade frozen?
I make meatballs from scratch for others and use frozen "meat-less ball" for myself
#3. Do you use napkins at home? Paper or cloth?
I use papertowels. I know, please don't send the green police after me.
#4. Share a recipe for a white sauce.
Heat 3 TB milk in a saucepan, add 8 oz of cream cheese. Stir, stir, stir, add seasonings to taste, stir, stir, stir. As soon as smooth, turn heat down to lowest setting.
*add in seasoned and cooked chicken or fish
* toss with pasta
Go here to join in on this meme.
Wednesday, March 11, 2009
A Little Appetizer
Looking through my refrigerator and cabinets with only thirty minutes until my friends arrived, here's what I came up with!
Goat Cheese Stuffed Dates with Rosemary Balsamic Reduction
50 Large Dried Organic Pitted Dates
4 oz Goat Cheese, room temperature
2 teaspoons freshly ground black pepper
1 tablespoon olive oil
2 tablespoons minced shallots
1 teaspoon minced garlic
1 cup balsamic vinegar
1 large or 2 small rosemary sprigs
Reduction
Set a 1-quart saucepan over medium heat and add the remaining 1 1/2 teaspoons of olive oil. Once the oil is hot, add the shallots to the pan and sweat until translucent, about 1 minute. Add the garlic to the pan and sweat for 30 seconds. Pour the balsamic vinegar into the pan and bring to a boil. Add the rosemary and allow the balsamic to gently boil and reduce until only about 1/4 cup of balsamic remains, about 10 minutes. Season with 1 teaspoon of salt and 1/2 teaspoon of black pepper. Remove from the heat. Remove the rosemary sprigs before using.
Assembly
-Place dates on large platter or cookie sheet.
-Fill a medium size tipped pastry bag with soft goat cheese.
-Place tip of bag into each date and fill until goat cheese starts to peek through the other end of the date.
-Once all dates are filled, lightly drizzle balsamic reduction over the top.
*tip: use a large spoon to easily drizzle the reduction.
Goat Cheese Stuffed Dates with Rosemary Balsamic Reduction
50 Large Dried Organic Pitted Dates
4 oz Goat Cheese, room temperature
2 teaspoons freshly ground black pepper
1 tablespoon olive oil
2 tablespoons minced shallots
1 teaspoon minced garlic
1 cup balsamic vinegar
1 large or 2 small rosemary sprigs
Reduction
Set a 1-quart saucepan over medium heat and add the remaining 1 1/2 teaspoons of olive oil. Once the oil is hot, add the shallots to the pan and sweat until translucent, about 1 minute. Add the garlic to the pan and sweat for 30 seconds. Pour the balsamic vinegar into the pan and bring to a boil. Add the rosemary and allow the balsamic to gently boil and reduce until only about 1/4 cup of balsamic remains, about 10 minutes. Season with 1 teaspoon of salt and 1/2 teaspoon of black pepper. Remove from the heat. Remove the rosemary sprigs before using.
Assembly
-Place dates on large platter or cookie sheet.
-Fill a medium size tipped pastry bag with soft goat cheese.
-Place tip of bag into each date and fill until goat cheese starts to peek through the other end of the date.
-Once all dates are filled, lightly drizzle balsamic reduction over the top.
*tip: use a large spoon to easily drizzle the reduction.
Thursday, March 05, 2009
I Dream Of....
School?
I had the strangest dream last night. I found myself running across the junior high school parking lot frantic that I'd be late for the first day of my senior year,, only to reach the sidewalk as the homeroom bell rang. I walked into the school, up to the office window and said, "I'm sorry I'm late, I was picking up my parents at the airport. Can they send in a note later?" I think the office clerk mumbled something about needing it now. Next thing I know I'm wandering the hall of the junior high looking for room 3005. When I finally find it, its filled with kids from my graduating class, and they are starring at me. Matt came up to me and said, "Yeah, you freaked us out in high school and that's why we wanted to ruin your prom." Before I could open my mouth, our elementary school librarian was handing out locks and schedules telling us that our lockers would be located here in the Junior high, but that all of our classes would be at the actual high school. Right because that makes so much sense..... Before I could retort such an insane proposal, I found myself amidst w whirlwind of people in a multilevel maze trying to navigate my way to my classes. I walked into the library and cut through to the gym only to find that I had no gym clothes. Then I was sitting in math class realizing that I hadn't been to a math class in over a semester and I freaked out. I asked to be transferred to another class, but my teacher only spanked my hand with a ruler and said get out and go back to community college. Then I was sitting in the principals office and he told me that he was disappointed in my choice to be fifth in my graduating class, he said I'd never go anywhere in life...
And then I woke up.
I think the anxiety of waiting for schools is killing me.
I had the strangest dream last night. I found myself running across the junior high school parking lot frantic that I'd be late for the first day of my senior year,, only to reach the sidewalk as the homeroom bell rang. I walked into the school, up to the office window and said, "I'm sorry I'm late, I was picking up my parents at the airport. Can they send in a note later?" I think the office clerk mumbled something about needing it now. Next thing I know I'm wandering the hall of the junior high looking for room 3005. When I finally find it, its filled with kids from my graduating class, and they are starring at me. Matt came up to me and said, "Yeah, you freaked us out in high school and that's why we wanted to ruin your prom." Before I could open my mouth, our elementary school librarian was handing out locks and schedules telling us that our lockers would be located here in the Junior high, but that all of our classes would be at the actual high school. Right because that makes so much sense..... Before I could retort such an insane proposal, I found myself amidst w whirlwind of people in a multilevel maze trying to navigate my way to my classes. I walked into the library and cut through to the gym only to find that I had no gym clothes. Then I was sitting in math class realizing that I hadn't been to a math class in over a semester and I freaked out. I asked to be transferred to another class, but my teacher only spanked my hand with a ruler and said get out and go back to community college. Then I was sitting in the principals office and he told me that he was disappointed in my choice to be fifth in my graduating class, he said I'd never go anywhere in life...
And then I woke up.
I think the anxiety of waiting for schools is killing me.
Monday, February 23, 2009
Dear Nurse Miss Kelly
If you aren't in the mood to read a rant, than I suggest you file this post under "to be read at a later date."
I work in healthcare. I'm going to graduate school for public health. I understand the healthcare crisis. I have money taken out of my paycheck every cycle to pay for my health insurance. I don't have complex medical issues. SO WHY CAN'T I GET A DOCTORS APPOINTMENT?!?!?!?!
Last year I found a GREAT internist/gynecologist. I also found a great dermatologist. After much angst I did find a dentist, but after my visit, I decided that I wouldn't be going back there ever again. In December, amongst holiday cards and holiday bills, I get a letter from the dermatologist:
Dear Nurse Miss Kelly,
It is with deep regret that we tell you that as of Jan. 1, 2009 Dr. N will no longer be with the practice. She has decided to relocate to Florida. Please call xxx-xxx-xxxx to book an appointment with the doctor who will be taking over her patient load.
Noted. Due for my annual checkup at the end of January, I called to book an appointment "with the doctor who will be taking over her patient load." What does the secretary tell me? Our conversation went something like this:
"Hi. This is Nurse Miss Kelly. I'm a patient of Dr. N's. I'm aware that she has left the practice, so I was hoping to book an appointment with whoever took over her patient load."
"Oh, well you see, you are going to have to wait. It's a four month wait to be seen as a new patient."
"But I'm not a new patient, I've been to the office before! I have records there. I just need to change doctors."
"Yes. But you are new to the replacement doctor and she will need to do a workup. What do you need an appointment for?"
"Just my annual skin check. I'm sorry, I'm confused. All patients of a doctor who left must now wait to be seen as new patients?"
"Correct. You can be seen in four months. How does April 29th sound?"
I concluded our call with, "Let me check my schedule and I'll call you back."
I was pissed. Not only did that not make any sense, but also this lady was clearly very misinformed. What did I do? First I looked to see the names of the other physicians in the practice to book an appointment with them. Then I called back, spoke with a muffled voice, what if the same wacko picked up, and booked an appointment with another doctor. Yes the wait was two months, but that was much more reasonable.
Crisis averted.
Not even two days later, I get another letter in the mail.
Dear Nurse Miss Kelly:
As of January 1, 2009, Dr. JW will be leaving WCIMA and joining a private practice. She will continue to admit her patients to xx hospital. Dr. PC will join WCIMA in February 2009 and will be responsible for your care. It is expected that she will participate in the same insurance plans that Dr. JW has participated in. Please contact us at xxx-xxx-xxxx to arrange to see our new physician.
If you wish to continue your care with Dr. JW here information is listed below..
Great, I'll call and book an appointment with her new practice. I mean, I never thought that she wouldn't take my insurance, after al it's expensive to be in private practice, so the more patients the merrier, right? WRONG.
Since I fractured my pelvis last summer, my lifestyle has been chaotic, at best. I broke up with a boyfriend, was studying for the GRE's, worked ALL the holidays, had a fight with my best friend, applied to grad school, etc. Through it all, I continue to work nights, sleeping less than four hours a night. My energy levels have bottomed out. It takes all my will power to get out of bed. I have no stamina and my workouts, once my sanity saver and favorite pastime, are awful and I hate the thought of the gym. My runs have dwindled down to nothing. I haven't run in over three weeks.
I've continued to eat my vegetarian, almost vegan diet and be very conscious of what and how much food I put in my body. So I was concerned that I started gaining weight and more and some more. I don't weigh myself, I go by how my clothes fit, but I'd estimate that I've gained 15 pounds since I graduated from college. And that freaks me the hell out!
Recently, I've began having some other symptoms:
-dry scalp and skin
-swelling of the hands and face
-gas and bloating
-thinning hair
-increased exhaustion
When I woke up the other morning and my hands were so swollen I couldn't get my rings off, and I also didn’t fit into any of my pants, I knew I had to go to the doctor. Something isn't right.
I pulled the letter out of my files and dialed the number of my old doctors new private practice. After explaining that I had been a former patient of Dr. JW's, I asked the secretary if she was taking my insurance plan.
"Um, No. I'm sorry. She's not accepting any managed care. But she will gladly see you for a physical. Would you like to come in today?"
"Hmm, well. How much is a physical? I would like to continue my care with her if possible."
"A physical would be $1000. And lab work is about $400."
I cough and scoop my jaw off the floor
"I think I'll pass. Thanks though."
No way in hell was I going to pay $1400 out-of-pocket when I have insurance! Guess I'll call the old office. After being hung up on twice, transferred twice, and then on hold for 15 minutes I finally managed to speak with someone. I told her that I needed to make an appointment with Dr. PC. And then, like something out of a sitcom, she tells me, "Well. Right now we don't have a doctor covering. Dr. PC's joining the practice has been delayed, twice. In the meantime you can be seen by a resident until we get an attending on staff."
A resident? A resident?!?! No way, lady. I get that this is a teaching hospital, and I'm all about higher learning, but this is serious. It's my health we are talking about and I want an attending!
Frustrated beyond belief, I agreed to see a resident at 2:30 that day; nevertheless, I did insist on the name of the resident's attending to have for reference.
Two hours and four vials of blood later, I walked out.
Hopefully they can figure out what's wrong with me.
Hopefully I can figure out what's wrong with our healthcare system.
I work in healthcare. I'm going to graduate school for public health. I understand the healthcare crisis. I have money taken out of my paycheck every cycle to pay for my health insurance. I don't have complex medical issues. SO WHY CAN'T I GET A DOCTORS APPOINTMENT?!?!?!?!
Last year I found a GREAT internist/gynecologist. I also found a great dermatologist. After much angst I did find a dentist, but after my visit, I decided that I wouldn't be going back there ever again. In December, amongst holiday cards and holiday bills, I get a letter from the dermatologist:
Dear Nurse Miss Kelly,
It is with deep regret that we tell you that as of Jan. 1, 2009 Dr. N will no longer be with the practice. She has decided to relocate to Florida. Please call xxx-xxx-xxxx to book an appointment with the doctor who will be taking over her patient load.
Noted. Due for my annual checkup at the end of January, I called to book an appointment "with the doctor who will be taking over her patient load." What does the secretary tell me? Our conversation went something like this:
"Hi. This is Nurse Miss Kelly. I'm a patient of Dr. N's. I'm aware that she has left the practice, so I was hoping to book an appointment with whoever took over her patient load."
"Oh, well you see, you are going to have to wait. It's a four month wait to be seen as a new patient."
"But I'm not a new patient, I've been to the office before! I have records there. I just need to change doctors."
"Yes. But you are new to the replacement doctor and she will need to do a workup. What do you need an appointment for?"
"Just my annual skin check. I'm sorry, I'm confused. All patients of a doctor who left must now wait to be seen as new patients?"
"Correct. You can be seen in four months. How does April 29th sound?"
I concluded our call with, "Let me check my schedule and I'll call you back."
I was pissed. Not only did that not make any sense, but also this lady was clearly very misinformed. What did I do? First I looked to see the names of the other physicians in the practice to book an appointment with them. Then I called back, spoke with a muffled voice, what if the same wacko picked up, and booked an appointment with another doctor. Yes the wait was two months, but that was much more reasonable.
Crisis averted.
Not even two days later, I get another letter in the mail.
Dear Nurse Miss Kelly:
As of January 1, 2009, Dr. JW will be leaving WCIMA and joining a private practice. She will continue to admit her patients to xx hospital. Dr. PC will join WCIMA in February 2009 and will be responsible for your care. It is expected that she will participate in the same insurance plans that Dr. JW has participated in. Please contact us at xxx-xxx-xxxx to arrange to see our new physician.
If you wish to continue your care with Dr. JW here information is listed below..
Great, I'll call and book an appointment with her new practice. I mean, I never thought that she wouldn't take my insurance, after al it's expensive to be in private practice, so the more patients the merrier, right? WRONG.
Since I fractured my pelvis last summer, my lifestyle has been chaotic, at best. I broke up with a boyfriend, was studying for the GRE's, worked ALL the holidays, had a fight with my best friend, applied to grad school, etc. Through it all, I continue to work nights, sleeping less than four hours a night. My energy levels have bottomed out. It takes all my will power to get out of bed. I have no stamina and my workouts, once my sanity saver and favorite pastime, are awful and I hate the thought of the gym. My runs have dwindled down to nothing. I haven't run in over three weeks.
I've continued to eat my vegetarian, almost vegan diet and be very conscious of what and how much food I put in my body. So I was concerned that I started gaining weight and more and some more. I don't weigh myself, I go by how my clothes fit, but I'd estimate that I've gained 15 pounds since I graduated from college. And that freaks me the hell out!
Recently, I've began having some other symptoms:
-dry scalp and skin
-swelling of the hands and face
-gas and bloating
-thinning hair
-increased exhaustion
When I woke up the other morning and my hands were so swollen I couldn't get my rings off, and I also didn’t fit into any of my pants, I knew I had to go to the doctor. Something isn't right.
I pulled the letter out of my files and dialed the number of my old doctors new private practice. After explaining that I had been a former patient of Dr. JW's, I asked the secretary if she was taking my insurance plan.
"Um, No. I'm sorry. She's not accepting any managed care. But she will gladly see you for a physical. Would you like to come in today?"
"Hmm, well. How much is a physical? I would like to continue my care with her if possible."
"A physical would be $1000. And lab work is about $400."
I cough and scoop my jaw off the floor
"I think I'll pass. Thanks though."
No way in hell was I going to pay $1400 out-of-pocket when I have insurance! Guess I'll call the old office. After being hung up on twice, transferred twice, and then on hold for 15 minutes I finally managed to speak with someone. I told her that I needed to make an appointment with Dr. PC. And then, like something out of a sitcom, she tells me, "Well. Right now we don't have a doctor covering. Dr. PC's joining the practice has been delayed, twice. In the meantime you can be seen by a resident until we get an attending on staff."
A resident? A resident?!?! No way, lady. I get that this is a teaching hospital, and I'm all about higher learning, but this is serious. It's my health we are talking about and I want an attending!
Frustrated beyond belief, I agreed to see a resident at 2:30 that day; nevertheless, I did insist on the name of the resident's attending to have for reference.
Two hours and four vials of blood later, I walked out.
Hopefully they can figure out what's wrong with me.
Hopefully I can figure out what's wrong with our healthcare system.
Sunday, February 22, 2009
Four Foods- Salty!
Another week of late posting. Bad me! Check out everyone else's timely posts here.
#1. Potato chips. Flavored? Regular, ridged or stacked?
Baked, anyway they come.
#2. Cheese doodles. Yellow or white? Puffed or crunchy?
Pirate Booty, so white and puffy.
#3. Pretzels? Your favorite shape? Favorite flavor?
Honey Wheat Rods
#4. Share a recipe for salsa or dip.
Chipotle Chickpea Dip
1 large clove garlic, peeled
15 ounces (1 1/2 cups) chickpeas, drained and liquid reserved
2 tbsp. lime juice
1/2-1 tbsp. chopped canned chipotle peppers (adjust according to how spicy you like it)
1 tbsp. chopped red onion
1 tbsp. tomato paste
1/4 tsp. chili powder
1/4 tsp. cumin
salt to taste
more red onion for garnish
With the food processor running, drop in the garlic and process until chopped. Add the chickpeas and lime juice and begin processing. If it's too dry, add 1-2 tablespoons of cooking liquid from chickpeas or, if you're using canned, just use water. Add the remaining ingredients and process until smooth. Adjust salt to taste. Serve garnished with chopped red onions.
#1. Potato chips. Flavored? Regular, ridged or stacked?
Baked, anyway they come.
#2. Cheese doodles. Yellow or white? Puffed or crunchy?
Pirate Booty, so white and puffy.
#3. Pretzels? Your favorite shape? Favorite flavor?
Honey Wheat Rods
#4. Share a recipe for salsa or dip.
Chipotle Chickpea Dip
1 large clove garlic, peeled
15 ounces (1 1/2 cups) chickpeas, drained and liquid reserved
2 tbsp. lime juice
1/2-1 tbsp. chopped canned chipotle peppers (adjust according to how spicy you like it)
1 tbsp. chopped red onion
1 tbsp. tomato paste
1/4 tsp. chili powder
1/4 tsp. cumin
salt to taste
more red onion for garnish
With the food processor running, drop in the garlic and process until chopped. Add the chickpeas and lime juice and begin processing. If it's too dry, add 1-2 tablespoons of cooking liquid from chickpeas or, if you're using canned, just use water. Add the remaining ingredients and process until smooth. Adjust salt to taste. Serve garnished with chopped red onions.
Thursday, February 19, 2009
Oops
I must admit, I enjoyed a glorious four days/nights off. I did laundry, polished china, cleaned out my closet, filed for financial aid for grad school, caught up on t.v. (oh how I <3 DVR!), and slept. However, yesterday was a blah weather day. Gray skies, cold and windy, with bouts of sleetish (sleetesque?) precipitation and I had a headache. I took a power nap before leaving for work, but my head was still a pounding.
I'm not one to take much medicine, so my "medicine" cabinet is mostly hairproducts, toothpaste, and only two bottles of pills-Tylenol and Tylenol PM. After my powernap, I rushed into the bathroom to grab something to kick my headache before what was sure to be a busy night at work.
I popped open the bottle, grabbed two pills and swallowed them with my water. As I was putting the bottle back in the cabinet I froze... "Tylenol PM". Uh, oh.
Not really sure what to do (I've never been very good at making myself throw up), I sighed, walked out of my apartment, and walked into the first coffee shop I passed on my way to work
6:45 pm......triple shot of espresso
I'm going to tell you all something now, a valuable lesson if you will, espresso does not negate the effects of Tylenol PM.
8:30pm.....cup of coffee from the overpriced starbucks in the hospital lobby
9:30pm.....2 cups of green tea
10:30pm....bottle of diet pepsi (uck, I haven't drank soda in over 2 years!)
11:30pm....diet red bull (man, that stuff is gross)
12:30pm....at this point in the night, my bladder is ready to explode, my heart is racing, and my eyes are so heavy that I need life preservers to keep them open!
With each hour that passed at work, my eyes got heavier and heavier. Thank God my patient was sick and VERY busy becuse if I had one moment to sit down, I would have been out cold.
I'm not one to take much medicine, so my "medicine" cabinet is mostly hairproducts, toothpaste, and only two bottles of pills-Tylenol and Tylenol PM. After my powernap, I rushed into the bathroom to grab something to kick my headache before what was sure to be a busy night at work.
I popped open the bottle, grabbed two pills and swallowed them with my water. As I was putting the bottle back in the cabinet I froze... "Tylenol PM". Uh, oh.
Not really sure what to do (I've never been very good at making myself throw up), I sighed, walked out of my apartment, and walked into the first coffee shop I passed on my way to work
6:45 pm......triple shot of espresso
I'm going to tell you all something now, a valuable lesson if you will, espresso does not negate the effects of Tylenol PM.
8:30pm.....cup of coffee from the overpriced starbucks in the hospital lobby
9:30pm.....2 cups of green tea
10:30pm....bottle of diet pepsi (uck, I haven't drank soda in over 2 years!)
11:30pm....diet red bull (man, that stuff is gross)
12:30pm....at this point in the night, my bladder is ready to explode, my heart is racing, and my eyes are so heavy that I need life preservers to keep them open!
With each hour that passed at work, my eyes got heavier and heavier. Thank God my patient was sick and VERY busy becuse if I had one moment to sit down, I would have been out cold.
Friday, February 13, 2009
Waiting on His Steps
A moment.
A bad accident.
A very tragic injury.
A young life changed forever.
A broken family grasping for hope.
But what can we do for them?
Will faith conquer impending death?
Does modern medicine prevail?
Believe in God?
They do.
To trust.
They must believe.
We will try everything.
It is a long road.
One that many do not survive.
But they sit at bedside vigil.
And sing against the tune
Of the musical alarms.
She will live.
They pray.
We hope.
Our actions suffice
And instincts are wrong
But fear lingers ever present.
Each day brings a new change.
But no more can be done.
We join in their prayer.
Medicine is not God.
We know this.
Trust him.
-KS 2009
I'm not an overly religious person, but lately I've been rocked back into my faith. Life is precious.
A bad accident.
A very tragic injury.
A young life changed forever.
A broken family grasping for hope.
But what can we do for them?
Will faith conquer impending death?
Does modern medicine prevail?
Believe in God?
They do.
To trust.
They must believe.
We will try everything.
It is a long road.
One that many do not survive.
But they sit at bedside vigil.
And sing against the tune
Of the musical alarms.
She will live.
They pray.
We hope.
Our actions suffice
And instincts are wrong
But fear lingers ever present.
Each day brings a new change.
But no more can be done.
We join in their prayer.
Medicine is not God.
We know this.
Trust him.
-KS 2009
I'm not an overly religious person, but lately I've been rocked back into my faith. Life is precious.
Saturday, February 07, 2009
Four Foods on Friday 65
Here are this week’s four questions. Check out the FFoF meme for yourself.
Let’s talk about foods that sound funny.
#1. What’s the funniest sounding food or ingredient you know of?
Maybe I'm immature, but I still chuckle when people order the "Pu Pu Platter"
#2. How do you pronounce “cavatelli”?
(cah)-(va)-(tel)-(lee)
#3. How do you pronounce “gnocchi”?
(know) (key)
#4. Share a recipe that calls for mozzarella cheese.
Mozzarella Salad
Ingredients
4 ears sweet corn, in the husk
1/4 cup extra virgin olive oil
2 tablespoons sherry vinegar
1 teaspoon Dijon mustard
1 clove garlic, finely chopped
2 tablespoons finely chopped fresh chives
Sea salt, to taste
Freshly ground pepper, to taste
1/2 pound fresh mozzarella, cut into 1/4-inch cubes
2 ripe avocados, halved, peeled and cut into 1/4-inch cubes
1/2 pint grape tomatoes, halved
1/2 cup cooked black beans
10 large fresh basil leaves cut into thin strips
5 cups baby arugula, spinach or romaine lettuce for serving
Method
Preheat oven to 400°F. Soak corn in the sink or a bowl filled with cold water for 10 to 15 minutes.
Meanwhile, prepare vinaigrette by whisking together oil, vinegar, mustard, garlic, chives, salt and pepper. Set aside.
Once corn has soaked, place on a rimmed baking sheet lined with parchment paper. Roast for 25 minutes, until kernels are tender. Cool to room temperature, then discard husks and silks. Cut the kernels off the cobs and put them in a large bowl. Add mozzarella, avocados, tomatoes, black beans and basil.
Drizzle the dressing over the salad. Toss gently to combine. Season with salt and pepper and serve over a bed of greens.
Let’s talk about foods that sound funny.
#1. What’s the funniest sounding food or ingredient you know of?
Maybe I'm immature, but I still chuckle when people order the "Pu Pu Platter"
#2. How do you pronounce “cavatelli”?
(cah)-(va)-(tel)-(lee)
#3. How do you pronounce “gnocchi”?
(know) (key)
#4. Share a recipe that calls for mozzarella cheese.
Mozzarella Salad
Ingredients
4 ears sweet corn, in the husk
1/4 cup extra virgin olive oil
2 tablespoons sherry vinegar
1 teaspoon Dijon mustard
1 clove garlic, finely chopped
2 tablespoons finely chopped fresh chives
Sea salt, to taste
Freshly ground pepper, to taste
1/2 pound fresh mozzarella, cut into 1/4-inch cubes
2 ripe avocados, halved, peeled and cut into 1/4-inch cubes
1/2 pint grape tomatoes, halved
1/2 cup cooked black beans
10 large fresh basil leaves cut into thin strips
5 cups baby arugula, spinach or romaine lettuce for serving
Method
Preheat oven to 400°F. Soak corn in the sink or a bowl filled with cold water for 10 to 15 minutes.
Meanwhile, prepare vinaigrette by whisking together oil, vinegar, mustard, garlic, chives, salt and pepper. Set aside.
Once corn has soaked, place on a rimmed baking sheet lined with parchment paper. Roast for 25 minutes, until kernels are tender. Cool to room temperature, then discard husks and silks. Cut the kernels off the cobs and put them in a large bowl. Add mozzarella, avocados, tomatoes, black beans and basil.
Drizzle the dressing over the salad. Toss gently to combine. Season with salt and pepper and serve over a bed of greens.
Wednesday, February 04, 2009
I've worked the last six nights straight.
i had to stay 5 hours late on my last morning becuase a nurse didn't show.
two nights with sickest patient on the unit, four nights as charge nurse
bed census: full! (40 patients)
toal work hours = 82
total sleep hours =24
work to sleep ratio: > 3:1
my eyes are puffy
my ankles are swollen
i have no clean underwear
my refrigerator contents: ketchup, soy sauce, applesauce, soymilk, beer
number of unanswered emails: 35
number of times I've seen my roomate in the last week: 1
my neighbors upon seeing me in the elevator: "Ouh, rough night?"
what I want to do most? sleep
what am I going to do? sleep
why am I still typing this? who knows, goodnight!
ZzZZzzZZZzzzZZZZzzzzZZZZZzzzzzZZZZzzzzZZZzzzZZzzZz
i had to stay 5 hours late on my last morning becuase a nurse didn't show.
two nights with sickest patient on the unit, four nights as charge nurse
bed census: full! (40 patients)
toal work hours = 82
total sleep hours =24
work to sleep ratio: > 3:1
my eyes are puffy
my ankles are swollen
i have no clean underwear
my refrigerator contents: ketchup, soy sauce, applesauce, soymilk, beer
number of unanswered emails: 35
number of times I've seen my roomate in the last week: 1
my neighbors upon seeing me in the elevator: "Ouh, rough night?"
what I want to do most? sleep
what am I going to do? sleep
why am I still typing this? who knows, goodnight!
ZzZZzzZZZzzzZZZZzzzzZZZZZzzzzzZZZZzzzzZZZzzzZZzzZz
Friday, January 23, 2009
"I got no strings to hold me down"
Two weeks ago I got an email from Columbia…
Dear Kelly,
Happy New Year. I hope this email finds you well. The admissions committee is in the process of reviewing your application file and I was asked to see if you would be willing to take the biostatistics placement exam. It will help the committee in their decision-making process…
I nearly shat myself. My heart started racing. Biostatistics? Test? Now? Are you kidding me? It didn’t help that I read this email at 8 in the morning after a four night stretch at work. As tempted as I was to just shoot back and email saying, “NO!.” I knew that was essentially writing my own rejection letter. I did the next best thing and called the woman who sent me this email. Of course she wasn’t in the office, so I left a voicemail. Boy do I wish that she had the option to delete and re-record because I rambled and babbled and stumbled. I managed to leave her my number and the best times to reach me, but I hung up with a pit in my stomach.
Thankfully, I managed to fall asleep for a few hours that morning. I got up and went about my day (gym, grocery shopping, post office, shower, date with the firefighter). After a late night, I didn’t wake up until the 11 the next day. What’s waiting for me? A voicemail from the admissions woman. I had only missed her by twenty minutes; I quickly called her back. She picked right up. She sounded so happy and perky; I, on the other hand, sounded like a hoarse, stuffy nosed sick person. I apologized for my rambling message and she said, “ Well after reading your application it sounds like you have a very intense and exhausting job. No excuses necessary.” Phew! That made me feel better. I told her that I was glad we were able to speak in person. I had a few questions and felt that speaking was much more personal than email (bonus points?)
But onto the real issue at hand. What I wanted to know was if they wanted me to take the test because of a shortcoming on my transcript/performance, or if it was something they were asking all candidates to take? She quickly summarized why she had contacted me. She was a member of the admissions committee and they were in the middle of reviewing my application. They were very impressed with my undergraduate transcript (Ivy League, Magna Cum Laude), my letters of recommendation (two PhD’s well known researchers & the worlds best nurse- BSN, CCRN, MSW, NC, Reverend –I forget all of his other credentials), and my personal statement. However, what they were rather concerned about was my quantitative GRE score. My scores just didn’t match up with my other credentials. That being the case, they felt that they needed me to take a placement test to determine my quantitative (math) capabilities.
I took in a deep breath and said, “Sure. When would you like me to take the exam.” She said, “Great! Here’s the name of the woman you need to contact about the test. Best of luck, Kelly.”
I hung up and sat motionless in my bed. I hadn’t taken a statistics class since my sophomore year of college, but I did get an (A). When I contacted the exam woman in the afternoon, she said that the sooner the better. I looked at my calendar. This was a Wednesday, that Friday I was beginning a 5 night stretch. I told her that due to my work schedule the earliest I could take the exam was the following Thursday. And that was that. Thursday at 10am. I no sooner hung up from her and ran out to the store to buy a review book.
Over the next week I did nothing but work (and study), work-out (and study. I’m sure the other gym members were like who’s the nut on the treadmill reading a statistics book?), and “sleep”/have nightmares of linear regression models, T-scores, and Z-scores.
Before I knew it, Thursday had arrived. I got up early that morning and was at the gym by 5 (sans review book). After a good sweat and steamy shower I set out for 168th and Riverside Drive. Oh yeah, WAYYYY up there across town. Knowing that public transportation would take almost an hour, I opted for the cab (gasp!). What I didn’t account for was morning rush hour traffic. I left my apartment at 8:50. I caught a cab at 9:20. Absurd! My stomach was in knots, my heart racing. The cab driver asked me if I was okay- I guess my voice was shaking as I told him where I needed to go. He was sweet and dropped me off right at the door, wishing me good luck as pulled away. I made my way to the sixth floor, knocked on the door, and then- test time!
The woman’s chipper personality made me more at ease. She led me to a barren room, I said a quick Our Father and Hail Mary and began. Forty minutes later I emerged and handed in my exam. She asked me to sit outside as she graded it. I could hear her turning the pages, it seemed like an eternity. She emerged from her office, paused, then said, “Congratulations, Kelly! 20 out of 21.” My stomach flopped, my head buzzed, I felt all warm and tingly. It may have been just a test, but it was a sweet victory for me.
And now all I have to do is wait for their decision….
Four Foods on Friday 64
Here are this week’s four questions.
Let’s talk about things that might not be quite the usual fare.
#1. What’s the oddest thing you’ve ever made with bread?
A gingerbread house. We didn't have any graham cracker, nor molds to make gingerbread so I improvised. I toasted it, then sprayed it with shilack (did I spell that right?)
#2. What’s the oddest thing you’ve ever done with mac and cheese or pasta?
Dried Pasta Jewelry. Go here for instructions
#3. Is there a food you eat other then it is intended?
Sometimes I take boxed cake mix and add it to some canned pumpkin, stir and eat. It's (almost) guilt free. May I suggest you try it with Namaste brand spice variety
#4. What’s the weirdest food you’ve ever seen?
It's not weird, but my phobia is. You know those "eyes" on overripe potaotes- they freak me out.
(photo credit Food Boom)
Do you want to play? Check out Valmg's FFoF blog feature!
Let’s talk about things that might not be quite the usual fare.
#1. What’s the oddest thing you’ve ever made with bread?
A gingerbread house. We didn't have any graham cracker, nor molds to make gingerbread so I improvised. I toasted it, then sprayed it with shilack (did I spell that right?)
#2. What’s the oddest thing you’ve ever done with mac and cheese or pasta?
Dried Pasta Jewelry. Go here for instructions
#3. Is there a food you eat other then it is intended?
Sometimes I take boxed cake mix and add it to some canned pumpkin, stir and eat. It's (almost) guilt free. May I suggest you try it with Namaste brand spice variety
#4. What’s the weirdest food you’ve ever seen?
It's not weird, but my phobia is. You know those "eyes" on overripe potaotes- they freak me out.
(photo credit Food Boom)
Do you want to play? Check out Valmg's FFoF blog feature!
Friday, January 16, 2009
Four Foods on Friday 63
Here are this week’s four questions.
Let’s talk about Chinese food.
#1. Do you prefer to eat Chinese food in the restaurant or to have it delivered?
Delivered. Chinese restaunratns scare me. Cat foo yong.. any one?
#2. Do you prefer wonton or egg drop soup?
Neither, too much salt.
#3. What flavor fried rice is your favorite?
I'd say vegetable.
#4. Describe your favorite item on the Chinese food menu.
This is so lame, but my favorite is steamed veggies. Since I don't eat meat and the tofu isn't recognizable in most dishes, I stick to the green stuff (and the occasional carrot). =)
What about you? Go and check ou Valmg's FFoF blog feature.
Let’s talk about Chinese food.
#1. Do you prefer to eat Chinese food in the restaurant or to have it delivered?
Delivered. Chinese restaunratns scare me. Cat foo yong.. any one?
#2. Do you prefer wonton or egg drop soup?
Neither, too much salt.
#3. What flavor fried rice is your favorite?
I'd say vegetable.
#4. Describe your favorite item on the Chinese food menu.
This is so lame, but my favorite is steamed veggies. Since I don't eat meat and the tofu isn't recognizable in most dishes, I stick to the green stuff (and the occasional carrot). =)
What about you? Go and check ou Valmg's FFoF blog feature.
Tuesday, January 13, 2009
One Final Prayer
My last two shifts were non stop, but they are two shifts that I will never forgot.
X was accepted as in international transfer five weeks post burn. Although I've seen many patients with his % burn survive, the fact that at five weeks out none of his wounds were closed was not favorable. When X finally arrived in New York at the beginning of December, he was in renal failure, maxed on dopamine and norepinepherine for his blood pressure, thrombocytopenic, in respiratory failure and ventilator dependent, and in septic shock. Additionally a MRI of his brain revealed an acute cerebellar infarct. He had six surgeries for debridment and skin grafting but none of them took as his body was invaded with fungus and bacteria. I took care of him the better half of the last two weeks and grew to know his family well. They halted their lives abroad and moved here to keep vigil at his side. They waited and prayed and waited and prayed and waited and waited and waited and prayed.
In the last two weeks, X grew sicker and sicker. He had showed some signs of improvement early on (return of some kidney function with oliguric output, improved ABG's, improved coagulation, fewer bacteria invading his wounds) but he took a turn for the worst...
Pseudomonas in the sputum, blood, and urine.
Acetinobacter in the sputum.
Candida on the skin and in the blood.
Thrombocytopenia
ARDS
Pulmonary Edema
Acute Renal Failure
Collapsed Lung
Sepsis
Acidosis
20 kilos of fluid overload with edema making him unrecognizable
In those 25 hours of work I administered 8 units of blood, 8 units of FFP, 10 units of platelets but he remained thrombocytopenic.
The ventilator was on 100%FiO2 and he was still lethally acidotic.
He required continuous deep lavage suctioning that involved removing him from the ventilator and breaking PEEP causing his blood pressure to plummet.
He was so unstable we couldn't turn him to put him on dry sheets, yet he was putting out 11 liters a day in bed drainage (yes, we suction and measure this).
He was two days overdue for day #5 post-operative dressing (POD) change.
His eyes were dilated and minimally responsive.
He was maxed out on Dopamine, Levophed, Neosenepherine, and Epinephrine.
I arrived at work on Monday and was partially surprised to find X still alive. The three hours prior to my arrival his blood pressure was resting around 68/40, his heart rate tachycardic in the 110's, and his O2 sat around 73%. The attending physicians held a discussion with the family during the day and I thought they were leading in favor of DNR, but in a desperate twist of fate the father disagreed and said he wanted "every thing possible" to be done.
During the day, the family had kept vigil at the bedside, never more than three visitors at a time. In the middle of report from the day nurse, Xs alarms sounded, his O2 sat was 65%, he needed to suctioned. The day nurse (J) and I went in and prepared to suction. We no sooner finished when his heart rate began to plummet: 110-90-80-75-70-60-55......
J yelled to get some atropine began bagging the patient. I hopped up to begin compressions. In rolled the code cart and so began the code. His venous access lines ( a right internal jugular TLC, a left femoral TLC, and left femoral Aline) were a mass of "spaghetti" coming from the 13 pumps running on either side of his bed; however, when the atropine arrived J started pushing meds, I continued compressions ,and the fellow took over bagging. I felt ribs snap, I saw my artificial compression "V-tach" heart rate on the monitor, my triceps and deltoids tightening with every blow. And then it happened. The mother came running down the hall, stopped in the doorway, and yelled, "Stop! NO More! I'm his mother." We all looked up- all hands off the patient. At this point the attending physician was also in the doorway and he and the fellow clarified with the mother what stopping CPR would mean and verified that this indeed was her wish. With tears streaming down her face, she sobbed, "Yes. Yes." And with that we turned off the pumps and stepped back. I stood there holding the mother as we watched the agonal heart rhythm on the monitor...28, 23, 10, asystole. We checked- no pulse. And he was gone.
The monitor no sooner read asystole and the sister came running back in. She threw herself over her brother and let out a blood curdling scream. The crowds started to dissipate from the room and the fellow, J, and I began to comfort the family. After turning off the monitors and stocking the room with tissues, we all left and let the family grieve. I called the priest. It broke my heart as I watched the father pace frantically outside the room, refusing to set foot inside. After the priest left, I heard a noise coming from the room. I looked up from my paperwork and started walking towards the room...
Oh Dios de quién Único Hijo nos ha otorgado los beneficios de la vida eterna, concédenos la gracia que te pedimos mientras meditamos los Misterios del Mas Santo Rosario de la Bienaventurada Virgen María, debemos imitar lo que contienen y obtener lo que prometen, a través del mismo Cristo Nuestro Señor. Amen.
Over the last two weeks I'd listened to X's family chant prayers at his bedside, but suddenly I was moved. Not overly religious, but still connected to my Catholic roots, I stopped to think about what they were saying.
Let us pray. O God, whose only begotten Son, by His life, death, and resurrection, has purchased for us the rewards of eternal life, grant, we beseech Thee, that meditating upon these mysteries of the Most Holy Rosary of the Blessed Virgin Mary, we may imitate what they contain and obtain what they promise, through the same Christ Our Lord. Amen.
Jesus died at 33, their son didn't even make it to 30.
The post mortem care that followed was grueling. It took over 3 hours. Removing the dressings churned my stomach. X's skin was green with infection and textured with fungus. When all was said and done, I called the family in one last time to say good bye. As they kissed him their final goodbyes, I stopped the mother in the doorway and took her hand. I opened her clenched fist and placed something in it. She brought her hand closer to her face and opened her fingers--an ID band. She threw her hands up around my neck and sobbed, "Thank You. Thank You." I may not have been able to save her son, but I sure hope I can preserve his memory.
X was accepted as in international transfer five weeks post burn. Although I've seen many patients with his % burn survive, the fact that at five weeks out none of his wounds were closed was not favorable. When X finally arrived in New York at the beginning of December, he was in renal failure, maxed on dopamine and norepinepherine for his blood pressure, thrombocytopenic, in respiratory failure and ventilator dependent, and in septic shock. Additionally a MRI of his brain revealed an acute cerebellar infarct. He had six surgeries for debridment and skin grafting but none of them took as his body was invaded with fungus and bacteria. I took care of him the better half of the last two weeks and grew to know his family well. They halted their lives abroad and moved here to keep vigil at his side. They waited and prayed and waited and prayed and waited and waited and waited and prayed.
In the last two weeks, X grew sicker and sicker. He had showed some signs of improvement early on (return of some kidney function with oliguric output, improved ABG's, improved coagulation, fewer bacteria invading his wounds) but he took a turn for the worst...
Pseudomonas in the sputum, blood, and urine.
Acetinobacter in the sputum.
Candida on the skin and in the blood.
Thrombocytopenia
ARDS
Pulmonary Edema
Acute Renal Failure
Collapsed Lung
Sepsis
Acidosis
20 kilos of fluid overload with edema making him unrecognizable
In those 25 hours of work I administered 8 units of blood, 8 units of FFP, 10 units of platelets but he remained thrombocytopenic.
The ventilator was on 100%FiO2 and he was still lethally acidotic.
He required continuous deep lavage suctioning that involved removing him from the ventilator and breaking PEEP causing his blood pressure to plummet.
He was so unstable we couldn't turn him to put him on dry sheets, yet he was putting out 11 liters a day in bed drainage (yes, we suction and measure this).
He was two days overdue for day #5 post-operative dressing (POD) change.
His eyes were dilated and minimally responsive.
He was maxed out on Dopamine, Levophed, Neosenepherine, and Epinephrine.
I arrived at work on Monday and was partially surprised to find X still alive. The three hours prior to my arrival his blood pressure was resting around 68/40, his heart rate tachycardic in the 110's, and his O2 sat around 73%. The attending physicians held a discussion with the family during the day and I thought they were leading in favor of DNR, but in a desperate twist of fate the father disagreed and said he wanted "every thing possible" to be done.
During the day, the family had kept vigil at the bedside, never more than three visitors at a time. In the middle of report from the day nurse, Xs alarms sounded, his O2 sat was 65%, he needed to suctioned. The day nurse (J) and I went in and prepared to suction. We no sooner finished when his heart rate began to plummet: 110-90-80-75-70-60-55......
J yelled to get some atropine began bagging the patient. I hopped up to begin compressions. In rolled the code cart and so began the code. His venous access lines ( a right internal jugular TLC, a left femoral TLC, and left femoral Aline) were a mass of "spaghetti" coming from the 13 pumps running on either side of his bed; however, when the atropine arrived J started pushing meds, I continued compressions ,and the fellow took over bagging. I felt ribs snap, I saw my artificial compression "V-tach" heart rate on the monitor, my triceps and deltoids tightening with every blow. And then it happened. The mother came running down the hall, stopped in the doorway, and yelled, "Stop! NO More! I'm his mother." We all looked up- all hands off the patient. At this point the attending physician was also in the doorway and he and the fellow clarified with the mother what stopping CPR would mean and verified that this indeed was her wish. With tears streaming down her face, she sobbed, "Yes. Yes." And with that we turned off the pumps and stepped back. I stood there holding the mother as we watched the agonal heart rhythm on the monitor...28, 23, 10, asystole. We checked- no pulse. And he was gone.
The monitor no sooner read asystole and the sister came running back in. She threw herself over her brother and let out a blood curdling scream. The crowds started to dissipate from the room and the fellow, J, and I began to comfort the family. After turning off the monitors and stocking the room with tissues, we all left and let the family grieve. I called the priest. It broke my heart as I watched the father pace frantically outside the room, refusing to set foot inside. After the priest left, I heard a noise coming from the room. I looked up from my paperwork and started walking towards the room...
Oh Dios de quién Único Hijo nos ha otorgado los beneficios de la vida eterna, concédenos la gracia que te pedimos mientras meditamos los Misterios del Mas Santo Rosario de la Bienaventurada Virgen María, debemos imitar lo que contienen y obtener lo que prometen, a través del mismo Cristo Nuestro Señor. Amen.
Over the last two weeks I'd listened to X's family chant prayers at his bedside, but suddenly I was moved. Not overly religious, but still connected to my Catholic roots, I stopped to think about what they were saying.
Let us pray. O God, whose only begotten Son, by His life, death, and resurrection, has purchased for us the rewards of eternal life, grant, we beseech Thee, that meditating upon these mysteries of the Most Holy Rosary of the Blessed Virgin Mary, we may imitate what they contain and obtain what they promise, through the same Christ Our Lord. Amen.
Jesus died at 33, their son didn't even make it to 30.
The post mortem care that followed was grueling. It took over 3 hours. Removing the dressings churned my stomach. X's skin was green with infection and textured with fungus. When all was said and done, I called the family in one last time to say good bye. As they kissed him their final goodbyes, I stopped the mother in the doorway and took her hand. I opened her clenched fist and placed something in it. She brought her hand closer to her face and opened her fingers--an ID band. She threw her hands up around my neck and sobbed, "Thank You. Thank You." I may not have been able to save her son, but I sure hope I can preserve his memory.
Friday, January 09, 2009
WEEK 62: Four Foods On Friday
And I've been out of the loop for over a month. Life has been quite busy and work, well, overwhelminng. But it's a new year and I'm trying to get back on track. Valmg's been in a funk too, so hop ov over to here meme, check it out, and leave her some love.
Here are this week’s four questions.
#1. Waffles. Do you usually eat frozen or homemade?
What do you consider waffles made at a restaurant? I guess they are "restauarnt" made- but those are the only times I eat waffles
#2. Eggs. Do you buy brown, white, or it doesn’t matter?
Whatever is on sale, but I always buy organic, cage free eggs.
#3. Oatmeal. Do you usually make instant or cooked?
Cooked. Call me a snob, but I'll forgo the oatmeal if I dont have time to cook it. Cooking tip- Old Fashioned Cooking oats are MUCH Better in cookies.
#4. Bacon. Share instructions or a recipe that you use bacon in.
PASTA WITH SPINACH, BACON AND MUSHROOMS
1/2 lb. thick sliced bacon
2 tbsp. butter
1 c. onion, chopped
1/2 c. sweet red pepper, diced
1 c. sliced fresh mushrooms
1 bouillon cube in 1 cup hot water
Salt and pepper to taste
1 lb. pasta
10 oz. fresh, washed spinach (about 4 c.)
1 c. grated fresh Parmesan cheese
Cook bacon until crisp in skillet. Discard fat. Place bacon on paper towels. Add butter to same skillet (do not wash). Saute onions and peppers for 2 to 3 minutes. Add mushrooms, saute for 1 minute.
Over high heat, stir in broth. Bring to a boil. Lower heat and simmer for 2 minutes. Taste and add salt and pepper. In a large pot, cook, then drain pasta well. Return pasta to pasta pot.
Add the vegetable sauce and spinach. Toss over medium heat until spinach is wilted and most of the sauce is absorbed. Divide onto 6 plates. Top with crumbled bacon and Parmesan cheese.
Here are this week’s four questions.
#1. Waffles. Do you usually eat frozen or homemade?
What do you consider waffles made at a restaurant? I guess they are "restauarnt" made- but those are the only times I eat waffles
#2. Eggs. Do you buy brown, white, or it doesn’t matter?
Whatever is on sale, but I always buy organic, cage free eggs.
#3. Oatmeal. Do you usually make instant or cooked?
Cooked. Call me a snob, but I'll forgo the oatmeal if I dont have time to cook it. Cooking tip- Old Fashioned Cooking oats are MUCH Better in cookies.
#4. Bacon. Share instructions or a recipe that you use bacon in.
PASTA WITH SPINACH, BACON AND MUSHROOMS
1/2 lb. thick sliced bacon
2 tbsp. butter
1 c. onion, chopped
1/2 c. sweet red pepper, diced
1 c. sliced fresh mushrooms
1 bouillon cube in 1 cup hot water
Salt and pepper to taste
1 lb. pasta
10 oz. fresh, washed spinach (about 4 c.)
1 c. grated fresh Parmesan cheese
Cook bacon until crisp in skillet. Discard fat. Place bacon on paper towels. Add butter to same skillet (do not wash). Saute onions and peppers for 2 to 3 minutes. Add mushrooms, saute for 1 minute.
Over high heat, stir in broth. Bring to a boil. Lower heat and simmer for 2 minutes. Taste and add salt and pepper. In a large pot, cook, then drain pasta well. Return pasta to pasta pot.
Add the vegetable sauce and spinach. Toss over medium heat until spinach is wilted and most of the sauce is absorbed. Divide onto 6 plates. Top with crumbled bacon and Parmesan cheese.
Thursday, January 01, 2009
2k9 MEME
I got this MEME from O, who got it from All & Sundry. It's my last day off for the next five, so I figured what the hell-let's waste some time on the computer.
1. What did you do in 2008 that you’d never done before?
took the GRE's
2. Did you keep your new year’s resolutions, and will you make more for next year?
Is it a bad sign that I can't remember if I made one last year?
3. Did anyone close to you give birth?
two of the nurses that I work with, two of the girls I went to highschool with, and Anjali
4. Did anyone close to you die?
yes, one of my coworkers. RIP Tara. Miss you.
5. What countries did you visit?
St. Martin, St. Barts
6. What would you like to have in 2009 that you lacked in 2008?
Sleep and a social life; weird combination I know.
7. What dates from 2008 will remain etched upon your memory, and why?
December 19th- best Christmas party ever!
December 1st- I dischared the first pediatric trauma that I ever admitted
June 14th- I fractured my pelvis
8. What was your biggest achievement of the year?
Staying healthy
9. What was your biggest failure?
Not staying in touch with my friends becuase of my crazy schedule
10. Did you suffer illness or injury?
Fractured Pelvis
11. What was the best thing you bought?
My blackberry
12. Whose behavior merited celebration?
Amy: new job as a VP= all grown up
13. Whose behavior made you appalled and depressed?
The parents of my patient who pressed their child's face against the radiator. It made my blood boil.
14. Where did most of your money go?
Rent, rent, rent. Did I say rent?
15. What did you get really, really, really excited about?
The prospect of getting a permenant day position (too bad it was only a prospect).
16. What song will always remind you of 2008?
I don't know.
17. Compared to this time last year, are you:
a) happier or sadder? neither, I'm content
b) thinner or fatter? fatter and it's really stressing me out
c) richer or poorer?Richer. That's what happens when all you do is work and have no time to play!
18. What do you wish you’d done more of?
Stayed in touch with my friends, gone to church, slept (in no particular order)
19. What do you wish you’d done less of?
Stressing over the future
20. How did you spend Christmas?
At work. Hospitals never close.
21. Did you fall in love in 2008?
Someone won my heart over, but then broke it.
22. What was your favorite TV program?
The Biggest Looser (a guilty pleasure, I know).
23. Do you hate anyone now that you didn’t hate this time last year?
No.
24. What was the best book you read?
Quantum Wellness
25. What was your greatest musical discovery?
Our tiny little bathroom has great acoustics for shower singining
26. What did you want and get?
a complement
27. What did you want and not get?
a permenant day position
28. What was your favorite film of this year?
Rachel at the Wedding
29. What did you do on your birthday, and how old were you?
I worked, but at least Dr. MAtt was there *cue the dreamy music*! I turned 24.
30. What one thing would have made your year immeasurably more satisfying?
Working days so I could see more of my friends and family, sleep more, and make dating easier
31. How would you describe your personal fashion concept in 2008?
Hospital issued 50/50 Cotton, Poly scrubs; gym clothes; a conglommerate of J.Crew, Gap, and Bloomingdales
32. What kept you sane?
Escapes to the suburbs to see the L's or my family, late night talks with Natasha or AMy, and Wednesday Night Dinner Club
33. Which celebrity/public figure did you fancy the most?
I can't decide if the numerous adoptions and procreations of Jolie-Pitts is admirable or insane
34. What political issue stirred you the most?
The shit show otherwise known as our health care system
35. Who did you miss?
My family, my sorority sisters, Sarah, Memegrl and family, Shestartedit and family
36. Who was the best new person you met?
Cheryl. I'd be lost without her friendship
37. Tell us a valuable life lesson you learned in 2008.
Life is best lived with a little spontaneity.
38. Quote a song lyric that sums up your year.
Don't get all worried but if you remember this post, I'd say these lyrics just about sum it up:
What's wrong with me?
Why do I feel like this?
I'm going crazy now
No more gas, in the red, can't even get it started
Nothing heard, nothing said, can't even speak about it
On my life, on my head, don't wanna think about it
Feels like I'm going insane, yeah
-Rihanna, Disturbia
1. What did you do in 2008 that you’d never done before?
took the GRE's
2. Did you keep your new year’s resolutions, and will you make more for next year?
Is it a bad sign that I can't remember if I made one last year?
3. Did anyone close to you give birth?
two of the nurses that I work with, two of the girls I went to highschool with, and Anjali
4. Did anyone close to you die?
yes, one of my coworkers. RIP Tara. Miss you.
5. What countries did you visit?
St. Martin, St. Barts
6. What would you like to have in 2009 that you lacked in 2008?
Sleep and a social life; weird combination I know.
7. What dates from 2008 will remain etched upon your memory, and why?
December 19th- best Christmas party ever!
December 1st- I dischared the first pediatric trauma that I ever admitted
June 14th- I fractured my pelvis
8. What was your biggest achievement of the year?
Staying healthy
9. What was your biggest failure?
Not staying in touch with my friends becuase of my crazy schedule
10. Did you suffer illness or injury?
Fractured Pelvis
11. What was the best thing you bought?
My blackberry
12. Whose behavior merited celebration?
Amy: new job as a VP= all grown up
13. Whose behavior made you appalled and depressed?
The parents of my patient who pressed their child's face against the radiator. It made my blood boil.
14. Where did most of your money go?
Rent, rent, rent. Did I say rent?
15. What did you get really, really, really excited about?
The prospect of getting a permenant day position (too bad it was only a prospect).
16. What song will always remind you of 2008?
I don't know.
17. Compared to this time last year, are you:
a) happier or sadder? neither, I'm content
b) thinner or fatter? fatter and it's really stressing me out
c) richer or poorer?Richer. That's what happens when all you do is work and have no time to play!
18. What do you wish you’d done more of?
Stayed in touch with my friends, gone to church, slept (in no particular order)
19. What do you wish you’d done less of?
Stressing over the future
20. How did you spend Christmas?
At work. Hospitals never close.
21. Did you fall in love in 2008?
Someone won my heart over, but then broke it.
22. What was your favorite TV program?
The Biggest Looser (a guilty pleasure, I know).
23. Do you hate anyone now that you didn’t hate this time last year?
No.
24. What was the best book you read?
Quantum Wellness
25. What was your greatest musical discovery?
Our tiny little bathroom has great acoustics for shower singining
26. What did you want and get?
a complement
27. What did you want and not get?
a permenant day position
28. What was your favorite film of this year?
Rachel at the Wedding
29. What did you do on your birthday, and how old were you?
I worked, but at least Dr. MAtt was there *cue the dreamy music*! I turned 24.
30. What one thing would have made your year immeasurably more satisfying?
Working days so I could see more of my friends and family, sleep more, and make dating easier
31. How would you describe your personal fashion concept in 2008?
Hospital issued 50/50 Cotton, Poly scrubs; gym clothes; a conglommerate of J.Crew, Gap, and Bloomingdales
32. What kept you sane?
Escapes to the suburbs to see the L's or my family, late night talks with Natasha or AMy, and Wednesday Night Dinner Club
33. Which celebrity/public figure did you fancy the most?
I can't decide if the numerous adoptions and procreations of Jolie-Pitts is admirable or insane
34. What political issue stirred you the most?
The shit show otherwise known as our health care system
35. Who did you miss?
My family, my sorority sisters, Sarah, Memegrl and family, Shestartedit and family
36. Who was the best new person you met?
Cheryl. I'd be lost without her friendship
37. Tell us a valuable life lesson you learned in 2008.
Life is best lived with a little spontaneity.
38. Quote a song lyric that sums up your year.
Don't get all worried but if you remember this post, I'd say these lyrics just about sum it up:
What's wrong with me?
Why do I feel like this?
I'm going crazy now
No more gas, in the red, can't even get it started
Nothing heard, nothing said, can't even speak about it
On my life, on my head, don't wanna think about it
Feels like I'm going insane, yeah
-Rihanna, Disturbia
9 things About Me for 2009
1. I like green grapes but red wine
2. I can't fall asleep with dirty dishes in the sink
3. I can wiggle my ears
4. I don't play any musical instruments
5. I haven't eaten meat in 8 1/2 years
6. When applying to college I was torn between architecture and nursing
7. I floss after I brush
8. I prefer flats to heels
9. I'd rather go to bed at 10pm and be up at 5am, than go to bed at 1am and sleep till noon.
2. I can't fall asleep with dirty dishes in the sink
3. I can wiggle my ears
4. I don't play any musical instruments
5. I haven't eaten meat in 8 1/2 years
6. When applying to college I was torn between architecture and nursing
7. I floss after I brush
8. I prefer flats to heels
9. I'd rather go to bed at 10pm and be up at 5am, than go to bed at 1am and sleep till noon.
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