Tuesday, June 24, 2008

i need a drink.

We have, on the unit right now, ....

not one....

not two....

not three...

not four...

but FIVE SCREAMERS TONIGHT.




There is not enough Haldol in the world right now. Or Dilaudid. Or Zofran. Or Phenegran.

And for me, there is not a martini clear or near enough.

F I V E.

We had one call the cops on us. Unfortunately, they did NOT come to take me away.

Monday, June 9, 2008

Nurses Who Love Their Jobs.


I talked to two nurses who love their jobs today. You know how great that is when you hear stories about somebody who genuinely loves what they do? Of course you do.

Laura is an ER nurse who happened to float to the unit today. She's a vivacious (no really, that's the word) brunette, a little shorter than me, bright brown eyes. Very cute, roughly my age. She doesn't mind these messy ICU train wreck patients, and she can obviously handle them. But what she loves best is "keeping as many balls in the air as I can at one time." That's her talent and her love: juggling this that and the other thing and taking care of lots of different people with unexpected medical problems. She talked with enthusiasm about managing chaos. That's what she takes pride in....the ability to think fast, think on her feet and to react quickly to things.

And it makes her happy. How cool is that?

Sariah is a nurse who was finishing up hemodialysis on one of my patients when I came on shift. Sariah has coffee brown eyes, and she wears a modest scarf to cover her head. Her manner is always calm and soothing, unhurried. She loves to teach...anytime I've asked her a question about the workings of the dialysis machines, she's been wonderful about stopping and thoroughly explaining things to me. Now, I've been sending out feelers for other additional job opportunities, so I thought I'd ask her about what she does. I love CRRT...maybe I would like doing dialysis on an occasional basis. She really perked up when I asked.

She's been doing dialysis for over 30 years, she said, having started in general ICU. What she loves is knowing pathophysiology deeply and understanding that when she assesses a patient pre-treatment and finds a K+ of 9.0, she watches the change in the T wave on the EKG lead as she treats the patient, watches it improve as the dialyzer filters. She listens to the patient's lungs after she begins treatment and hears improvement, sees their breathing become easier, more relaxed. Dialysis is easy, she says! You should apply! It's wonderful to be involved in watching a patient improve, and so many of them recover so well after transplantation. She just glowed and it was obvious the great joy she gets from directly helping patients get better.

That was just so. Awesome.

And you know what? I'm having a great night. It totally set my night. Because I gotta tell ya...I LOVE ICU. I love sick as snot patients, people that have complex crisis needs. There's not a patient I take care of that isn't in the midst of a big turning point in their lives. They're not only sick but afraid, and in the midst of hard decisions. I love that I need to understand extreme pathophysiology: not that I don't have volumes to learn, I most definitely do. But I know that the body is likely to break in a handful of ways, and I know how to start getting a handle on those things emergently. There's always ways for me to learn more deeply. The deeper I learn, the better care I can provide for my patient clinically, and the better help, reassurance and knowledgeable resource I can be for families.

Laura was telling me that I'm a "good ICU nurse" because I'm "obviously a control freak". I was telling her that I love doing CRRT, really enjoy tweaking this drip to change the central venous presure here, futzing with the dialysis rate to improve this lab here, focusing on ONE patient at a time, and understanding that patient comprehensively and completely. Knowing their history, understanding the messiest of pathophys. Love it.

I'm good in a crisis situation, too....last night both of my patients had severe respiratory decompensation within the first hour of my arrival: one got reintubated, the other CPAP. I can do that. But unlike the ER, I don't want to leave those patients after the initial crisis is past. I'm happy talking to the family members about what happened, how their loved one is, what to do now, how recovery will look.

It's silly, but I'm a clean freak, too, and I do like doin that nursey stuff and giving baths and providing that fluffy comfort too. Don't ask me to do it for seven patients in a night...(screw that), but for people THIS sick, THIS fragile and suffering THIS much... Years ago, I was in a car accident and I got a free trip in an ambulance. One thing I remember is that hours later, my parents had seen me, a few friends had seen me...and my then-roommate Kelly arrived late that night. She said, "You look like shit, man." And she wiped the blood off my face. Nobody'd even told me I had blood all over my face. I'll always remember that stupid kindness of wiping the blood off my face. That stupid kindness of You Look Like Shit Man.

I know now all about prioritizing: airway, breathing, circulation is what I do. The most important things I do. But when my patients are stabilized, none of them ever have blood on their faces or anywhere else.

(Don't tell anybody. I don't think that fussy stuff is fashionable among professional nurses anymore.) (Doesn't mean I don't love looking up new drugs I don't know to learn the pharmacological effects on blood pH and other neato stuff.)

Yeah.

I love my job, too.

Cool, huh? I hope you love your job, too, some days. Pass it on if you do.

Tuesday, June 3, 2008

My dumb government.

Found this over at ERNursey: Home dialysis is available now. Something Medicare will only pay half the cost for because they'd rather pay the more expensive full cost of hospitalization.


Do I write to my Congressperson to fire the hell out of these people or is it my Congressperson that I need to fire?

Sunday, June 1, 2008

Proof of job security, #749

Patient in ICU has had type 2 diabetes for years. Family at bedside. Sugars "out of control" high. Physician chooses to write for subQ insulin, which RN gives.

Family goes home after dinnertime and gradually patient's sugars plummet.

Turns out family had been sneaking the patient candy all day without telling anyone.



This has happened to you, too, hasn't it. (Notice ungrammatical lack of question mark.)

Why do we keep interfering with natural selection?