Friday, January 07, 2005

First Full Week Back At Work

Holy. Mary. Mother. Of. God.

I was off a lot--a LOT--during the holidays. So much so that the week between Christmas and New Year's, and the weekend after New Year's, was spent lying around in bed, reading mystery novels, eating good South American food, and generally Hanging Out.

In other words, mama lost her groove.

Wednesday kicked my ass. Thursday kicked several asses. Today kicked our collective ass, then pasted its remains to the wall.

For those of you versed in hospitalese, we have a floor of 28 beds. We started with 18 patients, sent five home, and got sixteen admits. I'm not entirely sure where we put that last extra patient; there were apparently fistfights going on in admissions over our beds.

My day was crazy enough that I'm sitting here typing, eating slabs of cheese and Fritos, drinking a beer, and wishing desperately that I'd caught the hang of smoking as a teenager.

My first patient came from the rehabilitation floor. We'd sent her there two weeks ago. Night before last, the nurse had given her enough oral morphine concentrate for pain that she'd become nonresponsive and Narcan (a drug used to reverse the effects of narcotics) wasn't enough to bring her out of her stupor. She also had a temperature of 102 and pus leaking from her scalp incision.

No, not leaking. Oozing. Ooking. Yarking me out at 0700.

Anyway. She had a sodium of 126 (135-145 is normal), so off she went to ICU. We can't replete sodium with a high-salt intravenous solution on the floor; we have to do it in ICU. She was out by 0800.

Second patient is 42 with metastatic adrenal cancer. His prognosis is grim, to put it nicely. His pupils were two different sizes when I walked in, but the rest of his exam was okay, so we put it down to the morphine he'd been getting for pain. Luckily, we were right.

Third patient is 43 with what looks to be metastatic breast cancer to the brain.

Fourth patient is so manic I nearly killed him. Who on earth has myasthenia gravis and still files paperwork all day?

Fifth patient is a long-term IV drug abuser; smack and crank are drugs of choice. Guess who wants her two milligrams of morphine every hour?

We, as a floor, pride ourselves on getting out on time every night. It's rare that somebody has to stay to chart past the end of the shift. I was the first nurse out of there, having had one very early and one very late admit, and I got out at 7:30 pm. Everyone else is probably still there.

Best moment of the day: A surgery resident of the unusually arrogant type keeps answering the phone, then hanging up on the person when he finds that it's not the person he wants to speak to.....

Nurse Jo: "I need you not to hang up on my consults."

Resident: "Well, I paged *my* consult to this phone; what do you want me to do?"

Nurse Jo: "Let me answer the phone. And keep your paws off our snack foods."

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