Friday, October 30, 2009
Posted by Jo at 4:20 PM
Sorry about the lack of hair pictures; I didn't even think of taking one before I unsnarled the bun and went to bed.
And, apparently, forgot to take my fucking Effexor.
That doesn't happen very often, but I can always tell when I've gotten distracted and forgotten the Anti-Brain-Scurvy meds. I had a dream that the entire ICU crew had to walk from Dallas to the Gaza Strip, climb 300-story skyscrapers, and be catapulted across huge crevasses in a sort of Survivor-meets-Amazing-Race-meets-Python challenge. (Just for the record, I've never seen either reality show, so I don't know how accurate the catapult thing is, but there you are.)
If the crazy-ass dreams aren't enough to clue me in, the electrical shocks up my neck and down my arms will remind me. And if *those* aren't enough, the feeling that my brain has the flu will be, for sure. (Note to those who are saying "brain flu? WTF?": Yes, it really is like my brain has the flu: mentally achy, exhausted, and foggy as hell. It's bizarre and unpleasant.)
Thankfully, my brain is jacked up enough that one dose of Effexor XR is enough to set me straight again in terms of norepi and serotonin within about eight hours, so now I feel fine.
Thus, a public service announcement: I've gotten six emails in the last two weeks from readers who are dealing with stress, anxiety, and depression. I've told all of them this individually, but I want to make it public: If you are having problems with mental fitness, *please* see a doctor. Specifically, see a psychiatrist rather than a family practitioner.
General practitioners are fantastic, but they don't have the intensive training that a shrink does when it comes to both the mind and the brain. I went to see a family guy, a generalist, when I discovered that I didn't want to get out of bed in the morning, and I ended up on a drug that is difficult to dose, hideous if not impossible to stop taking, and the psych drug equivalent of swatting a fly with an atom bomb.
My shrink, the first time I saw him, raised his eyebrows both at the drug I was taking (in light of my personal history) and the dose I was on. In his words, "If that other guy thought you were really depressed and possibly bipolar [see archives as to why the GP was mistaken], he did everything exactly wrong." Turns out Effexor is best used for people whose depression and anxiety has been refractive to other treatments.
This drug saved my life. Period. I would've either drunk myself to death like the women in my family did generations ago, or I would've simply died of lack of mental stimulation and ennui. That life-saving, though, came at the cost of knowing that if I miss a dose of my Brain Vitamins, I'm screwed for the next eight hours, *and* that there's a very good chance that I will never ever ever be able to stop taking this particular drug.
Which, as long as an asteroid doesn't hit and the zombies don't invade Medco, isn't too bad a future to contemplate......but it would've been nice to work up to the Strontium 90 of brain meds rather than start out on them, if you know what I mean.
Here endeth the Public Service Announcement. You may all go back to your homes, your beer, and your regularly-scheduled Nurse Blogging now.
Thursday, October 29, 2009
How I lost two-and-a-half pounds this week, gained it all back without trying, and ended up with a potscrubber on my head.
I knew when I started this internship that ICU would be an educational experience.
What I didn't know was how educational it would be, and in how many diverse ways.
So I finished helping Brenda bag-n-tag her dead patient, checked on my dude who no longer has a larynx, a neck to speak of, or a right chest muscle, and levelled the ventriculostomy on my woman with the bleed, and wandered back out to the desk, chart in hand.
The girls were discussing interesting euphemisms for bizarre sex acts. I wasn't really listening, so I didn't notice when the conversation veered sharply toward hair and eyeliner. Hair and eyeliner don't interest me any more than euphemisms do; I normally let both my hair and my eye makeup do whatever they're going to do for the day, as I don't drag up well. I was charting, not listening.
Next thing I know, Katie's fingers are in my hair. Brenda and Dawn and all the girls are gathered around in back of me, and Katie is taking my hair down from its barrette and combing through it with her fingers.
I should point out here for any latecomers that my hair is crazy, crazy curly. Katie had been demonstrating a hairstyle with her own long, straight, naturally golden-blonde hair when somebody asked her if the same style would work with curly hair. Katie, not being a fool, did not grab Dawn or Brenda, both of whom have hair at least as curly as mine, as she thinks they're more intimidating than I am.
Or maybe they were both just less involved in something else. At any rate, here I was at the station desk, charting away, with somebody doing... ... ... something to my hair.
Katie is the MacGyver of hair.
I was in trouble.
Next thing I know, I've got a *thing* on top of my head. I guess you'd call it a high bun, and it's really pretty, don't get me wrong: it looks like somebody's interwoven a hundred tiny strands of crazy-curly hair into a complex and lovely rose shape, with little curly tendrils hanging down from the back. If I lean waaaay back in the chair I'm in now, I can just see it in the mirror. Lauren pulled out little tendrils from either side, and Chris poufed the front up very nicely.
It's a gorgeous hairdo. It just looked, for the last two hours of the shift, like I was going to the prom in scrubs. It's hard to have a serious conversation with a doc when he's known you for seven years with your hair scraped pack into a no-nonsense ponytail, and all he can look at is the springy curly tendrils escaping ever-so-casually at your temples. And the back of your neck. And a couple falling carelessly over your left eyebrow.
She did it all with one rubber band, in under five minutes. The woman is a genius.
I am in trouble. Next thing you know, I'll be learning how to put on eye makeup correctly. That seems to be almost as important as levelling an arterial line on this unit.
Oh, and the 2.5 lbs? I lost them because I am no longer working with people who bring Big Food to work three days out of five. I gained them all back today because the respiratory guys had a big lunch hoo-hah, complete with brisket.
I brought home a styrofoam coffee cup full of brisket. (It was the only empty container I could find; I covered it with paper towels and hid it in my lunch bag after ditching the fat-free yogurt and the low-fat cheese stick.) I ate at least a pound of brisket for lunch, and then went back for thirds.
Basically, I was a prom-bound, cow-filled, ventriculostomy-managing fool today. All I need now is the eyeliner, and I'm in like Flynn.
Wednesday, October 28, 2009
Tuesday, October 27, 2009
A fifteen year old girl was raped outside a school dance for two hours, to the point that she needed to be hospitalized in the ICU for her injuries.
As commenter Hooplehead said on Jezebel this morning:
And this is a key example of why guys need to go past giving lip service and actively help to dismantle the rape culture. You in particular not being a rapist is no longer sufficient. It is about you in particular being strategically situated to help potential victims and spark change in situations where women are viewed as nameless, faceless pieces of ass, to be used and exploited as men see fit. This is the patriarchy, right here, and it is high time that it was toppled. I hope they press charges on all of those worthless bystanders as well for aiding and abetting these gangraping assholes.
I cannot say it any better than that.
The more I hear about the world, the more I am thankful that I'm surrounded by men I know and love and can trust: guys like My Brother In Beer, The Towering Inferno, The Beard, Pastor Paul, Zombie Boy, Max, Chef Boy, my dad.
But that does not help the fifteen-year-olds of the world.
Let's say you're offered a drink. You're fifteen. You like the boy who's offering it to you, and you have no idea how strong that drink will be, so you drink it.
Then you realize that there are other boys around, all telling you to keep drinking. You want to be cool, so you do. And before you know it, you're sick. You're sleepy. Your father is looking for you, but you don't know that. If you did, you would get up and go to him. The security people who were supposed to keep you safe were told to go home a half-hour ago; if you'd known that, you would've gone looking for them earlier.
I have been very, very lucky. In the times that I've been drunk and vulnerable (as I am now; nothing makes Jo the Coruscating Feminist kill a bottle of Becker Vineyards 2007 Chardonnay like a horrible story), I've had male and female friends around who said, "We're in the drunk-and-vulnerable part of the night, and I am putting you to bed." Even through four years of college, where alcohol was essentially unavailable and thus binge drinking was common, I was never raped, let alone gang-raped while my fellow students stood around and watched.
This is the patriarchy. This is the paradigm that lets men and boys see women and girls as things to be used, rather than as full human beings to be respected. This is the root of gang rape, of date rape, of stranger rape, of rape as a war crime, of genital mutilation, of objectifying women, of beating women up. This is the root of the thought process that says that women are, by definition, commodities to be traded and possessions to be owned.
This is the paradigm that lets a dozen boys watch a girl be raped and allows them all to not do anything about it.
Years ago, when I was first divorced, I made a list of qualities I wanted in a partner. Top of the list, right after "must be larger than I am in at least one dimension", was "Must be feminist." As in, not only believing that women are human, are worthwhile creatures, but must work for that end. And as in, must treat the women he knows as human, worthwhile creatures. I have been lucky to build a network of male and female friends who treat women as human, worthwhile creatures instead of as commodities or pieces of ass.
I really, really hope that girl finds people like that in her life in the future. It takes a lot to kill a human, and it takes a lot to keep them from fully recovering, even from something like this.
Still. . . . there are times when I believe in the death penalty. Administered by women. With boots on.
Posted by Jo at 3:47 PM
Monday, October 26, 2009
And it was really nice.
For a whole day and a half, I had nothing to do but eat good food, yammer at interesting people, and listen to Neko Case and Fountains of Wayne on the car stereo.
Meanwhile, the family of a patient I had last week was discussing whether or not to turn off the vent and make Grandma a DNR. Grandma is not going to wake up, sadly; she had one of those intracerebral hemorrhages best described as "devastating". Oh, and she infarcted both frontal lobes. And then, because she was stuck in a tiny hospital with no neurosurgeon or neurologist, she herniated just enough to screw up her brainstem. Apparently she'd had a headache for a day or so, but being a tough mother, she didn't say anything to anybody. Her husband found her facedown in the living room one morning last week.
I also did not have to live the life of one of my former patients, who's back. We took a metastatic melanoma out of his brain about a year ago, and he's gotten to the point where he needs Interleukin-II therapy. That's the last resort for people with Stage IV melanoma and kidney cancer. Without it, five-year survival is about two percent (for renal CA) to four percent (for metastatic melanoma). So he's in the unit for the first round of fourteen days of IL2, if he can tolerate it, and we'll all see what happens after that.
And, finally, I do not have to be an old friend of mine who's currently in the unit with a galloping case of GVHD (graft versus host disease: it's what happens when you get a bone marrow transplant and the transplant, with its new and marvelous immune cells, turns against your body) after a matched, unrelated-donor bone marrow graft. That was a shock: I walked onto the unit this morning to see his name on the board and stopped dead. He was a sponsor for my church's youth group when I was a teenager, and I went to school with all three of his kids.
Now he's in a bed, so badly screwed-up that we have a specialist in burns taking care of his skin, on a vent, with constant drips going to try to save his kidneys, his liver, his lungs--*any* part of him, really. His doctor considers it a hopeful sign that he only had three liters of diarrhea yesterday.
Tonight it's raining. It's chilly and foggy and misty, so Max and I will have a cuddle party on the floor of the living room after I dry him off. I'll go to bed early, and wake up early, and head to the grocery store at the time of day when the horizon is bleeding into the sky, so you can't tell where the trees end and the clouds start. Then I'll run for a while, and lift heavy things, and give thanks that I can do that and still have the wherewithal to start a big pot of bean soup.
I live in a different universe from a lot of people every day. Sometimes there's overlap; mostly there's not. Mostly I'm thankful there's not.
Sunday, October 25, 2009
This past summer I got a very nice email from a very nice woman named Rose, who works at a company called Knit-Rite. Rose offered me some pairs of socks that Knit-Rite makes, and asked me to please review them here on HN.
Normally, I don't do product reviews in return for products. I prefer to spend my own money on stuff; that way, if it doesn't do what it's supposed to, I can bitch and moan all I want without worrying that I'll offend somebody. This time, though...I was intrigued.
I was also very hot and sweaty, and couldn't imagine wearing compression stockings for twelve hours in a hospital where the air-conditioning is from a previous era (the Neolithic). Rose was kind enough to let me put off the trial and review, and the socks arrived last week in tandem with mercifully cool temperatures.
Now then: I did not spend my own money on these puppies*. However, I would happily spend money on more of them; they're just that good. Seriously: if you've got problems with ankle swelling and sore legs after twelve hours on your feet, the two best things you can buy are Birkenstock insoles for your shoes (have them fitted by somebody who knows what they're doing, please) and a pair of Knit-Rite's Core-Spun Therafirm sockses.
Rose sent me three different pairs: A light pair of trouser socks in Screaming Sealing-Wax Red (to benefit women's heart health), a pair of heavier socks in grey (Silver Corespun) and a pair of white ones (Plain Corespun).
Bad news first: The red trouser socks, while pretty and bright and cheery, did not fit my extremely stumpy legs. I had to turn them down twice to get them not to go up over my knees, though they did--and this was a pleasant surprise--stay turned down without rolling or cutting off my circulation. They were 10-15mmHg compressions, just like the other two pairs, but they didn't seem as...I dunno, *beefy* somehow. I mean, my legs didn't hurt (though my feet sweated like hell, but then, they do that in nylons), but I didn't feel any real oomph from the socks. I like compression hose to have some oomph.
Ladies' nylon trouser socks from Knit-Rite: Grade: B+. Good for when you know you'll be standing around a while, then sitting, then standing, and need something that looks professional in a suit-and-blouse way.
Now for the good news: The other two pairs of socks? Rocked out.
I am not kidding, Peeps: These are going to get heavier rotations under my scrubs than even my SmartWool anklets (which, by the way, after only six months of not-too-heavy wear, are full of holes--I'm lookin' at *you*, Crappy SmartWool Manufacturers!).
The grey ones are very, very dark, almost black. They look like actual dress socks like a guy would wear with a suit. The compression is considerably oomphier than the red socks, but I couldn't tell much difference between the grey Silver Corespun and the white Plain Ol' Ordinary Corespun.
The white ones are, well, white knee-length socks.
Both are made with CoolMax, and both kept my feet from sweating. Looking at the boxes now, I see that the grey dress socks are made with a higher proportion of CoolMax to nylon, which apparently makes them static-resistant (they are. Definitely). Both have noticeable compression when you put them on, though you don't have to wrestle them into place like you do with higher-compression stockings. Both are generous through the toes, which is nice, because the last time I wore SuppHose ten years ago, I nearly lost my right big toe.
Both of these heavier pairs lasted well through two twelve-hour shifts during which I was running around with my hair on fire. My legs didn't itch, they didn't leave weird little grooves in my skin, they fit my 17.5" calves like a dream. And my ankles were not swollen at the end of the day.
Let me say that louder: MY ANKLES DID NOT SWELL ALL DAMN DAY LONG.
The only problem I had with the white socks was a little static toward the end of the day, but it was only noticeable to me.
So: Knit-Rite unisex CoreSpun by Therafirm Socks, either Silver or Plain-O: Grade: A+.
Try 'em out. Also check out the website; Knit-Rite does all sorts of fascinating things for people with prosthetics and AFOs and spinal braces. It's interesting.
Thanks, Rose! My white socks are in the dryer now, for use this week on the floor.
*Therefore, I have no clue what they cost. As long as it's not half my liver, though, it's totally worth it.
Wednesday, October 21, 2009
I suppose it's not a surprise to anybody that the last three letters of my license plate are GRR.
Because, given the day I had today, that is how I feel.
No, so sorry; we can't give you more than the scheduled number of patients for each day during your internship, even if you are the first experienced nurse we've ever had do this; it would set a precedent.
No, so sorry; we can't let you skip this two-hour long customer service class which you have attended every year for the last seven freaking years; it's a requirement. Even though you had it six weeks ago.
No, so sorry; I'm going to pretend I don't speak English if I don't want to do what you think might possibly, just possibly, be best for your patient. Instead, I'll write orders that will guarantee that your patient third-spaces all that fluid I want run in, because I've been ignoring your warnings about acute tubular necrosis.
Even my horoscope wasn't very encouraging. And I *never* read my horoscope.
If it weren't raining, I would go running. As it is, I plan to eat pancakes. And cheese.
Posted by Jo at 2:57 PM
Tuesday, October 20, 2009
I received three pairs of KnitRite light compression knee-highs in the mail today, courtesy of the KnitRite folks, who want me to review them. They make a variety of things from light compression to heavy compression to prosthetic shrinker stockings, and were nice enough to consider that my swollen ankles could maybe use some help.
This week'll be the perfect test of the socks, as I have a combination of sitting/standing, standing, and sitting to do for the next few days. I'll have a report for you all on Monday.
The last time I wore support hose to work was in nursing school. Sadly, they were cheap, and the toes twisted such that I had to remove the right stocking while driving down the highway at 70 mph, lest I lose circulation in that foot. We'll see how these work.
Monday, October 19, 2009
Faithful Minions will recall that I have two cats.
This is Flashes, doing what he does best, which is being sweet. (Yes, it's an old picture.)
And this is Notamus, cute little fuzzy forked tail and horns not shown.
I ate pancakes for dinner, then took my vitamins and went to bed. About ten minutes after I snuggled down into my comforter, Notamus started yowling.
I do not know why.
He made noises like a bandersnatch with bowel trouble, stopping only when I called and chirruped to him from the bed.
He came into the bedroom but did not settle down. Instead, he made those adorable chirping, half-purr, half-meow noises that kitties make when they're feeling curious about something.
Then he started in on the closet door. Now, Notamus's favorite sport is to yank the closet door open if I don't shut it completely and pull all my scrubs down of their hangers, onto the floor, and roll on them. So I keep the closet door shut tight.
But it's an old house, and "tight" in an old house doesn't really mean "tight".
"Chrrrr? Chrrrr? Row? Chrrrr?"
"Mrow? Chrrr? Chrrrrrr? Mrow?"
Flashes got off my leg, looked over at his brother, wondered aloud why brother Notamus was trying to take the closet door off the hinges, shrugged, and laid back down.
At which point Notamus decided that the ten-yard-dash from bedroom down hallway through kitchen and into storage room was the correct way to blow off frustrations.
Over and over and over.
I have an old house. It's pretty tight, but "tight" in an old house isn't *tight*. The wooden floors make noises when you walk on them. When a speeding twelve-pound cat puts his feet down as hard as he possibly can while running on them, they sound like a badly-tuned xylophone.
So I got up, wandered into the kitchen to have a glass of water and a cracker (the vitamins were making me queasy)--just in time to see the Notamus Acrobatic Show start. Thankfully, that only lasted until he fell off the kitchen windowsill and into the sink.
You're probably wondering at this point why I didn't lock him up in the utility room with the catboxes and the food and water. It's because I also have open shelves in there, and didn't want to awaken in the morning to hideous distruction. But, to continue:
After he fell off the kitchen windowsill, I went back to bed. Notamus went into the bathroom.
I have one of those nonslip mats in the bathtub. It's the kind you buy at Target that looks like little clear pebbles of various sizes, with spaces between. It sticks to the bathtub with teeny suction cups that make a pleasant POP when a cat gets his paw in a space and pulls up.
Notamus was enchanted.
"Chrrrr? Chrrrr? Mrow?"
POP POP POP POP POP POP scrabble scrabble POP POP POP
Flashes is still asleep on my bed. Notamus just went to lie down on Max's bed. I'm going to go try to get some sleep now.
If I don't, I might have a new fur hat in time for Christmas.
Things never work out like you hope they will.
You would think, in chasing blood pressure and potassium levels with the appropriate drugs and repletion solutions, that things would eventually stabilize. The human body, contrary to what you might think, has its own way of doing things--and this "own way" will cause more trouble (in terms of lab draws and brain-ache) than you ever expected.
Just because it's easy doesn't mean it's right.
Yeah, it's easy to replete a low sodium, but what happens if the paramaters the doctor ordered are wrong, wrong, wrong for that particular patient? Oops. Time to run the hypotonic solutions again!
You can't always get what you want.
Even if what you want is normal serum values and normal ABGs. Sometimes people have their own ideas.
Life is not fair, and nobody ever said it was.
Sometimes, no matter how hard you try to resuscitate a patient, that patient will simply not do what you want them to do.
Lesson learned: The human body tends toward stability, unless it gets a wild hare and decides not to.
Posted by Jo at 2:22 PM
What Nurse Jo is....
Listening to, with new respect:
Also, "Graceland", all over again. I loved Edie Brickell back in the day (even though she never bathed and always ordered her eggs over medium at Jim's when I was a dinette) and I love me some Paul Simon, but they're suck, both of 'em, since they got hitched.
Just shows how marriage ruins a person.
When you watch this video, remember that apartheid would still be in effect for seven more years,
and that mixed-race bands were not allowed to perform in South Africa. (Edited to add: Bryan in the
comments tells me that this is not true. My apologies for the misinformation.)
Vegetables, by James Peterson. A gorgeous cookbook.
Also, The Man Who Ate Everything, by Vogue's food critic, Jeffery Steingarten.
"I can chew like a cannibal/I can yell like a cat/I even had you believing that I really, really like it like that..."
This might be something I buy though I cannot afford it.
A size smaller pants! Huzzah!
Posted by Jo at 3:00 AM
Sunday, October 18, 2009
Faithful Minions will recall that there are very, very few times that I've shared actual dirty laundry on this here blog. Normally, if there's a personal story I have to tell, I keep it in the realm of macaroni and cheese or cute animal stories or how I nearly broke my knee in a fall at work.
The events of this weekend, though, have prompted me--because I am insanely pissed off--to do something I've never done before, which is call somebody out and name names.
It all started with a seemingly innocent phone call.
NCO Financial Corporation, I am looking at you.
You keep calling. You call during the day, you call during dinner. You call in the morning, in the evening, while I'm working out, when I'm otherwise indisposed.
And you will not get it through your thick collective head that the name "Jo Lastname" is in no way related to "Jim Lastname".
You refuse to believe me when I tell you that Jim doesn't live here and never has. Your last collections caller said snottily, "Well, ma'am, this *is* the Lastname residence" leading me to say "Okay, it's time I spoke with your manager."
"I don't have one," the caller, who I'll call "Chris" because that's the name he gave me, said.
"No manager?" I asked. "Nobody who supervises you?"
"You're all alone in that big, big call center?" I persisted.
"Ma'am, I don't have a manager, and I need to speak to Jim Lastname."
Listen up, boys: Jim Lastname has no connection whatsoever with me, aside from his initials. Not only does Jim not live here, but to my knowledge, he has never had this telephone number. I'm the only one who's been at this number for the last decade. I do not know Jim, and wouldn't recognize him if he showed up on my front porch in flames and covered with angry baby velociraptors. I am not Jim's wife, Jim's mother, Jim's sister, or any other relation to Jim. The only relative I have named Jim has a completely different last name and lives a thousand miles away from this telephone number, which, I hasten to remind you, is mine and mine alone.
No, there are no other people in the household, not like it's any of your business. If you really, really want to talk to a male, I'll have to put you on the phone with the dog or one of the cats (if I can get 'em to slow down long enough to meow at you).
No, I cannot get a message to Jim. See above: I have no clue who Jim is.
And you know what, NCO Financial? Even if you call me every twenty minutes for three hours like you did yesterday, these answers will not change.
Once I'm able to craft an email that won't sear the inbox of whoever's unlucky enough to get it, I plan to complain formally to the gentlemen (ha) at Giant Collections Agency, dba NCOF. First, though, I'll have to wait until my temper is such that anything I write won't be read as a single painful burst of high-pitched noise, with knives thrown in.
The best part of this whole saga is that it looks like, from what I've been able to find on the Innerwebs, that these folks often call people who've already resolved their credit issues through the original creditor. I feel sorry for Jim, whoever and wherever he is.
Posted by Jo at 3:51 AM
Saturday, October 17, 2009
The phone rang at three ack emma.
The prefix of the number was one of the ones that Giant Medical Complex uses. Sunnydale General is part of Giant Medical Complex, so I figured they were calling me in to work an extra shift or something, even though I'm not yet fully housetrained. I ignored the phone.
The phone rang again. Insistently. So I picked it up.
"Jo? Are you okay?" was the first thing I heard. "Mmmmmphggggrrblarg, yeah" was all I could manage to get out, but the next thing the person on the other end said snapped me wide awake.
"Are you alone? Are you in any sort of danger right now?"
What. The. Hell. Is. This?
Turns out the Sunnydale General security guys had gotten an anonymous phone call at about two-thirty, telling them that the caller had abducted one of the nurses from the CCU and was planning to do dastardly things to her unless certain conditions were met.
Most of the time, phone calls like that are hoaxes. I mean, crazies call the hospital all the time, threatening all sorts of crap, so it's not like Sunnydale Security isn't used to things like this happening. Apparently, though, this time it flipped 'em out enough that the night house manager was calling every nurse on the roster, counting noses and making sure all was well.
It's nice that they thought to do that. It was less nice when one of the guys from Security called me about a half-hour later, just as I had fallen back to sleep, to determine that no, I was not being held against my will; yes, I am alone; no, I'm not answering under any sort of duress. It's just me and the dog and the cats, dude. It's all good.
I'm a little nervous about what the rest of today and tomorrow will bring. The weekend started with one of the more unusual phone conversations I've ever had, and continued with two more.
Maybe I'll just stay away from the phone. It'll be harder for The Weird to get to me if it has to use a carrier pigeon.
Posted by Jo at 4:44 AM
Friday, October 16, 2009
The cats knocked a whole load of stuff off the kitchen counter at some point last night, and I didn't even hear it. I am not usually a heavy sleeper.
I am punchy. Punchy as heck, punchy as a kickboxing studio, punchy as a church social. But I am also crazyinlove with being in the CCU.
Critical care is exciting because you can see the results of what you're doing right away. It also is completely different in terms of how the nurse interacts with the patient and the patient's family. And, of course, with doctors. All of that has me totally stoked, dude.
On our neuroscience floor, I'd get the occasional patient with problems holding on to or getting rid of fluid. I'd get the very occasional person who tended to go into autonomic dysreflexia, or somebody with neuro changes that were scary or bizarre. Most of the time, though, the folks I worked with were pretty stable, so it took a while for me to see the results of any interventions I thought up or any meds I gave.
Not so in critical care. Cardene drips (Cardene is a drug to control blood pressure) are the shizznit--you titrate the drip up, and boom! In ten minutes, your patient's blood pressure is coming down, their urine output is decreasing (oh! I finally see how that works!), and their headache is abating. Also the shizznit is the technique of chasing electrolytes with stuff like concentrated salt solutions: who knew correcting somebody's electrolytes could make their neuro exam that much better that fast? Let's not forget, either, the fun involved with finally seeing exactly *how* a radical neck dissection affects the other systems in the body and provides a good reminder not to forget the sunscreen. I feel like I'm finally seeing illustrations of everything I learned in school, in real time.
Because most of the patients in our CCU have had something unpleasant done either to their central nervous system or their head or neck, it's important to keep 'em awake and alert, mostly. I didn't really think about that before I started (duh, Jo), so I was a little surprised at how much interaction I've been having with the folks in the beds. Thank Frogs for being on the floor for umpteen years and for learning how to explain things simply. I knew the talent for being able to translate Medicalese to English was important, but I didn't really realize how much *more* important it would be in this area. Let's face it: a lot of critical care doctors are such huge medical nerds that they sometimes forget to speak clearly; it's nice to be able to do some real good in that area.
And the MD/RN interactions? Holy cow.
I thought the relationship I had with the docs on the floor was good. Same docs, same sort of patients, much different environment. On the floor, we had a lot of autonomy and were treated with respect by the docs. In the unit, we work together much more tightly and much more collaboratively. It's not that there's any less respect for floor nurses among the docs I work with, it's just a different level of meshing in the unit.
On the floor, I'd notice the docs were rounding and stay out of their way. They'd flip through the chart, write a couple of orders, leave the orders with the unit clerk, and head on out. In the CCU, though, the RNs round on their patients with the docs. We're all there in a big group outside the door, and I'm expected to be at the bedside with the attending and residents, with all the latest lab results and drug titrations on the tip of my tongue. The pharmacists expect me to understand all the big words they use when they're explaining why they're changing a drug. The anesthesiologists aren't such jerks as I had always thought.
It's kind of weird, to tell the truth. Collaborating on a patient on the floor is one thing; doing it in the CCU is a whole new level of responsibility.
So, yeah. So far, so good. It helps a lot that most of the docs know me already and know that when I get very quiet and serious, it means there's a problem. It helps that I know them already and know when and how high to jump. Still, there's a huge learning curve, and I'm just on the upswing.
But damn, this is fun.
Posted by Jo at 2:29 AM
Tuesday, October 13, 2009
As in, I could tell when the person grading it got sick of grading it and was all, "Oh, fuckitall" and just gave up and passed me. Y'know, like that.
But we're not getting graded. This is all to tell our preceptors what we need help with (Jo: Needs Help With That Thing Bonking Away In Her Chest) and what to focus on. Which leaves me to focus on a site I just found: Bad Joan.
Let's open our bottle of champagne and break out the pizza, shall we?
I have never heard of this "Marcello Toshi" person, but I want to meet him.
Hmm. Is it a denial of my Methodist roots that I see this as a "going to church" shoe? (if church involves, you know, thigh-high stockings and a fascinator with lace in front...)
So not a "going to church" dress, but still. It's not a dress at all, actually; I think it's a nightgown. That doesn't mean I wouldn't wear it out in public.
Ehrm. NO. All *kinds* of ill-advised.
Okay. Now I feel better. I can go back to studying pulmonary hypertension and emergency drugs now, and maybe file my fingernails (entirely too long for a day on the floor, come Thursday; I'll pop through a glove).
Monday, October 12, 2009
Yeah, well, parts of it aren't so bad.
Relearning acid-base balances and hemodynamics and learning about Swans and pressor drips? That kinda sucks. But other parts? Not so bad.
I was thinking yesterday (which is why you smelled smoke) that the best thing about being an established nurse moving from one place to another is this: I already have people's confidence. I don't have to prove myself to anybody; they all know me already.
That doesn't mean that I'm gonna get all puffed up and forget to read my charts, but it does mean that I don't have to go through that awful eight-to-twelve month period that new nurses have to go through, when everybody including you is trying to decide if you really ought to be doing this in the first place. That's already done. Everyone I work with knows what I can do and knows that I don't, say, panic over nothing.
The flip side of that, of course, is that they also remember every screwup I've had in the last seven years. Which, surprisingly, is actually a positive thing. If Resident A or Nurse X remembers that I'm a little goofy about lab results, they'll be watching too, for the patient's sake. It's nice to have people at your back that know all the bad things about you; it means they don't panic unnecessarily.
And, of course, there's the beauty of knowing your own ignorance. When I first started nursing, every day was fraught with peril because I simply didn't know what I didn't know. Now I do: I know nothing at all about cardiovascular stuff, because a) I was asleep that day in school, and b) I haven't used it in umpteen years. I know nothing about complex neck dissections, open sternums, open bellies, or fresh amputations. I know next to nothing about new neobladders, ileal conduits, pulmonary edema, and free flaps that have just been placed. Although it doesn't sound like it, that helps narrow down what I have to woodshed.
And finally, there's the whole neuro side of what I'm doing. It amazed me to find that I know more--a *lot* more--about how brain injuries affect function than some of the CCU nurses do. That's because I've been working with people who are already on the way to recovering. If you have a left parietal bleed, for instance, it's not logical to expect that the CCU nurse will know that that'll likely translate to you ignoring your right arm. She or he has been too busy keeping your ass alive to worry about what you'll do later. It *is* logical to expect that I'll know it, since I've been getting those folks with bleeds ready for rehab for years and years. That helps a lot with family and patient education. It's nice, too, that I can warn them what to expect when they get to the floor and what they'll do in neuro rehab.
So, yeah. So far, so good. This week will bring rotations in the CVCCU, which fills me with terror. I don't know that I can keep six or eight drips straight in my head (which, I guess, is why you write things down) and I'm still not clear on how or why a balloon pump is a great idea, but I guess I'll find out.
Maybe this won't be so bad after all.
Sunday, October 11, 2009
Saturday, October 10, 2009
Friday, October 09, 2009
My child arrived just the other day/She came to the world in the usual way....
A few months ago, my pal Louise had a baby.
A few months ago, my pal Louise had a baby.
I have not yet met the baby, named Laura. She and Louise and Laura's dad live in Denmark, where I met Louise years and years ago during a college field trip to Copenhagen. (Yes, I went to that sort of college--the sort where you can get "life experience" credit for just, you know, living.) Louise and I were immediately great friends, the sort of friends you can only be with somebody who says, "This is my favorite song!" and then plays you a Danish translation of "Cat's In The Cradle," which is your favorite song, too.
Louise is a doctor now, and on maternal leave (which, in Denmark, is incredibly civilized and rational) and is enjoying her time with my niece. My niece is by far the smartest, most gorgeous (she looks like her mother, her grandmother, and her aunt, down to the turned-up Danish nose), most involved baby ever. Anybody else who has ever had a genius baby had just better remove their child from consideration, because Laura is, without hyperbole, the most wonderful child ever. And she will, I am sure, be a wonderful toddler and teenager, because her mother was.
Laura is, in short, the only thing that makes me wish I had had a baby when I had the opportunity.
Someday I will get to meet her and give her all the gifts I'm mentally stockpiling. Laura won't get anything as banal as Legos; no, she'll get a working stethoscope and a microscope and a good set of paints and a full box of Crayolas and the sort of Mister Science set I wished for as a kid but never had because my sister had used up all the cool, poisonous stuff. It's probably a good thing that we live eight million miles from each other, because otherwise Laura would be the most rotten kid ever.
I fell in love with her the minute I saw the first pictures of her as a newborn. It's as close as I've ever come to understanding what mothers experience upon seeing their babies.
Isn't she the most amazing child ever?
Posted by Jo at 5:58 PM
Thursday, October 08, 2009
Okay, okay. It was a fantastic day. I know there will be days when things don't go so well, when people code and die or I get shat upon or I can't keep track of my fluids or don't run a bolus and I'll end up not feeling so swell, but tonight?
I left work with a smile on my face. This has not happened in, oh....four years?
And *everybody* who found out I was moving to the CCU--from the attending physician who's spoken to me exactly twice in seven years, to the respiratory therapists, to the other nurses--said almost exactly the same thing. "What the hell took you so long?"
The MEDICAL FUCKING DIRECTOR, who is also a surgeon, and whom I've worked pretty closely with for the last several years, looked me up and down after I said I was in my CCU internship and remarked, "It's about damn time. I always knew you were a CCU nurse."
The best part of it? If you talk to the nurses in the CCU, they get all excited about their jobs. Like, one nurse's nose and ears turned all pink as she told me how cool it was to work with really sick people and know--rather than feel like--you've saved a life. There is none of that on the floor from whence I came; although people do love their jobs, there's no freshness any more, no enthusiasm.
I have tons to learn. Absolute tons. I've never worked with cancer patients undergoing treatment; I've never seen a really huge radical neck dissection fresh out of surgery. I know almost nothing about immediate postop care of urology patients. But I can learn. And I will.
Why didn't I do this years ago? I always knew, deep down, that I was a CCU nurse.
Tuesday, October 06, 2009
...only because I needed one thing more, just one thing, to make me stop wanting to stab my eyes out today, and to make me laugh instead.
To say I've had a bad day is to say the sea is moist, or the sky a bit up there, or the Pope possibly a very, very observant Episcopalian.
Any day that begins with the words, "What did I tell you yesterday? DON'T TOUCH MY PATIENTS!" and ends with the words, "Well, we think you might have glaucoma" is not a day to be cured with some sort of bullshit, meet-cute crap video for an annoying earworm of a song that never should've made it off of American Idol.
However, it does give me something to hate.
Ladies and germs, I give you: Toque-wearing, whining, meet-cute maestro, Daniel Whatsisfuck:
Posted by Jo at 4:08 PM
Monday, October 05, 2009
I am *so* glad I'm not working Wednesday.
Wednesday, Attila is coming over. And she's going to put me through another hour of high-intensity interval training, just like I did tonight.
It was the single hardest workout I've ever done. Seriously. You know how you say you're gonna cry if you're made to do one more thing?
I actually did cry.
The point for puking on my trainer had passed about forty minutes before.
Anyway, the dirty details will be up at Cranky Fitness on Friday, so check 'em out. I'm gonna have Attila write down every damn thing I do, with the weights I use, and you can be amazed. Or not.
Sunday, October 04, 2009
Let's talk about touch:
Humans want it. Humans *need* it; without touch, human babies die.
Let's talk about what kind of touches we give as nurses:
Starting IVs. Inserting God-Knows-What into God-Knows-What orifice.
Repositioning postsurgical patients who are in pain.
Helping people get out of bed--who are in pain.
Taking out staples, removing (or placing) stitches, putting on TED hose, adjusting traction, cleaning wounds, flopping back gowns so we can see incisions.
How many of those touches don't hurt? Not a one, that's how many.
I came to a horrifying realization several years ago: that I had spent an entire day with sick people, and yet not one time did I touch any one of them in a way that didn't cause them pain. With that realization came the memory of my most kick-ass instructor: she would come into a room, introduce herself, and--without putting gloves on or flipping out--simply *touch* the person she was talking to.
You could watch their faces ease, watch them relax. Here was a human contact that wasn't frightening, didn't bring the promise of pain, meant nothing except "You and I are both human and here's my hand on your wrist." She didn't talk about what was wrong with them, or how their night was, or anything else related to them *as a patient*--instead, she talked about them *as a person*. When their kids were coming to visit, or how the food was. They bloomed.
The most important part of that whole interaction? Warm, live, human skin on warm, live human skin.
We get so scared, as caregivers, of infectious nasties and incurable what-have-yous that we glove up the very second we walk into a room. I'm of the opinion that you can always wash, use alcohol foam, and glove up *after* you've had a little skin-to-skin contact that isn't scary.
I've held hands with my patients--not often enough, but I've done it. Occasionally, at the end of the day, I'll go into a patient's room without isolation gear on (please note that I know I won't have to see anybody else that evening) just so they can see, and touch, somebody who isn't dressed head-to-toe in plastic. I've touched people who were dying, without gloves on, because everybody else was somehow afraid to--and, dammit, if you don't need the skin-to-skin contact of another human when you're dying, when will you need it?
There is no substitute for touch. There is, likewise, no substitute for touch uncontaminated by and unconnected with fear. You can't get better if you're always afraid of what the next person is going to do with you. If you have that one tactile memory of connection with another person, one that's not overshadowed by pain or the anticipation of pain, it'll make you better.
My goal as a new CCU nurse? A minimum of one human, unscary, unpainful touch per person per day. If that means I scrub the skin off my hands between patients, so be it. It might be the only warmth they get that day.
I would prefer to be Harlow's Soft Mother any day.
Saturday, October 03, 2009
I spent the entire day in bed.
Which is not as fun as it sounds, because not only was I alone, I was getting up every half-hour to evacuate one or another storage unit that the human body has. In abundance.
Yeah, I called in sick. They can take it out of my hide later; the way I see it, if I'd had to sit for thirteen hours with limited chances to hit the bathroom, not only would I have come up with a bladder infection for reals, but anybody nearby would've been very unhappy with me. Because that tummy bug? The one that all the interns are getting? I got.
You would THINK (she says, grouchily, looking back at all the people who told her that "nurses never get sick after the first year") that working on a high-acuity med-surg unit with a fucking PRESSURE ROOM and dealing with people who have VISA and VRSA and all those great diseases that are known only by their initials would've PROTECTED ME from some bullshit stomach virus that somebody's kid brought home from school. I *mean*. But no, no; if it's possible to catch it, whatever "it" is, I'll catch it.
I'm half-convinced that the horrible cough/insanely high fever/body aches I had last Spring was H1N1, and devoutly, wholly hoping that it was. Because damn I do not want to do that again.
So, yeah. The entire day in bed, wishing for a dipstick (quit snickering)(you know who you are) to tell me whether or not I was really sickening for cystitis and wondering if Heinlein and Ben & Jerry's have curative powers.* Apparently, they did; I feel better now than I've felt in a week. The Rat Wrangler came by to offer a hug and moral support; thanks to all of you who offered the same. The hug was delivered in person.
Oh, and Molly? I've read differing opinions about cranberry juice and extract, and have come up with only two solid things: first, that you should not take cranberries of any sort with Bactrim, as the cranberry binds to the Bactrim somehow and renders it less effective. Second, that cranberry extract can *prevent* UTIs, but only prevent--once you've got honest-to-Frog symptoms, it won't cure you. (Don't ask where I got that first bit of information; it probably came from Ken the Pharmacist at some point over a bottle of tequila. Speaking of Ken the Pharmacist, he said something weird the other day: "Of course I knew you were transferring to the CCU! You have a whole blog dedicated to the subject!" Which made me look at him narrowly, but if anybody can keep my secrets, Ken can. I still don't know how he found it, though.)
Anyway, yeah. Cranberry capsules, water, and EKGs and Friday**. That was my day. I feel like I have a better handle on EKGs than I ever realized before; I can recognize all of the lethal rhythms and know mostly how to treat them, and I can recognize a number of the nonlethal ones as well. The rhythms that still give me trouble are the blocks. Those will get woodshedded into my brain in the morning.
Meanwhile, Max is outside going ba-roo ba-roo, incredibly happy because it's not only raining, it's appropriately chilly, so he can act like the big furry Northern, kilt-wearing Protecto-Pooch that he is. It's going to be raining again tomorrow, so I'll be up early for bacon and waffles and a big cup of coffee and some....sigh....cranberry capsules.
Thanks for all the well-wishes and encouragement. My mood is much better now that I'm successfully, rather than half-assedly, fighting off this bug.
*So I guess, in retrospect, that I spent the day in bed with three men. Hi, Mom!
**Don't hate me. I tried Before The Golden Age and Ender's Game, and they were both too dense. So was Eating Right In The Renaissance (all of his footnotes are in Latin and Old French) and We Band Of Angels.
Posted by Jo at 5:52 PM
Friday, October 02, 2009
You know that phrase "wheels off"?
I'm coining a new one: "wheels still sort of on, but making really funny noises, and gosh, it kind of worries me." Okay, maybe that's a little long. It still describes my day.
How is it, I ask you, that I can perfectly understand the structure and function of the heart, the way EKGs work, and whether or not a missed QRS complex means you have a block on Wednesday, then find it all impossibly dense on Friday? How is it that I can identify rhythms on one day, and not manage it two days later?
How is it, for that matter, that my grass can go four fucking weeks without needing to be mowed, then suddenly, it needs to be mowed twice in one week? It's not getting mowed today, and thus won't be mowed for the forseeable future, because it's supposed to rain from now until the Four Horsemen show up on their My Little Pony-style steeds. I fully expect to see Max slinking through the waist-high grass by this time next week. He'll have fun pretending he's a big lion on the veldt; I'll have fun trying to mow the back yard on just two Neuton batteries.
And cat hair. I had cat hair everywhere today; yesterday, there was none in evidence.
I'm beginning to sound like Andy Rooney.
Honestly, though? It's all beginning to hit, what I've done. I'm basically starting over in my career, and I miss my friends from the neuro acute care unit. We were family for nearly eight years; they got me through divorce, trauma, happiness, my sister getting married...and I just plain miss them. There are inside jokes my new colleagues just can't get, and quirks I have that they're not used to, and that makes the transition hard.
The guy who changes my oil went from being a sweet, kind of clueless nerdy type last month to having fresh tattoos of zombies on his arm and rivets in his ears today. *That* was a shock.
Max is getting grey around the muzzle. There's no other evidence that he's getting old; in fact, he's more active now than he was two years ago. But I still notice, and I wonder how much longer he'll be around.
And I'm fighting off, simultaneously, whatever bug is going around at Holy Kamole (fever, chills, nausea, diarrhea; not the H1N1 flu) and a bladder infection (hooray for cranberry capsules!). In an attempt to give my body what it needs, I've bought sour-cream-and-onion chips and Ben & Jerry's.
Frankly? I could use a hug. I wish my long-lost Polish buddy Arek were here; he gave the best damn hugs on the planet (partly because he was, like, seven feet tall and three hundred pounds, with an enormous curly red beard). I could use a couple of glasses of wine with Friend Pens. I could use a really, really good dinner with little deep-fried squidlians and endive and all those things I don't normally eat, then a walk in cool weather along a river I'm not familliar with.
*sigh* Potato chips and soprasetta for me, kids. And artichokes and clarified butter. And another beer, and another week, and maybe things will improve.
Posted by Jo at 3:17 PM
Thursday, October 01, 2009
Max went batshit insane today, just as there was a nice big storm blowing in. Normally, Max does not go batshit insane with storms; he instead scratches apologetically at the door and asks to be let in.
Not today, though. Today was growling, snarling, barking, howling insanity in the back yard.
Now, I have to set this up for you:
Imagine the biggest German Shepherd you've ever seen.
Cross that with something that's mostly blonde, much stockier than a G.Shep, and equally as furry.
Add a healthy dose of Mellow.
Toss in some love for kitty-cats.
Slap on a couple of pounds of happy, add a schmear of totally unflappable, and take out all the ditzy, weird, spooky behavior that overbred dogs can have.
You'll end up with a mutt who, like Max, is normally the calmest, most Zen being on the planet. He barks, yes, but it's understood that he's not really barking at the postman; it's a formality on both their parts. The postman regularly comes over to the fence to scratch Max's ears. Likewise, he'll bark at dogs wandering past (and bay at his girlfriend the basset hound), but he would never growl at or bite your average dog that comes right up in his grill. He's mellow, you see. He's kind of a Southern-California type dog, taking each day as it comes and chilling out.
So, when he went absofrigginglutely batshit insane, I let him in. I figured there was something out there that I needed to be aware of, and better he's in the house than out of it.
Sure enough, the doorbell rang.
Max went straight to the door, ignoring my "back" and "sit-stay". He stood at the door, looking interested. This is normal. Ignoring "back" and "sit-stay" is not. I opened the door.
On the doorstep stood a clean-cut young man who was obviously there to sell me an alarm system, or offer one for free for a limited time only! or beg me to put his company's sign up in my front window.
Max stalked forward, ears up, hackles rising, legs stiff, normally-curly tail straight out behind him. There was a low, almost-sub-audible growl that I could feel but not quite hear coming out of his chest. The guy on the porch said nervously, "Uh...nevermindseeyoulatersorrytodisturbyou" and left as quickly as I've ever seen a person leave who was not actively being pursued by an unholy combination of fire ants, cicaida killers, and door-to-door evangelicals.
Max got some cheese. ("Cheese? I LOVE cheese! How 'bout some bay-cun too?") He's now lying calmly under a tree in the back yard, grooming his hind feet. All the doors and windows are locked.
Let it never be said that I don't know how to take a hint.