Saturday, April 17, 2010

You'd need three words to say anything sweeter.

"You're cancelled."

God, I love that. I especially love it when I've already accomplished everything I wanted to do tonight (organize utility room shelves, wash and rehang curtains, finish laundry, vacuum, clean bathroom) and have had dinner besides, so the rest of the night is gravy.

And it's raining, to ice the cake. And it's supposed to rain all day tomorrow, too.

Max is indoors on his bed, snoozing damply and waking up with the occasional *boof* when he hears the neighbor dogs bark. You can, if you look closely, then see the wheels turning in his head: is it worth it to go outside in the wet and pretend to be Braveheart, or should he stay here inside, in bed? Bed wins.

The guy I took care of for the past two nights, the one with the crazy electrolyte imbalances (potassium of six, anybody? Calcium of three-point-eight? You go!) has transferred up to the floor. The other guy, the one who had his entire throat rewired, will be with us for a day or so more, but at least I don't have to be the one checking four pulses with a Doppler every hour and hoping the flap stays viable.

I feel so sorry for people who have complex head-and-neck dissections, or folks with really complex plastic surgery. It's never for a benign reason that you get a flap; it's always because you have to have a breast or two removed, or (God forbid) your entire tongue, and you get some new architecture on your face into the bargain. No matter how good we get at plastic surgery, a jaw that's rebuilt from leg bone will never, ever look like the one you were born with.

Add to that pain and fear and general anxiety that you've got a nurse coming in every hour on the hour, smearing light-blue conduction gel on your new face or new chest and checking for the swish-swish of a good pulse, and you've got hell on wheels. There is not enough Ativan in the world to make me willing to go through that, yet I ask if of my patients every night. They can't even *sleep*, for the love of Mike, and yet we expect them to get better.

You can, eventually and with enough support, get used to not looking like yourself. I imagine you can get used to having tattooed-on nipples (though I'd hate to have to) after a while. It's what we put them through in the meantime that kills me a little every day. I want to let them sleep, to feed them decent food rather than the weird stuff from the hospital kitchens, to touch them without gloves. I'd like to touch them without hurting them once in a while.

People go through hell before they heal.

Sometimes I wonder if the advances in surgery and technology really make it worth it.

With all of that, and with the continuing revelations that the people I work with on nights are ka-ray-zee, I've decided to take the job in the new neuro unit. It'll be back to all brains, all the time. I have to cast back six years to the last time I did brains and spines exclusively, and it seems at this distance to have a nice rosy cast to it. I'm sure there'll be parts that suck, but at least I'll be doing things that are less painful and invasive.

One of the unit managers came to me last night, envious that I'd gotten the offer to work on the new unit. Apparently, my current manager doesn't know my long-standing reputation as a rabble-rouser/pain in the ass, but everybody that does is excited that I might actually have something to do with how the new unit's laid out and run. As the other unit manager said to me, "Make sure you work it so we can see all the beds from the desk, okay?" Like I'll have anything to do with that, but it's nice that she has confidence in me.

One of the newly-minted neurology attendings asked me if I planned to take the job on the neuro CCU. When I said yes, he sighed "Thank GOD."

I guess it'll be okay. If it's not, there's always the general CCU to go back to, or I could conquer my mental block about telemetry and go work for CVCCU (note to self: cute male nurses on CVCCU! Wahoo!). We'll see.

In the meantime, I have Fritos to eat and a dog to scratch. *Boof!*


woolywoman said...

Oh, yes! Cancelled! I love being a nurse, just some days I don't like going there.
Fell ya on the head and necks. I teach every one at our big old center of excellence how to care for their new trach at home, and I tell you, I hate trach boogers. Usually a bonding moment for me and the caregiving spouse when they shriek "it's so gross!" and I have to say, yup, it makes you really appreciate nose breathing! Older people look fine after the giant free flaps- we seem to expect less perfection of the seventy year old face. Younger folks have it tougher- no matter how good the work is, its still not original equipment.

Marjorie said...

As an OR nurse, I definitely agree with you on the whole surgery thing. People forget that no matter how small the incision or "minor" the surgery is, it is still something invasive to your body.

Good luck on your new gig...

Take care,


Penny said...

BOOF!!!!!!!!!!!! I'm happy to hear about the new gig. Relieved.


Molly said...

woolywoman, I was doing my dad's trach care for a few months, and OH MY GOD IT'S SO DISGUSTING. I never did get used to the smell. I seriously don't know how y'all can do it day in, day out.

messymimi said...

Congrats on the new job! I hope it turns out great.

As for whether or not putting people through the hell of healing is worth it, I guess it depends on whether they honestly would prefer the alternative.

That is a tough call.

Anonymous said...

In my opinion, the only thing worse than a trach is a GI bleed. An old one. On the other hand, maybe they're the same.

Glad you're going to the new unit. Ours is the best unit in the entire system.

Alena said...

Try a potassium over 7.5 (not hemolyzed). That's what I came on to the other day. Gotta love pediatric metabolics. Yes, intern, I would order a STAT EKG. And despite what you say I will be taking this child straight on up to the PICU, we don't really like labs like that on med/surg.

p.s. love your blog, I'm a long time lurker.

Jo said...

Alena, I would contemplate a K+ of 7.5, but my head just exploded.

I am SO GLAD that kids are made out of rubber and springs. Yes, yes, I am.