Thursday, January 26, 2012

Why I love my job, part umpty-umpty-ump:

1. Standing around on rounds with the chairman of the department and the United Nations of Neurology (aka the residents), trying to figure out what the hell is wrong with a particular person. "He can't read out loud, but he can read silently and give you a good summary of what he's read." "Do you suppose that guy has edge-sensing and blindsight? That would be really cool. I've never seen a case of blindsight before." "How the heck are we supposed to get her to eat all of her food if she has total extinction of the left side?" (Me, having read Oliver Sacks: "Just tell her to turn her plate to the right until more food appears." Neurologists, not having read Oliver Sacks: *gaping in amazement*) "What about that one dude who sees only in black-and-white? Is that any better?"

2. Seeing function come back after TPA administration. Normally we don't do MRIs prior to TPA, just CTs. The MRI suite is always so busy that holding TPA until we have a solid MR image would push most of our patients out of the window (in terms of time, not literal defenestration). That means it's always kind of a crapshoot in terms of what we'll see, depending on whether the embolus was a clot or plaque or whatever.

3. Learning even tinier details of brain anatomy every single day. Just when I think I've got a good handle on things, some genius comes up with a theory that a patient's symptoms are due to a minor derangement of Whargarrbl's Foci of Bolognese's Range of the Straits of Inglewhazzit. It all starts to sound like Terry Pratchett, and I'm off to the textbooks again.

4. Learning really gross things about gross anatomy. Turns out there's a nasty situation that can happen inside an artery that causes a big snotlike glob of fat and plaque to detach partway and hang there in the blood streaming from the artery. Except that it's attached at one end to the wall of the artery, so it just goes "hrrbl hrrbl hrrbl" and blops around, occasionally causing TIAs. I can't remember the name of it, but if I see it again, I'll know it.

5. Knowing enough to explain what's going on when somebody in a different department starts freaking out about the YouTube video with that octopus? That's dead, and in soup, but then somebody pours vinegar over it? And I can explain how the acid in the vinegar stimulates the sodium channels and makes the octopus-food-corpse-guy want to crawl out of the bowl. That's really cool. I like that part.

Wednesday, January 25, 2012

In which Nurse Jo performs an assessment:

Nobody died over the last four days: good.

TPA given to two people who needed it: good.

TPA given to one person who has a factitious/psychological disorder: well, no harm done.

Intubation of one patient: very, very good call.

Extubation of another patient: good. I'm glad her daughters got to be there.

Lotioning of a patient: Jeebus grits, why did this woman have to use Johnson's Baby Lotion? I hadn't smelled that smell in better than twenty years. It took me back to watching my grandmother get ready in the morning, in her alcove lined with mirrored closets, and her vanity mirror with Johnson's on the table.

I think I might have to go buy some Johnson's Baby Lotion just for the helluvit.


Oh, dear.

Noticeable right nasolabial flattening. Left neck musculature overcompensates for right on swallow. Left and right shoulder shrug equal. Right facial and neck dermatomes non-compensatory; total extinction of buccal and mandibular distributions. Compensation adequate.

Crooked smile: my new trademark.

Tuesday, January 17, 2012

So, yeah. Hey. How you doin'?

Well, we're moved.

We have a spandy clean new unit with seven (!!!) beds, monitors, a central monitoring station, computers that work, (oh, crap, I just realized I have to call them about the call light system) and beds and so on that actually function and don't have bits broken off of them.

So that's what I've been doing for the last couple of weeks. That, and the usual keeping people from falling out of their chairs or having larger strokes or otherwise having complications that would keep them in the hospital for weeks and weeks.

The first thing I did in the Spandy New Unit was stretch my arms out from my sides and turn in a complete circle. That did not used to be possible. The second thing I did was walk from one end of the floor to the other, giggling, and saying "wahoo!" softly. Then I got my poop in a group and got the patient we had to move to her new room.

It feels a bit like a shakedown cruise. There's still a lot of stuff that doesn't work, and things that could be neater or more convenient, but we'll work those out in time. Right now, I'm just grateful to have a place to put people where I can be relatively sure that the walls won't catch fire and I can get them into and out of the rooms through doors wide enough to admit hospital beds.

Wednesday, January 11, 2012