Thursday, May 19, 2016

Ch-ch-ch-ch-changes. . . . .

It's been a rough couple of weeks on the neurocritical care unit.

Marcie left; she went to neurosurgery's clinic, to cat-herd all their patients into craniotomies and gamma radiation. Kitty is in Europe as a whole for a month--actually forty days--and I'm wondering what the fuck I'm supposed to do without her, since I can't get the EKG printer to work correctly. Deej is going to work in a post-surgical ICU near The Schwankiest Mall Ever. And I'm left, oddly enough, as the nurse that everybody turns to when they have a question.

I wasn't expecting this. First I was a new nurse, but with experience in places much weirder than Sunnydale (Healthcare For The Hellmouth)--thirteen year olds with a methadone card and a 17-week uterus, or a bookstore where people might actually pull out a gun if you didn't buy back their obviously stolen books. Then I was a slightly experienced nurse, with some questions about the finer points of, say, Mobitz blocks or pseudobulbar syndrome.

Then, all of a sudden, I was that nurse everybody turns to.

There's Beth, but she's more cardiac than neuro. And there's Shiny, but she's not particularly forthcoming, although her smile lights up her face and she's always ready to help. She thinks her English is worse than it is, so she keeps to herself.

So I'm the one everybody calls when they have an IV they can't start. Or when they have a patient who's suddenly satting 80 percent on a nonrebreather. Or when the 97-year-old granny who's on palliative care decides to stop breathing, but nobody's sure she's dead.

Protip: If they're cold, and their pupils are fixed, they're dead. Just sayin'.

We had a lovely, amazing, talented 27-year-old dancer with a barely-week-old baby in. She had given birth, and then suddenly stroked out. Not because of her pregnancy, but because of a rare autoimmune disorder. She stayed with us until Tuesday last week, when she projectile vomited and became unresponsive. And we discovered that she had stroked out the entire left side of her brain, full stop, no hope.

So we brought her back from CT and suspended treatment, and allowed her little boy in to see her.

At the same time, our 97-year-old granny was giving up the ghost after a right MCA stroke that had led to aspiration pneumonia.

I didn't have them at the same time; I was busy with a crack-addicted heavy drinker who came in with a potassium of 6.7 (insulin drip ahoy) and a sodium of 117 (oh hello hot salt). Still, I was the person that the other nurses came to when people stopped breathing.

And so I got to pronounce one patient with another RN and notify the doc for a second patient at the same time. They stopped breathing, both of them, at 0936 am. I hope that grandmama showed the young mom the way toward the light. Any other thought would be too much.

Patients transition without pain if we do our jobs right. I am transitioning from the bumbling medium-experienced nurse to the Old Salt With Tales To Tell. I hope I can do it fairly painlessly.

10 comments:

Lynda Halliger Otvos (Lynda M O) said...

Where would we be without women and men in the trenches with stethoscopes around their necks ?~! Thank you for all you do everyday.

bobbie said...

{{{{}}}}

Pam said...

Your time has come, Head Nurse Jo!

Old Fool said...

I thought that I was the only older salt with tales to tell. From my perspective you are still a bright young whippersnappern doing a great job.

RehabRN said...

Two words: oh my! Hope your weekend is good. You've had enough excitement for a month.

clairesmum said...

Take good care, Jo. You know it's hard to be the one that everyone else turns to for help...I hope there is at least one person that you can turn to when you need help, too!

cowango said...

Turnover is so rapid these days that the old salts monicker comes along fairly early in. one's career. But I think you deserve it.

Comradde PhysioProffe said...

Yeah, it's funny how you just keep thinking of yourself as still junior, and then all of a sudden seniority sneaks up on you. Very inspiring post!

Elle said...

Everywhere I have worked, there has been a tyranny against the most competent. Meaning: the most competent people end up working the hardest, fixing other people's mistakes and taking up the slack from the slackers. Hang in there. Your kindness and intelligence are badly needed in this world.

Anonymous said...

If you don't have a good doctor, you better have a hell of a good nurse.