In which Jo gets punch-drunk.

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.