Saturday, April 28, 2012

Big Drama at Sunnydale.

Phiddipus audax, the Daring Jumping Spider (how much do you love that name?) is making its summer home in my house. We do this every year: I see a cute black spider with white spots and bluish-green what-d'ye-call-em (those things that the fangs come off of. Not pedipalps, the one that starts with "c") and catch it and put it outside. This year I missed the Mother of All Audax, and she spun a nest at the corner of the wall and ceiling in the kitchen.

After some research, I decided that the thought of several hundred, maybe as many as a thousand, spiderlings was more than I could stomach, and sucked her into the Miele. I feel awful about it, but we need the rain. (Bonus points for the first Minion who understands that last sentence without using Google.)

Sunnydale's NCCU is in the grip of Big Drama these days. A particularly difficult doctor and a couple of grouchy colleagues of mine have made it their mission in life to submit incident reports for everything, and I mean *everything.* Unfortunately, the doctor writes up nurses for things that she, the doc, should've done (like writing orders) rather than get in trouble with *her* boss, and the grouchy colleagues are sending off irate and insulted emails about things like the lack of housekeeping standards 'round those parts.

I got written up for three things, two of which my boss and I agreed weren't really relevant. The third was not only totally justified, but pulled me up short. I've gotten careless about making sure orders get written, so it looks like I've been haring off on my own, making treatment decisions. This is obviously bad. Nurse Jo is going to spend more time checking orders prior to punching out, and probably doing a lot more last-minute running around to fix things as a consequence.

So yeah, I fucked up. I got called on it. Though I'm not crazy about the *way* I got called on it, it's a good reminder that you have to behave like a brand-new nurse all the time in order to make sure you're not getting careless.

The whole shebang also pulled me up short because it made me realize how scatterbrained I've become in the last few weeks. It made me analyze, thoroughly, *why* I might've gotten scatterbrained and careless, and I came up with what I think's a pretty good reason: I'm overburdened.

When I'm primary nurse in the NCCU (we usually have three nurses, with one taking three patients, another taking two or three, and a third helping out in the absence of a patient care aide), I have a patient load of three. These are acutely ill people who are generally leaping out of bed or desatting or doing some combination of the two, sometimes with a third fun thing thrown in.

I'm also charge nurse, dealing with staffing and bed assignments and crises. I'm also acting as secretary, breaking down charts and answering the phones and entering orders. The facilities management and biomedical repair staff deal only with me: they ignore the other day-shift nurses and hold on to their questions or problems until I'm on staff. I'm also the only person who's allowed to do certain tests (with hyperagitated goo and saline), so I do all of the ones in the entire hospital, as well as the clinic next door. Plus, I do around a hundred chart audits a month to make sure we're in compliance with whatever brilliant idea the Joint Commission's come up with this week.

Some of this stuff has *got* to be delegated. The most obvious solution is to delegate the chart audits, probably to the night staff (which will, I'm sure, make me their most favorite person ever). The other stuff, I'm not so sure about. We've got to get more people trained in the more obscure test protocols; the obvious solution is to train the charge nurses for the other CCUs. I'm not sure how well that'd go over, though, as they're just as overwhelmed as I am.

My first step is to chart exactly how much time I spend doing things other than direct patient care. Given that I round three times a day with residents, midlevels, and attendings, then implement whatever they want implemented, I think that charting'll show I'm really busy. Add in all the other stuff, and. . .well, it'll make a good argument for me getting some relief.

And hopefully, if I get some of this crap off of my to-do list, I'll be able to concentrate on what I'm there for: you know, taking care of sick people and not screwing up.

Tuesday, April 24, 2012

Monday, April 09, 2012

0:04 at Casa Del Snotbags

I'm strung out on pseudoephedrine (that beautiful demon) and researching plants from exotic nurseries. These are not, as you might think, nurseries that have dancing poles and topless women all over the place; they're nurseries from whom you can get things like amorphophallus* and elephant ear.

Notamus is out in the Kitty Koop, watching the bats with envy. He's convinced he can become a bat by his next birthday if he only tries hard enough. The best thing about being a bat, he thinks, is that he'll be able to fly to chase craneflies rather than just jump. (Sometimes I hold him up so he can reach one that's particularly high on the wall. Yes, I spoil my cats.)

Flashes is sitting on the kitchen windowsill, playing Bonk That Junebug. The junebug lands on the kitchen window screen and sits there. Flashes noses it, and it goes *bonk* onto the outside sill. Then it climbs back up and sits. Flashes paws it, and it goes *bonk* again. Lather, rinse, repeat. Infinitely.

They have both taken to leaving half-chewed junebug corpses in my shoes. This is better, believe it or not, than cranefly legs *everywhere*, including my pillows. It's like a battalion of drag queens with bad eyelash adhesive came over when they do that. "I love you; have a piece of bug" seems to be the new cat-speak.

Max's ears are coated with triple antibiotic and the rest of him is coated with citronella spray. He has a pleasant, lemony scent, like an enormous mobile air freshener. I really should've groomed him today, but the logic of headcolds is that you can't move during the day and have tons of energy at night. He's sleeping in the kitchen, alternately snoring and boofing very quietly as his paws twitch. I think he's finally catching the ice cream truck.

My cold is, strangely, better. I still can't produce anything more than a squeak when I talk ("I'd not mind that he speaks/In gibbers and squeaks/But for seventeen years, he's been dead") and my throat is kind of sore, but I feel almost okay. I sneezed something truly horrifying out of the operative side of my sinuses this morning; it almost made me re-think the wisdom of daily antihistamines for allergies. There's such a thing as stuff getting too dry up in there.

Still, I managed to make it out to the store for real Sudafed and soup and tater tots. As I went through the checkout line, the sixty-ish woman who was checking remarked on my lack of voice. I whispered apologetically, "Yeah, I have a cold."

"Honey," she said, "You go home and make yourself a toddy and feel better. Don't mind if all you want is your mamma. I get a cold, all *I* want is *my* mamma."

That made me feel better. Plus, The Lovely Diana gave me a recipe for a hot toddy that consists of honey, heated up, and double that amount of rum. She says it won't bring my voice back, but I won't care. It's apparently an old Cuban recipe, used far and wide on everybody from children to ancient grandfathers, and she swears it's safe as houses. Given her propensity for being attacked by wildlife on vacation, I'm not sure I trust her, but I'm willing to try anything.

Tomorrow's to do list: Nap, Rum, Nap.

*Okay, that's almost as bad as topless nurserypeople.

Sunday, April 08, 2012

My poor Max!

I got home tonight to discover that The Best Boy had a bloody head. Not specks or splotches of blood, but patches of bright red rubbed-off blood that had come from somewhere else. When I looked closely at his ears, I discovered that they were covered with the awful, horrible, nasty, icky biting flies that drink blood and come around in the spring.

Vampire flies. On my boy.

So I brushed them off and let him in and anointed him with antibiotic ointment. Then Flashes sat down and groomed his head, so that the blood wouldn't make him any less handsome. You could see where he'd shaken, hard, trying to get the flies off, and where he'd rubbed his face with his paws to discourage them.

Poor guy. I have no idea where the flies came from. It's war, though: tomorrow, rain or shine, I am putting out freaking fly traps and laying down cedar granules and nematodes.

And I have a cold. This is the first time I've been head-sick (as opposed to tummy-sick) since surgery. Eighteen months and no clinging head cold; this one could not be dislodged with zinc and Emergen-C. It is, of course, the Worst Cold Ever, and I Need My Mommy. I have completely utterly totally lost my voice and there are interesting poppings going on in the neighborhood of my right ear.

But I'm much more worried about Max. I, after all, have bourbon. Max only has ointment. He's sprawled out on his bed right now, sound asleep. I wish I could give him some Maker's.

I also wish I had a toaster that didn't have two settings: Raw and Burnt.

I also wish I had a gallon of Mom's Mexican chicken soup.

I guess this is what those damned swollen nodes in my chest were trying to tell me.

Friday, April 06, 2012

Clean CT!

No nasties in my chest.

There were a couple of swollen lymph nodes, one borderline, but once Dr. Crane looked at the back of my sinuses (conveniently exposed for his perusal) he said, "Oh my gosh! You have a lot of goop in there, for sure. Y'know what'll fix that up, is a Solumedrol Dose-Pak. . . "

(glances over at my face)

". . . . or not. Um. . .you don't like Medrol?"

"It makes me want to hug people."

"It makes you want to hug people. . . .?"

"Until they stop breathing."

The swollen lymph nodes are a reaction, apparently, to the horrid allergy season that's hit us this year.

My next scan is an MRI in four months. Wahoo!

Monday, April 02, 2012

Tap, tap, tap. Drum, drum, drum. Twiddle, twiddle, twiddle.

There's a lot going on at work, but I'm too distracted to write about it right now.

I had my first follow up chest CT today, with and without contrast, wahoo. Stevie was very kind and put a 22g IV into my 18g-worthy hand vein, so I have only a minor bruise on the back of my paw. Given that I bled for forty freaking minutes after I scraped my knuckle the other day, a minor bruise is a good thing. Maybe my aspirin dose needs adjustment.

Tap, tap, tap. Twiddle, twiddle, twiddle.

I'm obsessively checking my work email. Last time I had a scan, Dr. Crane sent the results to me there. I don't know how long it took, though, because I hadn't checked my email in days and days. Now I'm trying to remind myself that no news is good news, and trying *not* to read into Tracy's expression as she was helping me off the CT sled. Her usual expression is no expression and that's what I got today so that's got to be good, right?

Drum, drum, drum. Pace, pace, pace.

Surely it's going to be fine. Right? Right. Negative CT. Negative CT. Think negatively. Even if there is something there, it means that whatever-it-is was found quickly, so it'll be relatively easier to treat. Right? Right. But it'll still be negative. My goal for this year is to not have surgery.

Twiddle, twiddle, twiddle. Check email. Nothing.

I have to make lunch for work tomorrow, but I have no appetite and am therefore uninspired.

I'm going to go steam some asparagus. It beats pacing and twiddling.