A Peek Into My World

Here I am...almost midnight. I have a cup of tea in hand and I'm kinda hyper. You've been fair warned.

13 hours. 3o min lunch. 2 15 min breaks (if you get them). 3 assessments. 2 I&O's (intake and output). Q1 vitals (Q means every hour). Maybe Q1 glucose sticks if you get the short end of the stick. 1 CT scan. Countless meds. My life at work is measured in chaotic predictability. An oxymoron you say? Things are not what they seem...

People really have no idea what my day to day looks like. They either believe every minute is a trauma scene from ER where I'm sweaty from doing chest compressions and yelling "Get the crash cart STAT dammit!" Or they think I get paid to babysit deranged and demented neuro patients who throw their sippy cup on the floor a billion times and I have to pick it up. It's somewhere in the middle. So here's a layout for you, a night shift layout since that's what I'm currently entrenched in. Ready, set.....set....go.

I arrive at work between 6:30 pm and 6:40 pm (1830-1840). The charge nurse comes in, reads a synopsis of each patient, and then all hell breaks loose. By this time, I've learned to listen for the most pertinent information. Q1 glucose sticks= a huge pain. Contact isolation= skip that one. Wady (our term for actin a fool, trying to get out of bed and such)= guaranteed frustration by the am. Blood pressure issues= a sick patient (aka fun). At the instant the last syllable rolls off the charge nurses tongue, everyone begins screaming the pair that they want. There is a strategy to this: get there early so you get a seat next to the charge nurse and yell directly into their ear or get there late so you can stand over their shoulder for maximum proximity. Sometimes you get lucky, sometimes you panic from all the pressure and end up taking whatever is last. Sometimes it ends in hurt feelings, bitterness, and cussing. All that fun before your shift starts.

You either skip with glee or drag morosely to your side (depending on the pair you got) and get report from the off-going RN. There's also a system to this and some people get really FREAKED out if you don't follow it but that's for another day. You begin your 8pm (2000) assessments. Then you chart. The goal is to be done by 8:30-8:45. Now if your patient throws up or poops or some other calamity, the course of your night will already be altered. But you go with it. Flexibility, people.

At around 9:30 (2130), you can start doing your 10pm stuff. You go get your meds out of the pyxis, empty the foley bag, clear your pumps, give the meds, and chart. We do I&O's (intake and output, remember it- I don't want to have to define it again young lady) twice on night shift which is fine if you have one pump but sucks if you have to count about 9 JP drains, two chest tubes, an ostomy, a foley, and a flexiseal. If you don't know what some of those things are, there's a little thing called google.

Now at this point your night could go several ways. Your side could be getting a lot of new admissions so you spend all your spare time helping your cohorts. You could have an existing patient crump out of nowhere and end up coding him. You could have a habitual pooper (the worst) and spend every 30 mins cleaning up the same you know what. On a magical night, when the mice and birds sing to you and you're home by midnight with both glass slippers, everyone stays quiet. You spend some time chatting with your friends or reading a book. But sometimes you're bored and want to stay busy. So whether it's good or bad depends on how much sleep you got the day before and if you just want to go home already.

At midnight you reassess your patients, give meds and draw labs. If you patient has a great arterial line, then you can draw the blood from there and it takes two seconds. Piece of friggin cake. But let's say Pedro here doesn't get blood return from his existing peripheral IV's and has crappy veins. You spend about 30 minutes looking and poking at veins until finally you get barely enough and pray that lab doesn't cause a ruckus. I can't even get into the subject that is lab. Probably not ever, if I'm attempting to do this thing called sanctification. If you have a neuro patient, you might have to travel down to CT scan. You have to unhook your patient from all non life-sustaining drip meds, pack them up, and transfer them to a stretcher. That takes anywhere from 5-15 mins. Then you and either the respiratory therapist (if you're patient is vented) or a tech go down the elevator, push the stretcher really fast like this is vitally important (it makes it so much more dramatic and entertaining), get to CT, move your patient onto the CT table, take the CT, and do the whole thing in reverse. Reverse. reverse. Everybody clap your hands.

Everyone usually bathes their patients between 2-3 am because there's not much else you need to do during this time. Granted, if your patient is stable and sleeping, you might want to spare them the early morning embarrassment and let them do it themselves during the day shift. At 0400 you reassess again (last time) and chart.

Now around 0500 an ominous thing occurs. If you're a rookie, you get sucked in but later on you learn how to deal with it... Medical students. They come to your bedside about 0515 and want to anything and everything about your patients. If you don't know any better, you'll waste a good 15 minutes updating them because you believe they actually have some impact on patient care. Now don't get me wrong, I love myself a good med student, especially if he's cute and nice to me, but there's a time and place. When I'm tired at 0515 is not that time.

At 0530 you start again with meds, I&O's, and maybe a serial lab or two if we're gettin crazy. The doctor teams starting rounding and everything starts to wake up (except you, who are on your 3rd cup of coffee). Family members come back in and your replacement nurses make a lap or two before shift starts. Those last 30 mins (0630-7) are the longest of your shift. But they do come to an end, you give report, and assuming nothing happens and you don't have to intubate or code anyone, you clock out and go to breakfast. The sun is rising and the early morning traffic is at its best as you drive home to convince your body that yes, now is the time to sleep.

There you have it. I hope this affords more clarity to those of you who see my job as a nebulous cloud of abbreviations and big words. And if you ever want to go to breakfast when I get off, let me know :).

4 Truths and a Lesson

People often ask me "what's the craziest thing you've ever seen at work?" I will now share with you, blogging universe, some of the highlights after my own introspective moment.

Until college, I would not have considered myself an outgoing person. I was perfectly adequate. I was not the life of the party neither did I have fun stories to tell or make people laugh. I became more outgoing partly because I grew up a bit and became more confident but also because I forced myself into a lot of situations that seemed intimidating and did many things on my own. Now I'm the elected social chair of our small group (don't laugh, we like it) and I don't find myself uncomfortable in social situations (save a few, especially if there's a boy I have a crush on. Then I shut up completely). Generally I could talk to a wall and it would like me back.

Now people sit and listen intently and, can you believe it, laugh at my stories! Who would have thought I'd see such a day. Mostly it's because I have a cool job and see ridiculous things. But it's been a new change for me so thanks for laughing guys.

In no particular order....

Crack does more than kill your brain cells.

Gangsta comes in, high as a kite, complaining of a headache. Because it's not a life-threatening injury he doesn't get immediate treatment but waits in a room to be seen by the physician. Some time later a nurse comes in and sees him unconscious with a pool of blood behind his head. So naturally, everyone freaks out, takes him to CT, etc and guess what they find... I know you're waiting on the edge of your seat... Gangsta buddy here has a bullet in his brain! Apparently he was so doped up on crack that he didn't notice he'd been shot in the head. Not really sure how you miss that one...but he landed himself an emergency craniotomy and all expense paid trip to the ICU, complete with restraints and a draining device in his head called a ventriculostomy. Spin the wheel again and see if you get the corvette.

This one was horribly sad and I wish I had never seen it. A middle school aged kid went out to ride 4 wheelers with his dad, like many children do everyday. He had a helmet on and everything. But somehow he took a terrible spill, helmet came off, and he bashed in his brain. After he was delivered from the chopper, they rolled him in and you could see his brain. His skull had been destroyed in one area and I could see the inside. It's cool on a cadaver, not cool on a child.

You thought leeches were a thing of the past huh, along with bloodletting and casting magic spells on people with rabbit's feet. You have been misinformed sir. A young cattle rancher was practicing his roping with a calf, got the rope caught around his thumb, and took it right off. He did get the calf, in case you were curious. So in a valiant attempt to re-attach his thumb, they put leeches on it to improve the circulation and hopefully the thumb would heal back together. So you walk into the med room, open the fridge to look for some jello and hello! there's leeches, not to be confused with the juice or ensure. Just another reason why you should always check expiration dates.

Last one. A young girl is driving down the road, gets hit, runs off the road into a yard, and ends up with a 2X4 from a fence through her neck. THROUGH HER NECK. Because the paramedics can't just take it out, they have to saw off both ends and bring her to the hospital with a part of the wood still in her. (Obviously I did not personally see this but I read the chart so shut up). They take her straight to the operating room and remove the 2X4. At a cost. Her spine was so destroyed from the injury that she became a quadraplegic. I had her as a patient one day and she was the sweetest thing. Most of the time, quad patients are not the most fun and you can't blame them because their life was drastically changed forever. I'd be in a pretty bad mood, no doubt. She was younger than me. Talk about a reality check. You better believe I drove carefully on the way home.

There you go. Snippets of my crazy life. Lessons: drive carefully, flush that crack down the toilet, and call your mom to tell her you love her. Always wear a helmet and a seat belt. Figure out what you think about God. If you want to chat about it, let me know and I'd love to talk with you. Kiss your kids before you leave for work. Always put the safety on. Never go to bed angry. Don't drink and drive. At the end of the day, sometimes things just happen despite what you do to prevent it. But my kids have no chance. Not even sure if I'll let them play baseball. At least I've got some time to decide on that one.