7.22.2010

Torential downpour

Bear with me. I know it's long, but hang in there, it's very insightful!

I usually scoff at someone who seems to be exaggerating (even though I do it myself) about everything breaking loose, or when it rains it pours, or something to that effect. Today wasn't just a shower, it was like a tsunami followed by a hurricane that grew into a tornado. I know I will always have a job on days like this.

6:26am: drove the colossal truck to work and I couldn't get my iPhone's music to work properly with his confounded radio. Thankfully, my sunglasses were in there, so I wasn't fight the truck's will, the radio's refusal, and the sun's glares.

6:35am: dug around the truck for some (lots!) of loose change because I left my wallet in the bambino's diaper bag. Freaked out for a bit when I couldn't find my badge, and almost hit the car next to me with the truck's door.

6:40am: clocked in, and headed for the morning huddle where I found out 1) there were only two RN's and 2) our NCP (basically a CNA without a license) was the laziest person ever! I think she spent all morning on the phone or online with her bank, except when I pushed the glucometer in her hand and told her I had a patient with an insulin drip that needed a blood glucose every hour on the hour.

7:00am: arrived on the floor to realize that I got to get report from all three night shift people

8:00am: finished report only to realize that Dr. Cardia was already spewing forth her venom and orders better than any drill sergeant, contraindicating her and her associate's progress notes.

I passed meds and adjusted insulin and dopamine (for blood pressure) and hung milrinone (for heart failure) and cleaned poop and got blood for a few hours. I really don't know where the hours went as I was adjusting dopamine and chasing blood pressure, and blood sugar levels, and oxygen levels, but at 10:30am I realized that it was just about time to start over with noontime meds, AND give report on morning rounds, AND that Ms Dialysis was actively dying on us with her blood sugar (something necessary sustain life) in the 30's and 40's (normal is 70-120's).

1145: realized that me and Danielle wouldn't be relieved for lunch until 145 or later(!!), and that Ms Dialysis' heart rate is 36, respiration're probably 4 (very sporadic), and she's practically dead. Thankfully she was a DNR/comfort care, and no one had to rush in to crack her ribs to keep her alive for 30 more minutes. She passed at 12:19pm. She was in her 90's, recently been to a family reunion, and said goodbye to her close family. She was ready. Those kinds of deaths are peaceful, and relieving.

1230pm(ish): finished with postmortem care with that one, then Ms Previous-Name-Alert called out that she couldn't breathe. I trailed respiratory in there as soon as I was done with something I was doing. Her breathing rate was in the 40's (normal is 8-20ish), and her heart rate was 160 (normal is 80-100)! Crap, she's dying too!! (Ok, not really, but it was trying times). Plus, she wasn't my patient, so I kinda had to drag Danielle over and break the bad news to her. AND make sure Ms LazEE was still getting my patient's blood sugars. But wait, Ms LazEE was gone! Crap! So I ran in to that room to get a blood sugar-it was almost 1pm, reassure her that it's ok that her sugar is higher (inside I was berating her for eating lunch and drinking juice).

Ok, so think about it. . . then, add in Ms Current-Name-Alert who's world was going to end if she DIDN'T GET HER LUNCH TRAY REMOVED FROM IN FRONT OF HER IMMEDIATELY!! As in "the world will end if I don't get it taken out of here right. now." I can't for the life of me figure out why it's a big deal to have an empty lunch tray discarded as soon as the last bite is swallowed! Please, tell me!

Then, as I was giving Ms. Previous-Name-Alert some meds would keep her heart from literally exploding but also drop her low blood pressure even lower, so I gave her a bolus of saline--[[side note, that sounds like a story...** AT THE SAME TIME, Mr Current-Name-Alert sent his wife out because he couldn't breath. The one one the milrinone, for his heart (possibly meaning that he was dying too!), but he just had some sleep apnea. I still had to spend about 1/2 hour in there making sure he would live to go home.

2:00pm--yes, it all happened within a 2 hour-ish window. That's not that much time considering it takes about 15 minutes for a doctor to call back after being paged. And, Ms Dialysis' doc had to be paged twice, once when she was almost dead, finally dead, then after dead (45 mins),  and Ms Previous-Name-Alert's doc had to paged (two of them, TWICE) so, that's 30 minutes, but 15 mins overlap, so 1 hour. Then I spent 15 minutes with Ms Previous-Name-Alert givng her meds and saline, and rechecking her BP, then I spent 15 minutes in Mr Current-Name-Alert's room with his breathing. So we're up to 1 1/2 hour so far. See how fast the time passes?!

As I was doing my little side show, Danielle had her own going on too. And remember, our "help" had disappeared (to lunch, I later found out, for about an hour).
...anyways...
2:00pm: realized that if I wanted lunch I had better go buy it NOW, because the cafeteria closes at 2. Team leader was still in a Medical-Response-Team call. It's basically a pre-code blue. So I called someone else and ran downstairs to grab a cheeseburger with the handful of change from the truck. Thanks, supersized truck!

Oh, it doesn't end there. Danielle went to lunch, and Ms Previous-Name-Alert decided that her BP needed to be even lower, as in the sewers, not just toilet. So, being the good Samaritan that I am, I called Dr Cardia since Danielle was at lunch (remember NOT MY PATIENT) and tried to wing it with the doc. Didn't go to well, and I got chewed out for not knowing anything about her other than her BP was low and she was on a medication IV that was doing it! That's the last time I help out!

Oh, then Danielle got another patient who went all "I'm gonna follow in Ms Dialysis' foot steps and drop my blood sugar in to the 30's (normal is 70-120, and 30's kills!), too, and not come up even with 50cc of sugar solution injected directly in to my vein."

Danielle and I were trying to laugh light heartedly that there wouldn't be two patients dying the same way in the same day! Oh, Ms LazEE was sent home because the whole critical care census dropped (but not PCU census), so"we" were overstaffed. "We" being critical care area, meaning ICU, but PCU was sinking faster than the Titanic.

Thankfully, we made it to 6:30pm. Danielle was still tweaking her new patient's blood sugars, I was chasing my one patient's, and trying to admit an ED patient, while night shift was trickling in. Can I get some amen's when I say, "when it rains, it pours!"

**see the next post for my new short story. it's milling around in my head and going to be AWESOME!

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