7.22.2010

My medical short story

*ahem*

If a respiratory patient has problems breathing, it means she was probably going to be sent home before this happened.

And if she has breathing problems, she's probably going to have a super-ventricular tachycardia (SVT) to go with it.

And although she is put on a BiPap breathing machine to help her breathing, it's probably not going to help her heart rate, and with her heart rate tachy (going really, really fast), she'll probably drop her blood pressure in to the toilet.

If her heart rate is that high, then Dr Hospitalist will most likely try a medication to bring it down, which will have a side effect of dropping her BP in to the sewers.

At that time, the doctor will order a bolus, freak out, and call a cardiologist to consult.

When the cardiologist comes to consult, she'll whine and complain that the first doctor didn't do anything right, and order STAT tests (without telling anyone), and start her on a IV medication drip to help control her heart rate.

While she's there, she'll probably try to print out 30 pages, which our wonky printer will flip out at, and refuse to print it unless it can add a blank page every 3rd page.

And, probably, while the patient's nurse is at lunch, the aforementioned blood pressure that had stabilized will finally react to all the medication in her system and plummet even further.

Then, trying to save a life, I'll get chewed out, all the while praying that this doctor won't remember who I am as I play dumb.

And chances are, once all the systems return to normal, the patient will want the BiPap to come off because she feels "better."

But because she's not "better," her breathing will probably revert to it's previous stage . . . which will throw her heart into SVT again . . .

So, any one want to illustrate it for me?

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!

7.06.2010

To spill, or not to spill?

You know, there are so many things that people never mention about pregnancy and kids. Never. I'm not sure if it's because they get pushed in to the background by more important things, or if no one wants to be the one to spill the bad news. Because I'm sure if I had known some of these things, I wouldn't have been so eager to give up being the only one in my skin. Know what I mean? Like, at the beginning of the pregnancy (at least, the first one. I'll let you know if it holds true for the other ones) I felt as if I was being blown up. Like, as if I had a balloon pushing from the inside out. There was, but I didn't expect it too feel so intense. But it only was like that before things started popping out. Once my skin stretched and my belly popped, I was good. But it was so bad, that I was feeling clausterphobic. And I like being wrapped tightly in the covers, I like having an undershirt tighter than my outer clothes. But this, this was different, and uncomfortable.
Another thing, your baby belly may go away and slim down, but that extra skin, the part that stretched so you can have a cute baby belly? That's still there. It may not be noticable under the clothes, but look closely, you can see the wrinkly stretchy skin, similar to a balloon that's been deflated. *looks around* Did I just say that out loud...can you forget that's me, and imagine I'm slim, trim, and in shape? Great.
Enough about me. Now, the baby. Those emails "Is Your Baby's Development On Track?" They're all lies. My kid isn't dumb, by any stretch of the imagination (no it's not the parent pride, promise :D). He's not pointing at things he wants. He's not saying things he wants, "bottle" "juice," nope. Every once in a while he'll squeeze out "dad" or "mama," but there's no reason or predictability to it. He's even said "shoe" once, out of the blue. Yes, he knows what I'm saying when I ask him, "do you want to go outside?" so, he's not, not understanding. He's just taking his own sweet time.
Once he hit 11 months, my great eater morphed into the great food pusher-outer. Green beans, peas, basically all those healthy foods that he loved, he now refused to eat, unless they're baby food consistancy (you can bet I still take advantage of that!). He'll eat hot dogs, mac'n'cheese, anything from my plate that I don't want to share, any snack food.
What else...oh, yeah. Sweet baby breath has changed to the worse toxic morning breath ever. I even brush his teeth for a super long time before putting him to bed. He doesn't eat during the night any more, so that's not it. I'm thinking until he gets to use floride tooth paste, we'll have to battle it with frequent brushings.
I know there's more, I hit my head on things each day that I wish someone had told me. I'd even take mentioned then run the oposite direction at 55 mph!
Take what I've been emboldend to say and go forth and conquor. I think first time parents are so blind and young and stupid. I really do. No matter how "prepared" you think you are, the second child is always better. He's always welcomed with more knowledge and more smooth sailing (at least, theoretically) that the first. I know ours will. Some people...I think they'll always been up-tight and neurotic
That's just their personality. I tried to be type A concerning Brendon and things like germs, and clothes, and cleaning and the stuff that all first-time parents are supposed to be. But I failed, epically. The only time I boiled his pacifiers/bottles was when I first bought them before he was born, and a few weeks ago when he had that virus. *sheepish grin* He eats things off the floor all the time, but I do make sure I get it out of his mouth before he swallows it. WIN!
The one thing that's been hard to relax about it getting dirty/messy with food or dirt. I have to refrain myself from wiping his face after each bite. I cringe when he crawls into the dirt with his clothes on...well...even if he doesn't have clothes on, I cringe. I curl up and die each time I see him eating or playing with the dirt.
I'm sure any subsequent kids will be the same. I use the same towel for a few weeks -it's drying off a clean body, so where's the dirt?? I rewear a shirt or pants if I didn't do anything but lounge around the house. Why would I change things around for Brendon. We aren't unsanitary, but neither are we neurotic.
I probably scared you all from ever visiting my house, ever!, but that means I won't have to clean my toilets! WIN!

7.05.2010

Independence Day

We celebrate the time our country embraced it's independence. Not that everything was different the next morning. The only thing different was the mind set. 

 It united people from Boston to Concord against a common idea, that a king an ocean away would not blindly rule. They simply wanted to be heard, and if that meant they had to break away and do things they're own way, then so be it. 

 Today, we do things our way. We celebrate that with fireworks and food. 

Do we ever do anything without food? This was Brendon's first Independence Day celebration. I'm not sure he knew what was going on, but it involved food. 

 And people, and lights.

 And can I say once more, that I hate blogger and pictures? Maybe one day I'll be adventurous and check out wordpress or something else.