Off Service

When I switched to the ICU I did so very deliberately. I knew that I wanted a surgical unit. Medical and cardiac just wasn't me. In neuro we do our fair share of trauma patients as well as get plenty of surgical ICU overflow. Unfortunately, an ICU is an ICU and when the shit hits the fan we can get whatever they send us. We are lucky in neurosurgery that we don't get interns. All of our residents have at least a year under their belts and can be trusted not to kill the damn patients.

However, when we get overflow ICU patients you NEVER know what will show up! Neurology is the worst. Most neurology residents do not speak very good English and are downright scary. I have heard the neurology "class photo" described as the terrorists. None of them smile... its kind of creepy. So neurology could fuck up a wet dream. I had a confused old lady that answered 'yes' to every question. The resident asked if she was having chest pain.... 'yes'

does it hurt when you take a deep breath?
'yes'
are you short of breath?
'yes'
does it go into your neck and back?
'yes'

after a few minutes of this the resident and his intern approached me, very concerned. They asked how soon we could get granny to the cardiac cath lab. (its 3am)I gave them the "what the fuck" look, having watched her ekg all night and being more concerned if the coffee was fresh. They explained that she was having symptoms of an acute MI and needed to go to the cath lab as soon as I (?!?!?) could get the cath team together. OK, I have to see this for myself....

me:
Are you having chest pain?
'yes'
are you short of breath?
'yes'
are you pregnant (she's 77)?
'yes'
do you fly a helicopter under water?
'yes'

ok, have a good night. I did get an apology from the resident, which was surprising. It would have been funny as shit to see the interventional cardiology attending rip the resident a new asshole. I could have sold tickets.

So off service residents give me chest pain. It is hard to trust people with very little experience that I rarely work with.




PS: Princess Di died 10 years ago today. I was a sophmore in college and my boyfriend had come up to visit. I can't believe it has been 10 years.

Peaceful

Working in a hospital I have come to realize that there are very few things that a person can actually control in their lives. In particular, their death (beyond something like suicide) is almost definitely out of the patient's own hands.

I was surprised.

We had a patient who had an extensive family history of brain aneurysms in all male family members at or before age 60. This was a well-educated man who decided to make the most of his time. He retired at 55, took his wife and their life savings and bought an RV. This happy couple spent the next 9 years RVing all over the US. They spent time in the places that they wanted to be and enjoyed every minute.

One morning he had a terrible headache and collapsed. His CT showed a huge aneurysm had ruptured and there was blood all through his brain. There would be no chance at a meaningful recovery. This man and his wife had discussed things previously, and he wanted to donate his organs (if possible). The family had decided to take him off of life support, allow him to die in peace, and then allow LIFENET to harvest kidneys and liver (these are what can be harvested AFTER a patient's heart has stopped).

This is where I come in.

This was my patient. The OR and side room were open and waiting. I, along with the chaplain, Palliative Care MD (who is my new hero) and his family, would take him to the side room in the OR. Once there we gave him both pain and sedation meds, (although he was already unconscious and unresponsive) and removed his breathing tube. The chaplain and one of his sons said a prayer. The family then had Toby Keith music turned on, sat around the patient's bedside and started telling stories. The stories were the "good ones" that get told at family get togethers. They laughed, joked with each other and held his hands. When he died it was completely peaceful. I was lucky to be there.

After the family left the room we wheeled him into the OR and the recovery team were able to harvest both kidneys and his liver. The Special Forces Medic got a great anatomy lesson that night. (I got to stay and watch as well).


After all the violence that I see in my day to day work life, this was a beautiful thing.

Nine

I just finished my ninth twelve hour shift in a row. 60 hours last week and 48 this week. The cop and I are going to Vegas to see Jimmy Buffett in October, and my "staying in a shithole hotel" days are over. I'm eyeing either the Bellagio or Venetian. So I work my ass off so we can enjoy it later. The first 3 were in the ICU... boring as hell as is par.

Then three days in the ER.... much more interesting.

Friday:
In charge in green. Good night until granny gets moved down from Yellow. Granny has breast CA and mets everywhere. They also thought she may have TB. The family wanted the full court press. At the same time a dialysis patient came in all fluid overloaded. So we tubed both at the same time. I was trying to get some folks discharged when the PCT whispered in my ear that granny was coding. SHIT! The worst part, they got her back. As I was calling report she coded again and the family walked in on it. Yeah, thats when we stopped.

Saturday:
Trauma room. GSW to the groin, bleeding out. Got 2 of blood and emergently to the OR. 7 year old hit in the head with a horseshoe, she got tubed and went to pediatric ICU. Skateboarder fell backwards and hit his head. HUGE head bleed and went to the OR emergently. Guy shot multiple times in both legs, to the OR later for pins and screws. Guy stabbed multiple times by the baby's momma. He is going to be ok, just got about a million sutures. There were 7 total. I had a Scoreboard on our dry erase board. It said "US" on one side and "THEM" on the other. We won 7 to nothing!

Sunday:
Trauma room again. 9 traumas. 2 big accidents with multiple patients each. Every helicopter in our area was out there. I got a girl by a ground squad that was covered with diesel fuel. Got to take her (on the squad stretcher) back out of the trauma room to the decon shower, cut her clothes and hose her down. I was soaked by the time we were done. That night I also got a drunk good 'ol boy who was stabbed in the chest by "some guy." He has a lung injury and went to the OR pretty quickly too.

So thats all of the er shit that I did. The ICU was a story unto itself and I am too fucking tired to get too into it. Lets just say that last night I got floated to a surgical stepdown floor. This place is the closest to a third world country that I have ever seen. Holy Shit is it bad down there.

I'm going to bed now.... I hope to sleep for at least 18 hours. It had better fucking be dark when I wake up!!!

Back Home

It's been a while since I've written from the dimly lit confines of the trauma room. Here I am again, and its peaceful finally. The last three days have reminded me just how much I do love working in the ER. I have been in charge, run codes, played with vents, gone to the OR 4 times. Its a beautiful thing. No cracked chests, but no night is perfect.

The cop and I have been presented with an unusual decision. One of the special forces medics that trains here is also a Key West Police officer. He knows the ins and outs of actually living in the Keys and has offered to help point us in the right direction if we decide to move. I love it here, but something feels right about this. I know that you are not given very many opportunities to make this kind of change in your life, and I want to make the right decision. Is the risk worth it? What if I get a flight job here? Then what happens?

I don't want to be stuck in a rut, and I feel like this place is THE rut. I just home the right decision presents itself.... 'cause I know it won't be an easy one.

ER WHORE

I am working 9 straight 12 hour shifts. The cop and I are going to Vegas in October and I really need to get my shit together and get this trip paid for. So I'm doing 3 in the ICU, 3 in the ER and then another 3 in the ICU. It works out to 60 hours one week and 48 the following. I may actually pick up another next week so I can have 60 back to back.

Its been eventful... but I have to get ready for work AGAIN. Will update when this week from hell is over!

Shit, Motherfucker..

Fuck, Shit

Ok, now that I got that out of my system. I woke up Friday afternoon after 3 days off. I was feeling guilty because I hadn't picked up any shifts in the ED and it would show in my paycheck. So I got ready to head in to the ICU to hang with my man Porkchop. The cop and I were on our way and I was checking my voicemail. The coordinator if the ICU..... they have had 3 call outs and can I come in?

HUH?!??!?


I pulled out the planner and checked. Yup, I was OFF! (Hence the title of this post) I have never NOT shown up to work, but every now and then I will get all dressed up and not be on the schedule. Did I call the ICU? Hell no! I called the ER and explained that I was on my way and did they need me? (does the desert have sand?)

So I played in the trauma room for the night. Nothing big, but a good night nonetheless. For the second week in a row I have had to pull out my high school Spanish and make an ass of myself. I'm actually getting a lot better.

Saturday night I was definitely in the ICU, I double checked before I went to bed! Was all ready to hang with Porkchop again. We were sitting in report when the day charge nurse opened the door and asked for bed 24's nurse to come out.... they were going to open her belly.

The OH SHIT in the room was palpable. I am the only one in there that has ever helped with that before, so you know who was IT.

20 year old girl, drunk at 1130am, rolled her car and was ejected (no seatbelt) and the car landed on her. She already had a huge head bleed, bilateral collapsed lungs with chest tube, pelvic fracture, ruptured bladder, laceration to the liver for which she had been to the OR once already. She was crumping and I gowned up just in time to hand the trauma attending the staple remover. It was pretty fucking cool.

The rest of the nursing staff was watching and bringing me what I needed when I hollered. She did well, but her belly was so swollen that they had to leave it open. It had gauze packing and something that looked like plastic wrap on the outside. Needless to say, I was busy as hell the rest of the night.

Mom and dad kept saying "she has so many problems." Apparently it was a mere matter of time that this would happen. Dad knows she will not survive the head injury. I think mom is getting there too.

SO.... we are back to my favorite phrase.....

WEAR YOUR SEATBELT AND DON'T DRINK AND DRIVE

how simple can it get? I was listening to Buffett on the way home that morning.... this says it all...

I bought a cheap watch from a crazy man
Floating down canal
It doesn't use numbers or moving hands
It always just says now
Now you may be thinking that I was had
But this watch is never wrong
And If I have trouble the warranty said
Breathe In, Breathe Out, Move On

Question

One of the nurses asked me recently, would I rather be liked or respected?

I'm sorry, but that was an easy question. Respected.

She said "I thought you would say that."

HUH??? Am I that obvious?

I applied for two flight jobs..... one local, one not so local. I just want a freakin interview.

The Troll

I am getting used to the ICU.... after a year I certainly fucking hope so! The one thing that make me crazy is being stuck in one place for 13 hours! Grrr..... its the same people, the same noises and the same crap for the whole shift.

The clerk and I do NOT get along. She is a short, fat, bow-legged, bucktoothed evil wench. (this is actually kind.... I don't use the C word, but it comes to mind when I deal with her.) I know this sounds bad....... but allow me to explain.

My mom taught me to say please, thank you, and excuse me when appropriate. Even though I don't like this mushroom of a person, my mom would slap me if I wasn't polite. None of this is ever reciprocated, ever. I say thank you and get no acknowledgement that I spoke at all. My lab results (sometimes) end up where they should, but are usually scattered around the ICU. When the cop calls he is placed on terminal hold, I never know that he calls unless someone else answers the phone. She will, however come and get me when a patient's family is on the phone and I am in the middle of bathing a patient, giving meds or anything else that I HAVE to get done. She won't ask them to call back ("they have the pass code") and will continue to yell that they are on the phone.

I've caught her making snide remarks about how awful the ER is and how ER nurses don't care about their patients. (she really likes Lurch though). Some mornings it is all I can take to even look at her. So I (oh so sweetly) refer to her as the "Fucking Lazy-Ass Troll." It has as sweet ring to it doesn't it???

Sorry to vent like that... not attractive but it keeps me from beating her ass.

Porkchop is doing better.... he was awake last night and was able to touch his nose. Sounds like a small feat, but its a big one for the Pork!

The Other White Meat

Update on my pal Porkchop. When we last heard from him he was channeling Howard Stern on Viagra. Unfortunately, it loks like he crashed and burned about 24 hours later. When I got to work on Monday he was intubated and unresponsive. We actually had to put him into a medical coma to preserve brain tissue. They even took a piece of skull out too....

So my main man is sick as shit. Not to mention that his last CT showed that he stroked out the right side of his brain. If he gets out he will be in a nursing home for the rest of his life.