Eat the honeycrisp apple, even if there’s none in season that are organic. They are your favorite.
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Month: August 2020
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Covid Continues
We have as many covid+ patients now as we had in the initial surge. The problem is they’re just not getting better like the first surge did. We were part of the remdesivir trial early on, and now we’re giving per the compassionate use allowance of the FDA. We’re also using dexamethasone, as a trial has supported that, and convalescent plasma.
But yet here we find ourselves, a young gentleman who after ALL these treatments is still not doing better. He’s still paralyzed and prone 16 hours a day, and now his kidneys are failing, requiring initiation of continuous renal replacement therapy (CRRT).
The battle is still real. And we are still fighting it.
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The heart, 2 views
These 2 X-rays are from the same person. I find them amazing. Looking back and forth— the power of the heart, the speed at which things move and shift in our chests each second or less. Literally breathtaking!
Metaphorically and literally, we are crispy in California right now.
Last weekend was hot with crazy storms that set off a chain of many wildfires. Most of the fires have new types of names to symbolize this new catastrophic cause: “lightning complex” fires. Many lightning strikes hitting dried out & ready-to-ignite brush (it is wildfire season, after all) and then the small fires come together quickly, fueled by high winds, to form the larger “complexes.” I certainly wish I’d never had to learn that.
And back in the ICU, we are full of patients and short on nurses. For three of my regular shifts this week, I’ve been doing the work of 2 nurses (actually, more like 5– but that’s impossible so I focus on doing 2 and let the chips fall where they may). I’ve also worked extra shifts.
The amount of overtime I’ve seen people working is truly astonishing. In many ways, our team is really pulling together and doing the best we can with what we’ve got. This is what we’ve always done as nurses, and will continue to do. Even when it means no one gets a lunch break. Or the charge nurse is also the rapid response nurse is also the code blue nurse is also the break nurse is also the resource nurse….
You know what gets us through? Laughter! And kindness. I always end my shift huddles during times of high stress by reminding everyone to help their neighbors and be kind…
You know what else helps? Food and beverages! We order boba, pizza, fried chicken, sandwiches, Thai food… and if the coffee runs out? Omg, a national disaster!
It’s Sunday morning now. I’m preparing for a new week by washing my scrubs, washing and chopping my face work snacks: celery carrots and apples. If they’re not precut, I won’t be eating them… I made three sandwiches for three nights of work, and I ground some coffee beans to take with me tonight!
I have my go bag packed, in case I have to evacuate because of a fire. Last year, one jumped a body of water near a bridge (the wind carried it) and came within a few miles of my house. I pack for work the same way, like everyday is a small disaster— scrub cap, face masks, stethoscope, food and water supplies. Today the main difference is that the smell of fire and the poor air quality is here to remind us that emergencies will continue to occur— now we just have COVID too.
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Not your nurse mom, nope
There are a lot of things that bug me about how other people practice nursing. But I’ve been a nurse long enough (more than a dozen years!) and through enough failed relationships (plus one marriage!) to know that you can’t really change people. Plus, at least in nursing there are actually a lot of ways to get the job done.
Some RNs will always be better talkers than doers. Honestly, those nurses get assigned to the patients who literally need someone to just listen to them, while more organized self-starters are going to take the busy potentially unstable post-ops.
I’m ok with this and try to value each nurse on my unit for what they’re good at— and help them both grow and deepen current strengths as appropriate.
There are 2 problems with this laid back philosophy: first, there are always some nurses who want everyone to be like them—and these are usually the very Type-A quick & bossy types. These nurses are usually very good at their jobs, earning them coveted roles such as float nurse or RRT or frequent 1:1 assignments.
But as I mentioned, there are many ways to nurse. And sometimes you need the quiet and patient (read: slow) nurse for a patient who reacts badly to too much change. Sometimes you need a nurse with social skills to smooth things over. Sometimes you just need the biggest strongest guy on duty to make sure the sexually inappropriate young male patient with a TBI doesn’t act out with the female nurses. This list goes on and on. Patients develop specific tastes or show preferences that we try to accommodate in order to prevent resistance to treatment. It’s both ridiculous and sensible when you think about it.
But I digress. So what is the first problem with my laid back attitude to the variety of skill/methods in nursing? Well, that one groups of nurses I mentioned who are particularly type A and like all the other nurses to be like them? Well, let’s call them the A Team.
The A Team terrorizes all the other nurses. In their misguided desire to “improve” the unit, which to them means make everyone like them, they bully all the other nurses and often managers too.
Then I have to follow behind them saying “don’t worry, they’re just being dramatic.” And trying to unruffle everyone’s feathers. This can reach crisis proportions when the other nurses start fighting back. It’s really hell on my days off, though, as I get flooded with text messages from both sides.
Oh, and what’s the #2 problem for my laid back ways? Sometimes people develop bad habits. And bad habits are hard to break. IV med bags in the patient’s sink is one of my biggest pet peeves. Also leaving your trash for someone else to clean up in med room. Here’s one I found while sending a nurse on break. Note: I did nothing. I’m not your nurse mom & I’m not gonna clean up your mess.
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Sleep disruptions #1
Would you believe it if I told you that I get woken up everyday while I’m sleeping for work by—are you ready for it??— an ice! cream! truck!
Yes, that little boxy kind that plays music and has images of all the ice cream treats all over it. I have so many questions.
- Does a time machine drop this infernal music machine into my neighborhood just to keep me awake?
- How does someone make money doing this? Like, enough money to live on???
- Is the ice cream any good?
- If it is, do they take credit cards?
- Do they kidnap kids or adults or both these days???
07/31/2020
Would you believe if I told you that I haven’t posted in (insert # of days/weeks like I even bothered to look) forever because I’ve been busy? Well, I’d be lying. I have been working 3 or 4 days a week then having 3 or 4 days off and repeat. I like to think I’ve been busy but to be honest, no.
On the 3 days in a row when I work, there is literally no time for anything else though. I wake up between 4:30 and 5pm. Get ready for work, including make lunch (praying there’s food in the house since pandemic grocery shopping is the worst), and leave at 6pm. I get to work usually around 6:35-6:45 depending on traffic and take a few minutes to “print my list,” which is my giant tree-killing summary of each patient in the ICU and their one-liner H&P, chief compliant, and major events. This one-liner of course is more like a one-paragrapher…
We start each shift with a huddle at 18:55 and then I’m off to the races for the next 12 hours. I spend my shift breaking nurses, admitting patients, communicating with family members & doctors, in rounds, putting out fires, wiping butts, assisting in procedures, and getting report for the next shift. Whatever the night may need. After giving charge nurse report on an average of 26-32 patients, I only hope to leave before 8:30 when the parking garage will charge me $8 to get out. If I’m leaving this late, something bad happened. And it happens about once every two weeks.
I get home on average at 9am and try desperately to fall asleep by 10. Sometimes the adrenaline is still rushing through me from an end-of-shift emergency, or I have to eat because I simply didn’t have time to all shift–and I will not be able to sleep on a stomach that has likely been empty since a protein bar inhaled on the way to work at 6pm yesterday. Days like this, I hope not to be checking the time on my phone, which is shoved under a pillow next to me as I sleep.
And I get up and do it all again.
For those 3 days, I am, yes, “crazy busy” but then comes my three or four days off in a row… These frequent days off are the reason some people joke “how can you be tired; you only work three days a week?” Oh hell, I think there’s probably even a meme for that…
So then, those days off? What are they if not busy? The answer is complicated, especially since I work night shift. When I get home from my third shift, I go to sleep by 10 like normal. But I let myself sleep until whenever I wake up– usually until 6 or 7. I wake up like a zombie, stumbling to the kitchen for coffee and food. I’m pretty useless at this point, still tired from the work week. I stay up to watch some tv, maybe do some laundry– although as I type this, I’ll admit that is unlikely. And I’m back in bed by 10pm. My first day off, spent entirely sleeping…
There are weeks where no matter how much I sleep, I don’t feel rested. Days when co-workers are restlessly texting me about this problem or that, and I feel a weight of responsibility as I take their confessions
But as this pandemic and its necessary quarantine continue into its sixth month, my colleagues and I cling to each other. We are bound by what we’ve seen and done. We are a “quarantine family” of essential workers–and though we wear our masks, we cannot control how close we get to each other. Some days, we work shoulder to shoulder–arms crossed–to turn and lift patients, to hold pressure on bleeding wounds, to change dressings.
Now that we’re doing elective surgeries and the first three months of strict shelter-at-home orders, the ICU is busier than ever. Way too many cases of pancreatitis from months of heavy drinking, severe heart failure from heart attacks overlooked when people were too scared to go to the hospital. Kidney, liver, and heart transplants. Drug overdoses, and cardiac arrests–sometimes it seems like 5 homeless or near-homeless people found down and resuscitated every day. Their u-tox reports telling the story of despair and mental illness and drug addiction that plague our cities: meth, opiates, sky-high alcohol levels.
I spend my days off thinking about these patients. That first CT scan showed a lack of grey/white matter differentiation, a very poor prognosis and likely anoxic brain injury for our Joe Doe cardiac arrest patient. What had happened to him? Did they find out his name? Did the police have to come fingerprint him? And what about the woman whose chest we opened at the bedside? We all watched as the cardio-thoracic surgeon retracted the ribs, suctioning out & washing away blood and clots from around the heart. Then he searched for whatever might be bleeding, suturing tiny blood vessels and covering with small pieces of dissolvable clotting material.
07/03/2020
My life largely revolves around my work. I go to work; I work; I think about work; I talk to others about my work. One of my roommates is a fellow ICU nurse and the other is an EMT. My best friends are nurses. I talk often in therapy about situations I encounter at work.
My point is: I know medicine.
And I am once again flabbergasted by reports about police practices for “suspect” control that is dangerous, unnecessary, and I’m sure used most often against black men. Police are enlisting the help of EMS to inject those in their custody with Ketamine under the guise that they are suffering from a condition called “excited delirium.”
https://www.nbcnews.com/news/us-news/elijah-mcclain-was-injected-ketamine-while-handcuffed-some-medical-experts-n1232697
I regularly use Ketamine in the ICU and have assisted in procedures in the ED (emergency department) with it. I know why it’s used, it’s effects/side effects and most importantly the adverse effects that can occur with use.