Tag: teamwork

Categories
pandemic

In Canada, doctors do nursing

“And starting this weekend, at least one Toronto-area hospital will begin training physician volunteers so they can help critical care nurses in the ICU, as a way to immediately add more staff to keep up with a flood of severely ill COVID-19 patients.”

I had to laugh about this one. The medical residents, aka “baby doctors,” barely know how to do anything. I’ve had to teach doctors how to place an IV line, how to reduce a prolapsed rectum, how to talk to patients about death. And there’s no way they’ve ever considered giving IV antibiotics or other medications. Talk about chaos in the ICU.

I couldn’t find the original news article. See video report on Global News

Categories
intensivecare

I dreamt I died

Work has been shit lately. Covid is still surging in my ICU, and we’re busy with other things too.

Last week was an especially difficult week for our heart failure service, as every patient on service was deemed “not a candidate” for advanced heart failure treatment. Bottom line: this is end-stage heart failure and hospice is the next step. For many patients, this means removing a piece of equipment that’s been helping their heart do it’s job (like an intra-aortic balloon pump, or an Impella). This can mean almost immediate death, but many patients do go home from the ICU to die there. It’s emotionally exhausting but incredibly important work.

And it’s so important to spend some quality time with these patients. Last week, I helped a gentleman who was just days away from getting his Impella out to go home on hospice. He was itchy from laying in bed. I washed his back with real soap and water and washcloths. The put on lotion with a little massage. 20 minutes including gathering supplies. And it made his day! We chatted about traveling and life’s simple pleasures. These are the important moments at the end of life, and I was so happy to be there for him.

But despite that part of my job being so meaningful, there are other parts that are nearly unbearable. There is a day shift charge nurse who is mad at me no matter what I do, and who demands a ridiculous amount of report on our patients. She wants a full head to toe but the 90 second version. Do you know how long it takes me to prepare a cohesive and comprehensive 90 second head to toe report that also includes the plan and updates from when she was last on shift??? It takes about 5 hours to do it for 30-36 patients. And when I don’t give her all the info she wants, she asks for it in aggressive tones. If I don’t know the answers, she will eye roll, sigh and slam turn the pages of her printout. Actually, she does that sometimes anyways if she’s annoyed by something, anything.

I find this to create a workplace so toxic that it gives me panic attacks. I dread giving her report. I get short of breath talking to her. I often cry after interactions with her.

So what do I do when I tell my managers about this and nothing changes? That is the million dollar question facing me right now.

Oh, I almost forgot my dream. I had a left ventricular assist device (LVAD) in my dream, but it became dislodged internally. FYI, I’ve never ever seen this happen in real life… I was bleeding to death, surrounded by work mates. They could do nothing. And finally, as I was about to die, one of the help pressure on the bleeding spot as the warm feeling spread through my chest and I lost consciousness.

Whoa. Is that symbolic? I hope not.

Categories
pandemic

The Struggle for N95s

Think about the N95 mask. Our lifeline in the fight against covid. At once something so simple and so complicated. Would you ever imagine that the inventor of this absolutely invaluable mask is a man of only 68, who just retired two years ago? That the N95 was only invented in 1995. Invented. In 1995. Holy moly.

I guess I’m showing my age, but that doesn’t seem long enough ago for a mask that protects so many people from so many things… before covid, it was (and still is) used for those who care for patients with tuberculosis, novel flu strains such as H1N1 back in 2009, hemorrhagic viruses such as Ebola, and construction workers use it to filter airborne particles many of which can cause permanent lung damage as well.

A world without N95s seems like a very dangerous place.

So, the shortage that occurred during our covid surges throughout America and the world are a major failure. The lack of ability for even healthcare providers to have adequate personal protective equipment (ppe) is a sign of how broken our healthcare system and our government really is.

The continued dedication of healthcare professionals however–those who go to work anyways, even if they have to reuse masks for way too long or wear homemade masks and gowns–is a testament to the goodness of people, to the bravery that can be found even in the face of mortality.

I have been going to work knowing that if I get covid, I could die. But I go anyways. And I always would.

That is why I so appreciate the story if Dr. Peter Tsai, the inventor of the N95. He has come out of retirement to help companies change manufacturing plants in order to meet the needs of our healthcare system. And he does this for nothing. He feels it is his calling… read more about him in this feature in the Washington Post.

Categories
intensivecare

You have not lived until you have

  1. Pondered your own mortality while rubbing the arm of a man who speaks a different language than you, who is tied to the bed with 2 different kind of restraints and is still trying to hit you, who has survived a brutal car accident that deformed his skull and has now lost more of his brain to cancer, who is on a medicine to make him sleepy and comfortable but still flops restlessly in bed, who somehow manages to fart right in your face as tears come to your eyes, thinking about how you’ll probably die alone.
  2. Received the most vitriolic dressing down from an entitled white woman who no longer wants to be in the ICU but has unfortunately just had her 2nd brain surgery to remove a metastatic tumor. You try to set boundaries by saying “this is not a hotel; it is a hospital” to no avail.
  3. Bonded with your colleagues about all the shitty stuff that’s happened in your night—assignments changed, 2 admits, charge nurse yelled at you, expecting to get yelled at by cardiac surgeon because you didn’t extubate your patient, massive transfusion, and so on. It’s true that working in an an ICU is like going to war. The trauma bonds you.
Categories
nightshiftlife

Notes from an Extra shift

There is nothing better than showing up to work extra and finding a brown sugar boba from Yi Fang waiting for you.

Yi Fang— home of the best boba

Among the other fantastic treats I received: a homemade pumpkin chocolate chip muffin and pizza from one of our patients who just left the hospital after his heart transplant.

After being off for 5 days, however, I was pretty terrified that I would find a hospital overrun with covid and bursting at the seams with patients. And we do have a pretty full house… but amazingly, our covid numbers haven’t skyrocketed. House-wide we have only 29 total, 6 of whom are “cured,” and 2 are waiting for results. There are NO cases in the ICU currently.

This is definitely better than I had hoped for and expected, given the terrible news I’ve been hearing lately. Perhaps the hard work of London Breed, mayor of San Francisco, and Gavin Newsom, governor of California, is paying off in reducing covid infections and hospitalizations!

Also, one last thing to be so happy about this extra shift.

Labeling iStat cartridges with 2021 because next year is ALMOST HERE which means 2020 is done. GOOD RIDDANCE!

Bring on 2021!

Categories
pandemic

I’m covid negative, so now what?

On Thursday evening, while watching tv and learning to draw, practice session #4 this week, I decided I needed to get tested for covid before my parents arrived to visit for thanksgiving next week.

Just to be clear: I’ve been working with covid patients since early March including during the chaos when the entire country was running out of masks. But we have been lucky in the Bay Area, our surges have been smaller and more manageable. We’ve even had periods recently where no covid patients needed ICU-level care.

There was a time when my work mates and I were 100% sure that we’d already had covid—because how could we not?!?! Protocols were in flux, the federal government who was guiding our policies couldn’t decide what type of isolation precautions and PPE we needed. Not that the PPE (personal protective equipment) was even readily available then.

We probably had 20 pairs of goggles in our whole hospital… and reusable face shields? Oh hell no. Luckily our administration ramped up quickly, and many of our doctors with friends in tech hit donations of things like 3D printed face shields. We did have some crazy gowns mixed in there as our normal supply (made in China I’m sure) got depleted, but we got through the initial surge.

And while we were doing that, we also made our overflow hospital, overflow ICU, and organized anything else we needed. And then we did a trial run to make sure everything was do-able just to make sure.

As time went on, I actually became confident in all my colleagues’ abilities to deal with the covid patients. The isolation gear and protocols became second nature. I’m not worried that someone is going to expose us all.

So how does it feel to be tested for the first time this it a far in to the pandemic and be negative? I’m proud of my work crew. We’ve been keeping each other safe for 9 months now.

We just need to keep it up.

Categories
pandemic

An ICU nurse in Michigan gives her perspective

On NPR, you can listen to this 4 minute interview from an ICU nurse on the frontlines as she discusses patient regrets, masks, and surviving the pandemic with Audie Cornish on All Things Considered.

Mobley describes this very common experience:

“A lot of times before they’re intubated — which means put on a ventilator because they can’t breathe on their own — when they’re still struggling to breathe, and they’re saying, ‘Well, I didn’t know COVID was real, and I wish I’d worn a mask.’ And then it’s already too late,” she tells NPR’s All Things Considered. “You can see the regret, as they’re struggling to breathe and it’s finally hitting them that this is real. It makes me very sad.”

Hear more at ‘You Can See The Regret’: ICU Nurse On Patients Who Failed To Take COVID Precautions

Categories
Quick Notes

Pep talks and missed meals

Last week, everyone was still happy for the overtime and could see the $$$ in the missed meal breaks. Everyone was chipping in, picking up extra and actually in buoyant spirits (if that can ever be said about ICU nurses).

I actually texted this image stolen from Pinterest to a colleague in my happy and helpful bliss last week… perhaps it was delirium?

For my first few shifts this week, though, the nurses were just not feeling like doing as much OT. I can’t blame them. Our patients are incredibly sick. Our job is incredibly hard both physically and emotionally. There just isn’t as much support available as there should be even if people volunteer to work OT because nurses on overtime just aren’t working their best.

Also, it makes me sad to say, but the patients aren’t getting the best then either. As nurses we want to be THE BEST we can be for our patients, especially in the ICU, but when you’re working hours 12 through 16.5, you can’t always give your best. It’s sorta like the Rolling Stones’ song, loosely “translated” to this scenario: you can’t always give what you want, but you give at least what patients need.

On a happier note, though, I ended my week with a fully staffed night shift that gave report to a fully staffed day shift! First time in 3 weeks.