Boy, was it ever!!! And to make matters worse, it was dead silence throughout the unit. No action, no codes, no glucose readings, very little talking, and...I forgot to take a book with me! So, I was stuck reading the online journals and the medical dictionaries. Yep, that makes me an even bigger nerd!
I guess I earned it after a night like the night before. One of our patients coded three times in a matter of an hour. And as the saying goes, three times is a charm. It was a tragic case: sepsis, end stage renal failure, CHF, and a recent MI. The prognosis was poor from the beginning, but her two sons requested that everything be done for her. So, we coded, and coded...and coded again, to no avail.
The whole night I felt a sense of urgency. Even in the cafeteria on my lunch break, I was scarfing food down my throat trying to get back to the unit. I kept telling myself that I didn't want to miss out on anything. Sure enough, when I turned the corner to enter the unit, the nurse yells, "Call a code!" She and I were the only two there! As I ran to the adjacent unit to get the code box, 4 nurses ran in the opposite direction to offer their help. Within seconds respiratory, the time keeper, and the ER docs were there. It was a circus. To make the night even more interesting, we had a non-compliant NIDDM/HTN patient with an intracranial hemorrhage right nextdoor. It's unfortunate that we had to put her through all of that. The prognosis was so poor, and she had even mentioned to one of her family members weeks prior that she was tired of fighting. I left work so drained that I skipped the gym, went home and got right into bed. As for the NIDDM patient, she passed away a few hours after shift change.
In comparison to yesterday, tonight was an absolute bust. Just mind-numbing silence, and no responsibilities whatsoever. Well, at least I earned it honestly! What's certain is that there is another hectic night just around the corner! I can't wait!
Thursday, January 29, 2009
Saturday, January 24, 2009
America's Next Top Tenor
I've just returned from seeing Lawrence Brownlee in recital with Martin Katz. Both singer and accompanist are two of the world's most talented artists, and I am so happy that I got a chance to see them perform.
I almost didn't make it to the concert tonight. I've been so tired lately with work and responsibilities at home, but I knew this was a recital I could not miss. I've been a fan of Brownlee for some time. To hear his recordings is to be mesmerized, but to see him in person is quite a different experience altogether! His voice is so pure and seamless, and he's a fantastic actor! I would love to see him perform in the opera house. What's remarkable is that he is quite young, but his technique and stage presence are that of a seasoned professional. He IS a seasoned professional, I guess, when you take into account his CV and performance history.
You know you've been a part of something special when it brings tears to your eyes, and you leave the venue emotionally spent. I look forward to seeing him perform again soon!
I almost didn't make it to the concert tonight. I've been so tired lately with work and responsibilities at home, but I knew this was a recital I could not miss. I've been a fan of Brownlee for some time. To hear his recordings is to be mesmerized, but to see him in person is quite a different experience altogether! His voice is so pure and seamless, and he's a fantastic actor! I would love to see him perform in the opera house. What's remarkable is that he is quite young, but his technique and stage presence are that of a seasoned professional. He IS a seasoned professional, I guess, when you take into account his CV and performance history.
You know you've been a part of something special when it brings tears to your eyes, and you leave the venue emotionally spent. I look forward to seeing him perform again soon!
Saturday, January 17, 2009
TGIF
Yep, thank God it's Friday....or Saturday. I'm still trying to adjust to the whole working nights thing!
I've practically slept the whole day away, but at least I don't have to go to work tonight. Not that I mind at all...I love my job! We had a code towards the end of the shift last night. Poor guy had been combative all day, trying to work himself out of his restraints, and tearing his skin in the process. His wife passed away a few weeks ago, and not too long after, he was brought to the hospital with a temperature of 88 and a pulse of 15!!!
The children, still grieving over the loss of their mother, wanted a full code if something were to go wrong, and that's exactly what he got. He stopped breathing first, then went into V tach...after a few rounds of amiodarone and an ETT, he was stable but unresponsive.
This guy clearly doesn't want to be here. He is grieving over the death of his wife, and has no desire to live without her. I can understand the children's grief, but why make this man suffer any longer? When all the vital signs are leaning towards death, why prolong it? If the tubes were pulled and the warming blanket were removed, he wouldn't be alive! I doubt he will survive the weekend.
Ironically, for both father and child, love IS the most powerful force on earth.
I've practically slept the whole day away, but at least I don't have to go to work tonight. Not that I mind at all...I love my job! We had a code towards the end of the shift last night. Poor guy had been combative all day, trying to work himself out of his restraints, and tearing his skin in the process. His wife passed away a few weeks ago, and not too long after, he was brought to the hospital with a temperature of 88 and a pulse of 15!!!
The children, still grieving over the loss of their mother, wanted a full code if something were to go wrong, and that's exactly what he got. He stopped breathing first, then went into V tach...after a few rounds of amiodarone and an ETT, he was stable but unresponsive.
This guy clearly doesn't want to be here. He is grieving over the death of his wife, and has no desire to live without her. I can understand the children's grief, but why make this man suffer any longer? When all the vital signs are leaning towards death, why prolong it? If the tubes were pulled and the warming blanket were removed, he wouldn't be alive! I doubt he will survive the weekend.
Ironically, for both father and child, love IS the most powerful force on earth.
Friday, January 16, 2009
Full House
All beds are full once again. I must admit, it's been pretty low key lately; no codes, no deaths, and that's a good thing! What's the purpose of Western medicine if lives are not being saved?
We do have some interesting cases going on, though: thrombotic thrombocytopenia pupura, subdural hematoma acquired during sexual intercourse (I lie not!), and my personal favorite, Fournier's gangrene. I just found out that this guy has been with us for about two days. While speaking to another tech, she informed me that she got a chance to sit in on the debridement of the man's scrotum. He was so drugged up, however, that he was smiling and winking the entire time. Needless to say, she had to excuse herself. So...I'll be making my way to his room tonight in hopes of getting a glimpse of THAT!!!!
Coolest thing so far this week: standing bedside as the neurosurgeon performed a stat ventriculostomy on the SDH guy. Talk about AMAZING! I got as close as I could without contaminating the sterile field. I'm hoping this guy pulls through, but it's not looking good.
There's always a gleam of doubt when you're switching from one profession to the other. I often wondered if medicine was really the career for me. Sure, it seems interesting enough, but will my curiosity and love for learning leave me one day? It was paramount that I leave long term care in order to find the answers to these questions. Despite the good days, the sad days, and the slow days I can honestly say I have made the right decision! I am so happy to finally be on the right track in my life.
We do have some interesting cases going on, though: thrombotic thrombocytopenia pupura, subdural hematoma acquired during sexual intercourse (I lie not!), and my personal favorite, Fournier's gangrene. I just found out that this guy has been with us for about two days. While speaking to another tech, she informed me that she got a chance to sit in on the debridement of the man's scrotum. He was so drugged up, however, that he was smiling and winking the entire time. Needless to say, she had to excuse herself. So...I'll be making my way to his room tonight in hopes of getting a glimpse of THAT!!!!
Coolest thing so far this week: standing bedside as the neurosurgeon performed a stat ventriculostomy on the SDH guy. Talk about AMAZING! I got as close as I could without contaminating the sterile field. I'm hoping this guy pulls through, but it's not looking good.
There's always a gleam of doubt when you're switching from one profession to the other. I often wondered if medicine was really the career for me. Sure, it seems interesting enough, but will my curiosity and love for learning leave me one day? It was paramount that I leave long term care in order to find the answers to these questions. Despite the good days, the sad days, and the slow days I can honestly say I have made the right decision! I am so happy to finally be on the right track in my life.
Saturday, January 10, 2009
Very First Code
Last night has been the busiest so far. Although 3 of my 12 beds were empty, the events of the night kept me more than busy. Being busy is relative...my new job still can't compete with the amount of running, lifting, turning, pushing, and sweating that I had to do in long term care.
We've lost quite a few folks lately. I'm finding that in intesive care, and perhaps in all areas of medicine and surgery, you see lots of the same: respiratory failure, renal failure, MRSA, HIV, diabetic ketoacidosis, overdose. Perhaps part of becoming a strong nurse/doctor/respiratory therapist/PA is being subjected to the same diagnoses, and in turn, similar prognoses, drugs, complications. I find myself writing down things I'm not familiar with...mostly treatments and drugs. Last night, I became familiar with atropine and epinephrine.
Mr. A had come in two days earlier for only God knows what. I never could get my hands on his chart. Either the nurse had it, or it was nowhere to be found. You could tell he was sick just by looking at him: xanthoderma, anxious, restless, distended abdomen, not to mention the bloody stools that I helped clean up. He just had the look. His nurse, Tina, called his coding a few hours before he went into asystole. Once the code was announced, herds of people from all over the hospital came to pitch in. Respiratory, nurses, the resident, the doctor, and little ole me! Can you imagine 15+ people in a tiny room, moving around like ants in an ant farm? That's what it was like.
The nurses and therapists took turns performing CPR, and Tina prepared the atropine and epi. One round of drugs after another were administered, and Mr. A toggled between V fib. and asystole, his body bouncing off the table with every compression. The nurse mentioned that he could feel the ribs cracking beneath his hands. After four rounds of medications and no change in cardiac rhythm, the doctor called it.
Codes are nothing like television makes them out to be. There was no yelling, no passionate plea for Mr. A to pull through. On the contrary, there was laughter, idle chit chat, and smiling. Immediately after pronouncing him, everyone left as quickly as they arrived. Tina, myself, and the other nurses on the unit were left behind to clean up the mess. Overall, I think I did well for my first code. I didn't cry when Mr. A passed, and I didn't run out of the room when, while assisting the nurse with removing the backboard, a melodious sound of air escaped from his throat. I did, however, learn that Mr. A died a lonely man, estranged from his family, and befriended by a certain "colleague" who was his power of attorney.
Only two weeks on the job, and so many lessons have been learned. This is the kind of stuff I need to see and experience before the end of the year.
We've lost quite a few folks lately. I'm finding that in intesive care, and perhaps in all areas of medicine and surgery, you see lots of the same: respiratory failure, renal failure, MRSA, HIV, diabetic ketoacidosis, overdose. Perhaps part of becoming a strong nurse/doctor/respiratory therapist/PA is being subjected to the same diagnoses, and in turn, similar prognoses, drugs, complications. I find myself writing down things I'm not familiar with...mostly treatments and drugs. Last night, I became familiar with atropine and epinephrine.
Mr. A had come in two days earlier for only God knows what. I never could get my hands on his chart. Either the nurse had it, or it was nowhere to be found. You could tell he was sick just by looking at him: xanthoderma, anxious, restless, distended abdomen, not to mention the bloody stools that I helped clean up. He just had the look. His nurse, Tina, called his coding a few hours before he went into asystole. Once the code was announced, herds of people from all over the hospital came to pitch in. Respiratory, nurses, the resident, the doctor, and little ole me! Can you imagine 15+ people in a tiny room, moving around like ants in an ant farm? That's what it was like.
The nurses and therapists took turns performing CPR, and Tina prepared the atropine and epi. One round of drugs after another were administered, and Mr. A toggled between V fib. and asystole, his body bouncing off the table with every compression. The nurse mentioned that he could feel the ribs cracking beneath his hands. After four rounds of medications and no change in cardiac rhythm, the doctor called it.
Codes are nothing like television makes them out to be. There was no yelling, no passionate plea for Mr. A to pull through. On the contrary, there was laughter, idle chit chat, and smiling. Immediately after pronouncing him, everyone left as quickly as they arrived. Tina, myself, and the other nurses on the unit were left behind to clean up the mess. Overall, I think I did well for my first code. I didn't cry when Mr. A passed, and I didn't run out of the room when, while assisting the nurse with removing the backboard, a melodious sound of air escaped from his throat. I did, however, learn that Mr. A died a lonely man, estranged from his family, and befriended by a certain "colleague" who was his power of attorney.
Only two weeks on the job, and so many lessons have been learned. This is the kind of stuff I need to see and experience before the end of the year.
Thursday, January 8, 2009
Dead Man Living
While attending to Mr. Steven's oral care, I studied his face. Here is a relatively young man whose body is riddled with lines, needles, tubes of various sizes, all of which are trying to sustain his life. He looked defeated. He looked tired. But I still tried to offer him some positive words. I wished him happy birthday (he celebrated his 67th), and as I walked out of his room, I inquired about his prognosis. Of course, it looks grim...it is grim. The doctors are d/c'ing his comfort care this afternoon.
Out of curiosty I pulled his chart to find out what was ailing him:
COPD (cigarette smoker), bilateral pleural effusions, acute renal failure, chronic bilateral subdural hematomas, lung cancer, prostate cancer, and coagulopathy (facilitating hematomas?)...
Mr. Steven's in indeed a dead man living.
Fortunately, his family has agreed to let him go. I thought about Mr. Steven's and his family on the way home. Death, for most of us, is usually not a planned event. We are subject to its will, and are forced to deal with the chaos it leaves behind. But how does one deal with death when the day and the hour of its arrival are known? One thing is certain: Mr. Steven's is no longer suffering. Somehow that makes his death easier to deal with.
Out of curiosty I pulled his chart to find out what was ailing him:
COPD (cigarette smoker), bilateral pleural effusions, acute renal failure, chronic bilateral subdural hematomas, lung cancer, prostate cancer, and coagulopathy (facilitating hematomas?)...
Mr. Steven's in indeed a dead man living.
Fortunately, his family has agreed to let him go. I thought about Mr. Steven's and his family on the way home. Death, for most of us, is usually not a planned event. We are subject to its will, and are forced to deal with the chaos it leaves behind. But how does one deal with death when the day and the hour of its arrival are known? One thing is certain: Mr. Steven's is no longer suffering. Somehow that makes his death easier to deal with.
Tuesday, January 6, 2009
The Night Shift
There's something about working at night in the hospital. For the most part, it's eerily quiet; patients are sleeping, nurses are documenting, and us techs are giving patient care. There are no big bosses; no doctors, no administrators. It's peaceful...until the guy in room 15 stops breathing, and the meth addict/MVA case comes up from ER.
Then all hell breaks loose...nurses from all units are rushing to help. Someone's bagging, someone else is calling for the crash cart, and us techs...we are scrambling around to find the code box with all the medications in it. The new admission is getting hooked up to the monitors, while the nurse starts pushing Zofran to control her vomiting. It's all a bunch of hoopla, until the patient begins breathing again, the new admission falls asleep, and then silence covers the unit again.
I live for the hoopla-hell moments. It's what makes working nights exciting. You never know when a patient will crash, and you don't know what new patient will be coming through those double doors. Medicine is such organized chaos. In the midst of all of the uproar, something beautiful happens: a team of people come together to deliver quality care to someone in need. We take all of our energy, and focus it on the patient. And no matter the outcome, the feeling of accomplishment and satisfaction is undeniable.
Then all hell breaks loose...nurses from all units are rushing to help. Someone's bagging, someone else is calling for the crash cart, and us techs...we are scrambling around to find the code box with all the medications in it. The new admission is getting hooked up to the monitors, while the nurse starts pushing Zofran to control her vomiting. It's all a bunch of hoopla, until the patient begins breathing again, the new admission falls asleep, and then silence covers the unit again.
I live for the hoopla-hell moments. It's what makes working nights exciting. You never know when a patient will crash, and you don't know what new patient will be coming through those double doors. Medicine is such organized chaos. In the midst of all of the uproar, something beautiful happens: a team of people come together to deliver quality care to someone in need. We take all of our energy, and focus it on the patient. And no matter the outcome, the feeling of accomplishment and satisfaction is undeniable.
Sunday, January 4, 2009
Life As a Tech
So far, I'm really loving my new job! It's only been a week, and I have learned more in that time than all of my time in long term care. Amazing!
My primary duties allow me to get close to the patients. I am expected to read charts and become familiar with why the patients are there in the first place, and for me, this makes all the difference in the world. Tomorrow I begin working the night shift. I can't wait!
So far, I've seen all kinds of conditions. Respiratory failure seems to be the most prevalent, but we have patients in for renal failure, HIV, diabetic ketoacidosis, stroke, MVA, the list goes on and on. One case, however, really struck me last week.
We got word that a new admission was on her way up from the floor. She had just given birth, and since the baby was 6 weeks premature, it was taken by C-section. Complications with the surgery bought her a one way ticket to the ICU. It took her a while to arrive, but when I returned from lunch, there she was...15 years old and scared to death. My first instinct was to stop and stare in shock..."a 15 year old girl...why in the world are these young girls having babies?" But our eyes met, we exchanged smiles, and that was that. She had lots of visitors come by to see her. At least she has the support she will need to raise her child. I think the diagnosis was preeclampsia.
I think what I like about Critical Care medicine is that you have to act quickly and be calm all at once. You must be master of your emotions. Time is of the essence and patients are depending on you to make the right decision...now. I hope to be able to perform according to those standards one day. Critical care, it seems, is becoming a specialty of interest for me. I can't wait to see what awaits me tomorrow night!
My primary duties allow me to get close to the patients. I am expected to read charts and become familiar with why the patients are there in the first place, and for me, this makes all the difference in the world. Tomorrow I begin working the night shift. I can't wait!
So far, I've seen all kinds of conditions. Respiratory failure seems to be the most prevalent, but we have patients in for renal failure, HIV, diabetic ketoacidosis, stroke, MVA, the list goes on and on. One case, however, really struck me last week.
We got word that a new admission was on her way up from the floor. She had just given birth, and since the baby was 6 weeks premature, it was taken by C-section. Complications with the surgery bought her a one way ticket to the ICU. It took her a while to arrive, but when I returned from lunch, there she was...15 years old and scared to death. My first instinct was to stop and stare in shock..."a 15 year old girl...why in the world are these young girls having babies?" But our eyes met, we exchanged smiles, and that was that. She had lots of visitors come by to see her. At least she has the support she will need to raise her child. I think the diagnosis was preeclampsia.
I think what I like about Critical Care medicine is that you have to act quickly and be calm all at once. You must be master of your emotions. Time is of the essence and patients are depending on you to make the right decision...now. I hope to be able to perform according to those standards one day. Critical care, it seems, is becoming a specialty of interest for me. I can't wait to see what awaits me tomorrow night!
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