Friday, June 30, 2006

Yawners


Yawners
Originally uploaded by rosebuttons.
The Famous A. has a comment on reading this blog, apparently. Everyone's a critic. Ah well.

This post contains neither nursing content nor knitting content, maybe because I've had four days off work and it just seems too hot to be knitting. But mostly because this little person is just too darn cute and far more interesting than anything I can blither about purling or the reasons why cancer sucks.

Today I went to Target and spent far far too much money because a.) Queen sheet sets were on sale, and b.) I have to buy new underwear on a weekly basis because Ted eats it. Seriously. He snoots it right out of the hamper and chews it up. Grody, I know. Then I went to happy hour where I could only have one drink because I had to drive home. So I think I need to either a.) Hire a full-time driver, b.) Use my bus pass to get to and from happy hour, or c.) Pretend my car is always in the shop and make people pick me up. I'll be pondering my options.

Oh and also...even though I have recently fallen head-over-heels for the charms of the above-mentioned tiny person (have you SEEN her?!), I still despise the rest of the world's children. Today I was leisurely enjoying a refreshing beverage at Starbucks until a hoard of blond childfreaks descended upon the bench next to me and proceeded to bang on the bench with their toys and screech loudly and constantly at the top of their lungs. Their parentard conveniently disappeared into a nearby store. Apparently, children don't grasp the concept that an evil glare means "Shutthefuckup" until they are quite a bit older. I would gladly have taught them that but I didn't have the patience today. As I was buying a snacky in Starbucks, their parentard came in to order a drink and her ineptitude at ordering an iced tea was saddening. Here's one of my pet peeves #415: When someone orders a drink but insists on using a hand signal to show what size of drink she wants, instead of using her Grown-Up Words. PEOPLE! Puh-lease! Anyway, as I was saying, apples...and trees...not that far apart.

Thursday, June 29, 2006

Hello, world!


12 hours old
Originally uploaded by rosebuttons.
Today I met the most fascinating little person, little A., who just made her debut yesterday. She is modeling her very first handknit hat here, and quite adorably as well. I can't wait to get to know her better. And as her aunt, I get the fun job. I don't have to worry about whether she eats her peas or puts her socks on backwards or finishes her calculus homework before TV, I get to take her shopping and teach her to ride a pony and tell her which boys to avoid (pretty much all of them, but at least we have a while). Although I'm sure she'll have even more interesting things to teach me as time goes by.

So happy birthday, A., and welcome to the world. We're awfully glad you're here :)

Saturday, June 24, 2006

...

Billy died in the early hours of Thursday morning, the night after my last night shift taking care of him. After a conference with his doctors, his family made the decision to withdraw life support and place him on comfort care measures. He was extubated and died peacefully on a morphine drip with his family at his side. He was 25. I will remember the floppy blond hair and the wry grin from the photo above his bed rather than the war-torn body he left in the ICU bed.

I am sad and feel strangely guilty that I wasn't there. I never met his mother, just spoke to her on the phone each night I was his nurse.

I haven't even cried yet but last night I had three patients who needed their nurse to crack jokes with them, sigh in empathy at their pains and complaints, and make sure they got their antiobiotics on time. And we march on...

Thursday, June 22, 2006

B'Hamsters

Hey everyone...head on over to Change of Shift and read what other nurses have to say out there... It couldn't have come at a better time for me, sometimes it just helps to know that others are out there, slogging through the same quagmire that you are :)

Thanks for you supportive comments, it means a lot to me. And to answer anonymous's questions...I talk to him constantly when I'm in the room, just mostly telling him what I'm doing, etc. If he seems really alert and looking at me, I'll remind him what day it is, what time it is, that his mom called and she loves him, that kind of stuff. Sometimes during his bath I'll talk about the movie that might be playing on the television, and if we're moving/turning him, I'm telling him that he's safe, he's okay, not too much longer, we're almost done. His family is there constantly during the day, but at night it's just me. Last night he seemed to sleep better (mmm...propofol) but the night before he was a awake for a long time. I finally had to tell him, "That's it, Billy, I'm turning off the sci-fi channel, you need to go to sleep!" Did you know Knight Rider is on at 4am? Awesome stuff.

Ok, gotta run. Off to beautiful Bellingham for the night, the unofficial "capitol of subdued excitement!"

Can't sleep, the night weasels will eat me...

Once again, here I am, can't sleep. I'm bothered and even a bit embarrassed considering how much I love night shift and being up at night and sleeping all day and how much I rave about the fact that I'm a night person and have no trouble with this bizarre schedule at all... But it's the middle of the night (early morning, to some) and I need to be sleeping so I can be awake tomorrow during the day....

I don't have much to say about work or nursing these days...I'm still taking care of "Billy" and he's still really sick and I'm much too attached to the whole situation and it's really getting to me. But I don't know how to deal with it, and I don't want to change assignments, and I don't want to talk about it, and blah blah cancercakes. Two nights ago, my shift started like this: "Uhm, this is R on XYZ Unit, and my patient's sats are in the 70s at 100% fiO2, can you come help me out?"

"Sure, be right up. In the meantime, why don't you take him off the vent and bag him?" gah. NewbieICU RN (that's me!) gulps and wonders, "Hmm, now how exactly do I disconnect the trach tube and attach the ambu-bag? Of course I SHOULD know this..." And also, as your patient breathes 60 per minute and his sats drop to the 70s, is not the BEST time to have a learning moment. But we have these handy super loud alarm thingies that ring out all over the unit if your patient is in trouble (the kind they don't have on Grey's Anatomy!) so another RN popped his head in the door and helped me bag my patient. He recovered fairly quickly and the rest of the night was uhm...okay. My shift ended with helping the surgeon to take out Billy's third chest tube and I think I said, "Whoa, cool" out loud as the big tube slithered out, making a cool slurpy noise.

I got a lump in my throat when Billy's mom called to check on him, as she does nightly. I filled her in on how he was doing, and she choked up a bit as she said, "Tell him I love him. A lot." Then hung up. I got another little lump in my throat as I was giving him his bath and felt how emaciated and fragile his limbs were. He still opens his eyes on his horse-killing doses of propofol and versed, but he's not as responsive as he was. But he'll look right at me, and watch me as I move around the room, and I think he just thinks that he'd rather be dead than be how he is. I read all the latest physician progress notes in his chart, which all stated in one way or another, "Pt has been intubated for 30 days and has not made any progress or improvement. Will address this in a Family Conference."

So lately I just move numbly through the days, getting irritated at everyone and everything, trying to sleep when I'm not tired and sleeping because it's just something easy to do when I am tired. I have a headache that won't completely go away and my back and shoulders ache in sympathy and consequently I'm probably pretty whiny. I continue to think vaguely about a job change, maybe to a unit where not everyone dies...?

Monday, June 19, 2006

Blah blah blahcakes


I've been trying to explain to Tessa here why perhaps my new lifestyle isn't the best choice, but she doesn't quite understand. You see, all weekend (and for me, "weekend" = the days in between working, so in this case, the past four days) I've had a schedule like this (and I use the word "schedule" quite loosely): wake up, check email and drink coffee, eat and watch TV, nap while I watch TV, eat while I watch TV, check email again, knit a little, watch TV and knit, snack and watch TV, go to bed. Lather rinse repeat. Since this involves lots of sitting and sleeping on the couch, which Tessa is really good at, as well as lots of eating and snacking on the couch, also one of her talents, she has been quite content. She is proud that I have finally come to appreciate her lifestyle. However, in the human world, it is perhaps not the healthiest lifestyle for staying healthy and maintaining social relationships. Which, most of the time, I don't really care about. Maybe I just needed this little vacation from the world on Rose Island. It was quite nice...I was about to title this post "Why I love being single" because I did whatever I wanted for three whole days and no one could bug me about it. Then I realized it would be just as appropriate to call it "Why I am still single," because, in case you didn't notice, showering didn't figure very prominently in the "schedule" of "weekend" events. Of course, I did shower, although that "every day" thing is totally overrated. So is changing your clothes, because seriously, once a shirt has a stain on it, why bother changing because then you'd eventually have two shirts with stains on rather than one with two stains. Efficiency, people. The name of the game on Rose Island.

Note to the people who live in the condo behind me: I'm sure that sucks a lot about whatever toilet problems you're having, but I fail to see why you must TALK ABOUT ALL THE TIME in your backyard. Shutthefuckup and go back inside. Where I come from we call that WHINING. I can hear you and I am annoyed.

Note to my neighbor: For fuck's sake, MORE LAUNDRY? Enough already. See above t-shirt stain theory.

Note to myself: If you're wondering why you came home from the grocery store with four cartons of soy creamer, two boxes of sugary cereal, two kinds of ice cream and some Kool Whip, uhm...yeah.

I forgot to mention that maybe staying on Rose Island for four days makes one a bit irritable. Or maybe I stayed on the Island because I was irritable, who knows.

Anyone want to go to Canada for the 4th? Patriotism makes me throw up a little into my mouth. Best to leave the country.

Back to work tonight. It might do me some good to clean up and join the mainlanders. You know, the people who don't live on Rose Island. We'll see.

Friday, June 16, 2006

So many fillems, Fa'er Ted!

I've seen way too many movies lately to recap and review them all for you, sorry! So, in brief:

Run out and see these movies as soon as they are in theaters:
We Go Way Back
Wristcutters: A Love Story
Eve and the Firehorse

Rent these movies on DVD, or put them to the top of your Netflix queue:
The West Wittering Affair
Dreamland

You'll probably forget the names of them by the time they're in theaters, let alone by when they're on DVD, because you should have gone to them at the film fest.

Also in movie news, I quite liked Friends with Money, it was pretty well-written with some great performances. Frances McDormand is always amazing, I love watching Catherine Keener because I hate her with such a passion, and Jennifer Aniston actually managed to pull of depressed and pathetic. The movie itself made me feel kind of depressed and pathetic, but I consider it a mark of a good movie if it can make you feel something.

Just Like Heaven is just right if you are looking for a light, fluffy romantic comedy. Mark Ruffalo is wasted in this role, but funny and bitter just the same.

In nursing news, nothing to report. I haven't taken care of Billy lately, but he's been trached and has a PEG now (feeding tube surgically inserted into the stomach wall). Other than that, everyone has cancer and is gonna die. Well, maybe not really, I'm just in one of those moods that it seems like that.

Hey nursing students! Always remember that the antidote to heparin is protamine. And if you have to give heparinized stem cells to a patient with a history of HITS, what should you be watching for?

Saturday, June 10, 2006

I wanna be sedated

...of course you do, you're in the ICU.

My brain is pretty random this morning. I just finished my third shift, meaning I now have four off. Yay! I drank so much raspberry Crystal Light last night I think I'm having a pulmonary embolism. Don't ask me to explain the physiology of how that could happen, but it just might.

And because unborn babies retain their cosmic powers (until they are born and claimed by their human parents), Peanut has conveniently rescheduled the Snow Patrol show for sometime in September. Now I don't have to worry about missing the show if that date turns out to be a birthday, nor do I have to worry about missing a birthday because I'm mesmerized by Gary Lightbody and his funny antics on stage. However, because unborn babies have twisted and uncanny senses of humor, I'm sure Peanut won't show up on the 15th anyway. But oh well. I've got some SIFF tickets for that night. And also, Peanut, it's not nice that Mr. Lightbody is sick and can't go on tour, if you had anything to do with that. But you'll learn all that "nice" and "good" stuff in due time. Heck, I think I'm still figuring it out.

Ted is itchy today. You know what that means...bath time! This is not a manuever to be undertaken lightly. Just read this if you don't believe me. Enforcements will be called in. Dogs will be bribed. It won't be pretty.

Today I'm going to dye my hair and see a movie about evil aliens. Whee! What could be better? But first, off to bed. Good night, morning people.

Wednesday, June 07, 2006

Cheesecake theater

"Look me in the heart and unbreak broken" - Tegan...or Sara?

On Monday Jodi and I discovered that cheesecake is the perfect movie theater snack.

*spoiler alert!!!* We saw The Break-Up, with Jennifer Aniston and Vince Vaughn. Yes, it was funny, but 'real-life' funny, not The Wedding Crashers-pee-in-your-pants funny. And it wasn't quite what I expected...I thought it would be an amusing romantic comedy...you know the kind, where boy and girl fall for each other, go through a rough-albeit-laughable patch and come out happy in the end. Because that's how movies should be, since real life doesn't work that way. But it was like real life...it sort of picked up right where most romantic comedies leave off, and show the disintegration of a relationship and how life just continues, with no happy ending or tying up of loose ends. And it ends with the painful inevitable conversation that anyone who has ever run into an ex has had, the one where you smile with your mouth and tell each other how great you look and try really hard to make your voice show how happy you are then promise to keep in touch while you know deep down that you won't. Ouch.

Monday, June 05, 2006

More movies!


Welcome to Tessa's movie reviews! Here's a picture to show why there are so many more pics of Ted on this page than Tess. Because when I'm waving the camera around, he's always right there in front of me and Tessa is...well, here. She's a burrower.

More SIFF excitement this weekend...starting with Whole New Thing. It was an amusing coming-of-age story, fairly standard for the genre, except that it threw Canadians and homosexuality into the mix. It was set in a small Canadian town, where 13-year-old Emerson has been home-schooled by his environment-saving hand-knit wearing parents. When his parents decide to send him to the local middle school, his experience there is as painful and funny as one might expect. Then Emerson falls for his teacher, Mr. Grant, and goes through the agony of a first unrequited love. The middle was a bit drawn out and the movie was overall pretty predictable, but the interesting characters and the performances and the slight twist on age-old themes makes it worth watching. 3 out of 5 stars.

Next I hopped across town to my favorite theater, the Neptune, for Wristcutters: A Love Story. I have to admit, I was wary about this movie, as all I knew about was the synopsis, that it was a movie about a heartsick young man who, after committing suicide, searches for his girlfriend in the next world. BUT....this movie was awesome. When people kills themselves, they end up in an alternate world, which is "a lot like life, except just a little bit worse." I have to give the writers a lot of credit for never taking the easy laugh with the expected New Jersey reference, because it was so right there. People in this world work menial jobs, hang out in smoky dive bars, where the juke box only plays songs about death. Like songs by Joy Division. Heh. Anyway, the three main characters, Zia, Mikal, and Eugene, set off on a roadtrip to find things. Zia is looking for his girlfriend who he heard also killed herself, Mikal is looking for the people in charge (the PIC), and Eugene just didn't have anything better to do. Along the way they meet Tom Waits, who is looking for his dog and runs a holiday camp of sorts for people in this wasteland. His character and performance alone make the movie. Anyway, I can't even begin to do it justice, but I'll just say that it was hilarious and well-written and moving at the same time. 5 out of 5 stars.

Today I saw the West Wittering Affair. It's an English movie about three people who go away for a weekend in the country and get up to a bit of snogging, and the repercussions that follow. It's filmed almost in a documentary style. Pretty interesting exploration of sex and adult relationships, although a bit heavy-handed at times with overbearing music. But overall I ended up liking and sympathizing with the main characters even though they were generally unlikeable people who did not-very-smart things when it came to love and sex....so I consider it a successful film. 4 out of 5 stars. Oh, I also enjoyed this one because unlike all the other SIFF movies I've been to, I was not stuck behind THAT couple. You know, the very "Seattle" couple who are just trendy and androgynous enough to not realize they're wearing each other's clothes and are bonded together through a mutual disdain for shampoo.

Friday, June 02, 2006

How to be a really bad nurse*

*and lose the respect of your coworkers at the same time!

First of all, this process is easier if you establish a reputation for yourself as a generally lazy and incompetent nurse. Like, if other nurses get anxious when you go near their patients, you'll know you're on the right track. It helps to be fairly argumentative and judgmental, and say inappropriate and obnoxious things as often as possible.

1. Ask your fellow ICU nurse to watch your two patients while you find an empty patient room to take a nap in. Ignore the fact that she has an unstable vented patient of her own, and ask her to wake you up in half an hour. Act really annoyed when she refuses to wake you up. Also, be sure to act like her suggestion to tell the charge nurse where you are going is a stupid one. Then, ask the PSR at the front desk to wake you up in half an hour.

2. When the charge nurse wakes you up in an hour, show your annoyance by not brushing your messy sleep hair and wrapping a blanket around your shoulders when you go back to check on your patients. Other nurses will notice and appreciate your commitment.

3. Get really mad at the PSR who didn't wake you up, even though the charge nurse told her not to because she wanted to do it herself. Try to make the PSR feel bad by telling her you'll never trust her again. She'll probably hide just how bad she feels about that but she's upset, really.

4. When your fellow ICU nurse makes a snide comment about how you should bring an alarm clock to work if you're going to sleep on the job and not be able to wake yourself up, act really upset because she sure isn't funny. Better yet, prove to her that you are the mature and seasoned professional by refusing to sit at the same ICU desk with her for the rest of the night. She'll get the message even more clearly if you get up every time she sits down next to you. In case she still hasn't noticed that you're upset, throw your pen around and sigh loudly.

5. Because you no longer like your fellow ICU nurse for telling the charge nurse that you abandoned your own ICU patients to take a nap, you no longer have to help her at all with her patient. This will reinforce to her that you are upset and hopefully she will learn her lesson. For example, if you hear her patient's pump alarming in the room, don't enter the room or attempt to see what's wrong, just announce to her how long it's been alarming for when you next see her. The patient will understand too, even in his drug-induced coma. Well, probably even more so because the pump is probably alarming to tell you his coma-inducing drugs are running out. Besides, to help your fellow ICU nurse would just ruin your carefully-established reputation as Lazy Nurse. Your fellow ICU nurse will miss the days when you would shout her name down the hallway when her pumps alarmed. So there.

Thursday, June 01, 2006

When they open their eyes, they break my heart

Last night I took care of "Billy" in the ICU, a 25-year-old patient who had a stem cell transplant over a year ago to cure his leukemia. He recently started have trouble breathing and we discovered he had idiopathic pneumonia. A lung biopsy showed multi-layered fibrotic lung tissue. Essentially his lung tissue is scarred, stiffened...not too much you can do about that. So of course he's on a ventilator, laying on a huge expensive bed that turns side to side and warms him up and fills with air to prevent pressure ulcers. He's on large amounts of sedation but still has bronchospasms and coughs through the ventilator. It took days to find the right amount of sedation for him, he was stacking his breaths and coughing and fighting the tubes and drains. Throughout my shift though, he was fairly "gorked." Nonresponsive except the occasional grimace to really noxious stimuli, no spontaneous movements. So I went about my work, hanging medications, drawing labs, measuring input and output. I bathed him and turned him and changed the pads underneath him and he hardly winced. Then around 6am I was taking his temp and he opened his eyes and looked right at me. "Hey, Billy, you're okay, you're safe..." He just nodded a bit. I explained to him where he was, what day it was, and he just nodded. He squeezed my hands, wiggled his toes, and answered no, he wasn't in any pain. All the while, looking right at me. I asked him if he wanted to listen to music, and he nodded, so I tracked down a radio and found some rock station for him. I asked him if it was okay and he nodded again, then went back to sleep.

Billy probably won't ever come off the ventilator, he probably won't survive this hospital course. Statistics and mortality rates and his disease and all its horrible complications are against him. And that's tragic and not fair and everything else that describes life on the cancer ICU. But when he opens his eyes and looks right at me, he just plain breaks my heart.