randomity

That's my new made up word.

Last week I went out with J, a night nurse, and we apparently had a wonderful time. We had Vietnamese food, then continued on for coffee and cheesecake, then even walked in the park a bit. We stayed up until 1:00am, and the next day I was all happy and giddy and couldn't wait to see him again. Three days pass, and now I no longer want to see him again. We exchanged a few emails, the usual, "I had a great time, hope we can do it again." So that's not the problem. I have no idea what happened inside my head, except that the happy giddy feeling has been replaced and now I just feel weird about him, not entirely comfortable, and am remembering the not-so-good things rather than the "aww" things about the date. Nothing in particular was "not-so-good," so I'm having a really hard time explaining this. Except that now it's bothering me that he never asked the names of my dogs, and I think he was kind of pushy and cocky. Last night he called a couple of times, but didn't leave a message. In case I haven't mentioned this before, I'm really big on a few little things, like phone etiquette. Like, I obviously KNOW that you called (twice!) so a normal, polite thing to do would be to leave a simple message and I will call you back when I can. Do you think that if you call more than once, I will eventually be fooled into wondering what that funny beepy sound is, coming from this small piece of gray plastic, and press the start button?! Anyway, I'm confused by myself on this one. I just don't want to see him again. So there.

Last night little Ted was very ill, it was very heartbreaking. The vomiting and diarrhea are no fun of course, but it's even sadder to see him so lethargic and depressed. I ordered a pizza, and he slept in the other room the whole time I was eating! He was too sickies to even scratch his butt. This morning he seemed a bit peppier, although rather annoyed that all he got for breakfast was rice. I may go get him some boiled chicken (can I buy it pre-boiled? I don't want to touch it raw. And how does one boil chicken? Should I just cut it up, then throw it into boiling water?!) and cottage cheese for his dinner, maybe that will be more appetizing while remaining bland enough for his upset tummy. I also want to give him pedialyte for dehydration and metronidazole for a tummy bug and draw his electrolytes, but I must just be a doggy-mom first and a nurse second. Sigh.

In exciting news, this week I discovered these. Go look! NOW! And now I must look to my left in order to see myself, because I am absolutely BESIDE MYSELF in the cuteness that these things are. Can you even STAND it?! Can you IMAGINE the lambs?! ARGH! So I am well chuffed (and British, for a moment, apparently) that my dream farm, of miniature animals, will truly be complete. The pygmy goats, mini horses, and wee piggies will be pleased to have some wooly friends.

I have a job interview this week (shhhhh). I am super excited and nervous, not so much over the interview itself, but that if I get this new job, of the transition I will have to make. And it's a strange thing to reconcile in my mind, because I love my current job. I love the unit, and my co-workers, and my patients and their families. I love the work we do, the teaching and research environment, the support of the whole medical team, and the sunrises. But I don't love the medically futile things that we do, when I stop doing things FOR the patient and do things TO him, when people aren't afforded the dignity of dying peacefully and when they are ready. I don't love taking care of someone for weeks and weeks and always losing them in the end. I feel like a weenie because there are many wonderful nurses in our ICU who have been doing this for years and continue to do this, and I wonder what they're made of that I'm missing, because I can't do it anymore. But I also became a nurse there, I started as a wee nurse technician, only two quarters into nursing school, scared of someone else's vomit and fumbling my way around a glucometer, and I grew up into an emesis-bucket holding IV-starting ICU nurse. And now I guess I just want to see what else is out there.

Dating updating!

Gosh, I've been neglectful...are you all gasping for details on my coffee date with R?! Probably not, but you get them anyway. No juicy details to impart, but I will say that I was pleasantly surprised (comment from J: "Why are you always so surprised when a date goes well? Are you expectations that low?!") Uhm, I guess they are. But seriously, considering my past history, I think I'm still entitled to be surprised when someone shows up in clean, unripped clothing and buys me a cup of coffee. Anyway, R was pretty cute, funny, and smart. And also had a sweet sensitive side, since he wants to be a writer and loves reading. Aww. We even made plans to try to get together soon for dinner, so he's either a good liar and says that to all his dates or he actually maybe liked me a little, at least enough to want to see me again.

Tonight I went out to sushi with C, who I almost didn't go out with because he works in sales and lives on the east side and tried to get me to come over there for dinner. BUT I held out, convinced him to come to this side of the water, and gave him a chance. It was a not-unpleasant evening, but nothing memorable.

Tomorrow may be dinner or drinks with J, who happens to be a night shift nurse. Maybe we'll stay up all night trading stories about mucous plugs or nectrotizing fasciitis. I can't wait!

Oh, when I got home from sushi with C, I went to go comb my hair and a live spider fell out of it. Heh. If C doesn't call again, I guess I know why!

Also, I'm contemplating changing hospitals and units. Not that I don't love my unit and my coworkers and patients, but my interest has been sparked in something else. And I feel like I need to move on before I completely burn out, at least emotionally. My SuperNurse facade may be fooling you (and me) but in reality each of these patients and family members who get to me, then leave me, take a little bit of me with them. I don't want to give away any more information about my future plans until they're more concrete, but I'm already re-reading chapters in my nursing texts and checking the mileage from my house to New Hospital, so maybe I'm really ready. Stay tuned...

Smitten

IMG_1117
Originally uploaded by rosebuttons.

Who doesn't love Jon Stewart? Not this little girl! Only three months old, and already showing good taste. She's hoping that his sons are available when she turns 40, and is ready to start dating.

Death of a squirrel

This is the story of a hapless wee squirrel. A stuffed wee squirrel, bought for Ted while on vacation down AT the shore (the AT in that phrase carries a significance only you right coasters will understand), in an attempt to provide him with one more toy than the single stinky duck that he singularly loves. So, once Tessa fell asleep on the couch (I didn't actually have to wait very long for this to happen) I brought out the squirrel and presented it to Ted. Tessa just KNEW something was up, and the rest is history.


What do you have there? A new creature? A squeaky creature? I'll have that, thankyouverymuch. I must make sure it's dead.






Hey! She took my squ-- Hm, my butt itches.










I will soon rid the house of the squeaking creature! Resistance is futile.







Sigh. When are the snacks?







Don't worry. Ted may look quite pitiful in that last picture but I assure you that he got over the theft of his squirrel within three seconds and is much happier scratching his butt and looking for snacks than de-squeakifying small woodland creatures. He leaves that to Tessa. And yes, the fun never does end around here.

Rest now, my friend

He was 55 years old, I'll call him Sam. He'd once said that he was afraid of dying because "there will be a lot of empty pages in my book." I'd taken care of him nearly all of my shifts for the past six weeks, throughout his stay in the ICU. For the first few weeks, he was intubated and sedated. His son and daughter told me that he was slightly hard of hearing, but would prefer to have the television on in the background. The Learning Channel or Discovery, if possible. So all night long, I kept the channel on one of those, switching only to avoid infomercials. In the quiet of the beeping pumps and whooshing ventilator, I would fill the silence by talking to him about what was on TV as I drew his blood, changed his dressings, gave him his bath. Together we learned about the black plague and Emperor Caligula. Some nights were rougher than others...but we got through cold sepsis and some other hypotensive crises and looked like maybe we'd made it through the weeds. Weeks passed and eventually he was extubated (breathing tube was removed). He was slow to wake up, but each day became a bit more interactive. He could indicate if he had pain or not, nod and smile, he even had the good grace to smirk at my bad jokes. My nurse friend, J, and I got him onto the cardiac chair and wheeled him around the unit as the sun rose, to say hello to everyone and check out the views. He smiled more, and preferred to sit in front of the window when possible. He couldn't speak very well yet, but I got pretty good at carrying on a conversation with him my interpreting his nods, smiles, shoulder shrugs, and eyebrow lifts. I remember the morning we watched the rain come down, and lamented that somehow, we'd missed the end of summer.

One night I came on shift to find that he'd been reintubated two days before, and was worsening overall. Liver failure, possible GI bleed, counts dropping, unknown infection. The next night, he had a little blue sticker next to his name card on the door: Do Not Rescusitate. I continued to administer his medications, check his blood sugars, draw his labs, record urine output, turn him side to side, keep his mouth and eyes clean. I watched as his blood pressure dropped lower and lower. I called his daughter, who came in at 4am to spend the night. I said goodbye at the end of my shift, knowing it was the last time I'd see him. But in my mind, the last time I really saw him was the morning we'd watched the rain come down, and lamented that we'd missed the end of summer.

Those pages in your book, Sam? They're not empty.

So I am sad now. The same small sadness that I don't feel quite entitled to, since I know his children and his family are truly grieving, and compared to them, I barely knew him. It doesn't get any easier, because now when I feel sad, it just adds on to the sadness that I had for Billy, and for W., and the guy with my dog's name, and and and...

It was inevitable...

There they are, the Wiener Twins. It was about time, really. I've had at least one dachshund for over ten years now, and the hot dog costumes were bound to happen eventually. And they are worth it. There you have it.

Update on Love and Other Catastrophes: Mr.Lovesmelovesmenot finally fades completely into the background, after a performance of asshole proportions, impressive even by his own previously-set asshole standards. I think I still hear the fire trucks, something about some bridges burning. Ah well. So, my tears are wiped, the drinks are drunk, and I'm moving on. I'm jumping right back onto that dating train, if only for a bit of distraction and a reminder that maybe there are decent guys out there, ones who will pay for dinner, tell you that you look nice, and call when they say they will. I am meeting Bachelor # 1, R*, tomorrow for coffee. He told me a funny story about something he heard on NPR in an email, so I guess I'm a sucker for NPR-quoting microserfs. Stay tuned!

I have no good stories involving blood, mucous, or toenails, as I haven't worked in nearly ten days. Ahhhhhhhhhhh.

Here are some of my favorite things: Malbec, Dreyer's fat-free vanilla frozen yogurt, and sour gummi worms. Not all together, silly. That would be gross. Now, if you'll excuse me, I have big plans to cuddle with my little doggies, sip my wine, and watch Nip/Tuck.

Big walkies!

Today was the big 5K PAWS walk at Magnuson Park. Despite the typical Seattle September weather, we were there, along with over 1000 other Seattle doggies.

We signed in, then got the doggies properly attired in their stylish PAWS bandanas. Unfortunately they did not have Weenie Size and Tessa occasionally got her paw stuck in hers, and Ted's dragged through a few puddles.

While we were waiting for the walk to start, Ted wandered off and we had to convince him that he was not part of Team Terrier.

Then, we were off! Following the signs...

And five kilometers and two very wet bellies later, we were done, to much applause. Which the Wonder Weenies took in stride of course, because really, why shouldn't there be much applause for them all the time?

You know you're a dog person when...

This week in the ICU... two other nurses and I were just finishing bathing a patient, and stuffing pillows into pillow cases. K comments, "It was time that toenail came off anyway. I mean, did you see the tissue around it? It's necrotic. That nail was..." she glances at the sedated pt, then back at us, "that nail was D-E-A-D."

Me: "You're right, the nailbed isn't even bleeding. It's a good thing we removed it -- " then J cuts me off, "What?! Just because she's sedated and intubated she can't spell?" and suddenly K and I realize what she had just done, and bust up laughing.

Also, on a related note, we've discovered what really makes seasoned ICU nurses squirm. Nurses who have suctioned rivers of poo, poked and prodded open, oozing wounds, had skin blisters pop all over them, dealt with tenacious mucous plugs...show them a toenail which has fallen off, and they get a little weak at the knees. A whole toenail.

Well, tomorrow is the big PAWS walk! The dogs are currently resting up, after carbo-loaded and stretching. Okay, so they'd be 'resting up' anyway, but you get the picture.

Walking for Wildlife!

Me and my chubby couch potatoes are going to get off our butts on Saturday and do the PAWS Walk! It will be a challenge...for me, because I have to be awake around 8:00am, and for them, because, well, they're looking a little sausage-like lately. BUT it's only 5K, and I'm fairly confident we can all do it. Will try to get some cute pics but in the mass doggy confusion it might be hard! Anyway, if you're at all inclined, head over to my webpage to learn more about it, and what PAWS does in our community. And of course donations are greatly appreciated, you will get wet doggy kisses via email :)

In other news, I'm leaving town next week! Well, only for one night. But sometimes, that's all you need. Me and the my fearless travelling companions, the Wonder Weenies, and S, are all heading south to the ocean. We will learn about fruit that grows in bogs, eat pizza, run (two-legged creatures will be walking) on the beach, take lotsa photos, and enjoy our peaceful cabin in the woods. Ah. It will be lovely.

And now, your Ted for Today:

Today's Ted

Too-close shot of little Ted's head, just because. I think everyone needs a daily dose of Ted, so here is yours.

And now I am going to make a little pizza with little mozzerrella balls, because it's a little kind of day. I'm also going to clean the bathroom later. Maybe a little.

Hello? Reality calling. Please pick up line 6.

I am a terrible terrible person but I spend much of time of at work feeling quite frustrated by family members of my patients. Okay, that's an exagerration, it's not that much time. But proportionately, the amount of frustration I feel towards them is much more than I should (like never) since their loved ones are super sick, dying, in pain, all of the above.

So last night my fellow RN/friend fielded an early-morning phone call from a family member, and from listening to her end of the twenty-minute phone call, and watching the expressions on her face, I knew it was the exact type of phone call we've both taken many many times before. A concerned family member/friend calls, in our night-shifty case, early in the morning, and wants to be updated on their friend's condition. And here is where the Great Divide in understanding and information begins, from health care provider to family member.

ConcernedFamilyMember ["Connie"]: So, how is my sister? ["Susie"]? Any changes over night?

Nurse: (after verifying through several means and fingerprints and a hair sample that this person is who she says is and can be privy to Susie's super-secret-private health care information). She's doing okay, there were no major changes to her condition over night.

Connie: Oh good, so she's doing better then?

Nurse: Well, she's staying about the same. But she didn't make any changes for the worse, so that's a good thing.

Connie: Well that's good! Is she awake?

Nurse: Not exactly. She's on a lot of sedation and pain medication right now.

Connie: Oh. But shouldn't we wake her up? Is it bad that she's so sedated?

Nurse: No, it's actually a good thing. If her sedation levels are decreased, she tries to pull out her breathing tube and she grimaces like she's in pain, so we're trying to keep her very comfortable.

Connie: Well, if she's more awake, maybe she'll breath better on her own? And come out of the ICU sooner?
Here's where Nurse quietly takes a deep breath, closes her eyes, and starts to continue this conversation privately in her head, not saying what she actually wants to...

Nurse: No, she's not ready to breathe on her own yet, we do breathing trials everyday to determine that. But thanks for your opinion, even though you are not a medical professional, we really need people like you to do our jobs because otherwise we never would have considering your very educated point. Where do you work? Can I come and watch you, and tell you how I think you should do your job? I bet I don't need any special training either.

Connie: So how much longer then? A few days? A week?

Nurse: There's no way to say that at this point, as she's still dependent on dialysis since her kidneys aren't working yet, and she's on several heart and blood pressure medications...

Connie: Are those medications something she'll be able to take when she goes home?

Nurse: No, those medications are currently only in IV form, and they have to be running continuously... Or she'll die. Do you get that? She's super sick and has a high chance of dying. She's on life support and the ventilator and drips are the only things keeping her alive, minute to minute. If we could give her a pill and let her go home, believe me, we would have done it.

Connie: Because my Uncle Harry...he was on dialysis, but he got to go just a few times a week, and he was fine. And he was on this medication that made him make more urine. Have the doctors tried that? Since Susie's not peeing?

Nurse: Every case is very different. The doctors are doing everything they can to support Susie until her system starts to be able to recover on it's own. And again, thanks for your expert opinion. I'll pass it on to the docs, since they're really not actually doing anything, and your idea is probably the best they've heard all day.

Connie: Okay. Also, I noticed her toenails are looking kind of yellow, when I was there yesterday. She usually puts some cream on them for fungus or something. Does she still have that? Because she needs that twice a day.

Nurse: I'll will look into that, and make sure that's being addressed. Because that's super important. Because you know what else? Her kidneys shut down and her heart isn't sending enough blood to her toes and her medications are making them turn black and her lungs are filling with fluid and blood and she has clots throughout her liver that makes the rest of her skin look yellow and I need to change the dressings over her blistering skin and make sure her cardiac drip doesn't run out and suction her so she gets oxygen but dammit, her toes better not have fungus! I guess I am a lazy nurse because I didn't even put her toe cream on.

Connie: Yeah, because she needs that twice a day. I can bring some in if you don't have any there. And is her purple quilt in her room? Because that looks really pretty on her.

Nurse: Don't worry about it, we can get some here. And yes, the quilt is there. But it's on the chair, not on her. If it were on her it might get covered in liquid green stool, mucus, or blood. Probably all three. And also, you should be worrying about Susie's life, not Susie's toes. You should be hugging her children and thinking about how she lived her life, and how she'd want her life to end. You should be just sitting near her, if you can, and telling her how special she is, and playing her favorite music, or taking her dogs to the park and scratching them behind the ears, and not going to the pharmacy for her toe cream. Because Susie is very near death and this is going to be a terrible way for Susie to die. Do you get that?

Connie: Well, thanks for filling me in. I'll be in later in the afternoon. If you get a chance, let Susie know that I called. And that...we love her.

Then her voice cracks, and my eyes fill up, and I sigh and head into Susie's room to adjust her blood pressure drip and look for the toe cream.