You just keep me hangin' on...

Mr. F passed away yesterday. He had a soft-tissue infection just over his left hip bone, the result of an infected bone marrow biopsy site. After a couple of I & Ds in the OR and many many surgeons poking, debriding, cauterizing, stitching...and many many RNs packing, re-dressing, lavaging, infusing platelets, cursing surgeons...anyway, the infection was about the size of a melon. Well, the amount of flesh missing was would have been the size of a melon. It was horrible but fascinating. Poor fellow.

Anyway, the topic of this post was my musing that despite the fact that about 95% of my patients die within a few weeks of their time with me, and although I've been an RN for nearly two years, and although I've wrapped countless post-mortem bodies and handed countless boxes of tissue to family members and silently hugged grieving spouses/children/siblings/friends, never has MY patient expired on MY shift. Ok, wait, one did...a young women who we withdrew care on during my orientation in the ICU. They always wait till I go home...at least a few hours, sometimes a whole shift, then they go. Weird.

Tomorrow I'm off to my favorite little city, Portland. I've got some new CDs for the car ride (the new Beck and Portland's own, The Decemberists), a list of "needs" from Powell's, and my fleece. Really, I don't need anything more.

Of course I will miss this little face:







But he will be in good hands, getting lots of little doggie snacks and belly rubs and play time with his stinky duck. Now, I must be off to bed, I have to get through my biography of Elizabeth I before I move onto the story of Mary Stuart and the "mysterious" murder of her asshole husband, Lord Darnley. This stuff is better than soap operas!

Oh, no word from my new boss on the possibility of changing my start date. Looks like Europe may have to wait....

So sorry!

Have you missed me? I am a horribly neglectful bloggie friend.

First, it's official, I've given notice at Old Job and accepted New Job. So good-bye oncology ICU, hello pediatric ICU! I'm so super excited and scared to death and a bit sad and a lot nervous. But overall, it feels like the right thing and the right time to be doing this.

I have ten shifts left at Old Job, and suddenly last night decided it might be nice to hop over to Europe in between jobs, to treat myself and rest and rejuvenate my spirit, etc. So I'm attempting to get my start date moved back by a week, which would give me 12 days off. I'm leaning towards a brief but juicy tour of Budapest and Prague, although Amsterdam and Paris is a close second. But I've always wanted to go to Glasgow and tour the art and architecture of Charles Rennie Mackintosh. Plus the Scots are just awesome people. Then there's always the idea of just flying into London or Manchester, renting a car, and spending a week touring cold drafty castles during the day and sitting in warm toasty pubs with E at night, eating a lot of fish and chips and laughing our arses off at Dawson's Creek. Any ideas/suggestions? Of course this is all dependent on getting my start date moved and scraping together a small pile of cash...

Boys and dates in general, super lame. I'm tired of all the weirdos. And metrosexuals? You all need your own dating website. Or least you must identify yourself as such on your profiles. Because nothing makes me want to flee the restaurant faster then seeing you and the hair-with-product in it and your casual-yet-expensive jacket and your twitchy too-small hands. Somehow, not attractive. Give me mismatched flannel and endearingly out of place hair, along with big man hands, any day.

Change of Shift

It's up, it's official, the new Change of Shift over at Emergiblog. Head on over to read bits and bobs from the inner workings of nurse's minds, it's not for the faint of heart, but it is truly engrossing :) And of course, there's a little something from yours truly...

OH! I got to go to the morgue last night! These next 16 shifts will be filled with "I've always wanted to...". When the guy (totally blanking on his job title) came to pick up the body in room 34 (who was also a daddy, a son, a husband, a victim of a horrible disease, but mostly a really awesome guy, but I'm sure HIPAA prefers I just call him the body...) I helped him roll the black-shrouded 'mystery' cart downstairs. Then I helped him attach chains to sling under the white-plastic zipped up body-shaped parcel, attach the chains to the hydradaulic lift, raise the body off the cart, drop it down onto another stainless steel 'stretcher' and roll on into the refridgerated compartment. He then slammed the door shut, taped a stamped name-sticker to the door, and that was that. Full circle.

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.

Fire in the sky

This morning I woke up and my bedroom door was slightly ajar, and there was a strange light coming from the living room. I lay there, completely confused, wondering what possible light I could have left on overnight, and I was sure I'd remembered to turn them all off. After a few moments, and after I glanced at the clock, I realized it was just sunlight. I've heard that happens in the mornings, actually much of the day in fact. Hm.

I was quite pleased to see this article in the New York Times. As Tessa is always saying, it's about time more people realized they are associated with greatness.

Now I must suck down my coffee to fortify myself and perfect my Mean Voice in order to call my payroll supervisor. She f*cked up my last paycheck, and no one messes with Nurse Ratched's paycheck. No one.

In the meantime, I leave you with this thought of the day:

Belated

It was your birthday last week, so I just wanted to say welcome to your new decade, it's going to be wonderful. I have my camera with me nearly constantly but I'm kicking myself that this is the only photo I took of you on the actual day. I think that's okay though, since this is how I know you...walking along a path, with you at my side, calling for small dogs and laughing at their exploring. They were probably just at our feet in this shot. So anyway, happy birthday again, and here's to several dozen more years.

Are my eyes open? ...NO!

Bonus points if you can tell me where that title line comes from. Hint: It's from a sitcom.

My eyes are only half-open right now because I'm super tired but I think most of the super-tired that I'm feeling is actually the hazy weird feeling that I get after I take my migraine medicine. Good news: I no longer have a headache. Bad news: I feel like I'm underwater. Blurble.

Nothing much else to report. Oh, Bellingham is still there, still lovely and peaceful and relaxing. And also quieter and has cheaper more abundant parking. So there, Seattle. Pictures to come soon.

I've been taking care of S. at work for the past two weeks, the latest in my never-ending stream of post-transplant super-sick intubated patients. I read in his chart notes that he told the social worker, pre-transplant, that he hoped for the best outcome because, "...if not, my book will have a lot of empty pages." So far I've pulled S's blood pressure out of the toilet two separate nights and convinced him not to die of cold sepsis one night. But that's all fodder for another post. Right now my eyes are blinking too long and I can hear the ice cream and bad reality TV calling me from the other room.

And also, Boy still eludes me. Another weekend that he's out of town, another week to wait to see him. Ah well. At least I don't feel smothered.

The Ones

This morning a nurse friend and I had a conversation about The Ones That Get to You. These are the patients who, for undefinable reasons, just get to you. Somehow you connect with them on a different level than with your other patients. They are the patients who wander into your thoughts on your days off. Routine or mundane tasks caring for them aren't bothersome or easily put off. When they or their family members say "Thank you," and you respond, "No problem," what you are really saying is: "No, thank you. Thank you for reminding me again why I am a nurse, why it is important that I come to work, for providing me with the inspiration and energy to do my job..."

I wish I could say that all of my patients inspire me to give my whole self to my job and my tasks, but they don't. I don't slack off or not care about the other patients, but The Ones That Get to You are special. As my colleague put it, from the moment you feel that connection with these special patients, something tugs at your heart and starts to hurt a little. Because caring that much more about them means hoping that much harder. You lose just a smidge of your "professional objectivity" and you start to believe that maybe this patient is the one that fits into the "10% survival rate" category. You cling just a little bit more to the lab values that start trending positively. And you hurt a whole lot more when things don't go well, because you hoped just that little bit harder. But in exchange for the disappointment and the hurt and the loss when they lose their fight, you had that connection. You witnessed courage, strength, and in the end, peace.

The Ones That Get to You are the ones that I would much rather have met for the first time at cocktail party, or standing in line at Starbucks, or at the dog park. Because, then, in a perfect world, that would mean they didn't have cancer, and maybe we would have been friends.

Baby love

"Hey, Mum, that dishwasher is nasty. Buy me a new one. Please. T'anks verry mutch." (as said in an Irish accent. Just because that would be super cute.)






"Go ahead, mom, take your time doing your household stuff and helping Mr. Repairman. I'm very content here in Auntie Rose's lap. She's fun. She keeps telling me about the pony she's going to buy me and teach me to ride. That sounds pretty cool. Also, what's icecreamferbreakfast? She said I can eat that with her..."




This was pretty much my view for most of the day, but it doesn't get too much better than that. I even got a few smiles out of those chubby one-dimpled cheeks, and I'm mostly certain they weren't even gas. We watched HBO on-demand and drank some formula and had a couple of Code Browns (official hospital-speak for poop-in-the-pants) and even managed to put our own little fist into our mouth without missing and poking ourselves in the eye. And when you're six weeks old, that's big stuff.

I must say, after spending 48 hours this week taking care of people at the end of their lives, some slowly dying and some actively dying, and having to interact with people facing serious and debilitating and scary diseases, and needing three people to help me clean a 200-lb adult's Code Brown, hanging out with someone at the beginning of her life, who's just figuring out what she likes and doesn't like, is pretty cool. Somehow it's refreshing and comforting. Somehow it seems to restore the part of me that gets used up every time I wrap another body for the morgue cart, or hug a mother who is saying goodbye to her son.


Yes, Ted, you are still my firstest and my favoritest baby. Although you are an incredibly needy little thing...

This is my view the rest of the time...

The countdown begins...

As of this writing, I have forty-five minutes. Exactly forty-five minutes for the phone to ring and Nurse-In-Charge to tell me to come to work, for my regular shift, and earn my regular pay. BUT if the phone rings in forty-six minutes or thereafter, and the Nurse-In-Charge tells me to come to work, I will earn time-a-half plus two extra hours of pay. Let the nail-biting commence...

But also I have to admit that I don't really want the phone to ring at all, I want to stay home in elastic-waisted pants and a tank top (yes, I really am that spoiled that now I think even scrubs are 'getting dressed' and 'restrictive.' And yes, I realize that this means there will be moomoos in my future.)

So while I wait and try not to watch the clock or the phone, I have some fabulous tidbits of reading for your entertainment: First, I apparently have a very presitigious job. Go ahead, let it out, I know you're snickering too. It's a lovely sentiment and all, but apparently these people who wrote this article or voted in this poll have never actually seen nurses work, or probably ever met a nurse.
Above, nurses on a day off. Yes, we are alpacas. I do not have any photos of us discussing a fecal fat collection, wiping our patient's butts, suctioning liquid stool, gloving up to pick pills out of a basin of puke, packing a rectal abscess, taping a plastic bag over a dead patient's head, or, doing the windmill dance with our scrub pants pulled up to our armpits to the lady lumps song while pretending to spank each other at four a.m. Perhaps the term 'prestigious' in the survey was loosely interpreted to mean, "Thank god there are people weird and crazy enough out there to do that job because you couldn't pay me enough to step away from my cushy desk job which is lacking any contact with body fluids at all."

Also, Dr. Hebert has written a moving and eloquent entry on the case of the charges against the doctor and two nurses from a New Orleans hospital regarding their questionable actions in the immediate aftermath of Katrina. I've been wanting to say a bit about this lately, but he puts it into words much better than I could. It's extrememly thought-provoking, and unfortunately the case is going to get very polarized because of the hot-button issue of euthanasia. As an oncology and ICU nurse who has been a part of countless discussions and situations of end-of-life care and issues, this case seems to strike close to home. But also having seen families go through absolutely unimaginable horrors with their sick loved ones and losing people, I know that until you are actually in your own little hell, until your own unimaginable horrors are visited on you, there is no possible way to guess how you might react. Therefore, I don't think it's possible to truly understand or to judge how others react while they suffer through their little hells.

And finally, read this med student's post about his experiences in the MICU. As I read this, I kept looking over my shoulder to see if he was on my unit, and I wondered if I'd seen him at the code the night before. It's funny how I alternate between feeling like my job and my work environment and situations are so surreal and bizarre that no one else would understand, to reading a doc or a nurse's blog entry and becoming convinced that he or she has followed me through my shift and saw exactly what I saw.

CHA-CHING! It's now officially 7:00 pm.

What I learned at work last night

• The one time you don't walk-super-fast (because you NEVER run in a hospital) to an emergency light, it will really actually be a code and not just an "Oops, did I bump that switch on the wall?"
• In a code situation, just pick something, and just do it. That way it's harder to freak out. Like, grab the ambu-bag off the wall, open the box, put it together, plug the tubing onto the oxygen, turn up the oxygen, place the mask on the patient's face, chin-lift-jaw-thrust, hold the mask in place super tight and squeeze that bag. Doesn't seem too complicated but it becomes complicated when people are yelling, "Get the doctor! Where's the doctor? I called him! Where's the CPR board? Where did his son go? Normal saline wide open now!" among many other things I probably didn't hear.
• When you're doing something, just do it, don't worry too much about doing it right. Remember, the patient is already dead. I felt a twinge of, "Aw, sorry..." as I yanked his head back and pushed my fingers under his jaw to pull it forward till my tiny rationale mind realized that when someone is doing compressions on your chest while someone else digs a needle around in your groin looking for a femoral vein, the guy had bigger problems than if I maybe bruised his chin.
• When you need something, don't just ask. It won't get done. So find someone, make eye contact, and say, "Betty Boop! [insert name here] I need a liter of saline!"
• You have to take care of each other first and foremost. When the nurse whose patient it was looks gray and shaky, don't ask her if she's okay. Just lead her to a quiet room, put a warm blanket around her shoulders, hand her a glass of water. Then let her talk, or not talk, but just sit near her. She'll be in shock, and freaked out, and questioning everything she did and didn't do. So let her say those things, but keep reminding her that she did everything she could have done, she did her best like she does every night at work, and she's going to be okay.
• In real life, there is no Foreshadowing Music of Doom. Otherwise, we would have heard it during the our conversation about the above-referenced pt's quality of life, probably life expentancy, and the nurse's comment that hopefully he should die sooner rather than later, or his suffering will simply be needlessly prolonged...cue code light. See previously mentioned chain of events.

...

So this happened.

Despite everything we do, leukemia continues to be relentless and indiscriminate.

In the Navy!

The US Navy was in town last night. Well, not all of them, I guess, but many of them in their little white outfits (I suppose it's more manly to call them uniforms?) were having a night on the town (shore leave?) in Belltown. So what's a girl, even a dirty-socialist-patriot-hating-anglophile girl, to do? Well, after three martinis, dance with them of course! Every 'civilian' guy who happened to go out in Belltown last night wore a permanent scowl as he nursed his drink against the wall, cursing himself for not joining the navy and getting to wear a shiny white outfit that draws drunk girls to him like moths to a flame. Hahah.

Oh, and...
Dear Seattle,
We hate the Blue Angels. Nobody is impressed by them, nobody thinks they're cool. We think it's a great big old waste of money to pay those overgrown toddlers to fly around in their million-dollar toys, causing unnecessary noise pollution and indescribable traffic headaches. They make our doggies quiver and pee on the floor and do nothing to improve hangover headaches. So yeah, to sum up, not impressed. Spend your money on something else. However, if they were dogfighting or having some kind of 'demolition derby' in the sky, that'd be cool.

Things that are gross

First of all, I am not one to brag about the gloriousness that is Seattle in the Summer (apart from Seafair, tourists, traffic, and bikers taking up my lane of traffic), mostly because it's already crowded enough here and Seattle has already gotten a fat little ego and behaves pretty pretentiously about its great old self (but I digress.) As I was saying, I like to keep the secrets of the green, lush, sunny, temperate, rainless summer to myself, lest hoards of *gasp* right-coasters or worse, tourists, clog up my fair city. Also, it's just not nice to remind your friends in other parts of the country who are sweating and melting and sweltering and mostly complaining like crazy that you are so damn comfortable in your AC-free house in just an old skirt and a t-shirt. Ahhh. BUT...my point was that when you log on to Weather.com to see if you need to wear a light sweatshirt over your tank top as you walk around the lake, and the headline reads "Heat wave! Dangerous record highs!" then, in little letters at the top it reads, "local weather: Seattle, 64" you can't help but snicker a little and sigh happily. And before you go poking your little Rosebuttons voodoo dolls with blistering hot needles and sending me sucky weather karma, let me remind you that I spent 12 years in the midwest, that's "America's Heartland," (those are Quotes of Sarcasm), the Flyover States, aka the land of 10-month winters with temps around minus 50 and two months of sauna-like humidity and heat and mosquitoes bigger than kittens. So yeah, nasty hot summers suck. Huge hairy balls. However, Seattle summers don't suck. But shhh. Don't tell. I think the airport closes for the summer anyway, so you can't come. So do the highways. (Seattle drivers snicker, "Tell me about it. Just in the summer?")

Yesterday I went to Target, and bought some cheap clothes that I may or may not have needed. Then I ordered some Indian food, and stopped first at another Indian restaurant along the way to buy a jar of the Best Stuff Ever, mango relish. I was tempted over to the nearby Walgreens to buy some hair dye (currently burning itself into my scalp. Gotta shower soon, T minus 6 minutes). But between the restaurant and my car I had a mild spaz attack and dropped the bag with my hair dye and mango relish, causing the top to loosen and spew oily mango relish all over...my hands, the hair dye box, etc. So I sort of wiped off my hands the best I could and proceeded to the next Indian restaurant to pick up my eggplant bharta, self-consciously aware that I smelled like mango pickle. And although he was super nice and gracious, I could tell the guy at the counter was thinking, "These silly white girls. She is nowhere near of Indian descent, and I am not fooled by her attempt to slather herself in mango pickle. No free mango lassi for her.'' *Sigh*

edited to add: The title of this post refers to smelling like mango pickle, and wondering whether my hair will smell like mango pickle forever. I just got a little sidetracked as I checked the weather...

Randomly random

This is Ted. Tell him he's a big dog, he likes it.

This is the culprit, cute as he may be. He is the reason behind my weekly trips to Target for more and more underwear. Trust me, you don't want to know the details. However, I am about to go again tonight...not buying underwear tonight, just returning some things I bought on impulse while I was there last night buying underwear. Yep. I've got a lovely date planned with myself for tonight...I'll hop up to Target, then order some Indian food and pick it up on the way home, then watch Bridezillas and Hex on DVR, and possibly Unbreakable from Netflix if I'm still awake. I know, it doesn't get any more exciting than that. I don't know how I handle it either.

Hey nurses...is anyone else out there starting to get all into (I almost said 'excited' but then realized that even I am not that dorky) the idea of going back to school to get your masters and maybe even be an NP only to be gobsmacked by this bizarro DNP thang?! Can anyone else explain to me why this is happening (I know, I know, four-year doctorate prepared patient care provider yaddy yaddy more cheap labor for the Health Care System Monster sorry personal opinion). I'm mostly tempted to say f*ck 'em, I'm gonna be a stinkin' masters-prepared NP anyway and if you want to pay me less or fire me in 2015 than fine, I'll be happy milkin' my pygmy goats and teaching kids to ride ponies. Then a little bit of me says, hey, if my current Health Care System Monster is willing to pay for nearly all of it, who am I to turn down the chance to get a doctorate and just be done with it?! Those are my thoughts, as small as they are. Discuss amongst yourselves. Opinions?

I'm thoroughly annoyed with myself because I'm In Waiting. Waiting for a boy to email/text/call, if you must know. I hate being like this, because I'm an independent grown-up who doesn't sit around waiting for boys to call and dammit, they should be lucky if I even deign to answer their call. Stop laughing, I like to tell myself that. It almost sort of works.

So anyway, thanks for tuning in. I have a date with Target and Bombay Grill and the TV, mustn't be late.

What she said

Last night I asked my colleague how her patient W was doing, since I'd taken care of her for several weeks in the ICU. W had been extubated (breathing tube removed, was breathing on her own) two weeks ago, and been moved out of the ICU to floor care last week. She was starting to nod yes/no to questions but was not very interactive and hadn't said anything at all. My colleague said W was doing okay, slowly getting better, but somewhat depressed. So I stopped by to see her, tell her who I was, and that she looked a million times better, and was making good progress. She nodded a little while I spoke and seemed aware that I was there. A few hours later, her nurse found me again. "I need you again in W's room, come with me," was all she said. I went and stood near W's bed, and her nurse said, "W, tell Rose what you just said to me." I glanced skeptically at her nurse, but took W's hand and looked at her. "I want to go home," she said simply. "You want to go home?" I replied. She nodded, looking me right in the eye. And while I'm always loath to make promises to patients, I told her, "Of course you do. And of course you're going to go home. Not tomorrow, and probably not as soon as you'd like, but that's the path you're on. Every day you get stronger, and every day we all work really hard to get you ready to go home. And you're working the hardest at it. So I can hear it in your voice now W, that you're getting better and you're going to go home."

Then I went back to my own patient's room [ed: another RN had been watching my patient and my monitors while I was in W's room], to continue titrating his levophed to maintain a blood pressure that actually perfused his organs with blood and adjusting the amount of oxygen the ventilator was giving him. He is really sick, at least as sick if not sicker than W had been. Some of them get better, and some of them don't, I don't know why. Maybe if I knew why then I wouldn't be hopeful when the situation was futile or I wouldn't distance myself when there really was hope.

There was also a code on the unit tonight, not my patient however. I was entering the room just as two young doctors ran onto the unit then stopped short in the doorway. "Shit, I hate it when we're the first doctors at a code. Have you ever run a code before?!" one said to the other.

So I hear it's your birthday...

Thank you Jerry, and yes, it was yesterday! I'm officially an old lady, the big three-oh. It's a good thing, because now my knitting and sewing and old-lady name and wiener dogs all make a lot more sense. Plus, it feels kind of cool not being stuck slogging through my 20s anymore. I'm so over the 20s. The 20s were all about going to class and figuring things out and deciding what to be and what to do and what not to do. Not that I've got anything much more figured out, but I have learned things like not to keep drinking after you've thrown up (age 19), not to keep calling the boy if he stops returning your calls (age 20), how to read as little of possible but still ace the test (age 21), and how to get a real job that pays the bills (age 28). So now that I've got that stuff out of the way, I can be 30 and fabulous. And I'm going to try all sorts of new things. Already, I've been to Jack in the Box for the first time and eaten my first mussels (two different events, obviously). And it's only going to keep getting better from here!

I'm not going to tell you how hot it is here, nor am I going to complain about the weather. Contrary to popular belief (based upon the amount of people who do it), whining about the weather does not actually change it. Apparently, there are plenty of other blogs out there doing that if that's what you want to read. But I am going to mention that if you have absolutely nothing important that you need to be doing or anywhere you should be going, if you can get away with wearing nearly nothing, if you enjoy bad reality TV, and if you surround yourself with icy cold beverages, sprawl on the couch and point all the fans at you, this weather suits me fine.

I am also pondering why my neighbor, the Laundry Slut, continues to have at least eleventy billions loads of laundry to do EVERY weekend despite the fact that from April till October he NEVER wears a shirt. Tessa is currently barking up a storm at him because he's out in the yard, and even Tessa understands that public nudity is a privilege, not a right. A right specifically reserved for Colin Farrell and the Italian soccer team. And last I checked, furry Laundry Sluts were not members of that team.

Oof, I've left my post. Back to the couch, I don't think I've seen this particular episode of Kathy Griffin: My Life on the D-List.

I'm still here...

I haven't posted anything in a while, so I thought I'd drop in to say hey, I'm still around. Been working a lot lately, taking care of W. for a few weeks now. She's sometimes a tough patient, but I keep requesting her now, for whatever reason. Maybe because it gets easier to more experience you have with a patient, the whole "the devil you know..." thing. Maybe because the more you invest in taking care of someone, the more you have to be there for them. Last night her daughter asked me, "Is she going to wake back up? Is my mom ever going to be my mom again?" I don't know. Nobody knows. Maybe, or maybe not. There's such a super-fine tightrope we walk at work, giving realistic expectations but not extinguishing hope. Never extinguish hope, that's all some of these people have. You've got to hope for the best, because, really, what choice to do we have? Our chaplain told me once (someone else probably said this first, so I apologize for not giving credit where due), "Always hope for a miracle but never expect one."

Someone died this week. He was a cool guy. I want to link you to his obituary in the New York Times so you can read about his life and everything he did, but I'm too paranoid about HIPAA. He taught me that regardless of political affiliation, some people are just good people. He was warm, curious, funny, and open. He wanted to hear what you thought just because you thought it, not because you supported a particular party or 'side.' He wanted you to know more about politics, but he would give you a book or literature and encourage you to learn something through your own eyes then come back to discuss it with him. He found humor wherever he could. The love and compassion he inspired in his family members, evident from the way they looked at him and laughed with him was moving. He was genuine in a disarming way. When you strip away preconceived ideas and deal with people just as human beings, you are often surprised but always rewarded. It's unfortunate that sometimes it takes illness and suffering, or just putting someone in a neutralizing hospital gown, to approach that situation. So thank you sir, I feel lucky just to have met you.

I'm on stand-by tonight for work but I just received an 'ominous' call from my charge nurse, so I might be putting those scrubs on after all...

Tales from the Last Chance Motel

Last week at work, I took care of J., the woman who was in withdrawal and suffering from extremely altered mental status, although she was coming around a bit. I also took care of W., an engaging southern politician who said things like, "I have a five-pound appetite but a three-ounce stomach." He was a genuinely nice guy, the kind of person who, when he asks you how you are, asks you because he actually wants to know. I admitted him one night then got him ready for discharge him the next. So I came back to work this week and was guilitily pleased that J. had been transferred to another unit the day before. Then I found out that she had died that morning, a victim of her aggressive stage-four gastric cancer. And although I had discharged W., he had been re-admitted the next day but was currently on his way back home, via air ambulance, as he had relapsed and suddenly gotten sicker, so he wanted to be home to die. That night my another patient on my unit died, and I helped her nurse wrap up her body. My patient is also awaiting a celestial discharge, but remains full-code status and continues to undergo all treatments, such as mechanical ventilation, kidney dialysis, and a levophed drip (cardiac medication to keep her blood pressure up). She has gained over 80 lbs in less than three weeks, and when I move her or touch her she cries. Her tears are bloody and leave permamently stained rivers down her cheeks. Last night one side of her neck started swelling up like a baseball and we found a strange (fungal?) rash/spots across her chest. Yesterday another patient that I'd had a few weeks ago received her stem cell transplant but shortly thereafter went into respiratory distress, acute renal failure, and suffered a huge MI (heart attack). She was intubated and dialysed but her blood pH had been around 6.1 for nearly four hours. That's real BAD. So...yeah. I don't know why I'm typing all this, except that its what I mean when you ask me, "How was work?" and I say, "It was okay."

Wakey wakey

Although not a great photo, this is a view of the sunrise as seen from many of our patient rooms. After spending a darkened night making sure patients are breathing, whispering around sleeping family members, using a flashlight to check name bands, and ruminating over the horrors and unfairness of cancer, its always a comforting yet bittersweet surprise when the sun starts to come up, and the world outside starts to brighten. As if to say, "Things won't always be this bad."

My patient this week was going through probable benzodiazepine withdrawal, which presents somewhat similarly to alcohol withdrawal. Which is not a pretty picture. She may have taken up to 90 clonazepam tablets over six days, which is about 5 times the maximum recommended dose. She was delirious, narcoleptic, agitated, anxious, noncommunicative, impulsive...well, all that and a bag of chips. Oof. I'm drained from those three days of making sure she didn't pull out her central line, reaccessing her implanted port when she did pull it out, keeping her hands away from her foley catheter, listening to her cry, and hoping she didn't have any more seizures. Also, three deaths over the past three days on our unit, although all during day shift.

Then this morning I couldn't fall asleep because I was having this strange shooting and intense lower back pain each time I tried to lay down, which was rather bothersome. I couldn't remember hurting myself while bending or turning or lifting a patient, although it's certainly possible. All I could think of was, "Pt c/o lumbosacral pain, rated 7/10, nonradiating, sudden onset. Relieved with ibuprofen 800mg PO and diphenhydramine 25 mg PO. Reassess pt comfort q8hrs."

It's July!

Happy July 1st everyone! I hope you all enjoy this lovely sunny summer month, the barbecues, the swimming, the sunshine. Ahh. Just, please, whatever you do, do not get sick or injured. Buckle your seatbelts, wear your helmets, cook your meat thoroughly, remember that "beer before liquor..." Do whatever you must do to avoid having to go a hospital at all costs. Because July 1, all across the country, is the first day of being a doctor for all new doctors. Don't get me wrong, the first-year residents are, for the most part, a group of highly trained, motivated, caring professionals. Ready to save lives. Just as soon as they figure out the appropriate dose of tylenol and make panicked calls to their attendings. I worked with an R1 last night was only five days old (awww!), still wet behind her cute doctor ears. So fresh and new, actually, that she was still getting ice packs for patients herself. And bless her, she was sooo sweet and caring, and trying so hard. But her comment to another nurse last night sums it all up: "You have no idea how many patients we'd kill if it weren't for you guys." (meaning us nurses! Like me! Hah! Yep, now you should be scared!)

For the past several weeks, although I've been feeling better for a few days, I've had basically a persistent headache which evolves into a migraine every third day or so, and had to take excedrin or nsaids on a daily basis. Last night, I admitted a patient from another oncology floor, a young woman in her early thirties who had mental status changes and a seizure. The nurse giving me report began by saying, "So this young woman presented to the ER last night with intractable headaches but appearing otherwise normal..." By this morning she was incoherent, unable to communicate, and thrashing in bed, agitated and unconsolable. At one point in the night she was foaming blood from her mouth because she bitten down so hard on her tongue. I had to pinch her nose shut to get her to open her mouth and stop biting her own tongue. We have no idea what is wrong with her. But yeah, I have an appointment with my doctor to discuss my headaches.

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.

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 :)

...

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...

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...?

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.

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?

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.

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.

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.

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.

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.

Ted and the Duck

IMG_0689
Originally uploaded by rosebuttons.

Welcome to Ted's movie reviews! Well, not really, but the only interesting recent photo that I have is this one of Ted. Seriously, I do have two dogs, and I love them BOTH to bits, but the other dog, Tessa, chooses to sleep under her down blankie on the couch in the other room while I'm at the computer. Therefore, she is not such an easy target for my camera...

The Seattle Film Festival is in full swing, and I'm desparately trying to use up my 20 passes that I bought back in January. So far:

Adam's Apples, a Denmarkian movie, a black comedy. It's sort of about a Adam, a neo-Nazi ex-convict sent to live at a tiny little parish church and do community service or something. He ends up there with Khalid, a Saudi ex-con who used to rob gas stations, and Gunnar, an alcoholic who used to rape and kidnap women. Also a tennis star in his youth, although he now weighs about 300 pounds. And does shots of cough syrup, nearly two or three bottles a day. The priest of the parish is a bizarre psychopath who is in complete denial that he is dying of a brain tumor, has a paralyzed, retarded son, was raped and molested by his own father, and his wife recently committed suicide. He's just convinced that the devil is testing him, that's all. Adam is so annoyed and befuddled by this lunacy that he becomes determined to make the priest see the truth. It was strange and sometimes funny and sometimes disturbing. Overall, 2.5 stars (out of 5).

Then I saw Huldufolk 102, a documentary by a young American woman (who was at the screening!) about the phenomena of "hidden people" in the Icelandic culture. Apparently, most Icelandic people believe (or, "don't deny the existence of") hidden people or elves who live everywhere, have somewhat magical powers, and live in big rocks. So much so that entire roads and homes have been built around certain rocks in order to avoid upsetting the elves who live there. It was really interesting, mostly for the interviews with some fascinating Icelandic people. 4 out of 5 stars.

Three things

Three screen names that you have had: Rosebuttons, Intemperance, and Saro

Three things you like about yourself: My hair, my ability to nap on cue, and my photographic memory

Three things you don't like about yourself: My teeth, procrastination, and my headaches

Three parts of your heritage: Scottish, Italian, Marxist Hippy

Three things that scare you: Snakes, crowds of people, and I'm super afraid of heights.

Three of your everyday essentials: Coffee with soy creamer, checking my email, and watching Blind Date before bed.

Three things you are wearing right now: Dansko clogs, scrubs, fugly cotton work underwear. Yeah, I'm at work.

Three of your favorite songs: Thinking of You by Radiohead, Time After Time by Cyndi Lauper, and In Da Club by 50 Cent.

Three new things you want to try in the next 12 months: Yoga, growing an herb garden, starting a Roth IRA. Boy, will that make for an exciting 12 months.

Three things I want in a relationship: Someone who brings me take-out for dinner, booty, and more booty.

Two truths and a lie: I'm left-handed, I routinely report my neighbor's car as abandoned so it gets towed because he parks too close to my driveway, I believe that Oprah needs more media exposure.

Three things you can't do without: Lactaid, Burt's Bees chapstick, and my migraine pills.

Three places you want to go on vacation: Iceland, Budapest, and Costa Rica

Three things you just can't do: Eat most kinds of meat, be cheerful or even somewhat functioning and awake in the morning, save money. Not that I don't try. To save money, that is.

Three kids' names: Stella, Ruby, Daisy

Three things you want to do before you die: Drive across the country in an Airstream trailer with my dogs, live in Scotland, raise alpacas

Three Celeb crushes: Colin Firth, John Cusack, Andy Garcia in a white tuxedo. Oh and Prince William is really hot. I know that's more than three...it's not like it's going to overload my social calendar or anything though.

Three people you want to know these things about: Jodi, Steph, and Judi Dench.

Rosepetals and weeping p*nises

The title of this post sums up my shift at work on Tuesday night. Pt A lay dying in his ICU bed, officially placed on comfort care measures, in a peaceful morphine drip slumber. Our unit chaplain had held a small ceremony with his family earlier that afternoon, sprinkling rose petals over him and playing some soft music. Pt B, two doors down, was admitted with urosepsis and needed a foley catheter placed. The urologist was called, and he attempted several times to thread a small catheter through his urethra into his bladder...using a wire he had inserted into the urethra and into the bladder previously as a guide for the foley. This was unsuccessful; the doctor surmised the urethra was narrowed due to strictures and/or tumors (dx: bladder cancer). So...let's open up the narrowed area! He then inserted seven- inch long steel rods, about the size of a ball-point pen, into the pt's urethra, each one larger than the last, and wiggled them about a bit. All the while grasping the man's p*nis tightly (Ack! So tightly!) between his fingers while it weeped blood and urine. The pt winced a bit, and reported that it "hurts just a little." Eek. Poor fellow. I later had to call his doctor several times to get an order for something more than 1 mg of morphine for his pain. Good grief. I wanted the morphine just for having watched the procedure.

Also, I am dead inside and I hated Narnia. Again, good grief. Talking animals? Sons of Adam? Gross. And no, I never read the books. I don't think that would have helped. Still, yuck. And did you see the fur coats the children were wearing? Grody. I could smell the moth balls. Give me a good old zombie movie any day. Maybe a zombie movie where the zombies eat fur-coat wearing children and their talking beaver friends. Wheee!

McDreamy...

In defense of all nurses, particularly ICU nurses, everywhere, just a clarification for those of you who might be so enthralled by the realism and drama of Grey's Anatomy...

Just because you close the blinds in my patient's room -- my ICU-status heart-failure patient, who is connected to every sort of lead and monitor we can come up with-- does not mean you can just do whatever you want to him. Maybe you can sneaky-crawl into bed with him, but you cannot cut his LVAD wires without me or my monitors or any other nurse or tech or RT noticing. Heck, you can't even walk into my patient's room without me noticing. And also, you can't really get away with fake-killing my patient so he can get a new heart. But then again, absolutely no surgeon looks like Dr. McDreamy, or even Alex, or George, so I'm willing to suspend disbelief long enough to enjoy the show as well. And oh yeah, Izzy? You are crazy.

For you more experienced nurses out there...will lip-reading get easier? I spent ten minutes last night "conversing" with my patient while she mouthed words around her endotracheal tube and used hand gestures. I thought she was wanting to talk about dying, and heaven, and getting to go home, but actually, turns out she just wanted me to raise the head of her bed. Ah well.

As a side note, I have perpetual nurse's guilt. Does everyone have this? Does it go away? I finish every shift wondering what I forgot to do, feeling like maybe I didn't do every single little tiny thing I could have done, second-guessing most of my "nursing judgements" that I make over the course of the shift. It's not as bad as it sounds...I'm not a quivering ball of unconfident nursing jelly, but inside I sort of am. I suppose over-confidence is just as bad. But does trusting yourself more just come with time? (Bad-nurse voice in my head replies: No, you actually need to be a better nurse!)

Ack. It's hot out. The dogs are melting. They are like silly putty, they actually get longer in the heat.