Saturday, July 24, 2010

I got what I asked for!

It's amazing how many ways the saying "I got what I asked for!" can be said!! And I'm pretty sure I said it in several ways after my shift in the PICU yesterday!!

About 3 weeks ago my other little guy that I had been caring for (see previous posts, ie: Walking Around) came back to the PICU. He's what we call a "frequent flier!" So, I have been asking since he was admitted to have him move rooms, so the two could be reuinted again (thinking solely of their well beings of course!... OK- maybe not solely THEIR well being, but mine...really, if I was going to be paired in my far off corner of the PICU, I wanted my two boys to take care of!) Since they both just got trachs in the past 3 weeks, and their progress is slow, they will both be around the PICU for awhile. I figure they need a great nurse who will be there consistently and do all the trach teaching, so that's where I come in- see, THEIR well being is taken care of and so is mine!

So, finally after 3 weeks of asking, I got what I asked for! Little man moved back to his old bedspace....and big man got his "roommate on the other side of the wall" back.

What I wasn't bargaining for was little man deciding not to breath, desating to 26%(for those non-medical people, 100% is the number to aim for...therefore 26 is bad...REALLY bad....not liveable bad!), getting rigid chest so I couldn't bag him up, and me pushing the code button...on my first day of their reuniting! Thankfully, he passed out (again, 26% is not liveable...or awakeable!), his chest wall relaxed, and I was able to bag him back up and into reality.

Welcome back to your good ole' bedspace little man! He's done that to me before, so I guess he just wanted to relive old memories! Let's just hope those memories aren't meant to be relived over and over! Isn't there a saying "Too much of a good thing..."

So while in the morning when I found out the 2 were reunited under my care I said, "Yeah, I finally got what I asked for!!" my tune walking out of the building that night was more like, "Ha, yup, another day in the PICU...I guess I got what I asked for!" : )

Sunday, July 18, 2010

It's a Sad State of Affairs When....

*You work an exhausting 13 hours shift and can barely get your head on the pillow, only to dream about work. ALL. NIGHT. LONG.

*those dreams seem SO real you cannot fathom that the alarm clock buzzing at you is REALLY your wake up call….to go back to work! Hello, haven’t you been there a good 20 some hours now!?!?

*When something so awesome happens in said work dream, that you dream of blogging about it!

*When the actual job is not quite as good as the job in dreams

OK, so the last one wasn’t exactly true, but ALL the others were! Dreaming about work...and then dreaming about blogging about it!? Come on!!!

So what made the last statement not exactly true!? Well, part of it is I can't exactly remember the details of the dream anymore, other than I was in my typical corner at work...and working all night long. But, the other part goes like this:

I was down the hall from my patient today (same guy from all the recent posts) when I hear his “shaker” rattling. Since he can’t talk, we put a coins and caps into a plastic container with a lid which makes a good, loud noise when shaken…hence, what we call his “shaker” : )

I come running down the hall thinking he’s popped off his vent but instead he points to his fingers and does a wiping motion. I ask if he needs his hands washed and he smiles and shakes his head.

Now, in my defense the room was dark.

However, not in my defense…the odor could be smelled 10 doors down the hallway!!

I walk in to what can only be described as a murder scene….murder by POO that is!! There was poo EVERYWHERE!!! (I vaguely remember setting this scene before..and while it may have been in a previous post b/c certainly it's not the first time it's happened, it may also have been another one of my dreaming about blogging while dreaming about work times!).

Apparently he was playing his Xbox and accidentally dropped the remote control in his lap. He then realized he had poop on his fingers, so he reached for the call light/tv remote control to turn down the volume so I could hear his shaker (of course!). Once the tv was quiet, he reached for his shaker and shook...a lot...

So now he is laying in a pile of liquid brown stuff….and has (in typical toddler fashion!) smeared it on his bedside table, remote control, Xbox controller, shaker, and varying body parts! And the vigorous shaking has caused little poo droplets to fly around to the floor and one of the (close, but still!) walls. But, I remind you, he is NOT a toddler….he is 15!

*THANK goodness he decided that this was NOT the opportunity to scratch his head b/c those EVDs are just asking to become infected!

Through the entire wipe down process and bed change (which yes, dad, I did by myself!) he was laughing at me! Nice! And then for about 2 hours after it was all said and done, whenever any doc or nurse walked into the room, he wanted me to tell them the story. I say GROSS...he just laughs! Such a teenage boy!!

At least he was making me laugh today…last week he wasn’t doing so hot and we rushed to Stat CT twice…in one day! So I’ll take this teenager, laughing, and pooping all over the place over that one! At least he’s (bowel) moving in the right direction- PUN INTENDED!! Haa!!

Friday, July 9, 2010

Day by Day

Sunday: This week started by me working the holiday- something I'm well accustomed to as a PICU nurse. In all fairness, I think I enjoyed working and getting paid time and a half, seeing as we didn't necessarily have big plans anyways!! Plus, driving home in the storm validated those thoughts (sorry for all you who's barbeques and fireworks got rained out!). AND- what's more, we didn't have the SLEW of accidents we normally do!! One kid did come in after drinking a cup of lighter fluid (really, what adult puts lighter fluid in a cup on a table!?!?)....but compared to years past, we didn't have the trauma's that we could have.

Monday: DAY OFF WITH JON!! Did absolutely NO school work....Did absolutely NOT think of PICU work : )

Tuesday: 8 hours of meetings...yes, 8 hours! And then I cried for the last 4 hours of my shift! Well, I restrained....but I felt like it!

My patient was a five month old that weighed less than some newborns. She was extremely malnourished...dehydrated...but OH SO CUTE!!! Her mom is young and has six other kids at home. I guess this is her explanation as to why this baby has not been fed for the past 5 months.

Because of something called "Refeeding Syndrome" you can't just let her eat all she wants- it could literally kill her at this point! Instead, you have to introduce nutrition via IV...then add formula VERY VERY slowly.

How about holding a six pound peanut in your arms and feeding her ONE OUNCE of formula...then taking it away!! She gulped that one ounce down in about 10 seconds flat, and then looked at me with big eyes like "Why are you not giving me more!?" Oh, break my heart!! She screamed and screamed for the next hour until she was too tired, and fell asleep. Then an hour after that, the whole process started all over again : (

Wednesday: Time to get down to work: study, study, study. BUT- it paid off b/c I got an A on my test Wed. night!! Yeah me : )

Thursday: Back to work with my trach guy...and his neighbor who has been hard for me to take care of the past two weeks (as if Tuesday wasn't hard enough!). Trach guy is doing well with his now all the teaching begins with his family...that will be INTERESTING!!

Trach guy's neighbor was a 16 year old with a very large, very advanced brain tumor. She no longer is able to move, no longer able to communicate, no longer able to focus her eyes on anything. She now has kidney problems, breathing problems, and severe neurological deficits. And yet, despite being at home on hospice, to die as peacefully as she can, her mom brought her into the ED. And then we admitted her.

I have a very hard time looking at this poor girl, suffering, and thinking if her heart stops, I will be the one to push that code button and begin compressions. I will be the one to inflict pain, possibly breaking ribs, and "save" this girl....but for how long??

Now, I am not a mother. I cannot imagine having to go through this with a daughter. But I also know I could not imagine going through it myself. I hope that when I am at the end of life, those around me will be able to let the suffering end, and let me go.

Thankfully, we had 3 care-conferences with this mom over the course of the past 10 days. While I would say I have complaints that docs I work with are a little "too nice" sometimes and not able to deliver the bad news well, these doctors were very explicit and honest with this mom. At the end of my shift, I had discharge orders ready to send this poor girl home.

Friday: I did one phone triage today, although admittedly I just made a referral rather than a helpful recommendation. I don't deal with skin issues/rashes very least the non-life threatening kind : ) But my referral managed to be a success, so that counts!

And finally, I went to the store to buy gifts for not one, but 2 PICU nurse friends!! Apparently, this is the time for PICU nurses to be having babies!! I wrapped one big blue gift and one big pink gift...and it got me excited for the boy/girl twins that I'm determined to have : )

So that was this PICU nurse's week! Some ups, some downs...but isn't that what this adventure is all about!?

Thursday, July 1, 2010

Busy, Busy, Busy!!

This week has been super busy! Tuesday was my first day back at work after almost a week off....those aren't always the easiest shifts! BUT- my guy got his trach (no GT...what would the PICU be without a little bit of drama!?). That morning his dad and several other nurses said he had been very depressed, wanting to sit in the dark, not talking with people etc. since he got his trach last Wed.

Well let me tell you, I took care of a very different patient! I woke him up to do his first assessment and he opened his eyes and SMILED!! Hey-O...go me!! The entire day he was in a great mood....super smiley....laughing....wanting lights on! What a joy it is to be able to make such a difference for kids!!

We played Bingo on TV and though we didn't win he still had a great time...for those of you that don't know, every Mon and Tues there is Bingo on one of the floors. BUT, for the patients that can't leave their room (most PICU pts), you can tune in on the TV and play. When you win, you call the number, and there are tons of great prizes to choose from each week!! Such a great idea!!

That being said, he smelled FUNKY....and was slightly crusty under his arms! I asked him if he'd been refusing his baths, and again, he got a HUGE smile and shook his head yes!!! Nurses- you can't ask teenaged boys if they WANT a bath!! OF COURSE they will say no every he did! So he got a good scrub down, several applications of his Old Spice deodorant, and his teeth brushed twice that day!!

As for Wed and today...TONS and TONS of schoolwork, reading, assignments, and video watching for Physical Assessment!!! Jon is going to LOVE being my model patient for the upcoming video on head to toe assessments with complete history/physicals! BUT- I did sit out in the sun (with SPF on of course!) both days which was amazing...I am such a sun/hot weather kinda nurse : )

I think all this busyness is just a preview of what's to come over the next year. BUT- as long as it's stepping forward towards graduation, I'll deal with it one day at a time. Lesson learned this week: sometimes adventures are not always exciting or even fun...sometimes they manifest themselves as busy busy days...or weeks. But that's ok, b/c they are still a part of the journey...and adventure...of this PICU nurse!