What PICU nurse does when she has days off....Baking Edition!!

This year, my birthday fell on the day after Thanksgiving. Nothing like trying to pick out what kind of "Birthday Cake" you want when you know you'll be overstuffed for weeks after all that turkey, stuffing, sweet potatoe casseroles, mashed potatoes, etc. etc. etc.!

But this year I picked a GOOD one (thanks to the very enticing picture on my betty crocker calender)!! With a few modifications I'll be bringing this one to holiday or fall parties for years to come! It was super easy to make (which is saying a lot coming from me!) and turned out Oh SO DELICIOUS!! Give it a try and let me know what you think!

Pumpkin Cheesecake Bars (ingredients you'll need):

Cookie Base- 1 pouch Betty Crocker oatmeal cookie mix (1 lb 1.5 oz)
1/2 cup crushed gingersnap cookie

1/2 cup coarsely chopped pecans
1/2 cup cold butter or margarine

Filling- 2 packages (8 oz each) cream cheese, softened
1 cup sugar
1 cup canned pumpkin (not pumpkin pie mix)
2 tablespoons all-purposeful flour
1 tablespoon pumpkin pie spice
2 tablespoons whipping cream
2 eggs

Toppings- 1/3 cup chocolate topping
1/3 caramel topping

Directions:
1.) Heat oven to 350F. In large bowel, stir together cookie mix, crushed cookies & pecans. Cut in butter until mixture is crumbly. Reserve 1 cup mixture for topping. Press remaining mixture in bottom of ungreased 13 x9 in. pan. Bake 10 minutes. Cool 10 minutes.

*Yes, PICU Nurse has one crazy sister!

2.) Meanwhile in large bowl, beat cream cheese and sugar with electric mixer on medium speed until smooth. Add remaining filling ingredients; beat until well blended. Pour over warm cookie base. Sprinkle with reserved topping.

3.) Bake 35-40 minutes or until center is set. Cool 30 minutes. Refrigerate for 2 hours or until chilled.
4.) Before serving, drizzle with chocolate and caramel toppings. Cut into bars. Store covered in refrigerator.

*The finished product- ready to eat...along with chocolate birthday cake (thank you grammy!) and ice cream of course! hello dessert!!

*Next time I do this (and there WILL be a next time with this one!), here is what I'll change:

-Prepare in pie tin, or round cake pan. I didn't care for eating the bar (you couldn't use your hands anyways!)...I want this as a slice of cheesecake with a delicious crumbly crust instead!

-Double the pumpkin pie spice...once cooled, the pumpkin flavor was a bit too mellow for me

-Just drizzle caramel on top...the chocolate seemed to overpower the pumpkin flavor I love so much

Happy Thanksgiving!!!

Happy Thanksgiving...and a VERY special Happy Thanksgiving to the wonderful, amazing nurses working in the PICU today!!!

While my job is extremely rewarding, it also comes with working holidays, so on the ones I have off, I am extremely grateful!

With that in mind, today I reflect on what I have to be grateful for- PICU nurse style : )

Top 10 Things PICU Nurse is Grateful For:

10.) I'm grateful that I work in a place that offers free 10 minute chair massages every couple weeks to the nurses...umm, yup that certainly helps the shift!

9.) I'm grateful for a desensitized sense of smell that comes over time...it certainly makes all the poop, vomit, and blood (and other unknown bodily fluids at times!) I handle so much less disgusting!

8.) I'm grateful that I have my own public announcing system right within work...hey, working with almost 200 women makes the messages get around quick : )

7.) I'm grateful that I work for a hospital where the docs (most of them, anyways!) truly respect my opinion on MY patients!! They realize I'm at the bedside WAY (WAY!!) more than them and know my patient better than anyone else!

6.) I'm grateful when it's NOT my holiday to work....grateful for an alternating holiday schedule!

5.) I'm grateful for the patients that do such absurb, quacky, out of this world things...things that we can only laugh about!! It keeps us on our toes, and definitely keeps us laughing!

4.) I'm grateful for the shifts that I can actually eat a quick breakfast, lunch and dinner...and pee!! What a concept!!

3.) I'm grateful for the families that express their gratitude...few and far between at times, but it makes doing what we do SO worth it!! AND even more grateful for the amazing family I've been caring for recently who even remembered my birthday...Amazing (post will come with the super cute card they gave me)!

2.) I'm grateful when I leave work and my SUPER sick patient has lived through the day again, largely because of the care that I've provided!!

1.) I'm grateful to be able to say that I'm a PICU nurse...what a rewarding, exhausting, fun, emotional, satisfying career!!! I truly am blessed!!

I meant to take a picture of myself after my last shift Tuesday night....it would show you the INCREDIBLE difference of PICU nurse after working a bunch in a row & PICU nurse truly enjoying the time off and the holiday with family. BUT- since I couldn't get out of the hospital faster, I forgot about it. So I leave you with a relaxed PICU nurse at Grammy's house, thoroughly enjoying my time off! Doesn't get much better than family, laughter, wine, football, & blogging! Ahhh.....

Scheduling....On MY Terms : )

Yesterday morning I woke up and had fully planned to take advantage of the Friday off....getting a great workout in with a BFF, a massage, catching up some great new projects I have planned for the house!!!

I even posted this status on FB: "trying to suck every last minute of having a day off today before working 4 in a row...in nurses language = AGGHHH!!!!"

And then the phone call came (in the parking lot of the gym, nonetheless!). Whenever I see my work number on my cell, I kinda cringe! So I decided to let it go to voicemail in case it was something I needed to consider first! And it was quite intriguing.

It went something like this: "PICU Nurse, this is XXX manager- wanted to see if you could come in today...ANY time today...for any 12 hours...you can make them. AND I'll take you off tomorrow!"

Hmmm, come in Friday on MY terms....and get off Saturday!? Which also conveniently breaks up my 4 days in a row (hello, waking up at 5 am...standing on feet for 13 hours, and getting home at 9pm 4 days in a row...NOT fun!)

So I called back and made a deal...I would come in around 1 ("1-ish" were my exact words- hey if it's on MY terms, I'm not promising anything too specific!! These opportunities do not come along frequently!)

BUT I would NOT be staying for a 12 hour shift....I could stay until 11pm (which is the normal time a shift ends anyways). And of course, I would not be coming in Saturday to make up the 2 hours that I'd be missing.

In no less than 0.0001 seconds, my manager said, DONE!!

So I got my workout in (but had to cancel my massage...boo!) and then headed off to work!

Now anytime PICU nurses are called in extra (especially when it means we are taken off a weekend shift!) you can only expect BAD things!!! Our census and acuity would be HIGH!!! Our staffing LOW LOW LOW!!!!

But coming into it with the mindset that it's just gonna be bad always helps!! Helps me to take a deep breath and know that I can only do the work of one PICU nurse. And hey, if the situation always gets too bad, not enough hands, patient not doing so well, the code button is bright green in every room....on 2 of the 3 walls!

So in I walk at 1:35 (hey, traffic was bad, and I did say "ish!"). I was going to be an extra set of hands until 3pm when I would be put into an assignement. As I walked around asking nurses (there were 22 on...we needed about oh, 30 if you asked the ones that were there!) if they were ok, they all gave me an exasperated look, like "DO I LOOK OK??"

Ummm, nope....moving right along : )

Just kidding....I helped!!

However I had to stop right in my tracks when I came across this patient: a 17 year old developmentally delayed, half deaf, mostly mute, girl with a trach (permanent breathing tube in her neck) semi-attached to her ventilator was jumping on her bed....gown thrown on floor....diaper shredded beneath her...poop dripping all over...and trying to pull out her trach! She was making sounds and doing sign language because she was NOT happy!! Her ventilator was beeping off...as were ALL her monitors because she had effectively jumped off all her cardiac/oxygen leads!!

So why was she unhappy?? For one, who wants to sit in a poopy diaper...and for 2, she has this obsession with babies!! If she hears one crying she will sign OVER and OVER and OVER "baby" and "crying".

OK, so I'm not sure if it is true sign language, but it's her language... and she's what we call a "frequent flier" so I've gotten to know it over the past 6 years! She makes a cradling of a baby motion...and then draws tears on her cheeks....good enough for me!

So while her nurse was in the room across the hallway (oh, about 6 feet away) sweating profusely in her isolation gown, gloves, and mask, trying to calm one crazy mad baby who was also flailing in bed, I took charge of miss "shredded diaper-poopy bed-with my breathing life support barely hanging by a thread on my neck" patient!

She didn't seem too concerned with the show she was giving all families and employees walking by- and let me tell you, developmentally delayed teenager does NOT mean physically/maturationally delayed!!

So once I cleaned up the crazy mess, and reassured her oh, about 500 times that yes, the baby is crying...but yes, the baby was ok...she seemed to settle down!!

The rest of the day was certainly crazy busy, and I took care of a really sick baby with a really sick heart, but hey it's just what I was expecting. Adventures such as this can be expected on "Please come in whenever you want" desperate Fridays.

It's the other adventures that always throw us PICU nurses for a loop...but it keeps us laughing!! And THAT is what keeps us going! That is what keeps us on this crazy adventure that we call PICU nursing!

The 35 year old in the PICU

Every once and awhile, we'll get an adult in our PICU that had heart surgery as a baby, and now our surgeons are the only ones that know how to repair what they did 30 some years ago. So these adults come back to the PICU.

Yesterday I was the lucky winner of taking care of one such adult. Only she wasn't there for another heart surgery....she was there with pneumonia.

Now what in the world is an adult with pneumonia doing in our PICU!?!? Such is the way we roll sometimes apparently! In all fairness, she does have a complicated heart history & that's what brought her to us as opposed to her local hospital.

Taking care of an adult is NOT like taking care of kids!! Stated in another way: Kids are not little adults!!

I had a few laughs yesterday because sometimes our vocabulary goes on autopilot. But that needs to be changed when an adult is in that PICU bed!

Saying "Do you have to go potty??" is not so appropriate for an adult!

Or "does your tummy hurt?"

Or "Can you show me where your owie is?" (owie DB, not ooie!)

And things like automatically cutting up their food when it arrives isn't so much appreciated!!

But just like kids, she started getting cranky and whiney in the afternoon...so I implemented mandatory naptime. I turned off all the lights, turned off tv....made a nice quiet, dark environment for her to take her nap.

Even though she's not a kid, sometimes adults need others....PICU nurse....to take charge! And so I did!

But unlike some of the kids I take care of, I refrained from telling her "You can't get back up until you put your happy face back on!"...unfortunately, I think the words "Tell me if you have to go potty so I can help you" may have come out : )

What can I say....I'm a PICU nurse through and through!!

A Little Inspiration

Clinicals are over! Most projects and readings and lectures are caught up on (mostly!) Nothing exciting at work yesterday....

Oh what to blog about....

Here's a little inspiration that I found today while catching up on some of my leisurely reading. As a PICU nurse, we don't always focus on health promotion as actively as we should....we focus on breathing promotion, or keeping your heart beating promotion...or just staying alive promotion!!

BUT- as we are discharging more and more kids from the PICU, it is imperative that we give them education on healthy eating and staying physically active as they go home. This is one great thing that Primary Care offices do so well (at least the one I had clinicals in!!).

And why should kids do this???

Number 1, it will help them to lead a much healthier, longer life.

Number 2, maybe one day they can be in a magazine like this lady (currently 86 years old):

"Running is my fountain of youth. I ran high school track in South Carolina in the 1930's but then moved to New York City and had babies. Much later on, in my 70's, I worked for an elderly lady whose daughter jogged, and that inspired me to get some running shoes. I ran my first marathon in 1998 at age 74."

Yup, you read that right!! Hello!!!

I'm not sure what I find more amazing...that she ran her first marathon at 74 (ok, really, that she ran at ALL at 74!!)

OR that she said when she was in her 70's that she worked for an "elderly lady." I love her perspective on life!!!

And it started with her being active in high school (and probably much sooner than that!!)

So there's some inspiration for ya....to get off the couch, to lace up some sneakers, and to pound the pavement (or lift the weights, or climb some stairs, you get the point!). If this woman can pick it back up at in her 70s, kids today can too. And so can I. And so can you!!

*Found in Fitness Magazine (2008)- see, I told you I was catching up on reading...you should see my stack of magazines I need to tackle- pretty much from when school started until now!!

"I will NEVER drink again!"

Oh the famous last words!!

Several times a year we get teenagers in the PICU for an accidental overdose...or purposeful overdose gone all wrong. This week, the alcohol was WAY overdone for one 17 year old.

Apparently he and some "friends" were having a great night out...including a ton of drinking. They decided that it would be loads of fun to take a walk, but weren't quite coordinated to do so. PICU patient had WAY too much to drink and passed out.

Yup, just passed out, right in the middle of the street when they were trying to cross.

Well, at least his friends were "friend" enough to drag him to the sidewalk. But that's pretty much where their friendship ended! They saw an older man walking by and stopped him saying:
"This is our friend 'PICU PATIENT'- he just passed out"...

AND THEN THEY RAN AWAY!!!!

Luckily, this older man was not some psycho...or murderer...or rapist. He called 911 and the kid was brought to us.

However, the kid was brought to the ER, only knowing a first name and that he "passed out." After a ton of tests were run to figure out the cause of his passing out, it was ruled he was severly intoxicated!! So, he bought himself a stay in the PICU to sober up.

We had him connected to monitors and gave him loads of IV fluid. As he started waking up, we were then able to ask questions. Like, what is your last name? Do you have family that we can call??

His mom came in several hours into the day. Apparently she wasn't too worried that he didn't come home that night. Apparently this behavior is not too out of the norm for him. She certainly didn't have any sympathy for him.

The more he woke up, the worse he felt. At one point he started getting agitated saying "My head is killing me. Something is wrong!" His mom said, "Shut up- you just have a nasty hangover!"

Now ordinarily, horrible acute headaches would warrent concern for us PICU nurses....but we'll agree with mom on this one!

Numerous times throughout the day after vomiting and struggling through pounding headaches, the patient swore up and down that he wouldn't drink. Ever again! I believe "I will only drink water for the rest of my life" even came out of his mouth!

For this patient, that's probably a good idea. Scratch that, great idea. With the way he drinks, the amount he drinks, he can't afford to keep up this behavior!! At roughly $3,000-5,000, that was probably the most expensive night of sobering up this patient has ever seen.

Sometimes it's not always about the adventures that we go through as PICU nurses. Sometimes its about the adventures that our patients go through.

I think it's safe to say, this was one adventure this patient did not bargain for. One adventure that he will hopefully remember for the rest of his life. And next time he goes to pick up a bottle, a flask, a jug (whatever teens are drinking out of these days!), he will remember his famous words: "I will only drink water for the rest of my life!"

And if he doesn't stick to it, his next adventure should include finding some new friends. One that won't leave him passed out on the sidewalk!!

When a PICU Nurse gets sick...

When a PICU nurse gets sick, it isn't pretty.

Taking a "lunch break" to walk to CVS for pepto is NOT so much a "break"

Clearly not a break when the pepto comes right back up...throwing up in the locker room- definitely not pretty.

But where the true nurse shines through is in the attempt to go back and care for her 2 patients after the throwing up episode (yes, we know...nurses are the worst patients ever!)

It gets really ugly when PICU nurse almost throws up in one patient's room after smelling the patient's formula (thank goodness no parents were there!)

Then as she is running down the hallway, she almost throws up there...but makes it to another wonderful PICU bathroom toilet. Oh the joys of hugging a hospital toilet!

After barf number 2 she gets wise..."hmmm, maybe I should be going home!"

After throwing up episode 3, she realized, "hmmm, I don't think I can drive home"

So wonderful husband picks her up.... not before she has throw up #4 right outside the hospital doors... on the sidewalk... with employees and families walking around... and staring!

Not the finest moment for this PICU nurse!! And the fun begins again tomorrow....

My Last Day of Clinicals....in numbers!!

I had my LAST day of Primary Care Clinicals today!!! So happy....So sad!!! (well, mostly happy to be done!)

I still have 3 1/2 weeks of class left in the quarter, but it'll be nice to have my thursdays back to get homework done, so our weekends aren't so filled with tv/homework dates : )

So on my last day of clinicals, what did I see??? Here's my day in numbers:

5: Number of days a 15 year old has had a headache after bumping her head on the car door corner....

0: number of tylenol or ibuprofin (or ANY pain reliever) doses she's taken to get rid of the headache

1: number of concussions she thinks she has

0: number of concussions she REALLY has : )

4: number of patients seen for ear infections

3: number of ear infection patients who had a complaint of "my ear hurts really bad"

1: number of ear infection patients who did not complain of pain, but "my ear is booming" instead! (4 year old)

2: number of ears yellow fluid and some pus was draining out of profusely....EWW!!!!

3: number of patients seen with epistaxis (sounds scary- it's not...it's a nosebleed!)

0: number of epistaxis patients that had something "wrong" with them....it's dry season people!!

1: number of really cute patients seen dressed in all pink (including socks and crocs), who when I told them Pink was MY favorite color too, she replied, "Oh I don't really like pink, my favorite color is Gold!"

1: Number of patients that PROJECTILE POOPED profusely ALL over my preceptor as she squeezed his butt cheeks together after administering rectal tylenol

3: Number of people in the room when it happened

1: Number of people laughing hysterically!! (Me)

2: Number of people screaming (the 15 month old patient and my preceptor!)

Too many to Count: number of memories, laughs and lessons learned today, and every other day of clinicals at this amazing pediatrician's office

Thank you SO MUCH xxxx Pediatrics....you have taught me so much and my time spent with you was invaluable!!

PICU Nurse asking for Prayers

Jon and I have some friends who got some bad news today about the daughter they are expecting in 20 weeks. The ultrasound showed a potential neurological defect and the doctor is concerned about a few other findings.

Our friend called, devastated, at the news he just found out today. What was supposed to be an incredibly joyous occasion, ended with the doctor saying "Either way, your daughter is going to be disabled." While we are super excited about the news of a GIRL (!!!!), we also are so sad for them!

What I know: I believe in a God that can do miracles...only He can change the outcome of this little one, currently forming in her mother's womb. No doctor can prescribe this. No ultrasound technician can make it mysteriously appear on the screen.

What I Wish I Knew: I wish I knew the answers for them. I wish I knew that she would be ok. But, I don't. I am PICU nurse. I am JUST a PICU nurse. I cannot see the future. I cannot make miracles happen.

If I could, I would for these friends. I would form this little one's body so perfectly....I would mold her hands and feet, and allow them to move, showing her mama and daddy how precious she really is.

But all I can do, all PICU nurses can truly do, for their patients...and their friends... is pray for them....give them support... and be there for them throughout some of the toughest times in their life.

So please join with me in praying for this little one....for all the little ones out there...who's parents are grieving at the diagnosis, the prognosis of their precious baby!!

We love you!!!