The Waiting Room

Waiting rooms are an interesting thing. I tend to forget what waiting rooms are really like because we certainly don't have them in the PICU. That's what the ER is for (ooh, my ER friends are really cringing at that one...sorry!).

When I do find myself in the waiting room of a doctors office though, it's always an interesting experience. And today was no exception.

I was in the fertility specialists office again early this morning and just found myself laughing. Laughing at how different it is to be a patient rather than the nurse. And then just laughing at all of the other people in the waiting room with me!

First of all, if there is better birth control out there than the following scenario, developing it will allow you to become a millionaire! This couple, who obviously wants to have another child (unbeknownst why to me!) brings in their toddler terror...I mean precious baby boy. This kid is running around the entire office waiting room, screaming, jumping off the couches, and throwing the magazines everywhere!

This is in between him having the nastiest cough and runny nose which of course he is wiping away with his hands and then touching everything in the office...tables, chairs, magazines, doors, the weird little plaster 3-D pictures they have of naked women on the walls...everything! (sidenote: the plaster naked women freak me out a bit!).

Remind me never, ever, to read doctors office magazines again! Or touch their doorknobs for that matter (wow, does that sound a little nurse-germ-OCD or what!?).

So yeah, thinking about having kids? Come to this office with this kid, and it might make you think, "ummm, not so sure about that!" Or it may just make you think about disciplining your kids. Either way!

And then there's the couple that thinks they are the only couple in the entire waiting room. Except there are 6 other couples there. But they are talking about their week, what they want for dinner, and job stuff loud enough for us all to participate in the conversation.

What really made me laugh (and almost chime in on their oh-so-sweet conversation) was when the husband was flipping through a local restaurant magazine and commented that he wanted to take his wife there for their upcoming anniversary. Aww, cute right. She got these sparkly eyes and was about to go on about how she would be so excited when he interrupted her. Apparently while she was swooning, he was reading the fine print which said it would be $110 per person for this 6 course meal (like how I seriously heard EVERY single detail?...I'm telling ya...he was LOUD!). Then he says, "Wow, we should just buy blinds for the house instead!"

Oh there's a romantic for ya!

And then there's the lady who is obviously SO over not getting pregnant that she makes it known to the entire office. This lady is also the only one without her husband, or a significant other in there with her...which I'm thinking may have helped to diffuse some of her anger.

But, she would pick up a magazine, see a pregnant lady and then throw it back down on the table. Pick up another maganize, see a pregnant celebrity and throw it down. This time with a little growl! Then she starts flipping through ALL the magazines on the table, trying to decipher which one may not have a pregnant lady or pictures of baby nurseries in it. Except there were no "Plumbers Weekly" or "Accountants Digest" magazines in the mix. So she just flops back on her chair and starts grumbling to herself.

Oh I told ya that the fertility waiting room is one cool place to be! OK, not really, but at least there is some comic relief if you do have to be there!

And I must say that while I don't love that I have to be a patient there, I am certainly glad that I'm not a nurse there! I definitely wouldn't want my job to be centered around one lady part...enough said!

But more than that, I truly love taking care of kiddos. I love the chaotic, adrenaline rushing atmosphere that is known as the PICU. And I love being able to nurse a super sick, trying to die little one back to the terror that I saw in the waiting room...healthy, vibrant, and crazy!

Now how's that for coming full circle!

The Most Glorious Words

Yesterday I heard the most glorious words from a doctor at work.

Our morning started out with several conversations like this:

1.) PICU Nurse: The patient has been in this position for a really long time. I know that he doesn't really tolerate turning well, but I'd like to take him off the oscillator, suction him, and try to reposition him- it's been awhile since all that has happened. I can get a few other nurses and a respiratory therapist in here to help out. What do you think?

Dr Red (he doesn't wear red, doesn't have red hair, I don't know...just the first thing to come to mind!): Well, I think we should hold off. I'm not sure that we should suction him today. Maybe tomorrow.

PICU Nurse: Well, if he has more desaturations, I'd like to re-consider it.

Dr Red: Umm, ok

*And yes, the "umm ok" was REAL convincing!

2.) a few hours later:

PICU Nurse: The patient's blood pressure is really low. I know that we ordered dopamine for him, but that may take a bit to get from pharmacy. Do you want me to give a little bolus?

Dr Red: Well, I don't think we should give fluid. He's on a lasix drip and may be fluid overloaded.

*The attending physician was standing by overhearing our conversation. She then replied "Nope, we definitely need to give this kid a bolus. Get those pressures up!"

3.) about 45 minutes later I page the doc-

PICU Nurse: My vanco trough just came back really high at 47. I currently have the vanco running. Do you want me to stop the dose and repeat a trough in a few hours?

Dr Red: No, usually pharmacy wants us to complete the dose given immediately after the trough is drawn. We can just re-check a level tonight.

**3 minutes later Dr Red calls PICU Nurse

Dr Red: OK, so I just talked with pharmacy and they want you to stop the vanco. And if you could re-check a trough in two hours, that would be great.

PICU Nurse: OK, no problem.

*Just as I was getting ready to hang up the phone, Dr Red adds "Ohh, and I guess I'm done saying no and second guessing you. Everything I've shot down from you today has been the right call. So whatever else you think would benefit this patient, just let me know."

Oh yes! The most glorious words ever!!

No more second guessing and just trusting us bedside nurses!

Score for PICU nurse!

I think it not only validated that I am a good bedside nurse, but that I am ready to move onto being an APN (aghh, did I just say that...scary!). That I can think about the "tasky" things as a nurse, and that I can think about the direction that we should go in.

So it was a good day. A day that I was able to be the bedside nurse that I know to be, and also step up a bit and help coordinate care more.

But what was most glorious about this, was that it was validated. By Dr Red, by the attending physician overhearing our conversation, and by the entire team.

And this just goes to show you that there truly IS power in words. Glorious, glorious words!

Love/Hate Relationship

Know what I love??? My Job

Know what else I love??? Days off from my job!

Know what I hate? Chopping an entire bushel of onions.

But I guess if I'm chopping an "entire bushel" (do they even still say that word!?) of onions, then I guess that means I have a day off. And I'm making some amazing white chili (recipe from here) which I guess then brings me back to....

Know what I love??? days off that allow me time to chop an entire bushel of onions!

Days off are awesome. They allow me to do things like semi-sleep in. I say "semi" b/c I just can't seem to sleep in like I used to. Waking up at 8 am is a successful sleep-in type morning for me!

But days off also allow me to work out, to get a massage, to open a bottle of wine and sip while I cook an amazing dinner. Yeah, told ya...I LOVE days off!

And if you've ever cooked a dinner where your husband has stopped 3 times to say just how amazing it is, you especially know what I'm talking about!

But days off also allow me to reflect on the 3 days that I've already worked this week. And I've thoroughly enjoyed the patient that I've cared for over the last 6 shifts.

While extremely busy at work, I've thought about 22 times what a great blog post this patient or the situation that I've been in would make a great blog post. And about 21....make that 22...times, I've come home SO exhausted, that the blog post never happened!

So as I sit on my day off (night, now), I am trying to decide whether or not to compile all those thoughts, all those "remember when THAT happened!?" moments into one blog....

OR just keep enjoying the evening with my incredible grateful-for-cooking-an-amazing-meal husband...

Easy choice! The husband!

But I will leave you with one little nugget!

This little guy I've been taking care of (to the size of a 9 month old) is VERY sick. We have him on continuous medications to keep him both sedated and paralyzed. And he's decided that since many of his organs are failing and his liver and spleen have grown to the size of my head, that he only likes to lay "prone" (AKA: on his belly)...except we put a big roll under his groin and his chest to keep his belly and lungs from being squashed onto the bed.

So, in this position, and when on the oscillator (AKA: mack-daddy of ventilators...and yes, I said "mack-daddy!"), we really can't move our patients. But, I'm very concerned about this little guys skin, and especially the areas under the roll with lots of tension.

Enter little 9 mo old penis....with a foley in it. Talk about skin breakdown risk! And what an area! The parents are very aware of this risk. But when it comes to saving his airway...his life!...vs his future manhood, airway is always gonna win!

But, in the interim, step in PICU nurse to consistently check on the said "baby package". And just as I have a respiratory therapist in the room to help me lift, I find a perfect opportunity to thoroughly inspect the skin around said sacred area.

The respiratory therapist helps me gently and ever so slightly lift the bottom half of my patient off the bed. To which I try to inspect the area. Except, when on the oscillator you can't really move the patient at all...so I can't REALLY see the area.

Until I am bent over in the weirdest way possible, with my head in a compromising position on the bed.

And then enter a manager of the unit just happening to be walking by. As she walks by, she just happens to hear me say "Wow, that looks good.....really good!"

And given my positioning, she just busts out laughing in the hallway!

Because truly she understands that as a PICU nurse, I'm not only concerned about the life, and the airway of my patient, but also the little things such as skin integrity. And yet, at the position, and with my apparent word choice, it leaves no other option than to laugh at it all.

And so we set him down the entire 2 inches we have him lifted, and I remove my head from the bed. And then we all just laugh.

But I can laugh and know that yes, this is a great time at work. But I can also confidently laugh knowing that I am providing excellent, holistic, save your life AND your skin...and perhaps man organs...type care.

And that is a good day at work.

And the good days at work lead to better days off.

Which is where I'm at now.

So I leave you- happy, full of wonderful white chili, and grateful for my days off. But also happy for the days of work ahead. Because I love taking care of those that are super sick. I love my job. I love being a PICU nurse.

I Dream of Nursing

Oh you know you've been working too much when you spend an entire 8 hour night saving people in your sleep!

Last night I did CPR on a toddler on a stretcher in a cafeteria, did the heimlich on a big fat man at some weird store (what was he eating!?), and then went back to the toddler on the stretcher, who apparently I saved, but was now having a severe asthma attack!

Whew, what an exhausting night! At least nobody died on my watch : )

And at least I have this weekend off. Apparently it's time I had some time away from work! I fully intend to not think about work (anymore!) and just relax! Sounds like a great plan to me!

What fun or relaxing things do you have planned this weekend??

Interviewing

I had my very first, real, grown up interview today!

I don't really count any of the interviews I've done before "real" because they have all been very low stress, non-professional interviews. Even my interview for PICU nursing was piece-o-cake b/c I already worked there as a nursing assistant.

But today was the real deal. And it went great!

I woke up extra early, put on my suit (which I'm hoping I never have to wear again...don't know how lawyers and pharmaceutical sales women do it!) and made it to my interview 45 minutes early. Yeah, bit of an overachiever apparently...but you never know how traffic may be!

And then I proceeded to talk for the next 3 1/2 hours. Which let me tell ya, that is a LONG time to talk! If I don't have to talk for the next 3 days, I'll be happy!

But that doesn't seem too likely since I'm working the next 2 days. Oh well!

I'm just glad it's done. I'm glad it went well. I'm glad mostly everyone I spoke to was very laid back. With the exception of one person, it was nice and easy questions. Only once did I feel like I was in the "hot seat" with rapid fire questioning. So I guess I have nothing to complain about.

Except the nylons. Who came UP with these things!? Yeah...I've definitely been spoiled with wearing scrubs to work every single day for my entire career. This is definitely going to be a change!

And while I'm talking about clothing, I just have to brag about my mad thrifting skills. In one of my last classes teaching us the practicals of the APN role, we were told that a pant or skirt suit was an absolute must for all interviews. So I looked online, and promptly shut the browser down because of insane sticker shock!

And then I do what I do best and trudged (very willingly!) to the thrift store. Call me lucky, or call me skilled (I'd give myself credit for both : )...but over the past few months I have managed to pick up a navy blue silk blouse for $1, black pumps for $4, and the express pencil skirt for FREE.

But I couldn't go without the suit jacket...so when there wasn't one to be found at the thrift store, I went to plan B. I took a $10 off any purchase JC Penny coupon and found a perfect fitting jacket on mega-clearance for only $20. Yup, that's right, I essentially got my entire suit for $10!!! Love that!!

And I loved it even more when my friend from school recently asked if I bought a suit, and for how much. She didn't believe me when I told her my entire interview outfit, including shoes cost $15. And I didn't believe her when she said she spent almost $200!!!

Do you KNOW how many things I could get at the thrift store with that kinda $$??

So double score for PICU nurse this week: I got a killer suit for super cheap, and killed the interview today! And since things tend to happen in 3's (3 times the charm, 3 strikes you're out) I'm thinking I'm on a good streak for where the suit and interview are headed.

This may be the beginning of a very different journey...perhaps, Adventures of a PICU Nurse Practitioner. We shall see!

Goodbye 2011!

Happy New Years Eve!!!!

I have to say, not working Thanksgiving, Christmas AND New Years has just been weird. Awesome, but weird! I haven't had all holidays off since I was in college...and that seems like way too long ago!

In the past, Jon and I have done a variety of things to ring in the new year. We've gone to black tie formal parties, crazy huge parties, house parties, and even GameWorks (which was AWESOME!). But this year we have something much quieter planned.

We have some best friends in town staying with us and we have the most perfect day/night ahead of us! We've created an entire smorgashborg of food that would last a small army a week, but I'm pretty sure we'll have no problems polishing it off between this afternoon and tomorrow morning! And some festive cocktails will go perfectly with all the food goodness!

And then there's the Kinect which may counteract at least a few of the calories! Zumba, dance central, adventures, and sports...Oh yeah, it's gonna be awesome!

So I'm raising my martini glass to a great new year! Whatever you do tonight to ring in the new year, I hope you have a fun and safe time!

8 Memories of Christmas 2011

I love the Christmas season. Or maybe I just love days off over the holidays. But either way, this Christmas was no exception.

Tonight I am back at home, in my own bed, not believing how FAST it all went! I can't believe that Christmas is over!

It's true that 3 days in the PICU can seem like an eternity. Literally, AN ETERNITY!!! And yet 5 days at the parents house over the holidays is over in the blink of an eye.

But now that I'm home, Jonny and I are watching one last Christmas movie while eating some pizza. And it's given me time to think about what made this Christmas so special and so much fun.

And the overly stuffed feeling that I got after all the pizza tonight got me thinking about how much I truly need that "new years resolution diet" sooner rather than later...but I digress.

For now, I leave you with a few of my favorite 2011 Christmas memories:

1.) Matinee movies in the middle of the week! And if you haven't seen Mission Impossible III, you definitely have to! So great!

2.) Living in the most comfy sweatpants EVER for almost the entire trip!! You know, the ones that are snuggly and can even double as cozy socks!

**Oh, and playing footsie with my man : )

3.) Putting together a really hard puzzle...definitely not one of my favorite activities, but definitely a sense of accomplishment once it's done! Look at the determination of my mom!!

4.) All day bonfires. Oh I love the smell, the sounds, and the sight of bonfires. But I love sitting around it, laughing and chatting with my family even more!

5.) Going to the best thrift store ever...and coming home with 2 bags full of amazing new clothes, home decor items, and these awesome boots. Grand total: $35! Love it!

*These babies were all of $3...oh yeah!

6.) Christmas tree photo shoots that take way too long b/c Jonny just cracks me up! Oh I love that man!

7.) The endless amounts of peanut butter fudge, snicker doodles, coconut cookie bars, lemon bars, caramel, and other amazing Christmas treats. OK- I guess it wasn't "endless" b/c we certainly devoured them ALL!!! So quickly in fact, there wasn't time to take any pics! But YUMMMMM were they good!!

8.) And just being able to relax and chill with my family. To watch Christmas movies, to enjoy the extra cup of coffee or Friendship tea in the morning, to sing the occasional Christmas carol via Skype with family who couldn't be there, and just laugh a lot. This is what the holidays are all about to me.

And this was what made this year so special to me.

I hope you all had a great Christmas and are enjoying the last week of 2011. What made your holiday special this year?