Just wanting to cuddle

I got paid yesterday to sit in bed with a 3 year old and hold her. She still has the breathing tube in, and no family (mom in rehab, dad out of the picture, aunt who has custody just "can't bear to see her like this", etc.).

All she wanted (ok, other than the breathing tube out, like, yesterday!) was to be held!!! She was so stinking adorable, so how could I say no!

I had to completely shut out the germophobe in me, and just climb right in, where she nuzzled right up against me. We read books, we sang, played with toys, and she slept...a lot!

Everytime I tried sneaking out of bed, she would wake right back up and scream!! At one point when I told her I had to go to the bathroom she started to shake her head in a sassy little way! I said, "Are you giving me attitude?" and snapped my fingers back and forth, laughing!... to which she shook her head yes!

Oh this little one is going to be fiesty! She apparently has flicked off some of the other nurses (yes, she's 3!). She pinched my boob when I was trying to move at one point (yeah, that was NO joke...it hurt!). And the looks she gave me at times when I was telling her "no" showed me that she was saying all kinds of naughty things in her head!

All I know, is depsite her being on ridiculously high (and I mean CRAZY high!!) doses of morphine, versed and precedex (all medications to make her comfortable, not agitated, forget this horrible time, and chill), she better remember my cuddle time with her!!

Some days being a PICU nurse isn't so much about the knowledge or skills, but more about true nursing. Nursing a 3 year old back to health. And doing so in a way that involves cuddling as a substitute for sedative medications.

What a joy it was to leave work last night (minus the bruise on the boob!). I look forward to work on Monday, when the tube is out, and I can hear her sweet voice...Or what I'm hoping is sweet. If the 4 letter words are flying, we're going to have to have some words...appropriate ones for a 3 year old!

You learn something new everyday

Every day at clinicals, instead of getting a nice lunch break...or any lunch break at all, we go to "Noon Conference." We can bring our lunch there, so it's not like we don't eat, but we listen to a lecture, while trying to quietly chow down.

Most lectures are power point presentations put on by various attendings. This week was a bit different.

The doctor started writing on the chalk board (yes, those still exist, despite the fact that I keep hearing friend's kids only using personal laptops or projected computers onto white boards in school now!).

Anyways, he writes on the chalk board the following information: 3 day old, ready to be D/C (*discharged) home with mom from L & D unit, normal delivery, no complications.

Then he says, "The nurse calls as she's discharging the family and tells you that she just changed the diaper and there is a lot of melana. What do you want to know?"

Of course the room is quiet. Nobody wants to take a risk and speak out loud. Or maybe we were all taken aback that this was an interactive session! Either way, I thought, "Nope, definitely not answering!"

Except my thought process was shot down when the doctor decided to just randomly call on someone (probably the most freaked out looking person in the room!)...

ME!!!

Hello, the question is "What more information do you want to know?" Well, my first thought is "WHAT THE HECK IS MELANA!?!?!?" How am I supposed to know what questions to ask or what history to gather when I don't even know what the problem is!

Just one week (or so) after writing this post on teaching my orientee the importance of knowing medical terminology, here I sit not knowing a medical term...and one I'm being questioned on!

Luckily, I had just popped some blueberries in my mouth at the very time I was called on, so the doc said "Well I'll give you a minute to chew...so the nurse notices this new problem of melana...a good amount of blood in the diaper..."

THANK YOU!!!!! Now we're in business. At least I know the definition of melana!!! Blueberries are now my favorite food!!!

I was able to throw out a few pieces of information that I'd want to know. After saying, "Great we're on the right track" he let me off the hook. Onto the next victim...I mean student!

So I learned something new this week. And melana is now a new word I'll never forget! Fancy word for "bloody poop"- nice. So thank you GI attending for the learning experience. Thank you blueberries for the stall technique! Thank you bloody poop for...ok, what would you thank bloody poop for...gross!

Here's to learning something new this week...hopefully it won't revolve around poop! Although, I guess it's quite fitting being a nurse! What have you learned new this week???

Happy Valentines Day

Wow, I can't believe it's been almost 10 days since my last post! This past week just flew by....which I guess is a good thing : )

I hope that you all have a Happy Monday....Happy Valentines Day! The husband and I don't really celebrate, but hey, it's always fun to observe the holidays. Even if it just means that we make a fun pink cocktail with dinner tonight, I'm down with that!

I worked all weekend and other than waking up at 5 am on those days, I actually enjoyed it. The pace of the PICU is just so much more chill on the weekends. Less docs around, less family members...less noise! It's kinda nice.

That being said, I took care of a NICU baby. And it's SO funny how the PICU and NICU may share the last 3 letters, but they are WORLDS apart!!! NICU babies are a breed of their own. And PICU nurses just do not enjoy caring for them. These babies do things that are "normal" in the NICU world, but definitely not in the PICU world. And we care for them in a PICU way, which they are not truly accustomed to. So it made for an interesting 24 hours.

But before work this weekend came clinicals.

Clinicals were a little rough this week because my patient was super sick....dying sick. I walked in, saw the patient, looked at the chart, and told my preceptor "Seriously??" (channeling my best Meredith Grey). She just looked at me, smiled, and said "You can handle it."

I can, and I did.

But- it's so different being a nurse practitioner in end-of-life situations than it is being the bedside nurse. I totally wanted to change into scrubs, and get to that bedside to do the "dirty work"....be there with, and for, the family. Not be the outsider looking in...but be the insider collaborating things, orchestrating the way that this boy would be able to pass in peace, with his family right by his side loving and supporting him.

This is something that I'll have to figure out if I take a job as an APN in the PICU. Because I don't want to give up that role with the patient, with the family. I don't want to "check out" the way so many practitioners (and more docs!) do. I want to be there, be involved. Because in reality, I already am.

So this Valentines Day, I am relfecting on the love that I have. Love for my job in the PICU. Love for the kids that I work with (even the NICU babies occasionally!). Love for my co-workers who at the end of the day, come together to work as a team (and that's really what it's all about!).

Love for school...and I don't mean wake up at 4 am, feel like a zombie, school. But the things that I am learning continuously amaze me. I love understanding the WHYs of what we do...and not just the DO of what we do!

And finally, and most importantly, love for my family. The little things that they do, whether it be my husband, my family, or my friends-that-are-closer-than-friends-and-more-like-family, family.

The fact that my mom has no-doubtedly completely transformed the house into a big red and white valentine makes me smile...and more so when I look at my oh-so-not valentines house!

The fact that J asked me (again) this morning, "Um, so you don't want flowers or anything, right?" also makes me smile. This is our 8th Valentines Day together and the only one we celebrated was our first....so no, I do not want flowers : )

On this Valentines, whether you celebrate or not, I hope you too, are able to reflect on the things, the ones, that you love. Happy Valentine's Day!!!

*Sorry for the poor picture quality- it's a picture of a picture (I didn't want to rip the pic out of the scrapbook I made J). Our 1st Valentines together...we had been dating for almost 3 months...Wow, is all I can say : )

Gotta Start Somehwere...

So I've been precepting (teaching) a new graduate nurse for the past 2 months. All new grads get a 6 month orientation to the PICU, b/c there's just SO much to learn!

Most days I love precepting. It's fun being able to get someone new who knows nothing, and watch them grow over the course of 3 months (they get 3 months with me, or another day shift person, and 3 months with a night shift person).

And then there are days that I hate precepting. They go SO slow....you have to talk them through and explain EVERYTHING...and you have to watch them like a hawk. But, I remember where I came from (SO slow, didn't know anything, needing to be watched like a hawk!)...so the days of not enjoying precepting are few and far between.

Yesterday was a day I really enjoyed precepting. We took care of a little cutie who had just gotten a liver transplant (thanks to a gang member who got shot the night before- he was able to save the lives of 5 other people as well!).

I told my orientee (AKA: girl I'm teaching) that since she's nearing the end of her orientation she needed to be independent. Liver transplants are my VERY favorite patient population. They are super busy after transplant, but I just love them.

So knowing she would be super busy, I wanted to teach her time management and prioritization. However, little did I know I would be teaching some major "Professional Charting" lessons that had us laughing!

As I was looking over her charting I noticed comments such as:
"Red splotchies to pulms and feet" and "Purplish marks" and "Pretty big"

Alright, first off, I did not make a typo....she really put "pUlms"! After asking what the heck a "Pulm" was, she pointed to her hand (her pAlm!) And when I asked what it was called she replied (in a "duh" like manner!) "pUlm!"

To which I could only laugh, and replied, "Nope, that's a palm!!" She looked at me so confused, and just spelled "p" "A" "l" "m"??? Yup! It's a palm!!!

So moving on after making sure she said (and wrote) other various body parts correctly, we discussed how "red splotchies" and "purplish marks" and "pretty big" just wouldn't cut it!

Things like "Erythematous" and "Echymosis" and charting the exact size/shape in centimeters were more appropriate. And splotchies?? Yup, not a medical term....macular or papular or flat rash would be more appropriate (depending on the true description of the "splotchies").

We laughed through the whole discussion. She laughed partly b/c she thought she was doing a great job being descriptive. I laughed fully b/c she thought that was a great job being descriptive!!

It was a day that truly reminded me where I came from. There was a day where I too had never heard of erythema ("redness")....and couldn't tell you that ecymosis was just a fancy word for bruise (or "purplish marks" as she would say!).

And one day, she too will be teaching a newbie, and laughing at the funny things they will say to parents, or chart, or call their various body parts. Oh the circle of PICU nursing life...what a beautiful thing!

SNOW DAY!!!!!!!!!!!

"Snow-magedden"..."Storm of the Century"... If you live in the U.S. you couldn't listen to a single radio or tv station without hearing the constant warnings of this horrific storm that would be affecting Oklahoma to Maine!

Being somewhere in between there, it was all people were talking about at clinicals yesterday. Except I never think it's ever as bad as the newscasters predict. Probably because it's never really as bad as they predict!

But, the upshot of all the "hoo-rah" was my school was officially closing down at 2pm until Thursday morning. WHAT???

Being in the medical field, you don't just "shut down" b/c of some snow...or ice...or the world blowing up. You just can't!! So it was a huge shock to me that my clinicals would be cancelled...and we'd get to leave early!

Thank goodness we left at 2. It took me 2 1/2 hours to get home...I can't imagine what it would have been if we left at 5pm! And I'll say the roads at 2 weren't great. Everything was white so visibility was pretty bad. And the wind was whipping around like crazy blowing everything white right at ya!


This is pretty much what it looked like out my window the entire way home. Good thing traffic moved so slow, b/c it was hard to see! And good thing brake lights are red!

Yup, this was pretty much my maximum speed the entire way home! No wonder it took so long!

Even though it was a "crazy" storm, it still had its moments of beauty.

So I made it home safely, was super excited to sleep in, and have a SNOW DAY!!!!!! Jon and I fully plan on getting work done (he's working from home too!) but of course relaxing, and maybe even having a little Dance Revolution Battle!!!! What's a snow day where you're stuck indoors b/c of 60 MPH winds without a dance party : )

Oh, and the last picture is my patio furniture this morning when I woke up. It's still snowing and blowing like crazy, and the worst apparently is yet to come! But I don't see it as "worst"- I'm loving every single minute of it!!! It's not often (or ever!) you get a mandatory stay at home (when you're healthy) day! So that's exactly what I'm gonna do....and I'm going to enjoy every single minute of it!

At the end of the first of 9- 60 hour work weeks...

I'm ABSOLUTELY exhausted! I don't know how other people do it! Lawyers put in ridiculous hours. MD's are known to pull crazy all-nighters (although with the ever changing laws, that's getting much better!)

I'm thoroughly planning to enjoy each and every minute of this sweet weekend off! Sure, there's homework to do, but there's also some serious sleeping in to be enjoyed!

The last 2 days of my week were exciting, draining, emotional, fun, and eye-opening. Such is the life of a PICU nurse!

I was able to take care of a little one with a brain tumor. More than once doctors have told her family she would not make it. And more than once she's defied all logic in medicine.

She's had 5 brain surgeries, multiple chemo and radiation treatments (mostly study drugs), and she's even been to a "healing retreat." But still, the tumor is taking over.

Her "wish" was to meet the "I-Carly" character (Miranda Cosgrove) in concert. Many months ago she was granted her wish, getting front row seats, back stage VIP passes, and even entry into the sound check before-hand.

But, unfortunately, she wouldn't be able to make it...she's stuck in the PICU...really sick : (

So what did her mom do?? Like any amazing mom, she wouldn't give up. She ended up contacting the producer and long-story short, Miranda, along with a back-up singer, a guitarist and her mom, came and gave a short, sweet, personal concert for my little patient.

It was amazing. We were able to break some rules and pack her room full of family and friends...all getting to watch her enjoy her (most likely) last wish! Smiles were all around, but the tears were also free-flowing.

I don't know how the oncology docs and APNs do it all the time. Cancer, brain tumors, in children is just not right. It's not fair.

But to be able to be a small part of it, to make the patient more comfortable, and provide even the slightest bit of comfort to the family as well, is so rewarding.

Sometimes the adventure is not all fun and excitement. Sometimes it involves gathering the family. Singing sweet songs to a patient who longs to sing along, but a raging tumor will not allow. Providing comfort, to both the patient and the family. Smiling when they smile, crying when they cry.

It takes so much to do this. So much time, energy, effort, and empathy. And yet, I'm given back to in a much larger way.

Truly this little one has touched the lives of many. This is evident in the amount of people gathering around her bedside. This is evident in the way a celebrity rushed to give her a personal concert to fulfill her wish. And it is evident in the way almost every network in the area picked up this story and shared it with people.

To see her story, and a piece of the concert Miranda gave, click here:
http://www.huffingtonpost.com/2011/01/28/miranda-cosgrove-surprise_n_815445.html

*If you look closely, you can see me in the background at one point- I'm the one wearing the chili pepper scrubs : )

The Training Wheels are Off!

So they took the training wheels off today. We went into clinicals, got our patient assignment and had to present them in rounds. No more "observing"...no more being a shadow. We ran the show (for our patient)...

Now I normally don't mind public speaking. I love giving inservices or classes at work. Eventually, I'd love to teach!

But presenting in rounds is a whole other ball game!!

I was the last person in our group that had to present...great, more time to freak out about it...I mean think about it and prepare : )

But it actually went ok! Sure, there were some minor details that I missed...but nobody even noticed or needed those pieces of information. It wasn't as bad as the first APN student had...she got cut off by the attending within the first 10 seconds because she had totally left out large pieces of the puzzle. And then the questions just came firing away!

And luckily, all 3 attendings (PICU, Cardiology, and CV Surgery) were all VERY nice...and understanding of the learning process!! That makes a huge difference!

So tomorrow the alarm will go off at 4 am (not a time I'd ever like to see again after these clinicals are over!!) and I'll do it all over again! And I know it's only going to get better and better as I go.

The training wheels are off. Now I just gotta keep working on staying upright!