Lumbar Puncture

Getting the opportunity to do procedures in my PICU can be few and far between sometimes.  Yes, we have a very busy 40 bed unit.  Yes, we have very high acuity much of the time.

But given that I'm one person, assigned to 6 kids (sometimes more, sometimes less) and don't work 24/7, things like doing central lines, intubations, and LPs just don't come along all the time.

Until this week!  I got to do my first lumbar puncture (or "LP" for my non-medical friends and family).

I got so lucky, because the Neuro Critical Care APN decided to save it for me.  It wasn't my patient.  But she knew that I was coming in, and she knew that I needed procedures.

Schooling to become an APN is great for some aspects, but certainly not great in getting in procedures.  So this was the lovely that I got to practice an LP on:

                                                                          [via]
Nice, right? And oh so lifelike!  Especially because the manequin that I was working on failed to actually have vertebrae..not that those are important for anything other than being the very cornerstone of placing the needle!

But I digress...enough with how school did not properly teach me how to do an LP, and back to the PICU that will!

The patient was 3 years old, super cute, and was easily bribed with chocolate pudding and mac-n-cheese (girl after my own heart!).  Until her parents left the room and she saw us putting on our sterile gowns and such.  Then it was all out freak-out, and really I can't blame her.  Although she had no idea what was going to happen, strangers wearing the get-up cannot be good in the mind of a 3 year old!

So after a ridiculous amount of sedation medications, the oh-so-still-slightly squirmy toddler was still enough for me to try.

I got my landmarks.  I numbed up the area.  And then I put in the needle. While it took a bit of repositioning, there has never been a more glorious site of fluid flowing out of a needle before!

And I must say that the Neuro Critical Care APN teaching me could not have been a better teacher.  She was so calm, so patient, and just so helpful.

The 3 doctors and 2 nurses watching me (not participating) could have left the room on the other hand! At one point, one of the doctors that I work with said "We are cheering for you! Just think of us as your cheerleaders!"

But really, who wants a bunch of cheerleaders in scrubs watching you as you put a needle into the spine of a squirmy toddler.  OK maybe someone who is attention seeking.  But that's not me.

So despite having an entourage of unwelcomed cheerleaders, I will welcome the chance to do LPs in the future!  I know that kids are a hard audience (gee, a stranger is coming at me with a big needle and going to put that WHERE!?)...but the more chances I'm getting to do procedures, the more and more I'm loving my job.

So bring on the procedures...just leave your cheerleading bloomers at home. Because this PICU APN wants nothing to do with that!

Assertive APN

Yup- it was as bad as I thought!

Parts of it were actually worse.

At one point I found myself squatting in an alcove in the back of a secluded hallway thinking "What in the world am I doing here!?"

If you haven't read my last blog post, you have no idea what I'm talking about.  And the above sentence may just sound downright creepy!

So to fill you in- I'm talking about taking the PICU APN out of the PICU and plopping her into the great abyss known as the OR.

The OR could not be any different than the PICU.

And it certainly isn't for me!

I went there for airway management skills, and left with more frustration than knowledge.

We have 3 floors of ORs...3 FLOORS! And each floor has about 20 ORs.  So that's a whole lotta OR rooms that I have to troll myself into and try and convince the anesthesiologists to teach me airway skills!

Oh it was lovely fun.  Creeping outside each OR room, waiting for someone to show up.  And then it was the same speech- "I'm an APN from the PICU and I'm here to learn airway management."

This speech got me tons of different comments ranging from:

"I'm an anesthesia resident, and you cannot take procedures from me...I need this experience"

"Umm, this room is already a bit crowded...maybe you can find another OR" (stated by an anesthesiologist in a room with 5 other people...very standard for the LARGE ORs!)

I got a TON of "I already have a resident with me...go find another room without one."

And then there was the "Oh, I would LOVE to teach you, but I just don't have any interesting cases today.  Are you here next week?"

Gee, thanks guys!

I will say the most helpful and amazing 4 people I met all week were as follows:  3 were CRNAs (or APNs that are anesthesiologists), and an anesthesiologist that also worked in the PICU with me for the last 8 years!

Gotta love that the APNs stick together!  One even said, "I can't believe you have to go room to room, hoping someone will take you in...it can be brutal among anesthesiologists!"  Umm, definitely agreed!

So I'm done with the OR!  I want to learn airway management...its crucial in the PICU...but I don't want to do it this way!

I told our scheduler that the best way to get these skills would be to pair up with one of the CRNAs who will gladly take us under their wing, teach us, and give us the hands on experience that we need! And 2 of the CRNAs that I met said they would be more than happy to be the contact person!

So while this brilliant idea may not apply to me, at least it will help out our new hires from now on!

Its funny that all the APNs before me went through this, and have nothing positive to say about it.  And all of our attendings in the PICU have had to do this in the past year to keep up their airway management skills. And of ALL the attendings that went through, ALL of them have said "Ugh, that was the worst week ever!  I could barely get my hands on a patient!"

If anesthesiologists aren't letting PICU attendings intubate the kids, there is NO way they will be letting brand new APNs!

So this APN isn't going to be another one of the above...another APN that goes through, hating the experience and then letting others after them have to endure the same thing!

It is my newfound PICU mission to help the APNs that we have starting in January...and all the ones after that get their airway skills without wanting to gouge their eyes out!

You can now call me Assertive APN.  I may be new, but I get things done.

All in the name of the PICU.  Booyah!

Back in the OR

And here we are- another Sunday...another lonely blog post!

Grr...I so love blogging.  And yet I just don't do it much anymore! I don't know how people keep up with blogging several times a week, or every day.

What I will say, is despite me not blogging about it much, I do love it.  Being a PICU APN that is. And really, I think that's much more important.

So, moving on.

I barely got through my week of nights.  I got through.

There was a point at around 4 or 5 am on my last night where a nurse was asking me a question.  I could see that she was moving her lips, and heard words coming from her mouth, but really could not piece what she was saying together (sounds real safe, huh!?).  Well to my defense, once I snapped myself out of it, I made some really good judgement calls!

And funny, I told her "I am so sorry, I'm only like 50% right now. I promise in 30 seconds (after I do a weird jiggling and jumping sort of wake me up dance) I will be back to 100...ok, maybe 95%- but that should be good enough!"

After laughing at my ridiculous wake-me-up-now dance, she then replied, "You look WAY better than 50%. Some people around here are drooling and all baggy-eyed...but you still look fresh!"

I just laughed.  I saw myself about an hour before. If that is her definition of "fresh" for me, I am a sad case!

So I caught up a lot on sleep this weekend.  And spent some good, lazy quality time with my man.

And this week I'm back in the OR.  Oh, how I DO NOT want to go there.

I actually tried negotiating with our scheduler to see if there was a way to put it off until January, or February. Or never!

I know that its great experience. And experience that I definitely need. I just think going into someone else's home, a home that I've invited myself into by asking the nanny and not the homeowner, and then showing up saying "I need you to teach me!" is not the best approach.

I wish there were ample opportunities daily to intubate kids in the PICU. But that just doesn't happen (good for them, bad for me trying to learn).  And with the first year fellows also needing the opportunity, those chances dwindle exponentially.

So, I'll go into anesthesia's home this week.  I will try my best to be a great house guest.  And hopefully I will come out of it with a great experience and a bunch of successful intubations under my belt.

But if not, I will gladly run home, back to the PICU, where I know my family will be waiting with open arms. Especially because we are short staffed right now.  But, also because they love me!  Ahh, there's no place like home.

Back to Nights

Apparently my first call shift took a lot out of me, because I haven't blogged since that day!

I actually can't complain because it was a relatively quiet night and everything went well.  I even got to lay down for several hours.  And even though I never fully fell asleep, just being able to slightly "turn off" was nice.

I'm back to nights for this week.  I'm hoping that they go as well as the first one went.

One of the nights I work is Halloween though, so I'm not very optimistic...crazy things happen!

If anything, I'm hoping to see a few cute kiddos in their costumes.

Oh, and in my "spare time" I'm working on a post to answer some of the questions that I've gotten via comments and e-mail lately regarding my job, responsibilities, differences between bedside nursing and being an APN, etc.  Please don't think I'm ignoring you!

I promise, as soon as I shake off working nights and can think clearly, I'll be all over it!

Nights and I aren't friends.  I would love to be, but we just aren't.  I just calculated today that I am responsible for doing 39 call shifts (16 hour nights) each year.  So basically after this week I'll be 4 down, 35 more to go.

Oh well.  At least I love my job!

First Call Shift

I won't bore you with another pumpkin baked good post today.  Although, I am going to try a new pumpkin cookie recipe today...thank you pinterest for making me fat!

Instead, I will keep this short and sweet. And even about the PICU.

I am taking my first call shift (AKA: night shift) tonight on my own.  No more preceptor.  Just me, the big PICU, and a whole lotta sick kids with a whole lot less staff present.

But I'm actually really excited about it.

Yes, I'd much rather spend my Friday night on a date with my hubby, but if I had to work (and I obviously do!), I'm glad to be in the PICU.

So with excitement, nerves and a little bit of anxiousness, I need to find a way to chill out the rest of the afternoon, and hopefully take a little nap.

Hope you have a great Friday.  And if you're working the night shift tonight, give me a holla at 3 am...it may be what I need to stay awake : )

Pumpkin Chocolate Chip Brownies

I promise I didn't quit my APN job and become America's next great Food Star...although that would be AWESOME!!!

It's just that nothing crazy, super exciting, hilarious or really blog-worthy has gone on at work lately.

I will say, each shift that goes by I am becoming more and more confident.  I am feeling like I'm getting the hang of things, and while I have a long (long!) way to go, I will get there!

Probably the biggest adjustment has been figuring out how to keep the relationship with patients and families that I so loved being a bedside nurse.  It's definitely very different being an APN because I am running around the insanely large unit all day, and so my time with each patient and family is much less than when I spent the entire 12 hour shift at one bedside.

But I'm sure as time goes by, I'll figure that out as well!

Until then, I'm going to bake my way through pumpkin recipes on each of my Fall days off!

My pants buttons may not thank me come winter time (isn't that what stretch pants are for!?), but my palate certainly will!

Here is probably the most simple, quick dessert that can be thrown together for any party (or Monday afternoon!) and be a hit.

I didn't even have time to take pictures along the way, because from beginning to oven it took maybe 3 minutes. And then Jonny and I gobbled a good portion of them up....sad, I know.

Directions:
1.) Empty one box of brownie mix into a bowl (yes, my mom's homemade brownie recipe would be much better, but this is the speedy version)
2.) Add 2 whole eggs, and 1/2 to 3/4 can pumpkin puree (unsweetened)
3.) Add a few dashes of pumpkin pie spice to taste (and really, batter tasting is the best part!)
4.) Add a handful (or so) of chocolate chips...because really, more chocolate makes everything better!
5.) Place in baking dish, put in oven for 35 minutes, and savor the smells that will waft through your house

It's that easy!  And that delicious!  Yup, just one more pumpkin recipe that nailed it...add that to my recipe book!

Pumpkin Chocolate Chip Cookie Bars

It's been awhile since I've posted anything yummy that Jon and I have made.

Come to think of it, it's been awhile since we've really made anything all that yummy.  I mean, we make dinner together several times a week, but since we've been so busy lately it's been the same old thing most nights.

Until today.  I've felt extremely productive today.  I woke up at 6 am all on my own...thank you PICU for waking me up so early so often, because now I'm just used to it.  And sleeping til 6 felt like I had slept in!

So I got out of bed, and really got a ton of stuff done.

Including looking on pinterest for an inappropriate amount of time.  But I was on a mad hunt to find something that would satisfy my pumpkin and sweets craving without going straight to my hips...or other places weight seems to be creeping on!

And then I found THIS... and while it looked good, it didn't have pumpkin.  So, I made it my own!

And I think it's awesome!

Plus, it was super easy to make, and I didn't have to go to the store for anything...always a bonus!

Oh, and I didn't mention that there is not one bit of flour or refined white sugar...the base of the cookie is chickpeas!

Yes, I said chickpeas...but I promise it is good...and you won't even be able to tell!  So give this recipe a try, and let me know what you think!

Ingredients:
-1 can chickpeas
-1/4 cup + generous spoonful natural PB
-slightly less than 1/2 cup canned unsweetened pumpkin (not pumpkin pie filling)
-1/4 cup agave (or honey, or whatever sweetener you choose)
-1 tsp baking powder
-2 tsp vanilla
-pinch of salt
-dash of allspice
-generous dash (or 2) of pumpkin pie spice
-1/2 cup chocolate chips (I used milk chocolate because that's what i had, but semi-sweet would be good too!)

Directions:
1.) Preheat oven to 350 degrees
2.) Combine all ingredients except the chocolate chips in a food processer.  As you can see, I tried using a hand mixer because my food processor is small, and not all that....hint hint *upcoming birthday* : )  But, the hand mixer doesn't make the chickpeas smooth so you definitely do need a food processor!

3.) Once everything is mixed, spread in a baking dish. The original recipe rolls into cookie dough balls, but this was too moist with the pumpkin...so bars it is!

4.) Place in oven for about 40-45 minutes.  I tested this every 10 minutes or so until a toothpick came out clean.

5.) And enjoy...the best part!  As you can see we almost polished off the entire pan!

Hope you have a *sweet* weekend!