Tuesday, June 29, 2010

Long Day

After three days of work (during which I did not accomplish much - except a bit of a tan), I hopped on the greyhound to go to my home city to help my friend move. I spent 8 hours on Monday packing the kitchen and getting it all ready to go. At this point I was so tired. I got home, whined and moaned and bitched about being so tired, laid in the bed with all my clothes on and complained about being too hot. Then I complained that I had to brush my teeth, and then I complained that I was thirsty. I'm sure Jen was really happy to have me home for the evening.

The cat showed her affection for me most of the night. Then in the morning, I sluggishly got ready to go to school for a debrief day - because I wasn't tired and cranky enough already. So I was totally looking forward to this day because I have been isolated in this more rural (still a city - but more rural) hospital, with 3 classmates who aren't that bad, but are not my best friends from school. I had built this day up into this wonderful fun day of catching up with classmates and minimal learning. I was sadly disappointed. The power of how annoying all the other students are totally destroyed the joy I had at seeing the 10 students that I love.
I suffered through a day of everyone's stories, some group work, some learning. At 2 pm we are set free. I have arranged a ride with one of my country hospital classmates. We spend the 3 hour ride chatting about nothing, and I give her what I would consider some solid dating advice (even though she is a Mormon and I would guess has different ideals for dating etc.) The whole conversation is mildly ironic, and is drawing to a close when we enter into a massive thunder, lightning, and hail storm. It's so bad that we actually have to pull over and by the time we get home the delay has added 30 minutes onto the trip! I'm home now, nauseas (I'm sure the hot dog for lunch, and DQ for supper have nothing to do with this), exhausted and contemplating a 7 pm bedtime. The highlight of my day is realizing it is Tuesday - and a new Savage Love podcast is out!

Two more days of work and then a long weekend!

In case you need a personal defibrillator - one can be obtained at Costco. Yes seriously.

Saturday, June 26, 2010

Hot Tips

I am in the midst of 3 shifts, which always wears me out.

In my absence I offer some good advice.

1. If your patient has CHF, please do not discontinue lasix (message to the doctor)
2. If your patient with CHF is off their lasix, please do not encourage them to take more ventolin for their "wheezes." It increases their HR (message to the nurse)
3. If your patient is agitated, it doesn't mean they need BiPap, it means they need sedation. (another message to the doctor)
4. An ECG is not needed to come up with the diagnosis of "tachycardic" (message to the nurse)
5. Stop procrastinating and write your damn discussion post about epiglottitis (message to me)

I got off easy today, with no trach care. I watched a 6 year old girl get her arm set in the most unnatural way. They bent it at a 90 degree angle at mid radius/ulna. Thank god for propofol. The mom was so annoying. She kept trying to explain medical things to her daughter, who was clearly in pain and just not caring. I was annoyed and I wasn't even in pain.

I am getting sick or I am already sick. I haven't decided, and am full speed ahead on the Cold FX because I cannot afford a sick day!! I have to have 1600 hours of work time this year, and it's pretty tight.  I knocked myself out cold with some tylenol cold and sinus last night. At 4 AM I woke up, completely freaked out, with no pillow, and my blanked bunched up under my head. What the hell.


Thursday, June 24, 2010

Inappropriate

Patient - Elderly gentleman being prepped for surgery

Med lab tech is drawing blood, but the patient doesn't even have a wrist band with his name on it yet, so they call the nurse for the wrist band. She brings it, and the lab tech says... "Better this tag than a toe tag." OMG. Who says something like that?

I saw my first ever patient with platypnea. Usually patients feel much better when slightly elevated, but this poor guy was just drenched in sweat, and when I layed him down for the ECG his work of breathing seemed to disappear. Apparent causes of this phenomenon include:
  1. left atrial thrombus
  2. left atrial tumors
  3. pulmonary A-V Fistula
          (thanks Wikipedia)

I can't say that the patient had any of that. He seemed to have some Afib juding from the ECG, but there was so much artifact. First the patient was soaking with sweat, so I had to dry him off to get all the stickers to stick. Then he had a very hairy chest so I had to get the nurse to shave some spots off for me (definitely outside of my scope of practice). I just couldn't get a clear ECG. Sometimes it just doesn't happen.


On the personal front I have had 2 days off and no idea of what to do with them. First I mowed my grandparents lawn and took their dog for a walk (part of my ongoing plan to be the favored grandchild - this is not a hard contest). I also went for a nice long walk with my friend and her dog. It's a bit muddy out and I did fall on my ass once. See, this is ridiculously boring. I have nothing to do when I'm not at the hospital.

I have been living in a 4 bedroom townhouse on the college campus for the summer. When I moved in I had 2 room mates, and they were a bit odd, but I like having company, since I am afraid of the dark. Now they are both gone, and I am enjoying the space a lot. Tonight will be my first night all alone, but so far I am enjoying peeing with the bathroom door open.

Monday, June 21, 2010

Well no one died today.

Everything was pretty routine today  -

I did an ECG (I clearly do a lot of ECGs. This is mostly because everyone hates them and as soon as they can train a student to do it the happier they are) on an elderly man who did not speak english. He was in a lot of pain, of undetermined cause, so he had both of his arms crossed over his chest and would not move them. This took a long time. I put the stickers on the wires, and stuck them to him blindly under his arms. The only thing worse was the lady with a shattered left shoulder that was taped to her. Sometimes people do not like me. 

I was walking up to a floor, when I heard a clatter and a nurse shouting, "Don't you hit me!" Repeatedly. A man wielding an IV pole, with a chest tube in situ was hitting a nurse in the hallway. He then ran into the stairwell and slammed the door on his chest tube.... which he then PULLED OUT and fled down the stairs. Security tackled him. I was hiding behind a door, peeking out the window. Shortly after I entered a patient room, and awoke her. She looked at me as confused as could be and said, "I heard they found a body." Um you were dreaming! Code white does not mean we found a body in the stairwell. 

 - and then CODE. A woman was at the casino and went down hard in the bathroom. The security guard followed her into the bathroom (I guess because she looked unwell?) and witnessed her go down. CPR was started almost immediately. This particular lady has terribly fragile skin, which was torn by EMS on BOTH arms.  I opted to not try for that ABG - her arms were just bleeding everywhere. I got yelled at by a nurse because I didn't have any saline in my pockets to assist with dressing her arms. Right - the saline in my pocket. I'll remember that for tomorrow. In the midst of the melee, lab was drawing blood cultures, and having trouble getting a vein. This smart ass RN (and I do love nurses dearly) cuts open the dressing on her arm and starts palpating the radial artery. My superior asked him in no uncertain terms what the hell he thought he was doing. The RN was totally offended, and thought he should be able to just draw off the artery if he felt like it. This happened not 5 minutes after my superior did a femoral poke, asked JACKASS RN to hold pressure on it, and the RN turned around and just taped some gauze on it and walked away. Art pokes are serious business! It's not that this jackass RN couldn't do it, it's more that he's not certified to do it. What if something went wrong. 
Anyway. I got more blood on my shoes. The patient was responsive to pain, but would not open her eyes. 
The thing that always gets me is not the patient so much (except for that one pediatric code) but more the family of the patient. This lady had a very sweet husband who was just crying at the bedside. He kept talking to her and saying things like, "Oh sweetie, open your eyes. No sleeping before supper!" It's so sad. I have already learned to completely detach myself and become all business around patients in emergent situations - but I can't do it with their family. 
I left as they were transferring her to ICU - I guess I'll find out more tomorrow. 

Sunday, June 20, 2010

New Design

I've been playing around with some different designs for the blog. I like this one, but I am worried that it might be a little too flashy. Like burn the retinas flashy.

So how about the job market. I've started obsessing about finding a job when I'm done. Already. Just a mere 10 months to go and I already am planning my life on a McDonald's salary... Would you like fries with that? What's funny is that one of my teachers at college always said if we didn't apply ourselves we would end up working fast food. What is unfortunate is that there isn't jobs for all of us. Is it wrong of me to hope some people in my class drop out? The fact is that the college lets in way more people than could ever get a job. Now there are some casual positions every year and there are always maternity positions, but I want a full time job. I would like to replace my previous accountant income with a new Respiratory Therapist income.

 I also want to make a difference. Please see Rick's post about making a difference.

Do I sound confused? I guess I should just focus on getting through my practicum year, and passing the registry exam. A lot can change in a year.

Another rousing week on wards coming up.

Thursday, June 17, 2010

All the Emotions

Sad: A small ICU with one family waiting room. Extubating two patients on the same day, who later die at nearly the same time. Two families having to share the waiting room as they grieve.

Happy: Assisting an intubation of a 1 day old baby. BLES (surfactant) was administered and the baby responded beautifully.

Mad: The patient who had to be poked twice, because I missed the ABG! Oops.

Facts of life:

Ecstatic: One more 12 hour shift then home for the weekend. 

Wednesday, June 16, 2010

Preceptors

Here's the thing about 3rd year - the preceptors are going to make me or break me.

I am so lucky at my hospital all of the preceptors are incredibly nice. That being said there are definitely two different kind of preceptors at my hospital.

Preceptor type #1 - Initially helpful, but then uses  my newfound skills as a way to get out of doing stuff. IE - I am now good at ECGs, so I do all of them. I can run samples in the blood gas maching - "Will you do me a favor and do these." And so on and so forth. In this preceptor's defense, he is very good about instructing me and is very encouraging. Much in the way I would encourage someone who is making me dinner or something. You know? These preceptors are usually male.

Precepter type #2 - Full of instructions, I like to call these preceptors the "nurturers." They teach me the skill, and then they oversee and offer me support as I get comfortable doing it. I usually have to convince them that "yes, I do know how to do trach care already." These preceptors do not mind coming along when I go to do something, or having me tag along to just watch. Instead of sending me in solo.

I like both types of preceptors. The nurtures usually fill in and help me out when the males have sent me out and left me hanging. They typically offer to help me out when I have that terrified look on my face. I think both preceptors have their place and I'm not yet sure which I prefer - if I had to pick one or the other.


Interesting event of the day: Severely handicapped 17 y/o female pt needed to go for a CT scan. Brilliant idea was to sedate her, my preceptor suggested that maybe the mom could just stand with her, and keep her calm. No no, instead they tried for about 15 minutes to get a line into her in order to administer the sedative. After poking her about 6 times they then decided that the nurse could just pin her down while they tried to get as many good shots as possible. Genius. Because she wasn't agitated after stabbing her with a needle 6 times or anything.

Sad event of the day: After an entire day of monsoon-like rains, my dinner date and ride home completely bailed on me. I didn't even have bus fare on me, and wasn't in the mood for the bus anyway, given the monsoon. Luckily for me, good friend who leaves the car at my house in the night (lets just call her the car fairy) was available to taxi me home. Thank god. Monsoon. Did I mention the monsoon?


My future goat.

Tuesday, June 15, 2010

Midlife crisis

I am having a crisis. I am not sure that I want to do this job at all. I feel like I would rather live in a shack in the country. I would like 2 goats and a corn field. Perhaps some flowers and butterflies.

I think I would like to go on being self employed.

Instead I am learning to classify sputum. I may have made a big mistake.

Much better days

Saturday and Sunday were super low key compared to Friday. From what I hear this is much more the norm.

The bus doesn't start running on the weekend here until 7, so that was kind of a dilemma for me, since I need to be at report at 6:45. I was planning on just walking. The weather is nice and it's a good way to get into the zone before I get dumped into a crisis. On this particular day as I was sleeping and hitting snooze multiple times I WAY overslept the time that would have allowed me to walk to the hospital! I woke up in a complete panic. By some miracle my friend had left me her car outside! So I was able to drive to work, was completely on time, and walked in looking very cool and collected (which, of course, is a complete lie).

I went to do an ECG on an elderly patient. The conversation went something like this:
Me - "Hello, are you Sonja?"
PT - "Yes, hello."
I start setting up my equipment. I check the patient wrist band. It does NOT say Sonja on it.
Me - "You aren't Sonja."
PT - "No, you are."

UGH.

Otherwise on Saturday, I drank a lot of coffee. I watched a lot of HGTV. One patient kept converting into and out of Afib, which made some of us question the wisdom of giving more Ventolin.

I noticed a lot of the elderly patients on the floors were starting to look a little worse for the weather. They all seem very cold and tired, which makes me a little sad. In the downtime I also tested a lot of ventilators, and stocked them up and put them in the storage rooms. We use Evita XL.
It's very similar to a vent I learned on in school, but I still feel completely useless. I like that most of the ones we use here have ETCO2 right in line. It makes the patient wye very heavy, but it's great info to be getting right at the bedside. 

Sunday was pretty much the day of the grim reaper. The RT I was sharing a floor with treated one of his patient at 12. At 12:20, I was up doing my treatments, and the RN asked me if room 352 was mine. I said no, but she is on our list. I was informed that she had passed away quite suddenly. I passed the info along and everyone was quite in shock. They cleared out that room. 

I was called for a stat ECG, so I went up and found the patient. He didn't seem to be very responsive. When I asked the nurse about it, they said he had just been sedated for a procedure, so I ECG'd away. The results of the ECG were super interesting - Wandering pacemaker with an occasional PVC. About an hour later I was charting near the nurses station, when all sorts of commotion broke out. The patient had a blood glucose level of 0.1. They called for an RT stat, and my floor coworker came up in minutes. He then basically had to argue with nurses who wanted invasive procedures done even though the patient was on health maintenance (which basically means "no extraordinary measures"). They were calling the family and moving the patient into the single room - 352. About an hour later we were called for a stat ABG and ECG. I rushed to get the ABG supplies while my co worker got the ECG machine. We walked by room 352 and the patient seemed to be seizing. The doctor looked at us, and shook his head. We just put our supplies back. What a day.



We finished the day off by sedating a little 7 year old guy who had fallen off the play ground equipment and broken his arm. He did NOT want an oxygen mask on. Mom had to leave the room when the doctor set the bone, and dad was sitting in the corner looking super pale. And that's the end of swimming for him for 6 weeks, just in time for summer!

My friend has some property with a cabin on a large reservoir, not far from the city. I've been traveling out there with her a few times now, and it is so awesome. It is such a good place to unwind. Last night we went out on the kayak, and then she went swimming. It is definitely not warm enough for swimming yet! I hope to spend the July long weekend out there. That's all that's going on in my personal life these days!

Hospital sleep hospital sleep.

Friday, June 11, 2010

Not a great day.

I'm beat after a particularly long shift, and the 45 minute walk home afterward.

The hospital is not a huge hospital and not in a huge center, so the amount of traumas does not really compare to some of the hospitals that my classmates are at. Today we received an 11 month old who was under water in the bathtub for at least 10 minutes. Apparently he was left under the supervision of a 2 year old sibling.

I bagged him for more than an hour. We finally got him on a vent and the docs and nurses stabilized him. The air ambulance picked him up and whisked him away to a bigger center. The prognosis is not good. I think the most frustrating part was parents praying at the bedside. I wanted to scream at them - "Do you know what is better than praying? SUPERVISION." UGH.

After that I got in trouble for saying I didn't want to do an ABG - that ended up being an overly difficult one anyway. So I wouldn't have been able to do it anyhow. Then I did an ECG on a baby (0 days old), which was interesting because baby's traditionally do not hold very still. This one wasn't too bad.

Another ECG involved a patient who didn't seem to respond to me until I started to pull the stickers off. Then I had to use to call bell to get the nurse to help me. He called another nurse and I quietly slipped out the door.

I miss school.

Wednesday, June 9, 2010

Cavi Wipes: My new best friend.


What a day! In no particular order:
  • Decannulation: An elderly lady who had her trach plugged for three days! We were finally pulling the trach out! It was kind of anti climactic since the trach had recently been downsized, and there was no cuff. I undid the ties, and it it just kind of fell out. I am not entirely sure she even knew what was going on, even though we explained multiple times. 
  • ECG's: This is no longer new or special. The only kind of interesting thing about it today was that I got to do one on an 11 year old boy. 
  • Bedside Spirometry: Now, I think this guy was pretty lonely, because from what I have heard, young children grasp the concept better than he did. We got zero good tests, and his FVC actually DECREASED after we gave the bronchodilator.
  • The usual bedside O2 therapy, bronchodilator therapy, and trach care. The RT's actually just give me a list of patients, and a pager and tell me to meet them later. I usually respond to the calls for ECG's (because I like them so much - except the ones in psych).
  • And last but not least by any stretch of the imagination...
A patient presented in the ER with stomach pain, due to over use of NSAIDs from a shoulder injury. Docs were doing a routine scope when they dislodged a clot in a bleeding ulcer. Massage GI bleed ensued. We were called to do a stat intuabation. Intubation complete, patient receives 3 units of blood, and turns from a ghastly white to a humanish color. I am bagging, but since he is not completely sedated he is fighting the tube and the bagger is making that awful honking noise. The Docs attempt another scope to try to stop the bleeding. This involves copious amounts of saline and epinephrine down the scope. Patient retches and vomits wave after wave of blood. Everywhere.Eventually the bleeding seems to stop. Thankfully we inline suction, after he has been stabilized and transfered to the ICU, and get no blood back. The cuff worked! Patient is placed on ventilation, and less than one hour later is extubated. 

And this is why cavi wipes are my new best friend.

In other non-hospital related news I have modified my shower curtain. Yes, this is how exciting my life is when I am not at the hospital. It is a corner shower unit, but for some reason it does not have a glass door, but instead someone MacGyvered a shower rod and curtain to cover the opening. The shower curtain was about 6 inches too long and just sat bunched up in the bottom of the shower. Lord knows how many people have moved in and out of that place with the curtain like that! I couldn't deal with it at all. The bunched up shower curtain took up valuable showering space. I took the curtain out, and cut off the 6 inches at the bottom (which looked like it was growing its own little eco system of grossness). Now things seem much nicer in the shower and no one else has even said anything. I also went crazy on the stove, which looked like it had about 15 years of college student food burned onto it. My room mates just hide in their respective rooms all of the time - except when they are burning food onto the stove apparently. 

Saturday, June 5, 2010

What a difference a day can make!


Yesterday I was completely afraid to touch a trach, was not much interested in suctioning one, and definitely did not want to go poking around in there doing trach care. Well today I had no choice. I was definitely let loose on the wards, and was given half of the patients to see for myself. I was allowed to suction on my own - which although was a little gross, I can actually handle. I take an incredibly long time to get all set up, mostly because I am worried I will do something wrong. Which  I haven't seemed to do yet. I am not really allowed to do trach care on my own yet - just in case. 

Also on wards we came upon an unfortunate palliative care patient. The family is insisting the Sats stay high (who knows why?) and this sad lady is on 10 lpm via NP and 15 lpm non-rebreather. And is complaining of nose bleeds - I wonder why!

I am still on the ECG bandwagon - we do a lot of them. We went down to psych to do one today! Always an adventure. 

Blood gases update: I have now successfully completed 2 blood gases. I missed the first time on the lady today, but she was incredibly patient and let me go for it again. Success! Check out these ABG resutls:
pH 7.447, pCO2 65.9, pO2 77.7, HCO3 41.1.   Crazy things happening there!

Well I have 2 days off now, and am not quite sure what to do with myself! 

Friday, June 4, 2010

Day 2: I forgot to eat breakfast and lunch

Today was a more routine day.

I got to do two ECGs on my own. I got to give lots of puffers (including one to a TB query patient - awesome - hello n95 mask) and listen to lots of lungs.

Successfully accomplished my first ABG! Patient was completely obtunded, so that totally took the pressure off. ABG results yielded CO2 of 115, which obviously led into my setting up the bipap visions. This is a machine I had some practice with from school, but it was really good to see it in practice and set it up on a real patient. An hour later, I completely blew the follow up ABG. Oh well, there's always tomorrow.

I attended two procedural sedations and helped do a cap gas on an absolutely adorable little boy.

Meals really did fall by the wayside today, until about 2 when I finally realized I was going to pass out, and I gave myself a little time out.

Back again tomorrow!

Thursday, June 3, 2010

Day 1: The Real Day 1

I got to work 1 minute late! Not a good start. The bus runs every 30 minutes though, so tomorrow I will be 29 minutes early!

Since I am on wards this week, most of the day consisted of administering treatments to those unable to do it themselves.  What usually takes an hour or so took us MUCH longer today. We were called to do an ABG, and even though I have still not successfully done one, I am glad my preceptor took on this one. It was a confused elderly woman who eventually needed to be restrained by two LPNs so that the sample could be obtained.

I watched my first ECG, and then was allowed to fly solo on the second one. The patient (see elderly ABG patient above) was pretty tired out from the ABG and didn't put up much of a fight for the ECG. I need to work some more on my landmarking.

We were called to labour and delivery for a possible meconium. We waited an hour for the baby to finally arrive, and although he was a bit quiet, by time we left all was well (ie: he was shrieking) and he was quite a cutie! The mom was in a lot of pain - births always make me question the logistics of birth. Hearing that little snip when they cut the mom... is the worst part.

In the afternoon we split up the work and I did some assessments on my own. Mostly my preceptor just sent me into the patients she wasn't too excited about seeing again. She even once used me as an excuse to get the patient to use a spacer with his MDI. "My student really needs practice at this."

I hit the ER a few times. The first was a conscious sedation for a cardioversion. They tried adenosine first. The adenosine was not successful, so they moved onto cardioversion, and that did the trick and slowed the rate right down. The second call to the ER was to do some asthma teaching - to someone who has had asthma for a while and has all the inhalers at home... They wanted us to teach about the meds they were giving via aerosol in the ER. Strange.

12 hours down, 1588 to go.

Wednesday, June 2, 2010

Welcome Back!!

I arrived fresh off of the greyhound into the dorm of happiness.

In my absence there had been a power outage that caused most of my food to spoil. The power outage in some way blew my tv. It won't turn on at all. This is mostly sad because I had previously forgotten the cable for it, so last week could not watch tv. I carefully packed the cable in my suitcase this morning - for nothing. Now what will I do in the evening to veg the day out of my mind?

There also has been some sort of break down of the water system on campus. For the time being the water is not drinkable. I have been stealing my room mates bottled water.

I am so nervous to start my shifts tomorrow.

Tuesday, June 1, 2010

Just Wasting Time

I've been home for nearly a week. My orientation ended last Thursday at noon and my shifts start this Thursday at 6:45 AM. What have I accomplished in nearly a week of undisturbed laziness.

Not much.

We watched a bad movie or two. The most notable being "No Impact Man."
No Impact Man

This is a boring movie about a writer who doesn't have enough talent to write about anything interesting. So he invents a gimmick to draw some attention to himself - he is going to stop harming the environment. Some things he and his family go without include: electricity, new clothes, toilet paper, cleaning products, refrigerator (no electricity right), and the list goes on and on. The guy mostly buys into it, but his wife is a total sham. She has an office job for a big corporation. So every day she goes to work and enjoys all of these things at work. Along the way, they also decide to have a baby - even though he does not want one and eventually ends up "giving her for her birthday" the opportunity to have another child. OMG. Really? If you are with a guy who doesn't want to have a baby - don't have a baby. Do you think maybe that is something you guys should have thought about before you got married. He even confesses a bit that he was unsure about getting married to her. She is pretty whiny, so I can understand that.  He ends up getting a lot of publicity, but the movie really drags. 

Ok. After I watched some bad documentaries, Jen and I started to plan our wedding! This is something I've been putting off for months due to being completely pre-occupied with school. We finally made some decisions:
  • Location: Vancouver Island
  • Date: Easter 2011
  • Guests: Less than 40
We have been looking at quite a few venues and our favorite at the moment is Tigh-Na-Mara Resort. Too bad we don't live anywhere near it so we can't go check it out in person. 

We also have been planning a summer holiday (I have the month of August off - my only reprieve from my year long unpaid practicum). We have booked a trip to Ecuador - more on that later. It will serve as a sort of pre-wedding-honeymoon.

To round out my week I whittled my cell phone plan to practically nothing. Bell does not have a lot to offer in way of cheap plans. I looked around though, and Telus and Rogers are nothing special either. I no longer have internet, caller id, or voice mail. And still it is more than $40 a month! I am just waiting out my contract (January 2011) so that I can make a move to one of the alternative cell phone contractors (Virgin, Wind, Koodo - I'm not really sure).

And now all I have left to do is to book my Greyhound ticket back to my Hospital City and head back there tomorrow.

I'm increasingly nervous to start my first rotation! It is on wards, so that is at least a little less intimidating than ICU! A bit of a slower pace, with a little more ventolin and trach care, and way less vents.