Thursday, July 29, 2010

OMG OMG OMG

Just when I have almost lost faith in the ICU the day completely explodes and saves the internet from my personal life!

Yesterday was so slow, that someone called in sick, and we couldn't find anyone to come in. Still totally fine. Then the other student started puking - sent home. Mid-afternoon I was sent to Tim Horton's for treats. Totally fine - nothing happening, no crises.

Queue Today.

We started the day with 1 intubated adult and 1 intubated baby (32 weeks - so just tiny enough.)

First thing we get called to do a stat ABG on a patient we extubated yesterday. For the record I did not think she was with it enough to be extubated, but I don't get a say in things that happen. At 4 AM an RT was called because she wasn't looking great and they put her on BiPap. BiPap is great if your patient isn't obstructing. When we did the gas the pH was 6.9 and the CO2 was 110!! OMG, no one noticed this? Seriously. I wonder.

So there we go - intubation. Head count - 2 intubated adults. We also had to put an art line in, and my preceptor hadn't done one in quite a while, but we got the job done. We weaned to pressure support later in the day, and otherwise simply monitored this patient. Oh and I drew multiple gases off of the art line. Oh excitement. Oh the vamp.

We popped in on the baby to see if she would tolerate a switch to pressure support today, made the change and planned on extubating later in the day.

Our other intubated adult was a female with a neck mass that was compromising her airway. She was fully awake and not even restrained in any way. My preceptor the day before barged in and sxn'd her without even talking to her. She sxn'd her multiple times, and even instilled while the patient laid there patiently. Eventually after my preceptor loudly shouted to the nurse, "Can I get some sedation in here," the patient motioned to her clipboard and wrote a note saying, "Please leave me alone."
Anyway back to today. All of the ENT specialists (all 2 of them) are going on holidays so this patient was  airlifted to a bigger center today for closer monitoring by an ENT professional. Good choice. Cross this intubated patient off of our list.

Somehow this has taken all morning and I am just shoveling some salad into my mouth, when a code blue is called. As per custom, we all take off running down the hall. I lost all of the change from my pockets, but some nurse handed it into our office! So I have lost the change, and sprinted up a few flights of stairs, by the time we arrive I'm pretty much thinking they'll be coding me soon. The ICU staff turns to look at us and says, "Oh, we have this under control now." Great. No problem. However, we proceed to intubate (well assist anyway - for some reason the Docs really love doing their own intubations), and insert another artline. My preceptor is pretty freaking glad she had that practice one this morning since now a resident, the doc, the paramedics who have arrived to transport her to a cardiac center, and the transport RT are all staring at her. I totally am loving this whole time that I am being told to collect things, and run and grab things and I have no idea where any of this is. That really helps the idiot complex. Finally they take this patient away. We are back to one intubated patient!

We run over to the NICU to check on the baby.... and the NURSES have extubated. Well, whatever - this is just how they roll here.

After cleaning all of the dirty equipment (multiple vents, a bipap, and the baby vent) and doing all of the checkouts on them I think I had 30 minutes to sit down before shift change. Chaos, absolute chaos.

Semi Competent on the Drager Babylog


Mostly Competent on the Vamp Art-line System


Fully Competent  at consuming anything Tim Horton's.

Tuesday, July 27, 2010

Dread

I don't want to go to work tomorrow. I just don't feel like sitting around for another day watching TV.

We wrote the worst test possible today. On the bright side, studying more would not have helped. On the not bright side, I am not looking forward to the registry. The questions that were asked were of such great detail, I'm going to have to start making flashcards of every concept ever discussed in class, and then memorize all of Egan's in order to do well on the next one. Super depressing.

 I car pooled with a fellow student back to our rural site, it was interesting because she is a strict Muslim, and I am clearly not. She is being married to her fiancee (arranged marriage) next year, I am getting married to my fiancee next year (homo wedding). We don't really have a lot in common, but it was interesting to hear her talk about her life in Pakistan before moving to Canada, and her take on the life she will have after she moves over-seas to be with her new husband. It is amazing the friendships that can take place when you are just put into a different situation. We never really talked at school, but now that we are part of the small group at the outlying hospital, I have found that she is a really awesome person. She is genuine, and cares a lot about her family, and takes an interest in my life, even though it clearly must be abhorrant to her.

Since my professional life has clearly taken a turn for the worst, and for the boring, I'm going to have to start doing something no one wants. Talking about my personal life.

Monday, July 26, 2010

Sun Tans and Home Renos

Well this is getting redundant. We have one vent in the ICU right now, so we took part of the wards as well. Even then, the other student didn't have anything to do, so we gave half of the patients to her! I am trying to think of anything remarkable that happened... and I can't. Except for yesterday must have been full moon today. There were so many babies born!

We've been taking advantage of the AMAZING weather as much as possible and sitting outside. I know in the States this isn't maybe quite so exciting, but it seriously got really warm here like a week ago, and who knows when it will end. Summer is to be enjoyed and appreciated - if not worshipped. It's so hard to work a 12 hour shift, looking out the window, thinking of all the sun you are missing! This weekend, even though I was working, I got to see a lot of sun. We took as many breaks outside as possible, and I am getting quite a nice tan. We have to be careful not to spend too much time in the public eye, or people will complain that we are doing nothing. Even though we have nothing to do. So most of the time we spend our time locked away in a back room with a TV. Which is the reason that I've seen so many home renos shows. I've become inspired to buy a farm house, gut it and remake it from scratch :P I only have 7 more shifts until I am done for my summer break!

We spent a lot of time at work talking about my overwhelming fear of flying. Everyone agrees that Ativan is the way to go, and if I run out of that I should try Gravol. Less than 3 weeks to Ecuador and still need to get malaria pills.  I think Jen should learn some techniques to make me pass out if we hit turbulence - pressure on the neck or something?

I'm home for two days because I have an exam tomorrow. When will the school leave me alone! I am not in the least bit motivated to study. So unmotivated that I would rather do laundry, with our dryer that vents into the condo, in 30 degree heat.

Wednesday, July 21, 2010

The ICU

I've had two days in the ICU now. Mostly it's been pretty fun. I really like that it keeps me way busier than wards ever did. Even with only 2 ventilated patients we have been quite busy just keeping up with routine things. I love art-lines, so much easier to do blood gases. Ventilators are my favorite, and it's been nice to see patient data and be able to make the changes necessary to the vent - in real time, right there. So different from school where everything is hypothetical. We extubated someone on my second day and she was still doing great when I left. I went to a bronch, which was a total schmoz and the dr was kind of an ass. I've met the doc before but she had a student today and was trying to impress her I think. Also, she was totally wearing a belly shirt - we talked for the rest of the day about weather she was pregnant or not (food or fetus?)

We received a patient who has ALS, and is ventilated. Since being paralyzed and ventilated he has gone on to add 2 children to his family of 6. WTF. Why would you have kids you can't raise? Unless his wife wanted them? I still think it is insane, but I can't pretend to imagine what it is like to be in his situation, I will now pretend to reserve judgement.

Finally allow me to complain about the difference between the school (imaginary land) and the hospital (real life).
Cleanliness. Carefulness.

Example 1. I had multiple competencies while in school. One was based around open suctioning technique. We were required to be entirely sterile and if we accidentally hit the tip of the trach with the catheter and did not notice (see how subjective this is on the part of the adjudicator) we failed. This was just one of the possible ways we could fail. The other day I watched an LPN in normal gloves repeatedly ram a sxn catheter down the trach of one of my patients. It was clear there was some sort of obstacle in her path. The tip of the catheter was now bloody. She turns to me and asks, did you plug this trach? Yes you idiot, I plugged it from the inside. Anyway, there was a fenestrated inner cannula in and she kept jamming the catheter through the fenestration and into the tissue behind it. Awesome.

Example 2. Another competency involves putting in an art line. Again, we are to be entirely sterile. If you accidentally bump anything you fail. Seriously. (Except that I did accidentally bump anything and still pass - mostly because this teacher and I had already gotten into an argument because he is an ignorant homophobe... So I really actually think that is why he passed me and my partner). My preceptor was asked to insert an artline into a patient (a patient that was health maintenance only - no intubations, no CPR - so I'm not sure why she needed an artline). We got the bucket of supplies ready and headed into the room. My preceptor put on a gown, and I put on gloves. Yes that was the extent of the protective gear. One gown, one set of gloves. And then we did a mildly invasive procedure.

Why do we waste so much time being stressed out about these things in school, when NO ONE cares in the hospital. I know, I know - best practice.

Sunday, July 18, 2010

Grandma's Quote of the Day

"I had to go to Smitty's this morning because I was constipated. I just eat some bacon from Smitty's and then I have the shits."

Saturday, July 17, 2010

Spinal Tap

We got called to a conscious sedation. It ended up being less of a sedation and more of a little boy vs versed. Nothing could make that kid pass out! They were attempting a spinal tap, and finally the little guy got drowsy enough that they could hold him still enough to get the sample. What a little trooper - it was my first spinal tap experience.

We arrive at the ER (ED - I know, I know) and no one was wearing any kind of protection. No masks, no gloves. My preceptor saw all the spinal tap stuff and set up and asked what they were testing. Oh, just for encephalitis or meningitis. No big deal. She promptly retrieved us each an N95 mask. Which I haven't been fit tested for, but honestly - being meningitis free is kind of over rated. Don't you think?

I'm done my stretch of 4 days. Nothing terribly exciting happened. No one yelled at me, no major traumas came in.  I mostly just medicated and monitored patients. I also stocked some cupboards and did some photocopying.

Back at it on Monday - but I FINALLY get to start in the ICU. Looking forward to some vents!

Friday, July 16, 2010

The other side.

Today I worked with an entirely different group of people. A group of people who did lots of work and kept me busy all day. It was quite novel compared to the usual group of people I work with. They usually rush up, do as little work as possible and rush back downstairs with the ultimate goal of sitting as long as possible. This is totally discouraging to me, since I didn't change my whole life and my career to be a professional TV watcher. I didn't realize how totally discouraging it was until today - when I actually kept busy most of the day, even though there are relatively few patients for us to see right now.

I wonder how this happens - that there are some people who are super diligent and provide amazing patient care, but there are also those who totally slack off. We should not be watching TV during the day - we should be brushing up on our skills. I guess I am new and will get jaded with time, but there are a lot of really great RTs out there, and a lot of mediocre ones.

First things first today I arrived on my bike (that my friend found in an alley - I am so broke) and got myself all changed into my reds. I went to put my hair up and my hair elastic snapped. Of course it did. The girl who yelled at me before for talking during her movie gave me a new one! She must forget about that day. I haven't.

There were a lot of routine assessments today - but my favorite was again conscious sedations. We had two today. The first was a 2.5 year old girl who had a huge gash in her foot that needed stitching up. They were from a dutch family, and the girl had none (NONE) of her vaccinations. So not only did she endure 10 stitches in her tiny foot, she also had to get tetanus immunoglobulin and tetanus immunization. The final immunization what was finally woke her from her ketamine induced afternoon nap. Ketamine freaks me out. I am used to the tremors that these little guys have now, and the constant drool we suction from their little mouths. I really love that they refer to the stitch as "taking a bite."

The second patient was a middle aged gentleman who tripped and fell. He put out his shoulder and the ER doc was already pushing the drugs when we arrived. Of course the patient started obstructing right away making me look like an incompetent RT student. He came to muttering something about the new automation procedures and his trip to London. Awesome.

I love the ER. It makes me wish I was in a bigger center where I would get to spend some time dedicated to the ER. Now whoever is on wards just covers the ER. In some ways this is good because I generally get to stop in the ER once a day if not more, but I want to see it all!

I realize that now the Emergency Room is actually referred to as the Emergency Department - because you know, it's not just a room. Just in case someone was confused about that.

It is my grandparents anniversary on Sunday (50 somethingeth). I called to ask if I could bring them some lunch on Sunday. They have requested Burger King.

Thursday, July 15, 2010

Where does the time go.

A week absence! What a slacker I am!

I finished my OR rotation with a bang - a lackluster bang that is. I failed all my intubations on Friday! I was with a different anesthetist who was so intimidating and I just couldn't get it and I almost broke someone's teeth. All in all I was ready to leave the OR. Pretty sick of stocking carts and maintaining someone's airway while they are electrocuted.

After a four day holiday back home - which I can already hardly recall (I think I bought some sandals for Ecuador) - I am back in the hospital! I am in the middle of a 4 day stretch. I am majorly feeling the effects of my yellow fever vaccination. It cannot help that I am eating terribly. My best efforts to eat lots of vegetables and fruits is failing very sadly. I can't break away from my chicken fingers habit. More like addiction. I love them. More than anything. I especially love them with Frank's hot sauce and ranch dressing. And they are so cheap. Damn cafeteria always enabling my addictions.

I tried to count up all the ECGs I have done so far and can't remember most of them, but somewhere in the hundreds I suspect. I have gotten quite proficient (knock on wood) at blood gases. Most importantly I have discovered the art of re-direction. If at first you don't succeed - try try again. There was one gas that I failed, then my preceptor failed and the lady was whining and whining about how we had to poke her 10 times, which was a total lie. Obviously there was only 2 pokes. And multiple re-directs. Silly patient.

Today we had a 25 year old code come in. He didn't make it. His girlfriend had committed suicide a few months earlier and this guy had been trying to join her ever since. Congratulations young man on achieving your goal.

Oh and here is a good one - a pediatrician couldn't tell if an ECG belonged to the mom or the newborn baby. Why not check out the heart rate. Oh the heart rate is 160? I wonder... could that be the mom's ECG or the baby's ecg.

I have a new room mate! She is lovely and so nice. She's a dietician student doing a practicum so we have that in common! She has had a bad run of luck since she moved in though. Her camera was stolen and she has been having to have all kinds of awkward conversations with security. Maintenance is coming in to do some cleaning on Friday and now we are both kind of paranoid. To add to things I am babysitting some fish, and this is a strictly no pets building - so I'm sure we're going to get into trouble for that.

In other unrelated shenanigans I have rented out our condo for the time we are in Ecuador. Instead of paying someone to watch the cats, we are now being paid by someone who will watch the cats. Best shenanigan ever - as long as they don't steal our stuff.

Thursday, July 8, 2010

Success!

After an uneventful Wednesday I was ready for an exciting Thursday.

The most exciting thing that happened to me on Wednesday was getting yelled at by a bitchy RT who wanted to watch her movie in the break room - while she was working. I accidentally talked, and she snapped. No one was really impressed. She was apparently having a bad day because she was hungover, slept in and had to be called to come into work.

Over-sharer confided that she would like a small wedding. She has already told Matt that it should be at his house on the coast. Today she had some kind of injury and had to tell ever person we came into contact with. Every person.

Now for the exciting news... I didn't have to do ECTs today. I was actually busy doing other more fantastic things. One of the residents was not here today so I was able to join an anesthesiologist for most of the day in a case room. I successfully intubated two real humans (as opposed to that ridiculous manikin). The anesthesiologist just let me have at it. I was so nervous, and even more nervous because there was no stylet! I though that there was no way that would be happening anytime soon. It was really different identifying the anatomy in a real person - a few times I said I couldn't see anything, but when the anesthesiologist had a look she said it was a good view of the cords! I just needed to yank up a bit more on the laryngoscope. No teeth were broken and at the end of the day I had 2 intubations, and 2 LMA insertions under my belt. The anesthesiologist also let me go in and do my own airway assessment on the patients in pre-op. What a great day. Also no one yelled at me, which always helps.

I was able to trade away my OR shifts next week to a busier time. I'll be back in the OR in November - back to the wards for me next week. That's my calling in life - giving seniors ventolin. And also doing endless ECGs.

On the not hospital front - I have received my vaccinations for Yellow Fever and Typhoid. One step closer to Ecuador and can't believe I'll be there in a month! Yikes.

Tuesday, July 6, 2010

Learning Day

So there is officially nothing going on in the OR right now. Of 3 case rooms operating, only 2 are possible airway learning experiences. Unfortunately there is an Anesthesia resident, and a Family Medicine resident also learning in the OR right now, and they get priority. I spent the day sitting in an office, and intubating a dummy. I am more than slightly irritated at my practicum facilitator from school who has not answered my email or phone calls. My preceptors in the OR have suggested I tried to trade next week for another week later in the year, which I am trying to do, but can't since I am being ignored. I rarely complain, but they're going to hear about it this time.

I assisted with ECTs today. The Anesthesiologist corrected my grammar!?! Apparently I said, I was going to lie the bed down, instead of lay the bed down, or vice versa, I honestly can't remember. You know, since I was so focused on the patient who was being electrocuted.

Psychiatrist to patient, "Are you finding any improvement yet?"
Patient to psychiatrist, "Maybe a bit."

OMG - as someone who actually suffers from Epilepsy it still seems crazy to me that inducing them in the mentally ill would improve their quality of life, and also that if it is helping "maybe a bit" maybe it isn't worth 3 trips to the hospital for electricity induced seizures. Every week.  But whatever.

One preceptor (not the over-sharer) also bought me coffee today. I think this was inspired by 2 different things. Yesterday she sprayed me with blood from an umbilical cord, and has been traumatized since. She also feels sorry for me, since I sit in an office making labels for fun. For extra fun I also reconstituted some expired Dantrolene. Strange and orange. Speaking of - I am involved in a bit of an argument. Is increased petCO2 or increased HR the first sign of a malignant hyperthermia episode?

We learned and practiced all of the equipment from the difficult intubation cart today also. I loved the bonfils intubation fibrescope, which I mastered on the plastic dummy. Never on a human, don't worry. I also practiced with the huge bronchoscope, getting the hang of all the controls. Not a job for my mini hands, that's for sure. There is also the Storz CMAC Video Laryngoscope and the GlideScope Video Laryngoscope. There are so many things available for a difficult airway, I think the biggest problem would being familiar with all the devices. If you are a fan of the LMA you can choose from the classic,  Proseal, or Fastrach. My preceptor has suggested to me that if the Fastrach gets pulled out I should excuse myself for a long coffee break as it is sure to be a huge gong show.

As for my preceptor's personal life Matt has hurt his back, and was unable to go to work today. The puppy has bit someone and refused to pee in the rain. No one has time to take him to obedience school and they may have to get rid of him. Matt is unlikely to get into trouble while his back is injured. Stay tuned.

Monday, July 5, 2010

I have deemed the OR boring.

Jen came down for the weekend and we had a lovely peaceful time. Some may interpret peaceful as boring, but I really enjoyed it. Some events included a drive into the country, seeing a movie (Date Night), and eating multiple meals.

I started in the OR this morning. I'll spend the next 2 weeks in there, just observing the role of the RT in this particular hospital. In my opinion the role of the RT is not that awesome in the OR at the best of times. But right now more than half of the theaters are shut down for summer. This equals negative fun for a student.

Normally the RT stocks the anesthetic machines, and stocks anesthetic carts, and stocks needles, and stocks a lot of shit. Then the RT answers everyone questions about stocking things. Then we wipe some stuff down. Then MAYBE there is a c-section we can attend, but the NICU nurse takes the biggest role in baby care. Supposedly we get to do some intubations some time, but I haven't seen it. We are hardly in the room, we will get called if there is a problem, and otherwise we are busy stocking carts. Unless there is nothing going on, because they the stuff is not getting used off of the carts. So then there is really nothing to do. I hate it. I wrote a long letter of complaint to my practicum liaison. I miss wards. A lot.

Oh yes. Also we assist with ECTs. In case you don't know what that is - it's a draconian practice that I can't believe still exists. Basically it is electrocution to induce a seizure, used in psych patients. I guess it helps them or why would they keep doing it. At one point I had a room mate that underwent ECTs and for a week after she couldn't remember my name. I find it completely horrific, and am glad I will only have to see it for 2 weeks

At least my preceptor has a major problem with oversharing. This is awkward but adds an element of entertainment. For example today I said that I hoped I would have a better sleep tonight. She replied, "I hope I can, if Matt behaves." For the record, I have just met this preceptor today and I do not know who Matt is. I feign interest. She continues by telling me that Matt (her live-in BF) may have cheated on her on the weekend. To find out she needs to steal his cell phone and check the calls. For the record, she could have cheated on him multiple times, but has decided to take the high road. She then provided me with examples of these guys. I was surprised at the amount of detail she could provide. I then spent some time wondering  if a relationship in which one person has cheated, and the other thinks she has taken the high road by resisting, but still has someone on the line who she could call at any time is a really solid relationship. Maybe it's just time to call it quits. Just a thought.

After a few hours of practicing intubations on a dummy I got cut loose early, because there was absolutely nothing to do.

I thought since I am done early on OR days - 3 pm! I would love to make dinner and have actual nourishment, instead of something from the cafeteria. Instead I had a beer and some chips with tzatziki.

Cheers.

Friday, July 2, 2010

Happy Canada Day!!


Yes I realize it was yesterday, but I was working! So I am celebrating all weekend! Happy weekend everyone!