Thursday, September 30, 2010

First Night Shift : In summary.

The guys I was working with tonight were great and a lot of fun. Someone had brought in a remote controlled helicopter, and they were fiddling around with that, and joking that the babies were so small that this helicopter could be called in for an air transport. I've learned the value of lying. For example, when someone says, "do you want to work with peds and babies when you are done school?" you always should answer in the affirmative. Even if tomorrow someone asked me the opposite question ie: do I want to work with senior citizens, the answer is always yes. Whatever they are doing is obviously where I want to work. Please teach me.

The baby who was at the previous hospital (mom and dad are first cousins, weird joint problem) is at this hospital, so I got to check in on her. I didn't read the chart so I don't know what the problem is with the joints yet, but when I arrived she was just arriving back from surgery (colostomy omg). Add to the long list of this child's problems - born without an anus.

By 3 am I was wandering around like a zombie. Besides some monitorings, and setting up a new transcutaneous monitor there was not a lot going on. The new monitor correlated the CO2 to the arterial gas within 1 mmHg. That is amazing.

Brand New SenTec Digital Monitor. Fancy.

I passed a mirror and was excited to see another student wearing red. Then I realized it was me. Sad times.


At 4 am we were called to a delivery. It was still born, and later the RT I was with said it was the worst looking baby he had ever seen. Its head was kind of mushy, and it's skin was peeling off. It had no eyes. It was so sad. They starting to code it anyway. They intubated, did compressions, administered Epi, and put in a UVC. Which of course made no difference. The parents had no idea this was coming and watching their shock and grief was sickening. Dad kept saying "WTF is happening," over and over again. At some point I left. The room was full of medical staff that were actually qualified, and I was just in the way. As I left the room I could hear someone wretching and vomiting.

 Shortly after this they sent me home. And now I'm off to bed. To be repeated in some form or fashion tomorrow night.

Wednesday, September 29, 2010

Nightshift

I have my first night shift in the nursery tonight. I am planning on having a good long nap this afternoon to prepare. Likely I will not be able to impress anyone with my knowledge at 3 AM, since it will have all dried up with exhaustion. Oh well, they will just have to deal with tired me.

Unrelated - I accidentally signed a credit card slip "My Name, SRT" ugh.

Monday, September 27, 2010

5 x 12 = 1 hour

I have a secret for making time go faster.

I divide up every hour into 5 minute increments. So each hour has 12 increments.

In a 12 hour shift there are 144 of these increments. I find that if I am counting down from 144, time seems to go much more quickly than if I am just counting down 12 hours. It's totally neurotic, totally in my head, and I totally would have gone mental today if I hadn't had this to fall back on.

Today I endured 8 hours of neonatal ventilation orientation. About every other machine was prefaced with "we don't use this anymore." So I wondered what the point was. Also, my security pass again does not work at this hospital. I'm left standing outside a door at the mercy of housekeepers or porters walking by.

Awesome. Just 3 more weeks.

Sunday, September 26, 2010

I am one of them.

Oh dear. I have turned into one of those people that only updates their blog once every 10 days. My goal is every other day or so, or I forget about stuff I've done and it all blends into the background of a million days of the hospital.

So. I'm already done at my first neonatal rotation. I am starting tomorrow at my second neonatal rotation. How has this happened? Where has the time gone?

At first my time at the hospital was quite terrible. I was working with a few people who hated me (for absolutely no reason - which seems to happen a lot to students). It was a completely new world in the land of neonates. Talk about completely incompetent. The only thing I was good at was monitoring every two hours. And even that was kind of iffy. On my second or third day (see what happens when I don't update frequently) a new person came on at 3 pm. A person who seems to hate life itself, or at very least life at the hospital. She does the 4 pm monitoring and then comes personally to yell at me. And I quote, "We are not just supposed to write down numbers, I have titrated infant x's oxygen, and you should have done that earlier." I apologize. It totally ruins my entire day of loveliness that I have had previous to this (I'm not sure what happened earlier that was so lovely.. maybe some cute babies were born and some cute dads cried, and then I cried too). Anyway, the next day I am all proactive, and ask the therapist if I can wean some oxygen but she says no, that the baby is chronic and I shouldn't touch the oxygen. And she also looks at me like I am very slow.

Sigh. Whatever. Update on infant x. One other RT, working the night shift turned down that kid's oxygen. And he totally tanked, and ended up needing the O2 turned waaaay up. The parents totally lost it. So yes, good idea to turn down the oxygen. I'm never touching any baby's oxygen again.

I did have a lot of really good experiences. I am a pro at taping nasal prongs to a baby's face. I am totally not scared to wipe a baby fresh from the womb free of vernix and other associated baby slime. I can suction their mouth, and even suction their little tummy out. Another skill I have is wrapping a baby up and delivering them to mom and dad.

One day we had so many little guy's in need of oxygen therapy that we had to wean one off of high flow prongs, sterilize it, move it to someone who was being weaned off of CPAP, so that we could clean that machine and put it on someone else. Seriously.

The baby was exhibiting signs of RDS, apparently caused by cholestasis in Mom. We intubated and administered BLES (surfactant). I got to bag for 45 minutes. I am still new enough that it is actually a privilege and an excitement to bag a baby for 45 minutes.  The next day she blew a pneumo, and shortly after that was being transported to our more intensive NICU at another hospital.

The most sad baby I saw the whole time was a 32 weeker. Mom and dad were first cousins. This little one was seen repeatedly by genetics. Each humerus was quite short, and the forearms were unnaturally long. It was odd. And sad. Additionally on x-ray it was evident that all of the cartilage in her joints was actually bone. They were all fused. Every time she was moved she cried. It was my only experience with the ventilator the entire time I was at the hospital. They tend not to hold onto them. The other hospital came and got her.

What is interesting is that I start at that other hospital tomorrow, so hopefully I will get to find out exactly which genetic disorder she has, and follow her for a while.

Friday, September 17, 2010

Think a little...

We go to a routine resuscitation (abbreviated resus. or.... if you are the person paging us all day - "recess"). The baby is a little whiny so we suggest that we will come back in ten to re-assess.

We come back. The nurse tells us that the baby looked a little cyanotic so she put him back on the oxygen. The baby is laying on the warmer, which is turned off. The baby is unwrapped. The baby has a simple oxygen mask on that is connect to a blender that is set at 21%.
The baby is pink and looking great. Whatever.

Also, I saw the cutest dad ever today who was cheering the mom on the whole time. Then when the baby was born he burst into tears and said, "You did it honey! She's beautiful." I was almost crying it was so cute.

Also. I am tired and want to go to bed.

Monday, September 13, 2010

Babies Babies Everywhere

The babies are so cute. So cute that I have began to love humanity again. In fact one cute little black baby (is that politically correct? Maybe I should call it African Canadian.) Anyway. He has cute little black hair that gets all tight and curly when he gets all cleaned up. I wanted to put him in my pocket and steal him. They tend to get cranky when moved though, so I probably would have gotten totally busted. Oh well, no baby-stealing for me.

Lets back up. It's Saturday at 6:30 AM. I have just arrived to the hospital and am heading to Respiratory department. Oh right, it's Saturday, so all the whole department is effing locked up and I do not have a key card to get into anywhere. UGH. This did not help my whole hate of being up early in the morning and complete dread of starting at a new hospital. At all. Eventually some cleaning staff came by and I begged them to let me in to the department. 

I made it just in time for report. 

The staff was completely awesome to me. Well for most of the day. A therapist came on later in the day who made me nervous, made me feel like an idiot, and made my hands shake. So much that I completely screwed up transferring blood from a syringe to a cap gas tube and got blood everywhere. While she glared at me.
So that sucked. A lot. And after attending a days worth of deliveries she had me wrap up a baby (like a burrito!) and guess what!? I sucked at that too!

There is a baby in the unit with Tetralogy of Fallot. Which is a super crappy congenital heart defect. 
The baby was unremarkable as far as looks go. I wouldn't have picked it out as a heart defect baby. The sats were hovering around 85, and everyone was pretty happy with that. We had a bit of a quiet afternoon and we were able to do some research. My preceptor recommending a very good website for congenital heart defects. Nemours apparently is a heart center somewhere in the States - and it has some good info and I liked it a lot. Visual stuff is always helpful. And heart defects are always confusing - and hard to remember. Left to right, right to left. I don't know.

Also, I saw some opthamologists checking baby eyeballs for ROP. It was the most barbaric horrific thing I've ever seen, but apparently this hospital has amazing stats for ROP. 


Poor little button.


I also saw a little fellow with Prader Willi, and also... Asymmetrical Crying Facies. Seriously it was a crazy time. 

So that was day 1. On day 2 I was so much more confident. I was right in there at the deliveries cleaning the baby off, suctioning the mouth and nose, and filling out the paper work for the APGARS. It was much better and man - those babies are so cute. But the screaming that goes on in those rooms does not make me eager to start growing a baby anytime soon. And I was totally hormonal and cried at almost every delivery. Awesome. Good thing I was wearing a mask in some of them.

One little guy that I remember in particular was born with a pretty severe cleft palate. He was such a small little guy, and he was so mad, but when he settled down he was the cutest little boy I saw all weekend. Dad was pretty stunned I think, but took so many photos, and the staff couldn't keep their hands off this handsome devil. That was my favorite event of the whole weekend.

And then we watched About a Boy, and Ferris Buellers Day Off. And then they FINALLY let me go home early. 

The end. 

PS - Apparently Elvis had Asymmetric Crying Facies. FYI.


Favorite Movie of All Time

Tuesday, September 7, 2010

Babyland

So it's started again. Today I had my 8 hour orientation to the Level 2 nursery I'll be in for the next 3 weeks. I say three weeks, but really it amounts to all of 7 shifts.

I'm with one of my good school friends on this rotation so that helps a lot, but I still am not loving it. First I got to see the Arabella CPAP. Then I got to see a delivery, which I didn't even know I was attending, but then there I was in a gown cleaning off a slimy baby. I actually felt pretty bad, because had I known, I would have let my buddy go instead of me. He still hasn't seen a delivery! Good thing I re-memorized all of NRP (ha!) because in the afternoon we were subjected to several scenarios involving neonatal resuscitation. I have never intubated a baby dummy to suction for meconium so many times.

I saw the preceptor who made me feel like crap last year on one of my 4 hour rotations. I don't think she remembered me, but it is hard to say. It is just so different from the main hospital I am in, where everyone chats and is friendly. At this hospital, the students huddle at one end of the room and whisper, and the preceptors are at the other end - all whispering as well. Totally awesome. Also - I can't find anything. I didn't go to the bathroom all day, because I was too shy to ask where it was.

I found out that one of my other classmates has dropped out of the program. It wasn't too much of a shocker, but still kind of sad to hear someone leaving the program this far into it. This is the second of my classmates to leave the program during the practicum phase. Also, one of my fellow bloggers has also abandoned his RT dreams, with the plan of going back to his previous IT life.  I won't lie - I have contemplated it myself. I just imagine the money I could be making, instead of volunteering in a hospital for 12 months, and it is very tempting. Still, I think I just need to keep my head down and finish out this time. I might feel differently about everything when I'm not a student anymore. And when I'm not a student anymore, and not in the middle of all this, then I can make an educated and unbiased decision.

One of the worst things about this practicum year is the school component. It is never ending. Online discussions (which are more like research papers), classroom days, online quizzes, and always a big exam at the end. JUST LEAVE ME ALONE ALREADY. As an added bonus, between this semester and next I need to write a gagillion page research paper about "something interesting." Also, it needs to be presented to my "colleagues" (I'm pretty sure that they should only be called colleagues when we are all getting paid - otherwise, I am just the peon) in the form of a poster presentation. That's right, I need to cut things out, and glue them to a poster, and then present it. All kindergarten and like. I can hardly wait. It sounds exactly like my worst nightmare. I have until November to select a topic. If anyone knows of any "interesting" respiratory topics that could easily be converted into a thoughtful and engaging art project - please comment.

Fetal Circulation - Nobody's friend. 

Friday, September 3, 2010

Dread

I am home. Finally.

After another day of delays.. Yes, they checked us in at 5 AM, and then didn't bother to tell us that our flight was delayed to 4 pm. Thanks. Thanks a lot LAN. So we spent another day at a ridiculously nice hotel, and flew out that evening. Which meant we had to stay in Miami. Then we couldn't get a flight out of Miami, so we had to take the train to Fort Lauderdale and fly from there. I was so confused I acutally forgot what city I was in.

Anyway. We finally got home to our goofy cats.

Now, I have 3 days left until I have to orient to the special care nursery. And honestly I don't want to.

I do not want to go to a new hospital with all new staff and learn all new things. I don't really want to work with little babies. I have already seen enough births and c-sections. I remember when I thought these things were amazing and a MIRACLE and the GIFT OF LIFE. Well that is so last month.

I do not want to wear red anymore. I would work in Starbucks instead of going to the hospital again.

Post-holiday blues much?