Saturday, April 16, 2011

Finish Line

First of all I would like to give a huge shout out to my classmate who is running the Boston Marathon on Monday. You are awesome and I am so glad that we met at RT school.  Isn't it surprising where life leads you and the people you meet and who becomes your close friends.

I am reaching my own finish line. I have 5 (possibly 3!? depending on how the hours are added up) shifts left and that seems completely unbelievable. I remember my first days at the hospital - they can basically be summed up like this:

  • set up the ventilator? right now? like a patient needs it? OMG.
  • you want me to an ABG on this totally stable patient? (freaking out)
  • assist the intubation? Like someone has the laryngoscope already in some dudes mouth and is my job to get the tube ready or bag them up? OMG OMG OMG
  • Trach care - don't even get me started on trach care. Does this hurt? Can you talk? Are you not talking because you have a trach in or are you brain damaged?
  • Lactate of 17? WTF.
Ok so basically anything freaked me out. Assess the patient? No way. BiPap = Scary. Basically the only thing that I have ever really truly felt comfortable doing from the beginning was suctioning.

I always felt a little less mentally prepared than many of my classmates for the hospital setting. I know many of them barged into the hospital armed with all of their knowledge and skills from the many competencies we were subjected with at school. They seemed to have no fear, which was ok because I had more than enough fear for everyone.

I think I have finally outgrown this. After a 3 month hiatus from the ICU (due to Children's Hospital, PFT lab, Sleep Lab, and home care) I have returned with my skills intact. I spet the past two days in the ICU effectively alone. And it was fine. I managed the vents, and took care of the problems. It was totally fine. Granted nothing crazy happened, but I felt totally prepared, like if something crazy happened I would know what to do. I know all the steps. I know how to prepare for an intubation. I know how to set up and insert an artline. I can do the things that are required of me in a calm and calculated manner. 

Well I guess one less than optimal thing happened. But it wasn't my fault. I assisted a bronch on an elderly gentleman with a trach. It was absolutely the most swollen, irritated lungs I have ever seen. Mostly the bronch went ok, even though I forgot to hook up the suction and also it was being performed by a resident. After the bronch, however, my patient proceeded to cough up frank blood all effing day. He had blood all over himself, and then he would desat to the 50's and then I would suction thick and clotted plugs out of his lungs, and his sats would improved. At one point he gestured me into his room. He wrote this on his note pad - "please call the Dr. - I am ready to die." He was still alive when I left the hospital. Apparently the last thing he wrote on his notepad was - "I am packing it in." And he was dead by 10 pm. Unbelievable.

Also another one of my patients passed away. Actually 2 of them. That's always a little depressing, but expected. 

Today was really quiet, but had a disproportionately high amount of ABGs. I think I did 10 today. I got every single one of them - even the lady who had a BP of 60/30. She had two pokes - and both of them were completely by landmark because I could not feel a pulse at all. Skilled - right here.

Addendum: You know what won't help heart failure? Ventolin. For the love of god stop paging me and just give your patient some Lasix.

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