Thursday, July 31, 2008

Gonna Shine Up My Boots

Well my hiking boots that is.

Sent off the deposit today for a month long volunteer trip to the Indian Himalayas. I have to be in Delhi to meet the group on Oct 2nd. I am pretty EXCITED! And a little scared.

I've been longing to go back to India and Nepal since I was there 9 years ago. Ack! 9 years ago? Really??? Oh my. Now I feel old. Or maybe now I realize how young I was....so that was why my mother was having a nervous breakdown for the entire 7 months that I was gone!

They are very clear on the application forms and waivers that one has to be in "top physical shape" as we must get to the villages/settlements on foot, it's not a cushy land-rover-to-destination-trip. One of the passes is almost 14 000ft! Somehow I think it'll be a little more rugged than the last time I was close to that elevation...

And I figure if I am going to be in that neck of the woods, and spend the money and carbon footprint getting there...well....heck maybe I should stick around and head up to Nepal for a few weeks for some more trekking...any takers??

Training starts tomorrow.

Wednesday, July 30, 2008

Finally Something Good

It has been a rough couple of weeks here on the homefront and medical pursuits front. But tonight as I checked my email before tucking my wee self into bed I found this little bright star. It's from an enrollment manager at QRS School of Medicine where I emailed some questions and info about myself wondering if I ought to bother with an application...here was the response--edited for brevity but key parts intact (allow me to bold my favorite parts of the message):

Dear Albinoblackbear,

Many thanks for your response and for your sharing your details about your unique situation.

In answer to your question, I do feel that you are a great candidate for future success with QRS. A good number of our graduates and current students are not the “traditional” student, but rather have majored in another field or are embarking on their second or even third careers just like you, so do know that you are not alone!

Your grades are solid.

Best of luck to you on your upcoming MCAT. Do keep in touch!

All the best,

Nice Lady at Registrar

WOOOTTT!!

And on a complete non medical topic...I totally spanked my run today. Finally feeling like I am getting my running mojo back. It's a terrible self-defeating cycle with running...I take time away, get frustrated at how fast my abilities wane, don't want to run, go for another bad run, take time away, don't want to run...but this past week I've just been forcing myself to go out the door and I think I am over the slump. My spiffy new running skirt helped a bit too I think.
I like to think my legs are more of a 'cloud white' than 'skim-milk-bluish-white' as pictured...

Sunday, July 27, 2008

And Since Then I've Hated Myself Just a Little Bit

I am consistently in awe at the succinct beauty of C.S. Lewis' writings. Something I recently read by him raised this point,

"...we must hate the bad man's actions, but not hate the bad man. For a long time I used to think this a silly, straw-splitting distinction: how could you hate what a man did and not hate the man? But years later it occurred to me that there was one man to whom I had been doing this all my life--namely myself. However much I might dislike my own cowardice or conceit or greed, I went on loving myself. There had never been the slightest difficulty about it. In fact the very reason I hated these things was that I loved the man. Just because I loved myself, I was sorry to find that I was the sort of man who did those things..."

It has caused me to reflect on a recent incident from a few nights ago has been gnawing at me. I keep coming back to it in my mind, seeing myself react more quickly, with more confidence and ease, with strength. Like those times when you think of a really good comeback or joke but the moment is long past and you're just left to burn and smolder in your thoughts of inadequacy.

This 30 something woman in tight jeans, heels, and handbag has been coming in for her late night dose of IV therapy. She's suffering from a case of pyelonephritis. I am sure it is unpleasant and irritating to be sick to have to drag yourself to the hospital thrice daily, (two times to Ambulatory Care during the day, and once to the ED late at night) but I believe that this does not excuse her behavior in the slightest.

Each night when she comes in she harasses the nurse who must work at a slow jog to keep up with the IV therapies, the evening meds of the admitted patients, the call bells, the pukers, the criers, the poopers. It is the 'non-acute' side of the department which means you can forget a break all night and you can also forget getting to do anything fun (like assisting with reductions, sedations, intubations, chest tubes, etc). This woman will complain about the fact that she has to sit in a chair (a chair that just happens to go into full recline but I guess that is beside the point), because really she "deserves a bed". She demands blankets. No, HOT blankets. She needs juice. She needs a new IV site because this one is really bothering her.

One night the nurse actually accommodated the early site change and thus subjected the entire department to the womans wails, screams, and sobs while the new IV was put in. And I mean SOBS. There were tears rolling down her cheeks I-kid-you-not. I even went over to see what was going on and to see why one of my colleagues had clearly snapped and decided to shove bamboo slivers under someones nails that evening instead doing her job.

But no. It was just our little pyelo getting a #22G catheter in the arm.

So I am on the dreaded 'pit' side the other night. And I am dealing with the usual 10-pt-per-nurse ratio and I go to flush her IV with normal saline while we wait for her repeat blood work to come back to see what the plan for the next day will be. While I am hooking up the syringe she points to how badly her skin is doing, how the site is clearly not working and that it needed to be changed. Since 250mls of cipro had just gone into that supposedly "non working site" I was unconvinced but assessed the area anyway. Her skin was slightly puckered from the op-site but looked pink, healthy, and non-infiltrated underneath. I explained that it was the taping job and not the signs of a faulty site.

When I went to flush the line she almost knocked me over as she reached around to grab her hand in pain, screeching. The saline was going in with no resistance and again I noted no signs of infiltration or an interstitial loss. She demanded that it be taken out otherwise she wouldn't sleep that night.

Remembering back to the antics the night before I told her that since we'd been having such a hard time getting IV's in her I was less than willing to pull out a perfectly good site. I added that I was certain it would not go over well when she returned the next day without a saline lock in place (I was really trying to save this faceless RN unknown to me at the ADC program that kind of a start to her day...faceless RN if you ever read this blog you can thank me anytime).

I wrapped her hand up and went to tend to the patients in the department that were actually quite sick and in need of attention (in a non-pathological way). Like, for example, the woman in bed 6 with gross hematuria and the guy in 5 with hepatic encephalopathy.

As I am on the other side of a curtain nearby doing a quick EKG on a patient that had seemed to have vagaled but just wasn't coming around in a timely enough fashion for my liking, I had to listen to pyelo ranting at a just-below-yelling-decibel-level:

...yeah they have me in a hucking chair in the middle of the hucking department...no I am NOT in a hucking bed I am sitting here in a chair! Yeah I told her to take it out and she wouldn't...because it is so hard to start a hucking IV on me!! Yeah, they are so hucking brutal down here...they are waaay hucking better in ADC...I just cannot believe the hucking treatment I am getting....I don't even hucking know what the huck I am waiting for...this stupid hucking antibiotic isn't hucking working anyway!....

And on and on and on she went in a similar fashion. I could feel the anger rising in me. I felt my face beginning to flush and my heart rate starting to rise.

Why was she allowed to pollute our emergency department with her sense of entitlement, her anger and her foul language? Why was I feeling so incredibly offended by her mouth? I used to be a basketball referee for crying out loud! I've been called every name in the book in front of hundreds of people and I had never taken it this personally.

Why was the person who was the least in need of emergency care in the entire department allowed to rudely and inappropriately disturb patients and family members with dissatisfaction over her care?

Because I didn't do a thing about it.

Ugh. It makes my stomach turn a flip every time I think back to it.

Why didn't I walk over to her and say, "please turn off your cell phone, as you can see there are signs everywhere restricting their use. Also, please refrain from using such offensive language. If you are not happy with your care here please feel free to be seen at XYZ emergency which is about a 10 minute drive away. Thank you and good night".

I am so angry with myself for cowering away from the confrontation that would have spared my other patients, family members, and colleagues from her ridiculous (and totally unreasonable) ranting.

And I am also unhappy with myself for hating this woman who was sick and clearly has other issues than her pyelo or she wouldn't be acting out in the way that she did.

I have been thinking of ways I will deal with these things in the future, how I will handle them more pro-actively. How I will learn to "hate the bad man's actions but not hate the bad man". How I can try to see those poor qualities in myself and change them; the sense of entitlement, the impatience, the desire for attention.

And how I will let go of this, move on , regrow that thick skin I once had, and keep smiling.


Saturday, July 26, 2008

Ketamine Harshing My Mellow

I've given ketamine to several pint sized humans in my old ER with predictable results: the eyes get glassy and go in opposite directions, the doc performs whatever needs to be done, kid cries a little, parent freaks out because the child does not look sedated, procedure is over, kid starts coming around, and then kid freaks out.

Previously I gave little pause to this common chain of events but tonight seeing an adult go through the hellish journey of a bad ketamine dose I am starting to rethink our cavalier usage of it with the tots.

38 year old man comes in with anterior dislocation of his shoulder. He injured it last week and then tonight while asleep it popped out again. He was in excruciating pain and had to keep his elbow suspended above his head for comfort (something I have never seen). Anyway as we wait for the pre-reduction films to come back my colleague pops 50mg of ketamine into the man's IV and we wait for him to get all gooey so we can begin the reduction.

As simple as slowly lowering the arm allows the shoulder to slide back into position. Nice and smooth. And the reduction is complete.

Then he starts losing it.

The man is crying out in complete horror and fear, waking up our few sleeping inpatients. "What is happening to that guy?" is muttered throughout the department. He was shrieking like he was at hells gate, tears streaming down his face, a look of complete panic in his glassy eyes. Mostly nonsense peppered with "noooooo!" , "don't let me go under again!!!" and "what have you done to me?" were some of the phrases that began to ring through the hallways of our previously peaceful 5am ER department.

I took up full time occupancy at the bedside trying to calm him down and reassure him. He thought that each time the BP cuff inflated that I was putting him under again. Then he was sure that because I kept telling him where he was and that we had just fixed his shoulder that he was in some sort of loop of existence that he couldn't get out of.

Finally he started to come around a bit but was still very leery of his surroundings and my motivations with regard to his well being. I asked him simple and direct questions about his life and family to keep him on track, at his insistence "ask me more questions". I myself was having flashbacks to talking friends down from bad trips at rainy music festivals and loud dingy clubs, "no Kent, there are no worms in your tent and no they are not crawling through the ground and then through you..."

He was finally able to focus on my face and told me that he had seen horrible things and for a while had been reliving a frightening experience from high school when he was bullied for being gay because he was the smallest guy in his class. My heart really went out to the guy. He was visibly rattled.

His wife and daughter showed up and their presence seemed to solidify that things were once again as they seemed. I knew he was OK when I heard him singing, "what a long strange trip it's been" while I drew up his dimenhydrinate for the road.

After he left I couldn't help but think of the many babies and toddlers I've seen coming out of ketamine anesthesia. All of them did seem to have an air of panic about them and most were carried out of the department clinging to a parent, wailing. I always just chalked it up to being scared, post-procedure, and being in a strange place. But now I wonder what 'long strange trips' they'd been on. What had their little Sesame Street watching brains created for them to trip on?

The other thing that gave me pause was, back in my raver days I remember many kids taking ketamine for parties. I'm usually not one to judge about the poisons people pick to party on but, ketamine?? Seriously? How much more dangerous can you get than being surrounded by thousands of strangers on a dissociative anesthetic which can cause you to slip into a coma? Really. Nothing says "party girl" like being in a vegetative state at a rave. Strange indeed.

A fascinating drug nonetheless. The wiki is an an interesting link ,if you've got time to give it a read.

My medical directive may have to be expanded from "DNR----and if you have to restrain me please do it chemically and not physically" to also include "and if I need to be consciously sedated please do it with midazolam and fentanyl. Thank you."


Note 'ketone' and 'amine group' in structure, hence the name. Sorry, I love organic chemistry. I had to!

Thursday, July 24, 2008

Slogging

This morning I worked on applications to:

Ross University
American University of the Caribbean
University of Calgary
University College Cork
University College Limerick
University College Dublin
National University of Ireland, Galway
Royal College of Surgeons, Ireland
Trinity College, Ireland.

Now I shall eat lunch and hit MCAT books.

Good times.

Wednesday, July 23, 2008

Mmm...Maggots...

I was a gong show last night. Hoppin' as always, dodging the array of bodily fluids that come my way. Finally at around 0500h I had a moment where I could sit down to chart on some of my patients and try to catch up on all of the paper work. I had saved a tiny piece of the blackbeary, raspberry, strawberry crumble that I made a few days ago for dessert to have as my snack. I was at the desk, happily eating the crumble-goodness and had one bite left when I looked down and to my HORROR saw maggots in the tupperware that I was eating out of.

GACKKKKKKKKK!!!!!

The service aid was sitting there as I spit out the remaining bite and threw down the spoon and container in disgust.

Now the only reason I even KNEW they were maggots was because they looked exactly the same as the maggots I was pulling out of a patients festering leg wound last week (not medical grade maggots, back alley maggots). Those were super maggots though...MRSA Super Maggots (I had imagined them with tiny little capes, impervious to methicillin and radiation flying through the ER department with Zorro like eye masks). My crumble maggots were just regular old left-crumble-on-the-stove-for-two-days-and-even-though-it-was-
covered-in-plastic-wrap-became-infested maggots.

I felt sick immediately but didn't vomit. Instead I popped a gram of metronidazole, not so much for the maggots but to ward off anything else that might be growing. The last thing I have time for right now is food intoxication.

The only good thing about the larvae-lunch evening was the doc I was working with. He was a stellar human. It was a nice change to hear things like "great thinking!" and "excellent assessment" and "what is your opinion?" I was shocked. MD's don't throw that lingo around with the nurses usually. Actually feeling like one of your colleagues might value your experience and background to hear you out is such a refreshing change sometimes! Plus, he ordered the things I asked for, and got rid of patients I asked him to boot. FINALLY someone recognizes my BRILLIANCE. ;)

And no it was not because he was trying to get into my scrubs. I am not that naive.

One shift left in said ER. Then it will be head buried in MCAT books mode.

And then...???

Tuesday, July 22, 2008

As Seen on T.V (and just as glamorous)

Last night was hellishly busy. I had a really heavy (but overall pleasant) patient load. On top of the usual belly pains, IV antibiotics, sore throats, vomiting x 2h, "sore ears", and back pains, I had two admitted LOL's* who both had anemia from G.I bleeds. Both had diarrhea (one of them several times--those were good times) and I was running blood transfusions on both of them all night.

Transfusions are a major pain in the derrière as you have to take vital signs on pt every 5, 15, 15, 15, 15, 30, 30, 30...etc. mins. And when you've got two at the same time it means a lot of running around. Plus each lost an IV site which had to be restarted. One of them had nothing for veins and was needed three separate lines so I was running out of options. It's good that I have no pride in terms of gauge size because I put a weensy one in for the potassium and left the garden hoses for the blood and pantaloc.

I also had a raging ETOH'er who was detoxing and needed regular full bedding changes from his soaking sweats and sedation to keep off the potentially life threating delirium tremems he was going through. Nice guy actually, from Egypt. Was dismayed to find out he had cocaine on his tox screen and assured me he had never done the stuff. We brainstormed a few ways that he had ingested it, then he figured it was some guy from Florida that gave him some cigarettes that made him feel "funny". Those guys from Florida. Gotta watch 'em.

My LOL's were cool too. One of them was a 96 year old who told me when she got out she was planning to start training for the Olympics because she wanted to go to Whistler. She also referred to the IV pole with several heavy hanging IV bags and blood units as her "Christmas tree" and her arm all taped and attached as her "decorations".

The only heinous patient was this dude who had MRSA in his lungs and was adamant that his isolation precautions were "bullshit" and that he knew all about "SARS" and that it could only be transmitted by blood. I attempted to explain that it was MRSA that he had, that he was putting others at risk, and that it was highly contagious through droplet transmission. Anyway he ensured that we all knew his stance on the matter by using the patient phone all night, leaning over the nursing desk, leafing through the magazines, and going outside for several cigarettes to "loosen up his chest". I tell ya, if I was the MD that guy would have been packing his little patient belongings plastic bag and on his wee way out the door before you could say "superbug"**. But no. I was not the doc, I was the one getting blood and poo all over me all night.

Which brings me to the funny part of the day. After work I was on my way to Save on Foods (I know, I know....it's just not right to go to a grocery store after working in an ER all night) and was walking towards the double doors when I looked down and realised I had dried blood down the front of my leg and all over my shoes. It was also at this point the wind changed and I realised that I smelled like melena and truly was a threat to society. So I turned around and walked back to my car laughing to myself at how ridiculous this job can be sometimes, drove home, had a shower, changed, then went back.

Got home and fell into bed, did my usual daily C.S. Lewis read, and attempted to sleep. The lyrics to a Gillian Welch song called "Bar Room Girls" pops into my head. It could be called "Night Shift Girls" and ring just as true...

"Well she tosses and turns, 'cuz the sun is unkind
and the heat of the day
is comin' in through the blinds...
leave all the blue sky
to the rest of the world
'cuz the neon shines
for the bar room girls"



*Little old ladies.
** After 6 days of contaminating our already MRSA friendly ER the pt was finally discharged home. Why he was there that long is a mystery to me. He refused to wear oxygen, refused nebs, and was simply taking his meds from home anyway. So what were we doing for him? Well, other than bringing him hot water, juice, sandwiches (and following him around with the most potent cleaning supplies known to man).

Saturday, July 19, 2008

Bad Day

Today was not so good.

In fact, I had a really really crappy day today. One of the worst I can remember in a long time.

It was not at work. No one spit at me, or swore at me. No co-worker made a snippy comment. No one died. No, I was just here, trying to study for the old mcat. But as previously posted there is some major upheaval in the clan of the Blackbear right now so it made studying attempts futile. I eventually gave up and lived in the blogosphere for a while with a trickle of drool coming down my chin.

Then I attempted to be productive by filling out applications for medical schools. I mean, it only takes half a brain to manually enter every class from the last 6 years of university into an online form. Which, any other day would have filled me with glee and excitement. Would have given me a charge, an oomph. I would have been proud of myself for taking a year off work, going back to school, going into debt, leaving my boyfriend, friends, family behind. I'd be patting myself on the back at how I stuck to my goals and now I have arrived in the place where I can finally start applying.

But it did none of those things.

Nope. It just gave me a great deal of self doubt. Suddenly my grades don't look so good, my volunteer work seems spotty, I never repeated that stats course that I did so poorly in...what was I thinking???

Ireland, Australia, Canada, USA, Caribbean...somewhere...anywhere...I really don't care. Just get me out of the land of The Great Unknown.

Maybe I ought to take up professional gambling...at this point it seems like more of a sure bet.

Thursday, July 17, 2008

Okay Now I Feel Bad

So...maybe you popped over to White Coat recently and read his post on the tragic death in a NY waiting room. It's an excellent post and I must admit feeling fairly shaken when I initially watched the video of Esmin Green hitting the floor and no one doing anything about it.

Now I feel bad about my Dying Swan post as Waittimes linked to it (which was flattering I must admit) but he mentioned the Green case and I felt compelled to leave a long rambling comment on his site to redeem my not-completely-heartless-health-care-practitioner-self.

I don't want to come across as someone who doesn't give a damn about my patients. Because actually, I do. Too much of a damn sometimes. And although I enjoy the twisted black humor of critical care, and get a chuckle out of health care related rants, that is not fundamentally what I am about.

It makes me cringe sometimes when I read comments/postings on some of the med blogs out there. One comment that will forever stand out in my mind was by a certain well circulated medblogger who referred to the drug addicts she brings to the hospital as "pieces of shit".

I think people with that mentality should not be allowed to practice. You cannot tell me that someone with that mindset gives the highest standard of care/compassion to their patients. Which is what people deserve.

We are so quick to judge others (and I am not immune obviously) but it is this apparent holier-than-though-superiority complex that sometimes makes me want to peel potatoes in the back room of a kitchen for a living.

Because at the heart of it (double entendre intended) we are servants. And I don't mean that in a demeaning way. We serve the sick. It is a wonderfully uplifting task at its essence, if you ask me. But sometimes that gets lost in the stress, the impatient patients, the putrid odors, the dirty work, the lack of compliance, the lack of co-worker support, the egos, the workload...I could go on.

So yes, humor is an excellent way to process things, and I hope that my slant on situations and events are not seen as crass or unfeeling. Sometimes I suppose I just want to be a jackass. But for the most part I am happy to be at their service.

Wednesday, July 16, 2008

No 'Crouching Senior, Hidden Bedpan' Last Night

Behold the Dying Swan


This is an excerpt from an email I sent to a friend of mine that needed some cheering up. Sometimes a few entertaining anecdotes from the night nurse are are just what the doctor ordered.

There must be some things that were funny about last night...Ah yes.

So I am starting an IV on this uber irritating 'dying swan'--that is what I call people who throw themselves on waiting room floors and flop about to

a) get attention and
b) get seen more quickly*.

So she's in the ER because she's got diarrhea and vomiting...blowing her stale smokers breath** into my face while I am attempting to get the line in and she yells to her husband

"this is the last time I eat your mothers cooking!!!"

I howled.

What else....oh yeah. 100% true. There are two guys in the department, one is named Bob Bobby*** he's got a sore knee and is about to go home. The other guy's name is Bob Hoppner but he'd been hit by a semi trailer after riding his bike out in front of it. The semi swerved but still managed to clip him on the way by (breaking Bob's pelvis in the process).

So I give Bob Bobby his tylenol 3's and discharge him. A few minutes later a woman comes in and says "I'm looking for Bob---Bobby"

I reply:

"oh you just missed him! He just walked out the door"

She looks at me like I ought to be on the short bus and says "Ummm, NO. Bob got hit by a semi today and has a broken pelvis! There is no way he walked out of here".

Then I realize she was looking for Bob Hoppner but was saying it like "Bob...Bobby" (in case I knew him as Bobby).

Whooppppsss. Slight confusion. Almost the same name. Ahh...er....no really I do know who my patients are. Really! He's in bed three....sheeeeeshh.

Hmmm....there has got to me more...

Uh....the "more" phine the better??

Tough crowd....tough crowd....can you hear me in the back??? tap tap....is this thing on????

OK then we get this 70 year old farmer who fell down the steps of his porch successfully giving himself the most OUTSTANDING spiral tib/fib fracture I have EVER seen. The EHS boys must have gotten all excited because they cut off his one pant leg to Daisy Duke length and left the other leg long. I was shaking my head at his fashion statement (I mean really, if we can take bib snowpants off without cutting you can take off GWG's without cutting). So I comment on his new 1/2 short 1/2 pant combo and tell him now he has pants that he can wear when he's just can't decide what to wear. He laughed pretty hard. It may have been the morphine...

Later I was escorting via ambulance this head-injured hockey player (with a fractured skull) for a CT. Anyway, he's this big manly man who is trying to play it cool but when the sirens went on he gets this big grin on his face and looks at me saying "WOW--ahhh COOL!! I feel like such a BADASS!!!!". And then three minutes later (because he is a head injured lad with no short term memory) he suddenly looks up at me and says "WOW--ahhh COOL!! I feel like such a BADASS!!!!"

Evidently he felt like a badass.

Yeah. It was a pretty good night. No acute renal failure with chronic diarrhea like the night before.

*This tactic actually increases wait times usually, plus makes it hard for the staff to see you as we often lock our eyes in a roll to the ceiling when you do come into the department. If you really want to get seen more quickly (and you are not in respiratory arrest) slap on a tin foil hat and say you are having chest pain.

**My empathy for people is inversely proportional to how much they smoke while waiting to be seen. If you are well enough to smoke you are well enough to be at home watching Springer. Unless you are a psyche patient.

***These are obviously not their actual names but the nature of the names reflect how the mix up occurred.

Saturday, July 12, 2008

My New Name

I hadn't realized it but apparently I've changed my name to "The Agency Nurse".

I know, I know. We're the scum of the earth. Pulled from the flotsam and jetsam of nursing pools all over the country. We're all money grubbing, over-paid, under-qualified, who-knows-what-kind-of-background, shady RN's who are probably running from the law or some probationary-license hearing in another province.

I stood in the ER department waiting room in my green OR scrubs* for 20 minutess, wearing stethoscope and ID badge (giving what I thought would be indications that I was there to work and not for a sore throat) before someone acknowledged me. And I knew they weren't so busy that they couldn't say "hi--we'll be right with you" which is something I always endeavor to do when I am on the other side of the desk no matter how crazy it is. This power play of "I'll stop pretending I don't see you when I feel good and ready" is complete BS in my mind.

Finally someone lets me in, and I am off and running.

Or rather standing at the nursing desk twiddling my stethoscope.

So I make myself busy by seeking out the things I always locate first when in a new ED:

salbutamol
ipratropium
naloxone
epinephrine
diphenhydramine
glucometer
peds/adult NRB
peds/adult neb mask
ETOH swabs
IV start kit
NS bags
crash cart (and how to take it apart)
narcotics (and keys to same)

Now I can breathe a bit easier.

So I wander around like a tool, hear my new name "The Agency Nurse" being uttered every now and again. I think, "whatev...you don't know me" because they don't.

And the worst thing is the agencies exacerbate this problem by sending medical nurses or dialysis nurses to work in ICU's or ER departments which makes all the staff nurses pretty sure that if you are "agency" you have no idea how ED's work and you (in turn) are only going to make more work for them (while making more $ per hour).

After about an hour the PCC (manager) came on the floor and said "I know YOU!"


I had worked in this ED in November of 2006 for a couple of weeks. Her first shift in the hospital was covering night manager, and it was my second shift in the department. The other night nurse had called in sick so I was alone with a full ER and a full waiting room. It was fun at first but then things got really hairy and I had to call her to the department to help out. We ended up having an absolutely insane night: young woman with 3rd degree grease burn, an M.I, 3 psyche patients who were completely psychotic and had to be in restraints, all on top of the usual ER stuff like abdo pains, little old ladies, etc.

Anyway, she points at me and says (in front of other RN's, MD, MD student) "We had such a blast that crazy night! Remember the burn and the MI that came in at the same time?? Oh it's great to have you back!"

OK so now at least I had a bit of street cred.

Still no one else actually talked to me for the rest of the shift, which I was expecting. They still didn't call me by my name.

Ding! Ding! Ding!

Round 2 starts in t-5 hours.

Wish me luck (or blog fodder at least).

*I have old OR scrubs from hospital X that I 'borrowed' because I got in a MASSIVE argument with the head of infection control over the fact that the hospital provided clean scrubs (and bins to put dirty ones in) for the CCU, ICU, cath lab, OR, and dialysis staff but NOT THE ER staff. That means we wear our own scrubs to work and take then filthy-covered-in-who-knows-what back into our HOMES.
OK, excuse me? Does anyone else see a problem here? When we get patients we don't know yet if they have MRSA, VRE, TB, scabies, etc. etc. So we take care of these people for our shift then wear those clothes home. All the other dept have the luxury of time to tell them what little critters folks are bringing with them to the hospital and so can glove and gown etc. accordingly.
The infection control woman told me that

"as an ER nurse I should be using universal precautions with everyone".

Someone slap me! I have never thought of that!

So I asked her if universal precautions meant gloving, gowning, specific instruments for every patient in the department. And she said "no, just the ones you suspect are carrying something".
Sigh. You'd think an infection control-bot would know that you can never know who is carrying what, sweetheart.

Wednesday, July 9, 2008

Back in the Saddle

So tomorrow I am heading to the coast for a 2 week ER contract. Today I pulled my scrubs out from the back of my closet and found my stethoscope. Those clothes are like a costume that I haven't worn in a really long time...I seem to forget the role that I used to play in them.

I am feeling pretty excited and slightly gun shy about going back to work after not touching a patient for almost a year. Plus I was outpost nursing prior to going back to school full time, so it has been over a year and a half since I've even stepped foot in an actual ER department.

As opposed to me flicking on the lights in an empty clinic, and making my way to the trauma room in the middle of the night, wearing half pajamas and half clinic clothes. That has been my only type of emergency 'department' for a long time.

Why is is Murphy's Law that when you are wearing a polka-dot drawstring pair of pants to see a see a kid in the middle of the night (who you saw that afternoon and seemed to be improving) that they inevitably are the pt that needs to be medivaced by the Infant Transport Team and a peds resident? So this big group of SUPERSTARS show up with a couple of bush pilots and you look like you just crawled out of the tickle chest on a kids t.v show. They think you're a psyche patient that is also being medivaced and look around for the nurse (true story).

And you spend the rest of the pack and stack time trying to demonstrate to the transport team that you are
a) not a psyche patient (at least not that night)
b) a competent and knowledgeable health care provider despite your appearance, slowed speech, and lazy eye from lack of sleep.

But this job will be nothing like that. This is a nice, old fashioned, rural ER. Now I have to play nice with others again. I don't get to do the fun stuff like suturing when I am in the south. It's tough having your skill set and brain usage cut in half. It's not that actually. I am still using my brain, I just have to mostly keep my thoughts to myself.

Now I am back to needing an order to give a tylenol. Back to biting my tongue. I am sure it'll be fun though, overall. I do miss working and I do love being at the bedside.

So tomorrow brings another 6h drive through the mountains. At least I'll have David Sedaris
and Atul Gawande trapped in my ipod for the ride.

Thursday, July 3, 2008

Back to the Concrete Jungle

After a brief foray at home I am on the road again to Alberta for an MCAT prep course. Nothing like an 8h drive in the heat to make my day. Thank God for books on tape, podcasts, and good music.

Let's see...that puts the total money already sunk into this exam at around, oh, 3500$ (not including gas, travel expenses, and cost to replace clumps of hair torn from head).

I really hope I don't wake up someday soon and decide I am going to pursue becoming a chef instead.

Running lately has been kicking my ass, which has been super frustrating. I miss running in -11 degree weather (my favorite temp). Crisp and dry with my trusty icebreaker on. It is so fine, those cold winter nights. Though I recently discovered road riding!!!! Which I think will be my ticket to sanity while this hot weather lasts.

That is if I can somehow finagle a new bike....hmmmm....may have to pick up a couple more shifts next week...

Anyway, off to the cram course I go!


Tuesday, July 1, 2008

Currently My Two Favorite Posts

These guys are geniuses.

Really. The "lookey-loo" and the impatient patient have never been depicted so accurately in any medium.

If you've ever worked in the ER setting you'll definitely get a chuckle out of these posts.

Classic.

My only question is why do I rarely come across folks with this humor in the ED's I've worked in? Everyone just seems to take themselves so damn seriously.

Props to these guys (or gals...I think they are guys...).

I Get Knocked Down

So after a brief foray into the depths of self loathing and despair (and just a couple of tears shed) I wiped the snot with the back of my hand and did what I always do in these moments...I reached for my visa.

Only this time it wasn't delicious wine, books, fine cheeses, or a new pair of running shoes I was aiming to use it for. No.

I coughed up the ~1800$ USD for an online MCAT course. Yuppers. I know that these things have mixed reviews from my friends who took the demon test, but I figured if being a couple more k in debt means acing the MCAT then where do I sign? Thanks Kaplan for your easy to use interface and UPS delivery.

Yesterday was a good day after said purchase actually. I studied for several hours and got a sense of how far I have to go (pretty far) to attain a competitive score. I realize now that since I didn't get into XYZ with my academic record my MCAT score is going to make or break my application to other schools.

It just kind of chafes me that there are people out there right now taking the 10 000$ 6 week courses that run all day as prep. That is really what I'd rather do but short of remortgaging my house that is not going to happen (note the words "gag" and "mort" are both in 'remortgaging').
Forgive a Veruca-Salt-type-foot-stamp while I say "It's not fair! I want the 6 week intensive MCAT course and I WANT IT NOW!"

I guess that is just one of the downsides to living in BFN Interior Mountain Town, no such classes in my neighborhood. Or within 500km for that matter.

Back to my new online master.

Oh and, I just signed on the dotted line to pimp myself out for 2 weeks of night shift work on the coast. Should be good for some interesting blog fodder. A tiny ER. Only one RN on nights with on-call doc sleeping in the cast room. Just how I like it. Usually very busy and then very quiet.