Saturday, May 30, 2009

Ahh, the Downtime

So my contract is done. I have another 8 days off until my next one starts.

This is why I love travel nursing.

I have a couple of posts I'd like to make about some other experiences up there, but I am going to give it a little time and space. Small town, sensitive topic...

Finally saw the orthopedic surgeon with regards to my chronic knee pain. Three different docs (including my hero Olympic athlete sports med doc) and three different diagnoses. One thought it might be a fat pad ---which I couldn't help but think "Now I have fat knees? What's next? Cankles?"

I had decided that 'patellofemoral pain syndrome' was the fibromyalgia of knee pain and was starting to think that everything was in my head. So I just ignored it and kept running and biking, getting hopped up on ibuprofen. Vitamin I helped in the beginning but it started to feel like I was 'chasing the dragon', you know...going for that first great high you get from a drug? After a while, even if I took 2 extra strength it'd only give me GERD symptoms and crank the pain down to a dull roar (and before I hear about it I'll just say that YES I have read some studies about NSAID use with distance runners so don't bother scolding and citing).

Anyway, turns out I have (drum roll please) patellar tendinopathy, or jumper's knee. A.k.a--knee pain.

How anticlimactic.

He showed me on my xrays where you can see how the chronic inflammation at the insertion has caused a 'bone bruise' to my patella. Awesome. Apparently this type of tendinitis is slow to heal (double awesome) and the best treatment would be to go in a straight leg knee immobilizer for about 3 weeks and then no activity for 3 weeks after that. Impossible. Can't work on crutches. Maybe when I start school if it is still bugging me I'll give it a go. He also advised putting a 1/4 of a nitro patch directly over the area of pain to increase blood flow to the area--interesting...guess I am hitting the pool to get my cardio for a while. *Shudder of boredom/loathing.*

In the meantime...J and I have a climbing agenda for the next few days. Spent yesterday climbing at Squamish, really fun mellow day. I discovered that despite my weight training for the past 10 weeks, I am in fact, as weak as a kitten. A blind kitten. A newborn, blind kitten.

Found a completely dorky video of the route we did as our last climb of the day, Pixie's Corner, a fun 5.8. I do not know who that dude is but it's entertaining.

Today we're going out again and J has promised that I will get spanked. I am already looking forward to the post-climb beer....mmm...

Friday, May 22, 2009

I Want Babies!

Sometimes things come out of my mouth before I think of how it might sound to others. 'Others' as in the other people in the check out line at Safeway this afternoon.

A few days ago I was chatting with one of the docs who knows I am about to start medical school and I was lamenting the fact that I have never really had any ICU or maternity experience as a nurse, and how I wished I had before starting my medical degree.

He told me that while I am here he'll let me catch any babies that arrive when he is on call. SWEET! He's really nice and keen to teach so I have been quite excited about this prospect. Last night he was on call and we did our best to not call him in for things we could deal with on our own so he got to sleep most of the shift.

So today I was getting coffees and he spotted me, came up to me in line and said

"Thanks for last night, you were so GOOD to me! Really, it was what I needed...had a great sleep too."

"Oh yeah, no problem", I said..."we had fun, that is what it is all about right?"

"Cool, ok well I am on call this weekend so maybe we'll see if we can make something work" he says as he's walking away--referring to me getting some OB experience.

"Yeah, thanks! Just don't forget that I WANT BABIES!!" I said over the din as he disappeared down the aisle.

As I turn back to face the line of people the lady in front of me is staring at me with an odd expression--a raised eyebrow and pursed lip. I think--what did I just yell out? I replay the conversation in my head--IDIOT! I wanted to explain--no no no, I don't want HIS baby--he's got some of his own, and I don't even WANT to have babies, and no we were talking about work, and no I am not really interested or having an affair with one of the local pillars of this small community...er...ah....oh forget it.

Yeah. Smooth. Really smooth.

P.S BINY I know you are going to have a field day with this... :)

Wednesday, May 20, 2009

Country Doc Saves Boy With Home Drill

This gave me chills, especially listening to the doctor describing the procedure. Having faced a few scary situations in the arctic--though obviously never anything this harrowing--I can appreciate the statement the doc made when describing what prompted him to take action, "the actual procedure itself was not as terrifying as the possible outcome if I didn't do it.''

Here is the full article.

I recommend listening to the doctor describing the event if you go to the article.

Pretty amazing story! I can't help but think, what if we had to do this in the ED I am currently in. Note to self, on night shift tonight...suss out where drill and makeshift shunt might be...

Sunday, May 17, 2009

It's Not an ER, It's a Safe Injection Site


I wish, oh how I wish I could take credit for the title of this post. But alas I cannot.

It baffles me, the number of people in this town who have standing orders for IM or IV narcotics. I have never worked in an ER with so many drug addicts who come in on a regular basis for their RN given, doctor ordered fix.

There are a couple of people here who you can set your watch by. Who needs a sundial when you have a Demerol 100mg q4h patient coming through the door?

One of my colleagues remarked today as we were both drawing up narcotics for patients with such standing orders, "its like this place isn't an ER, it's a safe injection site".

The statement made me howl with laughter but then sent me down a more introspective rabbit hole.

Ok. So why should I care if someone is a drug seeker? It doesn't affect me in any way, I am just carrying out the orders. I should be able to give it as impassively as azithromax. Right?

Well except for it does affect me...my tax dollars pay for each visit. I run on the streets that she drives on after her injection.

What if I am the RN that gives the dose that finally puts him in to meperidine toxicity? Am I responsible because I am supplying a drug which has clear guidelines regarding its dependency and possible toxic side effects...supplying that drug waaaaayyy above and beyond the recommendations.

Should I just be pleased that this patient is getting clean pharmaceutical grade narcotics in a safe environment?

Why do I support real safe injection sites and harm reduction initiatives but get irritated every time I see one of the 'standing order' patients in the waiting room?

Is it even ethical for me to enable a prescribed drug dependency?

I've been doing some reading on meperidine use for headache management and it seems to only be recommended if the patient has perfect renal/hepatic function and is getting less than 600mg/24h or for only a 48h window of time. Yeah, no, no, and no in some of these cases. I feel like refusing to administer next time...but that isn't right either. What some of these people really need is a rehab clinic, a support network, a different childhood, coping mechanisms, withdrawal protocols...none of this comes if a self-important RN withholds a dose of medication.

Hmmm...

Friday, May 15, 2009

Same Same But Different

I wonder sometimes if I really do in fact like rural emergency. I always thought I did, and always thought I would go into emergency medicine when I finished MD school.

But these last few months I have been questioning that decision. I really like actual emergencies...codes, acutely ill patients, problem solving the mysteries that collapse on the triage desk. But what I don't like is the mundane, CTAS 4 and 5's that come into emergency departments on a regular basis. The worst part about the sore throats and narcotic seekers that come to emergency is that they have to wait a long time because they are NOT EMERGENCIES. So by the time you assess them in the department they are hissy and pissy because they have had to wait. And rightly so (the waiting part, not the cranky part).

So the cranky jerks who are abusing the system are the ones that I have to listen to whine all night.

AGHGHGHHG.

I just don't know if I want to do this as a career anymore.

In this place I am currently working, several docs have just left town, thus leaving hundreds of orphan patients. There is no one in town accepting new patients and no walk-in clinic. Hence my current contract not in ER but in a glorified clinic. I can't blame people for having to access health care in the ER because there is no where else for them to go, in fact I feel really badly for people who have to wait ages to have something like a Rx refill (like the 78 year old gentleman who sat quietly for almost 5 hours to get his furosemide refill). But this is not why I am an ER nurse. And yes, I know it comes with the territory. But I guess I need to get back to major tertiary centers before I forget how to run nitro, insulin, integrelin, and blood at the same time.

But now I feel at a bit of a loss. I don't think I know what I want to be when I grow up anymore!

Yikes.

On the upside I've met and worked with great people so far here, and have just agreed to come back for 5 weeks in July/Aug. Not so much for the ER side of things but because I love being on the ocean, having access to organic food and a decent gym (two things that most northern communities cannot boast).

Now on to more soul searching...



(People checking in at the triage tent this fall, somewhere near Chansal Pass...)

Sunday, May 10, 2009

First Day


So far so good.

First shift of this travel contract. My roommie is a clean, hard-working, athletic, smart, bubbly, travel maternity nurse (who doesn't drink my soymilk or have the t.v blaring at all times). She invited me out for dinner with 3 of the other agency nurses tonight. Had a great night and was impressed that all the girls ordered beer. Agency nurses are so cool.

The ER is tiny and there are a lot of people in town with standing orders for meperidine (WTF?) but the staff seem to have good breadth and depth of experience. One of the docs today let me suture a sweet ankle lac and for the first time I didn't use prolene--I kind of liked the nylon sutures...different memory than the prolene ones. Anyway, I automatically dig docs who let me suture (it usually means they are cool/lazy/willing to teach/not obsessed with territory).

I think I may choose to stick around here longer than 2.5 weeks if they offer to extend. We'll see.

Tuesday, May 5, 2009

More Amazing Brain Development Information

Ok. If you have a few hours to kill in a car (like I always seem to...) let me recommend listening to this radio show. It is from one of my favorite podcasts, "Ideas" on CBC.

This feature, The Brains of Babes, especially episode one, has some fascinating discussion about studies linking heart disease and diabetes to fetal/early childhood health as well as pre-pregnancy maternal health.

And while we are on the matter of fetal/early childhood development can I also mention that the two most recent books that left my jaw on the floor were, "The Brain that Changes Itself" by Doidge and "In the Realm of Hungry Ghosts" by Mate. Really, if these books don't fascinate you to the point where everyone around you rolls your eyes when you begin yet another sentence with "so I was reading today..." then send me your copy and I'll send you the money for it. :)

My apologies if I've mentioned these books before on Asystole, but listening to those features on Ideas just reminded me and I wanted to give them the props they deserve.

So there you have your summer light reading list.

Oh, and add "Book of Negroes" by Hill to that. Finished it today.

Wow. What a book.

(I know that is the weakest review of a book ever, but seriously...just read it.)

Pack, unpack, rinse: repeat.

Oh duffel bag. How I love and loathe thee.

Last week I moved out of my quaint little mountain abode. Sniff. Was sad to go, for a few reasons. I stared out those living room windows plenty in the past few weeks wondering about these big decisions and major life changes on the horizon. Out those windows were snowy peaks, alpen glow, and swirling flakes. Not far down the road, the most beautiful section of highway running along the ocean and through the southern coastal mountains.

Though I am very excited about my upcoming move to Ireland I am already starting to feel nostalgic about the beautiful landscapes and people that I'm leaving. I've been in BC for 5 years now and have a hard time imagining myself settling anywhere else in the world (well I have a hard time imagining settling anywhere right now....but eventually!)

This week was supposed to me my first week of classes in the Caribbean. I certainly wish I could be jumping into studies this soon in Ireland. These next months of working are going to be difficult as I feel so ready to start school.

Instead, this weekend I am flying to a Northern coastal town to work in an ER/ICU for the next 3 weeks. Hoping that they'll let me play a little with the ICU patients as it is another area that I feel totally clueless in. Be nice to get a handle on a few things before losing my status as 'insider' and becoming 'med student'. After my three weeks are done on the west coast, I am heading NE to Baffin Island for a month, back to one of my favorite Inuit settlements. One of the few places that has soy milk and a working treadmill in town. Small luxuries.

So now I unpack from the move and pack for the next travel assignment. I'll be glad to turf this duffel bag for a while come September!