Thursday, July 8, 2010

Back in the Saddle

Yesterday was my first shift back in the ED after 10 months away. I received a genuinely warm welcome from all of the staff which made the first day seem all buttery and smooth.

I have been chuckling at all the things I have forgotten (how to turn off alarm monitors) and all of the tweaks I am noticing to my practice (ridiculously long patient histories). Also, now I have these urges to perform unnecessary assessments on patients. For example, I suddenly feel the urge to palpate everyone's lymph nodes (and name them off while doing so). I also want to locate apical beats, listen for carotid bruits, and attempt to elicit reflexes.

It had been pleasing to be back in direct patient contact land--for the most part--until I had to be at the other end of a call bell belonging to a *very* curmudgeonly old man who spend most of the afternoon yelling at me and shitting in various locations in the ED. One clogged hopper and sweaty procedure in the patient bathroom later I was ready to throw in the towel on the old nursing gig. The doc I was working with took that moment to remind me of my recent spiel on how I "loved being back at the bedside again". It was well played.

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I had an ICU patient this morning who was an elderly woman, not doing so well post-op. It was decided that she'd be switched to palliative, as her pre-op wishes were DNR. Yesterday she was very fidgety, puling at her ART lines and central lines, so had to be put in restraints. Thus my first order of business today (once the status had changed) was get all those invasive lines out and take off the restraints. She looked so much more comfortable and settled once all the tubes and wires and drains were removed.

I heard later that she'd passed away after being transferred upstairs. It gave me a small moment of thankfulness that I'd been able to make that passage a little more comfortable. Those feelings always make me think "...hmm...palliative care? Maybe."

I do feel accomplishment for both letting patients go peacefully as well as traumatically bringing them back to life.

Tomorrow I am going to be a medical student. I am following one of the surgeons in the OR, his exact words as I left today, "don't worry, we won't let you burn anything important tomorrow". Gotta love the twisted hospital humor. Looking forward to the day. Fingers crossed I won't get the spins and water brash like I usually do when I step under the lights with a mask on.

2 comments:

Grumpy, M.D. said...

It's always good to get back to patient contact. For all my whining, it's still why I do this.

Good luck in OR. I never had any problems seeing (or participating in) surgery, just made me realize it wasn't my thing.

Old MD Girl said...

Palliative care is great. You actually get to make patients FEEL BETTER, which is surprisingly rare in medicine. Psychiatry is nice for the same reasons.