Naps 1, Blog 0

Yesterday was the perfect day to catch up on all of your blogs and my posting but instead the wiles of a rainy day, warmth of my bed and 20 hours of wake time tricked me into doing, well, nothing. Napping and nothing. So, I am posting yesterday's entry today since I never got around to it and since nothing much is going on right this very second.

Monday, December 07, 2008

Rainy Day Essentials

I actually made it through a three night stretch without being floated to another unit or having my shift canceled. It's been over a month since I have worked full week and have been out of payed time off for about half of it. The time off itself is great but starting the new year off just as broke as the last one ended is not how I envisioned a new beginning. Just before the holidays shifts have become harder and harder to come by. I'm not talking extra shifts but scheduled ones. Somehow the hospital is able to close down whole 15-bed pods on each floor due to a decrease in patient admissions. It is difficult for me to believe that less people are ill or injured during months of November and December. More likely I think that house staff is at a minimum, people who would normally be admitted for 'observation' don't make it past the ER and that others would rather put off a hospital visit and remain at home with 104 degree neutropenic fevers, festering wounds caused by wine corker mishaps or wait until the trickle of blood from their rectum becomes a gushing torrent.
To this third group of people, I have this to say: On any normal day, during any other time of the year, you would rush over to be looked at, checked over and treated. Why are the holidays any different? Being with your family is important, yes, but this is your life we are talking about (all except wino but not to say your digit is any less important). We want you (and your extremities) to be around for many holidays to come. Exercise good judgment and take care of yourselves people. That is why we are here.

Anyway, it was somewhat refreshing to work a full week and this morning when I walked out of the building the sky was dark and stormy, the air was chilly and the rain was coming down. There is nothing better than leaving work at eight a.m., after your last shift, knowing you can either rush right home to go to sleep or laze around and enjoy a cold, rainy, winter's day.
So here I am. Showered and wearing my flannel jammies, cozied up with my coffee and book, in clean sheets next to a puppy that smells like Pantene*.
One of the many things on my mental to-do list for 2008 (not resolutions per say) is to actually finish one book at a time instead of starting a new one a third of the way through the previous one. Currently, I have four in process. The first book on my list is Bright Lights, Big Ass, which I started before Thanksgiving and have been itching to get back into. If you are looking for a light, easy read that will have you in stitches I totally recommend Jen Lancaster. Seriously funny stuff. Do not try to read this book at 3 a.m. when patients have just gone to sleep (or similar situations requiring complete or near silence, say a golf tournament or Wimbledon).

My coffee is getting cold and my book is waiting. Happy Monday Tuesday to you all. Good day and good night.






*This story and possibly pictures for another day when I am less annoyed and can laugh about it.

Did You Know...

"...the human head weighs EIGHT POUNDS!"
Johnathan Lipnicki in Jerry Maguire

Also, the average length of the human intestine is approximately 25 feet long.



Setting: In my patient's room a few hours after giving him a pretty potent concoction of stool softeners.

Him: What ever that was that you gave me sure did the trick!

Me: Oh good! I'm glad to hear that. That's what I'm here for!

Him: By the way. How long ARE a person's intenstines?

Me: (thinking this is going somewhere I don't necessarily want to go) I'm not sure. Maybe 20 feet. That would be my best guess but I can go look it up if you want. Why? (Why I asked why was purely habitual and impulsive. Ok. Maybe I was a tad curious.)

Him: Because I think I pooped about eight feet.

Me: (laughing) And lost about eight pounds.




My job is done here.

A Cardinal Rule of Radiation Oncology

This room had not been cleared for use
by nuclear medicine at the time these photos were taken.
Somebody should have notified the bird.

I am a participant in Holidailies 2007.

Conversations At Work

"Who's the doctor on call tonight?"

"Dr. Halliday."

"Haliday-ee! Celebraeeete!"

"You are so 34 years old."


(ooh yah... ooh yah! Holiday!)

7 More Things

Seven Reasons Why Working Weekend-Night Shift Does Not Suck

1. No rush hour. There is hardly any traffic on the freeways or service streets. This means I can take another ten minutes to get ready, laze around and goof off.
2. Parking is a breeze since the closest parking lot is usually not occupied by the weekday-ers.
3. No waiting. You are almost certain to catch the elevator immediately. Also, the awesome, weekender elevator crew are more likely to offer you a ride when you need it.
4. No fuss. No muss. Ancillary staff are at a minimum. Procedures, scans and treatments (unless STAT or ASAP) are usually held until Monday morning. Doctors round later. This means blood draws, weights, vital signs and other unpleasantries that wake my patients can wait until later so I can blog chart longer.
   
5. Ativan, Benadryl, Restoril, Xanax are the patients' drugs of choice at this hour.
6. I get to work with the bestest, craziest and funnest people during these shifts.
7. Aside from being named the newest possible carcinogen, while working the weekend-night shift you have access to the best holiday store hours with the least number of shoppers during the week and a legitimate excuse to sleep all day. Hallelujah!
   

I am a participant in Holidailies 2007.

That Kind of Night

She* came out of the room, cursed a little under her breath and threw her glove down. This is how it landed, I swear.




*I'm finished with the third person too, I swear.

Color Me... bored

Here I lay on my heating pad, surfing the net and drinking hot tea. And, oh yeah, did I mention it's raining? Right. So, the other night my friend, SB, found another cool site to occupy our time during down time at work. If you go to Crayola.dot.com there is a Digi-Color page where you can draw, paint and color with your choice of Crayola tools. You Your kids could spend hours there!

A few of us at work held a drawing contest in which the first topic was Milk and Cookies. We had fifteen minutes to create our master pieces. This was my entry:

A Delicious Snack (of your choosing) by Kathy-rine

I know, it's a piece of work alright and the best part is the crayon floating above the cookies. One of the judges, another nurse, said it looked more like a plate of biscuits and a salt shaker. An astute observation and I really could have gone for biscuits with honey and hot tea at this hour of the morning. Anyway, SB won with her portrait of Santa's cookies on Christmas morning. It was quite cute and creative. Unfortunately, I don't have photographic evidence of that one. Then, I was working diligently to complete my entry for the topic of Tropical when, at five a.m., my patient spiked a tem of 104 . Not a good sign when your immune system is shot all to hell. Subsequently, several sets of blood and fungal cultures and a chest x-ray took precedence over my "Bird of Paradise" (to be completed at a later time).
I did not work lastnight but SB did. When I woke up, I had a text message on my phone from about 3:30 a.m. Apparently, things have again calmed down on the BMT unit. This is SB's latest creation:

Tropical Fish by SB

Laying in bed, on my heating pad, loaded up on tea and ibuprophen, with nothing to do (and not to be outdone) I decided to try a Crayola rendition of Van Gogh's "Starry Night". Yes, I need to get a life.

Crayola Starry Night by Kathy-rine




***UPDATE***

SB just texted her Milk and Cookies entry!
And the WINNER IS:

Santa's Cookies by SB

Heard At Work

"How old is the patient?"

"Sixty-nine."

"Sixty-niiiiiiiiiiiiiiiiiiiine!"

"How old are you?"

Sometimes, More Is More

Cupcake, originally uploaded by scoobers

Cupcake season has officially arrived! The air outside is cool(er). Ovens are fired up. Bloggers are baking. Each time I log on I see cupcakes galore and the places where I don't see cupcakes I find people seeking them out. Lori, this is yet another tortuous post for you to endure during your prenatal cravings. Apologies!

Today, my friend, KB turned thirty-six years old and so I thought I would officially ring in cupcake season by whipping up a batch of my own special*, sprinkled, delights for her. I planned to make enough so that her 'herd' would be able to enjoy them as well. I filled the cups half way with batter so I could stretch it out and make more of them. I ended up with cakes not mushrooming over the tops of their tinfoil incubators but resembling golden brown hockey pucks. In order to compensate for the missing tops I layered the sweet, delicious vanilla cream frosting on pretty thick.

On her way over to my house tonight, KB received a phone call from the family of one of our patients who told her that he had lost his year long battle with cancer. It was pretty tough to hear because I know they made every effort, tried every option and that he fought with everything he had. The family is super tight, as is the bond between my patient and his brother. I pray that he finds the means to make it though such a difficult time.

Now, I can't sleep because my mind is running in circles, again, over the reactions of others towards choices I have made and continue to make. Earlier tonight, KB and I drove out to the hospital together to visit another patient of ours. On the way there I told her that a couple of the other nurses shook their heads in a disapproving manner when they found out that we visit our patients after they are moved to ICU or keep in touch with them or their families after they are discharged. We talked about the line that should not be crossed and how to know when you've reached it.

During the conversation between KB and our patient's brother he told her that 'D' told him to let, specifically, the two of us know that he felt truly cared for by us. Going beyond our 'work' in the hospital made a difference in his life and the appreciation for that was voiced by his family. This only solidifies my thinking that our patients are still our patients whether or not we see them when we clock in to work and that taking the time, our own time, to make sure they are taken care of makes a difference in how they perceive the 'care' they get. I plan to continue giving more of myself to my patients and their families. If this means that I become attached to some of them and end up hurting because of an unfortunate outcome then so be it. The sorrow I feel is nothing compared to what they must go through and if spending time with them, crying with them and following up with their families after they've gone is what it takes for them to know that their caregivers truly care, then that is what I need to do.

Right now, I am going to go to the kitchen to soothe myself with cupcakes, extra extra frosting and a big glass of ice cold milk.

*By 'my own' I mean my own box of Betty Crocker vanilla cake mix and white vanilla frosting.

Caught Unawares

Seen outside of work:
An EMT standing next to his ambulance blowing snot-rockets onto the pavement.

Me, "That's awesome."
Him, "What?!"
Me, "What do you mean 'What'?"
Him, "Oh. Well... next time you see that you'll remember me!"


Yes, thank you. Next time I need to borrow an air-hankie I'll know who to go to.

Heard at Work Lastnight

"My crack hurts. Can I borrow your lip stuff?"

Rosati's To the Rescue

Oncology nurses get similar responses when people find out what they do for a living. We hear, "Isn't it depressing? That must be so hard. I could never do that," to which I reply: Yes, sometimes it's a tough job but I love my patients and taking care of them and their families. Caring for them and seeing them along their journey through diagnosis, treatment and planning for the unforeseeable future is nothing compared to the physical and emotional suffering that they experience every day. If I can help to make that journey a tiny bit easier, then I have done my job. I can not imagine doing anything else.

Note to self: You are human.

This morning, I left work a big bawling baby. A total of four embarrassing melt downs, one of which occurred at a patient's bedside. Six nights on a pod full of confused, yelling, incontinent patients is manageable. Add to that the previously discussed elements of the job I love and it is just a matter of time before the breaking point is reached.

I feel like I'm insane.
No alarm. I woke up at 7pm. I have decided to take tonight off from work. I talked with the designee (charge nurse, head nurse) and arranged a preplanned sick call.

Tonight, I am regaining my sanity with mind numbing TV (currently an ANTM mini-marathon), celeb bashing magazines and junk food. I am going to play with my puppy, catch up on your blogs and eat pizza.

My first bite and I already feel better.






Thanks Head Nurse for the advice on how to do it right.

*Heard from the Nurses Station

Multiple IV infusion pumps are alarming.

Bed 2 puts his call light on.

Bed 4, "Nuuuuuuuuuuuurse! I need water!"

Bed 3, "God DAMMIT!"

Bed 4, "Waaaater! Nuuuuuuuuuuurse! I need waaaaaaaaaaaaaaater!"

Bed 7, "Somebody help me, pleeeeeeeeeeeease!"

Bed 5 wretches.

Bed 4, "Nuuuuuuuuuuuuuuuuuuuuurse!"

Something crashes to the floor in Bed 1. Thankfully, not the patient.

Bed 4, "I want to see the monkeys!"

Laughter from Bed 8 (and the nurses station).

Bed 4, "Nuuuuuuuurse! Nuuuuuuuuurse! Nuuuuuuuuuurse!"

Bed 3, "Oh, Damn."

A dying infusion pump from the dirty utility room continues to beep.
'C' smothers it with pillows.

Bed 3, "Oh boy, oh boy, oh boy, oh boy."


*I am on auditory overload.

Sound of Sedation

" Sound of Sedation"

Hello patient, my old friend

You're on the call bell once again

You're still calling, nothing to say

I could be surfing on eBay

But now you're snoring

and no one's turning blue

Woo, woo, woo

This is the sound... of sedation

* * *

I gave them all some benadryl

Some get IV, some get a pill

Patients sleeping without puking

Held the Colace, no one's pooping

Now they're all snoring

So, no one's turning blue

Woo, woo, woo

This is the sound... of sedation

* * *

~Written by O.M. RN

***ahh... what we do when patients are sleeping.

Weekly News: Tofu, Life and Passing

Asian Chicken Salad from Pei Wei...
minus chicken, plus tofu

My wonderful extern, 'K', and HUS, 'V', were so awesome and went out to get us food for dinner at work last night. The consensus was Pei Wei, a step down from the pricey PF Chang's, but equally yummy. One of the ICU nurses, who happens to be a vegetarian recommended the Asian Chicken Salad but instead of chicken, tofu. Keeping with my low carb, low lipid diet, I decided that this was a good option and decided to try something new. So this week's new experience helped me to stay on course. They forgot the ginger dressing (which everyone who had tried it before claimed it to be "fabulous") so I tried it plain... the mint leaves were somewhat overpowering so I resorted to Newman's Own Italian (my favorite and loaded with bad stuff... so just a drizzle). It was pretty good and I would order it again. I expected tofu to be mushy white ick but it was pretty darn firm and tasty. I was actually surprised that it LOOKED a lot like chicken strips.
On another note... work news. A patient that I had been taking care of for the last four nights passed away. The multitude of family that was there at the beginning of the shift had just left, except for two. I was there with his son and his wife when he took his last breath. It is an indescribable experience to witness such a thing. My heart went out to his family as he came in a few nights ago, walking, talking, laughing, waiting for treatment when things took a turn for the worse. Such a nice person in general. I am so glad that my patient had family there with him when he finally left this earth. Mostly though, I am glad his son decided to stay. He was the one I was most concerned about because he did not seem ready to lose his dad. He will now have this moment and memory that he was there for his dad in his final hour. He passed quietly and peacefully.
When I tell people that I work on an oncology unit I get asked quite a bit if losing patients bothers me or if it gets too depressing. Yes, I have to admit that it is overwhelming at times but for the most part I am grateful that I am able to make such a difficult time for people a little more bearable a burden. When he finally passed, I was sad for the family. I took a long look at my patient and felt more sad knowing what a decent person he was and what a loss it is that he is gone.
It's funny though, that while I was alone with him, cleaning him, packing up his things, that I only began to tear up when I saw, among his clothing, some nice pants, shoes and a pair of suspenders. I'm not sure why it affected me like it did but I can see him not as a patient but as a person I could have said "hello" to at the grocery store or walking down the street.

I am so glad that I do what I do.

All In a Night's Work: II

'Neutrophil' courtesy of Onc0link.org

• 4 the number of shifts out of seven I have worked so far
• 14.5 the number of hours worked in a 12 hours shift (damn good over-time)
  
• 3 the number of patients I took care of last night (thanks, Sue for blocking beds)
  
• 3 the number of patients who are severely neutropenic
• 1 the number of patients who have an antibiotic resistant bacteria in their blood
• 1 the number of patients who crashed to the floor when no one was looking (about 5 minutes into start of shift)
  
• 3 the number of STAT procedures ordered to rule out bleeds and/or fractures
• 10 the number of times I had to call the doctor regarding patient status
• 2 the number of patients who were bleeding from their nether-regions
• 2 the number of blood products given
  
• 60* the number of liquidy, bloody stools/urine that were dumped
• 6000* the number of cc's of bodily waste measured, dumped and flushed
  
• 1 the number of times I, myself, was able to pee during my shift (finally at 0500)
  
• 15 the number of vital signs that were taken
• 0 the number of CNAs (nursing assistants) that were staffed to help us
• 1 the number of foley catheters placed
• 1 the number of IVs started
• 7 the number of blood draws performed
• 50* the number of IV narcotics, antibiotics and other meds administered
• 5 the number of minutes I got to scarf down my cafeteria salad
• ? the number of miles walked (or ran) in the nurses station
• 1 the number of toilets that burst a pipe and flooded a room
• 2 the number of times that I laughed so hard I almost peed myself

Thank you, J, for all of your help! You have no idea how much time you saved me. Everyone else... thanks for the laughs! Good times! See you tonight and nitey-nite!



*approximate number only as I truly could not keep track

Bloody Hell!

As you may know, I work the night shift. I have two front doors, both which have door bells. I tend to park close to the main one in the drive so that the back laundry door is the most accessible to those who come-a-knockin'. This is the doorbell that I can not hear while I am trying to sleep during the day. This week I worked six twelves in a row so that I may have this weekend off to go to Mexico (so excited I can hardly stand it). Three is normal, four is an occasional extra shift (and bearable) but six drives me into the ground. I have averaged 3 1/2 hours of sleep per day the last five days. Needless to say, I am beyond exhausted. I was really looking forward to a long, uninterrupted sleep today. Nyquil on-board, I don't even remember hitting the pillow.
Fifteen minutes ago, the bell I try to cover up was rung, and rung, and then rung again. I managed to slink out of my bed, stumble down the hall and peep through the hole to find the solicitor, a mere stick figure, making his way back down my driveway. He did leave a calling card... see above photo.

I am more than frustrated and now unable to sleep again, hence this irritable post while visions of homicide dance in my wee little head.

God Bless and Holy Mother of Pearl (that was for you 'K').


... right back atcha, JW.

7 More Things

Good Sam, originally uploaded by scoobers1.

Jenni started this off by 'tagging' me with seven random facts about me. Here are 7 more things that just came to my mind.
I am at work at 4:10 am. All my tasks are done. Everyone is sleeping (thank you, Ambien). Here are 7 things I do to occupy my time:

1. Write in my blog.
2. Play Text Twist.
3. Read my book or various catalogs/magazines.
4. Surf the net and answer email.
5. Eat.
6. Walk the stairs (12 floors!)
7. Plant my face in the desk

SPF: Small and Pink

This week's Self Portrait Friday assignment was to post a picture of something small and pink.

A Good Night's Sleep, originally uploaded by scoobers1.

I was at work and had been thinking about what to do for SPF when Lou pulled a couple of Ambien out for her patient. Lucky, I had my camera with me. For a night shift nurse, this is a handy drug to have in your patient's arsenal... for the patients and the nurses! : )

This was another idea I had at the last minute to deviate from the working world. I have a series of "Dragonfly" drawings in my bathroom. They are my favorites in the house so I thought I'd share.

Breakfast of Champions

Blue Moon, originally uploaded by scoobers1.

Ahh... I just got home from a long night's work. I cut an orange off the tree in my back yard and poured myself a Blue Moon. Does anything sound more refreshing than that at 9:30 in the am? To most, yes, but as I've said before, working the night shift does have it's perks... every hour is happy hour!

Cheers and nitey nite!

p.s. sorry Shelly, no lemon tree! Blue Moon blasphemy? Maybe, but it just tastes better! : )