I'm not sticking my finger in there!

I am currently enjoying a three day in a row break from work. I think it's the longest I've been off in one stretch since coming home. I love, love, love it. I have been there a lot lately, even curling up on the couch in a meditation room for a night. Then there were a few days with really horrible roads, where it took me two hours to get home.

I have had some interesting, and really sweet patients last week. Patients who hug me and tell their roommates that I'm the best nurse in the hospital. Flattery will get you everywhere with me! I heard another nurse mention that she had to digitally stimulate a colostomy q4 hours. I thought, thank god I don't have that patient, because I am just not going to stick my finger in there! Plus, he kept asking the night nurse to "finger him". And who do you think I ended up with the next morning? Same guy. And the first order of business that day was to explain to him that it was almost time for him to go home, and if he needed to stimulate his colostomy (which was 5 years old by the way, not a new thing!) he could do that himself, with a glove. Then I had to empty his colostomy bag which was full of completely formed stool, and doing it reminded me of squeezing frosting out of a tube. So gross. I hate ostomies, especially colostomies, with a passion.

fate is making all the decisions

After returning from Nepal, I found it very difficult to care for our patient population. Grown-ups who whine and complain about the amount of ice in their cups, the hardness (or softness) of the beds, the kind of foods on their plates, the medicine that's saving their lives is constipating them, the pain from surgery is too much... etc etc. I found myself wishing more and more for intubated, ventilated, sedated patients. I look at these people and think, you came to us for medical help. YOUR choice to have the procedure, to come to this facility. It's not the Hilton. We're not here to make sure you eat delicious food and sleep comfortable and undisturbed. We are going to poke you and prod you and wake you up every hour, we're going to serve mediocre food, the beds might not be top-notch in comfortability, but they do flatten in 3 seconds so we can do CPR and save your ass.

So I applied to every job I could in the hospital, and still haven't heard from anyone. No one. Nada. I guess it's not meant to be, but surely I'm not meant to play waitress for the rest of my life?

Working in the field!

I finally got to carry out one of my lifelong nursing dreams... do a service trek and serve rural communities! Of course, I did it in Nepal, where I speak the language, and so had the added experience of being a translator, which I loved. Now I'm hoping to lead a group every year to the clinic we worked at, and start to make a little progress in the area. I loved it there, the community of Sherpas was wonderful. Nursing there was more like being a doctor, though. I diagnosed and treated just using my own brain and the rest of my team. I was terrified at the thought, at first, but after a while I got kind of used to it.

We had some severe cases, like an infant suffering from hydrocephaly, looked like it was going to die soon. We had a guy with a GI obstruction, most likely, a woman who swallowed something sharp when she was drunk, and a woman coughing up blood with TB-like symptoms. But mostly we saw a lot of GERD, aches and pains, babies with diarrhea, dehydrated adults, and wounds and skin infections. The clinic could use a lot of training with the workers, more reference books and drug books, and some programs on ergonomic lifting, hygiene, and birth control.

I'm excited to really be a leader and take group after group. It's totally my niche in life!

In other work-related news, my love affair with cardio-thoracic surgical tele unit is over. I no longer click with management or my co-workers, and I'm a little bit bored with the patients, too. I think it's time to move on, and re-stimulate my brain again. I applied to the baby NICU, L&D, and visiting nurses. I haven't heard anything back, so we'll see what happens. I want more experiences so that I can be a better clinic nurse in Nepal!

reconfiguration

I nearly lost my position in the "unit reconfiguration" that is taking place. They are taking beds from our unit, the cardio-thoracic surgical stepdown, and beds from next-door neurosurgery, and creating a middle unit for otolaryngology and plastics. The positions on all floors were bid on by seniority, and by the hair of my chinny-chin-chin I managed to grab the very last day/eves spot! I would've cried. Not a single cardio-thoracic nurse volunteered to become a plastics/oto nurse. No thank YOU. This whole split cause us to lose some fantastic nurses, and was just unfair and unpopular all around. Everyone had a stomachache, for weeks.

So it is back to business on my unit of choice. I'm ecstatic even if it means being lowest in seniority. But hey- I wanted to work Christmas anyway. Triple time here I come!

patient stalkers

I took care of a very difficult patient, or should I say a patient with a very difficult family, for two 12 hour days. I bent over backwards to keep the family from going over the edge, and to keep from calling security (as the night shift had done). I went out of my way to deliver on all kinds of bizarre requests, and tiptoed around their ever-changing moods. I was exhausted by the end of those two days, but I was also tired because the family stalked me around floor, trying to convince me to join a Jewish group and go to Israel. I told them several times that I wasn't Jewish, but they didn't believe me. The stalking got out of control, to the point where if I left the conference room they would be standing outside of it, waiting for me.

I spent the next two days at work under an alias, at the opposite side and end of the hall, because they were looking for me. I think I did really good work with them, considering how hostile they were to the rest of the hospital staff, and I'm glad that they liked and trusted me. I also got much closer to the PAs on the cardiac surgery team, and one even gave me a hug at the end of the day and told me I did good work. Still, I'm more than relieved that they'll be gone the next time I go back!

that's what it's all about

I made a bond with a patient we shall call T. Patient T came in for an esophagectomy and removal of the stomach. He has been through three J tube placements, and last week, on one of my days with him, he developed a huge leak around the 3rd tube, as he had with the first two. Large amounts of tube-feed BM seeping out and all over his skin. He was miserable. I was miserable. It was a Sunday and the thoracic surgery team was being manned by everyone's LEAST favorite resident. I was upset by their response but I didn't know what to do about it, either.

In the afternoon, the leak progressed to a constant gushing of acidic fluid and BM. I went upstairs to the GI floor and got ostomy supplies, and attached an ostomy bag around his tube's insertion site. For this I was pronounced a hero by his wife. Patient T texted his whole family to tell them that for the first time all day, he wasn't covered in goop. It was a victory for everyone, but it also allowed me to measure the output, which up until now the team had been pooh-poohing. His tube feeds were stopped, a dophoff tube was surgically placed, and he is now being evaluated for a small bowel obstruction. ALL of which I had suggested in the morning!

I have grown close to him and his family during the weeks he's spent here. Even though he wasn't my patient yesterday, I stopped in and did a cervical dressing change for him. I know that this is why I went into nursing- the ability to really play a major role in someone's healthcare, in the way they get through their day.

pulling the plug

Life on my unit has been relatively uneventful. Just the usual requests from constipated patients to just "reach up there and get that piece out" (ewwwww) and cute little old ladies with inguinal hernias that pop out at random times.

The other night, however, I was selected to take care of a patient who has decided to turn off his own LVAD and die naturally. He has been a favorite and a regular on our floor for the last four years, and many nurses were shedding tears over the news. I had not taken care of him much, so I was a good pick because I wasn't sobbing every time I passed by, but it was still very sad. I do enjoy palliative care patients, because I like to think that I had a hand in making their deaths more comfortable and dignifying. I would consider working for Hospice or a palliative care team at some point in my career.

As far as going to grad school, I always thought that I would get a year or two of nursing experience and then immediately go for it, but after just one year of nursing I realize that becoming an NP at this point would only limit me. There is so much out there for nurses, there's L&D, emergency medicine, geriatrics, ICUs... a lot to do and learn and experience. So for now, plans for grad school have been put in the "someday" bracket, to be revisited at a much later time.

good nurse, bad nurse

I got banned from a patient's room, by the patient. She had mental status changes, and was being just goofy... so the service asked me to get a urine sample for a drug screen. She went into the bathroom for a long time, and then I heard her flushing, flushing, flushing. I was getting concerned that she was trying to flush something down the toilet, so I knocked and poked my head in, said "are you ok?" She flipped out, told me I was very rude for opening the door, and that she didn't want to "call the authorities" but she would if she had to.

From then on, she wouldn't let me in the room and I had to have other nurses go in and do her meds. She complained about me to everyone who went in there. The first time she yelled at me I felt like crying. I need some thicker skin, I know. I'm just used to patients really liking me, and not used to dealing with people who aren't at least somewhat polite.

Needless to say, I gave her up to someone else.

the grim reaper

Yesterday I was taking care of a healthy looking 58-year-old man just diagnosed with terminal lung cancer. Supposedly, the service had already told his wife about this. She asked me, suddenly, how many stages to cancer are there? Without thinking, I said "four". She about collapsed into my arms. I held her while she sobbed into my shirt. I had no idea what to say, what to do. I tried my best. She went over to him and hugged him and said she loved him so much. I had to get out of there. Later, the team came in and told her she should take him home, there's nothing more to be done. I had to step out of the room lest I burst into tears, too.

See, I work on a floor where we usually send people home, healthier than they were before. I haven't built up a very thick skin for this kind of stuff.

The charge nurse bought me a cookie. Cookies do help.

houston we have a problem

They are taking some of our beds to form a new unit full of yucky services like oto and plastics. We will go from 48 beds to 36. This is horrible, horrible news because it means our group of nurses will splinter and scatter to the wind. We are a great group that works well together. We are notorious for having the best teamwork in the hospital. Now many of us will be put in a position where we are forced to choose between working on a different unit or finding a job elsewhere, or even switching shifts.

This is terrible. People were in tears. And the kicker is that they are doing it because we complained about having off-services. Actually, we complained that we were taking off-services when cardiac patients were ready to come to the floor. BASTARDS.

good news on the floor!

One of our patients is a fairly young guy (in his 50s) who has been here for 55 days with heart failure, a heartmate (left ventricular assist device), and kidney failure. He was not going to be discharged until he got a kidney and heart transplant. So he was just sitting around every day on top of the transplant list, waiting for a donor to pop up. We took a long walk the other day and he told me all about how he felt perfectly healthy until 10 years ago, and then he was diagnosed with CHF, although he was asymptomatic. He developed a 3rd degree block, and was implanted with a pacemaker, only the small hospital who implanted him put in the wrong kind, which only exacerbated his heart failure. Since then he has had two LVADs and one RVAD and his kidneys have gone into failure.

The day before yesterday his AICD fired several times when he went into sustained VTach. He spent the whole evening scared to death of it happening again.

Yesterday the big news came... a heart and kidneys were on their way! He was wheeled off to OR with this stunned look on his face. I hope he's doing alright. Everyone on the floor is so excited for him!

opportunities for overtime

The nursing world continues on... I have friends now that make work enjoyable, and with whom I can talk about work stuff. Nothing thrilling has happened as far as patient care, nothing noteable, except that I've continued to have nursing students who all seem to like me a lot. It's really gratifying to help others grow in nursing and see how excited they are with what they did at the end of the day. I still remember what it was like to be a nursing student, and I try to be the preceptor I never had but wished for!

The other day was horrible, when three of my patients were off the floor and all came back at the same time. I had a migraine, too. It was a nightmare. I ended up leaving at 7 but made up for it with 16 hours of overtime ever since! In a place where jobs are hard to find for most, I'm really grateful for a job where I can work extra pretty much every week, and get paid nicely for it!

from admit to discharge

The patient I'd taken care of for 8 days was finally discharged to hospice yesterday. It's a rare thing to have someone for more than one day on our floor, let alone 8. I hope that I had some impact on getting the family to understand her desire to be comfortable in her last days and to stop fighting a losing battle. I hope I was able to convey kindness and compassion to her in her last days. That's what being a nurse is all about, afterall.

I actually had three patients whose families loved me and thanked me every day for being there with them and for helping the medical team to hear and recognize their individual concerns. I learned a lot about being a patient advocate and helping someone to either heal, live, or die with dignity.

knocking on death's door

On the first day of four days in a row, when choosing my patients I skimmed the list for the oldest patients up for grabs, per my usual habit. I ended up caring for an 81-year-old stage IV cancer with mets patient who's husband of 64 years had passed away three weeks prior. Over the four days I cared for her, I watched her go from adamantly insisting she be a full code, to begging me to knock her out and let her die. Yesterday I pulled the daughter aside and offered to refer them to palliative care. She didn't seem open to the idea. I called the primary oncology physician who told me she'd "already had this discussion with the family". I said I knew that, but today things were different and per the patient's wishes she should probably reassess. The other children came in later and spoke with the physician about their desire to comply with their mother's wishes and allow her to be comfortable in her final days.

I stepped into the conference room as all the kids started to cry. I felt an obligation to be someone strong in their presence. I fought hard to get this patient morphine from a resident, and then sat with her holding her hand and asking her to tell me about her trips to Europe, to take her mind off of the pain. The morphine didn't work and her begging to be shot and knocked out bothered me a lot. I was grateful that her family members arrived and understood that she was ready to go.

I also had a patient a few days back who came to the psych ER with panic attacks, but because of "chest pain" had to be ruled out for an MI per protocol. It was ruled out, and then some asshole of a doc on cardiology service didn't want to give him ativan, so as punishment for the patient ordered it q4 hours IM. I told him I wasn't going to give it IM when he had a working IV and could swallow pills. I gave it IV and continued to page this guy to change the order. Eventually, he did. I know what it's like to have panic attacks, and I'll be damned if I'm going to stab the patient in the ass just because some prick of a new MD thinks he's drug-seeking ativan because he's never had a panic attack before.

Two words: Patient advocacy.

high times

I had some learning experiences at the beginning of this week. On Tuesday I had a patient who's BP bottomed out. I had to get our Rapid Response team to come, and we had a hell of a time getting the service there. In the end, he went to the unit. The rapid response nurse was awesome, made we want to work in the unit just to get a better handle on things.

I thought no day could've been worse than that, but the next day was. I had a THE patient who developed a leak in her cervical incision, and also threw a fit and refused to cooperate with me when I told her we needed a new IV. Then there was a different patient who appealed her discharge, and I had to get patient relations and social work involved. I requested out of that team and had a calm, relaxing two work days after that. Patient's who are nice, cooperative, and stable. Ahhh.

I'm most excited about getting together on March 7th with my trek nurses. I can't wait to see the group dynamic and get everyone excited about Nepal.

escape artists

On my second twelve in a row, I had a patient with declining mental status and hepatic cirrhosis. He was also a 'code brown-er' (meaning poo, and lots of it!). But just as nice as could be. I'd requested a sitter but no one was available until 3:00. He had yanked out his IV and his Foley bag was full of blood. I would have to keep a close eye on this one. I asked a tech to take him for a walk while I discharged someone else. I came straight back from the discharge to check on him... not in his room. The tech said he'd left him there a half hour ago. His tele monitor wasn't picking up, meaning he'd left the floor. He'd removed his brief (diaper), which meant somewhere in the hospital was a confused 47-year-old in a gown with his bare butt hanging out the back, a walker with a big 'ole 'Property of Hospital' sign on it, and a telemetry monitor to boot.

I called security while the techs searched the floor. I felt like a big dope calling the physicians and saying "I lost the patient". He was found outside of the hospital, starting down the road, in the snow, in his little hospital footies. His feet were like blocks of ice. I felt like a parent saying "Where were you? I was worried SICK!"

Needless to say, I got a sitter.

Ah, adventures!

gift upon gift

I think I would actually like to do home health nursing for a while. My mother did it when I was growing up, and I think I would like it. I will stay where I'm at until the two year mark, I think, but then we'll see. I do know one thing- before I go anywhere else, I'm taking time off and traveling! To Nepal of course, but I will do a few other things, too, while I'm at it. Bangkok, Lhasa, India... I'm in dream world, but I can't help it. I feel so trapped in this nursing job. I can't take time off without pay no matter what I do.

I got a starbucks gift card from a patient I only had for a few hours before sending her to OR. She and her family really liked me, I think because I was in a funny mood that morning. People like to laugh, right?

My french-speaking patient's grandson-in-law wanted me to come over for dinner. But when I got there hours went by and dinner still wasn't ready, and I had to leave. I wanted to do good by this patient as far as lowering his sugar, but I don't want to become too entangled in the family. I've done that before and it's not good for anyone. I am still "the nurse" and I am there for one reason only. I have to keep reminding them and myself of that.

I got several nominations from patients who filled out a form, basically a kudos award. You don't really get anything for it but a certificate, but it looks good in your file. And it makes me feel good.

I believe

I believe I will remember this patient for the rest of my life. I believe that I am doing the right thing, even if I'm breaking the rules.

Today I called the outpatient clinic and scheduled an appointment and interpreter for the French-speaking patient I mentioned in the last post. Then I called the house, without response. After work I drove out to the address listed in the patient's file. It was in the poorest area on the outskirts of a small but diverse university town. The apartment complex was crowded in next to the freeway, and almost every apartment had plywood for windows, except for the patient's. The apartment was being rented by his granddaughter, with whom he is staying, as well as her husband (I assume) and four small children.

I was greeted at the door by a shy but friendly five-year-old and an 18-month-old (by my estimate) wearing a dirty shirt and a diaper. She put her arms up and clamored to be picked up, so I did. The granddaughter, her husband (or who I assume to be her husband), and the patient all came out and hugged me, kissed me, shook my hand, and hugged me some more. I was offered a seat on the couch where the small toddler sat contentedly on my lap and drooled away. I made small talk in my very limited French, and in English with the little girl who told me her name and that she went to kindergarten. There was a basinet set up in the livingroom, where the seven-week-old baby sleeps during the day. The little girl brought me a bottled water.

The patient appeared healthy and well, much to my relief. He told me via the grandson-in-law, the only English speaker in the house, besides the kindergartner. His blood sugars had remained in the mid to upper 200s. A look of worry passed over the young man's face when I said that the patient had an appointment tomorrow afternoon. I then asked, quickly "can I pick him up at 12:30?" He responded with a huge smile and translated for the patient. After a few more minutes, I told them I had to go, but would be back the next day. "Demain!" I said in French, reaching to shake the patient's hand. "Demain!" He exclaimed, and gave me a big hug and a very French pecks on each cheek.

This family is the essence of goodness, I feel. And I wonder what took me so long to realize that this is my calling. These people live in our backyards, people with no one to look after them. People who are sent home from hospitals as lost causes. People who open their doors with complete trust, hoping against hope that in this hard country where everyone lives behind locked doors, and no one speaks to their own neighbors, that a good person will show up and do the right thing.

It's not just me, either. Over the past few days, I found nurses on my own floor who told me stories of dropping by an elderly patient's house a few days after her discharge, to check her wounds. Nurses who invited patients living nearby to come to their apartment to learn how to use their glucometer. I felt extremely proud of them. Going out on a limb, risking your own neck, sweeping aside rules set up by big business and beaurocracy in the name of good, that gives me hope. Our humanity gives me hope.

health disparites enrage me

Here is a copy of the email I wrote to the nurse educators on our floor about the patient I took care of yesterday:

Hi [nurse educators],
I would like to pass along the plight of a patient who was recently discharged from our floor. Because you are a nurse I very much respect, I thought I would share his story. This gentleman is 66 years old, a military official from Guinea, Africa, recently arrived in the US to visit his daughter and grandchildren. He collapsed in their home and was brought [here] by EMS. Unable to afford missing work, and caring for four young children, his family did not accompany him to the ER and did not arrive until the next day. He speaks no English, and required a French translator for all communication.

The patient was found to have a blood sugar greater than 500. He was re-hydrated and put on a sliding scale and intermediate acting insulin for meal coverage. Even this did not control his blood sugar, he still had chemsticks consistently in the 200-300s. He told us via interpreter that he took insulin in his home country of Guinea, but did not know what kind, and had not brought it with him to the US because he "felt fine".

His service was Medicine Newburgh, and they decided to discharge him the same day, but had to wait for family members to arrive before he could go. I took care of him both days. When his granddaughter arrived to take him home, she also spoke so little English that she required an interpreter as well. I paged social services and the MN service to come in and talk with her and the patient. The resident came in and told the patient that he could go home now. He did not mention to the patient that he would require insulin injections and frequent blood glucose monitoring. He did not explain to the patient what diabetes was or its consequences. After the physician left the room, I asked him about patient teaching. I was told that it "didn't matter", he was going to "end up in the ER again anyway". His discharge paperwork included prescriptions for a glucometer, insulin syringes, and novolin insulin to be taken 10 units BID.

I brought our glucometer, and insulin to the patient's room and with the interpreter present, I spent more than an hour and a half discussing and demonstrating how to check the blood sugar, what is normal and what is not, what to do if sugar is very low, or very high, what symptoms he might expect, to test and write down his glucose levels four times a day, how to draw up insulin, where to inject it, what to do if he misses a meal, the importance of eating consistently and a healthy diet... etc. I taught everything I'd ever learned and remembered about diabetic care. The patient and his granddaughter are very intelligent, he demonstrated back to me how to check his sugar and inject insulin correctly on his first try, and they both asked intelligent questions. I gave them written materials in French. I could tell that they were very concerned about money, and social work was working with them on temporary insurance. I sent them down to our pharmacy with the interpreter.

The patient is supposed to have a follow-up in the clinic within one week. I asked the physician for the name of his clinic nurse, so I could let her know ahead of time to speak slowly and clearly when scheduling an appointment with the family. I was told that he has "no clinic nurse". I worry that the patient will not receive an appointment time, or that he will not understand instructions on the phone. I also know that the insulin coverage he will administer to himself will not adequately control his blood sugar, and the long-term consequences will be devastating. I am disgusted with the care he received from the MN service, and wonder how it might have been different if he had had insurance, or had a been a white English speaker. The way I see it, those patients who face the great challenge of communicating across a language barrier, or who are unfortunate enough not to have insurance, ought to be given extra attention the best care that we are able to give, not simply sent home as though we do not care what happens to them just because they have no money, or don't speak English.

I have discussed this case with [our nurse manager]. I know that disparities in healthcare for minorities exist, but was shocked to see it playing out right under our noses on [our unit].

Thanks for reading.

language lessons

I had a patient today who spoke no English, only French. His family was not around, so I spent the better part of my day trying to remember high school French. I did ok... I guess. The interpreter came for the important stuff. My friend had a guy down the hall who only speaks Hindi... I did much better interpreting for him. I just love the fact that we are a hospital in such a diverse area, with so many beautiful cultures and languages flowing around us. It's refreshing.

So my Pod, or the section of our unit that I'm assigned to, has been nicknamed 'The Pod of Death'. Our acuity level is sky-high, with a ton of off-service total care patients. All these broken bones, and ostomies, and seizures... they need to go! We want CABGs, esophagectomies, and lung biopsies! This is other stuff is just... crap. And we're working like slaves.

what a day, what a day

I never knew it was possible to do a 12 hour shift like I just did. Two discharges before 11, two admits before one. My first experience with a foley irrigation system, and a fresh esophagectomy who yanked his NG tube out 10 minutes before I was supposed to go home. Coffee, coffee, more coffee, and not enough time to pee.

My feet flew all over those halls, the hour hand on the clock was spinning out of control, but in the end I had a couple of satisfied patients, I think. At least, I'd like to think it made some difference.

knock me down a few pegs

My manager was extremely impressed with my email from the previously mentioned world-famous surgeon who paged me with a kudos. She even showed it to my supervisor. After my stellar weekend, though, I took a patient with a fistula-turned-ostomy that kept leaking. The resident came and did the dressing change when it leaked, much to my relief. But an hour later, it leaked again. I've never changed an ostomy bag, especially one this complicated, and had to scramble to find someone to help me. I found someone and we got it done... in about 45 minutes, dressed in extremely stifling plastic gowns because the patient was VRE precautions.

Still, the patient was very grateful and wanted to fill out a 'You're super' for me (patients can fill these out and we get a certificate and a pin each quarter if we receive one).

I think I have my team for the Nepal trek. I'm hoping for permission to take a total of four nurses, including myself, from day shift, and at least one from night shift. I also have three nurses from other units.

The inauguration of our new president brought hospital staff together... I bonded with the transporter over our mutual excitement. Usually, they don't even talk with us nurses. I think it's been an amazing experience, and so many african americans have been talking with everyone now, instead of just with each other. It's made me happy that we are uniting like this, and crossing racial lines.

getting things done

I worked three days in a row, without switching patients. I find this the be the best way to move a patient's progress forward, consistency in nursing that leads to follow-through. I think it gets a nurse fired up to see improvement the day after she put in a lot of hard work. At least, it does me. I had some arguments with interns and residents, and really stood on my own two feet as a patient advocate and equal member of the health care team. I was proud of myself, proud of the flower that my patient gave me, proud of the message from our best surgeon that said 'Good Job!' on my pager, and proud of way I handled a particularly difficult patient, one that no other nurse could stand.

I am thinking about doing a self-defense program for the nurses on my unit. Not now, but later.

my unit, my ball and chain

I'm frustrated. As interested as regular nurses seem to be in doing a service trek, management (especially senior management) is not that excited. Well, we've never done it before so I guess it's to be expected. We will just have to will it into being, without any extra support. Maybe when we do it again, it'll be different.

I feel very tied down in this job, the schedule is so rigid and I know that it has to be, to maintain order with such a large collection of employees. Still, it's stifling.

It's still amazing to sign my name with RN, BSN after it.

ambitious projects afoot

Yesterday was a long, tiring, yet worthwhile day at work. Near the end of my 12 hour shift, I had a patient wheezing loudly and desatting rapidly. Respiratory was paged, without response. The supervisor was paged. No response. 20 minutes later they showed up to give this guy his albuterol treatment. I was fuming mad. Only a few minutes later, I gave a scheduled dose of IV metoprolol to 73-year-old patient with a HR of 77. Less than a minute later, she was bradying down to 42. I stat paged our assistant charge, and then paged her service. She was asymptomatic so I wasn't panicking, just concerned. Everything worked out fine with both patients.

I spent much of the day working out the details of our unit trek to Nepal this coming fall. Springing the idea on my supervisor was nerve-wracking. She seemed cautious and I hope the idea will grow on her. We will be able to put a lot more in stone when the holiday schedule and vacation schedule comes out.

Today I met with the program coordinator for the Alzheimer's and Dementia certificate program at my alma mater. She was ready to sign me up for classes right then and there! Unfortunately, financial and time arrangements prevented that. I am hoping to get started right away and can't help but feel SO excited about it. Just working towards another academic goal thrills me to death.

mandated, schmandated

It's not cool that they mandated me off on my ONLY holiday. I'm pretty sure it's an issue because I was already mandated in September. Totally didn't follow the rules on that one. I wanted the money, dammit!