Finishing up orientation

I've been in a lot of classes, some interesting, some not. I've also had some very interesting patients. Like the patient who was brain dead but whom we couldn't 'pronounce' braindead because he was on 'innercool', a hose that brings his body temperature down to 33.0 celcius. I had a patient that we withdrew care on, and I got to watch her cardiac rhythm go from sinus to all sorts of arrhythmias to asystole. I do feel that for the most part I'm independent, and I have learned a million things and gotten SO much smarter in this short time. I'm going to nights for a week and then hopefully I'll be let loose to be on my own.

4th week ICU

I'm definitely getting more comfortable on my new floor. There is still SO much I don't know, but it will be that way even when I'm off of orientation. I find myself now getting a bit annoyed with having a preceptor. I don't like anyone else adding things to "my" flowsheets, or I sometimes disagree with the way we are titrating the insulin, etc. I guess I'm a bit anal, and fit right in with the rest of the ICU nurses!

Last week I had classes, some interesting, some not. Most of what I got out of it was a sense of comeraderie with other ICU nurses, new and old, and a profound respect for the nurses who have been in it for decades. They are so amazing.

I have been having a lot of difficult discussions with family members about their dying loved ones. It's hard to know what to say to a family that is faced with the most difficult decision of their lives: when to pull the plug, or just stop life support. But as hard as it is, I find myself jumping right in and being willing to have that conversation with the family if they want to. They seem eager to talk to the nurse, to know our opinions, to share their feelings. I don't have the right way of explaining things down pat yet, but my preceptors are good at helping me out with ideas. I didn't realize what a huge part of ICU nursing it would be, dealing with grief and decision making with the family members.

This weekend I tried to relax, sleep in, and work on the yard. I do feel very proud of myself for advancing in my career and being willing to take the plunge into a totally new area in order to learn and grow in my profession. I feel like I am becoming a better nurse, even when it's hard. Add that to the small gardening projects around the house (I'm not a gardening person) and I feel more proud of myself than ever. It's nice to be able to give myself a pat on the back, when I feel so emotionally down.

2nd week ICU

This week I felt pretty independent. Not that there wasn't a lot to learn, but for the most part I felt like I could've done a lot of it without a preceptor. I have to admit- I thought it would be harder than this. The vent and ABGs and pressors and paralytics are really the newest things... for the most part though, it's business as usual. I draw labs myself, and get bladder and central venous pressures, and bag people occasionally. But I had a CF patient that made me feel at home- always on the call light, and in pain. We ambulated her and I bagged her the whole time!

Today my patient had a 1 in 2 million rare lung disease called alveolar proteinosis. It can only be fixed with whole lung lavage. Only trouble is, he can't oxygenate well enough to undergo the procedure- so he is going to placed on ECMO and then they're going to try. This is a ground-breaking surgery, that's never been done on someone this sick, and that could only be performed in a very small handful of hospitals by only a few pulmonologists in the world. I got to listen in on the meeting with the family, and I felt like I was part of a discovery health special.

Of course, this lavage on ECMO crazy revolutionary procedure can't be done tomorrow, because the president is coming, and specialists are prohibited from performing intense procedures that may tie up precious resources... just in case Obama develops a chronic lung condition in a matter of hours!