a little bit about me

I have had a fever of viral origin for over a week, continuously. This morning I woke up fever free, but found that I could not blink or close my left eye. I had a dentist appointment, and he found weakness of my cheek, eyelid, and lip muscles on the left side when grimacing, smiling, puckering, and squinting. I had no right-sided weakness on the rest of my body. My eye is very dry from not blinking, and I also discovered that I cannot taste anything on the top or left side of my tongue. What I can taste on the right side has a strong metallic aftertaste.

I'm lucky that it's mild enough that I don't look completely odd, I can still make facial expressions with just a bit of droop or stiffness on the left side. Such a mild case should be totally resolved in two weeks. I'm on an antibiotic in case an infected tooth nerve root led to the inflammation, but it was probably the virus with the high fevers.*update* A family friend just happens to be a facial paralysis specialist. She started me on a steroid burst and antiviral.

From The National Institute of Neurological Disorders and Stroke:
http://www.ninds.nih.gov/disorders/bells/detail_bells.htm

What is Bell's Palsy?

Bell's palsy is a form of temporary facial paralysis resulting from damage or trauma to the facial nerves. Each facial nerve directs the muscles on one side of the face, including those that control eye blinking and closing, and facial expressions such as smiling and frowning. The facial nerve also transmits taste sensations from the tongue.

What Causes Bell's Palsy?

Bell's palsy occurs when the nerve that controls the facial muscles is swollen, inflamed, or compressed, resulting in facial weakness or paralysis. Exactly what causes this damage, however, is unknown. Most scientists believe that a viral infection such as viral meningitis or the common cold sore virus—herpes simplex—causes the disorder. They believe that the facial nerve swells and becomes inflamed in reaction to the infection, causing pressure within the Fallopian canal and leading to ischemia (the restriction of blood and oxygen to the nerve cells). In some mild cases (where recovery is rapid), there is damage only to the myelin sheath of the nerve. The myelin sheath is the fatty covering-which acts as an insulator-on nerve fibers in the brain.

The disorder has also been associated with influenza or a flu-like illness, headaches, chronic middle ear infection, high blood pressure, diabetes, sarcoidosis, tumors, Lyme disease, and trauma such as skull fracture or facial injury.

updates

- My CCRN exam is set for the 28th of November.
- We ratified our nurse's contract. I think our show of numbers and solidarity really made a big difference.
- The virus I had with continuous fevers caused me to miss three days of work and ate up all my PTO. And I feel really, really out of sorts without going to work.

they don't make this easy

I've had seasonal influenza for the past six days. I had to call of to work this weekend, that's 24 hours of paid time off. I'm supposed to work Monday as well, which is tomorrow. If I don't go, I will only have 4 hours of PTO left. In our institution, you absolutely CANNOT call off without enough PTO in your bank to cover you. So I'd be ok, but god forbid something else happen this month.

I have been feeling better, and would like to go back to work tomorrow (get me out of this house!!!), but I spiked a fever last night, again. And I know that I shouldn't be returning to work without it having been 24 hours fever-free. Which means if I don't spike a fever all night, I'd be fine. But if I did, it would be too late to call in!

And most importantly, I take care of patients who are severely immunocomprimised. It could kill them. I guess that settles the whole argument.

Isn't it sad that administration can put such fear into their employees for calling in, when it can be a life or death situation?

the good fight

Soooo my nurse's union, part of National Nurses United, has been struggling to settle a contract with our administration. We've been picketing (not striking), marching, rallying, and showing up to every meeting and press release we can. The administration wanted to slash raises, double healthcare premiums, limit scheduling flexibility, ramp up disciplinary actions, take away healthcare coverage for those on extended childcare leave and disability leave,raising the age of retirement, and other unmentionable acts. They claimed that the current state of the economy leaves them no choice but to slash the nursing budget. And yet our health system has been making money and increasing bonuses and salaries to those at the top for the past three years.

Our bargaining team has announced that a tentative agreement has finally been reached. The administrative seems to have backed off of some of their demands... in response to nurses showing up in the THOUSANDS to protest! YAY nursing power! Yay to the little people! Yay to patients who have happy nurses who are proud of the work they do and the people they work for!

Will I vote yes on the ratified tentative contract? That remains to be seen.

raising the bar

I'm going to take the CCRN... I paid the money, I've been studying (sort of), and I got my authorization to test in the mail. And then I lost it. So I am now trying to get a new one, even though the card said "DO NOT LOSE THIS NUMBER". Hopefully the receipt for the huge fee I paid to take it will be good enough to get another card.

By the way, I'm just a sucker for certifications. And tests. It makes me feel better about myself. It's just a test, doesn't make me a better nurse! But does provide a great learning opportunity. Oh, and I don't get paid more.

scared of the SICU

MICU vs. SICU... is this a problem anywhere else?

MICU says... SICU nurses are uptight, snobby, picky, and generally assholes. This may be attributed to the fact that surgeons think they are gods, therefore SICU nurses think they are demi-gods.

SICU says... MICU nurses are too laid back, give too much fluid, deal with too much poop, and have patients who are generally too whiny, uninteresting, and die too often.

Yesterday I was super tired, so went downstairs for a cup of coffe with an extra shot. Went back up the elevator, got off, went around the corner into the unit. Noticed a new sign above the badge swipe-in. Then noticed that the lighting seemed different, and the blinds on the break-room window were closed. I stood there blinking and feeling disoriented. Then noticed that the people around me looked "uptight, snobby, picky" and busier than usual. Then noticed I didn't recognize a single one of them. OOPS, I walked into SICU, not MICU. Got off on the wrong floor. And I high-tailed it out of there. WHEW... that was a close call.

finding my talents

I came to the ICU because the thought of sedated, intubated patients filled me with warm, fuzzy, relaxed feelings. I settled right in, turning my patients and giving meds without any arguments or cajoling or convincing on my part. Hey, this is the life, I thought. But after 8 months of mostly comatose patients, I was startled to find where my real talent (and passion) lies: interacting with families (and the occasional patient).

From an earlier note:
A patient I had recently, dying of cancer without treatment options, leaving a young son behind as an orphan, grabbed my hand and looked me in the eye at about 3am, and said to me, "Every moment of this life is precious. Live EVERY day as if it is your last." Those are a dying man's last words, and when I said thank you to him, he said "don't thank me, those words come from God". And I believe he may be right.

That was an awesome experience and reminded me of my old floor days, when I was always pre-selected to care for "especially difficult" patients and families. I think I did a good thing, even if all I did was listen and hold his hand. It was a unique gift to give.

I've also found another strongsuit of mine- helping families come to terms with choosing comfort care over continuing aggressive treatment, comforting family members during codes, explaining treatments and outcomes sensitively to overwhelmed family members, etc. For someone who wanted to get away from a lot of "people-interaction" by coming to the ICU, I've found that family-interaction is always the most rewarding part of my job!

Just the other day, a co-worker received a coding patient from the floor. Her very nice family waited nervously in the hall while we tried (and tried, and tried) to place a line so we could get a blood pressure. Pressors were maxed. Her family very appropriately changed her to a DNR. She was intubated, had a heartbeat, but no blood pressure that anyone could discern. The patient's daughter stood by anxiously (the rest of the family waited outside) so I went to her side and gave her a realistic, but sensitive, update. I immediately discerned that although she had wanted us to try, if our efforts weren't successful, she was ready to let her mother go. I was the one who pulled aside the senior resident, and said "the family is ready to discuss withdrawal".

The whole unit breathed a sigh of relief. The nurses and doctors had all been muttering under their breath about our wasted efforts, but no one had gone to the family members to give them a realistic picture of the patient's condition and assess them for their readiness to withdraw. The family chose to withdraw and extubate 20 minutes later. Both daughters cried and asked to hug me. She was not my patient, but I felt like the family members were all my patients.

Another man I admitted by jet (yes, I love our huge, rich hospital!) was being placed on ECMO after coding and maintaing a PO2 of 42 for more than 2 hours, without a blood pressure compatible with life. Although the surgeons refused to stop cannulating for ECMO (gotta love those surgeons, they just never give it up!), I went to the waiting room to talk to the family members, who I'd meant when he was admitted three nights ago. I knew he wasn't my patient anymore, but I felt the need to check on them. I brought tissues, and asked what additional questions they had at the moment. I explained what was going on at the moment. I only gave them the info they were ready to receive. I hugged the wife and then left. I hoped it made a small difference.

I also had a wife of a patient, who was a nurse, tell the other nurses that I was her favorite and a wonderful nurse. How sweet!

I'm moving to day shift, and I'm excited to have even more interaction with family members, and participate in rounds and plans of care in the morning. Oh, and finally having a normal sleeping schedule.