anybody out there?

I have no idea if anyone actually reads this... but in any case, I'm still here, and still working full-time with a 4 month old as a single mother. No more 3 in a rows at work. The 2 in a rows about kill me now. I have to get up an hour earlier to leave for the babysitter's, and come back an hour later and put the baby in bed.

And I'm pregnant. Whoo. Not yet 6 weeks, but enough to add just that little extra bit (a lot actually) of exhaustion.

I have also been severely irritable at work. Usually I am happy with my job, grateful to be an amazing ICU at such a good facility, grateful to have a job I love that I went to school for. But I'm unable to keep myself from just wanting to snap at the doctor's, and yell at my patient, and stab some of my co-worker's in the eye with a cue-tip. Then I get so tired, at the end of day 2, tears are coming to my eyes and I'm about to just break down like a big blubbering baby begging someone to just let me sleeeeep.

I haven't told anyone at work yet, either, so right now they all think I'm on lifting restrictions, because I won't lift or turn without a lift or extra help. We do it all day long, and I don't want to break my back when I still have my foster son and a big belly (soon to come) to carry around on top of everything.

I don't think anyone has yet noticed that I'm only dipping into the decaf coffee (and I'm usually a coffee addict) or that I'm sweating and about to pass out whenever we're turning and cleaning a really fat patient, no wait, maybe they did notice that. In fact, two co-workers actually said (not seriously) maybe you're pregnant. My job is physically demanding, but many of our nurses get pregnant and continue to work, but I just never realized how seriously hard it is! And I'm only at the very very beginning!

My boss is going to be so thrilled that I'm going to require another leave for the baby. Oh effin' well. I'm so sick of bosses. And bitchy co-workers. And crazy, uncooperative patients. Have I mentioned I'm cranky as hell??

cra-cra

I'm sitting here at the end of a long 12 hours, the first of three 12 hour days in which I won't be able to spend any time with Moose, and what have I been doing all day? Singled with one of our frequent-fliers, in DTs, again, all over the bed, insisting on being butt-nekkid, calling out for his mom, his ex, and asking us to take the ashtray off his penis and get him off of the toilet.

Oh, and last week, we had a young woman who had attempted suicide for the 3rd or 4th or 5th time. We were getting her through the overdose, sitter at bedside, and she got up to go to the toilet. Sat down on the toilet and... plop, out falls a little baggie of xanax from her vagina. Quick as a wink, she fished those pills out of the toilet and got them down before the sitter could even crawl over the bed in search of a call light.

To make a long story short, we ended up with 5 security guards putting her in leathers while she screamed "suck my diiiiick!" at the top of her lungs.

And Mr. Naked man next to me here is chewing up 20mg of ativan an hour like it's nothing but good 'ole NS. These people are so lovely.

big day back

Yesterday was my first day leaving Moose to go to work. He was under the excellent care of his nurses and doctors, but still. It was stressful. Also, I had a long night rocking him and sleeping in the chair.

At 0800, my admission rolled through the doors with no warning or report. A code from the floor, so the whole code team rolled in, with the other 50 med students/gawkers hot on their tails. Oh, and the patient was head to toe covered in blood. As were the members of the code team, and her bed, and her equipment. It was really a sight. After getting her into the room, she lost a pulse again. At least, I couldn't palpate one. I'm not a great femoral pulse palpator though. But anyway, we did more compressions and 1 of epi, we got a good pulse and sinus tachy. It took several of us to organize and clean her up, but we finally got her stabilized and presentable.

Then let the family fun begin! Everyone, especially husband, seemed to agree that with her advanced stage IV cancer, she had already been nearing the end and would not want to spend it on "life support". Ok, that's great, we would withdraw. But no, wait, oh my god, there is a new DPOA form from last night in her file, where she (very strangely) had switched her DPOA from her husband to her best friend, and detailed out that she wanted to stay on a vent until 12 months had passed. What?! Totally different from what her family and friends had discussed with her.

Hours of detective work later, it was determined that she had had altered mental status at the time, some nurse or someone had helped her fill it out, but it was not complete and therefore not legal, and everyone was able to agree that she would not want to live out what remained of her life on life support.

So we withdrew.

Whew. What a day.

the day before Moose

The day before my life changed forever was this last Tuesday. I had a Down Syndrome patient who has a very bleak prognosis. Not that we couldn't get him through the acute phase, but it was difficult to imagine he would have much quality of life anymore. It was so hard on his family, and I really connected with them. I felt like I did some real good in the world when they told me that I explained things so well, and wanted me to talk to everyone else in the family. It seems like a lifetime ago, but it was a great couple of days taking care of them, and made me realize again why I do what I do.

I was also told that some of the "gossipers" had been saying I was lazy. I was so annoyed. Mostly because I don't like to not be liked. I feel like I am SO nice to everyone, and go out of my way to offer my help. If I have downtime, and someone asks me to help them, I'm there in a second. I'm happy to do it. These particular co-workers do not even talk to me. They don't ask me for help or include me in any conversation at all. Nevertheless, should they ask me anything, I would happily help out.

Grrrr. I really don't like that feeling. Such snobishness. It's way less than on my last unit, but it's still there. I just don't have thick skin, no matter how I try.

So on Tuesday I was glued to my phone (even though I try never to carry my phone around with me while I'm working) because I was waiting to hear if I would receive my very first foster placement since I was licensed in April. And it happened. I am now the proud (tired) foster mom of an adorable 3 month old little boy I call "Moose". He was a premie at 29 weeks, so his adjusted age is 3 weeks old. I love him to pieces!

The nursing part of all of this is that he's still on O2, and I'm managing his sats and tracking how much O2 he needs until his next steroid injection. I've got a little O2 and HR monitor, concentrator, and humidifier all set up. It's the little mini one baby ICU in my living room. It has made becoming a mother overnight a little easier, because I can feel so in my element as half nurse as well as mother.

If you want to follow the my foster care story, head over to All My Pretty Ones.

exhaustion

Am I getting old or something??? I'm only in my late 20s! But whenever I work 3 12s in a row, I just am plain exhausted the next day. I can't fight the sleepiness. I sleep for around 24-36 hours afterwards! I do struggle with Excessive Daytime Sleepiness but the 3 in a rows really exacerbate it. I guess I can't do it anymore.

On the other hand, it's not like my job is THAT strenuous! I had one day with a floor status patient, who generally just slept, and two days with a filter patient who was out of it. So what did I really do besides just hang out, change the filter bags, chart things, and do one bath? I mean, that's not exactly hauling bricks for 12 hours!

I have to get my sleepiness under control. I will be going to the sleep clinic. In the meantime, working on going to bed earlier and trying to stay more active and busy during the day. Bah.

In other work-related news, I am running another clothing sale. When I first joined the ICU I immediately wanted clothing with our unit logo. They said sure, go for it. Apparently if I wanted to do that, I'd have to set it up myself. I did and it went pretty well. This time I've gone with a different company, and offered some different clothing items as well as taking away the scrub options. We're allowed to wear t-shirts/sweatshirts and by and large that's what everyone wants.

I enjoy doing these sales because it gives me a chance to interact with my co-workers and do something for them and the unit.

Ah just remembered a dream I had where I found out some of my co-workers didn't think I was good at my job and resented me taking filter patients. Ouch, insecure much?

I dare you

I did tube feed shots with an intern. Osmolite 1.5. I thought it would have a vanilla-y taste.

It didn't.

Liquid cardboard, concentrated, soaked in whole milk.

Bottoms up!

overheard a resident saying...

"What?! Wikipedia was WRONG???"

It's July!!!

The new medicine interns come in at 5am sharp (about an hour and a half before they really need to), with starched and ironed, never-before-worn LONG white coats. The ICU nurses are watching them. We can smell fear. The corners of our lips our turned up in a slight, patronizing smile before they even open their mouth. We are prepared to teach, but we can't really keep a straight face. We're braced for the worst. They are fresh, eager, faces rigid with the effort of keeping up, let alone staying a step ahead. We are waiting for them to declare themselves to be either one of two things: 1) total moron. 2) pretty good for your first month!

Meanwhile, orders are written in strange ways. Seniors look haggard, their eyes bloodshot. Following an update from the "doctor", family members are often left standing with big WTF??s written on their faces, as the nurse breezes in to translate (or correct, or explain 'differently'). Everything will be OK. The nurses will take care of you. We've got this. We'll get through a month of snarky comments, eye-rolling, and patience-trying teaching moments... and hopefully our new interns will leave our unit primed and ready to take on the world.

I love July.

new foster/ttc blog

I had to move my foster care/trying to conceive blog for privacy reasons. 27andfostering no longer exists. If you follow me here and would like to follow that part of my life, leave me a comment here.

why we do what we do

...because I had a thank you card from a patient and his family member in my mailbox, with a gift certificate. I only had this patient when he was admitted, and one other night. What made the difference was the time I spent talking with his mom. I knew she needed someone to just listen and connect with, and luckily I had the time that shift.

After everything that's happened, I'm going to probably scan my thank you notes and put them in my file!

super-size weekend

What the heck? Why did all of my patients (all two of them, but all sounds better) suffer from morbid obesity this weekend? The first had a panus made of steel... it took a strong couple of arms to lift it so I could get in there, elbow deep, and scrub it up. But damn, nursing has been doing a good job with her, all of her nooks and crannies were intact and yeast-free. Unfortunately, when she sat up for PT, the panus weighed down her thighs, so she could not lift them to march in place. Good god. It's terrible.

The second patient I had weighed over 500 pounds! He was also extremely tall, perhaps verging on giantism. Still, his BMI was about 55. He was too long for our beds, even the bariatric beds. And he was right at the weight limit for our ceiling lifts. He had lymphedema of one of his legs, and this leg alone probably weighed about 100 of those pounds. It took five of us to bathe him.

I don't know what's going on anymore... obviously morbid obesity puts you at greatest risk for landing yourself an ICU bed, but daaaamn. I'm going to kill myself lifting and turning these people!

And just for fun, I will share with you what a terrible condition lymphadema is... the below photo is not my actual patient, but is quite similar to what he was suffering in one of his legs:



Thanks to TAFA Healcare corporation for the photo.

two successes

1) My fourth time putting up a new set for the CRRT. I did it with NO help this time. Got all of the supplies, returned the blood, flushed the sorensen with heparin, took the old set down, put the new set up, hooked everything up into the right place (I think), re-attached the patient, hit the "continue" button and... BOOM shaka-laka! It ran! No hitches! No alarms!

2) Got one of the "Making a Difference" awards that patients or their families can submit about staff members who they felt were excellent. I appreciate the family who nominated me more than they know, because these are all submitted through our managers, and god knows I needed a good mark on my record after everything that's happened.

Take THAT HR. Treat me like a 'bad nurse' and I'll prove you wrong every time!

Also- it's been 10 months since I had a discrepancy in our (Pyxis equivelant) machine. I promised my supervisor I'd make it to one year discrepancy-free. Let's just say my discrepancy track record was NOT GOOD. But here I am, 10 months discrepancy clean and sober! I think he should by me a cookie from the cafeteria when I get to my one year mark...

P.s. I was not snagging narcotics from the machine. Most of my discrepancies were witnessed countback or return errors.

it's still not official

But my manager pulled me aside to tell me that it's going to be a written warning.

I'm ecstatic, really I am, that I'm not getting fired for this bullshit. But even getting a written warning irks me a lot. If they audited every nurse on say, one unit, they would end up with half of the nurses there getting in trouble for viewing files of spouses/family members because they had their verbal permission.

It's just ridiculous.

I've had two floor status patients the past couple days, who were actually really pleasant and appropriate. If all floor patients were like that... ok, I still wouldn't like it, but it was ok for a couple of days. Both were very liberal older people, who liked to read and discuss politics/culture. Very enjoyable conversations actually!

As opposed to the patient I have today, who is much more my cup of tea (elderly, demented, on pressors, lined up) who screams at me every time I try to do anything, and gives me snarky comments when I do something he actually wants. For example, "the lights are too bright". I shut off the lights. "There ya go! It's just one brilliant break through after another in here..." he says.

Basically, it's nursing heaven for me: elderly gentlemen, end of life discussions, pressors, arrhythmias... but I get to go home at 1pm, downstaffed! (I'm on overtime.)

when I was just a little nurseling

I remember this day clearly: I was between my 3rd and 4th year of nursing school, and I had the opportunity to spend a day in the ICU (the one I work in now!). And I HATED it. I couldn't for the life of me understand why those ICU nurses were so crazy about their jobs!

Here it is, my post from 5 years ago: ICU not for me

this is getting boring

It's going to be one boring nurse blog if all I ever write is "they still haven't told me ANYTHING!"

My union rep assures me that no news is good news. Something like, "oh we forgot all about it! And we think we'll just leave it that way. Now go be a good girl and follow all the rules." That would rock my socks!

I've had another whole week off, thanks to downstaffing last weekend. Our census has been at an all time low. Last week I went in and there were 10 empty beds (out of 20)! I have never seen that before! We were running with 8 nurses! (Usually we run with 13-15.) And you know what 10 empty beds really means, right? It really means 10 potential admissions! Not all at once of course, we staff for 3 possible admissions per shift.

So where are all the sick people? Is it too nice out, you'd rather die peacefully in your old age sitting out back, watching the sun set, hearing the birds chirp, drinking your favorite mixer, wearing comfy pjs and listening to your fave tunes? You prefer that to a tube in your urethra, anus, nose, airway, arteries/veins, and several fancy/expensive machines to beep/alarm and otherwise lull you into the great beyond? Even if I promise to hold your hand (for 30 seconds, with a glove)?

Ok fine, have it your way. Stay home. We always have our loyal livers to rescue us when respiratory failure and sepsis are scarce. There will always be alcoholics with GI bleeds, and drug users found down, and our 10 empty beds have been waiting for them with open arms.

therapy

I have done two things today:
1) Seen my therapist
2) Retail therapy

There may be other therapies in which to partake while I await the judgment...

this nauseating wait

No news again today, except for them to say they "need more time" to discuss.

How hard can it be? It wasn't a complicated case! Argh!!!

my weekend in the stocks

I am serving my first sentence for violation of THE PROTOCOL: A 3 day wait to hear what my punishment will be.

Trying to say "chin up!" in my head.

HIPAA is not a joke

I got one of those nasty surprises from work, the one we all dread deep down... an email that I'd done something horribly wrong pertaining to accessing patient files (didn't say exactly what the situation was) and they had scheduled a disciplinary hearing. I confirmed that I would be there and my head was in a total tailspin. What did I do??? Was I going to be fired for whatever it was??? I've been shaky with a roiling stomach ever since. This is my job, my identity, my income, my career, my lifestyle.

I'm so lucky to have a union. I called my union rep, and she was able to tell me the details. Long story short- I had been randomly audited, and "dinged". Yes I accessed this person's files, but I had their full permission. However, said permission had not been submitted as per protocol before I accessed the files. Therefore, I was subject to investigation and discipline.

Lucky for me, I was able to obtain a written signature from the person prior to my disciplinary hearing, that she had given me permission at the time. But even that seems not to be enough. Although they seemed to hint that I would not be fired, the type of disciplinary action they are going to take will not be revealed until Monday, another particular form of torturing me for my failure to comply with protocol.

I have to say, though, that having the union behind me was a big help. My rep knew the procedure and the history of similar cases and was able to get me through it, just like a defense lawyer, I guess. She's got a lot of power, and the administration repects and listens to her. They believe me that I had no ill intent to spy on this person, as this person testified on my behalf, but to what extent they still feel the need to punish me I don't know.

I'll be happy with a written or verbal warning.
Anything more than that, and the union and I will contest the action.
I hope and pray it doesn't come to that.

You cannot even open your own minor childrens' files if they are age 10 and up, even in emergency situations, without prior written consent from THE CHILD on file.

Follow those rules, guys!

free time

So what does an ICU nurse do when she's not working overtime every day?

Why, I hardly know what to do with myself!

Luckily, it is a very warm Memorial Day weekend, and I have gotten all my gardening done, and some swimming, too! Also had lovely visits from friends and family every day. I heard they had to mandate nurses home for the holiday. I will be doing a few night shifts starting Tuesday night, which is a nice way to ease back into it. Having 5 days off in a row has seemed like a vacation to me!

babies

Also, since both of these blogs are anonymous, I figure I can keep them connected. I am a licensed foster parent now, awaiting my first placement. I am also trying to get pregnant, via sperm donor. So if you want to follow those sagas, this is the place: 27andfostering.

my favorite patients

#1) 80 something year old woman with end-stage lung disease, no longer able to live without a BiPAP (seriously, desatted to 70% within seconds of removal). Her whole supportive family was right by her side every minute. She was totally out of it, and the daughters decided they would withdraw care later and go to comfort care. Then... snap! Old lady woke up and started chatting and being totally appropriate! So, I encouraged the daughters to talk with her about HER wishes and if she wanted to proceed with comfort care. (Big change of plans in unconscious to consious patient!) Guess what, she told me she was "ready to go". She made her own decision, and the rest of her family arrived, including guitar-playing great-nephew. They had a champagne toast, cake, sang the fight song of her favorite team, and then she called me in there. She thanked me for her outstanding care and said she'd chosen the best hospital to come to. Then she folded her hands over her stomach, leaned her head back, closed her eyes, and said "ok, I'm ready!"
I started morphine. We turned the BiPAP support down a little bit at a time, until we eventually removed it. She slipped away within an hour, no gasping, struggling, or anything else we typically see. She simply closed her eyes and slipped away.
It was PERFECT. And the reason I do what I do.

#2) My patient yesterday was a touch delirious. He was extubated but re-intubated during the night. I went in to turn him after having been in a staff meeting for 45 minutes, during which he'd been sleeping. This guy had mitts on, because otherwise he would extubate himself. But boy did he HATE those mitts! He even tried to bite me sometimes when I put them on. So I went in there to turn him, and oddly, he was totally unresponsive. Like, only responding to sternal rub, but no longer interactive or looking around per usual. I went and got the resident. We both tried to wake him. We couldn't figure it out... all vitals were the same, labs and gas looked good... did he stroke out??

Jokingly I said to the resident, oh I know how to tell if he's awake or not! "*Patient*, do you want me to put your mitts back on??" Suddenly, *patient* shakes his head emphatically NO! WHAT???? Gasp. He was FAKING it??? The resident burst out laughing. She said, "I think he just doesn't like you!" Not true! I replied. "*Patient*, you like me, don't you?" He shakes his head no. I can't believe it! The resident is laughing more. I said, "*Patient*, you don't mean that, do you??" He shakes his head no.
Aahhhh I love these delirious patients! What a hoot!

#3) Ok not a favorite patient, but a least favorite patient, perhaps. 50-something-year-old male cocaine user, found down by his ex-wife, from whom he stole thousands of dollars that day. He came to me with a positive head CT, minimum reflexes, blown pupils, etc. He was labile, and temp climbing up to 106.9. His parents had the DPOA power since he was divorced, and they made him a DNR, but not a withdraw. Soooo... I slaved away to keep this brain-dead guy alive. Then the ex-wife comes running in, having finally found a sitter for her two small kids (patient was the dad), madder than a hornet, just having found out that she had NO money anymore. Oh she believed he had quit the habit, it all started up again when they lost their house a few years ago, but he PROMISED he wasn't going to use ever again. She has no money, no job, two kids, he's left her with nothing. My scrubs were wet with her tears.
SOCIAL WORK CONSULT!!!

The patient died within hours, after his mom in Denver told us to go ahead and stop treatment, it being obvious from a pH of 7.0 and our total inability to oxygenate him that he wasn't going to last anyway. Not to mention the fact that he was HERNIATING.

But I talked to the ex-wife throughout, and she kept saying how nice I was, how much it meant to her. I'd like to think I did just a little tiny bit of good in her world, that day.

hunka hunka burnin' love

That was what I called my patient, the cocaine addict found down, when his temp hit 41.6 degrees celcius (107.0 degrees fahrenheit!). Then the next day I had a 21-year-old college kid, in the ROTC, who ran 9.5 miles in heavy gear, go down with heat stroke. He was intubated, and I got another interesting admission. HIS temp had peaked at 41.7 degrees in the ED! Hot damn!

So for the second day in a row, I threw my liters of saline into ice water buckets before infusing them, created wind tunnels with fans, and packed people on ice. In the ED, I heard that they also draped him in a cold wet sheet. There are such thing as cooling blankets, too. But that's awful high tech (and takes a long time to arrive from central stocking).

So, heat wave in the ICU this May.

get your DPOAs in order

Seriously. Just do it.

Patient W sat in our ICU for weeks, never better, but never worse enough to declare himself. He had lived for 15 years with his wife and her daughter. They were at his side throughtout his ICU stay. They were his family, without any legal rights. His biological family was a hot mess. Security was called on them several times. His DPOA fell to his mother, who had dementia. He was not legally married and had no legal children, so that's the way it was. The family didn't like his significant other or her daughter, but then, the family was never around him while he was alive. But they felt so important once he was mostly dead and they were being asked to make decisions on his behalf.

If you want someone to speak for you or have a say in your medical care when you cannot, for god's sake, get the paperwork done. You may not like whose lap it falls into!

Eventually, the patient declared himself and died. The daughter of his long-term partner, who was his daughter in every way but blood, called and specifically asked for me (when I was caring for a different patient). She wanted to tell me how much my care had meant to her and her mother. They had stopped coming into the hospital because of the crazy family drama, and because they knew he was gone but couldn't bear to watch his body suffer. They had said their goodbyes and knew that he knew he was loved by them.

So sad. I'm so honored to have given them what little comfort I could.

seriously?!?

The shenanigans need to stop!

I was the most upset I've ever been when a co-worker "reported" me to the supervisor for the following things: initiating an insulin drip prematurely, left a primary pump infusing normal saline at 270cc/hr (as a flush), and did not document 10cc/hr saline drip that was running all night.

Lordy. Upon further investigation, the supervisor decided that my initiation of the insulin drip was not inappropriate at all, and he would have done likewise. The other stuff is too ridiculous to comment on.

Also, two staff members, who went unnamed but who supposedly are not tattle-tales like the other nurse, said that I had been using the a dictionary website too much during my shift. Well well well... is my bookwormish getting to people? I had a super easy assignment that weekend, and made a point to offer my help to EVERYONE else. It's perfectly fine for people to sit around chatting, or go out for smokes, or stare into empty space for long periods of time, but not ok for me to use a dictionary???

All of this may not have been a big deal except for the fact that I was in an extremely fragile emotional state that morning. I was going through a break-up, fighting off a cold, and just finished with a string of night shifts... among other things. Then I had to deal with all that nonsense. F'd up I tell ya.

Why I don't like quads

Subtitled: Why I feel like a heartless bitch when I take care of quads.

You know, it's 7am, everyone is choosing assignments, and the last assignment to be chosen is likely to be the assignment that includes a quadriplegic. Make that an AWAKE quadriplegic. NO ONE deserves more sympathy than these folks, perhaps. It is a fate worse than death, to have lived your life in a healthy body, independently. And then... you can no longer do anything for yourself. Yes it's terrible. And each time I take one on, I try to talk myself into being the most saintly, patient, sympathetic, compassionate nurse ever to walk the planet.

But you know what? Within 10 minutes, at least 20, they have completely 100% DRAINED THE LIFE out of you as a nurse! You spend the rest of your 12 hours wishing you had chosen any other assignment but this one, because not only do your hate your patient, not only is he spitting and clicking at you even though you just spent 30 minutes in his room getting his pillow in the right place, NOT ONLY have you also catered to his super annoying relatives as if they were the gods, but now you also feel extremely guilty for how much you hate this poor pathetic patient!

Yeah 12 hours is about all I can do in, let's say... about 6 months. That's my quad time. Then I'm out.

And if you're judging me, go ahead, think it. I don't mind. Because I have a reputation for being one of the biggest pushovers to have for a nurse, any awake patient can tell you. There's nothing I won't do for them. This chair is uncomfortable? I'll get you a better one. You want a milkshake, with half chocolate mighty shake, half vanilla ice cream, a dash of 2% milk and half a cup of half-melted ice chips? Yes, I'll make it for you. I'm THAT NURSE. And still, quads drain me. They drain me fast.

admit/discharge

Today I admitted a rapid response patient from the floor. He was struggling for each breath, and decided he wanted to be intubated. He was a cancer patient, age 60, and had previously been a DNI/DNR. When they can't breathe, it's so scary many patients change their mind. As we were preparing to intubate, he told us that he did not want ACLS, compressions, defibrillation, etc if for some reason his heart couldn't take it.

I explained everything in a calm voice while chaos swirled around him. I told him we were going to put him to sleep and he wouldn't feel the breathing tube being put in. That he wouldn't remember it and would wake up later. But he didn't wake up later. Anesthesia intubated, he bradied down, dropped his pressure... we gave fluids, 1 of epi, and 200mcgs of phenyl. He lost his pulsed. We stopped. He was pronounced.

It doesn't usually happen like that in my unit. People usually come to us almost dead, or they slowly slip away throughout their stay with us. They aren't usually talking to us one minute, dead the next.

The daughter almost threw up when she came in, she was crying so hard.

My other patient's daughter said to me later, "I think I saw a dead body being wheeled out of here, oh my god that was horrible." I said, "yes, that was my patient from this morning. He didn't make it." Her jaw dropping, "How do you do this job?!?!?! I'm so glad I'm a teacher!"

by the way

I just realized that I never mentioned that I passed my CCRN. With a terrible migraine, I might add. Wow, it's a hard exam. About half way through I started making guesses, because my head was pounding. It's a miracle that I passed, but I did. Damn, I must be smart! Heh heh...

I've been making some sweet overtime money, but I'm about to go on a four day stretch, which I haven't done since Thanksgiving, and man that was rough. I just go into it like a soldier going off to war. If I'm lucky, I'll stay at a friend's house near the hospital for optimal sleep time.

Yesterday, I was singled with a patient with a wound vac. The wound vac cannister was filling up hourly, she was weeping from everywhere, and leaking from her Dignicare (rectal tube). So, she was busy. But for some reason known to the charge nurse only, I was given a second patient at 3pm. I guess I didn't look busy enough with the one. The 2nd patient was also very busy. Bleeding out, in fact, with a case of refractory ITP that no one knows what to do with anymore. So JUST because she was a DNR/DNI, did NOT mean that she was comfort care! Which means she was still a lot of work because I was massively transfusing, using pressure bags for the blood products and fluids, just to keep her pressure up. Because of course it bottomed out, and the family started arguing about using pressors, and I had to stop the whole show and get the (still mentating) patient to make her own wishes known. She didn't want pressors. Which is fine, but that's actually MORE work for me, not less, because that meant 6 liters of fluids to pressurize into her lines. All the while delegating everything for my other patient to other very helpful co-workers.

Anyway. She stabilized but I don't know what ended up happening. All I know was that I got out a half hour late. And that annoys me. Also, the honey nut cheerios I finally opened, and had a mouthful of when her pressure tanked, were just a cupful of soggy mush when I finally got out of the room.

Just another example of a day in the life of a nurse like MOI!

Anyway.