life updates

I haven't posted in a long time... mostly because I've been posting at my other blog. It was a blog about fostering and my pregnancy, but unfortunately my pregnancy came to an end after a placental abruption. I went into irreversible labor and was forced to deliver my daughter, who was not old enough to survive. I named her Avalon. My foster son was returned to his parents permanently in Mid-November, and everyone, including myself, was very happy for them.

As far as work goes, I was on my way in to work the morning I abrupted. I called literally 5 minutes before shift change, panicking as blood was gushing out of me. I've been off work since December 8th, and January 8th I go back.

My life is so different now, at least internally, that it will feel strange to go back to work. I almost wish I could start over, work somewhere new. Maybe most people would want familiarity after such a loss, but I'm feeling like I can't bear to remember how happy and pregnant I was working there before everything happened.

I had some moments as a patient I know will stay with me. There were nurses who made my day (the nurse practitioner who told me to come to triage if I was worried AT ALL, the nurse who numbed me up before inserting an 18g in my arm), and there were nurses who were major FAILS (the nurse who told me the baby would be "disposed of" when I asked what would happen to her body). The doctor who delivered me was also not impressive... when I was complete she ASKED me if I wanted to push. No, of course I didn't! She just kept saying, "you can push if you want to". And if I don't? Jeez. I needed so much more. And where was the nurse? Nowhere.

I also related very closely to those family members we always think should "withdraw" on very sick MICU patients. The patient is going to die anyway, no matter what, so we always think the choice should be simple. Just pull the damn plug already, your loved one is just going to suffer! Nothing's going to change! Well, you know what? My placenta was falling apart and my daughter was going to die, but I still didn't want to be the one who pushed her out, who ended her life with premature birth. I was in very active labor, she would come out no matter what, but I still didn't want to be the one to do it. I get that now, and I wish I didn't.

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!