patience

I've noticed that I have far less patience during night shifts than I do during day shifts. It could be because I'm awake at a time when I should be sleeping, or b/c my patients are awake and needing things at a time they should be sleeping. Either way these last 2 nights have been particularly difficult. I'm pretty sure my patient assignment contributed. I had 2 incontinent, massive patients who cannot move on their own (one of whom is Spanish speaking only, which gets really old and really frustrating when she does not understand or speak one single word of English). But my other patient was the worst. I walked in there and this was our first encounter:

Me: "Hi Mr. J, my name is Nikki and I'm gonna be your nurse tonight."
Patient: "Yeah. I've been waiting... Look. before you do anything or give me any of those meds, this is what is going to happen. You need to get me my 3 PhosLo pills."
Me: "Ok, well Mr. J, you can only take those pills with meals, and you're actually not supposed to be eating. You're NPO because you have a proce----
Patient: "No. I dont care, I'm eating damn dinner. So just get me my pills and when you come back you can help me change out of this gown, get back into bed, and you need to empty all my drains. But I'm going to eat my damn dinner."

...lovely. And of course all you can do is smile at them and do the best to accommodate. I dont ask for much from my patients, just some effort and a little pleasantness. I understand being in a hospital sucks but you're not there to get pampered, you're there to get better. I have no problem helping you do something you clearly have difficulty doing. But, if you're going to demand stupid shit from me (me, your nurse, aka the person who brings you pain medication) like pulling the blankets over you when you're capable of doing it yourself, OR if you're going to ask for my help wiping your own ass (b/c yes, the next thing he needed me to do was literally wipe his ass) then you better F-ing ask me nicely.

For anyone who's ever regretted a drunk dial/text/conversation... :)

"Telephones are, without question, useful devices. But they are also, it seems to me, the verbal equivalent of houses without toilets. Telephones allow minds to communicate with minds (or tongues with ears, at least) in clarity or turmoil, in semisomnolence or drunkenness, in lust, joy, hysteria, stupefaction or any other state that fails to render a human physically incapable of holding up a quarter-pound chunk of perforated plastic - which is most every state there is. That telephones can connect us in seconds to any creature on earth foolhardy enough to lift its own chunk of plastic is wonderful. But it's also terrible, given what a lot of people think and feel about each other. That's why, until they're equipped with some sort of flush or filter or waste-disposal system for the billions of words that ought not to be spoken, I'll not trust the things."
--The Brothers K


(Not that this relates in any way to my weekend. My birthday weekend was awesome and full of drunkenness and fun. It just so happens that I read this paragraph today and thought, "hmm, i can totally relate." :) )

I have amazing friends :)

Thank you to everyone for all the birthday messages, texts, and phone calls! Even though I am slightly bummed about turning 25 and entering the quarter century club, today was a great day. I did have to work though, which was kind of a bummer, but I actually love my job, so its all good. Caroline had the cutest hand-made card waiting for me when I came in, PLUS Lisa baked a DELICIOUS cake: super moist yellow cake with this creamy vanilla frosting with a hint of lime. (Sounds kind of odd, but trust me, it was amazing.) Then when I came home, Laura made me dinner, bought me flowers, and went to Georgetown Cupcake and got me 2 red velvet cupcakes - my absolute favorite!! Have I got a great wife or what? :)



I love birthdays, they make you feel so special. Thanks again for all the birthday wishes! Love you!

Pre-Birthday Day

Today was wonderful. Expensive, but wonderful.

It started when Lisa came over last night to watch the NCIS premiere. NCIS + plenty of beer = random weekday of drunkenness. Awesome. Lisa ended up crashing here last night and then today was a day of pampering. Massages then pedicures. Then tonight was our monthly dinner. There are 5 girls (including me) who all started on our unit at the hospital at the same time 3 years ago. Now Kerri and I are the only ones who still work on 6 Bles so now we get together once a month and go out to dinner and catch up and stuff. Its a great tradition. And tonight we went to this fantastic little French restaurant and wine bar. Delicious. It was fun to get dressed up and go to a nice restaurant, its been a while since I've been to a fancy place for dinner.

All in all, great day. I hardly even care that I have to work on the day of and the day after my birthday. Plus, there is weekend celebrations to look forward to. :)

Day 1 of 3

Alright. I could talk about how today I worked a 13hour day and sat down for a total of 20 minutes all day to stuff my lunch in my face, or how I did not pee for 14 hours (i swear this job is going to give me a bladder infection), or how I dont even feel like a nurse anymore because I spend all my time figuring out this whole computer system and scanning medication barcodes... I could. BUT since I feel like all I do recently is talk about work, I'm not going to. (And I think I'm starting to scare Danielle with all my stories...) :)

Instead, I'm going to talk about my one patient: 50-something-year-old female, s/p liver transplant and the reasons I love her:
A.) She's a nurse practitioner (although this kinda makes me nervous - taking care of a fellow nurse esp as a new grad) and i have much respect for NP's
B.) She's in the Navy and I overheard her using military lingo, which totally make me smile. :)
C.) She's from Boston and has the cutest Boston accent. (And I'm such a sucker for Boston accents, I'm sure you can all figure out why)

So, military speak on top of a Boston accent = super cute. Plus, she was a really easy patient medically, which is always nice. Anyway, she brought a smile to my face. And thats all (the nice stuff) I have to share for now. :)

residents

I love where I work and I love that we are a teaching hospital. But sometimes I hate having to deal with residents. We definitely have some good ones - we've been really lucky because our team lately has been really good. But we currently have one doctor (a 4th year) who is... well, he's not good. He doesnt discuss anything with the team, he just writes whatever orders he wants, and he never returns his pages. One of his first days on our service he took one look at a patient's Dilantin level and decided it was too low. Had he looked back he would've noticed that that particular level was therapeutic for the patient, and he probably would've left it alone. Instead, he decided to increase her PO Dilantin to a stronger IV dose. The patient was later non-responsive and frothing at the mouth. Yep. Good decisions there. ...Another night we had a patient who was practically CODING and he didn't return his pages for over an hour because he was CHANGING A DRESSING. Seriously? ...Yesterday our patient who is ordered for IV lopressor (a beta-blocker) had a BP of 160's/70's, HR in the 70's. Nothing too crazy considering he has a history of hypertension, but he was ordered to get the lopressor so the nurse hesitantly gave it. The following convo took place:
RN: His HR is 47.
MD: okay.
RN: I had given him IV Lopressor and his BP is better, but it dropped his HR from 72 to 47.
MD: okay......? so, what do you want me to do about it?
What?? Are you telling me you're ok with a 73yo post-op patient with a HR in the 40's? How about order something that isn't a beta-blocker? How about switch his medication so that his HR wont come to a complete stop. I mean, come on. ...Doctors. They really should listen to the nurses more. :-p

Ohhh yay for work...

Yesterday/last night was absolutely absurd. First off, I got home yesterday morning at 8am from working the night before and slept from 8:30-1pm. At 1pm, my body decided it didnt want to sleep anymore so I just laid in bed for the next 4 hours hoping that I would miraculously doze off. Didn't happen. Came in to work for night shift #2 after sleeping 4 hours and these are my 4 patients:

Patient #1: Liver transplant, encephalopathic (confused), severely edematous, O2, total care (I'm talking he cant even raise his arms or move his legs), and weighs well over 300lbs.
Patient #2: 80yo female, admitted 2 nights ago for a wound dehiscence (the staples from her surgery busted open). Sweet lady, but very needy; She calls for help for the tiniest little thing and she's terribly afraid of feeling pain. This may be insensitive, but seriously, if you have surgery there's pretty much no avoiding pain. Not only is she a handful to begin with, but the nurse who had her during the day failed to take off any of her orders so I was left to clean up the mess, which meant Patient #2 was going to be on IV medications for the next 6 hours straight. (This nurse is awful. How she is a travel nurse -- no, no, how she is a nurse in general -- is beyond me.
Patient #3: Old small bowel transplant who had his ostomy take down (ask me if you want to know more) with a possible obstruction. Because he's obstructed he's nauseous and to help, he has a G-Tube (tube in the stomach) to decompress the stomach. BUT, he has major pain issues and the only thing he can get is Dilaudid pills every 2 hours (which is not enough to keep him comfortable). The thing with giving pills is that you cannot have your G-Tube suction because you will just suction out anything he swallows. So he has a tube but it's not doing its job because he's taking his pain pills so frequently. If he doesnt take his pain pills, he ends up crying (literally) in pain.
Patient #4: my easiest patient: 70yo female with an abdominal incision that is leaking and therefore needs to be packed and have a dressings applied to it. She also needs IV supplemental nutrition.

So, they're a bit of a handful. Nothing too crazy medically, just all very needy and time-consuming. No big deal. BUT, last night was our "Go Live" night with the computerized system, so the medication pyxis (the machine that holds ALL medications) was down and we had to deal with that at the beginning of our shift. I was passing meds, doing my assessments, charting, etc. and I'm all caught-up with everything by midnight. Pretty good. Well, at midnight, we "went live" and all hell broke loose. The medication machine was still not working, Patient #3 needed his pain meds but I couldnt get them and he needed something to help him sleep but I couldnt contact the doctor to get a verbal order because he was in the middle of a Code. Patient #2's blood sugar dropped down to 51 (low blood sugars = Not Good) and she needed her nerve medication but couldnt get it b/c of the system being down so the only thing I could do was rub her feet. (first of all, gross. 2nd, like i have time to sit there and give you a foot massage, i mean come on.) Meanwhile Patient #1 was confused and needed help going for an MRI (aka two petite girls trying to move very large man who cant even hold his own head up onto a tiny little stretcher with the transporter standing there, useless. Riiiight). All night long we were trying to figure out the medication system, how to chart, and how to draw all of our morning labs, how to check our orders, ALL while still remembering to care for the patients on top of dealing with the computer stuff. It was insane, to the point where it was comical and all we could do was laugh at the situation. I worked from 7pm to 7:45am with no break aka no food. I managed to shove 2 peanut butter crackers in my mouth while running down the hallway sometime around 4:30am so that my stomach wouldnt eat itself but other than that it was basically non-stop all night.

The computer system is good in theory but its all still very new and the transitioning and getting used to everything is the hardest, and at this point there just seems to be a lot of room for error... Which, obviously you do not want when dealing with patients' medications. I'm not back till Tuesday morning so I'm seriously praying that they figure out most of the kinks between now and then. siiiigh, sorry for the rant. Ok, now that I've been awake for nearly 22 hours (and havent eaten in 17), its time for SLEEP.

Can't Sleep...

I always have a hard time sleeping before my 2nd night shift. You would think that after working all through the night last night, I'd be exhausted and sleep all day, but apparently my body just wants to torture me. Today, though, I think part of the reason I can't sleep is that at midnight we switch over to our online charting system. At 12:01am we will start charting assessments online, I's & O's, our Medication sheets will be online, labs will be printed from a hand-held printer, etc. etc. I realize that in reality Georgetown is behind the times since we haven't switched to a computerized system yet, so it is pretty exciting that we're finally doing that, but its also very intimidating to learn all this stuff. I took the class a month ago and haven't really practiced using the system since then, so I can barely remember how to do anything we learned. And lets be honest, what is the likelihood of this system "Going Live" and working perfectly? Georgetown apparently hired 70 travelers just to cover the floors and have extra staff around while we're in transition. It's pretty intense and as if our shifts aren't busy enough as it is, now its gonna take twice as long to get everything done while we figure out how to use the computers. I'm actually kind of dreading having to work tonight...

9/11

To be honest I completely forgot that today was Sept. 11 until I opened my computer this morning to check my email and get on Facebook. Its hard to believe all this happened 8 years ago. I still remember walking in first to my Anthropology class where my teacher was freaking out about something. We had no idea what was going on but we were herded into our gym to listen to some announcement. I had no family in NY so I don't think the reality of it all hit me until I was sitting on our field hockey field waiting for my dad to pick me up. I'll never forget sitting at that spot and being able to see the Pentagon and all the smoke coming from it.

Reading all the articles of people making a difference in the world is touching and heartwarming, but at the same time it makes me feel so bad that I've done nothing with my life. I know countless people who are currently in the military and serving our country overseas and I have another friend who just joined the Navy 2 months ago. But I don't just mean making a difference in relation to 9/11 or serving in the military. So many people make changes in the world everyday, and this kid did it by the age of 16 (he was the feature story on CNN.com today). Sigh, I think all these stories combined with what today means for us has made me wish I had something more extraordinary to say for myself, you know?

Kitchen

I love this bar. Its a small Southern Bar, with country music, and fun people. It's in Glover Park right next to Gin & Tonic. I had never even heard of it, but Chris and Brad had told me about how it's their go-to bar -- it's their MadHatter. I went with Ally a couple weeks ago to check it out and loved it. So I took Laura there last night. Last night there was a bartender who was absolutely trashed. I mean, you just take one quick look at him and know that he's gone. He was hilarious - serenading us to any song that came on, pouring drinks left and right, dancing, etc. He grabbed Laura's drink, took a sip, decided it was no good and threw it in the trash. Then he proceeded to just make shots instead. At one point he took off his shirt and was dancing on top of the bar. He was pretty cute, too. But more than anything he was just really entertaining. Who was he? The OWNER. haha, love it. :)

For the Ocho

...because only you all would understand. :)

So, Steve-O is in town this weekend and we had planned to try to meet up at a bar last night. Unfortunately, we kept missing each other's texts and phone calls so we had no set plans. Laura and I were out at Madhatter and decided to wander over to Rumors...

A little background: Rumors is the bar that Sean and all the Sigma Pi boys used to go to allll the time. A couple weeks ago I ran into Matt Brown out at a bar and we chatted and caught up on everyone's news -- Matt is living with his girlfriend (big move!), Sean is still dating his girlfriend from about a year ago, and he took the Bar exam and moved back home to MA. Matt also told me that they never really go to Rumors anymore -- the Rumors phase is done.

Back to last night: I walk into Rumors and see a guy who looks like Matt Brown. Laura and I did a walk-by to see if we could tell if its him. Still couldnt tell, so we walk across to the other side of the bar so we could get a different view (we're creepers, I know). I discover that this Matt look-alike was wearing a Wake hat and determine it must be him. So I walked over and said hi. Then I proceed to text Steve-o and say, "I'm standing next to Brown, where are you?" Naturally Laura and I do a walk through of the bar to scope out any potentials and to see if we can find Steve-O. I see him standing next to the upstairs bar and he's talking to some guy with a baseball hat. I couldnt really tell but I assumed the kid he was talking to was this guy John (Sigma Pi, '05) who I know, but not that well, so I decide to just say hi to Steve-O and talk to him for a few minutes before saying hi to John. After talking to Steve-O for about a minute or two this other guy leans over to us and says, "umm, hi Nikki..." Oh guess who it is! Its not John. Its SEAN. I had a mini heart attack and was like, "oh my god I totally didnt realize that was you!" Followed by lots of hugs, then small talk, etc etc. It was actually really nice to chat (once I got over the initial shock of seeing him). While I'm back talking to Steve-O, I noticed that Sean was standing next to this girl (and thanks facebook I recognized her as his gf) and he introduced her to Laura, and then leaned over to her and said, "And that's Nikki over there" but we did not get a formal introduction. At the end of the night she walked over to me and said, "Hi Nikki. Sean really wants me to meet you, I'm Allie." So we did the small talk for a little bit while Sean was standing off to the side talking to Laura trying to ignore the complete awkwardness of his current gf chatting it up with his ex-gf. haha good times. :) She went to undergrad and grad school here in DC and is currently a therapist for a private practice up in MA, where she's from. Anyway, Sean is trying to find a job and just kinda hanging out till November when he finds out if he passed the Bar.

But in all honesty, it was kinda nice to see him again (aside from my heart stopping when I first realized it was him). haha, oh Friday nights at Rumors...

I'm a nurse!

Well obviously I've been a nurse for over 2 months, but now I'm actually a nurse on my own! I'm officially off orientation! Yesterday was my first day without a preceptor! Yay! And all of my patients survived. Double yay! :-p

Party Notes

• Firefly is dangerous. And by "dangerous" I mean amazing.
  
• No party should ever be without jello shots
  
• If you spill on our carpet, you will be forced to drink from a sippy cup
• Keg stands are always a good idea
• Why didnt we play more flip cup in college?
• (FYI: My team always wins at flip cup.)
  
• I am nowhere near as good at beer pong when sober as I am when I'm drunk
  
• Late night dance parties are my favorite
• Random drunk boys who want to fight are total mood killers
• Cartwheels across my living room. At 3am. In skirts.