Christmas Spirit

I am normally the type of person who starts listening to Christmas music halfway through November. I have decorations up the day after Thanksgiving. I get my Christmas shopping done early, and I am always super super excited about the holidays. For some reason this year I have been totally lacking in Christmas spirit. Up until last night I was incapable of listening to xmas music. (No seriously, I would try but when I'd listen to a song, about 1 verse into it I'd have to change the radio station. Weird, right?) And I've been totally slacking on my shopping ideas. I dont know if its because I havent gotten around to decorating so it just doesnt feel like Christmas, or if its because I have a shitty work schedule (Christmas day is day 1 of 4 in a row. I know, it blows. I dont want to talk about it) so I havent been excited about it because I know I wony be able to enjoy it as much as I'd like. Either way, someone/something stole my Christmas Spirit. I even tried watching Elf, which of course I thoroughly enjoyed, but it still didnt put me in the Christmas mood.

But! I am excited to say I finally found it! My Christmas Spirit, that is. Yay! It took my parents forcing me to decorate the basement and a little help from the cast of Glee singing some Christmas carols, but I'm FINALLY excited/ready for Christmas! The decorations are up, the tree is lit, most of my presents are wrapped, and I finally watched Love Actually, which is the true start of the holiday season. :) Yay for Christmas!!

seriously?

Just another example of how RIDICULOUS patients (and their families) can be:

Dr. P: Did you hear about what happened when [Ms. W] tried to leave AMA?
Me: Oh yeah! She locked herself in the bathroom and then tried to walk out naked?
Dr. P: Yeah, J. sat down and talked to her to try to find out more information and discovered she has an extensive psych history. And apparently the whole family banded together and lied so she could [pass the psych eval and] get this transplant.

WHAT.. THE.. F..!!! SERIOUSLY?! There is a reason we work-up patients for transplants and they have to be cleared by psych. I cant even begin to tell you how much it angers me to see patients get organs (organs that HUNDREDS of people are waiting for) and then they just let it go to waste. If this patient is not capable of taking care of herself and her new organ, she has no business getting one. AND! What makes it even worse is that after the family LIED to get her this surgery, they dont even want to take care of her!! Are you F-ing kidding?! If you're going to cheat the system so your family member can get a transplant, the LEAST you can do is make sure she keeps the damn organ! UGH.


And another story, just for fun:

We have a patient (23yo female) who just had a small bowel transplant. She's kind of a pain in the ass-- super needy, obnoxious, you know the drill. And the mother is about 20 times worse-- demanding, in-your-face, head up her own ass, etc. (To paint a picture: they threatened to leave Against Medical Advice while the patient was getting pre-op'ed because they didnt have a private room. In other words, the doctors were in the process of HARVESTING THE ORGAN so she could get the transplant and they threatened to leave because she had a roommate. Are you kidding?! You're going to be in that room for 3 hours and then you're going to go to surgery, you ungrateful little brat.) So basically the mother thought her daughter was not getting adequate care and thought she herself knew better. She has no medical background whatsoever, mind you. So she decided to mess with her daughter's IV pump and turned it off. Then a day or two later the patient starts screaming in pain and the doctors decide she needs emergent surgery and when they're in the OR they discover that she clotted off part of her NEW bowel (she had a blood clot that inevitably blocked blood flow to her bowel thus causing part of it to die). Needless to say, she had to have a portion of her NEW bowel removed and almost lost it completely. Hmmm, well Mom, maybe if you hadnt turned off her HEPARIN DRIP, your daughter woundnt have clotted and would still have a fully functioning, complete bowel. Because of you, a perfectly good bowel nearly went to waste. Next time you should probably leave the medical/nursing care to those who are properly trained. IDIOT.

I swear some days it really takes all that I have in me to not yell and slap some sense into people.

happiness

omg, this video just makes me so happy. :-p

Day shift???

I've been working a loootttttt of nights recently (i think in the last 5 weeks I've had 4 day shifts) and the minimal day shifts I've worked have been weekends or I've been precepting a new grad (aka the shifts have been cake). Today was the first day I was an actual nurse during a weekday day shift in I dont even know how long. I figured the day would be busy, but I was not expecting a day that was borderline insane. I am going to steal D's idea of letter-writing to elaborate on my day:

Dear Intern who decided it was necessary to call me and interrupt my 3pm lunch break to fax an order to the pharmacy,
Are you kidding me?? Faxing orders is the Secretary's job. It's what we pay her to do. Do NOT interrupt my first and only attempt of the day to sit down just so I can do her job. Did I mention I've been here since 6:45am and it's now 3pm and I am just NOW on my lunch break??

Dear Charge Nurse,
I already have 4 patients, I've been running around like crazy all day long, and I was the last one to take a lunch break (if you can call 7 minutes during which I inhaled food, a "break"). Did you really think I was the best choice to take on a 5th patient?? Especially when the patient is a POD2 small bowel transplant with everything under the sun going on with her. I mean, I am all about being a team player, but REALLY??

Dear Nurse in the Endoscopy unit,
I specifically told you my patient had blood products running at that you needed to be with her during transport. Not only did you not transport my patient, but you did not administer the blood products that she needed. You can expect an incident report from me.

Dear Ms. T,
You are my star patient and the only thing that got me through the day. PS - thanks for the baked treats!

Dear ICU nurses,
You are the bane of our existence. Just because you work in the ICU, you think you can ignore protocol. News Flash: Protocol is there for the safety of the patients. When you disregard it, you not only make our lives difficult, but you put the patient in danger. Next time you have a patient on a continuous PCA, I suggest you copy the flowsheet correctly. Next time you have a Heparin drip, I suggest you have the orders written down somewhere so that when I receive your patient I know what rate she should run at. Afterall, we wouldnt want her BLEEDING OUT b/c you couldnt give an appropriate hand-off of care. Seriously, I cant imagine what kind of a clusterfuck you people work in.

Dear bladder,
I am sorry I did not have time to empty you during my 14-hour work day. Please dont get infected.

November 11

"I thank God for my life and for the stars and stripes. May freedom forever fly, let it ring.
Salute the ones who died, the ones that give their lives, so we don't have to sacrifice all the things we love."--ZBB


I cry every time I see this:

Vacation?

Me: Haha, oh Ben. I love that you're even more cynical than I am.
Ben: Well when you get to a certain age, it's totally appropriate.
Me: When you get to a certain age? So are you saying its not appropriate that I'm cynical?
Ben: Haha, at your age, no. You're way too young to be cynical.

I think I am in desperate need of a vacation b/c I have found that I get super irritated at work very easily. I dont know if I just work too many shifts in a row (which has its perks since I usually get a couple days off in a row after that) but I have definitely noticed that my threshold for annoyance is significantly lower than it used to be. Dont get me wrong, I LOVE my job, and I LOVE being a nurse. If you've ever heard me talk about my job, you know that there really is NOTHING I would rather be doing with my life, but I just dont have the patience anymore. I know its all part of the job, but I'm tired of dealing with pharmacists who dont put in orders in a timely fashion; I'm tired of lab technicians who "lose" specimens; I'm tired of patients who pull out their IVs 20 minutes before my shift is over, who try to manipulate you for pain medicine, who refuse to get their assess out of bed and do anything for themselves, or patients who yell at you and question your nursing judgment. Sorry for the bitch-fest. I just need a break. Or I'll at least settle for a pleasant, appreciative patient who can remind me why I do what I do. Siiiiigh.

Nurses know best. :-P

It still baffles me how doctors can write orders and "care for" patients without ever assessing their patients. I realize that this is part of their job and training to be able to do this to an extent, but I just dont understand how they can be the ones ordering treatments, medications, interventions, etc when they're not the ones at the bedside constantly evaluating the patients.

Last night I had a patient (W.) who was pretty lethargic, didnt want to keep his eyes open for me, and when he did open his eyes he had this blank stare on his face. He was just "off." W is pretty familiar to us but during previous admissions he'd always had kind of a weird affect, which of course made taking care of him last night that much more challenging because I couldnt tell if he was just being weird or if something was actually wrong. About 3 hours into my shift I decided to bring the doctors to take a look at the patient just for my own comfort and reassurance. We get to the W.'s room and of course he's sitting up in bed, eyes wide open and the docs look at me, give me a hard time and laugh, "Come on, Nikki. He's fine." And I just tried to defend myself and claim that he hadnt been like that the last 3 times I'd gone in to see him. I can tell they kind of believed me, but unfortunately they cant do anything since what they see is a patient who is alert and responsive. For the rest of the night I was constantly battling with W. to actually stay alert. He developed a low-grade fever (100.6) and the docs just said to give him Tylenol. I continued to claim that he was "off" but when the doctor would go in there, W. would either be asleep and the doc didnt want to wake him, or I would've just harassed W. and woken him up enough to a point where he could actually answer a question. They attributed his weirdness and lethargy to the fever, which is fair, but they still didnt want to do any more. I kept checking on him and his temp just kept increasing. By the time my shift was over, he was febrile (temp=103.6), tachy (HR=130's), tachypnic (respiratory rate=32-34), and borderline hypertensive (BP=145/100). Septic much? I think so. The day nurse ended up transferring him to the ICU 2 hours after I left and W. had a seizure within an hour of arriving to the ICU. ...Yeah, sure Dr. C, "He's fine."

...Just another reason doctors should listen to nurses.... :-P

Fall Back

Seriously? Adding an extra hour to your night can take up to a week to adjust to?? Try working 3 night shifts in a row and then switch your body clock back. Not fun.

Sidebar, I'm super excited to finally be able to go out on a weekend AND we get an extra hour of sleep (aka an extra hour to recover from the inevitable hangover)! :-p