Out-Shouted

Rules are as follows:

A.) Thank the blogger that gave you the award.

B.) Sum up your blogging philosophy, motivation, experience using 10 words. (Haha, you know me much better than that.)

C.) Pass the award on to 10 other blogs you feel have substance.

Sum up my blogging philosphy? Goodness. I try not to travel through life without taking something important away from each and every day. Writing helps me organize those thoughts. I often don't quite know exactly how I feel about something until I've put together a post about it. It's a wonderful creative outlet for me--and surprisingly other people seem to enjoy reading it from time to time. Thanks to all who visit!

1.) New Nurse In The Hood was so kind to select me as a "blog of substance". Thank you NNITH! The feeling is mutual, so I'll have to say her blog is the first of my 10 picks also. She curses like a sailor nurse--and who doesn't love a good potty mouth?! More importantly her care and concern for her patients fairly oozes off the page. She calms my fears that it is indeed possible to survive the first year of practice after school with a sense of humor and curmudgeon tendencies intact.

2.) Running Wildly is quite simply, my hero. An experienced nurse, her comments bring validation, and sometimes gently set me in my place. Her integrity and honesty is so transparent in every post, it's little wonder that her blog is loved by many. She and her husband make pretty babies too. She's about to return to work following maternity leave--stop by and wish her luck!

3.) Nurse J and I have much in common. It's so awesome to find kindred spirits through nothing more than posting my silly ramblings on the interwebs. The real deal ICU nurse fighting the good fight. Go check out his writing, he's got some good stuff.

4.) Man Nurse Diaries is a great little place to hang out. He speaks with wisdom that belies his relatively short nursing career. And the man is unabashedly passionate about birth, children, nursing in general. He's also been greatly supportive of me as a man in the nursing profession. Thanks bud!

5.) Asystole is the Most Stable Rhythm is a great blog written by straight up legit nurse taking names and slapping asses in medical school. I love reading about her exploits (especially when she shows up her hotshot med-student classmates--a favorite hobby of mine). While reading her posts, I can't help but feeling like I may some day end up down the same road...

6.) Adventures of Student RN Tiffany is the blog of a dear friend that I feel like I've been through it all from the start of nursing school with. She's an amazing woman, and an inspiration. She's currently on a short hiatus from school while she ventures into beautiful motherhood, but the sooner she returns to the nursing field the better for all patients everywhere.

7.) KLS, Student Nurse, well she's no student nurse anymore, she's graduated. Better yet, she's got a job! Another pal that I've followed from the start of nursing school.

8.) Head Nurse--it just doesn't get much better than this. So much nursing experience--is it possible to feel mentored over the 'net? Delightfully sarcastic. And I eat that crap up. Check her out if you haven't already.

9.) Raspberry Stethoscope is a blog that I just recently found. She's an ICU nurse. She's headed for advanced practice. She's also a runner. Do we see a pattern here?

10.) Life According to Candace is a great read. Candace has all the delicacy of a fine bottle of Thunderbird. What she concedes in social tact she makes up for in humor. You will laugh. Hard.

There are so many more great blogs out there--many of which are in my blog list in the right sidebar. So get to clickin'!

What...you're still here!??

Rhythm Detected, No Shock Advised

6 days since I've posted. Eek. Bad blogger. Heart still beating though...

In my defense, life has been very full lately. Two full time jobs, 3 children, no daycare--it's a lot for two people to keep up with. And there have been some extra things in the schedule as well. Last week my oldest daughter and I drove 9 1/2 hours to meet up with my parents. She continued on with them another 4 hours to the family farm. She's spending 10 days with grandma and grandpa. I turned around and drove back home, another 9 1/2 hours. We left at 0600, and I pulled in at 0300 later that same day. I covered 1282 miles in 21 hours--average speed including stops for meals: 61.05 mph. Needless to say, I was a little punch drunk the next day.

My dad is planning to drive across the country to the West coast in a couple weeks. He's taking about 10 days, and making scenic stops along the way. I'm contemplating going with him as the timing works out perfectly--I'd get back home the night before my classes start. I was hoping to get away from this metroplex that I hate can hardly stand before classes start up again anyway. It'll be pretty low cost to me since he was planning to go anyway so he'd be picking up most of the tab. Most of all it will be a chance to spend some quality time with my dad. That hasn't happened in a very long time--probably 15 years. Turning 71 this year, he's starting to age a bit. The last few times we've visited, I can tell he's starting to feel the mileage. He finally retired, and they're staying busy, but I can hear the slow-down a bit.

Running has had some lows and highs. Last time I wrote about running, the beginning workouts for week 5 seemed like a step backward. But for some reason, they were NOT. They hurt so bad! They shouldn't have, so I'm not sure what the deal is. But the middle workouts were tolerable, and the final workouts for the week went really well. 20 minutes straight. The first time was on Tuesday, after I'd worked all day. The second was just a little bit ago today, and I actually ran an extra minute, and then jogged the first minute of the cool-down as well. Very gratifying. It was the first workout in a couple of weeks that I didn't have to combat thoughts of quitting the entire program during the latter half of the workout. Sunday we start Week 6. Since we do each week work twice, we've been running for 10 weeks at this point. We've made slow but steady progress. Still no appreciable weight loss, which is frustrating. Can you imagine how much easier it would be to run if you could take a 65 lb backpack off before you started?

Work has been interesting. Joint Commission was at our hospital the last two days. I'll have a post about that coming along soon. And I helped take care of a Pakistani man who came to our country just 10 years ago. Now he has lung cancer, and I'd like to write about that experience as well.

And I certainly hope to make it around to all the blogs on my bloglist, it's been several days...

I Used To Be a Runner

Back in junior high and high school, I ran track. My events were middle distance--the 800m and the 1600m. I also ran the anchor leg of the Medley Relay, and occasionally the 3rd leg of the 4x400m Relay.

I never was a natural born runner. More like I was scrawny and farm-hardened. And stubborn. My times were respectable, but not record setting. My fastest mile was a 5:31, and my fastest 800 was a 2:02 split in the medley.

People that know me today probably have a hard time fathoming the person I used to be. When I say, "That was more than 100 lbs ago," they think I'm teasing or exaggerating. Neither of which is true. So I post this photo as proof--taken at the end of 10th grade. If you haven't recognized me, I'm standing in the back row (on the outside like usual) dressed in the gray shorts and gray tie.

Like I said, "I used to be a runner."

Now I'm more of a Clydesdale...

Cashing In Frequent Flier Miles

Today at work the charge pager went off detailing a full arrest that was coming through the doors of the ED. If the paramedics and the ED staff were successful in their efforts, we'd soon have the patient on our unit. As I readied the room, gathering suction, a vent, a Bair-hugger, restraints, SCD's--the whole nine yards--word came that it was a diabetic frequent flier.

This guy was known around our hospital because he visited. A lot. In fact, he'd only been discharged 3 days ago, on the 14th. He was admitted 4 times in April, twice in May, and twice in June. His last hospitalization for DKA lasted over 2 weeks.

He's lost 3 toes, 4 fingers, and most of the muscle mass on both buttocks and thighs. His kidneys are gone, ESRD, and his liver enzymes through the roof.

Did I mention he's 25?

You don't end up an old man at 25 without some compliance issues. Diabetes is quite manageable these days, especially Type I.

As we stood around waiting for news, we chuckled nervously that the RT on shift in the ED is like 1 for 25 in his CPR record. And then the family started arriving en masse. They wanted to wait in his ICU room while the drama played out in ED, and they set up home base there to begin their competitive grieving--wailing and carrying on so much the other patients and families began to ask questions.

As fortune would have it our trusty RT doubled his percentage, (now 2 for 26), and they got the patient back.

They should have left him dead.

He rolled onto our unit with a core temp of 90.7*. His pH was 6.81, his pCO2 was 125. He has no pupillary light reflex, no corneal reflex, no gag reflex, hyperactive c7 and s1 DTR's, a positive Babinski, an absent vestibular ocular reflex. His brain CT was normal (for the moment), but it wasn't long before he started decerebrate posturing, and the twitchy spastic jerks that always seem to accompany an imminent herniation.

Lifegift was consulted, but the way he's treated his body combined with the fact he's VRE and MDR enterobacter positive pretty much precludes placement of any of his tissues or organs.

Such a waste.

A waste of a life. And heaven knows his family tried to save him. Not to mention the staff of our hospital. There was no lack of trying to reach him. In fact he hated coming to our unit, leaving AMA once, simply because we force him to be compliant.

Just makes you wonder why people choose that path?

Now it's just a waiting game until the family chooses to withdraw, or he goes on his own.

Hodge Podge

Sorry for the lack of posts, but my wife called in to work last weekend, so evenings I normally would have spent writing blog posts, I spent in family time instead.

Work has been super busy, and I've been working a lot. I'd been assigned a preceptor as an extern, but in the short term she's precepting an actual intern. Normally I hang out with her for the majority of the time I'm at work, with a few exceptions. These days though, since I'm an orphan, I spend more time with more people. I can tell they're beginning to trust me more by the simple fact I'm being sent into rooms to take care of increasingly complex nursing tasks by myself. It's gratifying, really.

"NurseXY, can you go change the chest tube dressings on bed 12?"

"NurseXY, bed 7 needs their central line redressed, do you mind?"

"NurseXY, can you go pull the femoral sheath on bed 4?"

It's nice to be used for more than blood sugars and turns. I seem to be pulling copious amounts of femoral sheaths lately. Most likely it's because the sheer enormity of my hay hooks is enough to scare even the most persistent hematoma into submission. That and when the doc specifies a particular time to pull (instead of relying on a bedside ACT), I have the strength to actually will the femoral artery to clot, simply by applying enough constant pressure to physically push the patient through the bed. It turns out it may actually be possible to return the blood from two trays of 4x4s and a washcloth soaked through back to the patient if you push hard enough...

Running is going pretty well. We're nearing the end of the second week of Week 4. The first workout of Week 5 seems almost like a step back, but the subsequent workouts definitely up the ante.

I had a hiccup last week where I wasn't able to finish a workout. I'd gone to the gym immediately after a counseling session, and unfortunately that was all I could think about on the treadmill. Oddly enough, even when said in a "safe" place, incredibly hurtful things are still hurtful. Especially when they come on the heels of laying your heart and soul bare to highest level of vulnerability. Fortunately, 2 days later I was able to complete the workout without problem, and at a faster speed yet. I'll not be going to gym after counseling again. Too painful. Too many kinds of pain.

That's all for now I think. More soon. Sorry it's not witty or particularly interesting.

*Giggle*

The "S" Word

My day at work started off nice and quiet. No heart surgeries scheduled, 1 cath scheduled, and 6 patients. Lots of staff because two interns on orientation were there with their preceptors, along with two other nurses.

Then someone said the "S" word.

I'm sure it was just a casual mistake. A slip of the tongue. Probably didn't even realize what they'd said.

"I'm so glad we're slow today."

And then the other "S" word hit the fan.

Two CABG's hit the books, three scheduled cath's (and we got them all even though they sometimes go to the floor), two STEMI's came through the ED, along with a drug OD (47 y/o whose wife of 30 years left him.) Not to mention the 20 y/o woman with a history of lupus and ESRD who ended up tubed because she kept desatting. Turns out the "pneumonia" the docs were treating her for was actually bleeding in the lungs of unknown cause. She got a PICC line, a Quinton, and bronched. She had a rough morning.

At one point the nurse I was working with was tripled with the lupus/ESRD girl, a fresh CABG, and a fresh cath. They were rolling in faster than we could call staff in.

Rough day.

On a different note my wife and I started marriage counseling tonight. A step forward, but not an easy one.

And I'm getting sick with the snotties. But now I'm just being a baby.

Tip From A Lowly Extern

If you are going to brag to the house supervisor about all your previous hardcore ICU nursing experience and that you can easily handle floating to the ICU for the day...

...and then you feel it necessary to brag about all your previous hardcore ICU nursing experience to any ICU staff member who is (un)fortunate enough to be within earshot...

...and you're subsequently assigned a new admit from the ED sent to the ICU for sepsis with suspected peritoneal fistulas...

...and then you insert a foley catheter and get immediate return of 5200 ml of bloody, purulent "urine"...

...you should probably call the physician immediately (0730) rather than waiting until lunch time (1200) to brag about fixing your patient's distended abdomen by simply inserting a foley...

Because then your patient could have been rushed to emergency surgery at 0730 and you would have looked like you saved the patient's life with some timely critical thinking skills...

...rather than looking like a total farking idiot in front of the physician, surgeon, house supervisor, ICU staff, and patient family as the patient gets hustled off to surgery 5 hours later.

Oh yeah, and you probably wouldn't have gotten written up and pretty much banned from the ICU either.

But hey, what do I know, I'm just an extern.

Happy Independence Day

In the dawn's early light, my son and I greet the day together. He sits in my lap, head back against my shoulder, his small hand grasping my thumb, pulling my arm protectively across him like security blanket. We sit quietly on the couch, the dog snuggled up against us. BBC America is on, and we're watching Top Gear--a fantastic episode about the Transfagarasan Highway in Romania. Jeremy drives an Aston Martin DBS Volante, James a Lamborghini Gallardo Spyder, and Richard drives a Ferrari California--cars that can only be described as works of art. And the stunning scenery is beautifully shot, as is par for this show.

It was a great father-son moment. And what's more American than a father, son and their Scottish dog watching a British show about 2 Italian cars and a British car, driving the most famous highway in Romania?

Happy 4th of July!

Drowning Doesn't Look Like Drowning

I ran across this article on my internet travels and thought it was great.

It's summertime and a hot one at that. Unfortunately all too often, people and that cool inviting water just don't mix. Just this past week at my wife's work, 4 near drownings were admitted all 4 years old or younger.

As we tell our friends with kids--you don't want to visit my wife at work. By the time you get to see her, things are ugly and there's no guarantee they'll get better.

Anyway, here's the article:

Drowning Doesn't Look Like Drowning