sick day

hospital dates have turned into hooky days.  i called in sick yesterday because i spent the weekend away; one night in portland and the other on the coast, at manzanita beach.  i highly recommend a weekend away and a sick day.  it does wonders for the mind, body, and spirit!  

need i say more?

the taj

if you dig deep enough, every person has an amazing story!  my patient today seemed to have MANY. the best though, the one that made me slightly jealous, took place in india.  at none other than the taj mahal.  when my 65 year old male patient was 19 years old, he and several buddies drove a VW van from england to india...  while visiting the taj at dusk, closing time, he and his friends hid.  and they spent the night in one of the world's most famous buildings!  in the morning, they splashed around in the reflection pools.  and although a few of his friends were caught, my patient was not.  i cared for someone today who has slept in the taj mahal.  can you say you know anyone that has done that?

Source: deviantart.com via christa on Pinterest

bi-birthday week

i rarely wish i was at work.  but today, i wish i was working so that i could be the lucky nurse to delivery my sweet 73 year old (soon to be 74, this thursday) her new stem cells.  i cared for her yesterday and she expressed her disappointment that i was not working today.  a friend of mine will be infusing the two bags of stem cells.  she'll do a great job.  but i hope she remember to sing happy birthday (my practice when giving someone a transplant).  i know she'd get a kick out of it!  happy birthday b - - - -!

TTP

yesterday i cared for a 45 year old woman newly diagnosed with TTP - thrombotic thrombocytopenic purpura.  say that 12 times fast!  it's a clotting disorder thats onset is rather sudden and if left untreated causes death - rather rapidly.  micro-clots form in the blood stream raising havoc in the kidneys, heart, and brain (just a few of the vital organs!).

the most successful treatment of this disorder is called plasmapheresis (seriously, why is everything in medicine so hard to pronounce?).  anyhoo, what it entails is a dialysis-like machine.  yesterday, my patient had 4L of plasma "exchanged."  that's FOUR LITERS of donated plasma exchanged with her crappy plasma.  it's quite the ordeal.  it requires a fancy kind of line (intravenous access).  and takes multiple hours.  any time the body loses or exchanges liters of fluid (as in dialysis or plasmapheresis), blood pressure is critical and susceptible.  hers was decent, but on the low end of normal all day.

so when a nursing assistant found me and told me my patient decided to leave the unit alone to get a latte, i was a bit worried.  my patients are not allowed to leave our floor.  with a hematocrit of 22 (seriously low) and a platelet count of 10 (crazy low), she is at a huge risk for a fall with potential for a lethal outcome.  no joke.  a fall with a platelet count of 10 could cause a serious brain bleed (just read the post from last week to know what i'm talking about).

i decided the damage was done.  the nursing assistant had told her not to leave.  but she did anyway.  she's an adult and can make her own decisions.

but i really became worried when the secretary called me and told me to get down to the cafeteria STAT with a wheelchair.  my patient was dizzy, about to fall, and nauseated.  apparently some physicians were at her side, waiting for my arrival.

it was quite the scene i arrived at.  my patient was surrounded by not one but three physicians.  there were orange juice containers and sugar packets strewn about (i guess they assumed she was diabetic and had low blood sugar; quite the contrary... when i brought her back upstairs, her blood sugar was sky high thanks to their "help").  and one of the physicians was trying to check a blood pressure.  i kid you not, she seriously said out loud, "i forget how to check a blood pressure."  when i offered to do it for her, i got no response.  now that i think of it, they didn't really talk to me at all.

i thanked the physicians for their "help" and returned my patient to my unit safe and sound.

old folks

work was a bit nuts this week.  each day had its own excitement.

TUESDAY:  hospital date # 2

WEDNESDAY:  fall, black eye, and head bleed

THURSDAY:  line placement, MRI, delayed chemotherapy and possible extravasation

i could write about so many things.  but i feel inclined just to mention the sweet patient that i admitted on tuesday morning - a 73 year old woman who has been married for 55 years.  when doing her admission history, i asked about her past medical history.  she said, "i'm healthy - aside from cancer."  she has an attitude about her, a feistiness that will hopefully serve her well during transplant.  her husband and daughter sat by her side, teasing her about reading "soft porn" on her kindle (seriously, i can't even use a kindle!).  and although she's quite wobbly on her feet (due to osteoarthritis), she refuses to use a commode at her bedside; "i have just a little bit of dignity left.  i will walk to the bathroom!"  she called herself a troublemaker and apologized for "allowing" her central line to literally fall out of her chest, prompting stat x-rays, a delay in her chemotherapy, and causing us to scramble and reorganize her day and our plans.

i thoroughly enjoyed caring for this little woman.  in some ways, i suppose she reminded me of my own grandmother who was feisty in her own right, obstinate and stubborn beyond belief (much like myself).  it's strange how once you lose your grandparents, you stop hanging out with elderly folks.  unless you count your parents, who are slowly aging alongside myself.  older folks have so many great things to teach us... i almost can't wait to head back to work next week to see what trouble little b---- has gotten herself into!  and what lesson she can impart to me to make me more optimistic and just a bit wiser!

hospital date #2

i went on a second hospital date this week.  i could get used to dates mid-day.  kissing in seattle's drizzle makes a 12 hour shift much more exciting!  the york peppermint patty from the gift shop that he brought me as a "gift" was just icing on the cake...

nurse suspended

some crazy shit went down at work yesterday (and i'm not talking about my date).

this week at work, i have continued to be the computer support person.  i have not had patients to care for, only staff and charts and computers.  it's been kind of strange.  a bit boring.  but a nice change of pace.  so, when my charge nurse (and friend) asked me to pick up a patient last night at about 4:45 PM i was a bit thrown for a loop.  as the computer support person, i'm not supposed to have patients.  but i went with the flow; i could tell something weird was happening.

sure enough, something weird happened.  all around the same time, my other friend got pulled into a room with our manager.  i saw the two of them together.  nosy, i wondered what was happening!  but it wasn't good.  our manager ended up questioning her about the narcotics she had given to her patient.  what time did she give them?  how many?  he was not accusing her of anything.  he explicitly stated, "you are not in trouble.  but answer these questions honestly.  and don't mention that we're having this conversation."  of course, she told me.  but...

i could ramble about every minute detail that transpired within a 20 minute period.  or i could just cut to the chase.  a nurse that i work with, the nurse that trained me on my unit almost 6 years ago, was suspended.  obviously, it's a hush hush matter.  i don't know definitive accusations or details.  but i do know that i ended up with one of this nurse's patients for the remainder of the shift.  that the nurse was sent home immediately.  that while i was getting a quick report from the nurse, my manager handed the nurse being sent home a business card (probably with the hospital's lawyer or the nursing union's representative info on it).

whatever went down wasn't good.  narcotics are missing on my unit.  and a nurse was sent home.  sounds like a big deal to me.

i left work feeling hyper, anxious, and a bit awestruck last night.  i recognize that i have the potential to hurt people at my job; we handle very dangerous medications.  but i forget how much trust is put in our hands.  how much access we have to things people pay really good money for on the street.  how mood altering and addictive some of the things i handle on an every day basis are.

i feel for this nurse.  i believe that the nurse is a good person.  but i am so thankful that i have zero desire to do what that nurse may have done.  that i am content with a nice caffeine buzz.  and the giddiness i feel after a hospital date!

first

i'm not going to divulge much about this, but...

i had a FIRST at work today.  in the midst of my 12 hour shift, i went on a date.  how hilarious and fun is that?  although the "date" was very much innocent, something about it felt trashy and a little grey's anatomy!  me, in my scrubs, sneaking away from my unit, going on a walk along the montlake cut, soaking up the few rays of sun that shone today, and giggling with a new man. 

hmmm...

 

knock, knock

i took care of a 25 year old boy yesterday.  he has cancer.  and as part of his treatment, he got chemotherapy infused in his central nervous system (intrathecal methotrexate).  sadly, a side effect of his treatment was paralysis, from the belly button down.  it wasn't supposed to be a side effect; but it was.  so for the last month, he has learned to be as independent as possible.

one would think that a 25 year old boy with cancer who "accidentally" became essentially paraplegic would be angry.  but instead, this boy has risen to his challenge.  and he is kind.  and polite.  and appreciative.  and determined.

because life can always get worse, this poor dude also has a bad case of diarrhea.  of course he does.  he can't get himself to the toilet.  and his nurses are all practically his age (i'm making myself almost 7 years younger!).  so to avoid the embarrassment, he has learned to get himself on and off a bedpan AND to clean himself up.

so, imagine my surprise and delight when at the end of the day, this guy wanted to tell me a knock-knock joke.  i wish i could tell it to you out loud.  it's sort of a joke you need to HEAR.  so if you don't get it, read it aloud.  say it a few times.  and laugh.

"knock, knock."

"who's there?"

"smell mop."

"smell mop poo?"

ha, ha, ha.  i laughed hysterically.  a nurse always loves a good poop joke!

get it???  smell ma poo!?!