I hate that feeling...

When I go home and go to bed with a feeling in the pit of my stomach. I want to call the unit up and ask how my patient is doing since I left. But I don't.

Then in the morning, the already bad feeling completely drops to the bottom of my stomach when I look at the assignment board, and that name is gone.

Then I go about my day wondering if I could have done anything different.

Some days are hard.

Excuse me, your ascites is leaking.

Typical ICU day, LOL with a nasty PEG tube is septic from the site. Serious ascites going on. Stinks to high heaven. GI doc comes in and removes old nasty PEG. No big deal right?

Wrong.

From the second he walked out of the unit (because, let's face it, weird shit never happens with doc standing at the bedside) she starts spewing from the site. A nice greenish smelly fluid. No big deal. We'll just put a nice big dressing on it. Right?

Wrong.

The dressing is soaked in seconds. Remove dressings. Hold wads of towels over site until we figure out what the heck to do. Our ICU brains get to work on a ghetto way to fix this. Hmm, a colostomy bag? Sounds like it would work right?

Wrong. 

We put the bag over the site and quickly turn and toss the patient to change her green soaked bedding. Then I hear something. Drip. Drip. Drip.

 The wafer has pulled away from the skin and that lovely greenish liquid is flowing over the edge of the bed. Onto my shoes. 

Great day in the ICU. 

In which I ponder spelunking. And I don't mean in caves.

I mean spelunking as in "Hey, KLynnRN! Wanna go spelunking with me on this new patient?"
I mean foley catheter insertion on obese people. Ladies in particular (but I've donea good cave diving on a male).

It's really an art. Almost a recreational sport, like the real thing. The similarities are eery.

1. You need to train for such ordeals. You can't just go traipsing through the deepest, darkest cave if you've never done it before. You might not recognize landmarks. And you could get lost. Spelunking is not for newbies. You should attempt smaller caves to hone your skills first.

2. Equipment is vital. You can't just grab some rope and a backpack and trek into unknown territory. You need to set up your tools. You need to know what all your tools are for. And grab a flashlight. You will always need a flashlight.

3. Don't go solo. You know that movie where the guys hand gets stuck under a rock, and he didn't tell anyone where he was going? Same thing. Don't assume it will be a typical experience. Let your coworkers know where you'll be. If fact, recruit a few helpers. You'll probably need it.

4. Be prepared mentally. Spelunking is not for the faint-hearted. You may see things that will haunt your dreams. You make smell odors that will ruin your lunch. You could have a cave-in rendering you trapped and claustrophobia may set it. Consider these things before beginning. Prepare yourself.

5. The finale. When all is said and done, and the legs are propped and the belly flop is held back, and XXL lady parts are parted like the Red Sea, you peer into the unknown. You see a little wink. Like the light at the end of the tunnel. You head for it. Liquid gold bursts forth and you've made it out of the cave to daylight!

Don't forget to wash your hands :)

No you did not just do that!

The other day, a coworker and I were helping another coworker get caught up so we could all eat lunch at some point that day. We decided to double team her intubated and sedated patient so we could get it done faster.

We blew into the room like tornados, checking blood sugar, scanning meds, scanning patients armband. All of a sudden the patients daughter appears out of nowhere. We quickly introduce ourselves and let her know we are helping the nurse. By that time we are actually finish and go to excuse ourselves.

"Wait! Wait!"she says "I need to ask him a question with you two in here."

Odd request, but whatever, families are usually weird like that. We stand by and listen.

"Daddy?! Daddy??" the patient opens his eyes "Do you want treatment. Like that chemotherapy and radiation like before?"

Pt nods enthusiastically.

"Daddy?! Daddy?!" he opens his eyes again. "God forbid something should happen, but if it does..."

At this point of course we are thinking she's asking about DNR status.

"...can I have your camper?!"

Seriously, I'd like to think he comes back to haunt her. Or better yet, rip her ass to pieces when he gets extubated!

Letters to the floor.

Dear Floor Nurse #1,

I do realize I did not check Mrs. Smith's blood sugar at 12 noon today. Per protocol we check blood sugars q6h on every ICU pt. However, Mrs. Smith has no past medical history of diabetes and no abnormal sugars since admission. Not that I feel the need to explain, but... I did not check her noon blood sugar because my other patient, Mr. Bi-pap, wasn't doing so well. What's that now? You say her blood sugar is in the fifties now? Well, sorry to hear that, but I transfered Mrs. Smith to your floor almost four hours ago. And we are now in the middle of shift report. Sounds to me like to should either go grab an amp of D50 or call the doc. Not call me. 

Thanks.

Dear Floor Nurse #2,

Yes I do realize Mrs. Postpartum was admitted for preeclampsia. No her BP was not high before I discharged her to your floor. What was it for me exactly? 120s/80s. For six hours for me and several hours for night shift before I got here. You say her BP was elevated when you took her vitals right after you recieved her? Well you do remember she ambulated to the bathroom when we got down there (first ambulation in two days) and had a nice poop (first poop since admission). She also knew she was going to see her brand new baby for the first time, in NICU. My BP would probably be high too. If you're that concerned, call the doc, not me.

Why I put up with it.

Some days make it all worth it.

Long story short, I have a patient who we are having trouble weaning from the vent because he flips the hell out when the propofol is turned down.We have orders to extubate per protocol if weaning tolerated because the only thing holding up the process is the damned propofol. So RT and I decide to go for it.

I go tell my charge nurse I'm going to be MIA for a while and to please keep an eye on my other non-critical patient whose awaiting transfer orders and I drag a chair into the room and pull the curtain.

I dial down the propofol. He opens his eyes and two seconds later that familiar reaction ensues. I gently take his hand and calmly talk him down. He mouths around the tube "I can't breath!" and "What happened?" I remind him of his surgery and the fact that he's on the ventilator and assure him I will be right there so everything will be OK. He calms little by little, closes his eyes and drifts back off to sleep.

This process lasts an hour with be turning the propofol down and calming him down; propofol down, calm him down; propofol down, calm him down. Finally he is mostly awake and trying his hardest to stay calm.

"Ok go." I tell RT who has been in and out of the room the entire time. She is already set up to extubate.

I turn off the remaining amount of propofol  and RT pulls the tube a few minutes later. After the usually coughing and gagging has subsided, he takes my hand and squeezes tightly as he begins to cry.

"You are my angel." are the first words out of is mouth. "Thank you."

"You're welcome." I say.

"Really, you are an angel. Are you married?"

"Not yet, but I will be soon." I say, showing him my ring.

"Good. Tell that boy he better be good to you. Or he's going to have me to deal with!"

Sometimes I just love my patients!!

Find the humor...

You know what makes a shitty day better?

Watching your new admit via helicopter landing while listening to the MASH theme song with your work BFF.