|Since I had the weekend off (the 2nd Sat/Sun in a row - I usually only get one unbroken weekend each month) I decided to check out the stores after work. Too bad I was tired and only lasted a couple of hours - it was the perfect time to shop! The Carlsbad mall was open and there was hardly anyone there, I bet there weren't more than 50 people in the entire mall! I dragged myself home around 1030 (my legs were tired!) and came home to bad news.
I'd had a message from Judy (my Aunt) on my cellphone but her phone was breaking up so didn't get it all, she called again just as I was walking in the door. Her youngest son, Kurt (is he 40 now?) was admitted on the 30th and has a diagnosis of congestive heart failure. For you non-medical-type people, CHF: impaired pumping capability of the heart that is not keeping up with the metabolic needs of body tissues and organs; it is associated with abnormal retention of water & sodium. Decreased cardiac output causes an increase in blood volume within the vascular system; this congestion in the vessels also interferes with the movement of body fluids in & out of the tissues and causes edema (swelling). The American Heart Association has good info on CHF and you can read more here.
|12/3/02 Tues (1038): Today in 1967 the first human heart transplant was done by Christiaan Barnard in Cape Town South Africa on Louis Washkansky - think of the progress science/medicine has made in the last 35 years! The 'holidays" today are Telescope Day, Make A Gift Day, Mail Holiday Greetings Day, International Day of the Disabled Person. And guess what, tomorrow is St. Barbara's day :) oh, and Santa's List Day, have you been naughty or nice this year?
I worked on 4East last night with Jenn and Marcy. Not bad, I had 3 patients, Marcy had 3, and Jenn had four. Once in a while starting with 4 backfires - we usually like to do it as it means we don't have to take an admit later. But then when there are no admits you end up with the most pts :)
Had a couple of pts who were having high blood pressure; one didn't have a PRN med so there I am at midnight, calling doctors. The third was just a 23-hour observation after intra-arterial chemo and he left just about 0730 this morning. I have to say it was a pretty good night. Enough to keep me busy but not so much that I was going crazy. But I'm tired, so goodnight!
|12/6/02 Fri (1002): There seems to be a difference of opinion, Encyclopedia.com says Mercator died 12/5/1594 but the University of St. Andrews in Scotland says the day was the 2nd. Anyway, if you can't remember why the name Mercator sounds familiar, you can go here and read about him. Today is Microwave Oven Day, think back to when we didn't have them; yeah, yeah, I can remember those days! It's also Eid-Al-Fitr, it marks the end of a month-long fast during the month of Ramadan, you can read about it here. Of course I would think every American knows what tomorrow is???? December 7th, ring a bell? "A day that will live in infamy."
I worked Wednesday night, on 4East again. This time it was Kathie and an LVN until 2300, then we picked up another LVN at that time. Janet, the Palomar nursing student, was with me again. Since I hadn't been there the night before and had different patients from Monday night, it was not as easy on me as the other time. We did have some excitement, though. During report day nurses said just about everyone was having high blood pressure. We only had 3 patients to start with and I let Janet take them. One was there with leukemia (4East is mainly the oncology floor) and had been there for a while. Had an NG tube, TPN, piggybacks, not a lot, but enough to do.
The 2nd one had already had her chemo and was getting piggybacks of Leukovorin at specific times, it's a "rescue" drug. It stops the effect of that particular chemo, which otherwise would kill you. I set my watch to beep 10 mins before each dose was due; just in case something was going on I didn't want to miss the timing. [Judy E., it doesn't take a special certification to hang the Leukovorin (as chemo would) so that's why I was letting Janet do it, but I was there each time :) ]
The third pt had been admitted directly from the oncologist's office, he wasn't sure what was going on. Her diagnosis was metastatic breast cancer (reminds me, I need to go get squished!) and she was weak and throwing up. She was one of the pts with high blood pressure. We waited a little bit after the aide checked it, she'd been sitting up, throwing up so Janet wanted to give her a little time to recover. I went back in to check the blood pressure and it was 222/99, since she was unable to take po meds (po = by mouth) I called the doctor since Janet can't take orders, I would have had to have the Dr repeat them to me and sometimes that irritates them, so I just called. We got an order for Procardia, it's a capsule you poke with a needle & squeeze under the pt's tongue.
So Janet does this, and usually you wait about 1/2 hour or so & check; she was going to go back in about 15-20 mins. My little voice (I guess you'd call it intuition, I call it my little voice) told me to "check the patient." There was no reason to expect anything would be wrong, but that's what it told me to do. I walked into the room and the pt was having a seizure. Myra, charge nurse, just happened to be on the floor. After the seizure (no history in the chart of this) pt is unresponsive, pupils don't seem to be moving, her fingers are dark & oxygen saturation is 57. We put on an oxygen mask, NRB (non-rebreather) with 100% O2 and her O2 sats come up - remember, you want them greater than 93%. Checked her pupils again, with all the lights off, and they were sluggish, but that's better than fixed!
I called the doctor and he's perplexed, doesn't know what's going on. I'm thinking maybe she has mets to her brain and he must have read my mind, before I could suggest anything he ordered a CT scan of the head and then to transfer her to ICU. He got the husband's number and called him, which I thought was nice, he could have had us do it.
One of the other orders was to put in a Foley (catheter for urine) and Janet had all the stuff there was going to do it when Myra said to wait as she was going down to CT in a couple of minutes. Yes Janet's a nursing student, but she's also an LVN who works in an emergency room, which Myra didn't know. I told Myra it was okay, Janet could do this in about 30 seconds - and she did! I later told Myra I was the one she didn't want trying to place a Foley in a hurry as I'd never put one in a female before, just never had the opportunity.
Pt's down getting her CT scan, Janet and I are discussing whether this is something to call Judy for. I took two steps towards the paper that lists "when to call the instructor" and the phone rings - it's Judy! I told her she was psychic, we were just discussing whether to call or not. It wasn't as if there hare been a med error and Janet didn't harm the pt so I was leaning towards waiting.
Pt comes back up and we're waiting for an ICU bed, oh! While this is going on and we're in the room working on her, we heard "code blue" overhead. We pause and look at each other, I was wondering who called a code blue on this pt when it wasn't necessary. Then we heard the rest of it, it was a code blue in the lobby. Apparently a car pulled up out front (the front doors are locked at 8 or 8:30 pm) and dropped someone off who had been shot. There just happened to be someone going by inside and saw him fall outside. I guess they figured the ER entrance was too busy and someone might see the car, who knows.
So the pt is back and we're waiting for an ICU bed. Myra said she had some movements, but they weren't purposeful. I was praying she'd be all right. She'd open her eyes on command, then drop right back down. Got her to squeeze my hand and move a leg, but she wasn't all there. I kept pushing, looking for signs of improvement. Myra came back and I was telling her the pt's right grip was stronger than her left as I told the pt to "squeeze my hands." She grabbed both hands & squeezed hard! I told her, "hey, you just made a liar out of me, good!" I stopped to see her on my way home that morning and she could tell me where she was and what her name was, which was definitely an improvement.
I meant to call last night to see how she was, but while all this is going on my throat was getting more and more sore. By the time I left it was very painful to swallow. Came home and kind of collapsed, throat hurt, head hurt, neck hurt, face hurt! Seems to me if you feel that miserable you should at least have a temp to prove you're sick, I didn't, not until this morning. It was 101 degrees this morning, but it's already come down. Throat doesn't hurt as much, head still hurts and now I'm coughing up junk - isn't that a pleasant thought?
Just called the hospital, talked to Fred (one of the nurses), and the pt is back up in the same room she was in the other night. She's alert & oriented, no more seizures. She also had an MRI which apparently didn't show anything going on in the brain. I'm glad she's better, had me worried!
Got an e-mail from one of the traveling nurses, Leslie, she's back home in Kentucky and said she had to tell someone that "the weather stinks!" It's 17 degrees with 2 inches of snow. I wouldn't mind some cold weather for a while.
|12/8/02 Sun (0324) Today is Night of the Lizard King, now whatever does that mean! Well, I typed that into a search engine and it seems Jim Morrison of the Doors was called the Lizard King, but he died in the month of July, not December.
Learned a new word today - omphaloskepsis it means "contemplation of one's navel as an aid to meditation." Greek mythology holds that Zeus released two eagles, one from the east and one from the west, and made them fly toward each other. They met at Delphi, and the spot was marked with a stone in the temple of the oracle there, a stone they named "omphalos," Greek for "navel" (it supposedly marked the center of the world). Mystics have been practicing omphaloskepsis for centuries, but it wasn't until the early 1920s that English speakers combined "omphalos" with another Greek term, "skepsis" (which means "examination," not "skepticism"), to create a word for studying one's own middle and thinking deeply.
I didn't make it to work tonight (rather Sat night), the cold got worse, chest hurt (lungs rather!), head, neck, and I was just unable to get things going. I called in at 10am on Sat, giving them plenty of time to know they'd need a replacement. I would have liked to have gone in, I have Janet with me again tonight and it would have been easier on me to be on the same floor a second night, knowing my patients.
DREAM ALERT! I'll say it again, dreams are weird! I was at a friend's house, don't know who it was, and we were going to go out to dinner, they'd set me up with someone. Turns out he was a real dweeb and weird. I managed to get rid of him and when I went outside the friend's baby was lying in the front yard. But just at the bottom of the steps was a crocodile, and just past the crocodile was a huge rattlesnake, the size of a python. The baby was on the other side of the snake. I remember yelling for help, then managing to skirt both animals I was wondering how to grab the baby without causing the crocodile to lunge or the snake to whip around. Someone else grabbed the baby by the feet and it was safe.
Omigosh! I'm an adult film star! I was reading the Kim Komando newsletter and did what she suggested: "Ego surfing" is a relatively new term floating around tech circles. It refers to searching the Internet for references to oneself. If you have never done any ego surfing, it makes for an interesting adventure. Just go to Google, http://www.google.com, and search using your name. You might be surprised at what you find, especially under the "Groups" heading."
So far I have a doctorate in linguistics and I teach at a university in Colorado; I died of cholera in 1833 in Kentucky; I have a Ph.d in psychology; I specialize in upscale real estate in New York City; I'm a porn star, I had a starring role in the movie Face On The Cover; I motivate people to do better, "Barbara Fox was very helpful for me and helped me build more self confidence." I'm a news reporter in Los Angeles; I'm a painter who has works for sale in different galleries; I've been born several times in the 1700's and 1800's; I'm a doctor, an oncologist; a teacher; an author; a scientist...and it goes on & on!
If you've never seen the movie "A Christmas Story" rent it - it's soooo cute!
|12/9/02 Mon (0257): Hey - today is Donny Osmond's birthday, he's soooo cute! Today is Weary Willie Day, hmmmmmmmmmmm. Emperor Sigismund died on this day in 1437; who is this you ask? You can go here to find out :)
I was supposed to work tonight, in fact I did go in as I didn't want to mess up Janet's (Palomar Student) schedule so close to graduation. I got thru report and about 15 mins later realized I couldn't make it thru the night. I asked Lee what would be the chance of getting another nurse in at 2300; it was okay. After discussion, I went ahead & sent Janet home, she'll come back Tuesday night to work with me. Too bad, it would have been an interesting night as there was a pt there who'd had a dehiscence of his sternal wound after a CABG in November. If we'd stayed we would have done a dressing change at midnight, the day nurse said it was easiest to pack the wound on inspiration, as that's when the structures opened up more.
So I come home and even though I'm tired, my chest, throat, head, & body hurts, I can't sleep. And when I can't sleep where do you find me - yep, here!
Before I forget again, I have to admit something - I just love those Joe Boxer commercials where the guy is dancing around in nothing but his shorts!