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1/11/03  Sat  (1320):   In 1770 Benjamin Franklin shiped the first batch of Rhubarb to America from England.   I'm certainly glad he did, it's quite tasty, in pies that is.  I remember in Alaska pulling it out of the ground and munching on it, only a kid would like something so tart & sour!  But......add some sugar and stuff it in a pie and it's even better!

My horoscope today:  'Extremely poor day to use obscure euphemisms or medical metaphors. In particular, avoid "kajoobies" or "shvontz" like the plague.'  I think I'm a preceptor tonight and tomorrow night, so I guess I'd better watch myself!

Scoured the house before locking up last night, to make sure I had everything.  Last time I left my watch and it was several days before I got back to pick it up.  Jake & Liz found out that it goes off at 0700 every morning!  I think I managed to get everything this time :)  Locked the door, left the porch light on and proceeded to walk to my car.....and ended flat on my face!  I forgot there was one small step and my right foot hit it and layed me out flat!  One minute I was walking and the next I was down and my first comment was "oh shit!"  Of course your first instinct it to put out your hands as you fall, that's the best way to break a wrist, either the radius or even worse, your navicular bone which can be hard to heal.

I layed there for a minute, luckily no one went by, taking stock before I moved.  Right knee was hurting, left wrist was hurting, palms were burning, left elbow was a little achy.  I started moving things, one at a time.  Wrist seemed to move okay, elbow moved, whole arm moved.  Put my hands down to push myself up and nothing fell apart as I pushed myself to my knees.  Amazingly I was in one piece, and still am.  Nice colors on my knee, left wrist seems a little tender on moving it around and poking, but I'm going to think positive and believe the navicular is okay.  All in all I was very lucky!  Guess I still have strong bones :)
1/13/03  Mon  (2324):   Today was Blame Someone Else Day, did you?  Tomorrow is Dress Up Your Pet Day, something Jay Leno hates with a passion!

My horoscope for today:  'You will develop a passion for Cajun cuisine, and will refuse to eat anything that hasn't been "blackened". Your family will draw the line at blackened corn flakes, however.'

I was on 2East Sat & Sun, worked with John and Sarah again.  Poor John, he was the one who had the "handful" the other night and he got a patient who was almost a handful.  Not quite as bad, but he'd keep yelling "help me," and if anything was in reach he'd throw it.  Pretty good arm, he tossed a soda clear out of the room over to the nurse's station.  Sarah had to keep giving one patient blood, she had a bleeding diverticulitis and kept bleeding out the rectum.  Sarah would replace the blood and she'd just keep bleeding out.  She didn't want surgery and she was a no code (meaning don't do CPR).  Sarah had her again last night; although she kept getting blood for low H&H, at least she wasn't bleeding it out as fast as it was going in.

I did pretty well.  I was very busy Sat night.  Patient who had CABG surgery, another one with pneumonia and another with CHF (congestive heart failure), then an admit.  This guy decided to go on a drinking binge and stop taking his meds,
and he was a diabetic.  His blood sugar in the ER was in the 500's, it's supposed to be 70-110.  By the time I got him he was in the 200's, and luckily the doctor changed the finger sticks to very 4 hours, instead of the every 2 it was right then.  He didn't go thru DT's, managed quite well throughout the night.  Was a little needy, and even more so the last night.  Sometimes the young ones (42) are worse than the older gentlemen!

Had 3 of the same pts last night, picked up a new one.  Lady lived with caregivers, tripped over their cat and fell.  Was in bed for 3 days with hip pain before they brought her to the ER; yep, she had a hip fracture.  She needs to be stabilized medically before surgery can be done.  She was in traction, but the Dilaudid I was giving her, carefully as she also had renal problems, helped to keep her comfortable. 

Last night went very smooth, in fact had time to go downstairs with MaryAnn around 0100 to get an inservice on the new IV pumps.  On the way back we split up, she went upstairs and I went to the cafeteria to get a Dr. Pepper.  Stepped inside and suddenly the lights went out.  TOTAL blackness, and it took about 5-10 seconds for the generators to kick in.  That may not seem like a long time, but try standing in utter darkness, seems much longer.  Then I thought about MaryAnn, she'd had just enough time to get on the elevator; turns out she'd just put one foot in when the lights went out.

Checked the blood sugar of my little lady with the hip fracture and at 0700 it was 68, she was alert enough for orange juice, managed to get some down her.  Checked again about 0725 and it had dropped to 66 and her level of consciousness was significantly different than previously, with just that small drop.  So I didn't pussyfoot around, I gave her an amp of Dextrose (sugar), this stuff is wonderful.  You can see them come around as you give it.  By this time it's 0735 and the day nurses are out of report so I brought them up to date and let them get the follow-up finger stick.

I had to go to a class at 0900 so I went down to the cafeteria for breakfast to kill some time.  We're getting new telemetry monitors and they're pretty snazzy; the computer hardware/softwear is amazing.  That was over at 1100 and I was so tired I wasn't looking forward to walking up the long flight of steps on the way home; Kerry was nice & drove me around the corner & dropped me off home.  I had to go to the store, got home about 1230.  So, I was gone from 1830 last night until 1230 today, 18 hours!  Have you ever been so tired you couldn't sleep?  My whole body was tired, plus it was still a little achy from my prat fall at Jake's.  I was thinking about that, if anyone had been looking from the house next door, it must have looked hilarious - someone walking along, then suddenly hands fly up and they disappear from sight, you hear a thud and then "oh shit!"

When I was at the store I was in an aisle, there was a girl helping her grandmother shop and around the corner came an older man talking on a cellphone.  Not talking about what he was buying or needing to buy, just chatting.  So he sees the two of us, we're not close, there's plenty of room.  He stops, stares as he's chatting, then goes around the lady & her granddaughter and as he goes by me I hear him say something about being having to deal with traffic in the store, "it's crowded & people are in the way."  What!  It's me and 30 feet away another grocery cart with 2 people.  I wanted to tell him, "maybe if you put the phone down and watched what you were doing you wouldn't have any problem pushing your basket around."  But I didn't.
1/15/03  Wed  (0142):   Today is Just Do It Day - Make the Connection, so whatever you're thinking of doing, just do it!  It's also Strawberry Cream Day, but strawberry cream what?  Pie?  Soda?  Don't know. 

My horoscope for today:  'Would you just
Stop? Nobody else feels the need to dance around like that...'

I've updated a lot of pictures and stuff and marked them on the main page.  If you've already looked you've discovered that I forgot to add the link to the new page of pics at "Jake's Place."  Well, it's there now, just one page and if you'd like to take a peek without going to the main page you can click
here to do so.
1/16/03  Thurs  (0230):   Today is Nothing Day, darn it, I have to go to work tonight so I can't just do nuttin'!  Tomorrow is Ben Franklin's birthday, quite a brilliant man; Sunday is the Lewis & Clark Expedition Bicentennial.  They set out from St. Charles, Missouri, on the Missouri River (I just happened to be in that city last August!) and went all the way to Oregon.  I wonder if you could retrace their steps, wouldn't that be a fun expedition?  Sure would be a lot safer, wouldn't have to worry about hostile natives.

My horoscope today:  'Beware of the Spanish Inquisition, today. They may show up unexpectedly.'
1/19/03  Sun  (0141):   It's Popcorn Day, tasty stuff!  I can't wait for Wednesday, it's Answer Your Cat's Question Day....well, maybe I can.  I answer them every day!  Today in 1978 the last Volkswagon Beetle was made; the ones they're putting out now just aren't the same.  Now I know why it's Confederate Heroes Day,  it's Robert E. Lee's birthday, which is a State holiday in Alabama, Arkansas, Mississippi, South Carolina, and Tennessee.

My hororscope for Friday:  'Good day to review what you know about hamsters. I think that's all I should really say, except possibly that it's often considered impolite to see how much food you can pack into your cheeks, when dining out.'

My horoscope for Sat:  'Due to a bump on the head today, you will lose all memory of what you did with your keys. Or at least, that always makes a dandy excuse.'

Sunday's horoscope isn't out yet, so we'll have to wait and see.

I worked on 4East the past two nights and I had an orientee with me, Sally.  So what did I do for 2 nights, sing "Mustang Sally," and "Ride Sally Ride!"  It is more difficult than I thought!   Luckily she knew what she was doing, she just has the same problem I did when I first started - time management.  After working with Janet (Palomar Student) and Sally I can see where I was and where I am now.....
what a difference. 

Thursday night we only had two patients, was I ever bored!  One pt had 2 chest tubes, one on each side.  She needed a lot of TLC, which worked out well since we only had two.  The 2nd was one who'd been there for a while and there wasn't much to do for him.  We were told at the beginning of the shift we were getting a pt who had a pulmonary embolism and was also 33 wks pregnant.  Had no idea how they were going to treat this one as they're put on heparin (blood thinner) for PE's but you couldn't do that with her being pregnant.

Then I find out the doctor is wanting a continuous fetal heart monitor on her....."
I don't know nuthin' 'bout birthin' babies!" There's no way I (we) could have taken that pt, that is not our field, our expertise.  That field was never a particular interest of mine, and my school experience did nothing to further that interest.  Anyway, they ended up sending her over to the maternity/labor & delivery part of the hospital.

Friday night we had 4 patients, the two from Thursday, and we picked up two new ones.  One had just had a radical mastectomy for breast CA, she was doing well.  The 4th was having hematuria and CHF exacerbation and was hooked up to a 3-way catheter.  He kept clotting off so we had to run the fluid in fairly fast, which means we kept going thru the flush bags pretty fast.

Anyway, Sally took care of all four of them and did all the charting.  My responsibility is to make sure she is doing everything right.  And that's hard without getting bossy!  We seemed to get along okay and I thought she did pretty good.

Sharon was there both nights and since it was her 5th night in a row on Friday we gave her 3 pts.  Marge (LVN) had the other four.  Marge was off the floor, Sharon was at the nurse's station desk and Sally & I were at the other desk.  From the west side we hear a thud, then someone saying "Oh God, help!"  The 3 of us jumped & ran, Sally & Sharon were ahead of me when I realized I couldn't go as that would leave the floor uncovered.  Turns out one of the pts on the West side had a seizure (he was in the negative pressure room, used for TB pts), ended up on the floor and wasn't breathing.

They called a code, then he began breathing, so cancelled it.  Then later we hear them call a code for the same room, and cancel it again.  It was Liz's pt and every time he had a seizure he'd stop breathing.  Liz said on the 2nd code blue his lips were blue, face had no color, "he looked dead."  This time the ER doctor came up to see what was going on and since the pt obviously needed closer monitoring they sent him down to ICU.

I was covering 2 of Marge's pts and right off the bat one of them had some rhythm changes that needed to be addressed (bundle changes vs SVT).  His vital signs were okay and there were no new orders from the doctor.  The pt had felt the episode, so it was understandable he was concerned.  We did all we could to allay his fears, but he would occasionally feel a PVC or two and think the same thing was happening.  He was writing down each time he'd feel "something" and even complained to Marge that "I felt this at xxx time, xxx time, xxx time, and no one came in to see how I was."  She had to explain that he's continuously monitored and we don't run in to get vital signs for occasional PVC's.

Anyway, it was an interesting couple of nights.  It was hard not to jump in & do things for Sally; I did occasionally and she said that was her only complaint.  While she was charting I had a bunch of free time so I was reading the Reader, weekly "newspaper" out of San Diego.  Has pretty good articles, but the best part is reading the personal ads.  This time they weren't as good as they can be.  We did laugh over a couple:

"I am a certified master of the Lambada, that's the forbidden dance.  Interested?  I do shadow puppets too.  Must have all appendages.  I have mine."  This one had us in hysterics and provoked a lively discussion.  The other one also had us laughing:

"I'm a lonely man.  I'm 50, lonely, handsome, lonely, slim, lonely, honest, lonely, romantic, lonely, passionate, lonely, imaginative, lonely.  Did I mention I'm lonely?"
Do it now!

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