Saturday, March 30, 2013

The Princess Shift

I was on call last night, 3p-7:30p. Our ER is so totally busy and important that we have to take call. Are there other ER's that do this? I've never met one, but like fairies, that doesn't mean they don't exist. So of course I got called in while shopping at Costco. I love Costco and all those free yummies they hand out. Yesterday there was smoked salmon on crackers with with a sweet sauce, but I digress...

I got there to a not totally crazy ER, but what patients they had were pretty sick. I picked up 3 from a nurse going home. They all had cancer: 1 lung, 1 colon and 1 brain but the brain cancer was probably secondary, so he was going to CT to see if there was some old cancer hiding somewhere else. Gotta make your day, to find out you have a brain tumor. Last week I had a guy who had just been told he had a brain tumor and then a few hours later was told the good news that it wasn't a tumor, but an arterial-venous malformation that needed surgery so it wouldn't explode in his brain. Good news is really relative in the ER.

I walk into the room where my patients are, not really sure who's who yet and I see a woman my age crying. I ask her if she's ok and she says, "They're putting him in hospice."

Hi, I'm Susan your nurse. So, I hear you're going to die.

I don't really know what to say. Usually people's prognoses are not so definitive when I see them. So I don't say anything and just try and be helpful instead. I'm ever so helpful. So, while I'm trying to pass out everybody's meds, teach my other lady how to inject herself with lovenox so she can go home instead of spending the weekend in the hospital and minister to my dying dude, I get told I'm taking one of two codes that are coming in. I try and get caught up with my charting. First code comes in, I jump in help a little, then my code comes in. My patient was in respiratory distress and not breathing so good, so they intubated her. Otherwise, she was pretty awake. Like, very awake. So we sedated her. And then sedated her some more. Everytime I left the room for a minute to see to the THREE OTHER SICK PATIENTS I HAD, I got a call that my intubated patient was waking up and grabbing for her tube. Erg. I got her settled back down, got my lady discharged, took my dying guy off bipap for a few minutes so he could eat before needing the bipap again, I told him I couldn't make it better but I could I'd try to make it easier. I then tried to call report to MICU on my intubated chick. Who's waking up again!

I would like to take a moment to tell all the ER doctors out there that they are NOT anesthesiologists and that propofol sucks. I mean, it's quick to sedate you, but it's quick to wear off and quick to drop your pressure. Please, please, please use versed and fentanyl instead. That is all.

Put my guy back on bipap, suddenly remembered that the guy with the brain tumor hadn't been to CT yet, tried 3 times to get an ABG on my MICU lady who woke up AGAIN, more sedation (is she a drinker? is the line ok? why isn't she knocked out?) Called the respiratory therapist to see if he could get the ABG, he couldn't and left before I could stop him to do the transpot with me. Lady wakes up again, more sedation. Finally, I grabbed my relief who offered to bring her up to MICU while I finished up my charting and that he'd tell them I couldn't get the ABG. Searched 10 minutes for lost chart. Finished charting. Brought promised water pitcher to my hospice patient. Gave his wife a hug and held his hand and said goodbye. Went to get changed. Texted Gary to tell him to come pick me up, he said, "you've got the car." Oh, yeah. Well, it's been quite a four hours, what can I say.

Picked up cheesesteak and ice cream from Thomas Sweets for family. Was in bed by 10:30. Slept til S's alarm went off at 2am, cause she played with the phone. Really? But that's another post.

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