Amorous RN, or how not to be accused of same

During a brief moment of live TV, where as I'm usually watching something recorded by my Tivo, the weekend weather guy for the Houston CW affiliate was doing his thing. I was a bit dumbfounded by his name, Casanova Nurse. Really and truly, that's his name. Unfortunately his bio does not reveal the provenance of such a unique moniker. I like that he (most likely) does NOT live the life that his name could have dictated, skillfully wooing then abandoning patients in an endless string of medically-based conquests.

On that note, last week I was advised that I should make sure a female nurse or patient care tech was present whenever I examine female patients and to leave bed baths to the female staff as precautions against allegations of impropriety, which have ticked up recently. With the pain, lack of natural light (and therefore cues to the time of day), dearth of quality sleep, medications for pain and anxiety, or just idiosyncrasies, patients who've been in an ICU for days can become confused and somewhat paranoid. For instance, even in my short time working I've seen several patients who think that all staff discussions are about them, including gynecological surgeries for men and imminent childbirth for elderly women. Good thing I have a psych background, it's useful.

It's rather annoying that I have to be so cautious as I have no interest in molesting my clients and I can't really imagine a nurse getting in to this line of work with that intention. Still, better safe than sorry or as we often say, CYA.

Up all night

I started working nights this week. My schedule in general is:

- Wake up at 5 PM
- On the bus to work at 6:05 PM
- Work 6:45 PM to 7:15 AM
- Home by 8:00 AM
- In bed by 9:30 AM

Soooo much better than waking up at 5 AM. On my days off I'll wake up and hit the gym, do laundry, and grocery shop before those places close at midnight, then enjoy the peace and quiet of the night. At first I'm sure I'll do a lot of reading and movie-watching, but I do plan to go on some photo excursions around my neighborhood and finally get out to the music clubs to see some bands. A social life would be nice as well.

I was going to advise my friends to avoid calling me during the day, but I accidentally left my phone on yesterday and didn't wake up despite three separate calls. Yay for the air conditioner/white noise generator in my bedroom.

Hectic day, but I did it

Started the day with two patients, both of whom were ready to transfer out of our unit. After getting the requisite doctor sign-outs and orders for Patient #1, I started packing up the his things when the monitor for Patient #2 alarms. I look over and see no blood pressure on the monitor, then flick my eyes over to the patient who is calmly sitting up in her chair, then to the blood on her wrist. Dang, the arterial line has come out. I ask another nurse to grab a blood pressure cuff while I get some clean gloves and gauze to hold pressure on the site of bleeding. Cuff goes on, site stops bleeding, secure it with tape, then toss the bled-on pillow.

Call report on Patient #1 (the one who didn't bleed) and move him upstairs. Back to the unit and my open spot is already assigned for a patient currently in surgery. Call housekeeping for a stat clean and start setting up for the admit. Intersperse setting up suction cannisters, tubing, monitor cables, etc. with prepping Patient #2 to transfer upstairs. Call report on her then hand off to my preceptor cause here comes the admit, a "pump case" - cardio-pulmonary bypass pump during cardiac surgery - who will be on a ventilator while recovering from anesthesia. These guys can be quite unstable and this one is initially very hypertensive. Treat that, have family back for a quick visit and status update, and then catch up on charting.

Now as Patient #3 warms up (they're chilled during surgery to reduce metabolic demand), he's vasodilating and dropping his blood pressure. Calls to doctors for fluid orders. Hang multiple bottles of albumin (yes the protein in egg whites and shampoos, though this version is human albumin) as an intravascular volume expander. Success! He's stable, which is good because now it's time to set up for another admit in the bed formally occupied by Bleeding Wrist Lady. It's not part of some cruel hazing, just happens to be the only spot open for an admit.

My preceptor helps me set up the spot while I keep one eye on still-intubated dude. Patient #4 rolls out and we're off again with stabilization, family update, and charting. While fetching a medication my preceptor says in passing, "Don't worry about the bloody sheet behind [Patient #3]'s head. It's all good. Just wanted to warn you so you don't look over and panic." I appreciate the heads up.

90 minutes later it's time to report off to the oncoming shift. Whew. Four patients in one day with two of them pump case admits is unusually heavy. Of course I had lots of help from the other nurses in my section as everyone pitches in during new admissions and nobody's going to let you (and the patient!) drown. I was most proud when a co-worker said, "I like that I didn't hear any crying over here."

Love my Car Olé

Another nice weekend in Austin. This time I came up to visit with my wonderful (but slightly misanthropic), adorable (yet occasionally menacing) friend and former roommate Carole and her sister. Both now reside elsewhere and it had been a while since they'd been back to Austin. I didn't join them for the requisite trip to Toy Joy and Momoko, but I did attend the night swim at Barton Springs. Sure the water is 68 degrees but if you just start swimming, the exertion keeps you warm. Getting out is mildly uncomfortable, though I find that vigorous towelling and thoughts of perhaps going to Kirby or Magnolia for pancakes soon resolves the shivering and goosebumps.

Lots of eating out including meatloaf at Hyde Park, Thai pizza from Flying Tomato, breakfast tacos at Tamale House, and a strawberry cheescake snowball from Casey's where we heard but did not directly witness a two-car collision. Thankfully everyone was OK and I didn't have to spring into action. It makes me nervous that I might be called upon to render medical aid outside my job and volunteer activities. Of course I'll do it as needed, I'd just rather not have the "opportunity".

Oh hey, I just realized that Carole, her sister, and I failed to convene a meeting of the organization we founded many years ago. BOTA, or Bring On The Asteroids, is dedicated to periodically becoming so frustrated by the general suckiness of people that we throw up our hands and welcome an asteroid bombardment that will wipe out humans and allow the rise of a new sapient race. Hopefully the bonobos who are generally groovy and prefer sex over violence.

Medicine on TV

So I was watching an episode of a TV drama and there occurred a medical emergency which played out so poorly, I shrieked, "WHAT?!" at the TV. A very fit young man is in the hospital after being beaten up. One minute he's talking, then suddenly the EKG monitor (which an assault victim with no history of cardiac problems would not have) alarms and IMMEDIATELY a doctor comes running in saying "He's crashing. Get me O2 and an ambu bag." The monitor completely flatlines (wrong) and a couple more staff members (nurses, possibly) run in. The MD starts totally ineffective, fake-ass chest compressions with the patient still up at a 30 degree angle in the bed. The nurse with the ambu bag gives a few breaths, then caresses the patient's chin. Huh?

Oh it was so bad. I'm sure police and lawyers get riled by horribly inaccurate portrayals of their professions too. A guy asked me once which TV shows were the most medically accurate. The best one is Trauma: Life in the ER but that's a documentary show so it really doesn't count. I haven't watched it in a while, but ER was pretty decent in that the actors had practiced doing fake intubations, chest compressions, and other procedures. I recall as well that the treatments they rattled off by and large were accurate for the patient's condition. Of course, like all medical shows, the doctors did tons of stuff that really nurses do.

Scrubs is rather bad, both in the wildly inaccurate depiction of medicine and in severely dropping off in quality after the third season. Don't even get me started on House.

And then there's my favorite quack doctor. No not Dr. Nick of The Simpsons. I'm speaking of Dr. Spacemen (SPA-CHE-MEN) on 30 Rock. A couple episodes back Dr. Spacemen (wonderfully played by Chris Parnell) rushes in to see an unconscious man who he instantly and correctly identifies as being in a diabetic coma. After some ineffectual bungling, Alec Baldwin's character says, "Couldn't you just, you know, inject something right into his heart?"

Dr. Spacemen, with a look of concern and pity, responds, "I'd love to, but we have no way of knowing where the heart is. You see, every human is different."

BWAHAHAHA! Thank goodness for Tivo so I can pause and rewind because they weren't done. Spacemen grabs the phone and says, "Is it 411 or 911? [pause] New York. Uh, diabetes repair I guess?"

Oh how I love, love, love Diabetes Repair.

A typical Monday of late, in that it involves work, frustrated desire, and something funny

I didn't make it to the dramatic presentation. I transposed two theaters when I was looking at directions originally and when I realized the mix-up it was too late to make the show. Oh well, there will be other opportunities. I'll just have to stay on top of what's playing and plan ahead. What I like about Houston is that classic and contemporary, much-lauded works get mounted here. Quite different from Austin.

Yesterday work was a study in contrasts. When I started the day, I took two patients with the plan being that I'd give them up at 9 AM to another nurse so that I could get more practice admitting difficult cases. Two hours to assess the patients, document, give medications, while also managing phone calls from family, updating doctors on condition, and providing comfort care isn't much time. I didn't quite make it and by 9:30 just ended up fetching one patient's meds for the relieving nurse to give. Dang. Then I found out that the surgery schedule started late because resident interviews had begun that morning. We wouldn't be getting the kinds of patients I needed till much later in the day. I kept myself busy helping others and studying a little till my manager called me up for my 90 day review. I'm doing well apparently and get a small raise. Yay.

At 3 PM (or 1500 as medicine uses military time) I took back one of my original patients and prepared for a fresh post-op case. He came out at 1700 and the race was on to do as much as I could get done before the next shift showed up at 1845 while also, you know, taking care of the patient. As I was saying to Mybloody last night, I once started to write a post about post-operative care of patients who required heart bypass during surgery but when it took three paragraphs just to establish the basics of hemodynamics, I deleted it. Too complicated and therefore boring for anyone that doesn't want to actually do it I think.

Anyway, I again didn't quite make it in the time allotted. Between assessment, calls and conferences with doctors, warming the patient, managing blood pressure, giving meds, and documenting I didn't get to some paperwork and a few of the less important medical orders. I was and am disappointed that, though improving, I'm still slow. My preceptor said, "You did fine. Are your patients still alive? OK then." To which I replied, "That is *not* the standard I'm shooting for at this point." I'll get there eventually but I'm not one to be patient with my own progress, grumble grumble.

On a lighter note, this made me laugh:

I was ready to be impressed

Oh Houston, I'm trying to like you but you're making it difficult. Last week I got excited because I found out about the Westheimer Block Party. Lots of bands and artists, free, and just a 20 minute walk away. It started at noon, but after a long week at work I slept in, read a bit with Muriel's Wedding on in the background, went to the gym, and ate a leisurely early dinner before heading down to the Party. Three hours later I was walking back home rather disappointed. Here are some notes I jotted down:

- This band would like to be the Strokes. Now they're playing Tom Petty's "American Girl". Huh.

- Bandana. Why?

- The painter of stylized rotund people is here.

- Shitty drummer for a jazz band. Saxomophones.

- Screw is still a going concern in Houston. [Reading the Wikipedia entry, it's still a going concern everywhere. Shows what I know.]

- Between song time > song time = no good + me moving on

- Suck.

- Nice guitar, belongs in better band.

- A song I like! Now sucking.

This was the most entertaining thing I saw.

I really should stop comparing Houston to Austin, but it's hard when the city you love to pieces is not the one you're in and the one you're in jabs you in the ear with mediocre to poor music.

Tomorrow I get my first taste of Houston theater. My cultural hopes are elevated yet wary.