Friday, June 30, 2006

I hate my job, I love my job

Here's things I like about my job:

It's totally cool, No day is ever the same, I can teach, take care of patients, provide emotional support and spend a lot of time with families. I can wear scrubs or business clothes. My schedule is very flexible. My bosses are pretty approachable and listen to my concerns.

What I don't like:

Pay-not so good. I can be out for 24 hours at a time. I have to be tactful with people who I think are ignoramuses-not the people who may not know things about the donation process, but people who are really against donation and hinder the process(more on this). We are guests in the hospital and I have to play nice with everyone, usually easy for me, but I have limits. And the pay, did I mention I'm not getting rich doing this?

The last few weeks have been a whirlwind of personalities. I've been out a lot. I've done about a case a week for the last 7 weeks. That's 24 hours out, not to mention the referrals where I go and evaluate, but the person's not brain dead or not medically suitable or what have you. One weekend, I went out at 10am, got consent, finished by 7am THE NEXT DAY, went home and slept, woke up, went to another hospital, got consent and got home at 9am THE NEXT DAY(that's day 3, if you're keeping score at home). The family's like, "Who's that coming in and out all weekend? What's their name again?"

I have families that have been wonderful. Even in their grief, they wanted to give the gift of life. I've had families who were mad, threatening lawsuits and scaring the bejesus out of the hospital staff and they STILL wanted to help save a life through organ donation. I was screamed at-SCREAMED AT! by a crazy-ass neurologist (is that redundant?). I have spent 23 hours on site only to have the donation come to a screeching halt because the serologies came back positive. I had a nurse be very rude to me while I was giving an inservice on donation after cardiac death and then have the 'nads to say, "A non-heartbeating donor? WELL! You must be desperate for organs." And throughout it all, the family has been bitching like crazy totally supportive. And the baby! Did I mention that Laughing Baby is crawling! God in heaven. She's gone from completely immobile to a whirling dervish in like 3 weeks and I feel like I spend all her awake time picking her up and "refocusing" her energy on toys instead of, say, the electical cords. And she climbs like a monkey. I have NO idea where she got that from. All right, I'm done-before I wear out the caps key. (AM I SHOUTING!)

Monday, June 05, 2006

What to do when your patient's not dead

So here's my weekend. 72 hours on call and really, I shouldn't complain. I wasn't even out for a total of 12 hours. Friday, I went to a hospital close by, found out another coordinator was already there, so we both talked to a few people, got a few things done. We still hadn't actually seen the patient, cause there was a ton a family and we weren't ready to announce our presence. The neurologist had seen the patient and done the first clinical. So far, things going smoothly. Then we see the door open and a tech walk out. We look in at the patient... and she's moving. We sigh. Call that neurologist back, her patient's still alive(barely, but still).

Saturday, no calls. I slept like a cat. 8 hours of sleep, 1 hour for stretching, eating and using the litter box(eh hem). Then back to sleep. The family, bless them, left me alone.

Sunday, I'm back out to a hospital an hour away for a potential donor who "had nothing" ie they had no reflexes:no cough, no gag, no pupil response, no pain response and not breathing on their own. I get there and fortunately for me the respiratory therapist had put the patient on CPAP for a few minutes and she did indeed breathe on her own. Then I went into the room and noticed she was shivering. The nurse(who was very overworked, I admit) said, "her fever must be coming down too fast." Except, and here's the thing, dead people don't shiver. Not even brain dead as compared to your dead dead. Shivering, still alive. It's a fact. Look it up.

Just when I think my my weekend call is over, just when I said, "hey, this weekend wasn't so bad." What was I thinking? I get phoned at 1:30 in la manana to see another patient who's "got nothing, maybe a little breathing on her own, but not much". I head on out, luckily not terribly far away. I get there just as the patient is going up to the ICU from the ER. She's being bagged by respiratory. "Sure she's breathing on her own, see." and he stops bagging for a second. Deep inhale. They get her onto the bed and I take a look at her. Pupils equal, one sluggishly responsive, one brisk. I ask the doc to get a set of liver enzymes and call me in the morning. Well, later in the morning. And go back to bed.

So why do we go on site so early. Sometimes I feel like that scene from Monty Python's The Meaning of Life:

"I've come for your liver."
"But I'm still using it!"

I don't know about where you live, but in my neck of the woods the hospital staff(nurse or doc) are supposed to call when the patient meets certain criteria:
  1. Neurologically devestated-anoxic or an injury(bleed or trauma)
  2. GCS of 5 or less
  3. Loss of 2 or more cranial nerve reflexes

The idea being that the earlier we get on site, the better the outcome will be. Many times, like in the above scenarios, we just wait and see. If they get better, good for them(unlikely, though, as the prognosis for someone with a GCS >5 is pretty dismal. I mean, you get 3 points just for lying there). If they're not medically suitable ie multi-organ failure, HIV, cancer, then we say thank you for the referral and walk away. If they are medically suitable and brain death is imminent, we formulate a plan with the hospital staff about talking to the family, management and when, how and who is going to start the brain death protocol. So, yeah, I do feel like a vulture sometimes.

So nurses, (or docs) if you call us with a referral, here are some handy tips. Please give me about 5 minutes of your time. If you're too busy(and you frequently are) let me know when I can call you back. I need to know your assessment of the patient, their vital signs, their medical/social history, what drips they're on, their urine output and recent labs. If you don't know something, just say you don't know, you haven't gotten to it yet, whatever. I'll let you know when I'll be there and if there's anything that would help us, like maybe the doc will order LFT's or some other blood work to see if they're worth pursuing as a donor. It's a team effort.

Thursday, June 01, 2006

Busy, Busy, Busy

May was a busy month. I was out overnight at least once every week. Driving all over God's creation, too. Not to mention cars breaking down, teenage drama and still unpacking the last of our boxes. And the Laughing Baby is starting to crawl, God help us. Since I can't crate train the little scamp, I'll guess we'll be buying a baby gate.

My last 3 cases were a little disappointing. In 2, the family said, "take whatever you can, they won't need it anymore," but for various reasons we were only able to recover a liver from one and kidneys from the other. Other organs no good and not suitable for tissue.

The 3rd case was a youngster, in the wrong place at the wrong time. Perfectly healthy, except for the bullet in his head. Mom would only donate kidneys, I don't know why. I should be glad that two more people are off the kidney list, but it's frustrating. His liver was perfect! (not to mention his heart and lungs.) I guess I can see why people say no, but why the stipulations? Maybe she knew someone who needed a kidney. I'll never know.

Anyway, back on call for 72 hours. I spent my days off getting reacquainted with the family, playing with the delicious baby and some chores. And I STILL have boxes to unpack. Ugh.