Change of Shift

A day late and a dollar short....that's me. In case you didn't know, Kim at Emergiblog is doing a nursing blog carnival. Check out last week's, it's very good. A few of my favorites:

I swear I didn't steal her idea when I wrote my last post! Nurse Ratched and I are on the same wavelength.

But I have to point out these two to everyone I know. Get out the tissues....

Thank God for good nurses everywhere
and
why I, and every other TC, do what we do.

Check them out.

What I should have told my sister

I have inherited the title of "Family Nurse". My mother had it before me. When my grandfather would have chest pain or shortness of breath, instead of calling 911, he'd call my mother. Now, the next generation looks to me, apparently, for such sage advice as, "Don't call me, call an ambulance!"

Seriously, my sister calls me up the other night, she thinks she has a broken toe. She really banged it and now it's all black and blue. Now, for you gentle readers who have never worked in and emergency room, don't fear: I gave sound advice. Put ice on it, elevate your foot and buddy tape it to the next toe. And wear shoes with a firm sole for a couple of days. Take motrin or tylenol for the pain. All good. Good for her, she's doesn't have to wait for hours in the ER, no bill and the local ER has one less body in the waiting room.

Now, for you not-so-gentle readers who have worked in the ER, I realize I should have given her some different advice. Something like this: wait til 2 or 3 am, when the wait is shorter. Tell the staff that you banged your toe 2 or 3 days ago, but have been toughing it out and you thought 2am was a good time to come in. This will impress them and get you seen right away. For pain, have a couple of stiff drinks. Right before you show up, so if they start moving your toe around it won't hurt so much. And don't forget, keep asking repeatedly, "Is this going to take long?"

I know, I'm evil.

Good for her

Doctor, my eyes
Cannot see the sky
Is this the prize for having learned how not to cry


I got called out this evening to see a patient who was obtunded and vented, according to the report. I get there, only to see a gaggle of nurses giving report to each other. Then I hear one nurse say, "oh well, good for her." They part for me, and the nurse sitting at the nurses' station says, "Oh, (my OPO's name) is here. Listen, when I called she had nothing. I swear." I look in the patient's room and she's kicking her legs lustily. Apparently, in the interim, she woke up from whatever she OD'd on and is now kicking and fighting the vent, the staff and the restraints they've put on her. So, she's not dead. Good for her.

I sit down to write a brief progress note and call my office to tell them I'm leaving. Something from the front of the chart catches my eye. It's a suicide note. I tell the person on the other end of the phone and they make the typical, ER comment, "Well, let's hope next time she gets it right." I cringed.

Now, I've had my share of whiny, puking, usually teenaged suicide attempts. There may be some half-hearted scratches on the wrists. Or maybe they took some pill they found. Very often there is charcoal to be administered, then puked up, then administered again until you both look like you work in a coal mine. And the drama. Always the drama. I understand why health care workers have this jaundiced view of near suicides. Once I had a young woman with cystic fibrosis who was trying to live until her 30th birthday. In the next bed was a 20 something drama, who felt she would show her boyfriend by taking 5 tylenol and calling it a suicide attempt and was now generally being a pain in the ass. You just wanted to strangle her, or at least show her the woman in the next bed who would give anything to live to grow old.

When I hear that someone has tried to commit suicide I think of two patients, both women, who really touched me. The first was Patricia. Spanish-Pah tree see ah, not Pa trish ah. Patricia was how I learned that rat poison is basically coumadin, cause she felt the pain of living, made herself a rat poison shake and drank it down. She was basically okay but had to be watched for bleeding and given Vit K to help her blood clot for a few days. Don't ask me why, maybe because she had some things in common with me, but she struck a nerve. With my little Spanish and her little English, we talked about what happened. She was glad she didn't die and she wanted to get help. She was the first person I took care of in the ER that I ever visited upstairs. We couldn't really talk, but we communicated and she was glad I came to see her.

I can't remember the name of the second woman. Zoe? Zelda? She was also my age. She had been fired from her job and was driving back to live with her sister. While passing through my state, she pulled her car to the side of the highway, slit her wrists and jumped off a bridge. Some fisherman were in the water and pulled her out. She managed to escape serious injury. I remember being in xray with her while they cleared her C-spine. Her sister was in the waiting room. I asked her if she wanted to see her. She said, "do I have a choice?" I said, "you always have a choice." We locked eyes for a minute and she was crying and I started to tear up. She was the second patient I went upstairs to visit. Her mother was with her, high powered and full of money, taking charge and ordering the staff around. She demanded to know who I was. I looked at Zoe(?) and she looked just like a butterfly that's about to be pinned to a board. So scared and fragile.

How can you judge someone who wants to end their life? I wanted to take these women and hold them close and tell them that someday life will be worth living again. That they don't want to die, they just want the pain to stop. I don't think my coworkers, then or now, are cruel as much as they're in denial. Who hasn't had a dark thought, a secret urge to hit the reset button? I think they're whistling past the graveyard. By being cynical, they can convince themselves, "I'm normal and they're not." And if you haven't ever had that thought, then good for you. And my now awake patient, she doesn't need me hovering at her bedside, so good for her. I hope she wakes up and gets the help she needs.

I'm fried

Well, I have to say that doing Grand Rounds might have been the easiest thing I've done all week. And that's saying a lot, cause I thought GR was frustrating as all get out, what with the blogger and the mixed up links and the staying up all night fretting about it.

My laptop's broke. I was out for two days straight, trying to get 7 organs from a poor teenager who crashed his car. The last 24 hours on the case the RN and I were working our butts off, trying to turn around a crashing donor. In the OR, everything that could go wrong, did go wrong and I've spent the past 2 days second guessing myself, my boss and my career. Maybe I should work as a recipient coordinator. Maybe I should go back to the PICU. I'm confused. Then, today, when I still haven't really gotten any sleep all week, I get called out at 8am. And I'm the backup person. I shouldn't get called out unless everyone else is on downtime or out on a case. This led to harsh words exchanged between the Love Monkey and I and us missing a jazz fest we had planned for several months ago. We're better now, but it's my own damn fault. I need a vacation.

I was back home at 8pm. I got to see my little baby-boo sleeping all curled up. She's what keeps me going. I wish I could be home 24/7 with her. Aaaarrggghhh. And the thing is, I like my job and I'm good at it. But maybe it's not what I need to be doing right now.

Grand Rounds 2:42

Welcome to Grand Rounds 2:42 and welcome to donorcycle. . I’d like to thank everyone for their donations, er, submissions. So come in, grab and drink and peruse this week’s finest writing from the medical blogosphere.

Straight From the Heart: here are my favorites

1. Not only is this a well-researched and well-written piece, but you can get the t shirt! Seriously, the sweetest little baby I ever took care of had BA,
   and her life before and after transplant was like night and day. Thanks, Amanda, for this amazing post.
2. Navel Gazing Midwife goes out on a limb and shares her experiences with bipolar disorder.
3. Chronic Babe just has to vent…To sleep perchance to dream? Well, how ‘bout to teach, to shush or to punch?
4. A post from A Hearty Life about China's first heart transplant.
5. Aaah, look at all the lonely people. From Anxiety, Adiction and Depression Treatments.
6. And you thought HIPAA was scary? Here's a look at who's invading your privacy now. From Medical Connectivity.
7. Who doesn't love July 1st? I remember one July, they called a Code Red(fire), and all the new interns just heard "Code" and went running upstairs. Instead of laughing and pointing, like we did, About a Nurse exhorts us to act kindly towards these new docs.
8. Hey Fellas! Did you know childbirth is like baseball? Well, now you do. Thanks Milliner's Dream.
9. What do you do with a non-compliant patient? Go to their wedding, of course, like Doctor Anonymous.

The Brains of the Bunch

Do you know how many times I've heard, "my daughter's sister's cousin was brain dead, but she got better?" Jake, at Pure Pedantry, tells us the difference between a persistant vegetative state and a minimally conscious state. With charts and diagrams and not-so-large words.

Star-crossed lovers? Diabetes Mine has a different look at two up-and-coming diabetes drugs.

Health Business Blog and adaptive trials-coming to pharmaceutical company near you.

A cure for malaria? I'm interested.

A Nice Set of Lungs

Asthma vs. The Beaver. No really.

Breath Spa for Kids on pediatric ED visits. With a shout-out to the irrepressable Flea, who has something to say about time spent on the phone.

Sometimes we need a little medical management:

From The Doctor Is In, part of an ongoing series on medical reimbursement.

Make your own medical journal. From Clinical Cases and Images.

The Pharm Voice says we might one day be able to safe to visit Minnesota. Aetiology says it's okay, just don't drink the water.

Straight From the Doc offers an alternative to Cancer Commentary talks about Disease Proof thinks that just because you can sink a free throw, doesn't mean you know how to eat right.

Mental rumination can be a good thing. At Health Psych.

And while we're at it, The Happystance Project says that loneliness can be bad for your health.

The Bile Duct

What to do when the object of your lawsuit won't sit still. From Healthy Concerns wants you to Stop Blaming the Victim already. Nuff said.

Practice makes perfect. Unless you're My Life, My Pace, in which case practice makes for a whole lotta hurtin’.

Kim's in Ireland, but her heart's at Grand Rounds. And why is she talking about burnout when she's drinking Guinness?

Anikka's mom, from The Wait and The Wonder, on GI bleeds and mother guilt.

Urostream, with a Uro-rant.

I'm not sure about the analogies, but decide for yourself. Hippocratic Oaf and the coming "war".

No Bones About It

Dr. Jest and what keeps a widower happy.

Neonatal Doc, the HPV vaccine and the controversy it's creating.

Nick Jacobs, from Hospital Impact, on why it's better to be lucky than good.

Sorry surgeons, (but in my job, the OR's last and usually at 3am, but I digress.

Dr. Bard Parker with some required reading for young surgeons.

Barbados Butterfly, on what makes a good dog.

http://barbadosbutterfly.blogspot.com/2006/07/good-dog-rusty.html

And this youngster should have read Dr. Parker...

http://jaotte.wordpress.com/2006/06/27/my-first-day-in-surgery-part-iii-scrubbing-in-and-screwing-up/

Curse you blogger, for acting up again!

keep on blogging.

Well, I'm never doing that again. All right, maybe next year. The baby's up and I'm pooped.

Organ Donation Saves Lives!

I passed!!!

Hang on to your kidneys, I am now certified to procure organs! You may call me Queen of all Transplants, but since I am basically modest there's no need to kneel or genuflect or anything. As a treat, and because I'm a total dork, I'm thinking of getting a lab coat that A. has my name-T. Billie, RN CPTC and B. fits....because like Goldilocks, I have 2 lab coats. One is large and shapeless and the other is ridiculously small and won't button-from my svelte days in nursing school when stress and a diet of coffee, motrin and maalox kept me skinny. Aaaaah, nursing school.

mmmm, stylin'

Grand Rounds 2:41

This week, Grand Rounds are at RangelMD. Check it out.

Next week (gulp) Grand Rounds are here!

Send your submissions to donorcycle at hotmail dot com by midnight, 7/10/06

Also happening this week:

I sit for my certification exam

I have a meeting with the aforementioned crazy-ass neurologist.

And the baby is CRAWLING! And lightening fast, the little nipper.

And I'm on call for the 6th weekend in a row

So please......be gentle.