I've been offered a per diem position, which I may take 'cause God knows one job has never been enough for me. Not to mention that little "mommy thing" I do on my days off. I'll also be working at a transplant center, seeing donation from the other side as it were. PICU gets the occasional kidney transplant and we also see a lot of cardiac and liver kids, but so far they get sent out to NY or CHOP for transplants. I'm going to ride my bike to work-how nice is that? I'm going to get reacquainted with the family. I'm going back to school. 3 twelve hour shifts and the blackberry is getting tossed down the toilet(only kidding, IT guy).
I am interested in hearing from other TC's....people from all walks of life seem to read this blog, but WHERE are the TC's. Busy working, of course. Who has time to surf when you keep a schedule like this? So, if you have a good TC story, please email it to me at the address above. Please keep it all HIPAA happy, thanks.
So, there I was at 0315 Sunday morning. I was awakened at 0615 Saturday morning evaluate this patient. I got consent around 1800. Two and 1/2 years ago I asked another mom for consent all by myself for the first time. I was nervous as hell. I was waiting for a TC who spoke Spanish to arrive and help me out. Before she could get there, the surgeon told the family, "You can donate or we're taking her off the vent." I nearly crapped my pants. I did the consent and med/soc with a family member to translate. Between my Triage Spanish and her Spanglish we got it figured out. Why did they consent? Because they had a cousin who needed a kidney. Similiar family dynamics today, except I can't go into details because they'd be too telling. I will say that for the first time in 3 years I had a real ethical and moral dilemma. We convened the hospital ethics committee but I was still funky weird about it. Then I spoke with the hospital priest, who is awesome. Sometimes, the right person you need to talk to comes along at the right time.
Anyway, it's after 3am, my circadian rhythm is at an ebb and my scrubs could stand by themselves, I've been wearing them so long. Dinner was a bag of Cheetos and a peach Snapple. Ymmmm. Oh, yeah, and a donut for dessert. Also, my partner in crime came out to help me and brought me an enormous iced decaf. I know what you're thinking. Decaf? At 3am? Trust me on this: if you give up caffeine that little 5 mg in the decaf really perks you up.
The OR isn't going to be until morning, so I'll get relieved at 0700. Immediately following consent, it's very exciting. I mean, it's sad, because you're dealing with the family but you're also like, "Yes! I got consent!" Then, there are a million things to do right after you get consent. Phone calls to make, paperwork to fill out and fax. Orders to write, huddling with the staff to go over the best treatments to maximize organ perfusion and function. It's like you've been sitting on your butt a lot of the day waiting for things to happen and then you spring into action mode. That was me at 1800. Now my butt is dragging and my teeth feel fuzzy and I left my little toiletry bag back home. Uck.
I spent a lot of the night working on lung recruitment. She had some atelectasis on the right, maybe aspirated. The nurses were amazingly helpful. I'm lucky to be on this unit, they practically don't even need me. So we got respiratory treatments on board, started Solucortef, Gave albumin and lasix. A repeat CXR, repeat ABG's. We did the "30 second PEEP", putting the PEEP up to 30 for 30 seconds, then down to it's original setting for 30 seconds, then repeat the whole thing 2 or 3 times. Do another O2 challenge and repeat the ABG. Both lungs wound up being recovered, along with heart, liver, panc and kidneys. I know what I said last week, and I stand by it, but it feels good to know you made a difference to seven people and all the people they'll touch in their lives. Feels good.
My coworker left around 5 and I spent the last 2 hours trying to figure out how to get everyone to the OR at the same time, with help from triage and inhouse. Ever try coordinating 4 surgeons, their assists, their perfusionists and all the people who are driving or flying them to the hospital. It's a little like trying to rustle cats. Thankfully, I only got a few minor scratches. Have you ever had one of those mornings where you literally want to kiss the calzuros of the incoming nurse? It was that kind of night.