Saturday, September 29, 2007

A Tale of Two Jobs

Yes, I love the new job, as my aforewritten post shows. I love the babies, I love taking care of sick kids. I even love(well, maybe like a whole lot) taking care of stupid teenagers who ingest too much beer and fall off car roofs. No, really. I think it's because you can talk to teenagers in a way that you can't talk to other patients. "Dude! What the hell were you thinking?" and they just shrug and look sheepish. Plus, you can get away with the occassional curse word in front of teenagers, as long as their parents aren't around, like when you're hip deep in a dressing change and you drop your last piece of Telfa and now you have to stop everything and walk clear across the unit to get another one and so, without thinking, you mutter, "Mother-f*#ker!"

Sorry, but TC can curse like a sailor. In several languages, including Tagalog. It's a gift.

Anyway, I have had a series of patients in the last 4 shifts, mostly because I am low on the totem pole and so don't get continuity with my patients because some other, more senior, nurse, wants to take care of "her" baby. Whatever. The past couple of days we've had a potential organ donor on the unit and my former colleagues have been present. In was nice, in that I got to exchange some juicy gossip and catch up on the happenings around the office. It also shows me that, just like being Catholic, you never stop being a TC. I still say "us" and "we" when talking about the OPO. Actually, I instinctively typed "my" OPO. See what I mean.

So, even though it's probably good that I got out of that handbasket before it bursts into flames, I have to say-I MISS IT! I miss my old job. Or at least I miss the work, if you know what I mean. I miss the thrill of waiting by the phone and finally getting called out. I miss sitting around ICU's all day waiting for the doctors to finally start clinicals and listen to them whisper about you at the nurse's station. I miss the nervousness when it's finally time to ask the family and then the rush that comes when you know they're going to be a donor and you have 8 million things that need to be done all at once. I miss crying with the families and hugging them and listening to them talk about their loved ones. I miss knowing that you're getting one more person off the waiting list.

Also, I miss the free time I had, when waiting, to write as much as I pleased with no interuptions. I do have more free time now, but it's all spent at home and there are lots of distractions, including one who can crawl all over the desk and say, "Eat dat! Have dat! Want dat!" Right now, as we speak, I have a 2000 word essay in the works, that requires actual research and critical thinking as opposed to my usual snarky ramblings. My fingers are itching to type it, although I hear there's a cream for that now. In former days, I could pass the time in an ICU, tucked into an inconspicous corner, surfing and typing away on the best technology a non-profit could buy, while waiting for a doctor to decide if 96 degrees is too cold to start brain death and is it ethical to start pitressin on a patient who's peeing a gallon a minute if the organ donation people are in the same hospital.

Ahh, well. Maybe when the little distraction is older I'll go back.

Speaking of which:

I Cn Haz Cupcake!
** Sorry bout the run on sentences, I'm trying to finish before "The Big Comfy Couch" is over.

Wednesday, September 26, 2007

One more reason to be a nurse

If I were a better woman, I'd do my job without regard for accolades and thank you's.

But sometimes Thank You's are nice, too.

Sunday, September 23, 2007

Sunday night reading

I've worked all weekend and my feet feel like they weigh 20lbs each. Riding the bike to work is really nice, but that last hill on the way home is a doozy. Tonight I walked the bike up it.

Anyway, I'm overdue for my monthly coop article, so tomorrow will be spent busily thinking up a topic and then writing on it. Better late, if ever, is my motto. In the mean time, if you haven't read it already, Change of Shift is up at Kim's. I have a new post in the works, so check back in a day or two.

Wednesday, September 19, 2007

LPS(longer post soon)

Well, we all survived the weekend.

And I have to say, Sixteen-odd years and two kids later, I finally feel like a "real" mom. Mainly because I managed(with ample help from Love Monkey) 8 teenagers and one baby for 2 days and there were no injuries, no fights, nobody got lost and everybody got fed(if burnt weenies and ice cream cake count).

The weekend turned out to be nice. Around 9am the rain stopped and the sun came out, even if it was a little windy. Even the old folks came out-Auntie and my mom and dad. I had the most awesome video on my phone of this parade snaking its way out to beach, led by Auntie, with her walker, going full steam ahead, followed by the Teenager holding a huge Jolly Roger flag and various kids carrying all our crap out to the beach and the grandparents bringing up the rear-my mom with her cane and dad carrying the beach chairs. I was even going to post the vid for your delight and edification. But I didn't press record. Because I am tekniklee challenged! Auugh!

We had a nice fire on the beach. We did some swimming until the park ranger yelled at us. We roasted weenies and marshmellows and generally had a great time, including Pooter, who chased every "duckie" (read:sea gull) she could find. It was so great that I want to do the same for my 40th next year, except maybe not in December, unless it's a beach party in Jamaica-hint, hint.

Monday and Tuesday were 12 hour days for me, which I was looking to with dread as I'm still kinda sick. I feel loads better but I have this bronchitic cough that makes me sound like the illegitimate spawn of Betty Davis and Harvey Fierstein. Just what you want in a nurse taking care of your small children. I sound like I have the consumption, but REALLY-I FEEL SWELL!

Anyway, miracle of miracles, our census was low Tuesday, so they let me go 3 hours early! Huzzah! Then, later that night, the Pooter got sick and was up all night miserable. She still a little fragile today, but several doses of motrin and tylenol and some soup have made her happier. So, longer, more relevant posts to come. I'm going back to sleep.

Friday, September 14, 2007

Weekend Report

I've spent the last three days desperately ill, the last two days working and now, at 9pm on a Friday night, I'm leaving for a weekend at the shore with a dozen teenagers.
Please pray to the deity of your choice that:
a. It doesn't rain, and
b. I don't kill anyone.
DT(dear teen) has just called to ask me to bring her hairdryer down. HAIRDRYER. At the beach.

Wednesday, September 12, 2007

This just in....

Donorcycle's official fact checker and stats keeper has just informed me that 100-47 does indeed equal 53, not 63. Thanks, PJ, and keep up the good work. And for the record, you try writing with a toddler climbing all over you. Oh, wait, she was in daycare today....I'll have to come up with some better excuse.

Hollywood Healthcare

Recently, I watched a rerun of CSI. The Las Vegas one, of course, I'm no great fan of either David Caruso or Gary Sinise. But oh, that William Peterson. I just love nerdy guys. Which always gives my husband pause, as in, "hey, that must mean...". Sorry Honey.

Anyway, on this rerun, called "The Organ Grinder", a guy is found dead, yada, yada, bad guys, etc, etc but the guy was poisoned to death and it is IMPERATIVE that his organs be used in the investigation. Except that he was an organ donor. Aaagghhhh! How will we ever catch the criminal? In a scene that somehow manages to combine the trippiness or "Fear and Loathing in Las Vegas" with a graphic Jack the Ripper movie(take your pic), they show a flashback to the organ recovery(they may have said "harvest", I can't remember). "Eight organs in 2 hours," the coroner intones, with organs coming out in quick succession and tossed to waiting surgeons. Then cut to the cadaver, with incisions going up, down and sideways. "A Frankenstein" says Grissom. Oh, Grissom, you're so handsome, but you need to go back to your bugs, baby.

All right, gentle reader, where to begin? First of all, I have never, ever, NEV-AH(as we say in Jersey) seen an organ donor with anything other than ONE midline incision, from the top of the sternum to the pubis. If they're recovering heart valves and other tissue, they make a Y incision for the heart valves and then incisions along the extremities and pelvis to retrieve bones. Just organs, just one incision. And they don't rip out the organs, for goodness sakes. You know, these organs have to be used in a living person, right? Do I need to say they are handled with care? Not tossed around the OR like a live hand grenade. But you, as faithful donorcycle readers, already knew that.

Here's another thing. Many donors require autopsies. They are homocides, suicides, accident victims or sometimes they have just been in the hospital for less than 24 hours, requiring a call to the ME. In NJ, it is ILLEGAL for an ME to deny organ donation because of their investigation. In some cases, they may put limitations on it. For instance, say you were unfortunate enough to be shot in the left lung. The ME might then say that all organs could be recovered EXCEPT the left lung. Which we wouldn't want anyway, seeing as it had a big hole in it.

Here's the other thing. The medical examiner is welcome to COME TO THE HOSPITAL and see the deceased. Either up on the unit and/or in the OR. If they decline, we TC's have a special form, called "The ME operative report" that is filled out with all pertinent info, signed by the surgeon and then passed along to the ME's office, with pictures, blood, bile, urine specimens, copies of the chart and any radiology films, as well. We are a full service OPO, after all. We also call the ME prior to the recovery to set all this up. In this heartbreaking story, the grandparents' hope that their grandson's death would not be completely in vain is dashed by an ME's office that routinely denies organ donations in homicide investigations. A mom in Ohio had the same experience, when the coroner would not allow his organs to be recovered, even though his cause of death was obvious-a gun shot wound to the head. In such cases, it would be within the realm of common sense to deny cornea or eye donation-nothing above the neck. But really, do you need to see his kidneys to know how he died?

I hate to sound like a broken record, but donation is good for the donor's family as well as the recipient. Knowing that someone is going to live on with their loved one's organs is a balm for their wounds.

So where does this leave me with the guys in the crime lab? What would I say if I had an hour alone with Nick and Warrick? Nothing, of course, I'd be too busy staring into their goodness, have you seen Gary Dourdan's eyes? Oh, yeah, organ donation-where was I?

You might think, savvy, innernet-reader that you are, that TV is just a harmless pasttime, a way to unwind after a hard day, to put your feet up and have a nice cold one. Well, that would be true for only 67% of you. Because in 2005, a Gallup poll showed that 43% of Americans got their health info from the TV. Out in Cali, a group of OPO's and transplant organizations has started a campaign called Donate Life Hollywood, They explain that if a show's plot contained such inaccuracies about HIV, there would be an uproar.

Dr. Susan Morgan, of Purdue University and author of "Entertainment (Mis)Education, has published two studies showing that the misperceptions of organ donation portrayed on TV keeps people from registering as donors.

It's true. If I think back to all the story lines I've seen on TV about organ donation, they always seem to involve some urban myth-selling organs, buying organs, mutilating bodies, etc. But never do I see them resolve the problems or clarify the myths. Maybe it's not compelling enough TV. Which may explain why I read a lot.

Now, if you'll excuse me, I have a producer to write to.

Friday, September 07, 2007

Rutgers sinks the Navy 41-24

If you watched ESPN tonight, you saw that Rutgers Stadium was a sea of red, with one teeny little corner of white midshipman. Sorry Navy, but RU swabbed the deck with you.

Of course, this is the reason, just here to my left (although she's a bit bigger, now). Pooter now has 2 Rutgers shirts, red for home and gray for away games. I promise she'll always be wearing the shirt for games, cause that's what makes them win, you know.
The odd thing about living so close to the stadium and watching it on TV is the slightly surreal moments. I was watching the game and heard a helicopter on TV. Seconds later I heard it above my house, then heard it heading for the hospital. Then, being the nurse I am, I wondered if it'll be anyone I'm taking care of tomorrow. Fortunately, my neighborhood is quiet, so there's no rowdy partying or beeping, but I'm sure College Ave is hopping right now. Hopefully the ER will be quiet too, but it's very possible that tomorrow morning will see a small crowd of patients sleeping off their ETOH. Well, time for me to go to bed.

Catching up

I haven't been doing much writing lately. I feel like I'm in the doldrums.* Maybe it's the heat. While I generally eschew central air conditioning, I wouldn't mind sitting in a cooler right about now. It could be worse I suppose. At least I'm not in California.

I didn't write my monthly article for the George St. Co-op, which I put up on my Laughing Baby site. At this blog, I've been doing my bestest to bring you light and breezy postings, devoid of actual content, if at all possible. I haven't sent anything to a blog carnival in ages, and, in case you haven't noticed, I'm not writing for the NJO blog anymore. It was all part of a grand plan to start a large project this month, now that I'm only working 36 hours a week instead of 176 (go get your calculators, I'll wait).

I've also been ignoring some of my favorite blogs and blog events. If I have the time I'm going to sit down and read this week's Grand Rounds and Change of Shift. Then, if the baby's not crying yet and the dog doesn't need walking, I'll read the Grand Rounds from the previous week at one of my favorite sites, Rickety Contrivances of Doing Good. I wish I had known, I would have liked to post something for that one-sorry Susan.

Anyway, my horoscope for this week says that if I get off my lazy ass and invest some time in a new project, I'll make loads of dough. Hey, ya never know. But the get off my lazy ass part is good advice from anyone.

*And if you make any analogies concerning hot air and this blog, you'd be right on the mark.

Thursday, September 06, 2007

Horseshoe Kidney

Earlier this year I did a recovery from a donor and in the OR we discovered, unknown to everyone including her family, that she had a horseshoe kidney. According to this case study from Britain, such a kidney can be transplanted into a recipient with good results.

This is supported by data from Stroosma et al (2001). 13 In this article,
eight horseshoe kidneys transplanted en bloc and 26, which were split and
transplanted into 47 recipients, were compared with 110 transplants in a
control group. No significant differences were found either in the short- or
long-term post-transplant results. Furthermore, no difference was noted between
results from en bloc or spit horseshoe kidneys.

Last I heard, the recipient of our donor was doing well, also.

According to my mom, I had a great-aunt who had a horshoe kidney. She died young, but not from kidney disease. I think she had cancer. Apart from being a colorful character and a bit of a hellraiser, she had no other issues.

A horseshoe kidney is what happens when both kidneys become joined at one pole, usually the lower pole. This happens during fetal development, during the 5-12mm embryonic stage when the kidneys are still in the true pelvis and the renal capsule is not yet fully developed. Of kidney fusion anomalies, horseshoe is the most common. It has an occurence of 1 in 400 births worldwide and is not linked to genetics. There have been cases where one identical twin has a horseshoe kidney and the other does not. There is some thought that positioning of the fetus in utero can cause the anomaly, as the kidneys migrate up from the true pelvis into their normal dorsolumbar position. The cause, however, is not really known.

Many individuals with a horseshoe kidney go through life with no idea they have it. Symptoms include frequent UTIs, kidney stones, hydronephrosis, and ureteropelvic junction obstruction, due to the high insertion of the ureter. There is also a higher risk of trauma to the isthmus because it lies anteriorly to the spine. Treatment is usually reserved for when the patient becomes symptomatic; antibiotics for infections, and surgical or nonsurgical interventions for hydronephrosis or stones.

In about 1/3 of all cases, there are additional congenital abnormalities, often occuring along the midline of the body: hydrocephaly, VSD, cleft palate, spina bifida, anorectal malformation, malrotated bowel, club foot and polydactyly. People born with a horseshoe kidney are more likely to also have Wilm's tumor or renal cancer. Two sydromes are associated with horseshoe kidney, Turner Syndrome and Trisomy 18.

Two articles are included here and here for more info. I also found a link to some good pictures of kidney anatomy and abnormalities here, but be warned, it's not for the squeamish. You'll never look at pyelonephrosis the same way again.

I've also been looking at congenital heart defects, but GOOD LORD, it'd take me a week to write all that. Do you have any idea of how many different ways your heart plumbing can be screwed up? It's a wonder and a blessing that most babies are born happy and healthy.

Sunday, September 02, 2007