Sunday, October 26, 2008

It's still exciting to be on call....

Despite the sleep deprivation. I no longer take broken people off helicopters or spend days in the ICU trying to mend them, but being on call when you get a kidney offer is still pretty exciting. Or maybe I just need to get out more.

So, Thursday night into Friday, I get a call around midnight for a kidney offer. The surgeon says we'll take it as long as the biopsy and anatomy are good. For you non-medical types, that means that when they recover the organs, they'll write down if there's any noticeable injuries or disease that might effect its function, along with the size of the kidney and the veins, arteries and ureter. Then they take a chunk (a little chunk) and send it to a lab to be looked at through a microscope by a pathologist, again to see how good the function is. If neither suck, we'll take it. The OR is scheduled for the a.m., so we won't know 'til then. Now I have to call our potential recipient and make him NPO (don't eat or drink).

Then I realize that I've left my on-call book, with the wait list that includes everyone's phone numbers, in my office. So after I tell the hubby, I head on out to the hospital, fortunately only 5 minutes away by car(no, I did NOT ride the bike). Anyway, on my way to the office, I get another offer, this one for a teenager. So I grab the book, leave the office and get another phone call. This time to tell me that the intended teenager recipient does not have a blood sample on file and will need to come in ASAP to give one so that cross matches can be run. They run a blood sample of the recipient against the blood sample from the donor to see if there is any cross reaction to certain antibodies. Folks that are on dialysis have a sample sent every month automatically from their center, but this kid's no on dialysis yet. Plus, there's a special form that needs to be filled out and sent with the specimen to the local OPO and it's only-you guessed it-in my office. Well, maybe there was a reason I had to come in, because I don't routinely have this paper on me(although it's probably not a bad idea). Even if I did, though, this family doesn't have a fax machine, so I'd only have to meet them here anyway.

So what I do instead is head up to the transplant unit, make all my phone calls. I wake up to sleepy and now very excited families and tell them that they may be getting a kidney, not to eat or drink anything from now on except meds with sips of water and I'll call back when I know anything. With the second family I make arrangements to have them come in a few hours from now to give a blood sample. Then I head down to the lab, explain my plight to the one of the techs and he takes all my papers, along with instructions and leaves it on the desk of the person who does those tests. I have written at the top: "Patient S______ is coming in to have a specimen drawn for (the OPO). There is an available kidney for them and it must be sent to (the OPO) ASAP. Thanks." With my name and number at the bottom. Then I head for home.

Except I can't sleep. And I don't feel like blogging. So I watch some Anthony Bourdain and read a little and then toss and turn until 6:15 when, if I don't get out of bed this instant, I'll have to wait for The Teen to get out of the shower and she takes slightly less than forever in there. So I haul my carcass out of bed, get washed and dressed in my most-comfortable-but-still-appropriate-for-work outfit and, this time, bike to work. On my way in I get a phone call from the teenage recipient's dad, saying the lab can't find the paperwork. I say to have them look on So-and-So's desk. They come back on and say they have it. Sometimes, just sometime's, things work out the way you need them to. I get to my office, have a quick coffee and it's time for rounds.

Sunday, October 12, 2008

Well, it's been a week.

Last night I was remembering with longing those heady days before the baby came, when I had scads of time to do whatever, whenever I wanted. Then I remember that I was the one who wanted a baby so bad. Then I also remember that when I had all that free time, I didn't really DO anything-I didn't write the Great American Novel or go back to school or even clean out the basement, so stop whining already.

Needless to say, I'm not getting on the internets so much, and when I do, mostly I just surf the news sites. Then I have to take an aspirin and lie down. You really shouldn't read the news-it's not worth it.

Work's been, well, it's a living. I'm vaguely happy that I get to totter around in my heels and long, white lab coat. I have a signed prescription pad in my pocket that I get to whip out when someone needs a test or a medication. Then I wonder when did I ever become so shallow that a lab coat and a little authority can make my day? That worked well 'til Friday, when we all got a nasty-gram from the boss for things that weren't our fault, that made me want to march in there and toss down my resignation and THEN I got a stern talking to from the chief surgeon about things that were my fault and it took all the wind out of my sails, which is probably just as well. Until I renew my BLS/ACLS and get a new car, there's no point in job shopping.

Aside from the soap opera, it's a pretty swell gig. I have a bunch of patients who I really like that have just reached their 90 day appointment and so I won't be seeing them until December. During the first 90 days after transplant the patients come in 2x a week for the first month, then 1x a week, then every other week, plus many, many phone calls, so you get pretty attached to some people. Then, like little, baby birds, they fly off back to their regular, hopefully improved, lives.

I feel like I've been seeing all these weird articles about transplantation, but I haven't had the wherewithal to come on and share them. First up, if you haven't already read about, is a story from April of this year. Appears a guy committed suicide, his wife donated his organs and then, years later, meets the heart recipient, ends up marrying him and then HE commits suicide. There's been bunches of stories circulating about cellular memory, as if the second guy somehow "caught" the suicide bug from him. If you read the story from the South Carolina paper, I think you'll agree that it was in fact 2 guys who had the bad luck to hook up with this woman. Anyway, if you want a bit of "As the World Turns" meets "King of the Hill" with a little bit of "Heartland" (remember that show?) thrown in, then read this.

Saturday, October 11, 2008

Yes, Virginia, there's a new post coming...

Recently, a commenter named Virginia asked if nursing was a good profession to go into.

Hell, yeah!

As long as you can get RN with an associate's degree, it remains a great bargain, as far as college goes. Two (well, more realistically three) years of school for $50,000 a year? At least in my neck of the woods. That's not too shabby. While I can see both sides of the argument for RN's having a minimum of a Bachelor's, for the time being it remains that you can make a pretty good living with not so much school.

Nursing school changed me. I learned how to prioritize, I learned how to focus my thinking. It gave me a lot of confidence. I never realized how smart I was until I went to nursing school. It also brought me out of my shell. I am pretty introverted. (Seriously, Steve, I am). In clinicals, you just have to hitch up your britches and march into the room, introduce yourself to the patient and get on with it. I learned how to make mistakes and learn from them-the first time I logrolled a real person, I pulled out their JP drain. The first time I made a medication error, I walked into my bosses office with my head down and we had a good long talk about how to avoid that in the future. I learned that I didn't know what I didn't know and that NOBODY, especially in medicine, knows everything and if someone thinks they do, don't let that person take care of you or your family. I learned that it's ok to ask questions and that the learning never ends.

I went to nursing school with someone who wanted only to go into research. She quit after the first few weeks of clinical-she just couldn't take wiping butts. It's a shame, really, because if you can make it through two years of clinicals and one year of med-surg nursing, you can really go anywhere. Get a few more years experience, some additional education and certifications and really, where can't a nurse go? There's nurse legal consultants and nurse educators and nurse lobbyists and if you really like school, you can even become Dr. Nurse. You can go into pediatrics, delivering babies, oncology, school nursing, travel nursing, dialysis, emergency room, ICU's, home health care, public health and if you get tired of patient care and don't want to look at another human being, there's infomatics.

Become a nurse and you'll always have a job. Those baby boomers aren't getting any younger. I've been reading these articles about how to recession/depression proof your job and they always have healthcare at the top of their lists of desirable positions. (My poor daughter is going into fashion, but I told her people will always need clothes, too).

You get to do really cool things as a nurse that most people just watch on TV: I've taken people off a helicopter while it was still running, I've had my hands in someone's abdomen up to the wrist ("That's his pancreas. Don't squeeze."). I've held someone's hand as they watched their mom die. I've put band-aids on boo-boos. I've handed out a lot of tissues. And yes, I have wiped a LOT of butts.

Nursing is flexible. You can work full time, part time, per diem, just weekends.

You can go to work in your pajamas. Or scrubs, which is almost the same thing.

Oh, yeah, and you get to help people in a really rewarding way and make a difference in their lives.

And one last thing. If you run into anyone who pooh-poohs this and says, "Nursing sucks! Don't be a nurse!" Please tell that person to get the heck out of the field, because their sorry ass attitude isn't helping anyone.

Monday, October 06, 2008

Well, for those of you that go to Falling Down Is Also a Gift, you know that Anni is back on the liver list and pretty sick. Stop by and offer some words of encouragement and don't forget to keep Anni and her family in your prayers.