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.

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 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.

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.

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.

Cough.

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 eyes...my 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.

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.

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.
13,18

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.

I thought so....

You Are: 0% Dog, 100% Cat

You are are almost exactly like a cat.You're intelligent, independent, and set on getting your way.And there's no way you're going to fetch a paper for anyone!

Are You More Cat or Dog?

Thanks to RLBates for turning me onto this quiz. Her website, Suture for a Living, has a great post on another great surgeon and his role in transplant history, Dr. Joseph Murray. Check it out.

Today in Donation History

Just found out that today is the 39th anniversary of the first multi-organ multiple transplant. You can go here to Wired! for the story. The 5 teams, involving 60 surgeons, nurses and assorted personel(we're gonna need a bigger OR) was coordinated by Dr. DeBakey. Yes, that Dr. DeBakey, as in "pass me the DeBakey." Here's a look at his remarkable career. Another interesting bio is here. The man invented a continuous flow rolling pump in med school, in between studying I guess, that later was instrumental in developing the heart/lung machine. That was just the first in a long line of medical inventions. Dr. DeBakey, by the way, is still on faculty at Baylor.

The surgery, which took place on August 31, 1968, recovered a heart, one lung and kidneys that were transplanted into 4 people at one hospital.

Random musings

Out of the five different patients I took care of these past few weeks, only 1 is probably going to have a normal life span. Two may very well be dead before the year is out. I thought I was leaving the dead and dying and going to work with the living and recovering. Ah, well.







Maybe it's the reason why I've been exploring my spiritual side. (Do we only have a spiritual side? Who was it that said we're not human beings trying to be spiritual, we're spiritual beings trying to be human? 50 points and an organ donor card for the first person to tell me). Anyway, I know Kim talked about this somewhere on her blog, eons ago, but I stumbled across St. John of God this week. Not literally, because as a saint he's in heaven and I think his bones are probably in a church somewhere. St. J of G is the patron saint of nurses, firefighters and bookbinders, if you believe in that sort of thing. He could also be called the patron saint of aimlessly wandering through life until you finally get your s*#t together. That's a little too long to fit on the medallion, but it suits me. I can't say I'm really down with the whole patron saint thing. I keep recalling my best friend and daughter of a Methodist minister in high school who was constantly chiding my Catholic self for worshipping idols. She also used to wear orange on St. Patrick's day. It's amazing she lived to see graduation, but I digress. Anyway, it's nice to find a saint that wasn't gruesomly tortured to death or did fantastic miracles, like levitate or have the stigmata.







Anyhoo, there's nothing wrong with being pierced by arrows or having your breasts sliced off, but old John seems like a more down to earth kind of saint. So I got one of these. Actually, I got the last St. John medallion they had. Like most of my religious leanings, it falls under "can't hurt, might help". Actually, that's a little flippant, even for me, but like poetry and masturbation, I think religious beliefs are something you save for when you're in private. If you want to know what I truly believe, it will require some wine and a long night of talking.

St. John of God

On a lighter note, we finally made it to the beach this week, LM, Pooter and I. We're trying to pull together last minute plans for the 16 year old's B-day bash, so we went on a scouting mission to Ocean County. First of all, what's up with the Seaside Bridge(or whatever it's called)? One side is high enough for boats to pass under, the other side is a draw bridge. Wouldn't it make sense to make BOTH sides high enough for boats to go under? Or do they just like to stop traffic every 5 minutes in the height of Summer? The world may never know. We did find out that Island Beach State Park allows camp fires on the beach and you can stay til midnight as long as someone has a fishing pole. I know this may astound some of my readers in more enlightened areas, but NJ has some really odd beach rules. Like the idea that you have to pay to go on the beach. I was in college before I realized that many parts of the country think this is sacrilege. So, most beaches are swim between the buoys, no campfire, no driving, no dogs allowed kind of places.

Pooter loves the beach. She stood in the surf, tried to catch a few seagulls, which she calls ducks, and did her darndest to dig to China. We came with about 10 pounds of sand attached to us, each. I have also now lost enough weight that for the first time in several summers, my abdomen saw sunlight. Granted, my belly looks more like this:

And less like this:

But one of the great things about being on the far side of 30 is that you really, truly, no longer give a shit.

If only I had that attitude when I had my 19 year old body, I may have conquered the world. Both the world and myself are probably better off for me being young and stupid and now older and (mostly) wiser.

We also found the best bakery, Park Bakery, in Seaside Park. Have you ever had those little Italian cookies, that look like this:

Right? Everybody has. I worked in a bakery when I was in high school and we bought them from a larger bakery. Most small bakeries do that, they don't make them. Hence, they are usually dry, crumbly things. My grandmother used to bake her own, mmmm. Well, Park Bakery makes their own and they are amazing. I had no idea these cookies could taste so good(sorry, Grandma). So the ride home was spent sunburnt and tired, happily munching cookies. I love summer.

Why I <3 Surgery

I've always loved being in the OR. My mom was an OR nurse. When I was growing up we'd watch the shows where they show you the surgery in progress. Totally gory. I loved it. In nursing school we got 2 whole days of OR experience. One in the PACU and one where we observed an operation(unlike my mom's 1950's nursing curriculum, where she was basically prepared to RUN an OR after her orientation there). Much to my dismay, the surgery I got to observe was an arthroscopy of a knee. Big Woop. One of my fellow students, a big fella, got to see the resection of a bowel and promptly passed out. Wuss.



My plan was to work in the OR after I graduated, but in 1996 hospital's were still in denial about the nursing shortage. Even the hospital my mother worked at wouldn't hire me without a year's experience. While I looked for work, I enrolled in an OR certificate course. The first time I scrubbed in, the doctor asked me if I was a righty or a lefty. I told him righty, and he grabbed my left hand and stuck it in this guys abdomen up to my wrist. "That," He told me, "is his pancreas. Don't squeeze." So I didn't. Probably my most memorable operation at the time was a splenectomy on a guy who had idiopathic polycythemia. It started out as a laparoscopic procedure. Just like Jaws, it quickly became a matter of "We're gonna need a bigger hole." They had made an incision to remove the spleen, then they made it bigger. Then they made it bigger. This spleen was bigger than most babies. Seriously, I think it weighted 10 pounds.



Five months after passing my boards I still didn't have a job, so I took the first thing that came my way-nights on a cardiac telemetry unit. Part of my orientation was to take the critical care class and part of taking the critical care class was a ride along with the paramedics. Two minutes into the ride, we got called out to a local quarry where a woman had been electrocuted. It was the first time I ever did CPR. After that, I was hooked on emergency and critical care. We had to supply a nurse every shift to cover codes and I used to beg to be that nurse. A year later I was in the ER.



Cut ahead several years. I had worked almost three years in the ER of a level one trauma center and I wanted a change, so I transferred to the OR. It was still interesting. They put me into a specialty rotation-pediatric orthopedics. Since all things pediatric go together despite the best of logic, I was also trained to do general pediatric and pedi urology. Three completely different specialties. You'd never see an orthopod cross over and do an appendectomy once in a while, right? Whatever, I liked working with kids, even if they were only awake for a short time and I liked ortho. Hammers and screwsdrivers and stuff. Much better than working in vascular with needles so small they make you weep when you drop one and much, much better than, God help me, doing eyes.



The head of our pediatric orthopedics service was(and still is)the captain of the ship. Back when God was a child he had been in the Air Force and he still had a way of making you want to stand at attention and snap your heels together. Frequently, and with no prior experience as a Southerner, I called him Sir. If he saw an unfamiliar face in his OR, he was on the phone to the front desk. If he thought anesthesia was asleep at the switch, he'd yell at them to pay more attention to the blood pressure. I'm pretty sure he is the only surgeon I've ever worked with who even knew the patient had a blood pressure. He loved those kids and he could put in CD rods quicker and more assuredly than I could get dressed in the morning. He also didn't give a fart about anyone else. If you weren't paying attention during the case he'd rip you a new one. If you did your job with competence and alacrity, perfection even, he'd allow you to be in the room the following week. One time we had a kid go into spinal shock. Like a precision machine we finished the case while anesthesia worked to bring up her pressure and the tech gave units of blood from the cell saver. Every time one of the surgeons put a hand out, I put the right instrument into it without them having to say a word. Finally, the crisis was past and they started to close at a more normal pace. I was about 2 seconds too slow in giving him his monocryl and said, "Hey, do you think you could pay attention to the case?" Afterwards, I confronted him. I told him that I had busted my hump to keep up with his furious pace for two hours and he had to bust my (proverbial) nuts over the closing suture? He had no idea what I was talking about.



I probably wouldn't invite him out for a drink, but his group has operated on my daughter.

Some surgeons were pretty aweful. Some threw things. Some really did think that white light emanated from their rectums instead of waste products. But some were also down to earth and very personable. One guy, Chuck, was the hardest working guy in surgery. He had privileges in like, five hospitals and said he'd have to work until he was 80 to pay off his wife's credit card bills. The docs would get lunch every day in their lounge. Every Friday brownies were included and every nurse knew it. Chuck would bring the tray of brownies into the nurses' lounge and we'd all be like, "I don't know HOW these got in here." It takes a smart man to know that if you give the wife the credit cards and the nurses chocolate, all will be well.

The other great thing about the OR I worked in was the people. It was a really amazing group of people who all, mostly, got along and helped each other out and that makes for a great job no matter what you're doing.

But in the end, I missed emergency/critical care too much. Which is why I liked being a TC-you get to incorporate the patient care, teaching, family support and the occasional OR into one groovy job. I wouldn't mind going for first assist when I get my master's, but I'm not sure how I'd incorporate that into an NP position. Well, we'll see.

Change of Shift

Be sure to check out this week's Change of Shift at Nurse Ratched's Place.

Warning:Objects in the mirror may appear sexier than they really are

This is NOT what I look like at work.(although I think I've taken care of the chick on the right in the ER-tough night of partying, has a terrible headache and, oh yeah, can she get a rapid pregnancy test too? Yeah, I've taken care of that one).

Anyway, 12 hours on your feet is a bee-otch. How does Christina do it? In high heels and a garter belt, for goodness sakes. Remember, I've spent the past three years clicking through the hospital halls, giving orders and looking pretty. Now I'm back in sensible shoes and covered in body fluids. Literally. My first day back I had a post op who was nauseous. Guess who forgot how to duck in the last 3 years? Ewwww. Sweet kid. He asked if he got any on me and I just told him, "no honey, you totally missed me." The upshot of all this is that it gives me an excuse to shop for some new, cute scrubs. Dickies seems to be an especial favorite of the PICU set. I'm also on the lookout for some Curious George tops. I wanted this one, but I think it might not be appropriate for the little 'uns. The Little Pooter loves her some Curious George, but I draw the line at Thomas the Train. That show explains a lot about the British psyche, is all I'm sayin.

The past 2 days I've taken care of the sickest baby on the unit. His prognosis isn't good, but if he can make it to 10kg, he might be eligible for a kidney transplant. That might not sound like much. Heck, some of us can probably put on 10kg in a good weekend. But I have a sinking feeling that I'll vote Republican before this kiddie gains 7 more kilos. Not to mention the problems with his lungs, heart and brain.

Speaking of kids and kidneys, one of my sister's students is back on the waiting list for a kidney. She's 16 and her first kidney transplant failed, so she's back on dialysis. Please keep her in your thoughts and prayers that she gets a kidney soon. Here's a brief overview on dialysis, hemo and peritoneal. For a primer on dialysis complications, complete with nausea-inducing pictures, go here. Suffice it to say, being on dialysis is no picnic. Maybe working in the ER for so long gave me a jaundiced view(sorry about the mixed metaphore). Folks who have been on dialysis for a while do NOT look healthy. Their skin is dull, their hair is brittle. Long term dialysis can lead to osteoporosis, anemia, cardiovascular disease and arrhythmias. AV fistulas require special care and can get infected or clotted. Some people just seem to clot frequently and they come in often for AV revisions, but you only have so many sites for a fistula and so much vein to work with. And let's not forget the "routine" problems:you can't travel, you have to closely monitor what you eat and drink and you're hooked up to a machine 3-4 hours at a time, 3x a week. Every Mon-Wed-Fri or Tue-Thur-Sat, without fail, every week, until your kidney comes in. Having coded many people who were undergoing or just finished a dialysis treatmens, it is so heartbreaking to think that they died waiting to be free of that machine.

On a similiar note, my 8th grade science teacher, Mr. P, had an insulin pump for his diabetes. He named it Natalie. Natalie was a girl who liked him when he was a young man and he couldn't stand her but he could never seem to avoid her, either. He hated that pump, hence the name. He died from complications due to his diabetes in my freshman year-I think he was in his 40's, maybe 50. I think if I had to be hooked up to a machine to help me live, I'd name it something a lot ruder than Natalie.

Anyway, I was hoping to have more facts and figures on pediatric kidney transplantation, but google is not my friend this week. In fact, it's making my head ache, which is partly the reason I haven't posted in a bit. I really need to find a good, medical search engine that's free. Help a sister out and let me know if you all have any suggestions. That, plus the New Jersey weather has led me to a state of humidity-induced lethargy that requires lot of bedrest and frequent infusions of iced coffee.

Reminders!

Don't forget that Grand Rounds is at Med Journal Watch. Also, I'm still writing at the NJO blog. I have a new post up, so check it out!

Some stuff for Monday

Well, I don't know about you all, (or as they say in Pittsburgh, "Yens") but I could get used to not working weekends. It's only going to be for a few more weeks, alas, while I finish orientation. Meanwhile, while weeding through my stacks and stacks of emails I came across some stories on donation.

Starting off, this woman is celebrating her 22nd year with a donor kidney. While she reflects on all the good things that have happened in that time, it's also bittersweet thinking about the life that was lost.

Losing my religion: At first I wasn't going to even give this one any "cred", but I decided to link to it because this woman is becoming a thorn in my side(sorry, Jesus). She has a religious blog and uses her credentials as a paramedic to discourse on organ donation and other subjects. Seriously, this is why I don't go to church more often. On a lighter note, I came across what may be the funniest t-shirt I've seen in a while. Just don't let Father see.

I wish we would hear more about donor families. It is my sincere belief that donation doesn't just help the recipients, it helps the grieving families, too. Wondering what "presumed consent" is? Check back in a few days, I'm working up a post on it.

Wisconsin: It's more than just cheese! Wisconsin has the highest organ donor conversion rate in the country-83%. Twenty points higher than the national average. If memory serves, it was the Wisconsin governor's friendship with Tommy Thompson that brought about the HRSA breakthrough collaborative.

Over at Revive Hope, there's a call for people whose lives have been changed through organ donation. (BTW, cute baby picture, Steve. I notice the mouth is wiiiiide open. Hmmm.) Well, what are you waiting for? Get writing!

All right, enough for today, I still have to write my NJO post before the baby wakes up.

9-5

****Check out Change of Shift over at Emergiblog!******



I have been so behind on everything this week-my articles, my posting, checking my emails. I'm in orientation again, so I'm at the hospital 8 hours a day, 5 days a week for 2 weeks. Which may be fine for mere mortals, but there's a reason I went into nursing and it wasn't for the sexy scrubs. I like working like a dog for many hours and then enjoying several days off during the week. I like having the early morning hours before the family wakes up to get things done. Well, maybe next week.

Also, I'm the newbie again. Not really, I mean I know more people at the hospital I work at than probably the CEO does. I went to get my employee physical a few weeks ago and I was informed by the NP that it was the 4th time I've had a new employee physical there. I like it there, but not enough to stay and collect some seniority, apparently, which is another reason I became a nurse-you can easily move between jobs. My experience is enriched for it, my retirement plan-not so much.

It's a little hard for me, not being the expert transplant coordinator, walking onto the unit with my white lab coat and my donor bag. Now I'm just another staff nurse grunt. I suppose I'll manage as long as I can keep out of the way of my own ego. I will say it is a fine walk to work, about 1.5 miles one way but I've been getting rides home with hubbie. Today I walked home, up a major hill. Next week I should be done working on my bike and I can ride in. My bicycle-don't get excited PJ, I have to pedal. I've been sanding the rust off the chrome and next I have to put naval jelly on the chain. It's a really cool, blue 1960's Schwinn I picked up at a garage sale last month. I can't wait to ride it. It's no 1964 Impala, but it'll do. Either way my legs are getting a workout.

So next week, more writing. Now, I'm going to put my feet up.

Grand Rounds Beach House!

Grand Rounds is at the beach this week. Dude, I am TOTALLY there.