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whitewriterTwo Night10s(N10) in ICU.
So my clever Boss, short me on my day shifts - - and gave me two extra night shifts without changing my hours.
Instead of an E8 and then E12 (a desired pair that = 20 hours of work) she put me on 2x 10 hour night shifts (also, to total 20 hours).
Pretty damn clever.
-- And I realised just now I booked an E8 saturday shift at SSH which means in less than 24 hours I'll be back at SSH... (Saturday penalties are my motivation)
Night one
I had a deliciously boring night staring at a wardable 110 kg gentleman who had been in ICU for 20 days due to an infected total knee replacement (TKR) that had been washed out and debrided and flapped over twice from sites on his left thigh and left back.
I'm calling him Mr bed 26
Most depressing story I've heard for a while:
his son was recently admitted to my old stomping ground NSICU with a brain haemorrhage (catastrophic) and died; and his organs were donated on the very same day I had his father. Who is sitting in the bed, confused. Aware he was in Sydney but unable to name what kind of building or place he was in; and calling out for various family members (including his now dead son) to attend to him. Asking for the phone at 02:00 and so forth.
There's no point to tell him of his son's passing now; and whose job is that going to be if the time comes (if ever). His son was literally, 20 meters down the hall dying with other family members by his side whilst his father was in my unit; and the doctors are discussing if they need to amputate the leg where the TKR was done.
In typical ICU style I sat on my chair; and tried not to spend most of the night reading AF on my phone, too lazy to do much more.
For $45+ penalties and hour; that was a ridiculous night
Night Two
Semi- heavy double but both super compliant and easy to deal with
I can hear Mr 26/old mate from yesterday with a wet hacking cough he can't quite get up.
He's not getting any better.
I'm not sure why they couldn't find him a ward bed during the day.
The nurse in his bed space has romantic ballads from the 80-90s playing on youtube at the bedside and all the songs make me think of MSR.
My two, flank across Bed 26/old mate on either side.
Bed 25 - sick at home where he resides in a sort of boarding house whilst on a pension - Hx smoking and alcohol - for a week; multiple episodes of malena to then have an ambulance called where he is then taken to OT for gastroscopy - cauterised two ulcers - and now sits in ICU for 6/24 bloods; and pantoprazole infusion; NBM incase he bleeds more and needs to go to IR for more intervention.
Bed 27 - Mr 80 yr old amputee for vascular problems, now ready for the ward slept through the night. Woke up compliantly for tablets, rolls and whatever and was generally the dream patient.
Meanwhile my side mates were struggling due to Mr 26's constant bowels open and continuing cough and confusion/delirium (and turning 110kg is not easy).
Then there was Mr 28 who was on 100% FiO2 (bad) via HFNP 40 yr old cancer dude with bad lungs: -
So at 04:00 he asks for a pan. He's so breathless he can't lift his bottom (and this is on 100%) to get onto it so I'm like, roll over buddy and I'll shove it in. So we do that. All G. He sits there and sits there for so long that I have to get out of the isolation room he's in, to run the albumin on Mr 25 as his BP is slowly trending lower and lower the longer it takes me to get to it.
Joel returns. (and this is from Joel's mouth) Mr Breathless said he was done on the pan, so Joel takes it out: and then literally not 5 seconds later there's a massive fart... and it's diarrhea volcano.
All over the sheet. All over the bed rail. Then dripping through the edges of the bedrail, down onto the wheel of the bed, and onto the floor.
And when I say dripping i mean like, imagine 1L container of greek yoghurt. It was that type of consistency (but brown). Joel calls me back.
I reply "wow that's the biggest shit I've seen in 9 yrs." (Poor Mr 27 can hear everything).
Joel says: I think I need to use the suction to clean it (cause its like yoghurt consistency: imagine how many wipes it would take to clean that off the floor?!
So I'm like oh yeah I've seen that before but like, ages ago (as a student, 10 yrs ago Heh). He gets the sucker, and starts sucking the feces like a vacuum cleaner and it works pretty well.
We have to flatten Mr breathless (and also -- Mr super anxious) to change the sheet and get him off the massive... poo lava. I'm trying not to think about stepping on it - you know how, when your avoiding something it increases your chance of doing it: kinda like, when there's a pot hole in the road and your like aiming to avoid it but you still drive over it and your like DAMN!... sorta like that.
Fortunately, neither of us stepped on it.
Mr Breathless starts getting anxious due to the length of time he's laying flat and he's like I can't breathe!!! and I tell him a white(?) lie. His Sp02 is 77% on 100% FiO2 "It's okay your Sats are fine - your face is pink (it was pink)" and he went quiet. Joel just looks at me with eyes behind his mask: wtf the sats are not fine. But we keep going because, well, you can't leave a poor man on a soiled sheet.
Eventually he's cleaned and we sit him up.
Joel wants to put in a Zassi (poo tube). I'm worried he won't tollerate it without being sedated/ventilated.
But that's for the next shift.
At 07:00 Joel waxed lyrical whilst we rolled Mr bed 26 Old mate 110kg for his 3rd bowels open of his night.
"No matter how bad the shift is..."
and I interrupt while he thinks - "are you getting all philosophical on us Joel"
"no matter how bad it is -- there's how do you say it -- there's always an ending."
Hannah buddy looked at Joel and was like. Oh yeah. I'll try and focus on that ...
At the end of the shift I told Joel the best bit was when he got out the suction and was sucking the poop through it.
Another memorable moment was half threading through a guedel's airway and using it like a tongue depressor, and then threading through a y-suction catheter to catch that annoying gurgling sound Mr Bed 26 110kg was making when he just couldn't clear his cough. He was too alert to get the gaudels in properly, but it worked as a good tongue depressor to help guide the suction over the tongue down the gullet (non technical term) whilst Hannah held him down. Sometimes he sounded like he was drowning (but unlike Bed 27: his sats were fine). I did warn her that doing it too frequently could cause laryngospasm though. I think I scared her with that thought and she didn't try again.
Me? Doesn't scare me-- hand me that gaudels...
Meanwhile I'm chill. Somehow I got the two easiest pts two nights in a row.
So my clever Boss, short me on my day shifts - - and gave me two extra night shifts without changing my hours.
Instead of an E8 and then E12 (a desired pair that = 20 hours of work) she put me on 2x 10 hour night shifts (also, to total 20 hours).
Pretty damn clever.
-- And I realised just now I booked an E8 saturday shift at SSH which means in less than 24 hours I'll be back at SSH... (Saturday penalties are my motivation)
Night one
I had a deliciously boring night staring at a wardable 110 kg gentleman who had been in ICU for 20 days due to an infected total knee replacement (TKR) that had been washed out and debrided and flapped over twice from sites on his left thigh and left back.
I'm calling him Mr bed 26
Most depressing story I've heard for a while:
his son was recently admitted to my old stomping ground NSICU with a brain haemorrhage (catastrophic) and died; and his organs were donated on the very same day I had his father. Who is sitting in the bed, confused. Aware he was in Sydney but unable to name what kind of building or place he was in; and calling out for various family members (including his now dead son) to attend to him. Asking for the phone at 02:00 and so forth.
There's no point to tell him of his son's passing now; and whose job is that going to be if the time comes (if ever). His son was literally, 20 meters down the hall dying with other family members by his side whilst his father was in my unit; and the doctors are discussing if they need to amputate the leg where the TKR was done.
In typical ICU style I sat on my chair; and tried not to spend most of the night reading AF on my phone, too lazy to do much more.
For $45+ penalties and hour; that was a ridiculous night
Night Two
Semi- heavy double but both super compliant and easy to deal with
I can hear Mr 26/old mate from yesterday with a wet hacking cough he can't quite get up.
He's not getting any better.
I'm not sure why they couldn't find him a ward bed during the day.
The nurse in his bed space has romantic ballads from the 80-90s playing on youtube at the bedside and all the songs make me think of MSR.
My two, flank across Bed 26/old mate on either side.
Bed 25 - sick at home where he resides in a sort of boarding house whilst on a pension - Hx smoking and alcohol - for a week; multiple episodes of malena to then have an ambulance called where he is then taken to OT for gastroscopy - cauterised two ulcers - and now sits in ICU for 6/24 bloods; and pantoprazole infusion; NBM incase he bleeds more and needs to go to IR for more intervention.
Bed 27 - Mr 80 yr old amputee for vascular problems, now ready for the ward slept through the night. Woke up compliantly for tablets, rolls and whatever and was generally the dream patient.
Meanwhile my side mates were struggling due to Mr 26's constant bowels open and continuing cough and confusion/delirium (and turning 110kg is not easy).
Then there was Mr 28 who was on 100% FiO2 (bad) via HFNP 40 yr old cancer dude with bad lungs: -
So at 04:00 he asks for a pan. He's so breathless he can't lift his bottom (and this is on 100%) to get onto it so I'm like, roll over buddy and I'll shove it in. So we do that. All G. He sits there and sits there for so long that I have to get out of the isolation room he's in, to run the albumin on Mr 25 as his BP is slowly trending lower and lower the longer it takes me to get to it.
Joel returns. (and this is from Joel's mouth) Mr Breathless said he was done on the pan, so Joel takes it out: and then literally not 5 seconds later there's a massive fart... and it's diarrhea volcano.
All over the sheet. All over the bed rail. Then dripping through the edges of the bedrail, down onto the wheel of the bed, and onto the floor.
And when I say dripping i mean like, imagine 1L container of greek yoghurt. It was that type of consistency (but brown). Joel calls me back.
I reply "wow that's the biggest shit I've seen in 9 yrs." (Poor Mr 27 can hear everything).
Joel says: I think I need to use the suction to clean it (cause its like yoghurt consistency: imagine how many wipes it would take to clean that off the floor?!
So I'm like oh yeah I've seen that before but like, ages ago (as a student, 10 yrs ago Heh). He gets the sucker, and starts sucking the feces like a vacuum cleaner and it works pretty well.
We have to flatten Mr breathless (and also -- Mr super anxious) to change the sheet and get him off the massive... poo lava. I'm trying not to think about stepping on it - you know how, when your avoiding something it increases your chance of doing it: kinda like, when there's a pot hole in the road and your like aiming to avoid it but you still drive over it and your like DAMN!... sorta like that.
Fortunately, neither of us stepped on it.
Mr Breathless starts getting anxious due to the length of time he's laying flat and he's like I can't breathe!!! and I tell him a white(?) lie. His Sp02 is 77% on 100% FiO2 "It's okay your Sats are fine - your face is pink (it was pink)" and he went quiet. Joel just looks at me with eyes behind his mask: wtf the sats are not fine. But we keep going because, well, you can't leave a poor man on a soiled sheet.
Eventually he's cleaned and we sit him up.
Joel wants to put in a Zassi (poo tube). I'm worried he won't tollerate it without being sedated/ventilated.
But that's for the next shift.
At 07:00 Joel waxed lyrical whilst we rolled Mr bed 26 Old mate 110kg for his 3rd bowels open of his night.
"No matter how bad the shift is..."
and I interrupt while he thinks - "are you getting all philosophical on us Joel"
"no matter how bad it is -- there's how do you say it -- there's always an ending."
Hannah buddy looked at Joel and was like. Oh yeah. I'll try and focus on that ...
At the end of the shift I told Joel the best bit was when he got out the suction and was sucking the poop through it.
Another memorable moment was half threading through a guedel's airway and using it like a tongue depressor, and then threading through a y-suction catheter to catch that annoying gurgling sound Mr Bed 26 110kg was making when he just couldn't clear his cough. He was too alert to get the gaudels in properly, but it worked as a good tongue depressor to help guide the suction over the tongue down the gullet (non technical term) whilst Hannah held him down. Sometimes he sounded like he was drowning (but unlike Bed 27: his sats were fine). I did warn her that doing it too frequently could cause laryngospasm though. I think I scared her with that thought and she didn't try again.
Me? Doesn't scare me-- hand me that gaudels...
Meanwhile I'm chill. Somehow I got the two easiest pts two nights in a row.
