whitewriter (![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
whitewriter) wrote2021-02-08 09:28 pm
whitewriter) wrote2021-02-08 09:28 pm
Entry tags:
E12, N12
ICU delivers the best care, but most people don't want to be here.
And we don't have any covid cases (lucky us).
Someone was reflecting about this in the tea room. They we've had it rather good in the last year if the worst thing we have to complain about is that we didn't get Christmas party/lunch as good as it usually is.
Last week on nights, At 04:00 a kindly 70 yr old Asian man tried to gather information to support his theory that he was in a religious institution
whose goal was to keep him alive against his wishes, which were to die naturally.
He was about 80 and according to his address lived in a very posh part of Sydney.
He was well spoken but looked clearly unwell in the bed. He was sitting bolt upright in jammies, breaking a sweat trying to breathe on some ridiculeose amount of oxygen and flow on the HFNP.
He asked me what my religion was. (I explained I was brought up Catholic but I don't follow anymore)
Who was in charge of this place? (Dr W is the consultant this week and he'll be in around 0900)
Where was that man's office? (here)
Are you sure he's going to come here at 0900? (he comes every day, that's his job)
Can he go for a walk? (no) and why not? (we aren't going to get very far on 50% FiO2)
And what time is the doctor going to come around and talk to him because he wanted to discharge himself and go home. (0900)
And how come - how come he didn't sign any papers on arrival? (hospitals are funny in Australia. Medicare just works.)
He didn't remember being here for 4 days.
Or how he got sick, presumably post cleaning his air conditioning system (what a champ at 70 to do so) and contracting Legionnaires disease.
He says he wore a mask.
But on a background of autoimmune conditions that probably wasn't the best idea.
I explained this to him and that his condition was likely short term, and with support, he will get better.
He said he had no faith in this place ( with no windows, with no clear entry or exit, lit by florescent bulbs). He wanted to go outside.
I explained its 04:00 - and it's dark outside.
I don't think he believed me one bit. We tried not to call his family since it was still 04:00.
This afternoon we had a similar occurrence. Turkish man, convinced that his family would come and take him home. That he wanted to leave.
He's also on a tonne of FiO2 but also; dobutamine for cardiac function.
It was 17:00 so we called his family at his request; and a fury of talking in their language, of which I don't know what was said, the call ended.
Meanwhile my lady who had been hallucinating that her family was just around the corner, and the TV was on, and grabbing at things in the air whilst her eyes were closed looked almost normal sitting in the chair reading a trash mag.
Best thing about 12 hour Sundays is the 1.75x hourly rate pay for all 12 hours. Really missed this when I had to go back on 8s in MSH/SSH.
Then on the next day, Monday night:
I'm back with Val in bed space 33.
We're not to have the same patient two days in a row, but I cbf to argue the allocation.
I've appeased her with a cup of lukewarm green tea.
Delirium to the max she confessed to the psych today that she believes she's had an organ removed on Sunday morning sometime and that all the staff here are "in on it".
She's stopping herself from sleeping because she's afraid that something bad will happen to her when she is asleep.
Lack of sleep in a strange location with no windows = recipe for delirium.
The psych focused on the fact that her daughter visits her daily and she wouldn't let Val be left in a place where people who weren't to be trusted where taking care of her.
I stared at Val all night.
I did her vitals only when she was awake. I refused to do blood pressures 'just cause'. I'm not here for busywork. Sure she was hypertensive yesterday but we're pretty level tonight on SBP 160.
Keeping her in ICU due to delirium is a terrible idea. She'd be fine with a good AIN. You don't need to give an RN8 the best night shift of their life.
I replaced her electrolytes aggressively.
I stared at her playing with her NGT with her eyes closed. Looks for her glasses and water bottle with her eyes closed.
I doubted she was sleeping when others said she was.
She becomes too alert too quickly to be asleep.
The ileal-conduit bag became disconnected 3 times. The first time, I pushed it back in and called it lucky even though the bed had a wet patch. I padded it with blueys.
The second time I knew I should have taped the tube the first time.
The third time I cursed that I hadn't taped the tube aggressively as it still came loose!
There was no fourth time because I went hard on that bad boy.
I did her stoma dressings yesterday because they were leaking and despite them being redone, they still leaked on my shift and I felt terrible.
It's Monday today and the stoma CNE did them and 12 hours later not a leak to be seen.
Supposedly she used the same equipment too. The AM staff and I hypothesised that the Stoma CNE had skills we didn't have (clearly).
At 0300 she wanted to get out of bed. I pulled the no one gets out of bed at 0300 card.
I suggested we sit the bed up instead.
She complied.
I slept at least for 50 mins on my first break.
I don't think she's slept more than 30 mins all night.
I also wanted to add that ICU is the Queen of epic surgical wounds and dressings.
As part of her surgery, Val had her vagina sewen shut. From the top of her natal clef. Aka where the top of her butt crack would have been right under and around to her symposia pubis (public bone) was sutured shut. And there was a comfeel dressing somewhat barely holding it together as its quite a moist space at the best of times let alone post operatively.
The Turkish man whose family had turned up super quick when he wanted to go home has been discharged to the ward by the time I returned for my next shift.
I hope he gets his wishes not to return to ICU.
And we don't have any covid cases (lucky us).
Someone was reflecting about this in the tea room. They we've had it rather good in the last year if the worst thing we have to complain about is that we didn't get Christmas party/lunch as good as it usually is.
Last week on nights, At 04:00 a kindly 70 yr old Asian man tried to gather information to support his theory that he was in a religious institution
whose goal was to keep him alive against his wishes, which were to die naturally.
He was about 80 and according to his address lived in a very posh part of Sydney.
He was well spoken but looked clearly unwell in the bed. He was sitting bolt upright in jammies, breaking a sweat trying to breathe on some ridiculeose amount of oxygen and flow on the HFNP.
He asked me what my religion was. (I explained I was brought up Catholic but I don't follow anymore)
Who was in charge of this place? (Dr W is the consultant this week and he'll be in around 0900)
Where was that man's office? (here)
Are you sure he's going to come here at 0900? (he comes every day, that's his job)
Can he go for a walk? (no) and why not? (we aren't going to get very far on 50% FiO2)
And what time is the doctor going to come around and talk to him because he wanted to discharge himself and go home. (0900)
And how come - how come he didn't sign any papers on arrival? (hospitals are funny in Australia. Medicare just works.)
He didn't remember being here for 4 days.
Or how he got sick, presumably post cleaning his air conditioning system (what a champ at 70 to do so) and contracting Legionnaires disease.
He says he wore a mask.
But on a background of autoimmune conditions that probably wasn't the best idea.
I explained this to him and that his condition was likely short term, and with support, he will get better.
He said he had no faith in this place ( with no windows, with no clear entry or exit, lit by florescent bulbs). He wanted to go outside.
I explained its 04:00 - and it's dark outside.
I don't think he believed me one bit. We tried not to call his family since it was still 04:00.
This afternoon we had a similar occurrence. Turkish man, convinced that his family would come and take him home. That he wanted to leave.
He's also on a tonne of FiO2 but also; dobutamine for cardiac function.
It was 17:00 so we called his family at his request; and a fury of talking in their language, of which I don't know what was said, the call ended.
Meanwhile my lady who had been hallucinating that her family was just around the corner, and the TV was on, and grabbing at things in the air whilst her eyes were closed looked almost normal sitting in the chair reading a trash mag.
Best thing about 12 hour Sundays is the 1.75x hourly rate pay for all 12 hours. Really missed this when I had to go back on 8s in MSH/SSH.
Then on the next day, Monday night:
I'm back with Val in bed space 33.
We're not to have the same patient two days in a row, but I cbf to argue the allocation.
I've appeased her with a cup of lukewarm green tea.
Delirium to the max she confessed to the psych today that she believes she's had an organ removed on Sunday morning sometime and that all the staff here are "in on it".
She's stopping herself from sleeping because she's afraid that something bad will happen to her when she is asleep.
Lack of sleep in a strange location with no windows = recipe for delirium.
The psych focused on the fact that her daughter visits her daily and she wouldn't let Val be left in a place where people who weren't to be trusted where taking care of her.
I stared at Val all night.
I did her vitals only when she was awake. I refused to do blood pressures 'just cause'. I'm not here for busywork. Sure she was hypertensive yesterday but we're pretty level tonight on SBP 160.
Keeping her in ICU due to delirium is a terrible idea. She'd be fine with a good AIN. You don't need to give an RN8 the best night shift of their life.
I replaced her electrolytes aggressively.
I stared at her playing with her NGT with her eyes closed. Looks for her glasses and water bottle with her eyes closed.
I doubted she was sleeping when others said she was.
She becomes too alert too quickly to be asleep.
The ileal-conduit bag became disconnected 3 times. The first time, I pushed it back in and called it lucky even though the bed had a wet patch. I padded it with blueys.
The second time I knew I should have taped the tube the first time.
The third time I cursed that I hadn't taped the tube aggressively as it still came loose!
There was no fourth time because I went hard on that bad boy.
I did her stoma dressings yesterday because they were leaking and despite them being redone, they still leaked on my shift and I felt terrible.
It's Monday today and the stoma CNE did them and 12 hours later not a leak to be seen.
Supposedly she used the same equipment too. The AM staff and I hypothesised that the Stoma CNE had skills we didn't have (clearly).
At 0300 she wanted to get out of bed. I pulled the no one gets out of bed at 0300 card.
I suggested we sit the bed up instead.
She complied.
I slept at least for 50 mins on my first break.
I don't think she's slept more than 30 mins all night.
I also wanted to add that ICU is the Queen of epic surgical wounds and dressings.
As part of her surgery, Val had her vagina sewen shut. From the top of her natal clef. Aka where the top of her butt crack would have been right under and around to her symposia pubis (public bone) was sutured shut. And there was a comfeel dressing somewhat barely holding it together as its quite a moist space at the best of times let alone post operatively.
The Turkish man whose family had turned up super quick when he wanted to go home has been discharged to the ward by the time I returned for my next shift.
I hope he gets his wishes not to return to ICU.