Rainy Saturdays in ICU
Feb. 13th, 2021 11:04 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
whitewriterToday in ICU
tt's quiet.
It's boring.
It's rainy and humid and windy outside and the only way I know this was because I walked in it at 0700 to come here, and there's a little window in my patients room and I can at times see the rain and wind whipping about.
I remembered to bring an umbrella with me today. I've lost so many. This one's a freebie from the dumpsters outside Sallys apartment where hoards of international students have returned home, leaving their not worth it items behind.
Last time I was in bed 24 it was my first day back in small ICU. She's 63 but she looks late 70s. She's had a complicated medical Hx mostly due to alcoholism, liver transplant, and then a whole bunch of other related stuff happen to her this admission.
She's one to one because she's confused and at times can become agitated.
She must not have slept at all last night because at noon I gave her some diazepam as I scored her AWS of 4 due to hallucinations and uneasiness and she fell asleep like a light.
I feel sorry for the night staff tonight. There must be a reason she's 1:1 but I'm not really seeing it today.
Once today she wanted to get out of bed so I humored her and helped her out all on my lonesome for the first time in her 6 day admission.
I'm 178 cm and lift weights so I know my abilities but there will come a time when I'm not going to be able to do things like that.
I could see why she was desperate to get up, underneath her bottom was awash with messy sheets and multiple blueys and uncomfortableness.
I sat her on the edge of the bed and no more. And then slowly made her toddle up higher to the head of the bed before sitting back down and she obediently got back in.
Since then she's been knocked out and snoring
Despite this her blood pressure has been high all day and they've restarted her on various meds all trying to keep it down.
Clonidine makes her sleepy but the hydralazine did the best for the blood pressure from what I can see.
Next door in Bed 23 is another 60 something old lady who is now rather disabled - worse - as due to months long stay in ICU she now can't walk but remains in a body far too large. I think she's lost at least 20-30 kg this admission. She's got a tracheostomy and keeps pulling off the swedish nose covering it; until I gave her a clean one in her hand to trick her, and make her feel like she's got it off her trachy all the time- and no longer needs to reach up to the tracheostomy. Her nurse said the trick only lasted the 20 mins I was watching her. That's a shame. I thought it was pretty clever.
Apparently her whole journey started in 2005 when she had anal reconstructive surgery due to traumatic childbirth causing fecal incontinence (4th degree tear) and since then she's had multiple subsequent random abdominal surgeries for hernias and her pelvic floor - culminating in infection of the mesh here we are in 2020.
Knowing all of these outcomes are random, and just as likely to happen to the next person as it is likely to happen to me, I wonder about my own, current life choices.
And how these women feel about their own lives. Do their children bring them comfort in their illness?
Honestly, it is hard to say when they sit all alone in their rooms with no one but the staff to keep them company. My patient didn't tell me this; but when her sister called she mentioned that the patient told her Son on the previous day, that she didn't want to go on and she wanted to refuse treatment. She'd had enough. I think she felt by telling me, she was unburdening herself of this news.
Meanwhile bed 23 kept mouthing to me to "help her". She's not more specific and with her actual nurse gone (I'm babysitting whilst her nurse is on break) there's not much I can do other than push the spare tracheostomy Swedish nose back into her hand like a dummy and tell her she's alright.
Melbourne is back in lockdown as of midnight on Friday due to 8 cases from the Holiday Inn.
A man who flew in on Tuesday to visit his mother; was locked outside the hospital whilst they sorted out a rapid covid test for him.
Meanwhile, the rest of her family from Sydney were all inside; whilst she was very close to passing away.
The managers were seeing what they could do to expedite his entry.
Despite this; he remained outside - and the family used video call so he could at least see what was going on.
By the time the result came back (pretty quick, 4 ish hours maybe?) she had passed away but as it was negative, they let him in (that result isn't 100% - and what about all those family members that would have been considered close contacts of him: or the fact that he's been in to visit every day since Tuesday...)
Rules are rules but I did feel rather sorry for the family. We're not even in the affected state and our visiting policy just changed to reflect how well NSW has been going overall (unlimited visitors but everyone has to wear a mask and check in). - And it's not like he hasn't already been there and visited for the past 4 days (meaning that if he did have it, we were all in trouble...).
tt's quiet.
It's boring.
It's rainy and humid and windy outside and the only way I know this was because I walked in it at 0700 to come here, and there's a little window in my patients room and I can at times see the rain and wind whipping about.
I remembered to bring an umbrella with me today. I've lost so many. This one's a freebie from the dumpsters outside Sallys apartment where hoards of international students have returned home, leaving their not worth it items behind.
Last time I was in bed 24 it was my first day back in small ICU. She's 63 but she looks late 70s. She's had a complicated medical Hx mostly due to alcoholism, liver transplant, and then a whole bunch of other related stuff happen to her this admission.
She's one to one because she's confused and at times can become agitated.
She must not have slept at all last night because at noon I gave her some diazepam as I scored her AWS of 4 due to hallucinations and uneasiness and she fell asleep like a light.
I feel sorry for the night staff tonight. There must be a reason she's 1:1 but I'm not really seeing it today.
Once today she wanted to get out of bed so I humored her and helped her out all on my lonesome for the first time in her 6 day admission.
I'm 178 cm and lift weights so I know my abilities but there will come a time when I'm not going to be able to do things like that.
I could see why she was desperate to get up, underneath her bottom was awash with messy sheets and multiple blueys and uncomfortableness.
I sat her on the edge of the bed and no more. And then slowly made her toddle up higher to the head of the bed before sitting back down and she obediently got back in.
Since then she's been knocked out and snoring
Despite this her blood pressure has been high all day and they've restarted her on various meds all trying to keep it down.
Clonidine makes her sleepy but the hydralazine did the best for the blood pressure from what I can see.
Next door in Bed 23 is another 60 something old lady who is now rather disabled - worse - as due to months long stay in ICU she now can't walk but remains in a body far too large. I think she's lost at least 20-30 kg this admission. She's got a tracheostomy and keeps pulling off the swedish nose covering it; until I gave her a clean one in her hand to trick her, and make her feel like she's got it off her trachy all the time- and no longer needs to reach up to the tracheostomy. Her nurse said the trick only lasted the 20 mins I was watching her. That's a shame. I thought it was pretty clever.
Apparently her whole journey started in 2005 when she had anal reconstructive surgery due to traumatic childbirth causing fecal incontinence (4th degree tear) and since then she's had multiple subsequent random abdominal surgeries for hernias and her pelvic floor - culminating in infection of the mesh here we are in 2020.
Knowing all of these outcomes are random, and just as likely to happen to the next person as it is likely to happen to me, I wonder about my own, current life choices.
And how these women feel about their own lives. Do their children bring them comfort in their illness?
Honestly, it is hard to say when they sit all alone in their rooms with no one but the staff to keep them company. My patient didn't tell me this; but when her sister called she mentioned that the patient told her Son on the previous day, that she didn't want to go on and she wanted to refuse treatment. She'd had enough. I think she felt by telling me, she was unburdening herself of this news.
Meanwhile bed 23 kept mouthing to me to "help her". She's not more specific and with her actual nurse gone (I'm babysitting whilst her nurse is on break) there's not much I can do other than push the spare tracheostomy Swedish nose back into her hand like a dummy and tell her she's alright.
Melbourne is back in lockdown as of midnight on Friday due to 8 cases from the Holiday Inn.
A man who flew in on Tuesday to visit his mother; was locked outside the hospital whilst they sorted out a rapid covid test for him.
Meanwhile, the rest of her family from Sydney were all inside; whilst she was very close to passing away.
The managers were seeing what they could do to expedite his entry.
Despite this; he remained outside - and the family used video call so he could at least see what was going on.
By the time the result came back (pretty quick, 4 ish hours maybe?) she had passed away but as it was negative, they let him in (that result isn't 100% - and what about all those family members that would have been considered close contacts of him: or the fact that he's been in to visit every day since Tuesday...)
Rules are rules but I did feel rather sorry for the family. We're not even in the affected state and our visiting policy just changed to reflect how well NSW has been going overall (unlimited visitors but everyone has to wear a mask and check in). - And it's not like he hasn't already been there and visited for the past 4 days (meaning that if he did have it, we were all in trouble...).
