Schadenfreude
Apr. 18th, 2021 09:43 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
whitewriterI'm running out of time.
I had a run of 3 nights- and didn't spend any of my time pre-writing my entry like I previously have been.
Night one: I was sent to cardiac ICU and had a blast with the most boring-est ICU pt ever (lovely. Pure joy).
GCS 4. (hence the intubation- and furthermore, difficult airway due to Hx)
endocarditis.
I spent the night taking to the IP 4th rotation next to me.
An odd occurrence happened at 05:00. The IP realised she had given her tamponade pt the aspirin and heparin that was prescribed for her the pt before she realised in the notes, the doctors had written to hold those medications (but forgot to cancel the chart -- and also forgot to communicate these to either the incharge or the nurse themselves).
It was too late.
The deed was done.
The reason the meds were to be held until review was because it was considered that they both contributed to the pt tamponading post operatively (requiring 2 take backs to OT).
Now. I've made medication errors in my life. And I'm not proud of any of them and I've felt horrible after each one.
Seeing a junior go through the stress of worry that perhaps her error (but come on, it was the doctors fault for not communicating properly -- if they had at least canceled the order that might have helped) - but seeing a junior go through pain.
Made me smile. I was being naughty and not wearing a mask and I paid the price because she saw it. And got mad at me (as she rightfully should). What is wrong with me! What if that pt died? (a possibility).
Would I still be smiling?
That poor IP...
Have I been eirrevocablydamaged by my experiences as a junior midwife (considering my experiences as a junior nurse feel oh, so far away) such that I now just want juniors to feel the pain. That pain is necessary? Schadenfreude.
The next night I saw the IP4 had my easy lady. I hadn't heard of any tamponade in the aaspirin heparinguy.
There was a pt from the SRES round the corner that night - someone had a witnessed out of hospital cardiac arrest OOHCA - and had 1 shock delivered by SJA. And now they were at MSH. Small world.
Same night M. Winn is like "so what are you doing now?" (this is what happens when you don't announce stuff on fb - perm in small ICU i reply. I also state that "I defected" - like it's north Korea and I've left to the South - and he's like Ah small ICU is horrid. They work you like a dog and there's no recognition.
Yeah.
But it's different.
Friday night
Ridiculously heavy double.
I arrive to my post op who had initially arrived 3 hours before and was not recovered: was on an uncharted fentanyl infusion, awaiting for his PCA to be delivered from OT as per surgeons request. Oh and the post op orders include for him to have an NGT that some numbskull in OT forgot to place, so could ICU put down the NG please?
What an evil person.
You want me to put an NGT down in this poor, now awake man, who can barely speak English.
I was swearing inside all sorts of explanations whilst I was encouraged by my senior to use google translate (bad idea, waste of time) --and ended up doing the right thing and phoning his daughter and talking to her, who then talked to him, and then he was such a Gentleman as he let me put that NG down.
Also I got another fresh new admission from OT - this time a woman who was meant to go to the ward but due to her blood pressure being low (and by the way, the art line was toast) was now in ICU and can we stop the metaraminol because maybe (and this is after all the admission stuff was being half done) we will try and get her to the ward tonight.
Bullshit, she stayed and I ended up putting her on norad titrating it with the non invasive because the ART line was shit.
The junior Daisy was such a gem, and we helped each other out all night. And made it through somewhat victoriously.
I put my name down on the 2 person list.
Night three
Only to come in the 3rd night to find I also two patients again.
To be fair there weren't many 1:1's going.
I had: ?infected pacemaker leads and mixed type 1/2 respiratory failure in a 60 yr old gentleman who claimed he met Sting whilst working for a company called showtime who arranged all the freight for stars when they were traveling with their shows - back in the 70s. He was funny.
Then I took a late handover from a newbie who got thrown in the deepend with 30 mins warning : she wasn't to have Bed 24 (who was the guy in Bed 25 with no pelvis, I'm sure I wrote about him before) for the last 3 hours of her shift but rather - to have a new admission and she'd never taken an ICU admission before.
Mr 24 had been moved into Bed 24 from bed 25 due to CPE. He was found to have Carpbepenum producing enterobacteracea. I was extra cautious with hand hygiene and changing my contact precaution gowns that night. All his urine, drain outputs and the like all had to be solidified with a gel and tossed into the yellow waste bin.
At 2 am i asked the incharge if we could order for his room bins to be emptied because they smelled.
The garbage guy turned up at 02:30
I apologies to Mr 24 for so rudely awakening him with the bin guy at 02:30 because honestly: I thought the bin guy would see the order and turn up at a reasonable working hour - not the middle of the night - but who knew, waste management people worked at all hours.
At various times during these 3 shifts I heard patients praising how good MICH is.
That the care they get is really good, that they are so happy to be there.
Patients thank us over and over again. (not all of them, but some) and even making sure to ask when our "shift would be over" to ensure they can "make sure they say thank you before we leave -- if they're asleep and we just hoof off --"
Just such a different world compared to SSH (where I do get thanked by the women and their partners but I don't feel like I've given them gold standard care. I've given them medicalised, over-bearing care that didn't trust God or nature or women.) The feminist inside me dies at SSH. The magnanimous and altruistic side of me feels fed and satisfied at MICH even though I hate night shifts with a passion.
I'm happy to be forced to work a cruddy roster in a workplace where I enjoy the work. I'm also happy to personally choose to work somewhere I don't entirely enjoy- for the education and experiences I gain there, even if those experiences are not enjoyable.
Here's the kicker: both MSH and SSH are technically run by the same employer. -- different district, admittedly.
I had a run of 3 nights- and didn't spend any of my time pre-writing my entry like I previously have been.
Night one: I was sent to cardiac ICU and had a blast with the most boring-est ICU pt ever (lovely. Pure joy).
GCS 4. (hence the intubation- and furthermore, difficult airway due to Hx)
endocarditis.
I spent the night taking to the IP 4th rotation next to me.
An odd occurrence happened at 05:00. The IP realised she had given her tamponade pt the aspirin and heparin that was prescribed for her the pt before she realised in the notes, the doctors had written to hold those medications (but forgot to cancel the chart -- and also forgot to communicate these to either the incharge or the nurse themselves).
It was too late.
The deed was done.
The reason the meds were to be held until review was because it was considered that they both contributed to the pt tamponading post operatively (requiring 2 take backs to OT).
Now. I've made medication errors in my life. And I'm not proud of any of them and I've felt horrible after each one.
Seeing a junior go through the stress of worry that perhaps her error (but come on, it was the doctors fault for not communicating properly -- if they had at least canceled the order that might have helped) - but seeing a junior go through pain.
Made me smile. I was being naughty and not wearing a mask and I paid the price because she saw it. And got mad at me (as she rightfully should). What is wrong with me! What if that pt died? (a possibility).
Would I still be smiling?
That poor IP...
Have I been eirrevocablydamaged by my experiences as a junior midwife (considering my experiences as a junior nurse feel oh, so far away) such that I now just want juniors to feel the pain. That pain is necessary? Schadenfreude.
The next night I saw the IP4 had my easy lady. I hadn't heard of any tamponade in the aaspirin heparinguy.
There was a pt from the SRES round the corner that night - someone had a witnessed out of hospital cardiac arrest OOHCA - and had 1 shock delivered by SJA. And now they were at MSH. Small world.
Same night M. Winn is like "so what are you doing now?" (this is what happens when you don't announce stuff on fb - perm in small ICU i reply. I also state that "I defected" - like it's north Korea and I've left to the South - and he's like Ah small ICU is horrid. They work you like a dog and there's no recognition.
Yeah.
But it's different.
Friday night
Ridiculously heavy double.
I arrive to my post op who had initially arrived 3 hours before and was not recovered: was on an uncharted fentanyl infusion, awaiting for his PCA to be delivered from OT as per surgeons request. Oh and the post op orders include for him to have an NGT that some numbskull in OT forgot to place, so could ICU put down the NG please?
What an evil person.
You want me to put an NGT down in this poor, now awake man, who can barely speak English.
I was swearing inside all sorts of explanations whilst I was encouraged by my senior to use google translate (bad idea, waste of time) --and ended up doing the right thing and phoning his daughter and talking to her, who then talked to him, and then he was such a Gentleman as he let me put that NG down.
Also I got another fresh new admission from OT - this time a woman who was meant to go to the ward but due to her blood pressure being low (and by the way, the art line was toast) was now in ICU and can we stop the metaraminol because maybe (and this is after all the admission stuff was being half done) we will try and get her to the ward tonight.
Bullshit, she stayed and I ended up putting her on norad titrating it with the non invasive because the ART line was shit.
The junior Daisy was such a gem, and we helped each other out all night. And made it through somewhat victoriously.
I put my name down on the 2 person list.
Night three
Only to come in the 3rd night to find I also two patients again.
To be fair there weren't many 1:1's going.
I had: ?infected pacemaker leads and mixed type 1/2 respiratory failure in a 60 yr old gentleman who claimed he met Sting whilst working for a company called showtime who arranged all the freight for stars when they were traveling with their shows - back in the 70s. He was funny.
Then I took a late handover from a newbie who got thrown in the deepend with 30 mins warning : she wasn't to have Bed 24 (who was the guy in Bed 25 with no pelvis, I'm sure I wrote about him before) for the last 3 hours of her shift but rather - to have a new admission and she'd never taken an ICU admission before.
Mr 24 had been moved into Bed 24 from bed 25 due to CPE. He was found to have Carpbepenum producing enterobacteracea. I was extra cautious with hand hygiene and changing my contact precaution gowns that night. All his urine, drain outputs and the like all had to be solidified with a gel and tossed into the yellow waste bin.
At 2 am i asked the incharge if we could order for his room bins to be emptied because they smelled.
The garbage guy turned up at 02:30
I apologies to Mr 24 for so rudely awakening him with the bin guy at 02:30 because honestly: I thought the bin guy would see the order and turn up at a reasonable working hour - not the middle of the night - but who knew, waste management people worked at all hours.
At various times during these 3 shifts I heard patients praising how good MICH is.
That the care they get is really good, that they are so happy to be there.
Patients thank us over and over again. (not all of them, but some) and even making sure to ask when our "shift would be over" to ensure they can "make sure they say thank you before we leave -- if they're asleep and we just hoof off --"
Just such a different world compared to SSH (where I do get thanked by the women and their partners but I don't feel like I've given them gold standard care. I've given them medicalised, over-bearing care that didn't trust God or nature or women.) The feminist inside me dies at SSH. The magnanimous and altruistic side of me feels fed and satisfied at MICH even though I hate night shifts with a passion.
I'm happy to be forced to work a cruddy roster in a workplace where I enjoy the work. I'm also happy to personally choose to work somewhere I don't entirely enjoy- for the education and experiences I gain there, even if those experiences are not enjoyable.
Here's the kicker: both MSH and SSH are technically run by the same employer. -- different district, admittedly.
