whitewriter | Continued catch-up

Wednesday:
When you come back from 2 weeks off -just the same as you can expect to have a slightly dodgy roster just before you leave (say, 4 nights instead of 3, but compensated with your shifts being stacked so your 2 week holiday looks more like 3 weeks) you can also expect to have a double patient or be sent --
as everyone else who has been there for the last 2 weeks has their dates for doubling or sending more recently than you.

So I was doubled.
The first patient:
42+0 p1 (previous NVB) uterine rupture (yes this was in ICU) on a background of some sort of Hx of uterine surgery for endometriosis- and this was a spont labourer - so not an IOL (that is some real bad luck there).

The baby survived and was in NICU, but she had a massive 3L PPH with 3 U packed cells/FFP during OT and now was day 4 wardable.

Other than a suspected ileus which meant she could only have clear fluid and was trying to make breastmilk off 80mls/hr of 5% dextrose and jelly,-- and actually hadn't physically seen her baby since it was born due to it requiring cold therapy (this was not handed over to me).

I wonder if, she chose to go ahead with a future pregnancy, if they would suggest an LSCS at 38 weeks rather than NVB.

I also wondered if 42+0 was a risk factor for uterine rupture of spont labour - although, I suspect it only became a factor when one considers the previous endometriosis Hx. (As in, if it was 42 weeker spont laborer with zero other risks and a clean Hx this would not have happened).

The emotional part of my day? Wheeling her around to see her son for the first time in NICU-- and running into a midi student who is ex-ICU and then detailing to her how much I hated SCN as a student (well. I Liked it eventually but it took 6 weeks. I'm a tough nut to crack).

Pt number 2 was also:

61 yr old female with multiple abdominal surgeries for Chrons that has culminated into short gut syndrome. Apparently for the past 6 days she has been extreemly needy - calling out and demanding.

That's a nursing term for "spoilt brat" style of patient.
Get me this, that, this, no I want, can I have -where is - refusing to roll, or states can't roll themeslves etc.

Apparently she drove some people nuts. I took handover from the night staff (TT) who, like I said - scares me a little but whatever talking to she gave this lady to put her in her place and make her realise that we're doing the best for her, and she needs to take back some control by doing some things for herself: so actually, I had a decent day with her overall.

'Cept when I had to deal with 2 broken PCA pumps.

I left the shift wondering if I should have changed her stoma dressing (honestly, ran out of time) but knowing it was intact.

At 04:00 there was an email from the big boss to say all nursing staff were not to use their phone on the floor.

I've been keeping it in my locker anyway due to all that stuff with This

Someone wondered out loud in the tea room if anyone ever failed their IP. And I could think of a few that had "moved on".

If you want to stay, and no one wants you - you can always go to neuro-ICU, they'll take anyone. Thing is, most people don't want to work in what is sometimes considered a "dead end ICU" for being "much too specialised" (which I disagree with and that's another topic for another day). I loved my 4.5 almost 5 years there.

I left that shift forgetting to put my name on the 2 person list and wondering if I'd get 2 pt 2 days in a row again.

Thursday:
I tried to rock up early to see the allocation (and maybe discretely mentioned I'd had two) to see that someone was kind enough (TT, actually. See. She isn't a terrible person) to put my name down.

So I was a 1:1 ? kind of special for a non-scheduled, wardable, 195kg male who was initially transferred from a much smaller hospital to ours due to ?ECMO for pneumonia that ended up improving with regular treatment.

He'd required transfer to MISH via the only bariatric ambulance in the state, and was on a very wide and very special bariatric bed.

Highlights of this shift:
-calling security because he started walking away from me when we were outside and me just giving up and going inside to the covid temperature checking lady and saying "can you please call security and tell them to come help me with an absconding pt and then call Small ICU and let them know i need some help please"
- the number of times the porter had to reverse and reangle the bariatric bed to get it to fit through the door whilst the pt lay on it left lateral, peering from the head of the bed (no headboard)
- me explaining to the ward that the bed should stay with the pt even though they'd already done the same with their bariatric bed from the sleep unit - i'd looked at their bariatric bed and declared it small (it was compared to the ICU one and this was no small pt).
- The pt and his mum convincing me to take a piece of his usual "breakfast" because they "always bring extra" - it was pizza from the local lebanese bakery to his area. I had it at Morning tea.

Friday:
I finally got dialysis again. I looked at who allocated last night and I figured- every time it's her she always gives me an interesting semi- unwell case.

This time however, the dialysis would need to be set up and started from the beginning. This would be the third time I'd set one up and actually connected the whole system to a person.

The doctors dawdled all day before putting in a new vascath, made a huge mess which resulted in my pt needing a transfusion - and got that x-rayed and by the time they'd okayed me to start: it was well into the afternoon and both people who had earlier promised to help me had either - left (one was an RN from Bathurst who was given a 2 week "working experience trip" to see a large inner city hospital and experience dialysis and big surgical ICU type of cases) and the other was someone whose pt was in IR for a procedure.
His pt came back before I was allowed to start -

It took me about an hour to set it up. Painfully slowly, double checking everything with the protocol and two seniors.

Before I finally connected up the whole thing and it actually worked.

His case was exactly the same as - This guy, Mr 24. Aka Mr Mark. except instead of having a type A personality line of work; this guy was the local garbage truck driver for a regional area up North.

On paper he was A class family man.

His parents kept reminding the doctors he didn't drink, smoke or do drugs.

Honestly, that doesn't change our treatment of the man. Just makes us feel sorrier for him. At one point his mother told him "He was losing all the weight like he wanted".

Highlights (or lowlights) of the day.
-his parents being really clingy all morning, repeatedly telling their sedated son how much they loved him and how he was getting better and etc-- And their being worried about (what I consider to be) odd things like drain outputs.
-Not realising someone (one of the RMOs) put my PT onto 60% FiO2 from 30% during the line insertion and not reacting and changing it back sooner.
- Meeting his really sweet wife who had only just had a baby, 5 weeks ago. She was a trooper.

On handover I did the ETAB with the night RN, and had to handover the circuit. Hope it was set up all hunky dory.

Now I'm all caught up.

Long weekend full of absolutely f-ing nothing in particular (for once) lays in wait.
Oh the things I want to do *cough* read *fanfiction* cough.