Run of nights
Jul. 31st, 2021 02:08 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
whitewriterI had a good run.
Nights are like this: The first is the absolute devil. The 2nd, your only thinking about when hell will end, and on the 3rd you see the light at the end of the tunnel and (mostly) breeze through.
The summary:
Sunday - Night one
I got a standard intubated patient, who was intubated for a combination of ARDs and delirium. Everytime he'd get worked up (apparently afraid to be delirious) he would breath up, and desaturate, and the HFNP wasn't cuttiing it so they tubed him.
He was standard and boring and i was informed to "keep him on SIMV with 0 spont breaths overnight with a propofol capped at 20, dexmedetomidine and fentanyl at 10mcg/hr (which is a lot, btw)" and that was a breeze for the most part.
The only thing that pissed me off was that his wife is a current VIP of my district and she used this status to get around visiting rules of the ICU. I wish our hospital's execs had the balls to say "well no. that's not grounds for exemption" (which is: imminent death - or in the case of one fellow, he'd been there for 2 months stuck staring at a wall whilst he's been sick so we let his partner who lives very local come in for 1 hr a day) and not let her arse in
It's just not fair when 4 beds over there's a schizophrenic man who (intentionally) jumped from a bridge onto train tracks (and survived GCS 14 for confusion - with many broken bones) and his father who is his carer he lives with wants to visit him and isn't allowed to.
Or the man whose actually dying in the bed next door - only gets his partner in for 1 hour a day, until the last day, when they were withdrawing from CRRT since he's too sick for a liver transplant and he can't live without one.
This guy will survive. He's ain't dying anytime soon.
Anyways. A lot of us were ranting about this. It's just not fair.
Monday- Night two
I get sent to Cardiac ICU and I'm given a supremely easy HDU patient.
The kicker? I actually know him.
He's a member of my st John division (SJA).
I can't recall actually doing a duty with him- and actually, he looked so different: and I didn't know he was sick so that was a bit of a shock, but the name was familiar.
He called it out before I had to fumble through the "Where do I know you from?"
As soon as I'd gowned up to go in the room, his nurse turns to me and says "B says he knows you from St John". --
After handover - we got to talking and I realised the exact connection (I've been in 4 divisions over 11 years so someone knowing me from SJA is a pretty broad statement).
He asked me if there was somewhere he could get soda. This poor boy, is only 31. And he's been in hospital for weeks without visitors. They even had to get permission for his brother, who lives in a lucky local government area (LGA) -- (aka, not a so called hotspot) to bring in washed shorts for him, and take away his dirty ones (we don't have a laundry service). What happens to folks who live in an unlucky LGA and don't have any clean shorts? They do without?
Anyways the next night, as I have a lot of spare soda in my pantry that I'm definitely not drinking any time soon, I brought some to his room as like a "gift" and he said, my BGLs have been so high - And I thought, oh yeah. He's on massive steroid doses and we keep giving him insulin dextrose for High potassium (up to 6.0) despite him being on frusemide(admittedly not a high dose but still).
It was weird taking care of someone who "knew" you. Sorta like, say teaching nursing at uni, then your student gets sick and you happen to be working that night... and their your patient. That's how it felt like.
Tuesday - Night three
I get sent to R ICU.
R used to be covid ICU, but now it's an overflow iCU instead. For a few months there - it was closed and we handed the space back to TPU (like a day surgery section) but now because of the rising cases, it's turned back into "we don't know what the heck we're doing: we need the single rooms for all the potential covid cases - so they've chucked up a bunch of walls in small ICU, closed those beds to covid beds (at the time unfilled) and reopened R back up. The space was so disorganised with no real one "storage" area with defined stuff. It was like turning up to work in a new department and no one there was someone who knew where stuff was. We were all in the same boat, all sent to this "new" place which had been "created" at the drop of a hat. So you'd need a sats probe to monitor oxygen, and you'd have to be like. ok. Where do I get those... and spend 10 mins hunting for it. after 2 mins you generally give up and or ask but-- like I said, it was a mess and no one knew where stuff was- and if it wasn't there, that means walking there and back (approx 10 mins) to small ICU to get the item. So you'd make your list carefully at the start of the shift. Asked around if someone needed anything -- then find the time to make the trek.
I was first given a super easy single - who I knew from night 2 because he was next door to my easy guy- but got transferred to R because they wanted the arrest beds to be "easily accessible" I think. Can you imagine an arrest in R? That would be such a messy nightmare. In fact, I don't think I even knew where the cart was..... whups...
I'm sure there was one somewhere...
But the someone was coming onto overtime and as I am accustomed to, they are traditionally given the easiest patient. So. I was asked to take the double (which was fine) Until I realised 3 hours in to sorting my double out for washes early so I wouldn't have to be a mad chook at 6am, I'd be a mad chook at 11am I realised R is not like the systems in sortedICU around the corner. There's no box behind the bed saving the observations so I could save then once I came up for a breath of air.
It was like the old days when I first started and no box existed and you just had to stare at the monitor and memorise the BP and MAP quicksmart before the numbers changed.
Felt a bit like working in a makeshift war zone bunker. Absolutely zero windows, and stock in weird piles everywhere.
I had (not his real name) "Simon" again. He just can't get a break that guy. Since I had him, he's had massive PE's and when they put him on heparin and got to therapeutic, he bled out his drains (and that stuff was already like sewers pouring out of his necrotic pancreas- imagine blood too...) so they've gone to "subtherapeutic but he needs something" heparin at some low dose number of 5ml/hr to just .... have something without having something. He was looking alright on it though so perhaps it was working.
I intended to write this up earlier this week, but I was out of the mood.
It's 2am on the Saturday morning. I'd acclimated back by Friday for my next shift at SSH (quite possibly a mistake having taken that whilst SSH is currently an unlucky LGA).
Plus I'm hungry...
Nights are like this: The first is the absolute devil. The 2nd, your only thinking about when hell will end, and on the 3rd you see the light at the end of the tunnel and (mostly) breeze through.
The summary:
Sunday - Night one
I got a standard intubated patient, who was intubated for a combination of ARDs and delirium. Everytime he'd get worked up (apparently afraid to be delirious) he would breath up, and desaturate, and the HFNP wasn't cuttiing it so they tubed him.
He was standard and boring and i was informed to "keep him on SIMV with 0 spont breaths overnight with a propofol capped at 20, dexmedetomidine and fentanyl at 10mcg/hr (which is a lot, btw)" and that was a breeze for the most part.
The only thing that pissed me off was that his wife is a current VIP of my district and she used this status to get around visiting rules of the ICU. I wish our hospital's execs had the balls to say "well no. that's not grounds for exemption" (which is: imminent death - or in the case of one fellow, he'd been there for 2 months stuck staring at a wall whilst he's been sick so we let his partner who lives very local come in for 1 hr a day) and not let her arse in
It's just not fair when 4 beds over there's a schizophrenic man who (intentionally) jumped from a bridge onto train tracks (and survived GCS 14 for confusion - with many broken bones) and his father who is his carer he lives with wants to visit him and isn't allowed to.
Or the man whose actually dying in the bed next door - only gets his partner in for 1 hour a day, until the last day, when they were withdrawing from CRRT since he's too sick for a liver transplant and he can't live without one.
This guy will survive. He's ain't dying anytime soon.
Anyways. A lot of us were ranting about this. It's just not fair.
Monday- Night two
I get sent to Cardiac ICU and I'm given a supremely easy HDU patient.
The kicker? I actually know him.
He's a member of my st John division (SJA).
I can't recall actually doing a duty with him- and actually, he looked so different: and I didn't know he was sick so that was a bit of a shock, but the name was familiar.
He called it out before I had to fumble through the "Where do I know you from?"
As soon as I'd gowned up to go in the room, his nurse turns to me and says "B says he knows you from St John". --
After handover - we got to talking and I realised the exact connection (I've been in 4 divisions over 11 years so someone knowing me from SJA is a pretty broad statement).
He asked me if there was somewhere he could get soda. This poor boy, is only 31. And he's been in hospital for weeks without visitors. They even had to get permission for his brother, who lives in a lucky local government area (LGA) -- (aka, not a so called hotspot) to bring in washed shorts for him, and take away his dirty ones (we don't have a laundry service). What happens to folks who live in an unlucky LGA and don't have any clean shorts? They do without?
Anyways the next night, as I have a lot of spare soda in my pantry that I'm definitely not drinking any time soon, I brought some to his room as like a "gift" and he said, my BGLs have been so high - And I thought, oh yeah. He's on massive steroid doses and we keep giving him insulin dextrose for High potassium (up to 6.0) despite him being on frusemide(admittedly not a high dose but still).
It was weird taking care of someone who "knew" you. Sorta like, say teaching nursing at uni, then your student gets sick and you happen to be working that night... and their your patient. That's how it felt like.
Tuesday - Night three
I get sent to R ICU.
R used to be covid ICU, but now it's an overflow iCU instead. For a few months there - it was closed and we handed the space back to TPU (like a day surgery section) but now because of the rising cases, it's turned back into "we don't know what the heck we're doing: we need the single rooms for all the potential covid cases - so they've chucked up a bunch of walls in small ICU, closed those beds to covid beds (at the time unfilled) and reopened R back up. The space was so disorganised with no real one "storage" area with defined stuff. It was like turning up to work in a new department and no one there was someone who knew where stuff was. We were all in the same boat, all sent to this "new" place which had been "created" at the drop of a hat. So you'd need a sats probe to monitor oxygen, and you'd have to be like. ok. Where do I get those... and spend 10 mins hunting for it. after 2 mins you generally give up and or ask but-- like I said, it was a mess and no one knew where stuff was- and if it wasn't there, that means walking there and back (approx 10 mins) to small ICU to get the item. So you'd make your list carefully at the start of the shift. Asked around if someone needed anything -- then find the time to make the trek.
I was first given a super easy single - who I knew from night 2 because he was next door to my easy guy- but got transferred to R because they wanted the arrest beds to be "easily accessible" I think. Can you imagine an arrest in R? That would be such a messy nightmare. In fact, I don't think I even knew where the cart was..... whups...
I'm sure there was one somewhere...
But the someone was coming onto overtime and as I am accustomed to, they are traditionally given the easiest patient. So. I was asked to take the double (which was fine) Until I realised 3 hours in to sorting my double out for washes early so I wouldn't have to be a mad chook at 6am, I'd be a mad chook at 11am I realised R is not like the systems in sortedICU around the corner. There's no box behind the bed saving the observations so I could save then once I came up for a breath of air.
It was like the old days when I first started and no box existed and you just had to stare at the monitor and memorise the BP and MAP quicksmart before the numbers changed.
Felt a bit like working in a makeshift war zone bunker. Absolutely zero windows, and stock in weird piles everywhere.
I had (not his real name) "Simon" again. He just can't get a break that guy. Since I had him, he's had massive PE's and when they put him on heparin and got to therapeutic, he bled out his drains (and that stuff was already like sewers pouring out of his necrotic pancreas- imagine blood too...) so they've gone to "subtherapeutic but he needs something" heparin at some low dose number of 5ml/hr to just .... have something without having something. He was looking alright on it though so perhaps it was working.
I intended to write this up earlier this week, but I was out of the mood.
It's 2am on the Saturday morning. I'd acclimated back by Friday for my next shift at SSH (quite possibly a mistake having taken that whilst SSH is currently an unlucky LGA).
Plus I'm hungry...
