Lucy, Ed, and Carl Hamilton Park

First impressions, outside the hospital, are predictable. Height, weight, color of skin, expression; handshake, attention span, first and last name. Maybe you find out what their laugh sounds like, or you notice how everyone else in the room watches them with wary admiration, or you discover that they spit when they pronounce their sibilants.

Inside the hospital, first impressions are just as predictable, but in different ways. Every shift begins and ends with report, and every report follows the same structure, a whole unit reciting the history and status of each patient every eight to twelve hours, in unison.

This is an anxious fifty-year-old woman, the night nurse told me, patient of Dr. Ling, here for hyperkalemia and possible sepsis secondary to C.diff superinfection. Here is her entire medical history: bowel cancer, diarrhea, multiple intestinal fistulae to both internal and external abdomen, repeated surgical revisions, perineal remodeling with multiple additional fistulae, urinary tract infections, incontinence. Here, look at these reports: learn all about her rectum, her vagina, her most private processes.

Here is a picture of her chest, a scan of her abdomen. Look at her body, right down to the bones. Look inside her. Here are all the molecules we’ve found in her blood, in their rightful and wrongful proportions. Here is a transcription of her heartbeat from twelve separate axes.

Oh, her name is Lucita. She goes by Lucy. Want to go in and meet her now?

A young stroke pt, a bit of fetal physiology, and some pettiness on my part

I genuinely wasn’t prepared for the popularity of this blog, or for some of the sequelae that followed it. I thought a few people might read it, get a chuckle, and glide on by. So I wrote like the blog would be gone in a month, a forgotten vanity, an echo chamber for my rambling thoughts.

Instead, you liked it. Which is alien and bizarre to me, like discovering that other people really do like the smell of your farts. Are you guys… okay?

Anyway, a lot of things happened while I was on hiatus.

I launched my kid sister at the end of the summer. It was not easy and I spent virtually all my downtime helping her fill out paperwork, set up and attend interviews, and move into her own tiny room in a house where girls rent rooms to sleep in between classes. She has a job now, and passed her GED. I am so proud.

Also, I am so glad that I can flop on my sofa in my underwear when I get home from a shift.

Aside from all that, I also went to Yellowstone for five days because I was losing my mind and my first response to stress is to go camping, and I went to a cheese festival and got constipated and drunk, and I had a shitty run-in with a pt family who heard only what they wanted to hear and reported to my manager that I had lied to them. Fortunately, my manager knows that I am a thousand percent more likely to overshare than I am to conceal, and has been my facebook friend long enough to know that withholding information about medications is not something I am physically capable of doing.

Mrs Leakey, Jelena, and Wen Li

So, uh, I’ve been on hiatus.

I’ve been working on a few chapters for a book proposal, and trying to get things pretty enough to be useful for publication, but I really REALLY prefer blogging to book writing (at least in this format) and I’d like to get back to this. So I plan to keep working on the blog, not necessarily shift-by-shift but following specific batches of pts, and work on the book between posts.

The upside to this is: I have a lot to tell you guys about. I expect to update once a week from here on out, and I actually have a backlog of posts ready to go, so there shouldn’t be any major hiccups for a while.

You have been wonderful and supportive, all of you, and I promise that if any of you is ever unfortunate enough to end up under my care, I will wipe your asses with the warm wet wipes.

(I also told a trio of trusted coworkers about my blog, so they could peek over it and make sure it’s both factual and HIPPA-compliant. All three of them immediately identified Crowbarrens. Life is good.)

Anyway. Let me tell you about Mrs. Leakey.

A new post!

Late post! God, I hate working a huge raft of shifts in a row. Out of the last ten days I’ve worked eight, and tomorrow I go back for two more. You know what’s great? Having more than one day off in a row.

I came back the next morning and discovered that the supply-room coffee was even worse than usual, with a bitter, rancid edge that made it damn near undrinkable even with a carton of milk stirred into it, a petty-theft latte for the desperate. I coughed down a few gulps and rinsed my mouth in the sink, promising myself Starbucks as soon as I could get break coverage.

I don’t usually blow cash on Starbucks. I live a block from an independent coffeeshop that makes lattes to wake the dead, the kind of perfect espresso miracle that makes you sigh with relief every time you take a sip. It’s hard to get excited about the over-roasted stuff you get at the white-people-with-yoga-mats chain. God, I’m such a fucking snotty hipster these days I piss myself off.

(A week or two ago my husband and I dug an old, perfectly functional turntable out of the trash, bought a cheap pre-amp from an audiophile wizard of our acquaintance, and rifled a local yard sale for a few albums—ELO’s ‘Out of the Blue’, Tubular Bells, Neil Young’s ‘Heart of Gold’, and some Fleetwood Mac or other. We have been offending the neighbors ever since. This is probably a huge improvement over our usual evening soundtrack of Star Trek reruns, Bill & Ted’s Excellent Adventure, and Conan the Barbarian. The point is, we are now the worst kind of dad-flavored hipsters and should be euthanized for the good of society.)

But I can be as hipster as I want on my own time. When I’m working, I am 100% down for peppermint disks from the crystal dish in the conference room, PB&J in a paper cup with saltines, and the hospital cafeteria’s Clam Chowder Fridays. I have dumpster tastes and raccoon appetites and I belong out back of the Waffle House instead of in a high-tech facility for healing. Starbucks is outright classy compared to my workin’ self.

So it was quite a blow to realize that I was getting a pt who’d just landed fifteen minutes ago after having been airlifted from a smaller, rural hospital. Landing a critically ill pt—too sick to be managed by the local teams—meant I would be glued to the bedside, monitoring and giving meds and managing drips and performing all the little tasks that are so hard to adequately describe because they’re so boring. No time to go get Starbucks.

But if you can’t get coffee, adrenaline will do. I nabbed my stethoscope from my locker and headed down the hall with my pulse already picking up, seeing the cluster of transport techs and docs and nurses and other beasts swarming around my pt’s room.

Adjusting my plans!

Okay, so, that week off was desperately needed. I hadn't realized, but I was writing a ridiculous amount of verbiage, and it turns out that writing that much was a recipe for burnout.

Plus, I feel like you guys are starting to get the feel for ICU patterns: a little heart failure here, a little COPD there. Unusual things happen sometimes, between the cardiac caths and respiratory failures, but there are only so many times I can explain pressure imbalances or tell you that titrating vasoactive drips is both boring and strenuous.

So here's my new plan: I will post one shift report per week, based on the most interesting shift I worked, with extra coverage for any interesting short bits that happen on the other days. This will give me time to write another post every week-- a story, a piece of patho, or even an extra shift report.

I'll post the shift reports on Tuesdays, and the second posts on Fridays (Thursdays would make more sense except that my work schedule has me wrapping up a major week of work on Thursday nights, and I am usually dead by that point).

And yes, I will write up that one awful story. The first time I wrote it up, I wasn't satisfied with how it turned out-- clean-edged, internetty, and all about the shock value. I would like to rewrite it, and see how a year or two has aged it in my head.

See you all tomorrow night!

I meant to post Friday, but I was so tired after that last shift that I fell asleep on the sofa and didn't wake up until 1030. Today is my one day off, and I got about half a shift written, so I will try to finish it up tomorrow after work and post it then.

Boy I tell you what, working more than four shifts a week is a profoundly bad idea for my sanity. Definitely gonna have to find a better balance so I can make the writing work.

Week 9 Shift 1

I showed up late for work by about five minutes, having lost track of time while I was standing in the shower performing my usual morning devotional of cursing, groaning, and ordering myself grimly to wake up, come on, you can do it.

Any time I’m late to work I sort of creep in from the staff elevators and try to sidle up behind the group report cluster without being seen. No luck this time—a bright-faced unfamiliar nurse called out: “You must be Elise!”

Turns out I was precepting today. Okay. Surprise?

Maycee has moved on to another preceptor—each new nurse gets two days with each preceptor, to make sure they get a good variety of teaching methods. I like precepting and am pretty good at it, but everyone learns differently, and I have precepted more than one person who wasn’t really meshing with my style and needed someone a little more methodical and hands-on. Today I would be precepting Anne, who loves airplanes and hiking and pictures of gross wounds, and who was very patient while I poured half a carton of milk into a cup of ditchwater coffee from the supply room dispenser, then thousand-yard-stared my way through the first half of it before my brain came back online.

Our pt was a tall, strikingly pretty older woman who had been very active and independent before she fell last night, smacked her head on something, and developed a huge head bleed—a subdural hematoma. There are several different types of common head bleed, and this is not usually the deadliest, but an SDH can really wreck your shit.