Thursday, May 13, 2010

Just things

Ever since I went off orientation, at the beginning of January, I've been anticipating caring for an unstable patient . Not that I want an unstable patient, but I knew it was inevitable and the longer my stretch of stable patients lasted, the more I felt like the specter of a truly sick patient was my Sword of Damocles. Oh, I've had patients with issues, chest pain that turned out to be nothing, low blood pressure, although asymptomatic and with a normal heart rate, people who were violent or going through DTs, etc, but other than one incident when I was still on orientation, no patient who suddenly became critically ill.

Monday, my patient had been fine all night. I took his vital signs myself at 04:00 and they were normal. He said he felt OK and declined an offer of pain medication. At 06:00 I spoke to the patient and he was fine and by 06:20 he was having severe breathing difficulty. I did what I could for him in the room and then I paged the doctor who came up shortly and ordered a chest x-ray, labs, lasix. Luckily, we have a roaming team of critical care nurses that we can page who will assist in cases like this. I don't know what I would have done without that critical care nurse, who brought a monitor (we don't have cardiac monitors on my floor), got respiratory therapy in the room with a bipap machine, and had the confidence to handle a situation that was beyond my experience. Before long, general medicine doctors were in the room, and anesthesia, and the patient was intubated. The anesthesiologist handed the critical care nurse some IV pushes of sedation drugs, for the elevator ride to the ICU, in case he started to wake up, and then she was gone. This represented a level of nursing far above mine: pushing anesthesia drugs in an elevator. That's why I'm an acute care nurse and not a critical care nurse. I would like to do critical care, but not until I have more experience.

After the arrival of the critical care nurse, I did feel somewhat separated from the patient's care. I pushed a few drugs, I got an EKG, I tried to provide emotional support to the patient, but in general I felt like my function was reduced to errand running. (And I still had four other patients to care for.) But that was OK, I definitely learned a lot from the whole experience and I will feel more confident the next time I have a respiratory emergency.

Another career advance: I've been accepted at the University of Virginia and will be continuing my nursing education. I have mixed feelings about it. I'm glad to have been accepted, but I don't know if I can handle more school. Even now, with just a job to worry about, I am exhausted all the time. I can't sit in a comfortable chair for more than ten minutes without falling asleep. I am stiff and sore all over, all the time. And there's my family to consider. Mr. McP cried when he heard I'd been accepted at UVA and the other kids aren't happy about it either.

In other news, Drama Queen was accepted into the Governor's School summer residency program. This is the thing for which she interviewed in January, when we had to do an emergency repair to her sculpture with dental floss because that's all I had in my purse. It means an entire month away from home, and we are not allowed to visit and she will not be allowed a cell phone. The only way we will be able to communicate with her is in writing. Letters, that is, not email.

And Mad Scientist is definitely going away to New York for college. He had a phone interview with his adviser and is registered for classes, and we're awaiting his dorm assignment. He's supposed to be there on August 25th, although how we will manage that when my school starts August 21, is beyond me.

6 comments:

  1. Congratulations on getting into UVA! I have every confidence that you'll do well and somehow find a way to juggle work, school, and life.

    That's great news about Governor's School and college in New York -- lots of great news for the Crabstick family this month!

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  2. Wow, Governor's School is a big deal. Congratulations! (also on getting into UVA) I know what you mean about the sick patients--I totally used to feel like that.

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  3. Congrats on UVA. What are you going to be studying?

    Also congrats on Governor's School. I dream of Hippie getting into our version.

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  4. Congratulations to everyone! Those are major accomplishments!

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  5. That sounds both scary and awesome. Great news about your kids! And you!

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  6. The sicker The Better...U Rock!

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