Author: Raspberry Stethoscope

ok, so this is going to sound totallllllly stupid!

But, yeah, I totally saved my patient last night….hahah not.
Anyway, she had major abdominal surgery; was completely necrosed inside/ major sepsis from a perforated bowel from extreme IBS and narcotic use for the pain. So, yesterday she had some serious blood pressure issues. They couldn’t keep her MAP about 65, etc. and received like four 250ml bolus’. When I came on, she was holding steady, but then at like 1 in the morning, her pressure started to drop. 99/50 to 88 to 78.. I’m like…c’mon dude! So I bolus her once. I know it sounds insignificant and I will laugh about this later in life, but I felt proud that I just went ahead and did something rather than ask someone; mostly because this was only my second night off orientation and usually I have someone looking over my shoulder and when something goes wrong, they know about it, ask me what I would do, or tell me what to do.
Also, I am still getting used to the extreme autonomy I have as a nurse in the unit. I would never be able to just give someone fluids without talking to the MD first on the floor. Granted, we have standing orders/early goal direct therapy, but still…

So the point…I’m bolusing her, blablabla, still not coming up. And then I woke her up while fiddling with her lines (effing DUH) and her pressure went right back to 120-140!!!

I’m like…ok, note to self: whenever someone starts dropping their pressure, freakin’ wake them up. Nursing 101 people, i have mastered it. For the rest of the night, whenever she started to look like she might drop her pressure, I just went in there and like slammed something or called her name and her pressure would shoot right back up, ahhahaha. I crack myself up.

I guess I didn’t think to wake her up because she was in such intense pain and everytime she was awake she would moan out. I figured, sleeping and not moaning=no pain=happy patient and happy nurse.

I’m a total hero and genius, I know…hold your applause!

I survived my first night in the ICU on my own. Obviously, they didn’t give me the train wreck patients since it was my first time. I actually had one patient from like midnight to 5am because I transferred one to the floor. And then, of course, I got a patient right at 5:30. At that point, it wasn’t my responsibility since the other nurse was there, so I got her set up and then the oncoming shift took over. So happy for that. I hate having an open bed and just waiting to hear what I’m going to get; it’s totally builds my anxiety.
I also helped one nurse who got trippled by taking her patient to CT scan.

My one patient was quite annoying. He was on the vent, and would not stop screaming. Somehow no sedation was ordered?

Now I need to work tonight. And then I only have two days off and then work THREE IN A ROW *#$%#@$%@#$%@%*!!!!
When you work nights and have “two days off,” it is stupid because one of those days is from when you worked, so it is really like freakin’ 1 day off. I HATE DOING THREE IN A ROW, but I had to put myself on the schedule late.

I honestly need a break. I haven’t had one in soooo long. I went straight from my last job in August into CCIP and I’ve been working non-stop. Seriously, like a week or two would be grand.

Okay, so apparently I was confused and Monday I was not off orientation, but will be tonight. Man! At this point, I really want to just be alone and not have someone looking over my shoulder, despite how convenient it is at times. I know I will make mistakes and stuff, but I feel like I’m well-prepared for the most part.

I honestly now feel like I have not been having very restful sleep, but I also have not been exercising like normal. Lately, I have no motivation or energy to drag my ass to the gym. That needs to stop!

Yesterday I got my first check from working the night shift and I must say, it was pretty damn sweet. It is about an extra $10,000 a year or $300-400 per check, which totally comes in handy. However, I do not want to get used to this money. I am strictly going to use it to build my savings and pay off my MacBook Pro and some of my car loan.

This year I have not been in the holiday spirit. I didn’t even get a real tree!! But my mother let me borrow this 2-3 foot one and it looks cute in the corner of my living room.

 I suppose I am not in the mood for Christmas because I will be working! What’s the point? That, and I have a lot of bills to pay off, so I’m definitely not in any sort of shopping mood and already told my family not to expect anything from me. Really, I’m not a scrooge; I just want people to be real about life. Who can really afford to go out and purchase hundreds of dollars in gifts right now? I cannot and honestly do not want to. It doesn’t help that I’ve been having some problems with my family lately, either. Way too long of a story that no one would understand unless they’ve experienced it. Let’s just say I will probably be distancing myself from certain people unless they change their ways, which probably will not happen. I cannot be around people who are using drugs and alcohol to pretend that life is all fine and dandy. It makes me sad and depressed, but I am lucky to have other positive people in my life, like Mirza, his family, and my sister. ‘Nuff said!

Yesterday when I came home from the store, I found this little guy hitching a ride on my yogurt:

I think he must have been in my bag from the farm. Gives a whole new meaning to “slow food.”

Wow, I just made the most awesome mushroom burgers using this recipe:
http://americanfood.about.com/od/vegetarian/r/Mushroom_Burger.htm

My picture quality is terrible and I apologize, but I just wanted to EAT!

I missed a week of my CSA due to my work schedule, so we went ahead and picked up a share this afternoon.

There were actually a lot more greens to choose from, but I got so much last time and I could not finish it all, so we only took what we thought we could eat:

Any ideas for what to make!! hit me up!

I have survived night shift, thus far.

Tomorrow night will be my first night “on my own.” I put it in quotes because I’ve learned that I am never really alone in the ICU. The other nurses work as a wonderful team and everyone is out to help each other because it is all about the patient. I love that.

But, I am scared and nervous. It is time to cut the cord, though. Sigh.

The other night, my 3rd day post-op ventral hernia repair/liver bx/choley/abdominal rectus advancement with flaps decided suddenly that he wanted to start putting out massive amounts of frank blood from his bilateral JP drains.

Seriously, like >400ml from each in an hour. The oddest part? As soon as the blood hit the little “grenades” it seemed to clot. And not tiny clots either, massive chunks of clots!! And his pressure that had been running in the 140’s, dropped to low 100’s with his HR sky-rocketing into the 140’s!~ fun times. The coolest part was his entire abdomen was quite…lumpy. We all thought for sure that he must be bleeding. I mean, c’mon. As soon as we emptied the drains, they would immediately fill up! And when they filled up, he began oozing significantly from the incision site.

However, the surgeons on the phone did not seem to think it was a big deal at all. In fact, they said…oh, he’s just shifting. hmm, shifting?

Eventually, his drains stopped putting out so much and his vitals stabilized. But, he did end up dropping his HgB from 10 to 7…still, no idea what that was about. I had him for 3 nights and that was the first. I really think he might have been bleeding…perhaps retroperitoneal? But what do I know? I’m no surgeon. I wonder where he is now, though.
—

One thing that kind of surprises me on night shift is how people eat. They eat like it isn’t 2 in the morning, which is understandable, but doesn’t seem, um…healthy? I refuse to eat chicken quesadillas and cheeseburgers in the middle of the night/early morning hours. How am I surviving? Lots of H2O, fruit, lara bars, etc. I snack on these things throughout the night and it seems to hold me over pretty well until I go home.

I haven’t noticed any real issues yet with my sleep and I seem to be able to switch over on my days off pretty well, except I did 3 nights in a row and I’m not going to lie, it was difficult. In fact, it may or may not be related, but the last almost 48 hours, I’ve been suffering with a headache. On just the left side of my head. ugh. I eventually gave into the magical powers of Excedrin and it is gone.

Wish me luck for my first night as an ICU nurse by myself.

My first two night shifts were not bad. I slept ok, not great, but just ok. Also, I never hit that “wall” people talk about in the middle of the night when you just get so tired. I think I was mostly just running on adrenaline of being in a new situation combined with critical care patients. So far, the people are nice and awesome, too, so that’s a plus.
I feel like the night shift could give me a nice, slow pace to learn, but truthfully, I feel I would learn better on days because I feel I benefit a lot from seeing all of the different disciplines who come to see patients. And rounds? C’mon, the MDs in the ICU are quite smart and I always learn something new about my patient and their process when they round and everyone talks.

But, I am giving it a chance.

In other news, I have decided that I have a facebook addiction and it is not good. And so, I have logged out and removed the direct link to my account from my bookmark bar. I think I just need a break. I feel like facebook is just one big facade. I cannot explain it.

This article kind of explains how I feel: https://www.adbusters.org/magazine/80/quit_facebook.html

I just think I might be more productive or clear mind without it for awhile…and for awhile, I mean about a week or a few days at least. I mean, I’m almost 25, it just seems like a juvenile thing to be doing all the time, haha

As another side note, I’m currently reading this book: http://www.halftheskymovement.org/

You may have seen it on Oprah. Anyone read it?

In attempt to prepare for my first night shift, I have taken the liberty of trying to stay up as long as possible tonight, so I can sleep into the day tomorrow. So far? not working. I’ve been tired since 10pm and it now 1:30am.
So far, I have been smart enough to leave some chores for after THE AWESOME BILL MAHER, such as:
-doing the dishes
-ironing my uniforms
-cleaning the kitty litter box
-taking out the garbage

All that held me over until about, oooh, 11:15? yeah. I have also gorged on some Lindt Dark chocolate orange…oops? So much for eating healthy.

In my attempt to stay awake, I purchased some new teas to try out on the night shift. I don’t do coffee.
Black tea it is…

Organic Chai–spiced black tea.

Vanilla Bean–Madagascar vanilla bean with premium black tea.

I’ve tried exhibit A so far and it was pretty good. I’m still undecided how much I like black tea, but I’m learning to like/love it.
Sipped it in this cute cup I bought at the grocery store:

I then proceeded to munch on popcorn and order “The Ugly Truth.” Ugh, I knew it would suck, but it kept me awake.

Here’s some random photos for your viewing pleasure:

Damn, it is only 1:45. My goal was 3am, but I don’t see it happening? I love going to bed…It is like torture staying up:( I really just want to cry right now. I was not meant for the night shift. I like to sleep at 10pm and wake up with the sun!!

I just need to focus on the $$$$$$$$$$$$$$$
wish me luck

I waited in line for over 30 minutes at Walmart to return “room darkening curtains” that did not block out the light, go figure. Anyway, two people are in front of me and they announce that the first 5 people who have returns can move to line 1, so we go over there and the person behind me…again, another middle aged woman begins like almost running to the register. Me and another girl just look at each other like…um, no. She gets in front of us and we both shimmy our way in. I’m like inches from her and I said, “um, yeah, we were both in front of you” and throw my things on the check out counter. She says, “OOH LIKE I AM EVEN PAYING ATTENTION!!” I said, “oh really, that’s why you hauled ass to the line.”
freakin’ dumb-ass woman. you’ve been standing behind me in line for 30 minutes STARING AT THE BACK OF MY HEAD and then you’re going to pretend that you didn’t know.
After last week’s incident, I
am not taking shit from anybody.

ALSO, I am not going to Walmart until after Dec and January.

Sorry for such negative posts. I’ve just been disgusted with people’s behavior lately.

Has anyone else experienced the rudeness that comes along with the holiday season this year? please share!

Mirza and I were sitting around watching Jay Leno when to our surprise we learned that Bill Maher would be on. We both cheered like it was Christmas because he rocks. AND THEN, as they announced him, they said he would be performing December 3rd at the Tampa Bay Performing Arts center!! aaaah, if I didn’t jump out of my seat fast enough and grab my purse to buy tickets online, omg!

We’re soooo excited!! He’ll be here on Thursdays, which works out great because I need to stay up extra late, so I can sleep during Friday to get ready for my first night shift.

Any Bill Maher fans out there? Any Religulous fans who read this blog? C’mon!

Yesterday was a very good last day with my preceptor on days.

I’m super sad about going to nights. I’m not going to lie. I am most worried about when I will eat, exercise, and see Mirza.

We had some down-time (amazingly) and decorated the unit for the holidays. My preceptor and I put up the tree, and then I helped decorate it with another nurse while my preceptor wrapped empty boxes, like dignacare’s, to put under the tree:

We took these with her iPhone. Awesome!

Today was so fun because we went to Busch Gardens and had a great day!

And then, the day was pretty much ruined because of the disgusting selfishness of miserable American assholes.

I’m waiting my turn to get gas. I was not directly behind the guy because I think it is rude to do that and rush people, so I was directly behind him, but with my blinker one. I was close enough to where it was definitely obvious about my intentions to get gas. I waited 10 minutes and then this suv pulls up directly next to me and takes my spot. I saw her look over at me, and then look the other way. I pulled closer to her and said, “Excuse me, I’ve been waiting…” She said, TOO BAD!! why aren’t you in line!?!

I said, I’ve had my blinker on, I’ve been waiting!
She rolls her eyes and just looks ahead. I said, ‘Really?! you’re going to be like that…it’s a fucking holiday…wow, you’re a fucking bitch..” Then Mirza said, “yeah that’s the American way, right? Just take whatever you want!” And she says, “I just call it like it is!!” This whole time I am calling her a bitch and miserable person and disgusting. Mirza tells her that he hopes god and jesus save her soul (we’re atheist).

Then the guy leaves and she goes to take the spot and I pull up to block her (I’m crazy). I came within inches of hitting her. The whole time I am like NO!!! Then she pulls ahead of me because someone else left ahead of us.

@#$%#$%#$^@#$%^$%^ I’m so disgusted!! Why wouldn’t she just say, “oh i’m sorry, I didn’t realize it” and let me in. obviously i was waiting, she saw, and did not care.
When I drove away, she was getting gas, and I pulled up to her and told her, “you should be disgusted with yourself. I hope you never get sick and have to come to the ICU, YOU STUPID BITCH!!” I know, totally cheesy, but it was just how I felt. She laughed like the wicked witch as we drove away and flicked me off.

When we drove down the street, I was so angry that it literally made me cry. Is this how humans treat one another?! I think it is this society. It makes me want to not go out at all and just lock myself away. I’m disturbed and TRULY SICKENED!!!

I also want to add that this was not a young girl. This was a woman in her 50’s!!

To not have an entire negative post, here is my Max:

I started my morning at around 7 with a piece of peanut butter toast and yogurt.

A few hours, later, I made a smoothie with banana, ice, and Amazing Grass mango infusion.

And then I went for a nice half hour walk at Lake Seminole park!
I’m spending the holidays with Mirza’s family. I’m not eating anything until the feast!!

Let the coma begin…

I feel so good today! I don’t know what it is, but I hope this feeling lasts into the week:)

I woke up and organized/cleaned, which always makes me feel..cleansed? I decided yesterday that today I want to make a tomato sauce! I’ve been craving a nice, homemade sauce for awhile now, but I rarely make one since I know it could never compare to my mom’s!! She told me over the phone what she does, so I am going to mimic it the best I can. I’m also adding ground turkey breast to mine. She usually does the whole ground beef and italian sausage deal with amazing meatballs *drool* and she cooks it ALL. DAY. Growing up, I have found memories of the weekends when her sauces would start early in the morning and simmer all day long. The smell would permeate throughout the whole house. We’d always have good bread, too. I miss those days.

As much as I want to follow a vegetarian diet, I find that I don’t feel well when I do. I just feel better at times when I have animal products. Truthfully, this makes me feel guilty and sad, but I just do not like feeling like crap! Honestly, I’m all about listening to what my body needs. Sometimes it wants all fruits, veggies, and grains and rebels against any sort of animals, even dairy! And then there are times when I know I just need it.
Does anyone else feel this way? I feel guilty, I guess, since I read a lot of blogs related to vegetarianism and veganism, but everyone is different, right?

Lately, I’ve been on the search for a good, daily moisturizer. I was using Alba organics prior, but it is gone and I’m ready for something new. I use Yes To Carrots cream at night and I like that, so I thought I’d give it a try. I found a Yes to Cucumnbers facial kit on sale at Target. It includes a headband (haha), a facial cleansing gel, a facial hydrating lotion, and soothing eye gel.

After a bunch of errands this afternoon, I came home, put away all the food, and made a delicious lunch consisting of: whole wheat pita with hummus, baked until hot and then topped with organic spinach, fresh basil from my porch (love!!), organic tomato slices, and (the best) kalamata olives. I love making these little pizzas! On the side, I had a fruit salad from Publix.
I’m ready to start cooking my sauce!

Max says, “hi!”

Totally random, but does anyone else get extreme joy out of purchasing stupid things, like hand soap, sponges, etc? I don’t know, I’m a freak!

Thanks to those who tried to guess what caused the patient to code!

We’ll get to the answer in a bit.

So, yesterday there was still no response at all. At noon, we began to rewarm him/her. Our rewarming target is 37 C. We are rewarming him/her over 12 hours, so around midnight, he/she should have reached it. It is a slow process because rewarming can be dangerous, as well. We do it at like .35 C per hour.

Some of the side effects we tend to look for:
 -Of course shivering (just like when cooling), which he/she was on fentanyl and propofol for. He/She never did show any signs of shivering, goosebumps, etc so we did not have to use any drugs to paralyze him/her.

-Also, rewarming can cause vasodilation and subsequently hypotension and even shock.

– Obviously, we’re also watching his/her electrolytes, like potassium (K+) because it could increase (hyperkalemia) due to the shift of K into the extracellular compartments. For non medical people, we like to keep K+ tight control due to cardiac arrhythmias, etc.

-Seizures.

Unfortunately,  our patient has probably a <1% chance of recovery. He/She did not receive adequate blood flow (oxygen) to the brain for almost 2 hours (the duration of the code), and based on the neurological exam by us and the doctors, his/her prognosis is poor, to say the least.

The worst part, perhaps, is his/her family. Most of them live in another state, but he/she has a son who lives here. He is probably in his 20’s and apparently, he just got out of jail (for drugs) and according to a cousin, has another warrant out for his arrest. That isn’t the worst part. The worst part is that he has a young child, probably 4-5 years old. And the patient was the one who had custody of the child.  Now social services is on the case to try to find eventual placement for the child since the father will more than likely be back in jail. I hope the kid doesn’t have to go to a foster home because that would be so incredibly sad.

The son is quite uneducated and has no knowledge of medical stuff. The situation is confusing as it is, but when you have a basic intellect to begin with, it makes it almost impossible to explain the situation. The first day, he definitely was not grasping the severity of the situation. How could he? The patient went in for a routine thyroidectomy! At one point, another family member called and asked when she could come pick up the patient! At this point, we told the son that he needed to call family and inform them of the situation. We kept telling him that the patient is sick, he/she more than likely will not survive. But he still kept saying, “But he/she will wake up, right?”
um, NO!! Believe me, we were explaining everything in the most basic form that we could!
Eventually, he did get it and broke down, throwing himself on the floor sobbing.

So, what caused his/her code and probably death?


Some mentioned the Vasotec and they would be RIGHT! If you remember from nursing school (or medical, whatever), one of the adverse effects of Ace inhibitors is severe angioedema. In other words, severe swelling.  While in the PACU, he/she received the vasotec as a prn med due to some hypertension, which he/she has normally. It is a pretty popular and standard medication. Once he/she arrived to the floor, however, that is when the swelling began. And because everything was so swollen, they could not get the tube down his/her throat for intubation once in the unit (ie–get him/her on the breathing machine). And at this point, no one even suspected it was a drug reaction. Their initial thought was that it had to be bleeding/hematoma into the surgical site since he/she had his/her thyroid removed and that is in the neck area!

Why wouldn’t they think that, right? Of course, when they reopened the surgical incisions at the bedside, everything looked good!

It is quite sad and tragic. There is no way anyone would have known he/she would react to the vasotec in that manner.  Ace inhibitors is now listed as one of his/her allergies, but it will not really matter at this point, since he/she is not going to survive.

Hopefully his/her kidneys or corneas will be used to help save someone else’s life.

Boy, was today a long day! But it really flew by.

Here is the low-down: Pt in their 50’s in for thyroidectomy. Sx goes fine, pt transfers to medical floor. At one point, the patient receives prn (as needed) vasotec (ace inhibitor for blood pressure) for their BP to keep it nice and normal for the incision site. Pt is only on the floor for about an hour, I believe. Pt begins to have shortness of breath, they almost call a rapid response, but then he/she codes (PEA) and he/she arrives to the unit shortly before 1 am.
They proceed to code him/her for almost 2 hours. Surgery and anesthesia are at the bedside. They have a terrible time getting him/her intubated because of a lot of swelling at the incision site (neck). They reopen the incision site and find no hematoma or bleeding. At this point, the patient has received a crap-load of epi, vasopressin, and a bunch of other meds. He/She has also been shocked a few times. Eventually, he/she is intubated and on the vent. FiOs at 100%.

Fast forward to 6am when my shift begins.
He/She is on the following drips: levophed, amiodarone, epinephrine, LR.

During my assessment, the patient’s pupils are fixed and dilated, size about 6.

I could not elicit any sort of response from the patient: pupils unreactive to light, unreactive to corneal stimulation (ie–take cotton ball and touch eye ball), no response to pain what-so-ever.
For whatever reasons, the MD’s do not want a CT scan. Vital signs are labile. BP will be 135 systolic one minute and literally shoot up to 180/100 with HR in 70’s, and then minutes later, she/he is 95/60 with HR 58.
Intensivist decides around 8 that he wants to do Arctic Sun:

Basically, we cool the patient down to 33 C (make him/her super-duper cold) for 24 hours with the hope that the hypothermia will reduce some of the ischemic (lack of oxygen) injury to the brain and hopefully preserve some sort of function and then rewarm her 24 hours after we reach the set point temperature and then see how he/she does. It is pretty damn cool, you know, when it works. Apparently, it can reduce mortality from 35-39%. It has to be started within 6 hours after the patient arrests, and we were pretty much right on the 6 hour mark, with the hopes of cooling her to the set point within 2 hours.

(here is an article on Arctic Sun http://www.uihealthcare.com/news/pacemaker/2008/spring/articsun.html)

This automatically made the patient a 1:1 assignment, which means the nurse can only have this one patient and no other. Luckily, we only had an open room at this time, so we did not have to pawn any patients off to any other nurses.
We reached our set point at noon. At this point, the patient is now on: amiodarone, levophed, insulin, epinephrine, fentanyl (to prevent shivering since that will increase her oxygen demand), insulin, and propofol (aka–the med that Michael Jackson was taking. I know most people are familiar with this drug now because of that, but it is routinely given for sedation while in the ICU and on the ventilator).

We do not expect him/her to survive. We contacted LifeLink (organ transplant people) early in the AM and they are now following the patient.

Can any of the medical people guess what caused him/her to code?

Update tomorrow. This is a drama-filled patient.

As a side note, November is Lung Cancer Awareness Month!
For the month of November, I’ve been wearing my white ribbon:

And also a blue ribbon that was handed out to me today to show that I am a non-smoker! They also had cute keychains that said, “Don’t choke me with your second hand smoke.”

Lung cancer is no joke.

Statistics on lung cancer:
-Most common cause of cancer death
-Second most commonly diagnosed cancer in men and women.
“In 2008, more than 215,000 new cases were expected to be diagnosed and about 162,000 Americans were expected to die from lung cancer.”

Vist here for more information.

Just to let everyone know, I have purchased my own domain and the link to this site should be working in a few days. The new link is:

http://www.raspberrystethoscope.com

(note: the old link will re-direct you automatically, but just a heads-up)

I’ve been terrible about blogging. Lately, I haven’t been feeling well, mostly just feeling like I look like crap and I not enjoying life, that kind of thing! I just feel like I need a new style. Maybe once I get some extra money, I will go out shopping. All I ever wear is jeans (practically the same ones I have had for 5 years), plain solid shirts/tanks, and flip flops. I am 24, but I look like I am 16-17 at times! But I also feel like I have no sense of style, that even when I do try to go out shopping, it is too overwhelming and I just give up and keep purchasing the same crap over and over!

I also saw that I have gained 5lbs! I know it is only a number, and I honestly wonder where this 5 lbs is because I think my stomach is still pretty flat and muscular, so I am going to pretend I gained 5 lbs of muscle, but I doubt it. I think I need to join this whole Back on track month. Not for weight or anything, but just for general eating habits, exercise, and mental health. Honestly though, I am just hard on myself. I eat healthier than anyone I know in real life!

Luckily, I had two good days at work, so I hope it took me out of my funk. Only the next 3 days off will tell…

Last week I established a new primary. I am not sick and will probably not need to see her until another check-up, but I like to know there is a doctor (close-by) that I can go to if I DO get sick. I also had my teeth cleaned and my eyes checked. I am quite regular with my every 6 months teeth cleaning. We never really went to the dentist growing up, so now that I have dental insurance, I take full advantage of it! Also, I never had my eyes checked before and since I pay for it every month, I figured why not? And my eyes are in good condition, so there you go.
Today I am going to a dermatologist for a general exam and a few questions, too.

I have about 2 more weeks on days with my awesome preceptor and then I am being shipped to nights. My preceptor is incredibly amazing at what she does. She’s been a nurse for 18 years and I think 16 or 17 were spent in this same unit. Let’s just say she knows what she is doing and you can honestly see that she cares about her patients. She is continually telling patients (or families, since patients usually are not aware) that they are her boss. And you totally believe her too. And she is not afraid to tell you if you’re missing something or what you need to know, but she also praises. I love her! I know I am getting the best training for ICU with her because she does not miss a beat.

Let’s recap:
Saturday:: Let’s just say, I did NOT want to go to work. It was Saturday! argh! However, the day did turn out well. But, it was insanely busy. On the other side of the unit, there was a new transfer from the floor and I remember Rose* saying, “Room 2 will code today,” and I thought, alrighty then. I was doing well with my two patients, developing a routine, or trying anyway, when Rose comes into the room and says, “Stop what you’re doing,” and I’m thinking to myself, “oh shit, what did I do wrong?” and then she calmly says, “Dr. SoandSo is going to put a central line in room 2 and I want you to assist. I will take over your assignment while you’re gone, don’t panic!” haha. I seriously thought I did something wrong by the way she walked into the room. I went to room 2 and “helped,” and I say it lightly because my preceptor gathered all of the supplies (with me following) and then told me what to do. This man was SICK. Total liver failure. He had no pressure and I think I saw some fluids going in at 1,000ml/hr. I noticed this only because the pump was making so much noise! He put the line in and I helped the primary nurse clean up and then I went on my merry way back to my patients.

About 10 minutes later, “Code Blue, ICU, Code Blue ICU,” and we knew it was room 2. We ran to the other side and sure enough, everyone was already at the bedside setting up and doing compressions. PEA. The other nurses decided I should do the recording, score! I recorded while another nurse pulled meds and calmly explained how to fill out the form. This code was effortless. Everyone worked together as a team, there was not one ounce of panic or even real urgency. The nurses in this unit are pros. After about 3 amps of epi, 40 of vasopresson, some bicarb, and d50 we got a pulse with the doppler! Amazing, we “brought him back.” But truthfully, this was guy was not “back.” He would die, and we knew it.

I left the room and 10 minutes later, again, “Code Blue, ICU!” I went back and started a new sheet to record. However, this effort would obviously be futile. We coded him for about 7 minutes and then his sister wanted to come in and when she saw the horrendous scene (seeing your loved one being worked on so vigorously is not pretty) she immediately cried and told us to stop. We had planned to stop anyway since his heart was not responding, but I thought it was good for the family to see that YES, we were trying everything we could and there were many people helping.
And so, he died. I helped clean him up…had blood coming from his nose and I closed his yellow jaundiced eyes, so he would look somewhat presentable for the family to see him one last time.
Update on my other patients in a bit!

*name changed

I wanted to mention that “my” unit won the Beacon Award!

So, I got busy and lazy (all at once?) and never posted part 2 of my CSA Week 1! Did everyone enjoy seeing the awesome farm? I love just thinking about going there next week for my second batch. I have a half-share, so I only go every other week, which is perfect since it is just me (and Mirza when he eats dinner here, which is a lot).

What was in this week’s share? As mentioned in the previous posts, the farmers said this first harvest may be more of a “tasting” because of flooding, but there were still lot of greens to be had!

Pamela, the “farmer’s wife” gave us a print out that listed what we received (if anyone wants a more specific name of each veggie, just comment):

Turnip

Radish- Easter egg and D’Avignon (haven’t tried them yet, kind of scared of radishes, need recipe ideas!)

Choi-Joi Choi, Tatsoi, Komatsuna (totally new to me..)

Greens: Arugula, Red Mustard (holy spicy!)

Eggplant- Orient Express

Herbs-Greek oregano, rosemary, garlic chives, basil (still in the pot for this one)

I got everyone (like they’re human) home and prepared for STORAGE!

Before I left, I printed out this guide for vegetable storage and placed the pages in plastic protection and into a binder:

I know, I’m totally a geek, but it came in handy for figuring out how to best store everything.

Some photos of the loot:

The herbs smelt aaaamazing, hence the goofy face:

I really loved the eggplant, he was so cute.

Yep, I need help.

Next post on how the heck I am using all of these delicious plants!!

Around noon yesterday, I made my way over to the farm to pick up my share…

This is the driveway/walk to the farm. Along the fence are the cutest little wooden plaques painted with different sayings, etc. I wish I would have took a picture. Next time.

We could pick up our shares from 12-4pm. And since I arrived pretty much at 12, there were not that many people. I met the farmer’s wife, Pamela, and she was very welcoming. She had us sign in and then gave us a paper with the list of vegetables we’d receive that day. I found this extremely helpful because it has the name of the veggie and an explanation of how it looks, how it tastes, and how it grows, etc. They kept kind of apologizing for the harvest this week, how it will be much more in the future (there were floodings, see previous post), but to me, it was just the perfect amount! No complaints from me, I was excited.

After I packed all of my veggies into the bag, I went for a walk and wandered around, snapping a few photos:

I also took a video on my way back. It is a bit shaky and you might not be able to hear me, but…

More pictures:

Stay tuned later for more pictures of the awesome vegetables and what I received!!!!