Holy F!

an update, if you care

I've decided to use this as sort of the actual blog...cause it's cooler than myspace...I guess.

So I kind of love Sara Ramirez singing on the Spamalot soundtrack...fyi.

I am down to three weeks to go for my internship and I have days when I am totally sure that I'll be okay when I'm on my own. Days like Wednesday and Thursday, when I have my patients who are sick and have problems, but are more or less stable.

I also have days like yesterday when I am given what was a resonable assignment at 0600, but by 0715 when one patient has coded twice in the last hour and I subsequently spend the next 12 hours of the day exclusively in that room save for using the bathroom and the half hour or so when I am uncerimoniously escorted out of the room for lunch at 1630 (in defense of my preceptor, I was offered to go to lunch much earlier but the offer was something like "you can go to lunch now, I've got it, but they're going to float the Swan-Ganz catheter in now, so you can go eat, or help with the Swan...it's up to you"...I picked the Swan placement.) ...those are the days when I have this little mantra in my head that I repeat over and over that goes something along these lines "they WON'T let me kill someone...they WON'T let me kill someone...they WON'T let me kill someone..."

I've had more good days than bad, for sure...but it seems like I get one of THOSE days every week...a day when I end up spending the whole day in one room with a majorly critical patient wondering "why on earth did they give this patient to ME????? Do the other orientees get self inflicted, donor GSW's also? Do they also get the patient who spontaneously ruptures their spleen????...F" (as far as the spleen goes...the team leaders didn't know at the time of making assignments that that would happen...the guy next door had a Swan they wanted me to see; too bad I never made it into his room at all...whoops.)

I keep telling myself that I really won't have those patients from the start if they can at all help it. But then I think "well, I'm going to have to get those patients eventually...when will I know if I can do it if I don't get the patients..." I mean, this isn't like most entry level right out of college jobs...I'm not making budget reports or faxing memos (although I do fax orders) or just making presentations...these are critically ill patients. Some of them have died on me (two!!!) and a lot of them have certainly had the potential. It's not like the learning curve is dealing with paper work or presentations, and it's not like the learning curve contains difficult INFORMATION...I'm picking stuff up and trying to read as much as I can and listening to what the docs are saying...it's just that my learning curve is in the middle of life and death situations and once it's my patient...I'm sort of in charge of what goes on in my rooms...which is a little scary. I can tell the docs "no, not gonna do that..." and then I have to give them a reason and then sometimes they listen to me! I think I've had a healthy respect and fear for the situations I'm putting myself into right out of school; I knew this was going to be hard and I knew the learning curve would be steep and I knew this would be a big mental and emotional challenge, but I think that the closer I get to being on my own, the more I'm REALLY REALLY getting it. I'm the last line of defense for some of these patients. It's sort of scary.

I was the one in the room yesterday while the docs put in chest tubes...ME. They asked ME for things and I assisted with the procedure...it was very cool and very surreal. I wonder when that gets less weird. I had to stop myself from doing a dance after the attending said "Thanks Nicole" and then gave me orders for labs...it was all very grown up.

Last week we got a really nice kid in and his family was great...scared but great. Mom poked her head out while I was in the other room and told my preceptor "well, I was looking for Nicole since she's his actual nurse..." Whoa!!!!!!!! When we were transferring him to the floor (yay!!!! he was VERY bueno) she told me "I'm glad we're getting out of here...We love you, but I'm glad he's getting out of ICU". My ego just loves getting stroked like that!

Oh, and I really didn't realize this...when an adolescent gets in a traumatic accident...Cook Children's doesn't take them. Apparently the rule is that if they have facial and/or pubic hair then they come to my hospital. I think that is kind of suprising. I would think that Childrens would mean "anyone who sees a pediatrician ie, anyone under 18". Guess not! Hmmm, maybe we should also get donations from people wanting to help Children since we get patients from puberty up. Greedy girl. I also didn't really realize how fast our ER is. When they say "we stabilize and transfer", they REALLY mean it. A few of the trauma's I've gotten, I think their door to ICU time is less than 20 minutes. Quick assessment in the ER, CT and up stairs...When you get report, you best be ready cause they aren't kidding with they say "I'll see you in a few minutes" cause CT takes about 5 minutes when you don't have those stupid IV poles to worry about!

I'm on days this last week and then next week I switch to night shift...I'm pretty excited about the money! Like I said...Greedy girl.

I looked at some houses last weekend...two are very real possibilities. I'm going to look back at one hopefully sometime this week. I'm kind of hoping to find something and close sometime in December...taxes and all! Plus, I'm ready for it. I'm ready to finally be a real adult and pay my own way (now that I have a good job where I can actually afford it!) and do grownup things like paint (!!) and buy chair railing, which I hope is cheap.

I saw my neice last night. She is still freakin' adorable. I didn't get any new pictures though. I suck. We did however discuss football and how to put in chest tubes and the importance of deflating the balloon when floating a Swan and what wedge pressures REALLY mean to her.