Short Ramblings

I am tired of being sick. I hate taking antibiotics. 2mg of Ativan will knock me out for most of the day and leave me feeling like I have a hangover. Who knew they made little green drains to drain infections from the jaw - I sure didn't until I got one myself (another thing not on my life "to do" list but can now cross it off anyway). I hate that I'm missing my rotation because I was deemed too sick to be there, which is true, I need to get all better not just better enough to be somewhere. As soon as I am better I am going to eat all the good foods I can't enjoy right now. I already know what I am getting (or got in some instance) for my birthday: a green drain removed from my jaw and almost $600 dollars worth of sedation (versed and romazicon). Wow, what a way to celebrate.

Pull...click

There is something incredibly gratifying about stapling someone's head shut, but the perfectionist in me has a little trouble when the staples aren't perfectly spaced or one is slightly higher than the next. I could probably do and re-do head staples until I ran out of staple and still not be satisfied with my work. I like the noise it makes too, like a spring loaded toy gun, although I can't say I would personally like to have my head stapled.

4 more days and I go to days, it's a bittersweet feeling.

Other items on my mind - I haven't heard back from the county clerk about my absentee ballot for the general election, that's starting to make me nervous. My grandma sent the dogs Halloween costumes...Wrigley is so big she can barely fit her arms through both holes at once (they just don't make princess costumes in XXL - if you watch Desperate Housewives this might ring a bell or fat guy in a little coat from Tommy Boy) and Cubby's Pirate outfit, well, it doesn't help his masculinity any, but thank you anyway grandma it was a sweet idea and I'm sure I can fiddle with them to make them work. Also, Avelox (moxifloxacin is uber expensive ( over $200 for my 21 day supply), yes I'm still on antibiotics for this stupid sinus/nose thing and prednisone now. Thank goodness for great insurance and an incredibly low copay.

I love October.

It may be October, but you don't want to look like Frankenstein

I did some facial suturing by me onesy the other night - it took me forever to do it up just right, I wanted to make sure I would leave too unsightly of a scar - but inevitably it didn't look as good as what the facial pro's could have done, but I sure did try my best. The patient had patience for me, which I attribute to the fact his blood alcohol was just under 400. He was adamant that he only needed 3 stitches, but he really needed about 6 times that many total. I hope he doesn't turn out to have a Frankenstein scar...yikes.

I decided to take on a craft project for our niece and nephew for Halloween. Wish I would have thought of it sooner. I'm not big on toys and candy and nick-knacky things so I decided to make them some cute Halloween themed sweatshirts. I only hope I got big enough shirts for them to grow into a bit and that I finish them to send this week - otherwise what a waste. I ran into a few road blocks today trying to find the necessary materials, but at 3am this morning a new idea came to mind, hence I am up sketching and thinking and just waiting to go to Wal-Mart around 7am or so (believe it or not too many crazies at there before 7am. Normally I would be pissed at this uninvited brain activity and inability to sleep at 4 in the morning, but it helps keep me on my sleep-wake cycle for one more week. I am going to miss the night shift and my 3am scrambie eggs and bacon but it's a worthwhile trade off for more time with Shawn.

Team Compassion

There is a joke amongst some of the RNs in the facility I am working that jokingly call themselves Team Compassion - they even write on a pieces of tape Team Compassion and tape it to the front of their scrubs. What this Team really means is "we don't go the extra mile for our patient if their drunk or high or smelly or anything of the like and we whine and complain about the patient's being needy or whiny right after a traumatic injury." I never want to become this jaded or cold, even as a medic and now as a PA student, I treat all my patients with kindness and respect. The uncooperative drunk/meth head last night - you can still be kind and use a stern voice, and I sure don't grab an arm with force and yell at them or walk out of the room and say stupid b---- and go on and on how I hate those kind of patients. I'm sorry people that's your job, to help the sick and injured. I treated the prisoners/inmates with the same kindness and respect I treated every other patient in the free world - even though I know they have drug problems, or have murdered, my job is not to be judgemental but to provide the best healthcare I can regardless of the case. This can be very tough to do, and I admit I'm no perfect Patsy at this, there are occasions when I may get frazzled behind closed doors, but never do I treat the patient poorly. The Team Compassion has made me work even harder to go that little extra mile for patients, just to avoid becoming a member of this expansive team (I dislike them so much I didn't even tell them they spelled the Spanish word for boss - jefe - wrong on one of their stickers - it's not hefe morons). These people have also made me realize that I could never work at the facility I am rotating at, many of the RNs treat me like crap and I know that won't change even after the S is a C after the PA, they treat some of their patients like crap and so far as a student I have only done 2 things that I didn't do as a medic: suturing and pulling back a chest tube (oh and the paper clip fingernail too I suppose). Even when I jump in to do the trauma assessment, no one bothers to listen to me or write down what I say even though when someone else does it, it's exactly the same. I get it - I'm a student (or when they ask and I say a PA student they reply: oh a nobody.) One more rant then on to the positives, the anesthesiologists was helping the trauma doc practice his intubations last night with all the patients who needed to be intubated either from trauma or de-satting. Afterwards the trauma doc looked at me and said, that curved blade can really be challenging and I said yes, I'm a Miller (straight blade) kind of person myself, even though it has a higher potential to cause trauma to the airway and cause patients to vagal. He looked at me puzzled - you act like you have actually intubated before. I reply - well I have. Him: I don't mean on manikins, this is much different and more difficult - you would know that if you had actually done it. Me: well I had a couple field tubes when I was a paramedic and intubated in the OR too, and I found I can visualize much better with the miller. I left it at that and walked away.

POSITIVES: learning lots from the OMFS - the people who sew pretty on the face, I have even learned a couple of "plastics" moves suturing. I got to back a chest tube out 6cm the other day and then re-padded it, that was cool and I have rounded at 1130 at night on a couple patients I was with when they arrived via EMS.

Should've been a Boy Scout

So the other night I did a procedure I didn't learn about in school, but I may have learned about it had I been a Boy Scout (and hence a boy). The pt has a myriad of things gone wrong without getting into all the jazz and does NOT heal very well. Somehow, he hurt his pinky while at the hospital, on bed rest - it's swollen, the nail looks like it wants to fall off, it's purple at the tip and the skin is missing basically from the PIP to the DIP (between the knuckles). Some less than stellar provider during the day suffocated it with a tagaderm. I think he might benefit from having the nail drained to relieve some of the pressure, sounds easy enough - get a cautery tip and poke a hole in the nail, allow to drain. Well, at least that would be the case if a cautery tip were available but apparently to get them from surgery at 1am for something like this is frowned upon, so the PA says oh that's ok, can we get a paper clip and a lighter? Oh duh, why didn't I think of that? - Why? Because that seems a little insane to me. As I am standing next to the patient's bedside, holding the end of the paper clip into the flame watching it get red hot I feel like I should be on some outdoorsy trip doing this, not in a hospital - but oh well. It worked great, but the blood was too dry under the nail for any to drain. I had a difficult time writing a procedure note for this one: Distal end of paper clip heated by lighter until red hot to be used like a cautery tip (or something like that). I almost felt compelled to draw a picture, but thought the description was adequate enough. Turns out this procedure can be found under the heading Subungal hematoma drainage in the Procedures for Primary care book - good to know. Now how do I log that in Typhon?

Reminds me of the old days

Some nights are busy, and others you are just waiting for someone else to have a bad day for you to have a good one. I've had both those days lately. I am also reminded of how nurses (there are some good ones out there, so forgive this next bit), think they are the gift for healthcare and know way more than everyone else- which may be true in some areas, but when it comes to diganosing and making differentials they just don't cut it. Case in point - if the PA asks to be called if a drug isn't working in 15min, they should be called - not hear a "rapid response page overhead" which brings in the calvary (as if for a code or eminent emergency) an hour later, even though after the initial 15min it was evident the drug was not working - didn't feel like calling. I did everything not to laugh while the nursing supervisor as she repeatedly asked who the resident was as the PA repeatedly told her "I'm all you've got or you're looking at him or a simple finger point back to themselves and the PA's neck veins were so large at this point I could have darted it from across the room with an eye closed. Oh and I'm sorry but the classic line of "I'm the supervisor I can do what ever I want when I want" is such BS - if that were true then why have providers see the patient at all - her only concern was about how much nursing time had been spent I didn't hear one damn word about patient care in any of her rants - which was pointed out several times by the PA. Additionally, if a nurse is spending too much time with a patient or the patient's problems are ongoing and unchanging - 1. the nurse should actually know something about that patient(injuries, surgeries, NPO status), 2. someone should have been informed of the non changing status sooner. I guess some things never change.
I'm delirious I think and should try and rest the eyes for another 4 or 5 hours.

The heartbreak begins

The Chicago Cubs - that's our team - our only team. Last night's performance was typical Cubs fashion in the post season. we had high hopes for them this year (like every year)- like World Series hopes. I',m bummed I will miss the game because of my rotation - after last night I feel the post season is more important than my rotation. Tonight may the Cubs' bats be swift, gloves solid and balls plentiful.

Last night was ridiculously peaceful (I learned quick as a medic that you just don't say the Q word). i really didn't get to do much, and to be perfectly honest I am really tired of being rectal girl. Whenever I ask questions someone does whatever it is for me - which is really annoying. For example, for a non ICU trauma admit (stable old compression fx - old lady fell in shower on cruise ship) what are some of the guidelines you follow for admission orders? Instead of explaining this the paper is taken from me and completed for me, as if I couldn't put pen to paper myself. I am also already annoyed with the phrase "I will call you if I need you" which basically means find something for myself to do until whenever. I have not had the motivation to study during this down time - I even closed my lazy eyes last night fro an hour or two since I had to stay late for trauma conference where one of the trauma surgeons actually asked what JNC7 was - typical surgeon - out of touch with the root of medicine. I did get to do a couple sutures on one trauma's chin - only problem, he was very sleepy and kept moving his head and arm that was also being stitched, but in the end with two stitches his chin was closed, you couldn't even tell he'd been cut (thanks to dark skin and dark facial hair). Who knows what tonight will bring. I am hoping another PA is on tonight.

I'm bummed about this rotation in reality so let me vent about that for a bit. I loved my job as a paramedic - there's something about the adrenaline rush that was invigorating. I took pride in my squad - keeping it pristinely clean and well stocked and did the same when working in the ER - I was also polite and tried to be helpful and gracious to everyone. Yesterday when I am looking in a patient's ear, I realize the otoscope is caked in dried blood from who knows when, as is the holder and surrounding tubing - UMMMM EWWWW GROSS!! This isn't the first time I've seen this either. I never seem to be in the right place when a patient needs to be moved - I'm told to always go for the feet (I think because I look small and petite) but then scolded by the nurses that I don't do anything to help them roll patients and am only in the way. Then there are the hours - I'm not a resident, in fact I'm not even in med school so these hours are somewhat representative of why I didn't go that route - I've hardly seen my husband (in passing as I come and he leaves) which may be fine for some, but I know I will be gone after this rotation until next April so I really want to suck in every moment I can with him. Lately I feel like my time is being wasted in this rotation, it's feeling an awful lot like the first rotation which I loved oh so much (please catch the sarcasm), plus there is little direction, only direction in what I've done wrong - I thrive on a little praise. Like the stitches I put in last night - no word of goodness, but everyone praised the resident for his 3 in the elbow. I know days will have some more structure, but I'll miss all the trauma calls and I hate in patient stuff - it gets boring to me, but keeping an open mind maybe this will be different.

GO CUBS GO!