bits and pieces

my first 24...
which is to say, my first 24 hour shift at work. yes. 24 consecutive hours at work, taking care of patients. i know, i know, all you non-medical people are thinking (with a great big HARUMPH) that this is negligence, stupid and downright dangerous. perhaps even a few of you primary care folks are thinking it's a little crazy. well, it may be, but if it works for me, this may ultimately mean that i work 2 days a week instead of my current 3. Imagine it, 2 days a week of work and full pay. What would you do to work 2 days a week???? probably 24 hours.

I had to get up insanely early to get to work this morning, so i've been up for 21 hours already. My day shift was pretty decent, 8 patients, no emergencies, plenty of work, but status quo really. Highlights from my day:

• The 83 year old lady who insists that she 'sneezed' her NG tube out. Yes, 16 cm of naso gastric tube, taped to her nose. she cannot walk, cannot get up herself or barely lift her own head, but wanted me to believe she sneezed so fiercly that it blew her tube out. 3 times. UH-huh. I loved that one. Mind you I have a heart, I didn't put it back in. we'll figure out another way to feed her.
• the woman who went into cardiac arrest, only to suddenly sit up, tell is she felt much better now and no, she didn't need anything for pain. really. Oh and could i adjust her donut so it's right under her? she gets terrible sores if it's not positioned just right.
• colleague (and i use that term loosely) who during a break announced that some people should just die, i mean, it's like darwin said, natural selection. all jaws dropped...except hers of course. i still can't figure out how she escaped darwins well explained observation.
  

I thought it was all a stupid idea, the other 12 hours when 7 pm rolled around
and i wanted to lie down. yes, lie down and never get up. i thought 'maybe this IS dumb. maybe no one should work more than 12 hours at a time." Then i had a burrito and an orange and was a new woman. sadly, my recent GI distress had not entirely resolved and i had to sequester myself in the bathroom and corners to save my co-workers from myself. Good thing the hospital is such a stinky place and most things can be blamed on patients.

No sooner did i finish eating than an admission was on her way up, another patient was threatening to die and a third needed a central line that a critical care fellow was pleased as punch to do when i had a minute. yeah. i got a minute. ready, set, GO. I kept trying to write the orders for my new lady, while the RN let me know that the minute the other ladies family left, so did she, literally and permanently. I did the usual EKG, check vitals and pronounce her dead then paperwork, paperwork. The critical care fellow was pestering me and I loved the small talk he made while jabbing this lady on a hunting expedition for her femoral vein chatting about how low her platelet count was (the little buggers that allow us to clot and STOP bleeding, which he was making her do). After explaining the procedure to her (since he never bothered) and talking her through it (despite getting looks from him) I nearly grabbed the huge needle and stabbed him with it. When I finally got to the lol (little old lady) who was my new admission, she patted me on the hand and said she was in no rush, like the kindly grandmother she surely was.

It's 1:10 am now and I need a GD nap. I am now silently but very purposefully making a mental deal with my patients. I'll let them sleep, if they'll let me sleep. We'll see.

4:24 am

i was dreaming of my bed; my big, comfy, waiting to swallow me up bed. i dreamt i was out in a field somewhere lying down. i was so tired, and the ground was hard, but i didn]t care because of how tired i was. every time i rolled to one side my pistols dug into my hips. i kept readjusting them, knowing i couldn't take them off, knowing i might need them any second. i felt far from home and wondered if the sun was going to come up soon. it seemed oddly warm for winter, but i didn't care, because if i couldn't be in my bed, i could at least be warm.
"How many?" i heard her say, "two, oh, one and two more coming"
I reached for my pistol and it was vibrating. Odd, i thought, until i opened my eyes, not to see the dawning sky, but the call room cieling and my pager going off. We had another admission and I had to get up. The luminous face on my watch read 4:20. Ah well, at least i got a small nap, and would soon be in the bed i was dreaming of.

off to see the wizard...