Dr. Dickhead

Background info:

morbidly obese patient admitted with DKA secondary to major cellulitis infection, consult with pulmonologist

Dr. Dickhead: So, I'm here to see you regarding your sleep apnea. Your sleep apnea would improve if you lost weight.

My Patient: Yes, I know. I've had a rapid weight gain of about 150lbs in the last year or so.

Dr. Dickhead:  I see that you have been noncompliant with your diabetes, otherwise you wouldn't be here. (patient's Hemoglobin A1C was on the low normal side)

My Patient: I check my blood sugar a minimum of four times a day. It wasn't until the past week that I couldn't get the levels under control.

Dr. Dickhead: What do you do for a living?

My Patient: Well, I have a Ph.D. and used to be a counselor. Now, I'm a pastor.

Dr. Dickhead: *saracastic tone of voice*   Did you used to counsel people on weight loss?

My Patient: Why yes I did.

Me: *picking jaw up off the floor while shooting the "doctor" daggers with my eyeballs*

You know you're tired when...

leaving work after a 12 hour shift, you attempt to use your ID badge to "swipe" into your car.

Cardioversion

It was a hectic day, but I'm loving learning all I can. Today I got to assist with my first cardioversion. The cardiologist in our unit loves to teach and he has spent many 1/2 hour long teaching sessions with me when the opportunity arises.

Today he asked me to come to the room next door when I was finished with my patient. I walked in and they were getting ready to perform a cardioversion. The patient was in A Flutter. The Life Pak was already hooked up and conscious sedation administered. The cardiologist explained everything to me about the process. Even though the nurse educator had already extensively gone over this with me, it's good to have a reminder when you're nervous.

I operated the Life Pak under the direction of the cardiologist. The patient went into A Fib after I had delivered the first shock. I admit, I jumped a little when the patients body jerked slightly with the shock. When I delivered the second shock, the patient sat straight up and said "Ow" before falling back onto the bed. I jumped again. But he was in sinus brady and all was well.

The cardiologist took the next 15 minutes to explain everything to me, review the meds used for conscious sedation and how the patient won't remember any of it. He even made a point to wake the patient up and ask him if he had felt any it, to which the patient replied "no".

It was a good first experience. The people on my unit are very supportive and understanding with new nurses and are quick to include us when there are good learning experiences. I look forward to the day when I can be that experienced nurse helping the new nurse.

My first code

All I can say is, "What the hell have I gotten myself into?".  It was a Sunday and I worked two back to back 12 hour shifts. I had the same 2 patients (who were very stable) as I had on Saturday and thought it was going to be an easy day.

Lesson learned: NEVER even think, "Wow, I'm starting to get this down, I think today is going to go pretty easy". Never.

One of my stable patients was taking a turn for the worse and I watched him go downhill all day while we did various interventions. Approximately one hour before the end of my shift I went in to check on him and recorded his vital signs which were actually starting to improve a bit.

1800:  My patient: Hey girlie! How ya doing?
          Me: Great thank you! How 'bout you?
          My patient: Doin' fine!

1813: My preceptor screaming from the direction of my patients room: I need help in here right now!!

Everyone just stopped to stare for what seemed like way too long before they realized something was wrong and sprung into action. I am pleased with myself that I did react so quickly. I think I plowed down the respiratory therapist as I made a mad dash towards the room. Really, it is all a blur but oddly at the same time it felt like everything was moving in slow motion. I was scared out of my mind, but it's a good sign that I ran towards the room rather than away from it, right?

Anyway, my patient had pulled off his high flow oxygen and quit breathing. He was gray and unresponsive but his heart was still beating. I was amazed at the number of people in the room, all working as fast as possible to get him intubated. It was exactly 12 minutes from the time my preceptor yelled out for help until he was successfully intubated.

I helped where I could, but mostly stood back and observed as instructed to do so by my preceptor. I wonder if I can do this. I KNOW I can, I will learn, but wow, after it was all said and done, I really felt like I didn't know my head from my ass. Is this what it's like to be a new critical care nurse?