Stepping up to the plate

In the last 60 hours since our new block started, I have spent 40 of those in the NICU. I've been to quite a few deliveries. Most of them have ended up very happy. One did not. I'm still mentally grappling with the things I've seen in the last two and a half days, and I doubt certain mental images will ever leave my mind. I keep talking with my co-workers about it because I don't know how else to process everything, and unless you've been right there, understanding the emotions and hearing the guttural cries of someone just given devastating news can be challenging. Even when you know there is nothing else you or anyone else could have done to change the outcome, watching someone suffer such a great loss is heart wrenching. I cried both at work and after work on Monday, and I've actually cried again today. I honestly hope that I never lose that sensitive side, and I doubt I ever will.

I am so thankful to those people that God has called to work in intensive care settings because I am definitely not one of them. I'm a relationship-oriented person which is a huge part of why I love working in a clinic; I get to form relationships with families and partner with them to take care of their children. I have less than 80 days til I start my new job, and I am so excited that words fail me when I try to explain!

I came home after my 29 hour call (yay for friends who let me leave an hour early) and crashed for a glorious 4 hour nap. I'm now waiting for Hubby to get home. He'll give me a big hug, and I know I'll start to feel a little better. Then he'll take me to get food, and since we all know how much I love food (both to make it and to eat it), I know that will help too. He'll make me laugh, and humor (even when it is dark humor at times) is a necessity to make it through the hard times.

A friend of mine told me about a sign posted in the ICU where she did med school that asked the families not to be offended if they saw providers laughing; it doesn't mean we don't care -- it is simply a coping mechanism for us to continue to keep hope and be able to come back to face another day of the battle against death and disease. Sometimes laughing is the only way not to cry, and there is definitely a time and place for both. I've had my tears today; now it's time to let my sweetheart make me smile.

Soon I will be able to go back to bed and sleep (the very opposite of what I did last night on call). I know tomorrow will look brighter, and I am looking forward to another day of helping people even if it's outside my comfort zone. May God give me strength when I am weak and words of peace for others in their troubles.

Tear

I started as senior on a new service on Monday. Last night was my first overnight call; I have five more left of these occurring once every 4 days (with the exception of 5 days off for Christmas), and after 31 hours at the hospital, I'm tired. Despite all the frustrations that occurred, I had a touching experience last night that reminded me yet again why I love kids so much.

Early in the evening, I did an admission on a patient that I hadn't seen since my intern year. I remembered that this patient's mother passed away about 3 weeks prior to our initial meeting, and I knew that Granny was now the primary caretaker. I re-introduced myself to the family including my patient's younger sibling that I had not met previously, and soon the family had me cracking up laughing over how hilarious the kids are. The younger child (who I'm guessing was around age 4 or 5) wanted to be the center of attention and asked me to do an exam with my stethoscope, so since I had a few extra minutes, I complied. As I placed my stethoscope on the sibling's chest, I explained that I was listening to the heart. The sibling looked up at me with beautiful, trusting eyes, and matter-of-factly informed me, "That's where my mommy is."

A lump caught in my throat as I looked up at Granny. She smiled at both of us, and I'm pretty sure she had tears in her eyes. This sweet child exuded such innocence and love; I couldn't resist giving out a hug before I left the room!

Sleepwalking

I'm on PICU nights right now. I hate it. I work 7 PM to 9 AM Sunday through Thursday nights for 2 weeks in a row (except that on Sundays I come in at 5 PM). It gives me the required 10 hours off between shifts, but I think it's safe to say that not a one of us thinks 10 hours is enough especially when you work 5 shifts in a row. It's only two weeks, but it's already been a LONG week plus a day. Last night I had parents of a very sick child get angry because of things that happened before I even came to work, and they took it out on all of us. I understand people react differently when they are scared, but to this non-confrontational person, having someone cursing at me and insulting both me and my hospital was very unsettling. To top it off, I'm going 48 hours or so without seeing my husband; this may not sound like a long time given how much time we used to spend apart, but now that I've gotten used to having him around every day, it's awful to go for 2 days without seeing him. :(

Six shifts down ... four to go. Let the countdown commence. I finish Friday around 9 AM, and then I start a 10 day vacation!! My plans include decorating for Christmas, finishing up my shopping (almost done!), and sleeping. Since I'm working Thanksgiving night, I'm making our own Thanksgiving meal on Saturday; the full menu hasn't been planed, but it will definitely include my famous brined and roasted turkey! I seriously cannot wait.

The bubbly ...

I hate tapping big kids. By tapping, I mean performing a lumbar puncture on them. By big kids, I mean anybody over twelve months. This weekend, I took a hellacious PICU call (thirty hours with no sleep thanks to one child who kept me baffled all of Saturday night and most of Sunday morning). During the day, we admitted a teenager who presented with some very abnormal neurologic symptoms, and the decision was made to do an LP. Since I was not on the admitting team and was just helping out another resident, I stood by and watched as she attempted the tap. She was very confident and did a great job, but for some reason, she didn't get CSF. I was so not thrilled about trying for it; feeling for landmarks on a well-nourished 16 year old female is so much harder than feeling for them on a skinny two month old! I said a quick prayer, marked my spot, and went for it. With a few adjusts of the needle, I suddenly had CSF ... clear, beautiful CSF pouring into my vials. We measured an opening pressure, collected our precious samples, and quickly wrapped up.

A few hours later, we were running labs and vitals. Lo and behold, I had a champagne tap. :)

I needed that.

Blah

My last day off was Friday, April 3rd; that was a relaxing and oh-so-fun day! Hubby was able to take the day off from work, so we cleaned the house together (actually not such a bad chore when he's around) and then had 2 of our sweet friends over for fajitas and Wii. I came in dead last in bowling but actually got 2nd place in golf. Good times!

Ever since then, I've been hard at work. I broke down crying Saturday the 4th in front of the NICU nurses over my frustrations regarding the inequality of the workload among the residents and the different management styles of my superiors that left me stuck in the middle. The next day I was on call and cried again in front of my fellow and my attending because the large majority of my patients were getting sick again in front of my eyes; I spent that 25 hours going to deliveries and just trying to survive the night. The following Tuesday I started an elective in child abuse; I have learned SO MUCH and even got to go to court one day to watch one of my attendings testify. Thursday I spent the day getting recertified for PALS (Pediatric Advanced Life Support), so if anyone under the age of 18 crashes, I'm your girl! Over this past weekend, I got to cross-cover Heme-Onc for the weekend -- definitely NOT my favorite thing. 11 brand-new (to me) patients with rounds that dragged on for 4 hours each day (they normally last 2-2.5 hours during the week) ... I was beat down by the end of yesterday.

I've spent the rest of my free time last week studying for my Step 3 licensing exam -- two FUN days at a Prometric testing center! Today honestly wasn't too bad; I was able to finish up early and did a little shopping while I was out. Now I have to get myself excited to go back tomorrow morning and finish it!

In six short days, Hubby and I leave for NYC. Since he travels so much, we have decided to use his airline and hotel points for an anniversary trip every year as long as he continues to travel frequently. Last year was Napa; this year is New York. I've never been before, and he's only been for work, so we're both so excited. We're going to be staying here, taking this food tour, and going to see this musical. The plan is also to go here for an anniversary dinner. We're going to work on a final itinerary this weekend (because I love having a schedule) to see if anything else needs to be pre-arranged before we leave. We're leaving our sweet puppy with his Granny on Saturday, so getting to see my MIL will be a nice way to start our vacation (yes, I actually like my MIL!).

If I can just get through the next 18 hours, I know I will be fine. It's all downhill from here!

Little peanuts

I'm 3 days into my 28 days of my rotation through the NICU. I'm already tired, and I haven't even taken my first call. Tomorrow afternoon will be the first time I'll be going to "resus" (short for resuscitation) calls. It'll be the scary deliveries, but at least I will have back-up with me including a respiratory therapist and a nurse both specially trained for this with the ability to call a fellow if needed. I know I'll be saying many many prayers for myself, my team, these babies, and their families. By noon Friday, I will be 30 hours into my call; hopefully I will have helped to save a few lives by then!

SIlence

It's 3 AM, and I'm hiding in one of the callrooms in the Pediatric Intensive Care Unit (PICU). Those of you who know me well know that I hate the PICU. The kids are too sick and the stories too sad for me to enjoy it up here. I am beyond thankful for those God has called to minister to these precious ones, but I know my time here is only for a season.

I've got the TV on in the background to break the silence, but even silence would be a relief from the beeping of the monitors I hear every time I walk through the doors of the unit. Alarms are constantly going off, and something is always happening up here. It's never silent, never totally quiet. Some of these kids will walk about on their own with little proof they were ever here. Some will walk out physically broken from the tragedy of a horrible accident or from a crippling disease. Some will never walk out. We all hope and pray that our patients will fall in the first category, but those who don't simply break me. In between the lack of sleep (I've spent 51 of the last 82 hours here and will spend 20 of the next 30 here as well) and the emotions, I'm worn out.

Morning labs will be coming back in less than an hour, and then I'll have more decisions to make. Change the ventilator settings or not ... increase IV fluids or go down ... continue antibiotics or turn them off ... the decisions never end. Fortunately my shift does in about six hours, and I will be off for a refreshing ten hours before arriving again, coffee in hand, ready to face the battles all over again. Six more nights ... eighty-six more hours ... then I will move to a different battlezone.

Drained

About 3:45 AM today, I rubbed a mommy's back as she waited in the ER for her baby to move up to the Pediatric Intensive Care Unit (PICU). This particular mommy had just gone home YESTERDAY afternoon (I signed the discharge order myself) after a several week stay in the hospital for cancer-related issues. 24 hours later, they were back since their precious one had a fever (and a very serious infection as the story and the labs are unfolding). I had met this mommy a few hours earlier as we were preparing to send her baby up to my floor, but while he was in the ER, he took a turn for the worse and needed a higher level of care than we can provide on the floor. I wanted to come see the little one as well as this sweet mommy since they will hopefully be returning to my floor after the badness subsides. My Spanish is meager; I'm much better at asking direct medical questions than carrying on a conversation, but since no one around spoke much better Spanish than I did, I figured something was better than nothing.

Her eyes were red as I tried to comfort her. I don't know how much she understood, but I hope I was able to let her know that she's not alone and that we are going to do everything we can do to care for her little one. This baby was so fussy because of many factors including a strange environment, blood draws, and the infection to name a few, but one look at mommy made things so much better. I wish I could have provided the same thing to her.

Btw, my sweet little patient from my last post went home yesterday. I'm so happy for her and for her family.

This month is so hard, and I am so drained. I haven't been taking care of myself, and I am really starting to feel it. Working 68+ hours per week and fighting your natural circadian rhythm can really wear you down.

Brokenhearted

Late Wednesday night/ early Thursday morning, I helped deliver the news to three different families that each of their daughters has cancer. Each family's reaction was slightly different, but a common theme that ran through the night was one of shock and fear. Fear of pain, of death, of the unknown ... each family had so many questions. Two of the girls were old enough to understand what was going on, but the unassuming three year old and her family touched me the deepest.

As the fellow spoke and I nodded along, we explained to this family what the next few days held for certain and what the next few weeks and years possibly hold. Over the next several days, she would undergo several procedures and start a chemotherapy regimen after we completed an ID of the cancer cells. Late last night, I visited with the family as their little girl returned from her surgery and first dose of chemo. She was crying in pain from the procedure as well as from fear of the alien nasal cannula giving her the oxygen she needed. Her mom was cuddling her sweet little girl in her arms and trying her best to comfort her as her nurses hooked up her fluids and monitors. I explained to her parents why she needed the oxygen and then offered them the alternative to try a mask to give her the O2. They accepted my offer, knowing that this meant we had to remove two large adhesive patches from her cheeks. We have a solvent we use to help dissolve the glue, but it's still not a comfortable process.

My sweet patient continued to cry intermittently as her nurse removed the tape. Watching this process was difficult for me, so I can't imagine how hard it was for her parents. What almost made me cry was hearing her mom whisper to her, "Jesus will help you, my baby." Soon the tape was off, and I saw this little girl smile for the first time since I met her.

Ever since I walked out of the hospital this morning, this entire family has been on my heart. As I walked through Target this morning, I began to pray for them as I perused the aisles. My prayers later turned to myself as I asked God to use me as He will to support this family as much as I can.

For privacy reasons, I cannot disclose my patient's name, but if you read this, please pray for her and her family. God knows her name, and He is holding her in His hands.

Hold your nose!

I stink. I really do. People keep telling me that I'm the only one who can smell it, but I'm sure they've caught a whiff of it too. I spent the night in the hospital and haven't had a shower ... well, in a while. I've been here 29.75 hours, so it's been at least longer than that.

Why am I sitting here blogging when I stink? I'm waiting on a surgeon to call me back to talk about a patient he's covering. This one in particular is notorious for eating residents for breakfast, but at this point, I am too tired to care. If he doesn't call back soon, then I will just check it out to the night float. I need a shower, a meal, and a nap.

I forgot

I haven't taken call in almost 2 months. I forgot how tired it makes me. I'm sitting up again waiting on a chest x-ray (or CXR) to come back so that I can make a decision on a patient and then go lie down. Of course, as soon as I lie down, it'll be time for me to get up to do an admission, so I don't know what's worse: getting up after a short rest/possible nap or not lying down at all? Questions I ponder at 1 AM ...

The hubby is out of town this week. It's the first time I've slept alone in a house (not an apartment or condo) since I was in college. It's WEIRD!! There's something wrong with our plumbing system right now, so the toilets randomly gurgle, and I can occasionally hear water in the pipes near the laundry room. Those noises don't normally bother me, but they have caught me off guard when I'm expecting silence in the house. I feel relatively safe, but since I haven't done it in so long, I asked the hubby to get me the phone numbers of our pastor and music pastor since they each live 1/2 a mile away from us. I need male back-up in case something happens!

Whoo hoo ... x-ray is finally back. All is well. Think I'll go lie down ... 10 minutes is better than nothing!

I'm beat

Daylight savings time was not my friend. I'm on call and soooo tired. Why am I not lying down? I'm waiting on labs. Doctors (myself included on occasion) like to order early AM labs. Now I'm waiting on them to come back to decide whether I give a med now or order more labs in 2 hours and recheck levels then. Good times!

On the bright side, our house now has walls. I'll post pictures when I'm more alert. :)

On the down side, my fella's back in New York. The irony of it all -- he's been home for 7 weeks, and I've been on call q4 for the last 8. He left tonight (actually Sunday) for 4 weeks (still home on the weekends), and now I only take call 1 night out of the next 4 weeks. Go figure! I'm now at the point where all I can do is laugh.

WHOO HOO!!! My labs came back, meds given ... it's 1:45, and I get to go rest my eyes til I get paged. YAAAAY!