My World Right Now

I'm just busy. Busy Busy Busy. Again. Still. Always.
So here are some bullet points for you. A brief synopsis of my life, and this style seems appropriate right now, considering how I am spending most of my time.

• Work fricken sucks. For some reason it has gotten busy, and I'm not sure what is going on because it isn't flu season. No new obscure respiratory epidemic has surfaced. People are just...sick. And I make a living taking care of them, and so I am busy.


• School fricken sucks. This program I am in is accelerated, so the classes are only five weeks long. The last session I took was one class, and it was still busy because it was so condensed. This time I am in 2 classes: Legal/ Ethical Environment of Business, and Management Accounting. And if one was busy, two is insanity. I have 3 2,000-word papers due for each class this coming week. That's 12K words, y'all. With 60 hours of work. And 2 kids. I want to take up drinking. But if I do that, there is no way I will comprehend the hundreds of pages of reading they have given me to do. The mind-numbing reading.


• I got an A in my marketing class. Let me rephrase that: I rocked that shit out.


• Jesus didn't show up on a cloud or with a clap of thunder and take anybody away. I never thought he was going to and realized that Camping douchebag was a nutcase, but the agnostic/ borderline-atheist in me was secretly thinking, on a very small scale, that it would suck if I was wrong.


• I paid off the last of my pregnancy bills this past week. Zach has been paid for. It only took a year of crazy work schedules and living as if we were below poverty guidelines. Now I can try to regenerate my savings and since I know I am not going to med school anymore, we can work on buying a house after I have a little bit of cushion. Or maybe I should wait until the MBA is done. Hell, who knows?


• Evan is having some major psychological problems. I can only hope it is not what I think it is. I can say that I have been doing some research and when I read this one article, my heart sank because it was like I was reading about him.


• John enrolled in classes. Just a little vocational program for HVAC, but their median starting salary is comparable to my starting base salarywas as an RT when I first graduated. It would be nice to have the extra. I would say that I would slack off at work, but that isn't true. The extra would just facilitate us reaching our goals a little quicker. (See above.)

I think that's all. Sorry. I need to spend time writing academic papers now. And ptting my brain to sleep with Business Law. Peace out, homies.

No She Didn't

So I was taking care of a patient the other day, and what she said to me just came back to me for some random reason. Let me set the scene first:

It's hot in the hospital. Hot because, well, it's hot. We've had some unseasonably colder days here, so the a/c isn't rocking full time yet, even though it is supposed to be May/ Spring. And these frail little old ladies I go to see have the heat in their rooms cranked up. And I run from room to room to room. Up and working. And yes, it is hot.

So I'm in this room, giving this old bag her breathing treatment. And her room is sweltering. Her nurse is also in there to give her pain meds, and she and I were making small talk. I mentioned I was burning up, and she agreed that it was hot on their unit of the hospital. And the patient looked up at me with a sympathetic smile and said words that had me reeling:

"Ahhhh, menopause. Hot flashes."

"STFU, you old bag!", is what I really wanted to say. But that would get me fired or at least "talked to", and I try to avoid that. But her nurse? God, I am loving this nurse right about now, because she honestly looked at the patient and told her she was crazy, that I just had a baby last year.

Take that, Old Bag.

Menopause, my ass. You're just old. And jealous because I can breathe without torturing some poor, overworked RT.

Patient-isms and the Almighty ED

I am a compassionate person, for the most part. I swear it. If you are my patient, you can bank on the fact that I will do my best to take care of you. Without judgment, without fail. If you, in your lack of medical knowledge, say something that is utterly stupid in the strongest sense of the word, you can rest assured that I am not going to laugh at you in your face.

I’ll wait until I leave the room.

Recently heard by my patients:

“ I need my BEEEEPAP!”

“All I know is that when she was a baby, they had to put her in a plastic bag.” From a mom when asked for the history of her young infant’s delivery. My response? “ You mean they had to BAG her. As in a way for us to give manual breaths. I assure you that they did not put her in a plastic bag.”

“He said I have an internal fart. Something is blocking it from coming out.” Upon hearing that they have a myocardial infarction caused by a blockage of one of the coronary arteries.

“You have to SHUT UP! I have anxiety and the voices in my head said you’re being too loud!” This wouldn’t be funny if the patient were really mentally ill and wasn’t just trying to get some benzos for the weekend.

Of course these are just a few. And they all occured in the ER. This doesn’t include the funny crap we see. Like the stripper who fell off of her pole. Or the arrests. And the drunken people. My job is always, always interesting.

Case in point: just a few short minutes ago, I held in my hot little hands a real-life FBI badge. You know, like the one they flash on tv. Turns out they are just as badass as they seem.

What Have I Done?

Busy busy busy. Still.

Aside from working 60 hours this past week, I also started the journey that is to be my business degree. The online program is supposed to be easy, right? Since I have all of the pre- and co-requisites completed from my other degree, all I have to do is take my business courses and the degree will be awarded and I can move onto the masters. Okay. And this is an accelerated online program, so each class is approximately 5 to 6 weeks long. 2 courses at a time. No breaks for summer, which has me finishing early next fall.

Oh. Crap.

Because I started. I got my glossy new texts and I delved into the world of marketing. And my professor has us completing a paper or presentation literally every 48 hours. Because, in a degree program designed for adults with other obligations like job and family, there couldn't possibly be anything else for me to do other than prepare fictional marketing plans and writing papers to critique the business practices of the establishments I frequent. Along with 10 chapters of reading each week.

Maybe, just maybe, I will lose the little bit of sanity I have left.

Maybe all of my hair will turn gray.

What is more likely is that I will pull myself up by the bootstraps and get it done just like I always do.

And for an extra dose of fun? I submitted my application and resume for a PRN therapist position at a local rehab hospital. And they bit. Hard. As a matter of fact, I simply emailed about the position before I submitted anything and had the interview already scheduled before I had even updated my resume and started the app. A second job. For when I don't get as much overtime as I like. Like that ever happens.

Such is my life as a workaholic student wife mommy. Sometimes when you want it all, that is exactly what you get.

Proof of Life

Sorry. Not much to post about. Working like crazy, recovering well from the tendonitis in my left foot and ankle. Starting classes in a couple of days and spending my non-working hours doing such thinks as making sure I know how to navigate the online college experience and obtaining textbooks and needed software. Plus we are in the market for a new car and I have been dealing with that as well. So far, I have looked at the VW Toureg (too expensive), the VW Routan (grrr, a minivan), the CR-V (not much more room than we have now). Next up is the Chevy Traverse (love it, but we'll see what the dealer can do for me on price). Plus I'm trying to finish the book I've been reading that is completely unrelated to work or school before I find myself in the throes of juggling like a madwoman again. Sorry. Boring boring boring. Hope everyone is doing well out there in the Blog World. P.S. Zach has 2 teeth now. So cute.

The Good, the Bad, and the Ugly

I work amongst some of the most ridiculous, petty drama you could imagine, considering these are all college-educated adults. This one de-friended this one on Facebook, this one screwed someone's husband and as a married woman, another one completely removed from the situation took complete offense. And because another one is BFF's with the defriended one, the de-friendee is now on her shitlist. And on and on, so it goes. I mean, really. And I try to stay out of it. I really do. There are going to be disagreements because we work long hours under stressful conditions, and we are all human. I've had my disagreements. But adults move on. And we are not going to like every person in our department. There are about 50 therapists in my department. Someone is going to dislike me, and that is okay. But be an adult. Be professional. And so this post is all about work.

Let's start with the Good, shall we? One of my coworkers asked if Zach needs any summer clothes, and since I have only bought about 5 or so summer outfits so far, I mentioned that we could use some, that I haven't really shopped. Well, she had us meet her and gave me bags of her son's cothes to go through. Oh holy crap. There were 4 pair of swim trunks, 6 pairs of sandals, 30 complete outfits and a ton more separates, 7 pairs of light pajamas, and even an unopened pack of swim diapers. All looking brand new, all designer labels. So while I had this huge list of stuff the boys needed for summer, all that is left for me to buy Zach is bigger-sized onesies. Seriously. Love it!

The Bad: Well apparently, I have upset some people and I do not know why. I shouldn't care but I do. I have always worried too much about what others think of me and have been insecure about it. But I keep noticing people from work gone from my friends list on Facebook. Unlike some of my coworkers, I will not start WW3 over it. Hell, I won't even mention it to anyone. But it kind of makes me wonder what it may be the result of. Am I just a bad person? Am I completely pathetic for even worrying about it?

The Ugly: Apparently a coworker had her annual evaluation at work and my name came up. My supervisor mentioned the "problems" we have like I would instantly know what she is talking about, and I honestly have no clue. This person is always nice to me and this was the first I had heard of it. I just played dumb when I should have spoken up. I mean, there are some people who just will not like each other, but to go so far as to bring it up to my boss? Really? And the only thing I can think of was when I first found out I was pregnant with Zach and, keeping in mind the experience I had with Evan, I was sort of upset about it. This girl had been trying to have another baby for sometime, and got very upset, to the point of screaming at me, for being upset. She now, after my pregnancy, understands, I think. But at the time she was downright mean about it. I don't know if it stems from this or not. But this worries me. What did I do?

So anyhow, that is what is on my mind. Just a little concerned.

Reunited

"Reunited and it feeeeeels so goooooood......" Ummmm, not really. Yesterday, dear bloggy friends, I reunited with an old friend. It wasn't my recess buddy in grade school or my BFF from high school. It wasn't my college confidante or one of my sorority sisters (yeah, I was one of those). It was....dun, dun, dunh....The Mart Kart.

Yeah, I know. These things are great, making it possible for the infirm and extremely elderly and handi-capable all to go buy important things like food. And medicine. And their Depends. Well, they're great and wonderful and convenient...until you have to be the one on it.

Let's start with how I became an expert driver of the Mart Kart (yes, that really is the brand name of the cart Wally World uses. (Thanks to Evan, whose young and agile brain is able to store vast amounts of such useless info.) I became an expert while preggers, when I was on either bedrest or modified bedrest, and John would shout out, "Honey, I'm going to the store!" And I would yell, "Oh hells no, I'm COMIN'!" And most times I would just waddle to the car and ride along for some scenery, windows down for some fresh air and sunshine. And sometimes, depending what was needed, I would actually go in. But aside from my team of doctors' orders, I was physically incapable of walking through any store, especially the huge box stores like Wally World, Target, BRU. He would drop me off in front before parking the car, and I would be moving so slow that people passing me on all sides would literally create a breeze effect. Because I had been in bed for months and also because as soon as I tried to stand upright, the contractions would pull my belly so tight that it automatically had me walking stooped over. I would hunch and hobble and waddle my way to the electric scooters and hop on. I had so many misadventures on those damned things and became an expert.

Target's sucked. They had the big bumper thing on the bottom to keep you from getting too close to anything in the store. But this bumper thing is what caused me to crash into everything. It is what put the feat of God in the people working the electronics and how I got the best service as they brought different cameras to me so I could look and decide on one. There was no way they were going to let me get that close to a glass case. This was, of course, the same day I took out an entire rack of newborn clothing, and I am not even going there. Click the link if you want to read about Mach 5 embarrassment like no other. It was also the week before Zach's birth.

And then there was the time I thought for sure that I had been busted by the very one from my practice who finally told me, "No more, Andrea. You are to be on bedrest until you deliver. You're done." (I later 'fessed up and discovered that while he didn't see me that day, that according to him, he has busted many a bedrester that way.)

Or the day someone accused me of being on one out of laziness. Yep, I hate the things.

So here's what went down: I woke up just a couple of hours after falling asleep on Wednesday morning with my left foot filled with this intense ache in very localized places, yet still radiating up my leg, if that makes any sense at all. I honestly thought it was the weather because it was sunny and 70 here one day and literally 34 degrees and cloudy the very next day. And trying to storm on top of that. I have a bit of arthritis in that leg after having ACL surgery in 2003, so I thought maybe it was the beginning of that type of pain. I took some ibuprofen and went back to sleep. It got worse, but I went to work that evening as planned. Within 2 hours of starting work, I had no idea how I was going to make it through the full 12 hours. It was that bad. I did make it until all of my patients had been seen, though, and I handed off my pager to one of the other therapists. I had to make J0hn come and get me, and went home to ice and elevate my foot. Which helped. Until I tried to stand on it again. I ended up in the ER, getting it x-rayed. I felt silly and stupid and was seriously worried that they would think I was drug-seeking because there is nothing visibly wrong with my foot. Nada. Except I have the ugliest feet. Bunions, ingrown toenails, calluses. Because what I do for a living doesn't go hand-in-hand with sandal season. But I got people who knew me. And I turned down the pain shot I was offered and requested an anti-inflammatory injection instead. And they said it is bad tendonitis, that they could see hazy areas of inflammation on the x-ray, and that I may have some underlying stress fractures as well, but I won't know that until it fails to get better. But I am on crutches now. And spent last night drugged up enough that I slept through the entire season finale of Jersey Shore....Erm, I mean another show--a more high-brow show that isn't so embarrassing. Sucky sucky sucky. Because I apparently work too much. (In fact, it was Wednesday and I had already worked 48 hours this week....They may have been on to something!)

And so I am grounded for a couple of days. But Zach needed diapers because I never did manage to make the switch to cloth. And he needed formula. (Completely random tidbit and silver lining in all of this? That last night, I bought either the last or second-to-last bit of infant formula I have to buy for Zach! That crap is so expensive! And I have yet to decide if I am going to use the toddler formulas they make now.) And the fridge was bare here. And so I had to use the damned scooter. Again. And John laughed at me through the entire store, though Zach watched me from his perch in the cart and seemed to be fascinated that Mommy was motorized.

Such is life.

How NOT to Get a Job

Let me set the scene for you: It is 3 AM. I have been busy as all hell because A) people keep trying to die in the hospital and we have had more codes than I thought possible in one shift. And I have the main ICU. And B) I already have 10 ventilators going. 10 patients on life support, and they keep coming because you go to the ICU when you unsuccessfully try to die. Plus I am in charge, and I have one guy who is in a code and I am getting called for all of his patients he can't get to because of that. And C) they are complete bullshit calls. (Example: I got called all the way to the psych unit for a patient "not breathing well at all" and I get there only to discover he has a stuffy nose. That's it. Clear breath sounds, 99% on room air. But he has nasal congestion. Seriously? I have people who aren't breathing without my help and I get called for that???) And so I have come back to the department for a brief second to wolf down a sandwich and a Diet Coke. And the phone rings.

Ringgggg, Ringggggg.

Me:"Respiratory, this is Andrea."

Caller:"Andrea, are you an actual therapist there at that hospital?"

Me:"Yes, I am. How can I help you?"

Caller, to be known from this point on as MORON:"How many therapist do you have there with you?"

Me:"Ummmm, who is this?" I'm kind of creeped out by the question.

Moron:"My name doesn't matter. But I saw you have a full-time night shift position opened. Will you hire a CRT? Because it says the position is for an RRT. "

Me:"Well, we hire therapists with their entry-level credential contingent upon them completeing their advanced practice credential within a year of their hire date....."

Moron:"DOES THAT MEAN I HAVE TO TAKE THAT TEST?!?! I hate taking tests. Tests are boring. And that one is expensive!" (She's sounded very agitated now.)

Me:"Well, there is quite a difference in pay between a CRT and RRT, so it pays for itself pretty quickly." (I'm thinking that this girl is an idiot if she thinks this is the way to get a job. And obviously lazy if she doesn't have the gumption to take the steps to get a credential that will further her career so much.)

Moron:"Okay, whatevs, how many patients do you have right now?"

Me:"Well, in the hospital we have about....."

Moron:"No, not in the hospital. How many patients do you have? Right. now. How many units of the hospital are you covering? And how many therapists do you have there tonight?"

Me:"Well, we have 4, which is standard at night. I have the MICU, and I am covering all of the patients in that unit. There are 10 ventilators running up there right now and....."

Moron:"OH MY GOD! Do they always work you like that??? I heard they did. I work at XXXXX now and I only have 2 treatments to give before 8 in the morning. That's what I'm used to. I don't like to work a lot. Or very hard. Ewwww. And a ventilator? I hate running vents. I haven't run a vent in 10 years."

Me:"Ummmm, we are usually pretty busy here. And since there are only 4 therapists in house at night, all of us may be asked to handle a vent or an intubation, even if we aren't assigned to an ICU..." (Okay, now I think I may be being punk'd. Where's Ashton?)

Moron:"Whatever, I guess I can try it. Where do I fill out an application?"

I had to give her the website where she can apply online. And I had to tell my boss this morning that if anyone calls who works at that hospital, to please not hire them. Who? Who really tries to get a job like that? Especially in our current day where even healthcare professionals are having difficulties finding jobs. I mean, when I applied for my current position, I called. But when I called, I spoke with the director of my department and simply asked, in a polite tone, if they had any available positions for a registered therapist. He asked me a few questions about my experience, and before I had even completed an application, HR had called me to schedule an interview. I actually completed the application and submitted my resume at my interview. But I was polite. And professional. And was eager to work. And motivated. Really.

So we really do have an open night position. And I swear I will die if this girl comes to work with me. Absolutely die. The last thing we need on night shift, where the staffing is bare bones, is someone who doesn't want to do the job.

God help me. What is wrong with people????

First Do No Harm

Primum non nocere.

Of course we all recognize this as the cardinal rule of any medical practice. Nonmaleficence, meaning that it is entirely possible that the best course of action for me to take in an emergency is to actually do nothing. That doing nothing, and thus not causing further harm, may be better than being wrong in a manner that leaves my patient in worse shape. Now take all of that and combine it and roll it into a big ball and realize that I grapple with this in a split second when my patient has stopped breathing. That instant that truly seems like an eternity. The great void between the realization that your  patient is indeed pulseless and apneic, and the pushing of the big blue button that will trigger the calling of a Code Blue. In my career, I have had situations where I go back and think about  a patient and wonder if me reaching any conclusions sooner would have changed an outcome. And thus far, I have had the luxury of being able to say that I don’t feel as if I have harmed anyone.

Last night, I had to face that possibility when, after some aggressive airway management for a patient who wasn’t ventilating well, I witnessed the spiral. First the oxygen saturation starts to drop. And then the blood pressure is low, followed by the slowing of the heart rate. Finally you reach that chasm where the heart ceases to beat, whether it be a pulseless ventricular rhythm or completely asystolic. The patient is dead. Expired. And you can do all you can and whip out everything you have learned in years of education and professional experience in the hopes that it will help. That the heart will resume beating. (Not so much the breathing because, honey, I can make anyone breathe with the right equipment.) But this happened last night. While I was there with my hands on that patient, taking the opportunity to teach a new ICU nurse about ventilator basics. I have never had that happen to me. And after we got her back not once, but twice, and they finally got the stat chest film for which I kept begging, it was determined my patient had a pneumothorax. And so when the family arrived at the bedside and told us to stop all efforts at resuscitation due to patient wishes, in the blink of an eye, my role switched from caring for the patient to caring for the family. To help them find some peace in her death. I did all I knew to do. I extubated her, washed her face, smoothed her hair, tucked her in, and left the room so they could have those final moments with her on her death bed.

And then I went into my back office in the ICU and I cried. Actually I started crying before I got there, prompting fellow ICU staff to follow me to make sure I was okay. I was. I was still breathing. My patient wasn’t. It was the first time in my career where I was physically working with a patient when they went down, and my instantaneous thought was, “Did I do that? Did I hurt her?” Of course after logically recounting the steps to her demise, it is obvious to me that she suffered the pneumothorax before I did anything that could have caused it, and thus I cannot blame myself. But it just did something to me, and I cannot really explain why.

I love my job. Love it. But I have always had confidence in my professional skills and training. I haven’t really doubted myself before this. Well, I have, but not in the manner that I had to stop and think on whether or not I did damage. I have always said that the most dangerous person in healthcare is the one who will not admit that they don’t know everything. So with that in mind, there has always been a healthy dose of fear. There has to be when you are literally running someone’s life support. But that fear cannot be so great that in inhibits one’s performance, one’s ability to be on their toes when a true life-and-death emergency strikes.

Lately, as a senior therapist, I have been mainly working the critical care units. Once in a blue moon, my boss will give me something else so I don’t go insane, but it isn’t very often. And the thing about this is that I am in a teaching hospital. Meaning when there is an emergency and the code team assembles, it really is a team effort. In other areas of the hospital, this may not necessarily be the case because there are more seasoned physicians running the show. But in the ICU’s, you get residents. And the presence of “MD” behind their names has yet to give them the idea that they know all because of their education level. They know that an experienced ICU nurse or therapist has seen a lot and can help them. I work with them on intubations, on managing pulmonary issues. I give crash courses in blood gas interpretation or ventilator management. And in a code, when we get to the point where we have exhausted all possible causes, or in one where the cause is obviously pulmonary in nature, they look to the therapist. Me.

I don’t know what I’m getting at here. I think it is just that I had to think last night that it was possible that I hurt a patient. And even after coming to the conclusion that I did not, the fact that I could have just seemed to linger. And of course this has made me think of my role in the hospital even more than I have before. The pressure. The weight. The responsibility.

I upheld my ethical commitment last night. I did no harm. But I had to come face to face with the idea that I hold lives in my hands when I go to work and clock in at night. That I very well could hurt someone. I think it just caught up with me.

Bronchitis, Sinusitis, Otitis, Oh My!

So after staying up virtually all night, I couldn't stand it anymore.

I even tried taking my ultra-vast tome of Austen into the bathroom and sitting in a hot bath for what seemed like forever. It would have been relaxing except that heat made me cough even more. As in coughing so hard you puke. And I have gone through 90 puffs of my inhaler since Monday. So I stayed up as long as I could because, by the time I was finished in the bathroom, it was almost 5 AM, and I figured what's a few more hours? The plan was to call the doctor's office at 8AM sharp and get an appointment. They do this uber-frustrating thing where they book up all appointments except what they call "same day appointments" for the suddenly ill. But they will only fill same day appointments on that day. So unless you call as soon as they open, you ain't gettin' one, sister!



I fell asleep. And woke at 8:45. From coughing. And wheezing. And gagging.



And so I thought to myself about all of the people who clog our ERs for the stupidest of reasons ("My pee has bubbles in it!") without either insurance or the ability to pay the bill. Not making a statement about healthcare--we treat the indigent. But really? If tax payers are gonna pay for your visit, shouldn't it be a true emergency? Anyhow, I figure I am insured and can pay my bill, so double score! And in scrub bottoms and a ratty sweatshirt I have worn since yesterday, and with my hair so crazy I look like a lunatic, I go to the ER. Not sure whether it is my claim as one of them or what, but I got back pretty quickly and was seen even quicker than that. Turns out I have bronchitis, which is exacerbating my asthma, a sinus infection, and for a triple dose of fun, a middle ear infection. By the way, who gets an ear infection over the age of 5? Me, that's who!

So I'm on antibiotics and steroids and have to step up my game on my asthma meds. After calling in sick last night because I was miserable, I was ordered to not work tonight, either. I hate that. The only times I have missed work is for my bedrest during my pregnancy and when I was hospitalized for pneumonia a couple of years ago. I hate it I hate it I hate it.
So here I am, nursing myself back to health, trying to get better without innocculating the rest of the clan with my cooties. Of course this involves dowsing myself with Purell evert 5 minutes.

Being sick sucks.

The Catch-All Post

You know that receptacle on the kitchen counter or desk or wherever? It could be a basket or bowl or something, but its sole purpose it to be a place for random crap that people drop. Ours is a large ceramic bowl on the kitchen table. The Catch-All. Ink pens, keys, restaurant coupons, junk mail, my badge and stethoscope from work....You can find anything in there, and I'm sure we aren't the only family with one of those.
Well, this is the catch-all post. Because I don't wanna post a bunch because, well, I'll get to that first.

First of all, I am working like a slave. And it has caught up with me. And I feel like garbage in more ways than one. For starters, my job is getting to me. Last night, I had to withdraw care on a 45-year-old father of 3 who suffered a spontaneous aneurysm that created a massive bleed in his brain. He was gone. Brain dead. And after listening to the wails of his wife and children echo off of the walls of the ICU unit for about 6 hours, the family decided it was time to let him go. I hate doing that. The suffering. The sadness. And aside from that, my face will be in their memories of his death. They won't associate it with pathology. They will see the woman who came in and extubated him on command, knowing he would not breathe once off of the ventilator. And that is seriously some depressing crap. And furthermore, I am sick. Physically sick. I've caught it either from my children, who have both been ill, or from my nasty patients. Because apparently my position in healthcare denies me my basic rights to health and wellness and common courtesy. By this, I mean that multiple times a day, I lean over to listen to breath sounds and a patient coughs directly into my face. With their staph/ enterobacter/ pseodomonas/ tuberculosis/ strep/ gram-negative/ gram-positive shit. Yep, right into the air I am breathing. Nice. Thank You. So now I have it. The dry, hacking cough. The hot cold hot cold hell of a temporarily dysfunctioning internal thermostat. The aches. The stuffy nose. I hate being sick and haven't been since I caught H1N1 from--you guessed it-- one of my patients during my first trimester of Zachy's pregnancy. Being sick makes me a crabby bitch. So enough about that.

Evan is a celebrity around my hospital and his school. Last week, the Cincinnati paper had community event photos and since all of the catholic schools were having special events for Catholic Schools Week, Evan's school was no exception. They had a sock hop and there was a 5x7 photo of Evan on the second page of the paper, cutting a rug like it was nobody's bidness. As a result, people have been saving the clipping for us and I swear we have about 50 copies right about now.

Zachy had his hearing test today with the audiologist. They put these little things in his ears that looked like ear buds, which emitted sounds and measured the vibrations produced by his ear to ensure all was working. They use this in babies because it requires no cooperation at all. It's just measurment. But little Zach kept whipping his head around, looking for the source of the sound, which of course he could not see since it was in his ear. It was entirely too cute. And all is well. No hearing impairment detected. No collection of fluid behind his ear drums. Now we just wait and see what the doctor is going to do. I've checked my insurance benefits, since I doubt we meet the financial guidelines for a state-sponsored early intervention program. I only have to pay 10% and he gets 30 therapy sessions per year. The bad part is that this is 30, total. So if they do OT and speech, for example, they cannot combine to more than 30. We haven't gotten there yet. I really don't think it's all that bad.

John's dad is apparently engaged. We found out tonight over Facebook. They've been dating for awhile and we like her, so it is great news.

I hate my nasty neighbors and their nasty dogs. Really, I know hate is a very strong word. And I mean every bit of it at this point. It was bad enough that when they open their front door to the common vestibule we share in our duplex, my living room smells like dirty dog for about 15 minutes. And then we had the issue this past spring where their dogs were shitting in little piles on the concrete driveway by the doors of my car. So I have to be hyper-vigilant about where I step when I get out. Pretty tricky if you come home after dark. Or before dawn. And let me remind you that I work nights.Well, now they are doing it again. And for extra fun, they are hiking their legs and peeing on John's Harley as well. John's Harley that is valued higher than my only-2-year-old car. And on the weather cover, which was also expensive and which John touches with bare hands ot get it on and off the motorcycle. Now before you think I am an evil dog-hater, let me tell you I like dogs. I would like to have a dog but seem to be allergic to anything that is green or has fur. But there is such a thing as courtesy. And the lack of it these people have appalls me. Seriously.

So that's all. I told ya. Completely random. But I feel like dirt. See ya on the flip side.

It's The Little Things

On today, of all days, which happens to be the most difficult day on the calendar for me, I am choosing to distract myself with the little things I am loving right now that make life grand. Here's my list:
1. It's downright spring-y out there! Which means the neighborhood stroller brigade is out in full force. And while I am working at least 4 hours a day for the next 5 days, I will be able to join them. I can also bust out the Ergo carrier and away we go. To the park. For long walks. Window-shopping downtown. Hell, I don't care. We can go. And for the first time in a year, nobody is having a million contractions an hour or recovering from a c-section while the weather is nice.


2. International Delights coffee creamer. Seriously, folks. John likes Skinny Caramel Macchiato while I am partial to Skinny Vanilla Latte flavors. Both are fat free and delicious and eliminate my need to visit Starbucks daily. Speaking of Starbucks, the last time the entire fam went in there, by the time I tipped the barista, we dropped $20 on 3 drinks. Fo' reals. So I am loving this crap. And my fridge is stocked with it.





3. Reebok RunTone shoes. Now don't get me wrong: I am most definitely not a part of this new idiotic shoe craze. I do not believe for one second that a shoe is going to melt the fat on my ass, despite the fact that just about every major athletic shoe manufacturer has come up with their own version. But these were cute. And on sale for less than $100. And I needed new gymnies for work. And I bit. And tried them on. Helll-oooooo, Fat-Feet Heaven! And so they are mine.




4. Motherlove's More Milk Plus. Whoooooot! Because after the pumping debaucle at work last week (or lack thereof) this crap brought the supply back up in about 3 days. Well, that and me pumping like a madwoman again. Actually my pumping output tripled in that amount of time. And it replaced the gazillion other supplements I take because it has them all in it. I was taking 2 Goat's Rue, 3 Fenugreek, and 3 Blessed thistle capsules 3 times daily. Now I take 2 of these babies 3 times daily. For a third of the price. Holla!

5. A while back, I fell in love with Pediped baby shoes. And bought Zach 4 pair in th 0-6 months size. And they fit so well for so long that I was sure he wouldn't need a bigger size until he started walking, and thus ordered the next size up in the "walking" versions instead of soft-soled. But they were huge on him, and I ended up ordering 4 more pair in the 6-12 months size of the soft-soled and put these on a closet shelf. Now that Zachy is getting bigger and starting to explore pulling himself up to standing, I tried these on him and they fit. I have several pair, but these are just 2 of the styles I bought for him. A-freakin'-dorable! And so I felt justified in ordering the next size up, this time in sandals and other spring/summer styles. Shopping for shoes, even if they are baby shoes, makes everything better.


6. I'm working tonight. A little 4-hour "princess shift". This time yesterday, I was off work for today. Then my boss called to tell me a coworker, who has never called in in the time I have been there, called in sick for today. And so I gave up my full day off to help out. Why would this be on this list? Well, because it is difficult to think of your woes and feel sorry for yourself when you are running to codes or trying to keep people alive. Talk about a distraction!


7. My house is full right now, even though Ben is absent. It will never make up for it, but it is good to know. I get to hear the sounds of John playing with our boys. Of Evan's laughter in the house while he is off of school today (no idea why--not a holiday or Holy Day--hmmmmmm). Of Zach's squeals of delight.


8. Zach has learned to give Eskimo kises and it is too cute for words.

9. Still-toothless baby smiles. Don't get me wrong-I want him to cut his teeth. But there is just something so innocent, so pure, so new about a flash of naked gums when a baby smiles. And I am choosing to enjoy it while I can. It won't be much longer. (Incidentally, Evan took this picture of his baby brother just minutes ago while I was typing this. I love that you can get a true glimpse of Zachy's reaction to his big brother in the pic.)





10. This. This right here. Big Brother reading to Baby Brother. Because even in Ben's absence, this house is full. Of love. Of togetherness. Because Ben is the only one who could mke this better for me. Other than that, this is as good as it gets. Life with my two miracles and the love of my life. And because I can look at the boys, with their love of books, and see myself in them. I am there. And if I am there, then Ben is too, even if none of them realize it. And that is a beautiful thing.

We're Going To Hell

Okay, so we are horrible. We healthcare people. Because in order to do what it is we do everyday in an ICU, we have to make crude and completely inappropriate jokes. It's a defense mechanism, peeps.

And if Ol' Aunt Gertrude is dying, we call that "Catchin' the Jesus Bus". Seriously. So imagine my surprise to find this:

Ha! Hahahahaha. The devil is waiting for me in Hell.

Hell Hath No Fury...

...like Andrea pissed.
Seriously. (I think I may say "seriously" entirely too much. Kind of like the word "like" when I was a kid. Oh well. Roll with it because I am really pissed off.

Zach usually takes a bottle of evil formula at night before bed. One little 6-ounce bottle. Now, let me remind you that my boobs have been through sheer hell in the past (almost) nine months. I seriously cannot believe I have kept this shit up this long. (Oh, yeah, forgot to mention that you should expect profanity in this post because, once again, I am pissed.) Like the days where I found random black bruises on me. Or the plugged ducts. And how could I forget the days where I got as little as 2 ounces in 24 fricken HOURS. I didn't do this crap for fun. And it sure as hell has not gone as planned. I didn't want to take herbal supplements to keep the milk coming. I certainly didn't want to buy a hospital-grade pump. And I really, really had no intention of getting nice and intimate with a piece of equipment every two @#$%&* hours a day for at least a year. Okay, now with that being said...
You may or may not remember the early days when I returned from work a mere 5 weeks post c-section and all was sunshine and roses. We have the lactation rooms with the hospital grade pumps and leather recliners, etc. And if you have to pump, you have to pump. No questions asked. Period.
I have not pumped a single time at work in the past 4 days. And I am still doing the 12-hour shifts. In the wee hours of the morning when my boobs seem to be the most productive. So if I can't pump at work, it is a serious issue. And that issue has been my way of life for 4 days now. So while this time last week, Zach was taking one bottle of formula before bedtime, yesterday he only got one 5 ounce bottle of breastmilk all day. Because just one day of missed pumps is enough to do that to me. Now it is all but gone and I am back to killing myself practically in order to get my supply back up. One of my fave ER docs is working tonight and I am on the verge of asking him for another course of Reglan. It is that bad.
It went like this: I have had the ER, despite the fact that I told my boss that the ER, because of its lack of predictability, its distance from the lactation rooms, and the acuity of the patient population, is really difficult for me to cover while still breastfeeding. And she told me to have my coworkers help me and if anything came up, to let her know. I'm sure she doesn't really want me to do that. I would be in her office daily. Long ago, I stopped having someone cover my cell while I go to pump, which is really what I am supposed to do. It's just easier that way because I don't have to deal with the rolled eyes of my coworkers or have to explain why it is that I need this time to them. But the downside of that is that, when I get a call in the middle of a pumping session, I have to call my coworkers to get the patient seen. And the people I have worked with for the past 4 nights are not the type of people to help. For example, I was so busy in the ER last night that I didn't even get to attempt to pump until almost 7 hours into my shift (8 hrs. since the last pumping session). And when I finally got up there, as soon as I took my stuff out of my bag to get ready to do the deed, my phone rings. And it is a nurse who wants a PRN treatment for her patient because he is short of breath. I call the first coworker, who says she got called to a patient in the ICU. I have no reason to not believe her at this point, and so I call someone else. This someone else just happens to be the first girl's BFF. So the second one syas she is "up in the tower" ( a region of the hospital), not specifying which floor she is on, what she is doing, or anything else. I tell her what I need and her response was, "That doesn't sound urgent." And she hangs up. While it is entirely possible that she was correct in her assumption, we have no way of knowing this until someone lays eyes on the patient and does some sort of pulmonary assessment. And so I try to call a third coworker whose phone is saying he is "out of the zone", which means he is in an area of the hospital where his phone has lost signal. So I call the nurse back and let her know what is going on, and could she please give me specifics on the patient's status. She does and tells me he can probably wait until I am finished. So I start to pump. And literally 2 minutes into it, the phone rings again. 2 minutes. So of course the same therapists who were busy with the first call are still busy. And I have no choice. I stop pumping, throw my parts in my cooler without even washing/wiping them, and I go to the patient. Except on the way, I pass the first two girls, giggling and walking down the hallway. On the complete opposite side of the hospital from where I had assigned them at the beginning of their shifts. Together.It was all of 10 minutes after I had spoken with them and they were too busy to help me see one lousy patient. And so I was very pissed. And after that, I was just too busy to even leave the ER and never had another opportunity.
So tonight I report to work. For the first time all week, I am not in charge and so I do not make out the assignments. I told the one girl I can't do the ER tonight. Not after the issues that have gone on for the past 3 days. If I do, I will probably have no more milk for Zach. That's it. All of that work brought to an end like that. And she ignored me and put me there anyway. And in the morning I don't know what I'm going to do. Raise a stink? Go to HR? Post a printed copy of Kentucky breastfeeding laws on her locker? It's all enough to make me want to put in my notice, but my status as the breadwinner means that I need something else lined up first. Incidentally, my hospital was one of the first to recieve the Unicef designation as Baby-Friendly, meaning it makes extraordinary strides to foster breastfeeding. Pretty rich, isn't it?
Grrrrrrr.

How to Spot a Student

I work in a teaching facility where I am bound to run into any kind of student at any given time. EMT/ Paramedic students in the ER. Nursing students on the med/surg floors. Respiratory therapy students in my own department. Medical students any-fricken-where. You don't have to look too closely to tell they are students because their status as newbs just screams from them.



Let's start in the parking lot. If there is a cheap stethoscope hanging from a rearview mirror in any vehicle, that car belongs to a student. It's almost like a staus symbol. It's supposed to scream, "I work in healthcare and therefore am beyond cool.". Instead, it screams, "I am obnoxious and think I am going to randomly run from my car and into the fray to save a life. As soon as I finish school." I never did this. First of all, cheap stethoscopes are crap. You cannot hear with them. My very first stethoscope was a Littman Master Cardiology. $300. And it lasted me through my entire education and the beginning years of my career. As a matter of fact, I just replaced it last year. I never hung it from anything in my car because sun and cold, both, are damaging. And besides, I'm not that cheesy.



The Scrubs. If you have to wear scrubs as a uniform as a student, For the Love of All That is Holy, wash them first. Nothing says "I don't have a clue" like a pair of scrubs that still have that new sheen to them and come complete with creases down the legs or the sleeves. Just sayin'. We will all know you are a student, and by default, semi-retarded.



That Snazzy Piping. If by chance scrubs are not your uniform and you have an issued uniform (Student Nurses, this is you.), there is no hope for you. There is nothng that says you don't know what you are doing than that horrid piping they insist on having along every seam of every piece of uniform you all are made to wear. The only thing I can say to you is that it will all be over soon.



The Stare. They all have it to varying degrees. This goes for the resident fresh from medical school, looking lost and as if they are playing dress-up in Mommy or Daddy's lab coat, to the nursing student in the ICU seeing a critically-ill patient for the first time. All the way down to the RT students I encounter, who sit in our department waiting to do rounds with their preceptor and looking at all of us like we are Creatures from the Beyond. Nothing says "I am dumb enough to kill your loved one" like that stare.

It's not that I have anything against students. I was one once, and I was just as dumb. I never did the stethoscope thing, though. What I did do was feel uber-cool because I got to wear scrubs and have a steth around my neck. Ha! Those were the days. And then I couldn't wait to get out of school so I could buy cute scrubs in place of the navy ones they made me wear in school. Now, years later, those cutesy scrubs hang in my closet while I wear the OR greens everyday. I also don't feel quite so cool these days. Instead, I've become jaded. It's just what I do. When did it get like that? When did I get hard and bored and so blah about the whole thing? Maybe I need to revert to my student days.

Random

Not much to report from here. We are in the midst of some reorganizing and purging here in the house (as evidenced by Zachy's changing table on its side in the background of this pic!).



John got his second ticket this past week. Apparently he didn't stop long enough at a stop sign around the corner from our house. I think the local police just have an affinity for my car for some reason.



Zach's teeth are just right there. The two front lowers. Gah! I wish they would just break through. Tonight he gnawed on a whole wheat organic teething biscuit for the first time. He isn't particularly fussy or anything. I'm just impatient.



Evan is grounded. Again. He insists on making me be the bad guy. This week, he lied about homework, and so I took away priviledges. So later that night, I went to work and John let him have his Nintendo DS. (Way to back me up, Honey!) So I have confiscated the DS and now take it to work with me. Video games rot your brain, anyway, Evan! Read a book instead.



I am now addicted to the damned DS. Hey, those games can be pretty fun, and it sure does pass the time when I'm pumping at work!



Zach loves "Where is Thumbkin"!



Evan brought home a B in Science on this past report card. Seriously, Evan? Last quarter, he had a 99%. I was secretly disappointed. It was his lowest grade at 92%. Which brings up the grade scale for 3rd grade. This is new for Evan as a 3rd gader, but 95-100 is an A, 90-95 a B, 85-90 a C. A D is anything below 85%, which is considered failing for any grade above 2nd grade at his school. It seems like it should be another planet or something where 84% is failing. Poor kid. Times sure have changed since I was a 3rd grader, and I was in the gifted and talented program where my homework was so difficult that there were times when my mother would crack up laughing when trying to help me because it was too difficult for her! Seriously. So I sort of feel bad for Ev, and haven't been busting his chops about the B since it would be an A anywhere else. And with 92% being his lowest grade, I can't complain. I just know he can do better. Plus, all of the teachers left the same remarks in the comments: "Evan is too talkative in class.", "Evan has trouble paying attention duing class.", and my fave by far, "Evan is a remarkably bright little boy, is engaging and fun, but is entirely too disruptive in class." How can the kid get the grades he gets and be that disruptive? He must get that from his father.

I renewed my PALS this week. Yay, fun! And I also started looking into the home study program for my Neonatal/ Pediatric Specialty credential. That would make my credentials RRT-NPS. What is it about adding more letters after your name that makes you look more important? Anyhow, I don't need the cred to work the NICU, but it would make me look like a rockstar in the neonatal respiratory therapy world. And my boss would have no choice but to pay me a lot more. Which means the whole process, though admittedly rather expensive, will eventually pay for itself. Score.

Evan has been driving us crazy with the Karaoke machine John's mom bought him for Christmas. Apparently it has kids' songs programmed into it. There really is only a certain amount o time one can listen to the instrumental version of "This Old Man" before one goes completely, certifiably insane. Just sayin'.

Zach's hair has started to grow toward the center of his head in hilarious fashion. So from one angle, it looks like a fauxhawk. And from another, a Kewpie doll. Ha!

I guess that's all I have to report.

NICU

I hemmed and hawed and procrastinated until my boss finally asked of my intentions. And then I did it. Hesitantly at first. Maybe a little nervously. And finally with a little more surety to my pen strokes.



I added my name to the list of staff interested in a full-time position in our new Level 3 NICU.

I've known this was coming since before I was pregnant with Zach. I didn't know how the cards were going to fall and which of us therapists were going to get to take on this new role. And how my name has come to be on the growing list has been a sort of journey.

When I first graduated with my RT degree, I swore off kids. Actually, it started before I even graduated. As a student, I was required to prepare a case study each semester. The patient population from which we had to choose changed each time based on the courses we had covered that particular semester. And these were really involved. Day-by-day summaries of care, tests, drugs administered. Appendices involving translations of every drug given, every side effect, every abnormal lab value. I think the shortest one I ever prepared was 60 typed pages. So my very last semester, we had to pick a NICU patient and I picked the preterm baby of a 13-year- old girl. And my baby's meconium tested positive for illicit drugs all the way up to 60 days after her birth. I was appalled. I was broken-hearted. I wanted to kill the mother. And the grandmother. And I wanted to take the baby home with me and give her a good home. I thought then that my heart just could not take doing that every day. And then I graduated. And my very first code as a credentialed therapist was a 6-month-old baby boy. He had been "napping" in a bed next to a bucket of mop water. The babysitter claims that she went in to check on him and found him submerged, head first, in the bucket. We did CPR on him for what seemed like hours, knowing full and well that there was nothing we could do to get him back. I'm not a drinker, but I turned into one that day, and for that day only, when I left work. And again, I swore I never wanted to work with babies. I can treat an adult who did something stupid to ruin their body. But a baby who is ill because of a stupid adult? I find it very hard to keep from being judgemental in those cases. And I took a position at a hospital where I thought I would never have to deal with it. A tiny rural hospital where I was the only night-shift RT. Ha! I guess it was the hospital's location at the midpoint between Cincinnati and Indianapolis, but we had "bad babies" all of the time. I figure it was because the moms didn't have time to get to the big cities and stopped there. But I resuscitated at least one newborn per night of work. That's when I began to carry certifications in NRP and PALS (Neonatal Resuscitation and Pediatric Advanced Life Support) to say that I knew how to resuscitate our smallest patients.

That's also when I learned that, although it wasn't exactly my favorite among my job duties, I was pretty good at it. And then something happened. I ran into a neighbor at our complex pool who kept staring at me. One day she finally approached me and asked if I worked at the hospital and what I did there. When I confirmed, she told me where she knew me. She had watched me resuscitate her grandson through the windows of the hospital nursery. I didn't remember her because I was focused on the baby, but she remembered my face from that night. I thought it was pretty cool, then one random day, she knocked on my door. When I answered, she was standing there with this blue-eyed blond little boy. She guided his hand to mine and said, "You don't know him, but he is alive because of your work." It was the baby. He was 2 then. And that had to be the most rewarding experience of my career to date.

Since then, as I have added years of experience under my belt, I have developed this love-hate relationship with caring for babies. First of all, if I am involved in their care, it is usually because they are pretty damned sick. That alone is sad enough. And then I find it hard to keep from seeing my own children in their little faces. I can treat dying adults all of the time. But the kids? The babies are the ones I take home with me. The ones I internalize and carry with me. The ones who form the emotional challenge behind my work.

So I have done some soul-searching. And I have determined that I am tailor-made for the job. My reactions to the sick babies shouldn't exclude me from the role of NICU therapist, but should actually be a qualifying factor in my selection for the job. Because over the years, I have become hardened to adults. But not kids. Never the babies. And after 2 horrendous pregnancies, I realize that I am the type of person I would want caring for my critically ill baby--someone who actually cares about them, who will cry when they suffer and celebrate when they are well. And when I look at the mom of a premature baby and say that I get it, I really do. As for the challenging logistics of the job? I am the type of person who is always looking to learn more and more. And if I am not challenged, I lose interest. What better patient population for me than our most challenging, most fragile? And as for my nervousness, I think it is healthy. You have to be a little nervous when dealing with any critically-ill patient, yet still be confident enough to do your job. Because no matter how sure of yourself you may be, no matter how arrogant and cocky, the critically-ill human body has a way of knocking you on your ass and showing you that you aren't as great as you originally thought. In that aspect, a healthy bit of nervousness keeps you on your toes.

And so my name is on the list. And I'm scared. And I know I'll cry. And there will be days when I hate my job. But I am also excited. We shall see...

I Don't Even Want To Go Back There

Last night, we got a call to take a ventilator to the NICU for a baby. I was in charge and didn't have the NICU but rather the MICU. The girl who had it, though, wanted me to help her, and so I did. Shortly thereafter, I got called for a vent for the mom, who was to be going to the MICU. She didn't make it. Code Blue, Labor and Delivery OR. And so I went. She coded in the same OR where I delivered Zach. On one of my doctors. When it became apparent we weren't going to get her back, we called the husband and her parents back so they could say goodbye. Her father wrapped his arms around my neck and sobbed for his young daughter. I thought he was going to fall and I was worried I didn't have the strength to hold him up. My scrub top was wet with his tears. And I proved to myself that I am tougher than I know I am. In more ways than one.

She died. Her beautiful, full-term baby girl is a picture of health.

And right now, I don't know if I can stomach going back to that place. Right now, I hate my f###### job.

Big Brother (or Sister) Has It In For Fatties

A surefire way to piss off a control freak like me is to tell me what I have to do. Seriously. If you let me think it is my idea, I'll do it. But telling me??? Oh no, no, no.

And I work for a private Catholic hospital.
And they tell me all sorts of things.

For example, my birth control: Insurance pays zilch for it. Whatevs, I don't think the $43/ month self-pay expense is going to kill me. I am a little disgruntled that they would pay almost half a million dollars for Zachy's entrance into this world, yet still not consider my bc pill medically necessary, which is the only way they will pay. And there is no better way to convince the powers that be that you are bound for damnation than to tell them you are preventing pregnancy. Seriously.

So the latest and greatest: our fricken cafeteria.
Let's discuss this, shall we?
Our cafeteria is decent. And they open it for us night-shifters at 2AM every night, which is great. But at night, the food sucks. The lettuce on the salad bar is brown, the food on the hot bar congealed, the lady at the grill afraid of the actual grill and thus cooks everything at too-low temps ( nothing like getting salmonella at a hospital cafeteria!). It's bad. But on a few nights a week, we have a good cook, and she will make you anything and it will be edible, I promise. Enter the problem here.
They decided they care about our hearts. And our cholesterol. And our risk for hypertension. And so I walk into the cafeteria one night and I see the horror. No-Fry Friday. I shit you not. All I wanted was my damned chicken quesadilla, which it says on the menu is a heart-healthy choice! But nope! The grill is closed down. And on a night when the good cook is working! Oh the HORROR! The lettuce on the salad bar was brown. There was something made with mushrooms on the hot bar (highly allergic). There was no pizza-by-the-slice. And all that was in the cooler were little containers of potato salad (allergic to mustard, too). I ate a Heath bar, a blueberry muffin, and some potato chips. The quesadilla would have been better for me! For real!

So we are all disgruntled, right? And it is the talk of the hospital. We are all going to call everyone from the cashier working the register. all the way up to the President of the United States, in order to get our cheeseburgers back. A serious revolt was on the brink. And then Monday hit.

Meatless Monday.
You have got to be freaking kidding me. Seriously. No pizza. Still no grill. Still brown lettuce, but now no hot bar either. I ate popcorn and a Tootsie pop. Chased with a cup of coffee to replace the energy I would not be getting from my meal.

My hospital cares that my thighs have fat on them.
No, they don't.
They care that our insurance, though through Humana, is privately funded, and they have to pay for all of our heart attacks when the time comes.

Hey, Hospital BigWigs! I'll give you a hint: a heart attack would be much cheaper than one of my pregnancies. Just sayin'.

Lessons Learned

Somedays, I absolutely love my job. And like most people, there are day where I hate it. And then there are sometimes where the love and the hate are one in the same. Yesterday was one of those days...
A patient who broke my heart into a million little pieces. I was called to intubate this elderly woman who had been discovered down in her home. Without heat. She hadn't had the resources to pay her electric bill and her core body temperature was 74 degrees. She was in that shape for days before she was discovered by a relative. And the family! So guilt-stricken, not only because she had asked to borrow the money and they told her they didn't have it, but because nobody had checked on her in days.
A patient who made it all to real for me. A nice-looking, clean-cut guy. Dressed casually in a fleece and a pair of jeans, much like I do on winter days. I was sitting at a computer in the ER, charting away, when he came up and handed me this folded piece of paper, asking if he could use the phone to call these people. I unfolded the square of paper, soft and worn so that it was about to split where the creases had been, and dialed the number for him. It was for the emegency cold shelter the city sets up for the homeless on freezing nights. My first thought, considering his manner of dress and the way he spoke, was that he was calling for someone else. Since he carried on the conversation right there at my desk, I couldn't help but hear his end of the conversation. He had been carrying the paper around with him, too proud to use it, until it just got too cold and he had no choice. I heard him tell the person on the phone that he hated to take a bed from someone who needed it more, and so he had never used their services. But on that night, he didn't have a coat, either, and so he couldn't sleep on the streets. He even offered to sleep on the floor to take as little space as possible, if he could just sleep indoors that night.
The patient who was a reminder. I got called to the NICU for a preemie. 23 Weeks, 3 days. She or He wasn't delivered yet, but mom was dilated and her membranes had ruptured. They were doing an ultrasound because they suspected placental abruption, in which case an emergency c-section would have to be performed. They were trying to send her across the river to the OB Mecca where I was sent many times during both of my pregnancies. Apparently OB Mecca was full to bursting and so had to triage. This means they were only accepting patients to which they could provide the most help. 23 weeks is on the cusp of viability. 24 is the magic number, and so they turned her away. Her doctor had to explain to her the odds of the baby surviving with any quality of life intact. At a certain point of gestation, we automatically resuscitate, no questions asked. 23 weeks is not that point. And the mom had to make the decision that we were going to let her baby die peacefully in her arms.
People ask me all of the time how it is that I do my job. I usually tell them that for every single one we cannot save, there are several we can, so there is a balance. And for the ones we cannot save? I get to go in that room with that patient who is terrified of death, and I get to do something, anything, to make it a little easier for them. And then there are nights like yesterday.
Heart-breaking, soul-crushing nights. Nights where I take each and every one of them home with me. These happen to be the nights I get something out of my work.
The hypothermic woman reminded me to hold my loved ones closer. To never, ever take them for granted.
The homeless man, at a time when I am financially drained from the year we have had, reminded me that I may not be able to buy myself anything and everything I want right now, but I have a warm home filled with love on these cold, cruel nights of winter.
And the mom. Oh, the mom. She brought every contraction back. Every hospitalization for not one, but two pregnancies. I swear I could feel the needles in my hips. I could feel my belly torque and twist deep down. I was 18, 19, 20, 21, 22 weeks pregnant all over. I was in fear for my babies' lives all over again. But this time, instead of the depression that follows each time I deal with a preemie since my return to work, something very different happened. In the same instant those horrible things were brought into my mind, my head filled with other images. Evan's first cry, first step, first day of kindergarten. Those nights this past summer where the pregnancy was over and I spent five blissful weeks just getting to know Zachary. Zach curled into my chest, deep asleep. His beautiful smiles and giggles. Candles on birthday cakes and tiny baby feet. The smell of baby lotion and the sounds of John playing with our boys. Squeals of delight at a new milestone conquered. I was reminded of what could've happened to us and of what didn't happen. Of what we've survived and what we've escaped. And while I know that my last pregnancy did something to me emotionlly, I am on the way toward healing.

We are, all of us, just minutes from a moment that could destroy us. That family never dreamed they would never speak to their mother again. I'm sure the polite, clean-cut man never dreamed he would be homeless. And I'm sure that mom never dreamed she would have to make the call to allow her baby to die. Any of this could happen to me. Instead of letting this consume me and depress me, I am choosing to let this be a lesson learned: to appreciate everything I have, to love the family I have, and to focus not on the ways in which my children came into this world, but the moments I have had with them since.