Saturday, October 13, 2007

Coffee Time

We'd finished morning bedside report and I was out and about to see my patients before 0730.

When I assessed my first patient of the day, chosen randomly from a small group of people who had recently had heart attacks, bypass surgery, sternectomies, diabetic foot ulcer debridements, frequent ventricular ectopy caught while in surgery, pleural effusions drained by chest tubes, and other minor inconveniences, I offered the family member who sat with that patient a cup of coffee.

"Your breakfast looks good!" I said to the patient, whose tray was steaming away with bacon, a lobster omelette, a croissant with Swiss cheese, and a stiff demi-tasse. I turned to their family member and asked "Can I get you a nice cup of morning joe?" and they said "Thank you very much. That'd be quite nice."

As I walked to the kitchenette to get some coffee my phone rang and it was the Tele room and the monitor tech said that one of my other patients "just had a run of V-tach."

Oops. No, not that. It's V-tach, not yak.

I peeked in on the patient and did a quickie assessment and they were fine. It was only a few beats and they'd probably been having it on and off for years. Their pressure was 123/77 and they were sitting up at their bedside eating breakfast. But the dressing on their foot was a mess so I got some stuff and changed it out.

In the meantime Nuke Med had called and they wanted one of my other patients for a stress test. They were on a nitro drip so I couldn't just take their tele unit off and have Transport take them for the test, so I got a portable monitor and hooked it up to the patient while I promised them that I'd have their breakfast waiting for them when they got back from the test. That was a lie. It would probably be 1200 by the time they got back here and time for lunch by then. Crab quiche with fois gras on a baguette with a nice young Shiraz.

I accompanied the patient down to cardiodiagnostics then scooted back up to my other patients. My phone rang and it was my spouse. They "wanted to talk." We'd recently gone on a trip to the beach and I just do not travel well. I get... touchy.

Our Jungian therapist thought we should review childhood family vacations and the stressors that we "suffered" back then.

I said that I would be very happy to investigate those issues later after I'd opened my skull and poured a bottle of bleach directly into my brain, and then said "I love you, my eternal deepest soulmate, but I'm just a little busy," and thought about really good sex for a split second.

One of the certified nursing assistants who I love almost as much as I love life itself came up to me to let me know that one of my other patients had a blood sugar of 508. That's a little high. So I called the doc and covered the patient with the sliding scale insulin I had at hand. The doctor said we could probably discharge that patient home later if their blood sugars resolved and ordered every-one-hour fingersticks and weird coverage until they were below 200 times two.

We were going to discharge that one but his blood sugars said "NO."

They had a PortaCath so I got a Huber Needle from Supplies and restarted it. I'm not really supposed to do that. I'm "not certified," even though I've done it more times than Bush has mispronounced "nuclear."

Nucleationerizinous. Whatever the dickhead says. Too late now. We're just counting days until he's outta here.

"Coffee," I said to myself silently. For me and them.

It's no big deal. You just have to be clean. Real clean. Aseptic.

They ended up getting lab draws and insulin pushed through that. And way later we found out that they would stay the night and not go home, because their sugars didn't come down.

There were orders to change the antibiotics on Foot Ulcer Patient, so I transcribed those. His peripherally-inserted-central-catheter needed a new dressing because it was all bloody and yucky from yesterday so I fixed that up.

The repeat blood sugar on the other patient was still 490 so I phoned the doc and took orders for more IV push insulin. This patient wasn't going home. They were going to Intensive Care, unless their sugars stabilized into the sub-200's.

Hemodialysis called to ask for another patient to be sent up to them, but that one was still in Nuke Med geting stressed, so I made a couple/few phone calls to get them scheduled out. After that patient went up to dialysis they called me to come give them pain and nausea meds, so I got those out of the medication dispenser and went upstairs to the Dialysis Unit and administered the medications.

The patient was fine; hungry, actually. No vomit. That's good.

Then I went to the kitchenette but the coffee pot was empty. I started up a new pot and went to the original patient's room and said "Please don't take this personally. I've been a little busy and I had to put on a fresh pot."

The family member, who had slept on a cheezy cot all night, was very gracious.

"Don't you worry," they said. "We think you're nice." I did my aw shucks thing and went to get the coffee.

The coffeemaker had gone wild and there was fresh coffee all over the kitchenette countertop and the floor. I turned it off and started over. I went back to their room and explained: "I had to start a fresh pot," and they were very understanding.

I had STAT Lasix orders and a few other things to take care of so by the time I got back to the kitchenette the coffee pot was empty again. I wanted to make a fresh pot but there were no packets of coffee. I called Dietary and they didn't want to send a new box of coffee packs. "We'll send you some. Two or three?" and I said just send three but sooner was better than later and I thanked them very much for their help.

One of the trauma PA's had stripped the dressing off the foot-ulcer patient so I had to go put another back on. There wasn't any sterile gauze wrap so I called Supply and they sent up some for me. That took a few minutes.

The V-tach patient had been seen by Cardiology and they wanted a drip started so I called Pharm and spoke to Sylvia. I'd worked with her at another place here in The Valley and we chatted about her new stereo system. She'd bought Martin-Logans.

She'd heard mine and persuaded hubby to go for it. Hers were newer, bigger, and mo' better, and my inner stereophile screamed with jealousy. But hey, my old Clarities are doing just fine. It's a small room irregularly-shaped with its corner fireplace, and these things sound great.

Transparent and detailed. And loud enough, too. Salome was not a whisperer. Steinways that sound like Steinways, voices that sound real, guitars that sound like fingernails on strings, and stuff.

Then I went to get the coffee. It was done, so finally I brought a cup to that family member. I told them not to take it personally that it had taken so long to get it for them. They were so nice about the delay.

My phone rang and one of my patients had their call light on.


may said...

i'm glad the family were so nice and understanding about it because if they don't understand how things get in the way of the nurses trying to be nice (like offering coffee) some of them do take it personally sometimes and think you are just pulling thier leg by trying to be all nice.

it sounded like a busy day and i hope you still had the energy to talk to your wife about some childhood vacation issues, followed by that good pondered upon sex :)

shrimplate said...

Thanx for stopping by, May.

You probably have no idea how deeply I appreciate your blog. You are the best.

Anonymous said...

Your account leaves me exhausted. Sending good vibes.

from Ruth