In a Fog

I love the song I'm listening to right now...The Dance by Garth Brooks.  Wednesday marks a month since I had to say good-bye to Jagger.  It doesn't seem like he's been gone that long.  I still miss him so much.  I have learned to cope, but his absence does not go unnoticed.  I know in the future I will get another dog...after my trip sometime. 

I felt like I was in a fog at work this week.  I can't figure out why.  I don't have too much on my mind, I got plenty of sleep, I wasn't overwhelmed with patients.  I just don't feel like myself right now.  Sunday night at work was a relatively easy night except for having to talk to a doctor that was acting like a jerk on the phone.  I'm sure I've mentioned him the past...the cardiologist that gave me a hard time when I called because we needed cardiac clearance on a patient that needed surgery.  He likes to lecture & after going on & on, he said "I don't care what the surgeon wants or what he does...tell him I said that."  The reason I was calling him on Sunday night is because I had an elevated Troponin result on someone that had come in with chest pain.  So I called the cardiologist - even made it a stat call.  He calls back & pretty much yells at me "What is going on that required you to label this a stat call?"  I explain to him that the patient had an elevated Troponin when he was admitted just an hour ago & now it's even higher on the second set of labs."  He says that is not a "stat" call & then proceeds to lecture me about Troponin levels & that just because they are elevated, it doesn't mean the patient is in any danger.  So after he went on & on, he says he has no orders to give me right now since the patient is asymptomatic.  Ok, doesn't sound right to me, but he is the cardiologist after all.  I inform my clinical leader of the situation so she is aware & even she thinks it's odd that he's not giving any orders.  I go about my night when about a 1/2 hour later, it's the same doctor calling me again.  Ugh is my first thought.  Surprisingly he is calling to apologize!  GASP!  He told me he had a long day & he is sorry for taking it out on me, that he didn't mean to come across so rude.  Wow!  Shocking!  The rest of my night went well after that.

Monday night I went into work & my name wasn't on the schedule.  For a split second I thought about walking right back out the door & going home...but since I was already at work, I may as well stay if I can.  I go to speak with the charge nurse & she tells me I can be a unit secretary in the ICU if I wanted.  Fine...I don't mind putting orders in the computer.  I think I was there for about 2 or 3 hours & only had like 3 orders to put in.  I knew it was going to be a long night...but I wasn't complaining.  I was looking forward to a night that was calm.  I prefer to be in PCU because that is the staff I work with.  I knew the ICU nurses, but they aren't as easy to chat with as the people I'm used to working with. 

By 10:30, my night had totally changed.  I was asked if I minded going to the med-surg floor & taking PCU patients because PCU was filled & the ER was overflowing.  I said "Ok, no problem."  It was myself & another nurse and we admitted 8 patients in a row...back to back...with no breaks.  It sounds awful, but it wasn't bad.  It definitely made the night fly by. 

My first patient was a woman in her 60's that in the middle of the day...started having trouble remembering things & having strange speech, balance, etc.  They diagnosed her with a TIA.  It's not a stroke, but it does present with stroke symptoms that don't last very long.  The thing is...her symptoms are lasting, although they are not exactly strokelike symptoms.  It was more like amnesia or short-term memory loss.  I'll explain more about her later.

The next patient I got came in with chest pain.  As you all know...those are my favorite kind of patients!  Everything is so routine & easy to understand...except in this case.  My patient was originally from India & only spoke Hindi.  Hmmm...that could be a problem if he was experiencing chest pain because we didn't have anybody at the hospital that wasable to understand anything he said.  Well, except, he was able to tell me he needed water with no ice...???  I wonder if he understood more than he was letting on.  Anyways...the good thing about a patient that cannot communicate with the nurse - it makes the data assessment very easy...lol.  Luckily he had no episodes of chest pain that night. 

My third patient was another one that came in with chest pain...he was very easy to understand.  My only problem with his condition is that he had a positive D-dimer in the ER & they never followed up with a V/Q scan or a CT of the chest to rule out a pulmonary embolism.  When I questioned the nurse about it, first she lied & said the doctor didn't want to do anything about it - that he would address it the next day.  That didn't sound right to me so I told her I would have to call the doctor tonight (it was 2:30 am) & get it clarified & he'd be upset if I called him on something that was orginally ordered earlier.  She confessed that it was never mentioned to the doctor & that she would handle it.  I didn't care that it wasn't mentioned....just tell me that up front instead of lying.  I know they were busy in the ER...I totally understood it & would have made the call to the doctor when the patient got to the floor.  The ER nurse brings the patient & the orders and all that's written is "follow PE protocol."  Ummm...what?  Does he want a CT of the chest or a V/Q scan...that's the protocol.  So I ended up having to call the doctor anyways & mentioned to him that the patient's creatinine level was just a tad bit high & CT wouldn't touch him with that lab result.  All we had left was a V/Q scan.  I explained it to the patient & his wife...they were fine with it & the test was done.  He had no more episodes of chest pain.

My last patient was actually a med-surg patient.  I was told she was non-verbal & non-responsive.  She ended up not being brought to the floor until 6:30 am...so I made sure she was comfortable in the bed, started her IV & fluids and told the oncoming nurse that the orders were being put in now & that none of the assessments were done. 

Tuesday night I went in & found that now they had me as a PCT (patient care tech) on one of the PCU floors.  That's my least favorite job...especially when the floor is completely full.  Still though, I was happy not having to be a "nurse" that night.  It's always nice to mix it up a little.  My role as a PCT lasted about 2 minutes.  They sent a med-surg nurse to take my place & I was told to just hang out while they made sure all the PCU nurses had shown up.  So I chilled for about a 1/2 hour when I was asked if I minded going back to the med-surg floor & taking patients again.  I really didn't mind...it was a nice change.  I ended up with 2 of my original patients back.

I had the patient with the short-term memory loss again.  She was worse that night than the night before.  She couldn't remember how old she was, or that her husband was disabled & hadn't worked in 2 years or who her granddaughter even was.  She couldn't remember where she worked - even though the night before she told me in detail where she worked & what she did.  I don't know if medications played a role in her forgetfulness or what...but it was strange.  All of her tests were coming back negative & they couldn't figure out what it was that was causing this.  Scary stuff!  My clinical leader told me that her mother-in-law layed down for a nap one day & woke up unable to remember 1/3 of her life.  Strange!

I had my non-English speaking patient back.  He had gone for a stress test & developed chest pain while on the treadmill.  So they changed it to an adensoine stress test & he ended up having an allergic reaction to the medications used for that test.  I was trying to explain to him the medication I was giving him (Benadryl)...but I don't think he understood.  That's got to be scary...being in a hospital (or anywhere) & unable to communicate properly. 

My third patient was admitted the night before with COPD.  I don't even know why he is there...his labs were all very normal, no breathing difficulties, no fluid retention, he wasn't even on any oxygen.  Ididn't complain...give me all of the stable alert & oriented patients you got. 

My fourth patient was a med-surg patient.  Not the same one from the night before.  This was a new admit that had kyphoplasty done in the OR & I was getting her after the procedure was done.  She was easy to care for, but I did find myself checking on her quite a bit because she wasn't a PCU patient (so she had no heart monitor on).  I don't know if I could be a med-surg nurse now..I'm so use to knowing that my patient is doing ok by watching a monitor or at the very least...that they had a pulse.

That night was so easy that the time ticked by so slowly.  It was nice down there though.  It gave me a little taste of what travel nursing could be like because I didn't know the majority of the staff & they do things totally different down there than on PCU.  I have started doing a lot of research on travel nursing.  I just want to be sure to pick a good company & make sure the contract is written up the way I want it.  Part of me wonders if it would be wiser to go to one of the big hospitals in Orlando & try to get hired into an ICU training program to learn more critical skills before I venture off into the unknown. 

I'll think a lot about it during my trip.  It's only 7 weeks away! 

I paid for my first class towards my BSN.  It was $855 and that doesn't even include the books.  Ugh!  That's a lot of money for one class.  Oh well, a Bachelor's Degree in Nursing will be worth it in the long run. 

I worked a lot in the past 2 weeks...to make up for the time I took off.  I have been off the last 2 nights, but I go back tomorrow for Fri & Sat.  I hope this fog that I feel I'm in goes away & that I'm able to think clearly again. 

Have a good weekend everyone & Happy Easter!