1. Obama is president
2. I made my first turkey dinner, paleo of course
Some of the newsfeed on Instagram made me giggle. Lemme share:
And
I know who I would have voted for if I hadn't missed the absentee ballot (blerg). What? I am not telling you...
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The funny thing about traveling is that there are no permanent things. This can be a relief in a bad situation but it can also be distressing in a good situation, namely when very good friends have taken an assignment away from California. Far away from California. The expiration dates in life lately are really stressing me out. Maybe I should check my fridge, speaking of. And my own biological eggs. And my car tags. And my license. My birthday is coming up, you know. I know it is already penned in on your calendar. And by penned in, I mean I know Siri is aware and will remind you a week before so we can prepare. Thank you in advance.
Michelle and Bryan, who have become very great friends since the beginning of my California assignment (The Quintanos), have accepted a job in Colorado. They leave the beginning part of November, just after Michelle's birthday. Below is a picture from our second to last dinner. Michelle wanted to go to The Little Door for her birthday. I wanted to eat the lamb shank tagine. So it all happened, right there, right then.
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| Nevermind that non-paleo part to the left... Happy Birthday Michelle! |
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Back to work...
THE LORD IS TESTING ME!!!
Let me explain. With the unionization at Kaiser, we are never allowed to have more than three patients, only one more than I was used to in Pittsburgh, so that isn't too terrible. They are usually more independent than the patients I was used to also. However... as a traveler, if you don't get floated to another unit (not desirable), you are pretty much ensured a hectic day in your current unit. At least that has been my experience most often. As a traveler, you are given the discharges for the day as well as the complicated and unpopular patients with unpopular and demanding family members, "The Undesirables" if you will. I am getting dumber and less tolerant by the day.
Last Sunday was my worst and most bizarre day yet. I started off the day with two discharges and was waiting on an admission from home to arrive. This is also cumbersome because you have to fill out an admission assessment (asking things like "Have you ever felt like you should cut down on your drinking?" or "Which side of your stairs is your railing on?" or "Do you feel safe at home?"), page some doctor to please come and see this patient to start orders so that you have some sort of direction for your care, start an IV, etc. This was the weekend, it is next to impossible to lure a doctor to the bedside. I was not in great spirits about this day already.
Both of my discharges wanted out immediately, before any doctor had ever said "You can go home" or wrote any orders of the sort, so I had to expedite that process. There were paper prescriptions (in an e-world?!) to hunt down via the doctor and questions to be answered, appointments to adjust to suit their schedule and locations. This was happening simultaneously and it is customer service, so I did my best to "yes, ma'am" "no, sir" and smile my way through my frustrations and hiccups.
Just as this was all at a climax, my admission arrived, no IV, no paperwork, but thankfully stable and with a family member. Hurrah, more pressure. I settled them in and started some of my admission assessment but didn't even have her name or any report on her. The charge nurse relayed, "Oh you don't get report for this, I will tell you what I know" WHAT. How unsafe is that?
I got wind of the scenario and thankfully the patient was being seen by a pretty reasonable doctor who usually reports "You have a great nurse" at the bedside of his patients. Thank you for throwing me that tiny bone. Unfortunately, her veins rolled and I had to continue to ask for help to obtain IV access on this patient. And also answer the two discharges questions and get them out of here because, you know, they live really far away or he has been here for three days and additionally, his girlfriend had to get to work at 11am. How about not asking her to take you home, sir? Poor planning and unresolved frustration is now my emergency. Super.
I got those two out and got report that I was about to receive another admission. I had to finish my first admission quickly and get the ball rolling there for her. She asked if they could draw on the dry erase board and I said, "of course." Her husband was nominated to draw an angel on the board. While he was doing that, his back was turned to me and it read "God is with me" in puffy paint on the back of his denim shirt. Am I being punk'd?
Labs were drawn on this patient and she was unable to stay for the procedure as planned so discharge orders went in for her about four hours after her admission. I apologized that there was no real progress made today but she assured me that it wasn't a waste of time. She relayed about her and her husband singing and making music together. She handed me their latest Christmas CD and encouraged me to check out their YouTube videos. She tearfully crawled out of bed with much anxiety and some assistance and said that when she wrote her first song, she named it "My Blue Angel" and said "Today, I got to meet her ::sniffle:: ::tear::" That was me, in blue and I was later noted to even have an angel feather on my arm! She noticed and liked my tattoo. She also liked "Happy Trails" and sang it to me with her husband as she was being discharged. Sweet but terribly awkward, especially in the rush I found myself in. I stayed and listened and agreed to "check her out on facebook" per her recommendation. I'll get to it...
While I was getting her out, my other patient arrived and spoke mostly Spanish. How nice. How do you say "crushing chest pain" in Spanish? I better figure this one out fast. He was pleasant though and knew some English words, no pain, er, dolor. We made it work. His heart rate was in the 150s and the transferring nurse reported, "Oh his blood pressure has been stable in the 130s." So I hook him up to the monitor and fire up the computer to ask him HIS admission assessment questions, not expecting any hiccups here. His blood pressure read 219 on the monitor. Surely something was wrong here. I repositioned it and retook a value which came back at 231. Unbelievable. Trying the other arm I got 252. Am I being punk'd NOW?!? I paged the doctor while grabbing an extra blanket and finding new batteries for his "remote monitor" device just in time for his tears and crushing chest pain, oh Jesus help me.
My three empty rooms were being cleaned. My new admission was here. Pretty fair day so far, at least the way I am used to it flowing. My relief nurse came into my room while I was trying to battle this unstable person's blood pressure and heart rate, as he was scheduled for a bedside cardioversion to shock him out of this high beat rhythm, per the same reasonable doctor mentioned above. The CPR pads go on, he gets a little sedation and boom! He is shocked. It's kind of like a computer reboot. I was mentally preparing for my first one. I was kind of excited! Anyway, the relief nurse barged in to tell me that they were floating another nurse to our unit now to take over this patient and I was being reassigned to this new admission that just arrived down the hallway. The nurse who received him took off and she has the report to give to me. Okay, cool, let's play telephone. Her report told me next to nothing. I had to sit down and research the chart to figure out what was going on. The patient was sleepily sitting up in a chair and requesting to go back to bed immediately. The wife was requesting a sleeper seat for her overnight stay. And a blanket and pillow, etc.
Somewhere in the middle of that chaos, the relief nurse tried being friendly (?) and asked where I had been for the past few days because she was looking for me, she liked working with me. I told her that I had had a few days off. Curious.
They also had to float a nurse today, mid shift, to another unit. I volunteered, figuring I would get a break. The charge nurse quickly approached me and informed me that they were keeping a log of who floated, to be fair to the travelers, and since I just floated, it was the other nurse's turn. I accepted this, thinking, how nice, they are really looking out for me. I get one patient for now, have time to catch up and I don't have to do the undesirable float to another unit at 4pm. Even more curious. Well...
Once the above was all settled via the worst report I've ever given and received in my life, I got to some charting. I was catching up and it was almost 5pm at this point. A nurse came over to me and handed me the report sheet that we have to fill out at the end of the shift, asking how many I had to fill in. I said "just one for now" Well.. The relief was in my face again, urgently, saying "your patient in room 76", "yours", "check on him." I repeated that she confirmed that I had one patient and asked if this 76 had been here since 4pm and I was just finding out about him at 6pm (not unheard of). Turns out he was just arriving and that same nurse who asked me how many patients I had to write up a report on was getting report, saw me in the door and said "Sorry man" and left the room. Are you kidding me?!?
I took report and felt myself icing over. Graciously, this man was uber independent and didn't make any requests of me. His vital signs were stable and he had zero family members with him. MVP if you ask me! He was seated in the chair, eating dinner and watching television. I sat down to chart on ANOTHER patient for the day. I was exhausted.
There was another patient-to-be coming my way but that never happened before I left for the day, surprisingly on time. I don't know if I didn't chart everything I was supposed to or just rage-charted and blocked everyone out in the meantime, but how unsafe was that? Take it like a good girl, you are just here to help, traveler. "We like you." BS.
I need my trip home now more than ever.
In my last two days, I was shown mercy. My patients were somewhat difficult but there were only two of them. And at one point, I had one and she was so independent that she would unhook herself from the monitor, go to the toilet and re-hook up when she returned, reporting to me about her bathroom trip so I could chart accordingly. I guess we are friends again, Kaiser, but that was a mean trick to play on me the other day. A mean and unsafe trick.
With little chaos, I was able to squeeze some information out of the charts and piece the puzzle together, with a giggle and a smile.
These kinds of orders make me smile. Not only was this an issue, a doctor had to be involved and write this order. C'mon people:
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| "OK to chew gum" |
And
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| I was able to catch the sunset and the city in one of the empty rooms in the ICU. Pretty. A moment between the chaos giving me hope of a light at the end of this tunnel. |
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After the above situation, I spent a lot of time in my kitchen to de-stress, not eating but planning on it. I prepared for my Paleo Thanksgiving Dinner. I was also finally able to watch Gone With The Wind and The Birds, to get me in the spirit. The only thing missing was the Three Stooges marathon!
I made crab stuffed mushroom appetizers, cranberry sauce, turkey, stuffing (no bread), and sweet potatoes.
Cranberry Sauce
Yams or sweet potatoes or whatever
Stuffing (no bread)
My very first turkey, hurrah!
And Pumpkin Pie with nuts as a crust
By the time I tried everything else, I had no room for pie so, I did what any logical person in this situation would do. I went to bed on a full stomach and woke up to have pumpkin pie for breakfast. Delicious!
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For our final act, Michelle, Bryan and I wanted to revisit The Stinking Rose for dinner. They packed all day and met up for dinner the night before they left. Visibly, they were exhausted so I am honored that they sucked it up, drove to Beverly Hills for the night and spent some time before leaving California. Good luck in Colorado and come back and visit guys! It's not goodbye, just we'll see you soon, right? Right.
In the middle of all of this I have been reading this book that seems kind of cheesy but I would recommend it to you, any one of you. It was recommended to me by a friend. It's called The Five Love Languages.
It really breaks down how you give and receive love best personally and can improve your relationships. I learned a lot about my family and also my friends and have tried speaking these languages with much success. Otherwise, the book talks about miscommunication and an empty "love tank" like a gas tank, that ruins relationships. I think mine is bone dry at this point. I am really looking forward to getting home, spending time with REAL people and filling my tank back up. As well as my belly with some Thanksgiving feasts.
See you very soon!
XO
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