ICU/IMC/9East?!

I've only been an RN for a year plus-a-few-months, but in my short experience on an acute care floor full of potentially non-acute patients, I have never seen a physician make a decision to transfer a patient to a higher level of care without nursing pestering them (for hours) about it first.

Why is that? Why does it take multiple phone calls, the critical response nurse, the charge nurse, and the floor manager to convince the doctor that someone with consistently critical potassium values for 48 hours might despite constant IV replacement might (read: definitely) need to be on telemetry? Why is the resident not concerned over the fact that my tachycardic hypotensive patient has had ZERO urine output in the foley since the night before? Is it not obvious that the patient floating in a lake of her own blood every hour with the most whacked out labs of all time requiring constant transfusions might need to be on a floor where the nurse doesn't have four other patients to take care of?

I can think of a few patients in particular who we got transferred to the IMC after hours of paging, re-paging, arguing, and putting all my other patients' care on hold, and in every single one of those situations, those patients ended up spending weeks in the ICU.

One of them is still in the ICU.

When I started I didn't have the confidence or the experience to tell these reluctant docs that I disagreed with them. I would have thought that they know better, and if they think this patient should stay on our floor, then the patient should stay. Now thinking about the handful of way-too-sick-to-be-on-our-floor patients I've dealt with, and how taxing it has been to get them transferred no matter how obviously necessary it was, I am wondering what would have happened had nursing taken the lazy/passive route during those shifts.

I don't say this to throw our doctors under the bus. We have great doctors where I work. Wonderful, smart, great doctors. I'm not saying they should just know when the nursing care involved becomes too much for a nurse taking care of 5 patients. How would they know that unless we speak up?

...But really? Why am I the only one concerned about these un-replaceable critical chemistries?

Are patients only considered critical once they are arresting from their critically low potassium levels? Because it's going to be harder to call you and have a conversation about this when I'm doing chest compressions.

Beginnings

This time last year I was mourning the loss of the ever familiar first-day-of-school. And it wasn't just the first day of school, it was the long, painful walk home from the Co-op with 900 pounds of books, the new box of pens to replace the 50 new (read: lost) pens I bought last semester, the confirmation that, indeed, no one else did the "pre-reading" either, the first-day-of-school drinks downtown, and the first-day-of-school hangover. This time last year, I was missing what had been.

And I struggled with life and my new place in it.

Even now I still mentally break down my calendar year into semesters, which doesn't make any sense considering my schedule couldn't be more unfitting. I'm more likely to be working during typical "break" times, and I'm most likely off when the rest of the world is working. Christmas break might only consist of two days off near-ish the holiday, but on any random week I might be off for five days for no good reason. There are no more definite "starts" and "stops" during my year, which I originally thought would make for quick burn-out and time that stands nearly still. In reality, though, the past year couldn't have passed more quickly.

Some things changed.

And others never will.

There have been new adventures.

And time to do things simply because I want to do them.

I'm not sure at what point I will stop considering September to be the start of a new year. Until then, cheers to the past, present, future, and the lovin' from the oven I plan to bake all day tomorrow.

I've been very judge-y today. I get very judge-y when I drive and when I go to the grocery store. Particularly HEB. Is there anything more annoying than HEB? Particularly, the people (zoo animals?) in HEB? Anytime after 12:00 noon is a bad time to find yourself in that store, but precious kitty needed her precious kitty food this afternoon. A few things:

1. Now, exercise is hard, but I have confidence that you can huff and puff your way across the parking lot aisle to get your cart out of my now-ruined parking spot.

2. Stop listening to your i-pod. It makes it difficult for you to hear me growling while you daydream your way down the aisle in a zig-zag pattern.

3. Why don't you go ahead and touch all the apples before you put two in your little baggie? Maybe you should lick them, too. I want to bring as much of this moment home with me as possible.

4. I'm sure you mean well, cute-old-lady-on-a-motor-scooter, but those were my ankles you reversed right into. Check that blind spot.

5. Control your children. Tranquilize them as needed.

6. A pre-requisite for using the time-saving self-checkout is knowing how to use it. The trick is following both the spoken and written instructions, but maybe that i-pod blaring into your ears is putting you at a disadvantage.

And, finally,

7. If you want to take my parking spot as I get the hell out of there, it's courtesy to leave enough room for me to avoid pulling an Austin Powers as I get the hell out of there.

In other news, I saw a former patient during this HEB adventure also. We made awkward eye contact, and it's been driving me crazy since then trying to remember what he was admitted for. I still don't have the slightest idea, but I do know that I didn't like him.

I'm full of sunshine-y information today. Honesty is a virtue.

Actually I guess that's supposed to be "patience" is a virtue, but based on everything I've just said I obviously have none of that.

Happy Saturday! Or Tuesday for those of you with normal jobs and lives :)

I don't have many words. My mouth is too full of these cookies for words.

(...and my hands are too full from holding them to type...? Or something).

Actually that's just an excuse to save time because uploading the pictures took a l o n g time. I am not eating these right now because I nearly made myself ill off of them yesterday.

...But there's always tomorrow.

Mix the dry stuff.

Add some softened butter and an egg. Mix on low til it turns into dough (rhyme).

Make balls. Smoosh them.

Take them out right after they've cracked on top. Cool em off.

This filling, ladies and gentleman, is SPOT ON for oreo filling. I was grossed out by the need for shortening, but luckily I'd already spent too much money on organic-y non-trans-fat-y shortening the last time I crossed this bridge. And, in this case as well as the last one, it's completely necessary for texture.

My professional pastry bag.

Organization my dad would be proud of. I'd already smooshed the first 3 pairs together before I remembered to take this.

For the win.

The recipe is from Smitten Kitchen, and the recipe is here. I made mine smaller than hers so they'd be more true to regular-Oreo size, and I ended up with about a million of them. Half a million got sent to Julie to aid in her survival of med school, half a million went down my throat yesterday, and the other half million (?) will keep me happy for the next few days. Milk is a must. You need these in your life, trrrrust me.

"Can you believe this cake is gluten-free, sugar-free, egg-free, and it contains no dairy products?!"

...Well, I guess, but I'm not sure I want to eat it after that stellar description.

I'm not ragging on people with allergies and intolerances. I think it's great that someone's figured out how to make food that resembles the real deal without using, well, any of the things that define the food in the first place. Kids with celiacs can have a birthday cake? Rock on. I love it.

But as for everyone else - really? You pureed black beans into the brownies? You spent 900 dollars on obscure flours? And 900 more on a whole bag of xantham gum you're going to use once to hold the obscure flour concoction together?

If you need some extra fiber in your life, eat a salad. No one wants black beans in their brownies.

Good talk. See ya out there.

An addendum to yesterday's bitterness:

0500, my phone rings, I jerk awake thinking they're calling to tell me I screwed up my clock re-set and am now late for work.

"Kristin? We're canceling two nurses, you're first up."

"Yes."

"Go back to sleep."

At least, those are the highlights I remember from the conversation.

Zilker Park Kite Festival? Town Lake? Yes, those things sound appropriately opposite-of-work.

"Are we being too literal?"

"No you fool. We're following orders. We were told to comb the desert so we're combing it."

Anyone? Anyone?

There was a period of about two years (circa 1996-ish?) where I would watch that movie with my best friend every single time I went to her house. That is, after a few rounds of The Addams Family board game. It never got old. It still hasn't.

The movie, that is. It was on TV today. I can't vouch for the board game. Although if I learned anything from nannying last year it's that no board games are fun. Wah wah wah.

Tonight at 2 AM our clocks move forward just to piss me off, I'm convinced. As if 5:30 doesn't come soon enough already. I set my clocks ahead on my microwave and stove this morning to try to trick myself into going to sleep early tonight. We'll see. It's a pretty sweet deal for night shift. I, too, would like to "spring forward" in the middle of my shift.

Other happenings:

1. Kori and Adam's wedding is going to be perfect. I can say that because I know what the cakes are going to taste like.

2. John Mayer continues to be perfect. I can say that because he sang me a few songs at the American Airlines Center last week. No big deal.

3.