There Just Really Is No Substitute

You know, it’s amazing the things that modern medicine can do. Lungs don’t work?  We can put you on ECMO. Can’t eat? Can’t digest?  We’ll just administer TPN right into the blood stream, you know, cut out the middleman.  Pancreas doesn’t work? how ’bout some insulin shots? Kidney’s don’t work?  No problem, we have dialysis.  Liver doesn’t work? We can… actually I don’t know what we do for people in liver failure but I’m sure there are treatments, and when those don’t work anymore we’ll just get you a new one.  Same goes for kidneys, heart, lungs, pancreas, corneas, and more. And that’s just the beginning.  Have a headache? Take some Tylenol.  That doesn’t do it? Try some Advil.  Maybe some Excedrin.

It’s truly astounding.

BUT (There just had to be a but didn’t there?) none of it really works quite as well as a body that just works.  ECMO is very temporary and occasionally results in insufficient blood supply to the brain as well as kidney failure.  TPN is hard on your liver and it doesn’t take too long until the problems outweigh the benefits.  Insulin?  Again I’m not that up on diabetes but the mere fact that you have to give yourself a shot every day, sometimes multiple times a day, sounds like enough of a drawback to me.  Dialysis is amazing but it’s time consuming taking sometimes several hours three times a week. And then for those who go the transplant route there’s always the chance that they won’t get an organ or that they’ll reject despite the anti-rejection meds that they have to take for years on end and the risk of infection and… Even Tylenol and Advil take their toll (on the liver and kidneys respectively).

So what it all comes down to is that our bodies are amazing, they can do amazing things, and they’re unbelievably complex. And I’m dang glad mine works as well as it does.

Howling at the Moon

Was it a full moon last night?

I’m not really a superstitious person.  Part of me would like to be but it just doesn’t work out with enough consistency for me to really get behind it.  (Now if someone who broke a mirror really did have seven years of remarkably bad luck that would be a different story, but I’ve broken mirrors and I don’t think my luck is really much worse than the next gal’s.)  The full moon thing though, that may be a different story.  Really, most of the worst nights at work that I can remember were full moons, the very worst one was a full moon and Friday the 13th.  I’m not kidding.

Regardless, last night was crazy, absolutely insane, but when it finally calmed down (about 4am) and I got a chance to sit down and chat with some of my coworkers, Racheal, my nurse  every Wednesday night, and good friend, said, “I love working with Alison because the crazier it gets the happier she is.”  And you know what?  She was right.

I’m not be superstitious but I am a firm believer in the principle that when it comes down to laugh or cry, you might as well laugh. And up until last night I thought that that was about all there was to it, that was why I always find myself smiling and laughing and call the bad nights the “best night ever” but I realized last night when I was in the ICU getting ready to do life saving surgery, about ten minutes after helping do compressions on a different patient in the OR, that that wasn’t all there was to it, that this is why I do what I do.

Coming to work and taking out appendices all night is fine, it’s important work, it’s work that has to be done and it puts food in my kids’ mouths.  But it doesn’t really get the blood pumping.  Having everything the surgeon needs, even before he knows he needs it, on an elbow pinning is great, but it doesn’t leave you with the sense of accomplishment that having what the surgeon needs before he knows he needs it when cracking a chest does.

Sure, I love a quiet night.  I’ve mentioned before that every once in a while the stars align and I come in to work and do absolutely nothing for twelve hours, and I love that.  Don’t get me wrong I really love that.

But if I can’t do nothing, give me something to do, and make it a big one.

___________

P.S. Both patients lived and, last I heard, were doing very well.

So Sue Me

This is a repost.  I know I haven’t been blogging much lately and I have no excuse other than I just haven’t felt like it.  But I was thinking about this post the other day and since we’ve already had two of these this year I thought I’d give you your annual dose of serious depression.  Sorry about that.

No, actually I’m not.

Warning: This is NOT a humorous post. You will not come out of this one laughing, you probably won’t even be smiling.

About a year ago I walked down a hallway carrying a fourteen-month-old baby in my arms. A baby who would never get a day older. This sweet child was dead and I was taking his body to his mother.

It’s a sad story. The saddest part is that his death was totally preventable. He was run over by a family member in his own driveway. This man had simply not seen the child and backed his truck right over him.

I’m not trying to lay blame. If the glimpse I got of this man in the aftermath of this tragedy is any indicator, he’s laid enough blame on himself to last a lifetime. I’m just trying to… raise awareness, I guess.

Every spring and summer the company I work for, in conjunction with several other corporations in the area and across the country, runs a campaign called Spot the Tot. The idea is very simple. Walk all the way around your car before you back-out.

I know, you’re tired and harried and it’s hot and you’ve just buckled 87 children into various car-seats and boosters but it’s that 88th kid, that neighbor kid, that kid who came over because he heard your brood outside and he’s looking for someone to play with, who’s going to be where you just can’t see him.

If you’re lucky enough to be going somewhere without your children make sure that they didn’t follow you out for one more kiss before you drive off. (Also, if your children are anything like mine you might find that walking around your vehicle that one extra time saves you from running over a bike or scooter, or doll or what have you, more than once this summer.)

There are lots of other common injuries that I could warn you about. I could tell you not to let you underage kids ride four-wheelers alone but I’m afraid I’m fighting a losing battle on that one. I could tell you to be so so careful with your lawnmowers but I’m hoping none of my readers are dumb enough to let your kids ride on the engine block while you mow. (Yes, it happens. No, it’s not the only way kids get injured by mowers and you do still need to be careful because lawn mowers do not make for pretty injuries and they often result in amputations.) But these injuries are not as frequently fatal and to my mind the are somehow slightly less… tragic? Senseless? (I’m not sure what the word is and I’m not sure why I feel that way. I’m sure I wouldn’t if one of these others happened to my kid but there you have it anyway.)

I could tell you to get one of those safety-net things for your trampoline or better yet not to have one at all but the fact of the matter is, I think breaking an arm or two is almost a rite of passage for a kid.

It’s the things that stop passage that haunt me. Please, just be careful.

Happier posts to follow, I promise.

A Post About YOU! Oh, No sorry, That’s U.

My very dear bloggy friend bythelbs did a letter post.  And then she asked if we all wanted to do letter posts too and being the sheep that I am I said I did.  So she assigned me a letter.  The letter U to be exact.  And while coming up with ten things I like that start with the letter U may not be the easiest thing I’ve ever done it is, well… Oh enough with the intro already.

Underwear.  Or unders as we call them here in the Wonderland.  Because once one of the Wonderkids is in unders that means that they’re not in diapers anymore.  And that makes us all happy.  (I’ll also include here Underoos.  if I had a scanner I’d insert a great picture that I have of myself Christmas morning of probably, 1982ish, in my Wonder Woman Underoos that I wore daily everywhere I went.  Sadly, I don’t have a scanner so we’re going to move on ok?)

Ukulele.  Actually, I really am a legitimate fan of the ukulele, my dad has one, has had my whole life, and some of my fondest memories of my childhood are of nights that he would get it down and play it.

Oh and here’s a youtube video of a guy playing “while my ukulele gently weeps”.  Because who can resist that? 

Umbrella.  I love the rain.  I grew up in a land of frequent, amazing, violent storms and I always loved them.   Which makes the fact that I live in this rain forsaken desert (except for last week) all the sadder.  I miss my entire summers of “hazy hot and humid with a chance of thundershowers later in the afternoon.”

Urgent.  It may be a little bloodthirsty of me but I love a good emergency at work.  I like the adrenaline rush, I like the feeling that what I’m doing actually makes a difference, I like knowing that I’m doing what I do better than I did even six months ago; and I don’t really get any of that taking out tonsils.

Upside-down.  I like to see things from a different perspective.  Some of you may have seen pictures of me at the top of the Stratosphere in Las Vegas (heck, some of you saw me there in person) and while I was there, this is what I did. I know the two pictures look almost identical but if you look closely (at anything other than me) you’ll see that they’re not.  It’s just that I spent most of my time there in that position and I could have stayed there all day.  It was the whole city from a new angle.  I love that.  (And yes, the little sign next to me does say “Do Not Lean On Glass”  I wasn’t leaning on the glass I was leaning on the frame.  Give me a break will ya?)

Ubiquitous.  Because who doesn’t love Angela Lansbury?

Uniform.  Because who doesn’t love a guy in uniform?

Oh wait…

Underdogs.  I know it’s not PC but I can’t help it,  I grew up in DC, I’ll always be a Redskins fan.

Urban.  I’m a city girl.  I”ve never ridden a horse or touched a cow and I’m not that sad about that.  The smallest town I’ve ever lived in was Provo and I’m gonna be honest, it kinda freaked me out (that may have been more about the fact that it was Provo than the size of the town but be that as it may…) My in-laws, a lot of them, are small town people and I think that’s great.  But I just can’t function properly in a town where the only pizza place is closed at 8:05 on a Saturday night. It’s not that I’m going to order the pizza,  I just like to have the option.

Uh.  I give up.

In Which Alison Chooses an Alternative Lifestyle

That’s right.  You saw it here first.

For those of you who know Sean and me you’ve probably figured out that he’s we’re not the most … conventional couple to ever call themselves Mormon.

We do have four kids but I work full time.  And I love it.  And while Sean does work full time, he’s not the primary wage earner (I make more than he does) and he’s not a typical guy.  He’s not ambitious, he doesn’t define himself by what he does.

Over the last several years Sean’s been going to school and I’ve gone to school and we’ve had many many different plans for our life.  But the plans have always culminated with us being more conventional.

Who were we trying to kid?  We’re just not that couple.

So we’re embracing the alternative.

I’m currently a surgical tech, (and as I mentioned before, I love it) it’s the classic, surgeon asks for a scalpel and I’m the one who hands him the scalpel (as a point of interest I’ll tell you that they almost never actually ask for a scalpel, although I do have one who asks for a slashing instrument) and depending on the case and on whether there are residents around I often get to assist in surgery.  It’s so cool!

Unfortunately, it doesn’t pay all that well.  And I’ve reached the top of my ladder, so aside from so called “cost of living” increases, I’m never going to make any more than I do now.

Did I mention that I have three sons.  In a row.  And they’re little now but they’re going to grow and they’re going to be teenagers.  All at the same time!

So, I’m going back to school.

It’s going to take a while (three years would be the absolute best case scenario but that’s going to school full time and that ain’t gonna happen anytime soon) but the plan is that when I grow up I’m going to be a nurse.  When I’m done Sean will still work full time and so will I, forever.

My mother was a stay at homer and that’s what I always thought I’d be.  It’s taken me a long time to come around to being Ok, even happy with the idea that I won’t.  (There’s a monumental paradigm shift that most Mormon girls need to go through to get there.)  But I am (happy that is).  In fact I’m starting to even get a little excited about it.

Probably, at least to begin with I’ll work in the OR (hospitals love new nurses who are already OR trained) but after that who knows!  I could do anything!  The world would be my oyster!

‘Cause ya know, things always go just the way they’re planned.   Or er, something.

Tell Me What You See

My kids have been sick all week.  I’ve had two of them puking and the other two have… had trouble at the other end.  But when I got up this morning I felt just fine.  I went to work, had breakfast, did my thing.  All was fine.

Unbeknownst to me, at about 8:00 this morning Katie* called in sick.  She was supposed to work form 11:00 am to 11:00 pm.

At about 9:45 this morning I was still ok.  And at 10:00 I thought I was going to puke.  I didn’t, but it was a close thing.

At 10:30ish I let the charge nurse, Jason, know that I wasn’t feeling well in the hopes that he could find something for me to do that I could do sitting down.  He couldn’t so I kept working.  I was sitting whenever possible and I was moving at about half speed.  But I was still moving so that was ok.  But I was feeling progressively worse.

At 2:00 I got my lunch.  I went and curled up in a chair and slept through the whole thing.

When I woke up and I headed back to the room I had been in the charge nurse, Jason, told me that he knew I wasn’t feeling well and that he was doing all that he could to get me out and hopefully send me home but I’d need to stay for a little while longer.  I thanked him for his efforts, went back to my room and finished up the case we were doing, at which point there wasn’t anything else for me to do immediately.  But I still couldn’t leave.

A little background:  The operating room is staffed 24/7 but the majority of the staff only work from 7am-5pm.  There are usually 6 or 7 techs and 6 or 7 nurses who stay until 7pm and then from 7pm – 11pm there are only two teams and after 11, only one.  In the event that there are more cases going on than we have staff for, beginning at 5:00pm there is someone on call.  In fact there are four people on call.  Any one of them can be called depending on the kind of cases going on but if they’re just “general” OR cases the call schedule goes like this: 1. general call (first call)  2. Liver call (second call) 3. Neuro call 4. Cardio-vascular (CV) call.

Today I was one of the 6 or 7 who was supposed to stay until 7pm so even though I didn’t have to be in a room at 3:00 I had to stick around because the way the day was going they were going to need me to be there at 5:00.  And it was only because Jason, the charge nurse, is a super nice guy and took pity on me that I didn’t have to go in a room at 3:00.  So I sat at the front desk hoping that things would work out so that I wouldn’ have to be there at 5:00 and getting progressively sicker, until about 4:00 when I hit the junkie, I’m so sick I can’t even stand to be in my own skin phase, when it became clear that I was not going to be going anywhere but to an OR at 5:00.  Oh and I was not going to be going anywhere at 7:00 either.

Remember how Katie called in sick?  Well, they couldn’t get anyone to cover her shift which means that the person on call has to cover it.  Pam was the girl on call.   But if Pam’s covering the shift who’s covering her call? Remember our list up there?  It’s liver call.  I was on liver call.  And there were going to be a lot of rooms still going at 7:00.

Realizing that I was stuck my first impulse was to see if I could get someone to cover my call.  I made one call and during the course of that call was reminded that everyone had already been called when they were trying to get the 11-11 shift covered.  I was not going to be successful.  So I went to plan B.  At 4:00, with an hour to go before I was going to have to scrub in I went and found one of my doctor friends and told him of my plight and he administered drugs. (Sometimes working in a hospital is fantastic.)  He gave me some Zofran (pretty heavy duty stuff) for the nausea and and IV to rehydrate me and take away the junkie twitchy feeling.  At that point I looked like I was going to be there until about 9:00 and the doctor assured me that I would be feeling fine soon and that the effects would last at least that long.

So I slept sat for an hour in a quiet room with the magical elixir dripping into my arm and at the end of the hour did I feel better?  NOT EVEN A LITTLE BIT.  I still felt absolutely awful.  But there was nothing for it, I pulled out the IV, scrubbed my hands and went to work.  Very, slow quite ineffective work but work just the same.  As I finished the first case the doctor I was working with, who’s also a good friend of mine, commented on how bad I looked (I looked bad enough that that kind of comment was completely acceptable).  He even went and gave Jason a hard time, telling him to get me out of the hospital.

A little more background: I DO NOT TRY TO GO HOME SICK.  EVER. I do not complain about being sick at work.  I have been through two entire pregnancies since I got my current job and I didn’t make a peep.  Not one.  I worked straight through from conception to delivery twice and missed maybe maybe a total of 3 days.  Does that give you a little better concept of how I was feeling?  I also hate HATE hate to inconvenience people.  I will go a long long way out of my way to avoid getting in yours.  I regularly stay at work late so that they won’t have to call the call team in because I know that that is inconvenient.  I just really don’t want to be a bother.

Jason wanted to get me out, the problem was that he already had General call, Liver call and Neuro call there along with one or two people who weren’t on call but had agreed to stay and help out.  There were 5 rooms going.

Finally, after getting a hard time from my doctor, and there may have been some tears on my part (not directed at Jason, he was doing his best and really I felt bad for causing him more problems) because I just felt so awful, he called Richard who was the tech on call for CV.  As soon as they told that he was on his way I felt better, a lot better.  Not, “I’m going to hit the gym on my way home from work” better not even “I think I might eat again this week” better but definitely”if I had only felt this bad all along they wouldn’t have had to call anyone in for me” better.  I even felt a little guilty that Richard was coming in.  Not quite guilty enough to call him back (he was already on his way after all) but a little bit.

Unfortunately Richard is a little bit of a prima-donna and he was not happy about being called in to let me go home just because I wasn’t feeling well.  In fact, as soon as he got to the OR he was working on finding a way to not have to get me out, trying to shift people around, shake things up, and just generally work it out so that he wouldn’t have to work.  For ten minutes he did this.

And then all of a sudden they called out of room nine.  The case they were doing, the easiest, teensiest, nothingest case going in the whole OR had gone badly, really badly, this complication has never ever happened before kind of badly, and they needed to open the patient’s chest immediately.

That’s what CV does.  And only CV does it.

Richard wasted no time, he ran back to room nine and immediately started grabbing supplies and setting up for the case that they were now going to have to do.  And there wasn’t one other person in the OR who would have had any idea of what to do.

If I had felt any better, even the slightest bit better, I would not have cried and I would not have looked so awful that my doctor friends were offering to write me notes and Richard would not have been there.  If I had not felt as awful as I did, despite the drugs, rest and fluid that I had gotten, Richard wouldn’t have been there.  If I had found someone to cover my call or if they had found someone to cover the 11-11 shift, Richard wouldn’t have been there.

My religion teaches a lot about free will.  And I absolutely believe it, no one can make me do anything.  Including God.

But I wonder if sometimes He goes out of His way, maybe a long way out of His way, to make sure things turn out they way he wants them to.

Or maybe it was a coincidence.

______________________________________________

* All names have been changed.

My Job Makes Me a Bad Person

In the past when I’ve mentioned my job here I’ve gotten lots of kind comments about how great my hospital is (and by extension, I am) and I’d love to let you all continue to believe that.  But it’s not true.

Take your work for example.  Now I know that most of you are stay at home moms.  But I also know that that is still work (in fact, it’s a heck of a lot harder than the stuff they pay me for).  So you’re at home and you’re moming and you think that there’s a chance that your kid might be getting sick.  Now, we’re going to take emotion out of it, I know you love your kid and you don’t want them to be sick because you love them, but we’re not talking about that here.  You don’t want your kid to be sick because that makes a lot more work for you.  So their not being sick is good for you but if it works out the way you want it to that’s good for them too.

And if your kid is going to get sick, you’d prefer it happen during the day.  Who wants to have to stay up all night with a sick kid?  But that doesn’t hurt the kid.

And if your kid does get sick and starts puking you want them to hit the toilet rather than the floor.  It doesn’t hurt them one bit (although it doesn’t really help either) but it’s less work for you.  It’s ok, you can admit it.

But then there’s me.  To begin with I’m right there with you.  I’d prefer that no kids got sick ever. (Although that does bring up some job security issues.)  But after that, I’m a horrible person.

I work two night shifts a week, as I’ve had occasion to mention before that I’d prefer to not actually work while I’m at work so if a resident calls at midnight to tell us that there’s a kids with appendicitis in the ER it’s entirely possible that I’m going to encourage them to wait until the morning, the actual morning, to take out the appy.  That means that that poor kid will sit there, in pain, for an extra few hours.  I know this and sometimes it even makes me not try to get them to put the case off.  But I always want them to.

I get worse.

I’m on the transplant team at my hospital.  This means that every Monday and one weekend a month I’m on call and if we have a liver transplant I have to do it.  Putting in a liver takes a LONG, LONG time, a sometimes 12+ hours kind of long time.  So when they call me to tell me that we have a possible liver (all livers are only possible livers until the recovery team [don’t think too much about that] gets in there and sees the “new” liver to see if it’s going to be any good) I find myself hoping that the new liver won’t be any good and that we’ll all get to go home.

THAT’S AWFUL!!  We’re not just putting that case off, we’re canceling it which means that that poor kid is going to sit around with liver failure some more just waiting for a new liver.  Do I need to mention here how many people die waiting for transplants?

Now that you’re thoroughly disgusted with me, let me make it clear that while yes, I do encourage the resident to put the appendectomy off until I’m not working the next day, the resident doesn’t actually get to decide that, the attending does and they’re never going to put it off to convienience me.

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