I want to ride my bicycle…

I want to ride my bicycle…

But after reading a few of your blog entries, it’s also obvious you are fairly arrogant and self-important, and I’m glad I don’t work with you

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As amusing as this comment is from a recent poster, he does bring up a good point. When I talk about work, I am a miserable person and it puts me in a miserable mood. Believe it or not, you guys dear readers, know as much about my job as my parents do. Because I won’t let them ask me about work. Because when I talk about work, I turn into the little snippet quoted above. Not quite, but close enough. How would you like to come home and have conversations with me every day that were like my last post? I prefer to forget work as soon as I can after a shift, and getting things off my chest here is the best way to do that. BTW, if you don’t like it, no one is forcing you to read it. (And I never said anyone was stupid…)

I find it comical that the poster would find enough enjoyment in reading a blog by an arrogant, self-important stranger that he would waste time on more than one post. Just as I’ve got an interest in writing the blog, I suppose he’s got an interest in reading it, as do the rest of you. Well, maybe it’s for the better as he’d never get to the good stuff, like “That Sinking Feeling”.

Anyway, I guess the only solution is to ride my bike more.

Denial

What part of, “there’s a cancer eating away at your mother’s face” didn’t you understand?

I may elaborate more, but for tonight, this is all i can muster.

Who covers the ED when I’m at a code?

THis started out as a reply to a comment from the previous post…who covers the ER when I get called to a code (sorry about all the typos, I got a new keyboard that S U C K S):

Graham, It happened last night (weekend, night shift, floor codes, ER tanking). The senior FP resident is supposed to cover the ER when we get called away. last night I was finishing up a code in teh CCU, when the respiratory therapist got a phone call, informed me that there was a severe asthmatic in the Er needing treatment. Umm…hello, YOU are the therapist, shoudn’t you be running down there with me???

When I got downstairs, teh FP resident was sitting around the side where the resident’s admit from, nobody knew she was there, she didn’t ask if she could help, and the asthmatic patient was close to needing tubed herself.

i came close to givingg her epi just because the respiratory therapist was nowhere to be found. It was only because we have an incredible and motivated ER Technician, who is a paramedic STUDENT, who dug up albuterol from our ER and gave it to a brand new graduate nurse who is also a paramedic, and HE got the albuterol started.

There is otherwise no protocol in our ER for the nurse to start albuterol treatments.

It was a sucky night, my busiest night ever in terms of acuity. I think I saw about 36 patients, several critical, one flown out, one intubated, PLUS two codes on the floor. AT 6:20 AM I had another critical patient arrive. I mentioned ot the RT that he’d likely need BIPAP set up, and he actually said to me, “That will have to wait for morning shift.” I was apalled. All I would like to do is work in a place with competent staff. When the ER Technician/paramedic student is the most competent person I am working with, that’s really scarey. Someone could have easily died last night while my back was turned for just a second because we had only two nurses to cover all those patients.

My only savingg grace is that all my orders are timed…when the blood bank delivers blood before the nurse has even been back place an NG tube in teh GI bleeder, that’s scarey. It’s not the nurses fault, it’s the staffing. From 3-6AM the nurse supervisor actually worked in teh ER with us. it was great because she got to see us run a code, intubate a patient (with the student medic and the nurse-medic) and get her an ICU bed and out of the ER within about 30 minutes of her arrival. The Supervisor got to see how and why the ER can get overwhelmed in an instant.

BREATHE. <-- Perhaps it will be my epitaph.

A night like tonight

I’m not really sure how you describe it. I intubated 2 people. While I was upstairs, my partner downstairs intubated someone. AFter he left the night doc coded someone who died. I had a woman arrive from a nursing home that wanted no intervention and she died (why did she get sent?) None of this bothers me at all in an emotional way, it is what it is, and it’s a lot of fun (sometimes). So what made this night strange is the cluster of trying to intubate someone on the floor.

Before I tell you about it, I have a confession to make, you can call me conceited if you like. When I played soccer as a young one (from 5 to 18, competitively), I was pretty good. I had good ball skills. I knew the game. I could make space. I could cover players. I knew how to use my body to push people around without getting called. I could play with the boys or with the girls. I could score goals, I could play goalkeeper. My favorite memory was gettingg pulled out of goal to take a penalty kick, scoring and running back to goal. I would get extremely frustrated when our team did poorly and i used to wonder, even at 10 years old, how good the team would be if there were eleven of me and I played every position. I admit it, it sounds pretty stuck up. But that’s what I used to think. I felt that way tonight, in the midst of what should be highly trained medical professionals I had to be everybody…resident, attending, nurse and respiratory therapist.

On the floor in the ICU, I arrived to intubate a patient. By the time I arrive on the floor, the decision that the patient probably needs intubation has been made five to ten minutes prior by the residents working in the units. There has been some patient assessment, lab tests or catastrophe that leads them to the decision. They call a “code”, the operator overheads the code to the whole hospital. ON weekends and nights, the ED attending leaves the ED (even if there are 30 people in the waiting room) and goes to the floor, via the elevator, sometimes (if you’re me) getting lost on the way. SO, it’s not unreasonable to expect that by the time I get there, some basic preparation has been done. There are two intubation bags on each unit with tubes, stylets, handles, blades, etc, etc.

When I arrived at this particular bedside, the resident waited anxiously at the head of the bed for his chance to intubate. Suction was ready, but that was it. No bag valve mask, no tubes, no handles, no blades, no meds. The intubation bag wasn’t even there.

I handed over my “travel meds”, succs, roc and etomidate, to the nurse and requested that she draw up the etomidate and succs. A few minutes later (minutes are centuries during a code) she says, “we’ve already got versed drawn up, can we use that?” I’ll spare trying to describe my internal thoughts at this point. (If any of you have performed rapid sequence intubation, you’ll be rolling your eyes at this point as well. )

Me: “No, I prefer etomidate.”

ICU Nurse: “I’ve never heard of etomidate, do we have it?”

Me: “Yes, but I also brought some up with me, it’s in the box I brought.”

ICU Nurse: “Where is it, I don’t see it”

Me: “It’s in the bottle labeled E-T-O-M-I-D-A-T-E”

ICU Nurse: “Is this it?” -holding up bottle labeled E-T-O-M-I-D-A-T-E

Sigh. Meds are finally drawn up and given, I let the resident look and he TELLS me that he can see the cords, that he saw the tube go through the cords. I listen first over the epigastrum and immediately tell him to take the tube out. It was “in the goose”. SO now his O2 sat is dropping. I try to get him to help me bag mask ventilate be he keeps dropping, and finally had the respiratory therapist step in. We get him up to 100% and I look, and without any trouble, slide the 8.0 tube right through the vocal cords. I told the resident he just needed more practice, which is 100% true.

But really. It’s one thing to admit you can’t see any anatomy that you recognize. But to THINK that you’ve just put a tube between a set of vocal cords and instead put it into the stomach, well, that could kill a person. That’s why I’m there. I saved a life tonight.

The second code in the ICU that I also had to leave the ED for, was even more of a cluster. Fortunately, I let the hospitalist intubate and he did a great job on attempt number one. But the (young) nurse on this case also had trouble with the etomidate. She drew up 2mls of it, 4mg. Hmm. 4mg might be enough to put a newborn infant to sleep, but probably not. I asked her 3 times if what she was holding was the correct dose. Three times she answered yes and finally said the concentration out loud. Another nurse picked up the bottle and read the concentration and nurse #1 realized her mistake. In the end, I drew up the drug myself and we pushed it.
The respiratory therapist in this code was so excited that she was bagging about 60 times per minute. I had to ask her 3 times to slow down.

There were a variety of other head scratching things that happened in each code, but those were the major things that simply boggled me. If I wasn’t there, both of those people would probably be dead. You’d think that would make me feel elated, or that all those years of school were worthwhile, but really I just get annoyed at staff that seem inadequately prepared for their responsibilities. I put in the time to learn…why haven’t they? Sigh.

I ate about 3 chocolate chip cookies and a glass of wine when I got home. Somehow a bowl of quinoi with light soy doesn’t quite hit the spot after a night like tonight.

Tuesday night at the races…

Tuesday night at the races…


5/15/7

Only 5 women registered so they started us with the men. Two women registered with teh mens race so there were 7 of us altogether. Drafting off the men was allowed but we were scored separately. There were about 30-40 of us total, I’m not sure, I’m not good at estimating field size. I started off in the back and we were off. Holy cow. The first two laps were 27-28mph, and my quads were burning right away. AFter the 2nd lap i knew that I would blow if I tried to stay any longer, so another woman and I pulled each other for a few laps. We got lapped by the field and she jumped on and lost me, but shortly they dropped her too. So it was the two of us by ourselves for a LOOOONNNGGG time. I was pretty fried. Even though I tried to maintain a steady pace from lap to lap, I was very erratic in my speed. The front stretch is uphill into the wind so I was doing about 15-18mph on that part and still feeling like crap at the top and sitting up on the back stretch to drink some water. There were a few opportunities to draft that didn’t last long. Finally I looked up and there were only 3 laps left. The back half of the men’s field had just passed me so I jumped on and guess what… I was able to stay with them for the final 2 3/4 laps at about 25mph. it was a lot of fun to be in the draft and push myself to stay with them and know that I was able to do it.

Even though I felt worse than last week’s race and spent a large part of it riding alone, I can still see areas in which I’m improving…I stayed with the MEN this time for almost five full laps, 2 in the beginning and 3 at the end. 2 weeks ago, I couldn’t even stay with the women for 3 laps.

Tonight I was 6 out of 7, did 11.5 miles with an average speed of 19mph.

So I feel OK about the race, but it’s still a drag that there were not enough women to hold our own race. Hopefully next week.

5/8/07
I think there were 7 women in the field and we did a 20 lap race (10 miles). We started off fast – 24 mph. Wow, I was really impressed with myself. I settled in in the 5th position on the paceline and hung on my friend H’s wheel. She’s stronger than me so I decided my race strategy would be to just stay on her wheel. For five laps, that’s exactly what I did and the two of us cruised around with the other three women. it was exciting…10 laps of pacelining and feelingg like a real racer chick. I couldn’t believe it. The week before I couldn’t even stay with them for 3 laps. I was feelingg really good, not blowing up, draftingg well, etc. Then the group decided that H and I should do some work. I don’t really think they cared much, but they were worried that because H & I were new that we didn’t know how to pull through. So H pulled through and then sped up! I was pissed. She’s done way more racing than me, but all on mountain bikes. At least I know that you’re not supposed to accelerate when you pull through unless you’re deliberatly trying ot break up the field. I stomped on my pedals and accelerated from 22 to 24mph and felt my thighs burn. As I was doing it, the girl behind me shouted, “Stay on her wheel”. If I hadn’t stayed on H’s wheel, the other girls would have had to bridge the gap and been pissed at me. Although H never could have held that pace anyway.

So when she was done with her pull, it was my turn. I pulled for almost a full lap…too long. But I felt bad that I had drafted for 5 miles and figured I should try and help everybody out. When i pulled off, I dropped back in behind H, but i was really spent and I knew that I was falling back. I tried to stay on H’s wheel, but she was fallinng off as well. The I saw H look to her right, then her left, then put one hand up to her face. I knew what was coming. She blew a snot rocket right onto me. I screamed her name and she turned around to apologize. The three women in front of us just kept on going, oblivious to our antics and arguing! So I let H go and cruised solo for another 2 laps recovering. When the field of 3 lapped me, I hopped back on and was able to stay with them for the remainder of the race.

This was a fantastic race for me. I finished a solid 5th behind 4 really strong women, pacelined for 5 miles then was able to get back in the paceline for the last mile of the race. My average speed was 20.5mph! Holy cow!

Bike racing is getting to be a lot of fun.

🙂