full speed ahead

first things first:
happy birthday mom! turning 29 again, huh? we’re almost the same age!!

faux friday!
i have a long road ahead of me today: morning clinic and then a 3-11 ER shift. but i am definitely not complaining — this is the end of my two-day work week already. and i’m loving it. this week (and upcoming weekend) is like a mini-vacation built right into a regular rotation! weeee!

yesterday’s ER shift was fine, but not great. i feel like i kept a really positive attitude, which was good; however, i was faced with my fair share of challenges, both from the patient and nursing ends, and that was frustrating. my first patient of the day was a very healthy-looking 2 year old who was brought in because ‘she’s had a fever for 18 months.’ no fever in the ER, of course. we looked for any obvious source of infection or disability, but the strapping young toddler was clean as a whistle and we sent them on their merry way.

next came a young teen who had been in a bike accident the day prior, and his mom was demanding CT scans and X rays. on exam, he had a tiny scrape on his knee and some muscular back soreness, but that was about it. note to patients wanting lots of scans and things done: if you come to the ED the day after your accident, we are not going to be too worried about you. most of what is bad (head bleed, broken bones, etc) would have already gotten much worse, and most likely you would have been brought in much sooner. anyway, this would have been straightforward except that mom was very confrontational, yelling at me, the nurse, and then even the attending (at least she didn’t discriminate!). he went home with some motrin. an anger management referral for mom was also in order, but she was not our patient.

then things started heating up with an appendicitis (i think — will have to check out the op report today; i left as they were wheeling him to the OR!) and a baby that i had to spinal tap. for some reason, even though i felt like i was trying to be very nice, the nurses did not seem to be on my side. i got snapped at for asking someone to hold for the lumbar puncture (what?? i can’t help that it needed to be done!) and then again for not allowing the appendicitis patient to have tylenol, because surgery told me not to give it to him, since they were about to take him to the OR.

our conversation went something like:
ED nurse: can he have tylenol?
me: um . . . well, he’s NPO and honestly the cure for his fever will be getting that appendix out! let me ask surgery if that would be okay since they’ve already accepted him as their patient.

i call surgery, and they tell me ‘no, but start some unasyn.’ okay, then.

ED nurse: tylenol? he’s 39.6!
me: no, i’m sorry — surgery said no. um, we could give PR? (PR = per rectum)
ED nurse: continues ranting. i can’t BELIEVE we can’t give tylenol! we ALWAYS do that! i am NOT sticking tylenol up an 8-year old’s butt. YOU can give PR.
me: um, no, actually i’m leaving.

(and i did. it was the end of my shift. and surgery was coming to get the kid imminently).

not a particularly sweet note to end the shift on, but i feel like i didn’t deserve the hostility that i was getting. i know there are some nurses who read this — please, any tips? i really am used to having a great relationship with our floor and ICU nurses and i don’t know what’s going on here.

sultry affair

yesterday = 78. i was getting used to prancing out the house sans coat. the rest of the week = yuck. i guess that was just a little taste of what’s to come. mother nature is such a tease! the spring fling was fun while it lasted.

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3.11.09

workout: XT mixup! i did 20 minutes on the elliptical (levels 9 – 11, average HR 175, max 188) and then 20 on the upright bike (levels 3-4, average HR 182, max 189). i may be able to pound out miles on the road, but i do not have biking strength! the muscles used are completely different and i am amazed at how hard a workout i get on relatively low-resistance settings.

i also did yogadownload‘s 30 minute intro to yoga session again. it’s all doable for me except the plow — a move which actually makes me nervous about the safety of the c-spine. i am being extra careful when i do that one!

doin’ time: it was strictly a leftovers night, but we did enjoy some awesome seasonal dessert:
i absolutely have to have one every year. so sticky sweet, yet so good. that faux-yolk center gets me every time.

reading: 30 minutes reading about some cases in peds in review, plus some PREP questions during some down time on my shift.