Get me through this traffic. My patient wants to get home.
I figured out that critical care nursing is like defensive driving. Defensive driving is defined as: driving to save lives, time, and money, in spite of the conditions around you and the actions of others.
We are nursing to save lives, time and money, in spite of the conditions around the patient, the reactions of a sick body, and others.
Getting the sick patient in an ICU bed is like merging a highway through a tollbooth. One lane is coming from the ER, one lane is trying to get in after decompensating on the floor, and one lane is trying to get in post-operatively from the recovery room.
The charge nurse is collecting tolls, and patient tracking is trying to direct traffic. The urge to move patients sometimes causes road rage.
The nurses are driving and we can’t give the middle finger to those blocking the box in the intersection when the light is green because we are too busy preventing a ten-car pile up on the side of the road.
It is not just about the movement for us. There are illnesses out there just waiting to cut us off. Sepsis is weaving in and out of traffic with it’s fast yellow car. It’s a high-speed chase and the bad guy ARDS is coming up on us in its blue sedan full of old school metal just waiting to ram us into the ditch. The dump truck filled with gastric content just flipped the bend and spilled the belly juice into the perforated bowel. The landscaper’s truck is spraying our windshield with the tiny rock clots of DVTs, and emboli are everywhere. The drunken sports car made out with the telephone pole and now we have a head on collision with bloody brains. Sometimes we get stuck in a bottleneck; this one-mile per minute stage two pressure ulcer is going to get worse.
We keep driving and nursing. We look ahead and see the crash before it happens. We drive to prevent accidents. Sometimes we have to take detours. Cruise control isn’t really an option. It’s a good thing we know our way around.
My Dad always used to tell me: Don’t crack my truck up.
I think I lost the time to write. After a while it all starts to type out the same way. My eyes still hurt. I wondered how long this has been going on, and then I re-visited my old blog posting and found out it has been a year of eye troubles.
Eye drops are the worse! I don’t like administering them to patients, but even worse is dripping them into my own eyes. The eye doctor says my eyes are dry, and recommended some over the counter drops. I have tried them all. My eyes are still red, itchy and irritated. They are worse at the hospital, by shift change it looks as if I had been smoking some funny bones on breaks.
I am not sure how my eyes can be so dry, I certainly do not lack any tears over the last few years. I will be crying more and more as I suffer through one paper after another—at school.
Turned on, turned off. That is my love light switch and my head is a big red ball. When it comes to love I am like the annoying family member that demands the trivial of the nurse, while the nurse is critically thinking about the large scheme of things.
If only I could apply those thinking skills to my life, I would be a shooting star that never burns out.
I need perspective and I am back to revise my own care plan. I am wasted in vulnerability, forcing small bites of nutrition into a mouth that does not desire food.
Life is demanding me to get organized and I am headed….To the beach!
I am up-to-date on my NIH, BLS, ACLS, and CEs. I will pack up the house and start moving tomorrow. I am going home.
Who is standing in the middle of these organs trying to balance the see-saw? That is the imaginary Mr Rational on the pivot, and he is a buzz kill.
My heart has taken over my prefrontal cortex. My frontal lobe has selective attention and there is only one thing on my mind. I am out of control and I like it.
And if I break my own heart while I wreck my brain: I work with stellar neurologists and cardiologists. I will take a full strength Aspirin, wrap myself in sterile gauze, listen to my heart tones and check my pupils.
ahahahahahaahaha #loveme #loveme
Where does consciousness live? In the Reticular Activating System!
The RAS runs from the lower brain stem to the mesencephalon and thalamus– to the cerebral cortex, it is a path between our lower brain and our upper brain.
It brings together a response to the outside world. It filters out stimulus that we do not need, and we focus on what we do need to pay attention to.
If someone tells me something I do not want to know about, I will say—I am sorry my RAS filtered that information out as unnecessary to my knowledge bank, please try again later.
I slept now I am awake! I am aroused and paying attention, thanks to my RAS.
I found something about neurology that I really like: pupillary response. I know I can’t be the only one out there checking out pupils. I do it to myself in the mirror all the time.
Let’s balance this blog out like the ironworker walk- stories high. When I think about how hard it can be to nurse, I will just remember: I can climb a clinical ladder, but I couldn’t climb up a beam and work.
Maintains is the name of the game here and I am cleaning up the shop. I am sweeping the floor and catching up with the shine. I am happy to see that some of my favorite writers are still writing, and I am super happy that Nurse K is off the private duty blogger jobber. I checked out Kim’s Change of Shift, and I might even go and read Grand Rounds too (is that still around?)!
It has been a crazy year! I missed nurses week, the respiratory therapists and the EMS weeks! We all have rough years, seems I am not the resilient cockroach I once was as a child: the bounce back is hard but I am ready to hop on the happy ball and get it together. I might even go back to school!
I skipped on over to a new job in neurology. I love the low ratio. At first I was thinking: this is a cakewalk, the patients seem hemodynamically stable, there isn’t even any ectopy on the tele monitors!
It is not easy at all, I soon found out why the ratio is low: The impact of the neurologically impaired is devastating. The emotional toll is high. I have never bagged so many bodies in my life as I have in neurology. I figured out that the comparison between ischemic stroke occurs more than the hemorrhagic but the big brain bleeders die more.
I know I won’t stay in neurology forever. I think it is a good experience and I will take the information and run away with it. It will give me some balance because I always said: it can’t be Afib, CHF, AMI forever. I will get back to the heart, eventually.
Speaking of matters of the heart: If you are an ironworker and stumble upon this blog which is probably not likely since I am guessing stumbling is not in your nature (thirty stories high) message me.