A day without email

Soon, I hope to blog about the PICU conference I went to in Denver. But not tonight.

Today I came to work thinking that it would be a pretty easy day. Due to the crazy day T (who I precepted because her regular preceptor is off on medical leave) and I had had yesterday, I'd already arranged with the charge nurse to have a stable patient so that we could focus on charting and navigating the various computer systems we use. And the first ten minutes of report were going just swimmingly, when I got pulled to be in charge. Long story about specific precepting needs of a particular new hire. And we had two hemofiltration cases, one of which needed to have the circuit changed. Etc etc.

Crazy day. Three booked surgeries, two of which came to us. And two other surgeries that weren't booked for us, but that came anyway. One transfer out. Again, lucky that Tan Shaggy and NineYards (our new PICU medical director) were on.

Staffing the night shift was going to be tight. TL had already called a couple of nurses to see if they could switch off of Wednesday night to come in tonight. We had one taker, which was a relief. Then, AB, who was going to be in charge, called in sick. Not great news, but I wasn't about to argue with her, because she was clearly sick.

Finally had arranged everything. Had one patient that was trying to transfer in, but after consulting with Tan Shaggy, he recommended the patient to another facility. Lucky thing, because about 1745, the trauma pager went off. Bad news. Failure to fly (ICU code for fell out of a two story or higher window) toddler was coming in with bad neuro signs. The RT and I went down to the trauma room in the ED, and as soon as the kid rolled in, we knew he'd be coming up to our unit. I stayed to draw up intubation, code and sedation meds. When the kid was stabilized, the ED team took him over to CT, while I returned to the PICU and started getting things ready for his admission.

Again, lucky that MR was okay to take the patient. We gave RC her post-op, and started pulling things for the admission. Started prepping lines for art and CVP. ICP insertion and monitoring set-up. Ventilator. Miami J collar to change for the C-collar placed in the field. Primed lines of saline. Kid came up from CT, and we had trouble ventilating. Had to bag, with a fair amount of resistance. Pneumothorax. Chest tube set-up. And on and on.

I finally was able to step out and give the on-coming charge nurse report. Luckily LT had been team leader the night before, so she had an idea about most of the patients. By the time we'd finished, MR had finished up her part in the patient's care ... had gotten all emergent things done and given report to the on-coming nurse, and was finally charting all the fine details that hadn't been called out previously. When I went over to see how she was, she smiled up at me and said, "See what I'll do to get out of a boring spinal fusion?" I returned the smile and patted her on the back, and I was out of there.

The night air felt cool on my cheeks as I stepped out of the hospital gates. I felt jumpy as I waited for the traffic light to change. On busy days like this, it takes a while for the adrenaline to settle down. Finally, the pedestrian sign changed. As I was crossing the street, I suddenly remembered that I hadn't checked email once today. How incredibly bizarre.