Flags and nuts

Driving to work this morning, there was more environmentally-minded coverage of Russia planting a flag to claim seas under the north pole. And I was suddenly reminded of one my favorite Eddie Izzard clips ... "Do you have a flag?". I'll bet that Peter MacKay, Canada's prime minister, had no idea that he was echoing the standup comedy of a british transvestite of the executive persuasion.

Work today wasn't bad. At least at first.

But by 1300, we'd transferred two patients out, I'd given up my patient to someone else, and had taken over a doozy of a new admit, we'd had one child code and die, admitted two post-op patients, and taken another really sick heme-onc-er from the floor. It was ugly.

The patient I took over was a doozy, as I've said before. Late teen. Congenital hydrocephalus, ventriculo-peritoneal shunt with multiple revisions, and concerning mental changes overnight. They brought her down, and a neurosurgeon placed a ventriculostomy to monitor pressure within the brain, and drain exra cerebrospinal fluid. I took over just as he was finishing. Besides all the blood, the patient was just starting to wake up from the propofol infusion she'd been getting during the procedure ... and she was totally psycho. Speech was garbled. Wasn't oriented to time or place. Repeatedly asked for people who weren't in the room, despite being reoriented. Combative in bed. Agitated. Crying. Intracranial pressures in the 40-80's. Bullied the ICU docs (who were concentrating on the sick admit from heme-onc) into giving her sedation and pain meds. But still she didn't calm down for another hour or so.

When she eventually attained a restful state, I hd a little quiet time to catch up on her orders. Had to get the resident to change all her oral medicine to IV, since she was very lethargic, and wasn't following commands.

Then had to take my patient down for a CT scan.

Got back, and she went all nuts again. And really, I don't mind taking care of really sick patients. Actuslly, I relish it. But I am just not wired right to take care of patients with psychotic issues, the mentally disturbed, or gerontic patients.

CT results came back. Catheter not in an optimal position. ICU fellows wrote for a CT-guided angio. Luckily (for me, at least), there was already a procedure going on, and my patient would have to wait until after change of shift.

All in all, a brutal day. Had had plans to go out with some co-workers that night, but I totally bailed.

Instead, I came home and de-stressed by finding some of my other favorite Eddie clips available on-line. Caution, some of these clips are a bit more linguistically colorful ...
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Evil Giraffe
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