Sunday, August 15, 2010

Been a while.

It's been a while. There have been so many life changes, I can't even begin to start writing about them. Apologies to those who have left comments- when I write, I really like to spend time focusing on writing, and given a new job for both of us, a billion life changes, and a wedding to plan, I'm stretched thin.

Ok, the short version:

Will is now the CTO (chief technical officer) of a 3-D television company.

I just got my dream job, that I've wanted since I decided I was going to nursing school:
I am now working at UC Davis medical center in the Emergency Dept. We're a Level 1 Trauma center, which means: teaching hospital, sicker patients, and total insanity. Add the fact that the ED is moving to a 50,000 square foot brand new building in about 1.5 months, and there is total utter chaos.

Keep in mind I'm following HIPAA when I discuss patient stuff:

In the past month on orientation at Davis I've done CPR on about 10 people.
None of them lived.

I'm in process of filling out a ton of competencies. Our orientation binder is about the same thickness as an entire quarter's class. There are 10 new nurses orienting together, and I think they just added 5 more. There will be another 10 coming in soon.

As far as CPR and codes/determining death go:
The really cool thing is that not only do we use two different leads, we actually use ultrasound on the heart to see if there's any activity at all. If there is, we take a next step (still learning what that is, depending on the person and the attending physician's preference).
For those of you who may not know, in order for a physician to pronounce death, the patient has to have asystole in two different leads/EKG perspectives on the heart, which ensures that the patient really is dead. It's a failsafe. Using ultrasound is even more accurate. It's really cool how far they'll go to work to save someone.

I've driven a gurney at Mach 3 to the OR with blood dripping behind it a-la-Hansel-and-Gretel-trail, with a surgeon's hand in someone's chest holding their dissected aorta together while three nurses were hanging blood as fast as they could to keep that person alive. At least you can really say we tried. No, that person didn't make it.
The twisted thing is that all I could think about was BBQ afterward. I attribute it to the rib spreaders. What? I mean, I know, it's twisted. I warned you. This blog isn't always pretty, and we EMS folks are a little... different. Thank goodness.

I've seen someone pronounced dead after being coded for an hour. Asystole on two leads on two different monitors, ultrasound of the heart showed no activity. Full on "Time of Death: blah blah blah."
Somehow, a few minutes later, this person was in NSR (normal sinus rhythm: ie, their heart was beating. Normally. This kind of thing ONLY happens in soap operas, folks).
Nobody has seen anything like that in their entire career.

I've seen all sorts of other stuff. Crepitus (Sub-cutaneous air) from a pneumothorax, some really sick people in general, lots of intubations... it's a mad, mad place.

I've seen imminent delivery. That's actually kind of happy and fun, but messy.

The nurses I work with, for the most part, are some of the most intelligent, welcoming folks I've met. We are expected to have a vast array of knowledge, and to be able to anticipate a lot of interventions. Many of them have advanced degrees. Half of them have over 15 years of experience. I am a baby in comparison.

Nobody could ever be on facebook here. There's no way in hell you could do anything but try to keep your patients alive. Especially when 4 people come in with CPR in progress, the Resuscitation Room nurses need help, and your patient's blood pressure is dropping and you need help, too. It's insane.
And I love it.

I start nights again this week, which I'm not looking forward to, but at least I know what to expect.

On my off days, I'm back in my Sacramento routine: outrigger canoe paddling, cycling long distances on the American River Bike Trail, and I have yet to visit my old Bikram Yoga studio.
Our new place is infinitely better than any of our old apartments. It's a 2.5/1.5 with tons of storage, a backyard, a garage, a basement, and a rose garden in front. Our landlady is super cool and likes to share a glass of wine with me on the back porch.
Life is pretty good.

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