9 Weeks to go!

Well its already been a month on assignment! The thing that is killing me the most is this two job thing! I can not handle to work 5 days a week twice a month! Can't do it!! Especially since I really don't have any major financial goals...yet. I will work like a hebrew slave when its time to buy a house or something...now is not the time lmao!

I have been trying to be on my best behavior out there in Temple but I have had a couple of slips! I am only human but you get to fussin with me then Brandon has to show up and show out.

1) There is this one MD who has burned all of their bridges with the other docs so basically they have to answer their own calls...the thing is this fool doesn't answer his pager! So I paged and waited paged and waited...since its a teaching facility I decided I was going to go through the chain of command...well that wasn't working either so..."I need a MD to lay eyes on my patient...do I need to tap dance across this desk (nursing station) or start handing out sexual favors to get a response!?" The jaws hit the floor left and right! I had to really grab a hold to myself because I knew where I was headed...to the director's office the next morning sooo I whoosahed and prayed then kept going lmao. Well the patient turned out to be ok and I got some orders (the wrong ones) but hey my butt was covered! CYA!!

2) This sweet charge nurse was concerned about one of my patients O2 sats. I told them that it was fine and just let him sleep. I was in my other room when I saw them go into my patient's room and try and wake him up @ like 0200 in the morning! I kindly put the stuff I was doing on pause flung on the lights and in a true Brandon fashion: "IS THE PATIENT BLUE?!" of course he wasn't but come on people we have to treat the patients and not the monitor! Of course I felt so bad after that! The last thing I want to do out on assignment is burn bridges! They are so important! But at the same time I was tired and it was one of my nights in a series working so I was kind of pissy!

Everything is about money and budget and I hate it!!!!! You would think half of the things we do are for the benefit of the patients but trust and believe it has some financial significance to it! For example, skin documentation! JEEZ you can only document so much about some one's freakin back side ugh!!!! These institutions need to focus on where the real money savers are: THE PHYSICIANS! Some of these physicians need to grow a pair and just know when its time to let go of a patient. No I haven't been in the situation where a family member was dying in ICU but i mean you have to focus on QUALITY OF LIFE. Families should be schooled on quality of life when those chronic patients hit the door. I mean what quality of life does a 90 year old have trached and pegged in a nursing home!? Its inhuman and its a slow way of killing someone. I do believe everyone is entitled to health care but I also believe there should be a point in time where life saving measures should become comfort measures.All of this is sooo relative!!! I say this but I have difficulties bringing up code status changes to patient families. Well, I'm a lot better than I used to be.With out thinking twice I feel comfortable asking patients and their families if they want to be intubated...second nature now. I still feel strongly about physician's bringing up the conversation sooner. Some people rot weeks in ICU until infections and skin issues finally help them go see Jesus. Working in a major medical center then working in a hospital with out those "extraordinary" resources have made me appreciate code status changes! Every 80 year old crashing patient doesn't need a balloon pump or continuous renal replacement therapy! Gosh...at the same time I remember my friend Vicky telling me her grandpa is like 90 years old...had bypass surgery...fully recovered and still thrives more than some 40 year olds! UGH! The debate could rage on forever! I stand on the side where quality of life supersedes EVERYTHING! How will the out come of advanced treatments effect how this person lives!? How would this person would like to live?!!?!?!?

REAL STORY: There was this 80 year old who was very lively...probably more lively then I am! Traveled the world played tennis at least 3 or 4 times a week...felt short of breath and ended up in ICU. Later intubated, on continuous dialysis. This patient was in ICU for over 2 months developed a pneumothorax (http://en.wikipedia.org/wiki/Pneumothorax) and ended up with really bad subcutaneous emphysema (http://en.wikipedia.org/wiki/Subcutaneous_emphysema ) where basically you have air under your skin and it feels like rice crispies or Cheetos under the skin. This patient's pneumo was so terrible their head blew up like a basketball and required a chest tube. This patient literally looked like a circus side show...the spouse would come in and take pictures "close your mouth honey so we can show people how well you are doing" mind you this patient was completely out of it and mouth was opened related to their condition. Right after the insertion of the chest tube there was a document faxed stating a living will and how the patient did not want to be intubated. This is after being intubated for weeks and suffering pain the SPCA protects even animals from suffering.

With all that said: Make sure you make out your wishes in paper and get it notarized. I personally am going to make a HD moving specifying how I would like things managed in the event I become incapacitated! LMAO! Including how I want my services (minus all those horrible cliches) and a recording of myself I want to be played at my memorial LOL! 

Ready to get this NY state license on deck! I have already sent for the finger print card so I can complete the requirements for my California license also! I want to try an 8 week contract....4 weeks lol...shorter sounds so much more tantalizing now! 9 weeks and counting....

Please remember this is a safe place, tell me what you think! (But please be respectful of HIPPA, myself and of course yourself!)

BS RN