Monday, June 15, 2009

My Day

Let me tell you about my work day...

since I am still thinking about it a day later.

I got to work in my favorite ICU - Surgery, Burn & Trauma. I saw it all this weekend.

My partner was late, and we had work for 3 of us, but only 2 to do it. 16 ventilator patients, 2 more very recently weaned from a vent, and 14 or so on breathing treatments every 4 hours spread out over 4 floors. A lot of work. And a very sick trauma patient with 3 docs and 4 nurses and an RT all hovering trying to get blood in, keep up with the blood out from wounds, watching the monitor and patient, making vent changes, drawing labs and blood gases, getting chest x-rays. There was a staff meeting. I was called (I hate our work phones!) twice while in said patient's room, telling me I had to be at this staff meeting. Don't you morons (er managers) understand I am trying to provide excellent care here? You know, that excellent care that we aren't meeting our targets and are losing our measly little bonuses for? Then someone from the office called my partner (up to his armpits already!) and told him to cover my stuff so I could go to this staff meeting, and the Charge RT came to the ICU to help. What, am I ten and being called to the principals office for detention? Sure felt like it! I walked into the office, tossed down the papers in my hand as well as my phone, and leaned against a counter with my arms crossed across my chest listening to the meeting in progress. Bad attitude and anger spewed with me not saying a word. The topic was a hot button, and the supervisor was talking in circles getting nowhere with it. After 10 or 15 minutes of the same heated discussion (that we had 2 months ago as well) between my coworkers and the sup, I piped up "Next item on the agenda, please," trying to move things along. The next item on the agenda... Me. She presented me with my 10 yr pin and plaque. Great, I am throwing a temper tantrum and am rewarded for it? Don't I feel a little embarrassed. I did send the sup am email apology. It's as close as I could get to a real one. Patient care always trumps staff meetings! When I got back to my unit, the Charge RT hadn't really left the trauma patient's bedside, so I was at least justified in needing help. The pt didn't make it, but we certainly tried.

About the time I caught up (well after lunch) we extubated a pt I fully expected to fail miserably. The attending has the final say in decisions, and he overruled an RT, RN and a fellow. For the most part every patient deserves to be extubated once and be reintubated before we ask the family about a tracheostomy and open a can of worms with long-term ventilator issues. Dang, I hate it when the attending is right, but I love it that the patient did better than any of us expected. Even the pt's mom was not optimistic. Go, kiddo, go! I hope they had a good night, and the vent is gone from that room.

The surgery team didn't have enough to do on a Sunday afternoon. They're "all grown up" doctors in June and hopefully know what they are doing. We get the crop of newly minted just graduated doctors who don't know much at all of life in a real hospital in July. Try not to be sick in July. It's a painful month for those of us in a teaching institution. Back to the surg team. They decided that since they had family consent, they'd do some bedside work. Two patients, two percutaneous trachs. Easier to do them at the bedside on a lazy (only for them!) Sunday afternoon than wait till there was OR time on Monday, or maybe end up getting bumped to Tuesday. Am I behind in my work yet?

Heck of a day! And I stayed over for an extra 4 hours, which made 16 on Sunday. I love my job, when management lets me do it.

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