surgical day care, palliative care rotations

i just found out it's daylight savings time, already! (that might explain how i slept in so late!) =) luckily chris is more on top of these things than i am...

i'm in the middle of my "community" clinicals, which has been like a vacation since we don't have to do our lengthy work-ups before we go. (for orth, surgical, medical, etc. we have to do a full patient work-up, which takes about 2 hours, then complete the bibs of all their medical diagnoses and highlight, which can take anywhere from 2 to 4 hours, do two care plans, which takes about 45 minutes to an hour each, and pull and highlight med cards for each med they're taking. if it's not in the nursing med deck, we have to make one. finding all the information is torture. so the weekend before clinicals (on monday and tuesdays) i do nothing but patient work-ups.

aaaand, if your patient leaves (either celestial discharge or goes home) before your two-day clinical rotation is up, you are lucky enough to get to do one of these for another patient. overnight. knock on wood, i've been lucky enough to not have to do this. (i try to pick patients who are obese and/or diabetic, because they seem to have longer hospital stays. so yes, i am greatly appreciating my two weeks of community clinical. :)

last week i went to the surgical day care at the community clinic and watched the ENT surgeon perform two tonsillectomies and two septoplasties. it was a pretty slow day, but i was happy to get to see something besides fifteen cataract surgeries in a row. the surgeon was awesome. "you can't see anything back there. get up here and take a look..." he explained what he was doing, and i enjoyed watching him with the patients. i was really impressed with the surgical tech. i thought the RN would be doing more, but she mostly did computer charting, away from the table. the surg tech however, seemed as if she could read the doctor's mind. she'd pick up an instrument and hold it out to him without him even asking for it. i'm sure she's probably assisted on so many of these cases she could probably do the surgery herself, but it was still impressive.

i heard several horror stories about people passing out in the OR, and i really did not want to be one of those people! one girl told me she passed out...right into the surgeon's sterile field. (she was a primary nurse on my ortho rotation). how embarrassing! i never eat breakfast (my stomach is not awake at 6am!) but i did eat three pieces of lunch meat, (very nutritious...) just to have something in my stomach. looking back i'm not sure if that was such a good idea. once the surgery started, my curiosity overtook my paranoia and i was fine. i like watching surgeries, but i don't think an OR nurse would be the job for me.

one thing that amazed me was watching the nurse anesthetist. he'd complete his assessments (about every 15 minutes) and then go back to his Sudoku puzzle. i didn't think it was that big of a deal really, because his machines would beep periodically if something was out of range. i started to wonder if he was really paying attention to his job though, when i noticed the patient's bag of LR was getting low. the nurse got a new bag and put it next to the old one so it'd be right there when his old one needed to be changed. i watched the bag drain from the "9" mark, to the very bottom, and decided i wouldn't say anything unless the bag was completely emptied. which...about five minutes later, the last drop had been squeezed out of the bag and the drip chamber was slowly draining. i asked the surgical tech if the bag was okay, and she looked at it, and told the CRNA to change it.

on tuesday i went back to the hospital to shadow the palliative care coordinator. i had no idea what to expect from this clinical, but i love the nurse who oversees it, Edie. I got to the hospice house at 8:30am, and we set off for rounds. she goes to the ICU, CCU, CICU, and PCU rounds, and is available for patients to speak with regarding hospice care, if their prognosis is poor, or for palliative care, if they have a chronic disease or condition. i don't think people really understand what the difference is between palliative and hospice care, and tend to freak out a little when someone comes into their room from palliative care.

I thought the ICU rounds were the best. the doctor truly seemed like he was the most organized, and arranged for multidisciplinary walking rounds. it was a crowd, but everyone was on the same page and knew what they had to do. it was the physician, the dietitian, Edie, the pharmacist, the chaplain, the respiratory therapist, speech pathologist, social worker, and two unit managers. i loved being on ICU, and still think that's where my calling is. being in the patients' rooms and actually seeing how much equipment they're hooked up to was a little daunting, but i really like the critical thinking aspect of it, trying to figure out what's going on, and how it's affecting other body systems.

once rounds were done, Edie had an appointment with a patient's wife. he wasn't doing well, and was being kept alive by the machines. his wife was in her mid-fifties, at the latest. two physicians were in the meeting, along with an RN, the chaplain, and Edie. she wanted to take her husband off life support on friday, when her family could be there. she seemed so calm, almost stoic for the first part of the meeting, and i started to wonder about her. halfway through the meeting she broke down, which was hard to watch. seeing other people cry always makes me tear up. she pulled herself together shortly, and we finished the meeting.

i asked Edie about her later on, because i was curious about her coping mechanisms and what Edie thought of them. she mentioned that she'd be worried if she hadn't broken down at some point during their conversations, but seeing that she had, and how well she pulled herself together made Edie think she was coping and not denying the whole ordeal.

it made me somber friday morning, writing my paper about these two clinical rotations for my instructor, and realizing that a couple blocks away, this woman was saying good-bye to her husband...