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PICU, surgical post-op
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AliRae has 4 years experience and specializes in PICU, surgical post-op.

AliRae's Latest Activity

  1. AliRae

    How to teach in West Africa

    I am indeed on the Africa Mercy! Well, not right now ... I'm home for a quick vacation, but I'm headed back soon. Have you been? Or are you coming? =)
  2. AliRae

    cup feeding

    Just as a disclaimer right at the start here: I live on a ship in Africa, so the resources we deal with are WAY more primitive than what you've got. That being said, we cup feed a ton over here. Part of the reason is because we often don't have any bottles (they get stolen when patients leave) and so our only option is medicine cups. However, we do run a small feeding program for our cleft lip / palate kiddos who need to gain weight before surgery. These babies are almost always cup fed, since somehting like a Haberman feeder is almost unheard of over here. (I think we had one, but, surprise, it got stolen!) For these little ones, we get the mamas to express what they can and then mix with fortified formula to whatever caloric density we're looking for. This often means a pretty thick final product, and especially the kids with palates just can't get a good enough suck to get that out of a nipple. As long as the kids are held pretty much upright and the milk is trickled in super-slowly, we're not seeing much, if any aspiration. As far as nipple confusion, the babes here don't seem to get it. If a mama goes into surgery and we have to feed the baby a few bottles, they never seem to be fussed by it or by the switching back. (Although, more often than not, one of the other lactating mamas on the ward will just end up breastfeeding the kid, so we don't do that much either!) (I'm reading back over this post and realizing all over again what a strange life I lead...)
  3. AliRae

    I kind of need a hug.

    Jersey? Jersey?! Can you just stop by and say hi to my family for me while you're that close?! ;-)
  4. AliRae

    I kind of need a hug.

    Just as an update - the little one who got intubated on Saturday went back to Jesus this morning. His kidneys shut down overnight, and he was in full-blown ARDS, and when the dad came in to visit this morning, he and the mama asked that the machines just be turned off. We disconnected all his drips and turned down his FiO2 and snuggled him in his daddy's arms with his mama holding onto his feet and in a matter of minutes he'd slipped away. It was such a good death, the kind we rarely get to see in the ICU. It was just the family and me and the doctor who didn't try to hold on for too long but believed us when we said we thought it was time. And he went quietly, surrounded by the love he never really got to know while he was alive. And then, after all the nurses came to say goodbye they went out too, their poor dead baby on the mama's back, to try and find a car to take them home without charging them more money than they had. My poor heart can't take much more of this.
  5. AliRae

    I kind of need a hug.

    For once I'm posting an obscure question from the coast of West Africa. Today, I just need a hug. I was in charge, and one of our feeding program babies (not the one I posted about earlier with the high alk-phos - this is the one who was plumping up perfectly) hasn't been doing well for the past few days. He's had high fevers, a full body rash (kind of like a mild Steven's Johnson) and increasing work of breathing. Anesthesia (the ones calling the shots on his case) has been sitting on intubating him, since his CXRs have been mostly good - just some peribronchial stuff. Anyway, when I went in today he just looked bad, you know? I called the on-call, who came down and was totally useless, so I ended up calling in another guy, one who just got off the plane last night. (I had met him at breakfast, he seemed smart, and he said he did peds!) Thankfully he came right down and took over running the show. Listened to me when I said we needed a tube, and finally got the kiddo intubated. By the time all that rigamarole was done, his tiny reserve was GONE, and he satted anywhere for 50-70% on 100%FiO2 for several hours. In the midst of all this, while I was still trying to round on the wards and answer questions from all the new nurses working there, I got a call from the gnagway. "Hi, we have a dead baby." I ran up, and sure enough - a little 3-month old girl who was going to be admitted for surgery on her cleft lip TOMORROW was in her mama's arms, ale and starting to cool down. I ran her downstairs and admittedly lost my cool for just a second while I plopped her on the next open ICU bed (the one next to the intubated kid) and demanded "a stethoscope - RIGHT NOW." Long story short, she was long gone, but we coded her for a couple minutes for the sake of the mama, who probably didn't understand what was going on anyway. It's the first time I've ever used a clipboard as a backboard. It's also the first time I've called a death, cleaned up the baby and handed her to the mama only to have the mama look at me like she actually expected her little one to be breathing still. I held her while her mama tried to call her husband. They live way up north, maybe 10 hours by taxi, and she was going to have to go alone. With her dead baby strapped to her back, pretending that she was alive since she wouldn't be able to afford the jacked-up taxi fare that would be charged her if the driver realized he was trasporting a body. So I held her and I rocked back and forth, because really can we ever stop rocking them? And then I walked them out into the heat and I gave them some water and some transport money and the mama told me "Merci." I held the baby on her back while she knotted cloth across her chest and then she walked away, a tiny bundle in a pink hat on her back. I really just need a hug.
  6. AliRae

    super-high alk phos - any ideas why?

    Hm .... good point. Interestingly enough, we just had a patient who was discharged following a course of treatment for mucocutaneous leishmaniasis! First I had ever heard of it .... Baby is afebrile and negative for malaria on a smear. I'm figuring it's not trypanosoma, since she's completely symptom-free clinically with no swollen nodes. And most of the flukes come about my swimming in infested waters or eating infested foods, neither of which my little darling has quite gotten to yet in her development. =) I love the thinking though ... now that you've got me on this path of thought, the malaria does seem like the most likely parasitic cause, but we just routinely test for that if there's anyhting else going on, so we had already ruled it out. She's too young to have built up SUCH a massive amount of parasite, too, since a good portion of her life has been spent as an inpatient in our feeding center, which is a relatively well climate-controlled environment. It's a tricky one...
  7. Okay, my newest what-on-earth-is-going-on-here from the ship in West Africa ... We have a little cleft lip / palate baby who was admitted through our feeding program. She's 4.5 months old, and she was admitted almost 3 weeks ago at 3.24 kg. She's now 3.33 kg, despite lots and lots of feedings. The other day, a new doc was examining her, probably a little more thoroughly than she's been examined in the past (since we don't do much in the way of workups when a skinny baby has an OBVIOUS reason for not gaining weight like a lip/palate) ... it turns out she has a huge liver, so we sent labs. Here's where it gets interesting ... Babe has an alk phos of 2228. Her ALT and AST are up too, somewhere in the 50-80 range (I cant remember exactly) and get GGT is normal. Lab was trying to run a calcium on the tiny little sample we gave them when I left, so I'm not sure what it is. Mama is negative for HepB/C and HIV, but we didn't test baby because we didn't want to take that much blood if we didn't have to. Other than Paget's disease, which would be kind of unlikely in such a small one, and we're not seeing any bone deformities, we're kind of stumped. Anyone?
  8. AliRae

    What's your story? Why did you take up nursing?

    I was 15 years old when my cousin, a crazy, energetic 17 year-old guy, drowned in a lake at a summer camp he was working at. I live in the States, my cousins live in Canada. We drove through the night to get there, and I remember walking into the PICU where he was at around 8 in the morning. Those 2 days were the worst of my life, and most of it is a blur. But I remember his nurse ... she must have just finished bathing him. She was putting vaseline on his lips, lotion on his hands. She was so gentle and she was talking to him quietly. "It's a sunny day outside. I think it's going to be hot again." I watched in a fog as she cared for him, making sure he looked calm and peaceful despite the vent and lines and chest tubes. My cousin was later declared brain dead and we took him off the vent and donated his organs. Eight and a half years later, I remember that nurse almost every day that I walk into the PICU where I've worked for the past 15 months. Whenever a family acts crazy or yells at me or breaks down crying, I remember how it felt to be on the other side of the bed. And that nurse's compassion and care has been the standard to which I hold myself. I wish I knew who she was so I could thank her and tell her how much she's meant to me. So hey, PICU nurses at Sick Kids ... keep up the good work. Because of you, there's at least one more nurse in the ranks today.
  9. Our pharmacy actually keeps a notebook with the best names written in it. Recently, we had a new entry- Dalailama. No joke, spelled just like the real guy. (Most of us couldn't help referring to him with a respectful "the" before his name.) When the pharmacy girls went to enter his name in the book, they found he was the next one under Socrates. Good company! When I was doing clinics in villages in the bush in Zambia, I actually kept a list of the good names. Some of my favourites? Organ, Stew, Emergency, Obvious, Marble (one of the babies I delivered!), and the twins: Steve and Stevious. I miss Africa...