elizabells

My inside informant tells me that at least one of LPCH's units has such low census that other units had to absorb nurses who were at risk of being laid off. So basically no outside hiring was done this year.

Okay, I know I'm terrible, and I'm sorry you're having frustrations with this (and I would be BOILING mad if I were you) but I'm giggling like a fiend right now. It's late, I guess. Nothing about this yet in NYC. But our blood bank suuuuuuuuhhhhuuuuuucks at all times, so I'm not sure I would notice if they got any worse.

The tally from the last M&M was 18 in a month. Which more than doubled our previous high, which was 8. We took the other NEC twin off the other day 2/2 a bad bleed. On the bright side, I had the most rock-star cardiac the other day. Extubated less than 24h post op, eating shortly thereafter. Woot!

BWAH! I will be stealing "alcasnot" for everyday use. Although we just switched to this watery foam junk that's less like snot and more like... um... another bodily fluid. Which I am even less eager to rub into my hands. We call it "the spooge".

You know you're a nurse when you find yourself trying to convince your cardiologist that it's different when YOU look to Dr Google for theories on what's wrong with you, not like when a REGULAR patient does it and it's annoying. Ahem.

Jesus mercy. Now we have a neonatal leukemia. Our fellow told me today we've had fourteen deaths this month. The NEC kid died. We got another bad, bad NEC from an OSH a few days ago, and today they brought in her twin, also with terrible NEC. The hell is going on out there?

So in the past week, we've had: A former 36wk TGA who was grown for a while, full feeds, used to take him off the monitor and walk him around. Then we did his arterial switch. Died suddenly just after the OR. A harlequin ichthyosis. Died. Conjoined twins who shared a liver and one three-chambered heart. Died. A growing preemie who went from full feeds to his intestines in a silo, they're all dead and the surgeons couldn't fit them back in. Peeing bright red blood, K+ of 9 with rhythm changes. Gonna die. A 6mo old with MAPCAS who was initially deemed unrepairable, then decided to take him to the OR but with a 40% chance he'd make it off the table, made it through, been two months since then, got a Nissen a week ago, was sitting in his stroller today on room air, shrieked once, asystole, coded, shocked, lido, epi. Died. Whiskey. Tango. Foxtrot.

Well, we do have a new TEN PAGE flowsheet for PCAs and drips... that'll fix everything!

yappy, the thing that's frustrating is that we've DONE all that. JHACO hit us hard on our (total lack of) pain management this summer. The issue is a total culture change at this point. The knowledge is there, but the will is not.

You guys, if I told you how hard I had to fight and kick and scream today to get ONE DOSE of PO Tylenol for a kid who'd just been circed, who was lying there going ballistic, PIPP score of 10, with no fewer than FIVE doctors at my bedside watching him lose his mind, all "Oh, he just wants his pacifier" and "Maybe he's hungry!" No, maybe he just got the END OF HIS PENIS CHOPPED OFF. Jesus mercy, there are three residents and two attendings who are very, very lucky they made it home without having an isolette thrown at their heads today.

Phenergan IM hurts like a million angry bees. I had it ONCE, dorsogluteal, and I'm suspicious that that's why I still limp and have near-constant pain in that hip and leg, eight years later.

1. PLEASE stop pretending you understand more than the most basic English. The doctors are starting to think I'm crazy when I call them back for the tenth time to explain the gravity of your child's condition to you because you keep saying "Okay" and "Yes" when they ask if you understand what they've told you and then ask me the most baffling questions the moment they leave. I know you're scared, I know you don't understand what's happening, and I know you don't want to look foolish for not speaking English. But it's okay not to speak English. This is why we have translators. 2. When you come to visit your child with a bandage on your arm and you tell me you just came from the ER because you have an infected sore for which you are taking Keflex, please don't get huffy with me when I ask you to wear gloves to touch your extremely sick child. 3. When I carefully explain HIPAA to you for the second time in under five minutes (seriously)and why it means you can't wander up and down the halls peering at every other baby in here, do not tell me you are looking for a clock. I promise there isn't one in the isolette with that 500gm preemie.

"If the smell of smoke coming off you can knock me, who has smoked a pack a day for ten years, halfway off my feet and make me instantly nauseated when you come to visit your just-had-open-heart-surgery BABY, perhaps you should look into changing your shirt when you get here." Oh wait, I totally did say that. But, you know, nicer. I say this all the time. Sometimes it actually gets them to stop complaining for, oh, at least a minute and a half.

Oh, bitty, they hate me too. I got called into the principal's office and warned that my Pyxis usage was being monitored because I actually, you know, GAVE PRN's when they were ordered on an ECMO baby.

Pain meds for chest tubes? Oh, that would be nice. Most of the time I can't get them to order meds when they're putting the chest tube IN, like not even lidocaine, let alone Fentanyl or somesuch.