elizabells

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!

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 member 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.

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.

Man, we don't even let moms put their own breast milk in the fridge anymore. Like Steve said, triple scan with the barcode dealie. When a junior nurse screwed up EBM, they got suspended. Once it happened to a senior nurse, oh, hey, it's a SYSTEMS error, let's make a new policy. Siiiigh.

Nope. They were off for two weeks, paid. I do know of one woman who was actually infected while working, and the strain was identified as originating with a particular patient. She had multiple abcesses that had to be I&E'ed, and it took her a really long time to clear. Our ID people told her if she didn't clear she wouldn't be able to come back to work and probably wouldn't be able to work anywhere, ever again.

I promise that it's not. We just passed JCAHO, and while we did have to make some changes, this wasn't one of them. ALL of our cares on 99% of our babies are at 8-11-2-5, and the general practice is to do your gavage kid first, if you have one gavage and one nippler, so that if your nippler is slow, your gavage kid doesn't get off schedule. Nobody holds their gavage feeds. Not the younger, "poor work ethic" nurses, nor the older "supposedly awesome work ethic but still often found sitting watching YouTube videos or shopping online or taking multiple personal phone calls" nurses. People are people. Many of our younger nurses don't even take their full lunch break, while more than once I've waited over 90 minutes for a senior nurse to deign to show back up on the floor.

Or with every heelstick/IV start/diaper change: If you'd stop KICKING ME this wouldn't take so long and I'd leave you alone again!