Another month gone by.

April is drawing to a close.  This means several things to me right now.

My orientation period as a new nurse will be over in one week, and I'll be on my own.  That's not to say that I won't have help from my coworkers, but it is a transition from "orientee" to real, honest-to-goodness "employee".  I am really hoping that I do my job well.

Our frost date approaches.  I cannot wait to let all of my little tomatoes and peppers and squashes stretch out their legs and take root in our raised bed.

Our CSA should begin its weekly deliveries soon!  I intend to blog each week about what we receive and how we use/preserve it.

I will be 23 years old very shortly. I distinctly remember a time when I could not imagine living to be this age. Time is going by too quickly and it frightens me.  I am looking at my life and wondering if I'm really doing everything I can to maximize my time on this planet.  I need to find a way to give more, to be more creative, and connect with the people around me.  I've been very hobbit-ish lately, wrapped up with my own little life and concerns.  I'd like to change that. 

Baker's fury.

If I were just a little bit more mentally unstable than I am right now, I might just put a few bulletholes in the POS oven we have in this place.  14 cups of homemade granola, burnt to a blackened crisp.  The oven was set to 300 degrees.  The thermometer that I put in there read 300 degrees.  I put the baking sheets full of nuts, seeds, oats and goodness in the oven, and when I came back ten minutes later to stir them (halfway through the cooking time), the thermometer read 475 degrees, and my delicious, nutritious and somewhat costly granola had become chicken food.  I want to scream, cry, and break things.  I used to last of my sunflower seeds in it.  I need a hug.

The dark side of the garden

I am learning that in order to be a successful gardener, one must be positively ruthless.  Don't let the bright orange daisy-patterned gloves fool you!  A good gardener must marshall the land with an iron fist!

For instance, seedlings.  I nurture these little guys from seed to stalk, anxiously awaiting those first sets of leaves, watering them gently and moving them outside for sunlight and inside to protect them from the cold... but ultimately, the time comes when the seedlings must be thinned.  I pinch the heads off of the weaker half of the lot without a second thought.

And slugs!  I try to be a gentle person, and honestly believe in the right of all living things to exist and live in peace.  Except when it comes to slugs in my lettuce patch.  I happily sprinkle diatomacous earth on my top soil, humming as I do so, thinking about those little buggers getting their bellies all sliced up as they approach my tender green-lings.

And let's not even go into detail about what happens to those big, juicy grubs dug up while turning the soil at the start of the season... but it does involve eleven chickens chasing one another around the yard excitedly.

Oh goodness no, it's certainly not all flowers and strawberries and butterflies out there... not by a long shot...

Objective vs. Subjective

As nurses, we cannot document "this patient exhibits drug-seeking behaviors and is not experiencing any real pain at all, why the hell are we feeding their habit and allowing them to manipulate the system?"  Subjective documentation is a legal nightmare and will get you sued in a second, not to mention the fact that it may not always be accurate, as they are tainted by your perception of what happened.  All we may document is what the person says, and what we actually see.

So, this morning, my progress note looked something like this:

Pt c/o pain 8/10 "all over" and requested Dilaudid, no facial grimacing, pt smiling, laughing, ambulating in hallways with steady gait, full ROM and relaxed posture, talkative and conversational with staff, requesting snacks.  Given Dilaudid IV as ordered, encouraged to rest in bed and utilize positioning to assist with pain management, verbalized relief, will continue to monitor pain, sedation level and respiratory status.


Some physicians will prescribe the drugs just to shut the patient up.  And, if the patient states that their pain is above a certain level, and if the required span of time between doses has passed and there are no concrete contraindications for giving that dose, I must administer it.  Even when it is painfully obvious (bad pun) that they are high as a kite and horrendously addicted... even when the same pattern of behavior is seen again and again, each time they are admitted for a new complaint (which always turns out to be unfounded).

This particular patient will know the drug and the dose and how often they can get it, and they will stay up all night if they can, enjoying the high and watching the clock so that they can get their next dose as soon as possible. 

It turns my stomach.  And it also amazes me a little bit, as the large and frequent doses of Dilaudid we were giving to this person would be knocking me out into next week.  Long-time abusers build up such a tolerance...

Things I learned in the past week

#1 Mulching really does work.  The strawberries we planted in our windowboxes have doubled in size and vitality since mulching them with leaf compost.

#2 You can fit 2 humans and 6 full-sized bales of straw into (yes, into, not on top of) a 3-door Hyundai Accent.  I do believe that this pretty much defines urban farming. 

#3 Some people don't want to be around for their loved ones when they die, and after you've called them and informed them of the change in that loved one's condition, all you can do is accept their decision to go back to sleep instead of coming in to say their goodbyes.  To each his own.

#4 If you are doing something that is far enough outside the mental "bubble" of the general public (such as doing circus arts in the middle of a grocery store), they will act as though you do not exist.  This reminds me very much of Neil Gaiman's description of people, things, places and times "slipping through the cracks" in Neverwhere.  It makes me laugh, and pushes me to do more and more absurd things just to see if people notice.

Two years

I don't want to post about this past week of work on night shift, nor about the heavy labor we've done in the garden this weekend.  All I want to do today is celebrate the gift of having my Honeybunch around for the past two years.  Two years ago tonight we picnicked in the woods and watched the moon rise over the tree tops, and two years ago tonight we shared our first kiss. 
It's a happy day.  Yay us!!

Night shift.

I bawled my eyes out in despair the whole way home this morning.

Last night was my first shift on 11pm-7:30am. 

The entire hospital was full.  Med-surg patients overflowing into the rehabilitation unit.  Only two beds open in ICU, an ER full of patients waiting for beds, and literally no beds on our floor... we had only open room, but no physical BED to put in that room.  7-8 patients/nurse on our unit, with only one nursing aide to care for the forty-something patients.  And then, they pulled that aide to ICU for 2.5 hours. 

The whole night consisted of moving patients in bed, cleaning up their urine and feces (cleaning up people is fine, I'm certainly not above it and it's so very important for their health... but cleaning up people while they're yelling at you for waking them up??  I believe that is the definition of a thankless job), and doing a TON of paperwork.  I was so exhausted by the time morning came that I felt nauseous and dizzy, I was dropping things left and right... so relieved to get in the car to drive the 40 minutes home...
And then I discovered what 7:30am traffic looks like along that commute, and arrived home 70 minutes later after literally having to slap myself in the face to stay awake and breaking down into exhausted tears.

Give me back my early morning shift, please?  Give me back waking up at 5:30am on Saturday mornings without an alarm, give me back hunting down charts for hours at a time as they get passed from physician to physician to case management to physical therapy to physician to the radiology department as your patient disappears off the floor for a study and you still haven't even SEEN the orders...  give me back prepping patients for testing, handling pushy family members, and, "Surprise! We're ready to take your patient to the OR right NOW". 

I suppose this is something I'll just have to get used to.

Garden update

It's April and I am garden-giddy.

Our heirloom tomatoes are thriving... we transplanted them from the seed starting tray to their own little pots and I can almost hear them stretching out their little toes and drinking in long gulps of the summer-like sunshine.

We've started our squash seeds, and thinned out the pepper plants.  We're growing two kinds of heirloom sweet peppers, and then some cayenne, chiptole, sahuaro... and a mystery mix of hot peppers.  I'm amazed at how much potential energy a squash seed has stored inside its little package.  These guys burst into what you see below overnight!

On impulse, I decided to grow brocolli.  I have a dangerous habit of going overboard when I see the farmer's markets and garden centers with plants out for sale...

The strawberries have begun to blossom... I have them scattered all over the yard in containers, window boxes, and a small patch beneath our Japanese Maple.

We enjoyed our first serving of swish chard last night, wilted in aluminum foil on the grill with garlic and asparagus. 

Good Neighbors have planted some leeks, and I'm anxiously awaiting the sprouting of a row of carrots I planted in front.  Peas and green beans will grow behind and form a screen in front of the hot tub!

Casa de Chicken is almost finished!  The babies are sleeping in it at night now with a heat lamp and enjoying helping us fertilize and aerate our tomato and pepper garden plot during the day. 

A bit more paint and trim and we'll move it into the run before laying the roofing material and installing the roosting bars.  A few features of this design are particularly convenient: the roof overhang that keeps us from getting soaked in rain or sunburnt while cleaning, the metal floor surfaces for easy cleaning and to prevent the floor from rotting out, and the "poop chute"... see below :)

This is the "poop chute".   A shelf below will hold a plastic bin into which we will scrape all of the soiled bedding.  This makes for easy cleaning and transport to the compost bin.  We cover the chute with a peice of wood when not in use so it's not a chicken trap door :)

Two large nesting boxes on either side, set a bit higher than the floor of the coop, should be plenty of room for eleven laying hens to share.

Time to go collect some more free leaf compost... we're going to try growing potatoes in bags this year to open up more room in the raised bed for juicy tomatoes! 

Easter...

...means eggs!
Our girls produce truly delicious and beauitful chicken eggs...

But we couldn't resist purchasing a few emu eggs from our local health food store.  We'd been admiring them for weeks but couldn't justify the cost... but Easter seemed a fitting occasion. 

We used a Dremel to drill a hole in either end of the egg.

We used a bamboo skewer to stab and stir and mix up the yolk to make it easier to blow the insides out.

 Then a deep breath and blowing as hard as one can into that little drill hole!  The goodies inside streamed out, looking like custard.  Our dearTreeman friend looked on with interest, and perhaps a little bit of disgust...

 There was more in there than we'd thought there would be. 

Once the goodies inside were all blown out, we did a few passes of pouring water in and blowing it back out to rinse out the inside of the shell and removed the soft inner sac.  We set the eggs in glasses to dry, and made an emu egg scromblet (scrambled omelet) for breakfast.  I was surprised to find the eggs themselves somewhat bland in flavor, but wetter and somehow creamier than chicken eggs.  I think that they'd make better quiche or souffle than they would omelettes, but it was still tasty and nutritious!

Lastly, it was time to introduce the Chickiechickiepeeperpants clan to the egg of their dreams.

Bambi tried it on for size, but decided that she'd rather aim for quality rather than quantity.

A last minute trial

Today was my last day of orientation on day shift.  Starting Monday night, I'll flip to four weeks of night shift (11pm-7:30am) orientation before they cut me loose on my own.  In the past eight weeks, I've had patients die (who were DNRs and were supposed to die), and critical lab values to deal with... there have been codes on the floor, but none for any of "my patients" where I was really involved.  I haven't really had any true "emergencies". 

This morning I received in report that one of my patients, a middle-aged woman who had come in with new onset atrial fibrillation, was on a new anti-arrhythmic drug that we'd just started using in our hospital.  I'd only just recently gotten the education material on the drug, and was familiar with the protocol (which involved measuring QTc intervals on 12-lead EKGs after each dose and clearing it with the cardiologist before the next dose).  I knew that the protocol was to give 2g Mag Sulfate in 50ml normal saline over 10 minutes if the patient should develop a ventricular arrhythmia.  Fine, no big deal.  She wouldn't get her dose until noon, and when I went in to see her she was feeling fine, no pain, dizziness, shortness of breath, or palpitations.  She was gonna be an easy one!

She's sitting on the bed chitchatting with me, and I hear my name being paged to the nurses' desk over the intercom.  I excuse myself and go to the desk, to find the cardiologist and half the nursing staff staring at the telemetry monitor... I learn that my patient is in ventricular tachycardia.  Huh.  How about that.  V-tach is an arrhythmia that causes the heart to contract in a disorganized way, and if unresolved, leads to decompensation and lack of blood flow to the brain, heart tissue, and everywhere else.  The beating of the heart will degenerate further until it is simply quivering.  In other words, it is fatal if not corrected. 

I run into the med room, get the bag of magnesium from the med cart, prime the tubing, do my first two checks, and book it into her room.  Calm as a spring day, I explain to her that she's not tolerating the drug we'd been giving her for her heart rate, and that I needed to give her some magnesium through her IV to get her heart to beat in the right way, and that just to be safe we're taking her to the intensive care unit. She tells me she has a funny feeling in her head. I tell her to lay back in the bed and relax.

I do the calculation in my head, check it, and get the drip running.  I repeat back a verbal order from the cardiologist for IV Lopressor.    We hook her up to the portable heart monitor/defibrillator, and I run to the med room to draw up the drug, when I return the doctor tells me to hold off on the Lopressor for now, and he and I join our patient and two other nurses in the very crowded elevator down to the ICCU.  I jokingly tell her that it's all to do with the lousy cup of decaf tea that one of the other nurses made her this morning, she smiles.  We all pretend to not be looking at the tracing on the portable monitor. 

We get her into the room, hook her up to their telemetry, I find the chart to write the verbal orders, call for a stat 12-lead EKG, and chart a note documenting all that had happened in the last fifteen minutes.  I give a thorough and accurate report to the nurse taking over her care, give my patient's hand a squeeze and tell her she's well taken care of, and return to my work.  I learn an hour or so later that she converted back to sinus bradycardia.  I breathe a sigh of relief. 

I kicked ass.  I knew what to do, I did it calmly, safely, and quickly.  I was "the nurse", and I did my job without causing my patient to panic.  I feel prettty darn good about that.