Avoidance

I haven't been doing much writing around here lately. Work in the PICU the past several weeks was somewhat monotonous. See the sick babies, write progress notes, round, check the babies labs, round again, blah, blah... in to work in the dark, home from work in the dark.

Sick babies depress me.

The unit was actually slow while I was there. Given the time of year, I had expected a lot of nasty respiratory illnesses, but most of our kids were post-op kids. Tiny runts on ventilators working with half a heart, or trying to breathe through little buds instead of lungs. Tubes in mouths, stomachs, chests, bladder catheters... little plastic octopi plugged into walls. And the beeping machines... yuck.

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On weekends I have been working at my other job. The extra money will be nice when it comes in, but it probably hasn't helped my attitude. Some days are good and I walk out of there confident and ready to start my upcoming new job, and some days are not so good. One of the other residents and I were on together the other day, and although I was in the room helping her for almost an entire hour, the patient ended up dying anyway. We have talked the case over and over since, and even though everyone has told us over and over that we did everything right, there's still that feeling of failure.

I don't know why I take it personally when patients die, but I do. If anything, we probably overworked the code-- shocking, giving every medication, and doing compressions so vigorously our joints hurt the next day. Obviously there will always be some that are too sick to save, but it just aggravates me when people die in front of me.

Up until that shift, I was thinking that I was ready to start doing single-coverage (working without another physician on in the department), but now I'm hesitant to do so. On the one hand, I think it will be a good while before I have a case that emotionally draining again. We were lucky in that both of us were able to devote our attention to the one patient, and because I was there, I was able to go back to seeing new patients and cleaning up the rest of the rooms while she spent the rest of the evening dealing with the family and other stuff. I can't imagine what the would have been like if I had been there by myself, especially as I soon got wrapped up in stabilizing a patient having a heart attack and getting him shipped out as quickly as possible. I haven't had the wonderful experience of having to run in between two or more unstable patients yet, and am not looking forward to it.

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Things are starting to normalize around here. I have umpteen projects to do before I put my house on the market in the next few months, and kept myself busy this past weekend taping and painting the hallway along the stairs.

AG is safe and doing well, although frustrated by his minimal trips "outside the wire".

I did my taxes already, now I'm just stalling on paying them until April.

I'm back in the department starting tonight, so at least I'll be around my people more the next few weeks.

Jingle Bells

This is all gossip and hearsay, so of course I am determined to repeat it:

Apparently, after a patient passed away in the unit the other day there was quite an uproar. As they were being taken to the morgue by the transporter, a maintenance worker stated that he saw one of the arms of the patient move.

He said something about it to the transporter, who just kind of shrugged him off and continued with their delivery. The worker was really bothered by seeing this though, so he then reported it to the charge nurse. In the meantime, the body was delivered to the morgue and placed in storage (I don't know if there's a technical term for a morgue refrigerator).

The charge nurse immediately got on the phone with the morgue, who confirmed that they had the patient and was told that they hadn't observed any movement, but couldn't say for sure that the patient had expired.

And this is how one of our poor junior nurses got ordered to go into the morgue and confirm on the cardiac monitor that the patient was in fact, dead.

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First of all, I don't know who pronounced this particular patient, but it was someone who had been on a ventilator for days and was in multi-organ system failure. The odds of them having the strength to move anything other than it just being an act of gravity are extremely small. Usually, although the monitor screen is turned off in the patient's actual room so as not to distress family members, staff members are watching and recording heart rate, respirations, blood pressures, and oxygenation on a main screen behind the desk. While I can't speak for my colleagues, when a patient expires in the unit, they are examined for any signs of life. Despite all the technology, there's no substitue for listening for a heartbeat, feeling for a pulse, and feeling for any air movement from even the slightest of breaths.

Then, there is also often a lag time from pronouncing the patient to transporting them to the morgue to give the family plenty of time to come in to the hospital or time alone with the patient.

Finally, this particular hospital has a bizarre thing that they put over the stretcher (almost like a covered cake plate) so that people passing by in the hallway/elevator don't know that they are next to a dead body. I don't know how anyone could have seen any arm movement, unless it was before the patient was even moved over to the stretcher.

However, this story brings me to two conclusions: 1) The transporter should have stopped and checked the patient. If, by any slight chance the patient wasn't dead, it certainly didn't help to put them in a refrigerator. 2) The maintenance worker should be commended for not only having the courage to say something to the transporter, but also for bringing it to the charge nurse's attention.

So, I don't think we put anyone on ice prematurely. However, in the small off chance that this could happen, maybe morgue drawers should have bells in them, not unlike quaint Victorian coffins.

For an interesting read on urban legends and being buried alive, check out this snopes.com article.