Yesterday started out "bright" and early at 520AM, as I blearily stumbled out the door to the school parking lot to meet my carpool. Then FIVE of us jammed into a compact car, miraculously surviving the Schuykill Expressway and getting to 5 East JUST in time. Since yesterday was Shadow Day, we were each assigned to a nurse, to "get a feel for what they're doing". My nurse was a new grad, and really wonderful. She was willing to teach me (my non-emergent pediatric knowledge is LIMITED) and fun to work with.
We had 3 patients, ages 6, 13, 17, ALL with sickle cell. Woah. The hardest part of taking care of the OLDER two patients was the persistent desire to smack both of them upside the head. They seemed totally uninterested in the world, but avidly watched the clock waiting for the magic q3hr mark, when they could get their beloved M.orphine bolus. Now I understand that this disease is RIDICULOUSLY painful. I understand that a vaso-occulsive crisis is actually causing ischemic damage, and is totally uncool. I do. I get it. But the parents wouldnt' even help us kick them out of bed! And they KNOW better. You see, if a sickle cell patient (or really, ANYONE) just lies in bed, Bad Things Happen. Bad things like blood pooling (which, yanno, makes the clotting worse), lung problems, pneumonia, Bad Things.
Even so, the mother of the 17 year old boy wondered if we could give him a BED BATH, because he "didn't feel like getting up". This is a boy who was scheduled for discharge today or tomorrow. And he wont get up and move, even though it is the ONLY thing that will actually help his recovery. His mother glares at the nurses, and wants TWO to be present for everything, including connecting saline to his IV. According to the nursing staff, this patient is a frequent flyer, and doesn't WANT to be discharged- home is lacking in room service, unlimited cable tv, and m.orphine. Go figure.
The bright spot in my day was my youngest patient. This little boy had a VERY low hemoglobin- low enough to need a blood transfusion. What was his reaction? "I had breakfast. I ate it ALL. I don't WANT to stay in my room, the other kid (the 17 year old) is BORING. Can we go play?" My reaction: "Lead me to the playroom!"
We made mutant Mr. Potatohead dolls, with airplanes for arms, AND invented obstacle courses to navigate one-handed (his other arm was wrapped in an IV-protector, much to his annoyance). This kid was unstoppable. AND totally hilarious. His attitude was "there's a giant playroom here, and my mom is here. Whatever you people need to do is ok, as long as I get to to play afterwards". He's awesome.
AFTER clinical, I ran home, showered, threw my stuff into a duffle, and went back over to campus for my overnight VEMS shift.
THREE BLOODY CALLS on a Wednesday night! First one was simple: fairly obvious tib-fib fracture, kid was in a LOT of pain, but still apologized for swearing when we picked him up (they're cute when they're polite). Second AND third calls: one young freshman girl, food poisoning. We took her from her dorm to the health services building, per the request of public safety, who were afraid she would puke in their car. THEN 15 minutes later, the health services nurses (we really need to have a chat with them) CALLED US BACK to say they "couldn't care for her" and we should take her TO THE HOSPITAL. Seriously. She'd vomited FOUR TIMES...and had admittedly painful abdominal cramping, but clearly epigastric, and she was currently menstruating, so that would rule out most appendicitis AND tubal pregnancy...so I don't really know WHY our nurses refused to keep her- except to wake us up TWICE in the middle of the night.
So I'm tired, and cranky...but feel VERY accomplished.