SPU

Today I was sent to "observe" in the Short Procedure Unit. In other hospitals this is known as the "Same Day Surgery" unit. We (me and my counterpart from the other clinical group) spent most of the morning in the Intake part of the unit, bringing patients back, orienting them to the unit, helping get them into surgical gowns, caps, sock-with-treads, et cet, then taking vital signs, and completing intake assessments. We were only TECHNICALLY supposed to be OBSERVERS, but the nurses were busy, and pretty soon we were doing 2/3 of the intakes, while the nurses were doing the urine pregnancy tests, starting IVs, giving meds, and charting. This was fine with us, as we had something to do.
The remainder of the day we went to the POST surgical area, which is also known as Recovery II. Recovery I is the PACU, where patients are brought out of anesthesia, and vitals are assured to be stable. If the patient is going to be staying, they then are admitted to a floor. If, however, they've had a tonsillectomy, or a tendon surgery, or a fixation of a broken arm, or something, often they come back down to the SPU, and stay there until they are ok to leave- not nauseous, fully consious, pain controlled, feeling ok. We helped dress people, complete "discharge teaching", brought warm blankets and snacks, and basically did all those little things that are really nice, but nobody ever gets time to do for the patients. We got profusely thanked about 40 times.
If only our patients up on the Cardiology unit would be so grateful... :-p

Clinic

Spent last night helping at a clinic downtown for non-English speakers. Our responsibilities included doing all of the vital signs and "triage" to ready patients for their appointments, and we also got to go in with the nurse practitioners and see what THEY did. The hands-down coolest part of the evening was when we got to watch the doc on duty do an ultrasound on a patient's thyroid. The patient had a VERY large goiter, something I've never seen before, with necrosis and some liquefaction in the center. The doc walked us through everything he was doing, all the abnormalities. I'm not sure this was for OUR sake, or for the sake of the two COMPLETELY USELESS medical students. They didn't know ANY anatomy, and just stood there like idiots.
It was pretty great, altogether.

Echo

Echocardiograms are COOL. I just had to say it. I dropped my detoxing patient off for his Echo, and the tech invited me to stay, and showed me what all of the views were for, what to look for in the heart, and even gave me memorization techniques for visualizing cardiac anatomy. This came in REALLY handy when I was able to inform the doc that there had been abnormal findings in the Echo consistant with amyloidosis. As this was an incidental finding, not something they were looking for, I was worried that it would fall through the cracks.
Not that it would matter to my patient, on his latest of many strokes brought on by completely uncontrolled HTN, seizures, and cocaine use. He HAS insurance, but he chooses not to purchase his meds, as the 4 dollar scrip cost would cut into his cocaine budget.
And he smelled like a sewer, and refused my repeated attempts to clean him up. Honestly, I was going to be nice, and clean him, but Noooooo. That was just NOT cool with him. Instead, he wanted a second lunch, so that his wife could eat too, without buying food for herself. "nope!" i said, gave him a sub-Q injection, and left the room. With the side rail up, call bell within reach, like a good nursing student.

Nightshift

Sometimes being an observer sucks. Three calls last night, ALL of them intoxicated underaged idiots. Honestly, I'd like to do a presentation to the freshmen at Orientation entitled "Please stop before you vomit: how to not be a tool when you drink". Or, if that's just TOO MUCH TO ASK, I wish they'd start drinking at 3 or 4 pm, so that the calls to evaluate drunken kids would come in at 10 pm instead of 3 am when we're all tucked into bed at the squadroom.
One interesting fact is that the reaction to being caught usually falls out along gender lines: the girls are the ones who inevitably start sobbing, say their parents will be SO MAD, and slur incoherent questions about whether they're "going to get in trouble". Sweetie, you were in trouble BEFORE we got here. Yes, you ARE going to get written up if you're so drunk they called us. Its not like the campus cops are TRYING to get these kids in trouble. If they "catch" somebody, it's usually because theyre falling all over the pavement.
As a result of this terribly unsatisfying drunkenness, no trauma, and i barely slept.

CEMS

Yesterday I spent most of the day at Collegiate EMS (CEMS), the school EMT service. I'm on duty all tonight as well. It's a little funny when I'm onshift, as my EMT cert. expired last year in March, so I'm just an Observer until my EVOC class comes around soon...on the other hand, I've seen probably a greater VARIETY of calls than most of the other CEMS techs, as a great number of CEMS calls are (you guessed it) drunk college kids. 20 or more percent are called with the drunkenness being the proximate cause of the call (help help, my roommate wont wake up, help help, my roommate is puking, etc) and another 10-20 because they were drunk and did something like fall down a flight of stairs, slip on ice, punch somebody else, etc.

If I had ONE piece of advice to offer all the college kids on this campus, it would be this: STOP drinking LONG BEFORE YOU FEEL SICK. You can still get tipsy if you want, but for the love of all that is holy, being sick is NOT attractive, a good idea, or something you will be proud of in a few years.

Valerian

New night-before-clinical ritual: Chamomile/Valerian tea to knock me out faster so I get enough sleep.
1/2 cup in, and i'm already feeling the eyes get heavy. DO NOT USE when operating heavy machinery. Also, it can prolong bleeding times, so maybe not a good idea before surgery, or if you're on coumadin or heparin.

Wow....this stuff is GOOD!

Med-Surg

Long time, no post. I fail. So I've begun my second clinical rotation at Spiffy Urban Teaching Hospital, on the CCU/Telemetry floor. WHAT a difference from the sketchy nursing home! All the toys I missed are here, from blood pressure cuffs and pulse oximeters to blood glucose monitors. LOVE it. I don't think CCU is going to be my permanent home. I didn't get that "zing!" I feel when I walk into an ER, but I think this rotation is going to be a good one. We even get to go into the OR and observe, AND the cath. lab. Which is freaking sweet.
Only one patient so far, one that I will call "Pleasently Confused Lady". 88 or so years old, pretty frail, with every stereotypical old-person-malady in the book, from osteoarthritis to gout, to diabetes to osteoporosis. And she'd just had a new hip put in, even though she is SENILE. In the nicest way, of course, she'd pat your hand, call you sweetie, and grin at EVERYONE, but she couldn't follow even simple instructions, and has NO idea why her hip hurts so much. She even denied being in pain, while twisting in bed, moaning, and clutching her hip. We gave her morphine anyway, on the OFF chance that the pain scale wasn't precisely accurate for her. You know, since her heart rate would spike every time she moaned.
Tomorrow may be a snow day, which would be a mixed blessing- I wouldn't have to get up early, but I really do like the hospital.