I'll see you in the ICU!

I'm so tired, I don't have the energy to sleep, even.

What a tough and amazing week it's been.

So, on my unit, the nurses are so nice and amazing. I was joking today that I feel as though I've been adopted by the Philipines, because they are constantly feeding me and teaching me stuff...they're so amazing and nice.

I'm not on again until Wednesday, but Weds night they're going to a restauraunt called Saigon Grill, and said "of course you're coming" (this should be fun, they're a fun bunch.)

Anyway, of course I feel completely inadequate, like I don't know anything. My one saving grace is that I'm really good with physiology and pathophys and basic pharm, (the common meds we use over and over) so I'm able to talk through what's happening and why, so they all think I'm some kinda smarty pants (which, I'm so obviously not.)

"you're so good with the patients"
"You're so good with the families"
"what do you want to learn?"
I need it all. I don't know a damned thing...show me, teach me...everything.

We had the same pt for 3 days in a row, a super sweet guy, with acute renal failure on top of his cardiac problems, so he's confused, a lot. The hemodialysis is helping but he thinks we're in the airport, then a hotel, then a restaurant, etc.

He has two sons and a daughter. The youngest son was nice to me, but then as I walked out of the room, he turned around and ripped into one of the nurses, later demanded of the physicians an explanation why it seemed no one knew what the others were doing, and the attending...all he could do was put his head down and apoligize. Since I'd already met them and they trusted me, I was able to tell him that though it appeared no one was communicating, they were...and things were well documented for all the staff to read, and that the reason nothing had been done yet, is they were trying to rule out certian things, and wait to see if his dad was going to respond to certain therapies, or not, and that that in itself would help lead to a more confident dx. I reminded him that the clinical setting is not like running a company. You can't expect two patients with the same condition to have the same outcome on the same treatment. You can't rush this--they still don't know what's really wrong.

After the attending left with his tail between his legs, I told him not to push them to jump into a treatment. They had been wanting to do a pericardial stripping, and from what I'd looked up, that didn't look like such a hot prognosis (only 10-20% efficacy) and the risks were big...that they were not in agreement that this is a procedure that he needed etc.

My acting preceptor, Flora, said "you're so good, so confident to say things to him, he's mean"

Nah, he just wants straight talk; honest talk.

Then when the daughter showed up with her mom, I asked them about DNR/DNI and what they had in place. He had really responded badly to them trying to stick a duotube (duodenal feeding tube) in and the spouse and daughter came in to plead with the residents to stop. The worry is that he'd wither away without proper nutrition.

So, they thought they had a DNR but they had a DPOA and I told them that wasn't enough, and got the physician to talk to them about it. The spouse and daughter went home to talk about it, and read the forms, etc.

So, I did ok.
They thought I was a rock star, and the nurses were patting me on the back.

Anyway. I'm one of the lucky ones. I don't think the other student on my unit doing nights is learning as much, but at least she's learning more than a friend of mine who was placed in a step down unit.

Walking home together tonight, he told me that his preceptor is advocating against him and against students in general being on that unit. So, he's not having a good time.

Sad thing is, I think he's one of the best, if not the best student in this program. Not only academically, but with patients. So it's very sad. He's not alone...several people have shitty placements and are getting bascially ripped off with this integration experience.

I'm super lucky.
Finally, I hit a good streak.

Although, they like me so much they said the were contemplating not passing me for the integration so I'd have to stay in New York and have to come back...they don't want me to leave.

That's sweet, but couldn't I just come back to visit you all, instead? :)

posted by sketchmonkey @ 5:09 PM