Massive post ... updates from ICU
Makeshift ICU shut and has become a covid ICU due to 1 pt testing positive on their second surveillance swab. Which didn't come back until Thursday sometime, meaning that some staff have been in isolation (those who were in direct care of them) and all other pt's are considered close contacts.
However, I clearly have all the luck in the world at the moment.
Because since last Thursday however, I was rostered (after a letter from endocrine and the boss changing the roster) for the whole week off--- amazing -- and I decided not to book any shifts at SSH and take the whole week off. Where I spent the week cleaning the pantry (and completed it to full satisfaction) re-organised one of the cupboards (to partial satisfaction) and bought some lavender plants for the backyard which I aim to turn into a floral paradise (slowly but surely). The new plants have got to go in before November though or they'll die of heat if not had a good chance to take root before December/ Jan heat. I want to plant some hydrangea bushes as soon as I can find some to plant.
Had a covid-picnic with Yanny/Tim and Pete at Rodd point. That was relaxing
Enjoy the calm before the storm: restrictions are ending next week - and freedom day is Monday (which by the way I'm looking forward to as much as the next person).
The Weeks ahead post re-opening.
What I'm not looking forward to is how the floor is going to eb and change over the next coming weeks and months.
They've dumped a whole lot of new graduates (rejects---- some RNs are calling them. And I think that's really terrible. I usually reply saying, well I was a reject and I'm here in ICU 9 years later... people who get a new grad position right off the rank, we were lucky. It was a labour government that year and funding was high. People need to remember: new graduate spots are government funded and allocation are dependent on that- and secondly covid sucked money out of certain parts of the system, and placed stressors in all sorts of locations - for example, my batch of midstart midwives did not get a position. We're all 8yr RNs some of us went on thereafter to get CNE positions and flight nursing jobs and one is becoming practice accredited so we were not a sloppy bunch by any means. My theory is they [the district] didn't have a plethora of funding to keep us, and [the hospital] were worried they'd need the money for covid [all that PPE isn't cheap] so the hospital treated us exactly as the contract states. 1 year only. Their loss -really.
Then again, these grads haven't even touched a pump before in their lives-- apparently one of them didn't know (or remember, cause I'm sure they must have done it as a student) how to spike a bag. They come in as blank a slate into one of the busiest level 5 tertiary hospitals in the state, with a large capacity ICU that's slowly doubling in size. Senior staff, however is not increasing.
These kids, were plucked directly out of university - and given spots at the vaccination hubs under a guise it was a "new graduate" position (ps. they'll have a helluva time finding employment with experience only in a vaccination hub) and were then given 1 day to decide if they wanted to stay at the hub or go to ICU.
LOL. If they stay, they (the grads) will be limited to finding work next year in a nursing home or maybe, maybe a GP clinic.
Where was the interview? I don't think there was one. This is all third hand information off another ICU staffer.
I remember in my new graduate year wanting so badly to work in ICU. I wanted it more than anything. I wasn't interested in operating theaters (although I tried to turn my 3 months there as a learning experience from which to gain insight into perioperative nursing - and it was useful, to know how those places worked. There's not much about my time in theaters I'd forgotten most of it was not enjoyable. I wonder if that lovely tech Beryl is still there. She was about 70 and still working and she was just a delight to talk to. Won't ever forget her.) It was a terrible time, but that made me want ICU even more. Perhaps that's how I got here so quickly anyway - because I wanted it, and I targeted it. I was sure I'd like it (there were ups and downs especially in the first year - but I got through it just fine eventually seamlessly melted into the team. [I wasn't entirely sure I'd like midwifery. It turned out, I hated more bits than I liked] .
So don't call them rejects. Just because you weren't rejected doesn't make you any more special or more capable.
I'd probably have been livid if I didn't get ICU as easily as I did -- like what if I was a student last year, and they gave me a new graduate spot in XYZ ward or hospital, and no ICU spot - but I probably would have heard of these new grads at the vaccination hubs getting in "just because they said yes". I'd probably be livid.
That being said: holy shit could you give us [senior staffers] less of a workload.
kids off the street, coming into this place, without knowing how to use a pump and spike a bag.
If that's our starting point... boy do we have a long way to go.
Yesterday, I was asked to orient one of the grads (kids is what I want to call them)to the emergency box equipment. She asked about a checklist (this goes back to those stupid tickey boxes at SSH/MSH which we have a version of in ICU, that isn't frequently used but is there) -- but even just going through the emergency box took at least 30 mins of talking. I went through each item. What it is for, how to use it. She didn't know how to use a y-suction catheter (yeah) but I knew to cater my explanation to .. someone sort of at Pete's level. (Oh dear) Almost. Not quite but almost. Then as part of the safety checks, which is long and winded, I took on the topic of arterial lines - what are they, zeroing, alarms, setting alarms, what alarms do you choose, why do you choose it, etc. I would be amazed if 10% sticks. I went on for about 2 hours.
Meanwhile, the trainees that got here the usual and legit way
Some of the junior IPs (RNs newish to ICU that did go through an interview system and are in the 2 yr program properly, not just thrown here as a last minute thought regarding the last 6 months of their contract) are now being thrown into CRRT a whole rotation early with little support. I'm not sure they've even done the CRRT course, or perhaps they've just done it. The educator is hiding in their office somewhere and today I've gotten to skip off to upstairs dialysis where I'm sitting on a little computer and typing this very post.
Today
I'm babysitting the monitor of a woman who is on a hudson mask (crappy masks where the FiO2 isn't accurate) just so they can do rapid dialysis (rather than ICU style) which means, downstairs is minus a senior who can do dialysis (me) whilst I sit here. Negative: I don't get a "Real break" - but I'm not a nube, I brought my food with me and I have an illegal tea by my side. I look like I'm busy. I've been typing away for about an hour now since the kind renal RN gave me a computer which has no access to the ICU system but hey, has access to email (so I type this into my draft to sort out later).
I'm using this unusual gift of sitting on my butt at work to catch up on the post I really wanted to write last night or this morning, but prioritised sleep.
Other option: play on my phone (but everyone knows that's a bad look).
Yesterday's patients: A tale of 2 men
Why is ICU populated with ex- or current IVDU/Ice/heroin/THC users?
The usual mix of all walks of life have disappeared into "work from home", or perhaps the private system is taking them in at the bequest of the government.
We're taking mostly emergency cases only at the moment, semi-elective procedures seem to pretty much have stopped.
Some procedures are only done by us and people come from all over the country to have them done here (at the expense of the Commonwealth/medicare system).
Patient number 1:
Mr Absolutely lovely.
Youngish late 40s.
Covid neg
Hx. started using heroin in his early 20s, weaned? off to THC (I suppose that's one way to wean) but then got onto ice. Was working with some big companies and as a "boiler maker" before getting into some criminal activities and in his early 30s ends up incarcerated for 1 year. During that time he had a wife and 3 children (these people have a life too, somehow - like come on, if I was the woman and my husband was on drugs I may be naive and have 1 child, but after that, a 2nd and 3rd? come on. Was she blind or in a DV type situation perhaps? It doesn't say in the notes) . It was at this stage she divorced him - it states- due to financial concerns - (at this time he was without a job and or their shared finances were going towards drugs?) And post jail, he had to do a "court ordered course" which "prevented him from employment" but meant he got new start allowance (your tax dollars at work people) .
So that was all in 2016 - 2019.
Fast forward to today, he was found by the side of the road with a raging scalp laceration and some bystanders called emergency services. Where he was admitted to us, taken to OT, had a washout and was in ICU for the night after - not for extubation due to difficult grade 3 airway - so were staffed for and he remained a ventilated pt until around midnight when the nurse who had him, was swapping with the person who had ecmo next door - went for a break. He promptly self-extubated and was all confused and refused all sorts of things in the morning like heparin and pantoprazole because he was worried it would "make him sleepy" - (no buddy that's the propofol) and even the paracetamol, he refused.
I'm handed over that his belongings contain 3 phones. No one else, unless they have 3 girlfriends (I suppose drugs are another relationship of sorts) - has 3 phones - except people who are dealing. Probably selling too. He's having trouble finding legitimate work post incarceration and long time out of the workforce so its unsurprising
So now I come in the morning, he's 1:1 due to the fear of him absconding or causing a fuss - essentially as a current drug user - that tag alone is a red flag for someone who isn't likely to listen when asked to do something like "stay put and sit in a bed".
By the time I got there he was an absolute gentleman. GCS 15. Stated he couldn't remember what happened, and had only appropriate questions re: todays events/length of stay etc.
Huge movie style-head surgery wrapping going on his head with the crepe bandage (who says the movies are inaccurate)? - but not before long he was to be doubled overnight and due to an old staffer coming to help in the gap, the access had to play musical patients so that we could respect the staff doing extra hours.
So I was moved to... the dark side of covid
Patient number 2: The patient I wish covid denialists could come and see and take care of and witness for themselves.
Another drug user but this time IVDU, also was current (prior to admission)
40 something year old male
From Redfern - I always look at a pt's address and make judgements. Redfern is a very interesting suburb right close to the heart of central Sydney.
You have 2 parts to Redfern : gentrified city-worker-dwellers, professional types (I remember hearing of a uni mate's junior doctor brother and his ?partner buying an apartment there for approx. 900,000 circa 2016/17) - who have money to afford to live very close to the best train station in the state, top university near by (University of Sydney), kitch and edgy cafe scene in Newtown nearby, large, safe LGBTIQ+. Every second person is likely to be some sort of plant positive(kid you not). And then you have Housos - people who are living in community housing towers that go for 20 + stories. These are people who are unable to work due to disability or circumstance or life choices and therefore cannot work and are on a fixed income. They often troubleshoot problems together (or have conflict) face overcrowding and at times, have higher numbers of residents involved in criminal activity (compared to the general population). They are overly populated with an Aboriginal people and all sorts. For example, a friend of mine - who is an RN yr 8. whom herself owns property and has an aunt who actually owns a two story house in Redfern (kid you not, that thing even in a devilish state is worth at least 2 million+ dollars- she bought it when it was worth nothing) has a brother who has schizophrenia but has the good fortune of being allocated a unit by the government in one of these towers. It's good because her family can have easy respite and her brother has some freedom. Often her mother stays with her brother in this unit. These communities face uncertainty as the rising face of gentrification means the government has a keen eye on the value of these properties - often families stay there for generations, everyone knows everyone, they mingle with their neighbors in a manner different to typical professional worker owner types and it's not a good space for covid.
Now.
This gentleman came from Redfern. But which type of Redfern (Houso or wealthy professional), I don't know. I didn't google his address - you can always tell the houso towers from the regulars if you can see a photo.
The presence of Houso's keep house prices down in that area. Not that many people own houses in Redfern, its mostly apartments.
Okay anyways so this guy, was brought in because he was on the phone to a friend and he sounded terrible enough that they phoned emergency services for him.
They get to his house and his Sats are terrible, and he's brought in. Ends up on ecmo. Covid positive.
he's been in ICU for a month. Now he has ICU associated weakness of his arms, but his legs work pretty well and he's constantly agitated. Banging his head against the bed, banging his leg against the outside of the bed, hitting against the bed's breaks and causing a rukus- potentially to injury his head or leg. He has a tracheostomy and will agressively shake his head. He "yell whispers" despite the tracheostomy so hard, that you can almost have a 50% accurate conversation with him.
He wanted to phone his friends. So I assisted him to video call (with much issue) a friend - whom through me lip reading and listening to his shouted whispers - asked her to take him home. She explained she had a baby to take care of, and that he needs much more supports than was available from her capacity- (plus he's in ICU on dialysis and 50% FiO2 high flow which cannot be provided in a home setting in Australia) and she urged him to get better first and then they can see what they can do to take him home. She sounded very logical and supportive and wasn't overly emotional (about seeing him in a state of HFNP, with tubes, disheveled in bed.
I'd spend a good portion of time trying to figure out his wants. He demanded to be taken off dialysis. I got the doctor. I asked him why. He kept demanding to be taken off. I put up the precedex to max dose and asked them if we could start noradrenaline if his BP drops due to the increase in precedex. They were fine with it. Whatever gets him through the dialysis. We weren't turning it off. I thought he wanted to die - that he thought us stopping the dialysis would let him pass away (it wouldn't, btw he'd just be sicker and crappier but not dead). He didn't give us a reason. Just kept telling us to disconnect it.
Well too bad buddy. You get sick, you land in the place where bodily autonomy and choice does not exist- ICU - where we control everything.
Just as he fell asleep from the precedex, the new "ward assistants" aka. physios asked to do helpful duties in ICU rolled in and came and did a small workout with him -
right as bed 15, a woman with 1 leg missing, was crawling along the floor with her hands and a duffel bag of possessions strapped to her back whilst 3 doctors and 3 RNs tried to keep her both in the unit by gentle cajoling and thereafter, chemical restraint. I admire her tenacity. to crawl at least 20 meters - I barely had time to close the clear perspex doors of bed 19 so we could watch the commotion in safety rather than being afraid she might at any moment, come into the room.
So I'm chemically restraining this guy in bed - yet despite this he is head thrashing, and leg banging and demanding - yet there isn't anyone to really hand over to. Once again, they're short in the gap: 20:00 -22:00 there is no staff allocated - the access will "keep an eye on him". he's not someone you can leave alone and so the staff from another less aggressive and violent 1:1 pt (his main issue is pulling out his NG) comes to sit with him. I give another handover. and ensure all the 20:00 meds and obs are done before I leave.
I've missed afternoon tea (aka. my dinner time) so I have dinner before I go home- its past my home time which is 20:00 but If i eat after I go home it will have delayed bed time by another 20 mins because I'd need to wait 1 hour after eating to check my blood sugar (GDM rules) so if I eat first, then walk the 15 mins home, by the time I shower and take the insulin it'll be 1 hour. Check the BGL and straight to bed.
I don't do nightshift anymore (thanks to GDM insulin) and so staying late makes up a little for my guilt (of being the luckiest person on the floor). I know how short staffed they are on nights.
3.5 hours to write.
I went home early today because it turns out my "Mr easy pt" tested positive for covid ... Great. I was with him for 8 hrs making me a close contact...
I had freedom day plannnnssss!
However, I clearly have all the luck in the world at the moment.
Because since last Thursday however, I was rostered (after a letter from endocrine and the boss changing the roster) for the whole week off--- amazing -- and I decided not to book any shifts at SSH and take the whole week off. Where I spent the week cleaning the pantry (and completed it to full satisfaction) re-organised one of the cupboards (to partial satisfaction) and bought some lavender plants for the backyard which I aim to turn into a floral paradise (slowly but surely). The new plants have got to go in before November though or they'll die of heat if not had a good chance to take root before December/ Jan heat. I want to plant some hydrangea bushes as soon as I can find some to plant.
Had a covid-picnic with Yanny/Tim and Pete at Rodd point. That was relaxing
Enjoy the calm before the storm: restrictions are ending next week - and freedom day is Monday (which by the way I'm looking forward to as much as the next person).
The Weeks ahead post re-opening.
What I'm not looking forward to is how the floor is going to eb and change over the next coming weeks and months.
They've dumped a whole lot of new graduates (rejects---- some RNs are calling them. And I think that's really terrible. I usually reply saying, well I was a reject and I'm here in ICU 9 years later... people who get a new grad position right off the rank, we were lucky. It was a labour government that year and funding was high. People need to remember: new graduate spots are government funded and allocation are dependent on that- and secondly covid sucked money out of certain parts of the system, and placed stressors in all sorts of locations - for example, my batch of midstart midwives did not get a position. We're all 8yr RNs some of us went on thereafter to get CNE positions and flight nursing jobs and one is becoming practice accredited so we were not a sloppy bunch by any means. My theory is they [the district] didn't have a plethora of funding to keep us, and [the hospital] were worried they'd need the money for covid [all that PPE isn't cheap] so the hospital treated us exactly as the contract states. 1 year only. Their loss -really.
Then again, these grads haven't even touched a pump before in their lives-- apparently one of them didn't know (or remember, cause I'm sure they must have done it as a student) how to spike a bag. They come in as blank a slate into one of the busiest level 5 tertiary hospitals in the state, with a large capacity ICU that's slowly doubling in size. Senior staff, however is not increasing.
These kids, were plucked directly out of university - and given spots at the vaccination hubs under a guise it was a "new graduate" position (ps. they'll have a helluva time finding employment with experience only in a vaccination hub) and were then given 1 day to decide if they wanted to stay at the hub or go to ICU.
LOL. If they stay, they (the grads) will be limited to finding work next year in a nursing home or maybe, maybe a GP clinic.
Where was the interview? I don't think there was one. This is all third hand information off another ICU staffer.
I remember in my new graduate year wanting so badly to work in ICU. I wanted it more than anything. I wasn't interested in operating theaters (although I tried to turn my 3 months there as a learning experience from which to gain insight into perioperative nursing - and it was useful, to know how those places worked. There's not much about my time in theaters I'd forgotten most of it was not enjoyable. I wonder if that lovely tech Beryl is still there. She was about 70 and still working and she was just a delight to talk to. Won't ever forget her.) It was a terrible time, but that made me want ICU even more. Perhaps that's how I got here so quickly anyway - because I wanted it, and I targeted it. I was sure I'd like it (there were ups and downs especially in the first year - but I got through it just fine eventually seamlessly melted into the team. [I wasn't entirely sure I'd like midwifery. It turned out, I hated more bits than I liked] .
So don't call them rejects. Just because you weren't rejected doesn't make you any more special or more capable.
I'd probably have been livid if I didn't get ICU as easily as I did -- like what if I was a student last year, and they gave me a new graduate spot in XYZ ward or hospital, and no ICU spot - but I probably would have heard of these new grads at the vaccination hubs getting in "just because they said yes". I'd probably be livid.
That being said: holy shit could you give us [senior staffers] less of a workload.
kids off the street, coming into this place, without knowing how to use a pump and spike a bag.
If that's our starting point... boy do we have a long way to go.
Yesterday, I was asked to orient one of the grads (kids is what I want to call them)to the emergency box equipment. She asked about a checklist (this goes back to those stupid tickey boxes at SSH/MSH which we have a version of in ICU, that isn't frequently used but is there) -- but even just going through the emergency box took at least 30 mins of talking. I went through each item. What it is for, how to use it. She didn't know how to use a y-suction catheter (yeah) but I knew to cater my explanation to .. someone sort of at Pete's level. (Oh dear) Almost. Not quite but almost. Then as part of the safety checks, which is long and winded, I took on the topic of arterial lines - what are they, zeroing, alarms, setting alarms, what alarms do you choose, why do you choose it, etc. I would be amazed if 10% sticks. I went on for about 2 hours.
Meanwhile, the trainees that got here the usual and legit way
Some of the junior IPs (RNs newish to ICU that did go through an interview system and are in the 2 yr program properly, not just thrown here as a last minute thought regarding the last 6 months of their contract) are now being thrown into CRRT a whole rotation early with little support. I'm not sure they've even done the CRRT course, or perhaps they've just done it. The educator is hiding in their office somewhere and today I've gotten to skip off to upstairs dialysis where I'm sitting on a little computer and typing this very post.
Today
I'm babysitting the monitor of a woman who is on a hudson mask (crappy masks where the FiO2 isn't accurate) just so they can do rapid dialysis (rather than ICU style) which means, downstairs is minus a senior who can do dialysis (me) whilst I sit here. Negative: I don't get a "Real break" - but I'm not a nube, I brought my food with me and I have an illegal tea by my side. I look like I'm busy. I've been typing away for about an hour now since the kind renal RN gave me a computer which has no access to the ICU system but hey, has access to email (so I type this into my draft to sort out later).
I'm using this unusual gift of sitting on my butt at work to catch up on the post I really wanted to write last night or this morning, but prioritised sleep.
Other option: play on my phone (but everyone knows that's a bad look).
Yesterday's patients: A tale of 2 men
Why is ICU populated with ex- or current IVDU/Ice/heroin/THC users?
The usual mix of all walks of life have disappeared into "work from home", or perhaps the private system is taking them in at the bequest of the government.
We're taking mostly emergency cases only at the moment, semi-elective procedures seem to pretty much have stopped.
Some procedures are only done by us and people come from all over the country to have them done here (at the expense of the Commonwealth/medicare system).
Patient number 1:
Mr Absolutely lovely.
Youngish late 40s.
Covid neg
Hx. started using heroin in his early 20s, weaned? off to THC (I suppose that's one way to wean) but then got onto ice. Was working with some big companies and as a "boiler maker" before getting into some criminal activities and in his early 30s ends up incarcerated for 1 year. During that time he had a wife and 3 children (these people have a life too, somehow - like come on, if I was the woman and my husband was on drugs I may be naive and have 1 child, but after that, a 2nd and 3rd? come on. Was she blind or in a DV type situation perhaps? It doesn't say in the notes) . It was at this stage she divorced him - it states- due to financial concerns - (at this time he was without a job and or their shared finances were going towards drugs?) And post jail, he had to do a "court ordered course" which "prevented him from employment" but meant he got new start allowance (your tax dollars at work people) .
So that was all in 2016 - 2019.
Fast forward to today, he was found by the side of the road with a raging scalp laceration and some bystanders called emergency services. Where he was admitted to us, taken to OT, had a washout and was in ICU for the night after - not for extubation due to difficult grade 3 airway - so were staffed for and he remained a ventilated pt until around midnight when the nurse who had him, was swapping with the person who had ecmo next door - went for a break. He promptly self-extubated and was all confused and refused all sorts of things in the morning like heparin and pantoprazole because he was worried it would "make him sleepy" - (no buddy that's the propofol) and even the paracetamol, he refused.
I'm handed over that his belongings contain 3 phones. No one else, unless they have 3 girlfriends (I suppose drugs are another relationship of sorts) - has 3 phones - except people who are dealing. Probably selling too. He's having trouble finding legitimate work post incarceration and long time out of the workforce so its unsurprising
So now I come in the morning, he's 1:1 due to the fear of him absconding or causing a fuss - essentially as a current drug user - that tag alone is a red flag for someone who isn't likely to listen when asked to do something like "stay put and sit in a bed".
By the time I got there he was an absolute gentleman. GCS 15. Stated he couldn't remember what happened, and had only appropriate questions re: todays events/length of stay etc.
Huge movie style-head surgery wrapping going on his head with the crepe bandage (who says the movies are inaccurate)? - but not before long he was to be doubled overnight and due to an old staffer coming to help in the gap, the access had to play musical patients so that we could respect the staff doing extra hours.
So I was moved to... the dark side of covid
Patient number 2: The patient I wish covid denialists could come and see and take care of and witness for themselves.
Another drug user but this time IVDU, also was current (prior to admission)
40 something year old male
From Redfern - I always look at a pt's address and make judgements. Redfern is a very interesting suburb right close to the heart of central Sydney.
You have 2 parts to Redfern : gentrified city-worker-dwellers, professional types (I remember hearing of a uni mate's junior doctor brother and his ?partner buying an apartment there for approx. 900,000 circa 2016/17) - who have money to afford to live very close to the best train station in the state, top university near by (University of Sydney), kitch and edgy cafe scene in Newtown nearby, large, safe LGBTIQ+. Every second person is likely to be some sort of plant positive(kid you not). And then you have Housos - people who are living in community housing towers that go for 20 + stories. These are people who are unable to work due to disability or circumstance or life choices and therefore cannot work and are on a fixed income. They often troubleshoot problems together (or have conflict) face overcrowding and at times, have higher numbers of residents involved in criminal activity (compared to the general population). They are overly populated with an Aboriginal people and all sorts. For example, a friend of mine - who is an RN yr 8. whom herself owns property and has an aunt who actually owns a two story house in Redfern (kid you not, that thing even in a devilish state is worth at least 2 million+ dollars- she bought it when it was worth nothing) has a brother who has schizophrenia but has the good fortune of being allocated a unit by the government in one of these towers. It's good because her family can have easy respite and her brother has some freedom. Often her mother stays with her brother in this unit. These communities face uncertainty as the rising face of gentrification means the government has a keen eye on the value of these properties - often families stay there for generations, everyone knows everyone, they mingle with their neighbors in a manner different to typical professional worker owner types and it's not a good space for covid.
Now.
This gentleman came from Redfern. But which type of Redfern (Houso or wealthy professional), I don't know. I didn't google his address - you can always tell the houso towers from the regulars if you can see a photo.
The presence of Houso's keep house prices down in that area. Not that many people own houses in Redfern, its mostly apartments.
Okay anyways so this guy, was brought in because he was on the phone to a friend and he sounded terrible enough that they phoned emergency services for him.
They get to his house and his Sats are terrible, and he's brought in. Ends up on ecmo. Covid positive.
he's been in ICU for a month. Now he has ICU associated weakness of his arms, but his legs work pretty well and he's constantly agitated. Banging his head against the bed, banging his leg against the outside of the bed, hitting against the bed's breaks and causing a rukus- potentially to injury his head or leg. He has a tracheostomy and will agressively shake his head. He "yell whispers" despite the tracheostomy so hard, that you can almost have a 50% accurate conversation with him.
He wanted to phone his friends. So I assisted him to video call (with much issue) a friend - whom through me lip reading and listening to his shouted whispers - asked her to take him home. She explained she had a baby to take care of, and that he needs much more supports than was available from her capacity- (plus he's in ICU on dialysis and 50% FiO2 high flow which cannot be provided in a home setting in Australia) and she urged him to get better first and then they can see what they can do to take him home. She sounded very logical and supportive and wasn't overly emotional (about seeing him in a state of HFNP, with tubes, disheveled in bed.
I'd spend a good portion of time trying to figure out his wants. He demanded to be taken off dialysis. I got the doctor. I asked him why. He kept demanding to be taken off. I put up the precedex to max dose and asked them if we could start noradrenaline if his BP drops due to the increase in precedex. They were fine with it. Whatever gets him through the dialysis. We weren't turning it off. I thought he wanted to die - that he thought us stopping the dialysis would let him pass away (it wouldn't, btw he'd just be sicker and crappier but not dead). He didn't give us a reason. Just kept telling us to disconnect it.
Well too bad buddy. You get sick, you land in the place where bodily autonomy and choice does not exist- ICU - where we control everything.
Just as he fell asleep from the precedex, the new "ward assistants" aka. physios asked to do helpful duties in ICU rolled in and came and did a small workout with him -
right as bed 15, a woman with 1 leg missing, was crawling along the floor with her hands and a duffel bag of possessions strapped to her back whilst 3 doctors and 3 RNs tried to keep her both in the unit by gentle cajoling and thereafter, chemical restraint. I admire her tenacity. to crawl at least 20 meters - I barely had time to close the clear perspex doors of bed 19 so we could watch the commotion in safety rather than being afraid she might at any moment, come into the room.
So I'm chemically restraining this guy in bed - yet despite this he is head thrashing, and leg banging and demanding - yet there isn't anyone to really hand over to. Once again, they're short in the gap: 20:00 -22:00 there is no staff allocated - the access will "keep an eye on him". he's not someone you can leave alone and so the staff from another less aggressive and violent 1:1 pt (his main issue is pulling out his NG) comes to sit with him. I give another handover. and ensure all the 20:00 meds and obs are done before I leave.
I've missed afternoon tea (aka. my dinner time) so I have dinner before I go home- its past my home time which is 20:00 but If i eat after I go home it will have delayed bed time by another 20 mins because I'd need to wait 1 hour after eating to check my blood sugar (GDM rules) so if I eat first, then walk the 15 mins home, by the time I shower and take the insulin it'll be 1 hour. Check the BGL and straight to bed.
I don't do nightshift anymore (thanks to GDM insulin) and so staying late makes up a little for my guilt (of being the luckiest person on the floor). I know how short staffed they are on nights.
3.5 hours to write.
I went home early today because it turns out my "Mr easy pt" tested positive for covid ... Great. I was with him for 8 hrs making me a close contact...
I had freedom day plannnnssss!