Third week in training (February 4-8, 2008)

The third week of my training involved clinical rotations in the following specialties: Prehospital (as in an ambulance), Neonatal Intensive Care Unit, Emergency Room (with the medical director), Intensive Care Unit, and Labor and Delivery.

So, I got to hang out with firemen and medics at their firehouse on Monday. That was interesting. We got called to a house for a woman who is unresponsive. Okay. We get there and this woman is sprawled on the floor beside her bed unconscious and unarousable. We find pills all over the floor and her prescription bottle of Venlafaxine is empty. Overdose, you think? So, the medics ask me what Venlafaxine is and I say, “It’s Effexor. It’s a muscle relaxant.” (as in like I’m pretty sure) Hah! As if! I was only half right. It is Effexor, but it is not a muscle relaxant. It is an antidepressant. Imagine my chagrin. But I told the medics my error. Oops! My bad. From then on, I kept my mouth shut. Where is my damn PDA when I need it?

You know, you gotta give it to those medics. The room the patient was in was barely big enough to accommodate the patient and her furniture. Somehow, four medics found a way to squeeze in there and do their thing. Picture this: patient is about 300 lbs. Each medic is at least 6’1” and their weights range from about 190 to 225 lbs. I was squooshed in the corner trying to get out of their way. Somehow, they get her on a backboard and on a stretcher and get her out the door. Houdini would have been put to shame. I wanted a ride on the firetruck, but I had to be professional and not pout and bat my eyes so they would let me. Ah, well.

On Tuesday, I followed our medical director in a trauma ER while he went to see patients. Ok, so I had to learn how to think like a doctor. You’re thinking, don’t you do that already? Wrong!!!! Okay, maybe not. I’ve been trying, but not in an organized doctor’s way of thinking. Hey, I didn’t officially go to med school. So, one more thing got crammed in my brain to learn. It’s getting pretty cramped in there. My eyeballs, once again, threatened to pop out of my head. That was great, though. Our medical director is a totally awesome guy.

Oh yeah, so he made me look at these black and white pictures on a screen and expected me to give him interpretations. Ah, no. It was not a psychological test (but if it was, my state at the time would have shown up as psychotic and in need of serious therapy). They were chest x-rays and CT scans. They all sort of looked like black and white blobs to me. I was looking at one head CT and I asked what the weird-looking ball-appearing white blob on the screen. I was told it was a big blood blob in the brain. Oh. I guess that’s bad. Whoops.

So, another two hours passed by and I was still looking at these dang pictures (okay, the actual medical phrase is: radiological images, but, hey, it’s the same freaking black and white blobs). It was midnight (I was up at 5 am that morning). The lungs, the heart, the freakin’ brain all started to look the same to me. Where is the freakin’ radiologist who gets paid the big bucks? Have him (or her, all things being equal) read these things. I’M JUST THE NURSE!!!! Oh, oh yeah! I’m like a flight nurse now. Expectations have changed.

On Wednesday, I had a Neonatal Resuscitation Class. That’s like saving a ‘barely person’ person. Neonatal, as in just born – you know, barely a person yet. Hmmm . . . it's not so bad on a manikin. . .

I went to ICU on Thursday and played with some pretty cool toys. They had an internal cooler that circulated through the central line. There was the thermometer attached to a brain bolt, a gadget that measured pupils and calculates the percentage of changes every time it is used. The patient I was assigned to care for was a young man with a severe brain injury after snowboarding without a helmet. So unfortunate. His friends brought a lot of pictures of him and if his mother did not point out which he was, I never would have figured it out. I always wonder what could have been. He is 6'4" and weighed a solid 210 lbs in his pictures. The swelling and the bruises made him look so different. He is fortunate that he is in that ICU. Those nurses are amazing.

On Friday, I found myself in a birthing center. Yes, that was indeed scary. I seriously considered calling off, but I might as well get it over with. It's not like I can just call off when I get those calls in the field. When I got there, the head nurse told me that I was to assist with two births. No problem, I said. I'm just going to the bathroom. I went, hyperventilated, and probably would have fainted but I didn't want my head to fall in the toilet (the bathroom was barely big enough to squeeze into. It's like squeezing into the driver's side of your car and peeing right there. That's all the room you had in that bathroom).

I composed myself as best as I could (I also changed into new scrubs). I went out and steadied myself for what was to come. (Okay, the charge nurse came in, dragged me out, and told me I was needed that second). Okay, okay. Here I go. I rushed in, grabbed some gloves (smacked those babies on like they do on TV - with a, uh, smack), and said, let's go. I got blank stares from everyone in the room. The mom was breasfeeding. I said, wow, that was quick. More stares. The nurse in the room shuffled me out and directed me to the room next door. I was in the wrong room. With my gathered bravado somewhat diminished, I asked where I could stand quietly and observe. No luck there. In two seconds, I was whisked to the mother's side and before I knew it, I had a screaming baby boy in my hands, and a very warm sensation on my head from the isolette. Somebody handed me a blue rubber bulb and I thought, that's not going to light anything up. The L&D nurse motioned for me to use it to suction the kid's mouth and nose. Oh. Then I was given some wet and warm towelettes to wash up the screaming, flailing little creature in the isolette. Uhm, okay. He doesn't seem to like that very much. I wanted to give him back to the doctor, but the stern look on the nurse's face told me that I better finish.

That wasn't too bad so when I was told that another mother is about to give birth, I was ready. I knew what to do. So, I went in the room with a lot more confidence that I had earlier and I was ready for that kid to come rushing out. Yup! I am right there ready to catch. Here I am. Let's go. Suction bulb ready, isolette nice and heated, towels and warm blankets present. Where's that baby? Come on. Let's do it. . .  (silence . . . clock ticking loudly . . . ) Well????

The nurse told me that the mother is on an epidural drip and she did not feel like pushing. Oh. I see the baby's head, though. I was told that is normal. What? The kid is sitting in the birth canal with part of its head sticking out. That's normal? Humans are very weird creatures. Well, two hours later, the kid finally comes out. It is screaming its lungs out. You know, I would, too. Two hours of sitting like a sausage is a bit much for anyone to take. I mean, that's just not right. Anyway, I cleaned up that kid and gave her to mom. So cute. That's all well.

So, that wraps up the 3rd week of training. Done and over with. Now on to the training in the airplane. I'm ready. Where's my dang flightsuit???