My brain hurts

Such confusions and complications. I had a difficult night. Not difficult with clinical skills, difficult with figuring out who was in charge of my patients! First the Neurosurgery Trauma team orders a follow up head CT on my patient, then the ENT team adds Temporal Bones with the follow up CT, then the radiologists tells the techs Temporal Bones can be added to the initial head CT, so the techs cancel the second head CT not realizing the follow up order was written by a different team for a different reason! As I'm arguing with the techs, the patient is now two hours late for the exam. Of course the neurosurgeon calls my wondering where the follow up is, fortunately he was understanding and contacted the radiologist to clarify the confusion. Finally my poor patient got to go to the scanner, to find a worsening head bleed. So I had to travel again for another follow up. Then in the morning, ENT doctors order ear drops for my patient who is bleeding out her ear. Neurointensivists later comes to the bedside for their assessment and don't even look at what other teams have ordered. I tell them, by the way ENT wants this, they looked at the order and said, "WTH! How will we know what's leaking out? Cancel that order!!" In the midst of all this, Neurosurgery calls to order upright xrays to clear the patient's (who is sitting upright and has been for 4 hours) mediastinum since apparently it wasn't done before. I send the order to radiology, and the doctor calls back saying, "Nevermind, I found it."

In the meantime, I'm tracking down the ordering physician for my other patient who has to go for a head CT for temporal bones since the techs told me it was cancelled, but I had no order! I finally get ahold of the correct radiologist, since the one in the office at the time didn't want to "deal with it" and got my verbal order.

Remember I'm a traveler in float pool. I oriented on this unit once during a day shift and I work graveyards. Yes I have worked two night shifts, but it is still very difficult to figure out what the hell is going on amidst all the miscommunication. I am impressed with the staff nurses who hold it together so well, perhaps it's because they've dealt with this for so long.

OK, my venting is done. Now I have 7 days off for climbing and biking!!

SO MUCH TO LEARN

The beauty of nursing is the constant learning and teaching. It never gets old. Whether it's equipment or clinical, something can be gained everyday. My favorite, I think hilarious though the Resident probably won't, is when the Resident came to me full of excitement that he had found a 16Fr coude catheter,

but it wasn't, it was a 28Fr three way irrigation catheterFinally the correct catheter was found, and the Resident told me he has never placed a coude before, but needs to. Unfortunately the patient heard him say this, so he lost his chance. Darn! Fortunately a competent male nurse was available for the procedure.

There are many differences between working back home and working at a big Trauma I teaching hospital. I am following the advice of previous travelers,

"Take it all in, ask a lot of questions and stay on your toes!"

Red, White and Dead!

RED, WHITE AND DEAD

Fremont randomness again. In an attempt to gain the Guiness Book of World Records title for "Most people dressed as zombies in one place," FREMONT WINS!!

My friend and I participated in the fun, there were a lot of clever costumes. Would you ever believe 4,233 people would collect in one location dressed as zombies? It could only happen in Fremont.

Apparently Fremont won the title last year with 3,894 participants, but then England's Big Chill Music Festival took the title with 4,026 zombies the same year. So of course, Fremont had to win it back. Perhaps next year Fremont will reach its intended goal of 5,000.