Saturday, August 27, 2016

It's done

I had my surgery yesterday. I was quite nervous for it actually. I didn't know what would happen until I was under general anesthetic and could be examined that it would be decided upon.

We did the pre-op and it took FOUR HOURS!!!!  Goodness that was the longest pre-op process that I have ever been through. I would have expected that from the hospital in my hometown but not at this major city's hospital. It was ridiculous.

First I had to see a nurse and tell her what I was having done. Then she decided that I needed to have blood work and because of one of my IIH meds (diamox) I needed to have a ECG -> which showed that at one point I may have had a heart attack so then once I had those done I had to see a physician (after sitting around for somewhere like an hour and a half) and he kept asking me whether I have any chest pain or whether I can go up two flights of stairs without huffing and puffing. I indicated that I could and it seemed like they didn't quite believe it because they asked the questions just in a different manner. Plus I had to repeat all the same info I had told the nurse which I understand why they do it but I don't see why they don't just verify the information and ask if anything was missed or forgotten. He also asked about my IIH and I had to sign a release of information for them to get the neurologist's last progress note. So then I went and waited for another hour+ to see the next person.

Then I had to see an anethetist and repeat ALLLLLL the information all over again. And surprisingly enough they had the neurologist's note and so I had to discuss how I learned about that. Then I learned something new....
Succinylcholine (Sux) increases intracranial  pressure and should therefore indicate that it needs to be avoided. So I asked whether there was a chance that she would be my anethetist.... which she gafaughed and said "well there's 38 of us so it would be surprising if you do".... well guess what?!

I got the same anethetist!!! Rather shocking. Said that instead of Sux she would be using rocuronium (rock). She also had a teachling who said that once on the table she would give me some ativan - yay!

But HEEELLLLLLLL I woke up with a MASSIVE migraine!!!!!!!! Geeze my head hurt. But surprisingly my butt didn't! I was told that I received a fistulotomy. That it went smooth and exactly as planned. It was the first time in THREE years that my butt didn't hurt (well it was about 2/10 pain wise which for me is no pain really). I was sooo impressed that my butt wasn't the main bit that hurt.

Then I was given morphine on an empty stomach (bad idea!!!) and after I was out of PACU they wanted me to go pee which was harder than you think! They wouldn't let me go until I peed. However, I was extremely nauseous and just after I washed my hands I vomitted into the sink - OMG I couldn't believe it. I was so caught off guard, I couldn't even make it to the toilet 2 ft away!!! Thankfully when I exited the bathroom they had a basin that I could take with me back to my little corner and vomit along the way and lay down into my bed. Ugh I was so nauseous. So my nurse gave me a med to try to help me not vomit. But it didn't help. So I pretty much told my nurse that since I was out of options for meds to take to control the vomiting, I opted to be discharged so at least I could vomit in the privacy of my own home.

I came home, took a couple of my own meds (like zofran) so that I could feel better. Then went straight to bed and slept a whole whack load of hours. And when I woke up I wasn't nauseous OR in pain. It was glorious!!! Now for the healing part. I hope it goes accordingly so that I can go back to work and life and be able to exercise again!

Saturday, August 20, 2016

Getting ready

Next week is my surgery. On tuesday I have pre-op, then I'll learn what time I have surgery. I'm kinda nervous about it all. Going into this surgery I don't know what I'll come out of at the end of it. I'm sure hoping that this time next week I'll be over and done with.

And while I want to be optomistic, I've seen firsthand that that's not the way it always works out. I had a patient last year whose buttocks were a mine field of fistulas... I'm worried that I'm dipping my toes into a puddle I don't know the depth of which I'm getting into.

I'm just hopeful that I heal properly and that I don't have to worry about this issue any further.

And next week I also start the 'final' semester (good lord I sure hope that it's the final) - I'm getting a running start at it b/c the prof opened up the course already. It's going to be a doozy of a semester too. The other course is all about ATI, NCLEX and Kaplan - holy heck it's going to be a lot to keep my head above water. Plus I'm supposed to go back to work after I heal from this surgery.

Then we're supposed to move in the beginning of october. Hubby just asked me the other day what day I want to  move on. Problem is that I have a major paper & presentation due that week and so there's no way that it can be done that week - or it won't be a lot that I'm involved in. Good thing is that we're going to be in possession of both houses and so it doesn't really matter when exactly we move either than the fact that we're supposed to cut the utilities and internet here to move it to the new house. Unfortunately, I need the internet in order to submit my stuff so I don't know how we're going to work that.

Plus I'm sure that moving will add stress to my already stressfull life. Hopefully I can handle it all.

Tuesday, August 16, 2016

What is yet to come

I've moaned and groaned on here that a bigger house is needed.... been saying that for YEAAAAARS.

Now that I'm set to graduate and we can afford to actually move out of the hell hole, the in-laws have finally decided that they agree... no thanks to my BIL who is to be getting married in January and now that he wants a bigger area for his new bride, a brand new home is in order.

Move in date is October.

I graduate in December (God willing!) - and I just really want to move. But just in case that isn't the case, things will have to be done about this new house if we are to live with the inlaws still.

First off, there's only 4 bedrooms - the master bedroom is for my inlaws
then there's one room for my other BIL - the youngest one.
then another bedroom for my BIL who is getting married - he saw the house with my in-laws and I did not and supposedly he claimed this room..... I'll comment on this in a sec. It has a bathroom attached to it - sort of like a secondary masters bedroom.
Then the last bedroom is supposed to be for little tyke BUT

Hubby and I have been relegated to the basement (again!) and in this new house, the basement isn't finished - not even the studs! SO I said FORGET IT!!!! And I claimed the bedroom upstairs with the bathroom attached. I really don't give a crap about my BILs desires b/c this house was clearly bought with the intent for what HE needed, not what hubby, nor I or little tyke needed! 

PLUS - if I take the room upstairs, I'm certain that the basement will get done sooner! Plus I've made it clear that I don't want to live in the basement like I have to now. I know what I want done and until it is, I'm not moving out of that bedroom unless I get a nurse residency and then by golly, I'm gone!

So what must I have you ask?!
1. A full bathroom - beautiful shower, a nice vanity & sink, plus of course I toilet - BUT there must be a door leading to my bedroom AND one that everyone else could use (I don't want ppl going thru my bedroom to use the toilet).
2. Hard wood floors
3. Oh and while they're at it - put up the walls, cuz right now the basement doesn't even have the studs in!
4. At least one bedroom, two would be great.
5. A large window in the living room area since I actually like sunlight while I'm awake.
6. I would like a full fridge (right now I only have one of those small ones that kids take to college) and would like a hot plate and a microwave - so some cupboards would be good!

IMO I think I'm going to be upstairs for a long while. The unfortunate thing is that little tyke doesn't get a bedroom to herself until the basement gets done. I feel bad for her, but not enough that I would for go it all. 

Personally, I would rather just move away and get a residency. But we'll see what life and God has in store for me!

Saturday, August 13, 2016

Seeing it was amazing

So.... up next is another clinical experience....

The BIG case we had was a patient who was brought by ambulance as a stroke alert which means that CT tech is notified so that by the time that the patient arrives, they are at the hospital and the CT scanner is ready for the patient to be scanned. 

When the patient arrived, she could barely wiggle her left toes, had trouble lifting her left arm and sensation was drastically affected on her left side. Her pupil on the left side was sluggish as well. Her facial expressions were asymmetrical and she had a slight slur (ambulance personnel said that it was quite pronounced when then arrived) and grip was unequal bilaterally (less on left side). 

I immediately put her onto telemetry which showed A- fib (every other VS was within defined limits)– however the physician wasn’t concerned. I was baffled. I don’t understand why no one is ever concerned when they see this. I put in two large bore IVs (one in the AC and the other in the hand; on the same arm) and drew labs. 

Then she went to CT. It was clear which meant that she did not have a hemorrhagic stroke and if she had an ischemic stroke there was no evidence of that at this point. By the time that she had returned from CT her condition had changed, she was starting to be able to move her left side more freely. She was able to life her left arm almost entirely and slowly, but steadily she was able to raise/move her left leg & toes. Her left pupil was now reacting briskly. 

Upon return from the CT I did her EKG which still showed A-fib, however the physician struck this out and wrote out stable rhythm with occasional PVCs which I don’t agree with considering the A-fib was also showing on the strip rhythm. But as a student I don’t feel comfortable speaking up and disagreeing with a physician. I asked my preceptor about it and she said that she didn’t understand it but didn’t do anything further about it. 

We switched gears a bit to get the paperwork in order to give to the new hospital, give report but also still take care of our patient who thankfully every time we did another assessment was improving. By the time we transferred her to a stroke hospital, she was able to move all her limbs, her grips were strong and equal, her eyes were PERRLA, and expressions were symmetrical. 

I spent a lot of time with her and the family alleviating their fears and explaining things after the physician as well as answering many questions.  What I learned had to do with the last one. It was amazing to see a person with a stroke (a TIA is how the physician was classifying it given that her symptoms were dissolving right in front of our very eyes) and to see how the symptoms of it were evaporating slowly but surely, little by little. 

It was hard for me to reserve not telling this family that this event probably occurred because of her A-fib and that this physician simply ignoring this fact and not telling the family about it. I just wanted to yell it out loud!!!!!  Ugh so frustrating. 

I loved being there for this patient and for the family though through such a difficult time in their life. I could absolutely work in the ER and enjoy it for the rest of my life if I dealt with situations like this day in and day out!

It was also neat to see a stroke patient at that point and watch the symptoms disappear b/c coming from a neurology unit where we see the patients AFTER their symptoms have resolved or when their symptoms are more permanent. Frankly I thought it was awesome to see her symptoms resolve little by little. 

I think if I could do pediatric ER that would be awesome!!!! But we'll see how things pan out.

Friday, August 12, 2016

Clinical experiences

Liike I've said before, once my semester finished I would let you know about what I experienced - cuz it was AWESOME!!!

The first that really comes to mind is a guy who was on his FIRST date with a girl and wanted to impress her and they were on a swing set and tried to do a a back flip off it. Ya, bad choice! Obviously he didn't make it and put his arms back instead of falling on his butt. Again, bad choice!

When he walked into the ER all calm and stoic, just holding his arm (actually he looks like he had his arms crossed across his chest and so didn't think much of it) - we had no idea what brought him in.

Once we heard his story it was hard not to laugh at his antics. Of course not to his face! Nah, we went to the nurses station first. Ha!

We figured that we would be doing something requiring massive amounts of pain relief, I put in his IV and drew labs off it (we figured that the Dr would probably want to check his alcohol level!). So once that was in we got the order for pain meds - gave that to him thru the IV I put in and off he went to x-ray. Sure enough - dislocation - kinda nasty actually.

Doc told us that we would be doing a conscious sedation on the guy - boy did THAT make me excited!!!! My first time and I anticipated actually being able to participate in this. So I helped my preceptor get everything ready. Ensured that our guy was hooked up to telemetry and hooked up his IV to fluids.

Then we went to town and gave this guy a great show of support - the manager of the nursing department/ER picked up this shift because another nurse was sick (I'll tell you that story another time - it's interesting to say the least!) and so she volunteered to help the Doc pull the arm back into alignment. I was responsible for ensuring his airway and monitoring his sats & heart rhythm. My preceptor was the one who instilled the meds. It took about a min for the meds to kick in - but holy moly did he fight the meds!!!

It didn't take long or much pulling - but I ended up having to help hold the patient because the manager was having trouble keeping the reverse pull on the arm/shoulder. In the end it worked out. He barely even moaned - all he kept saying was "nooooo, nooo, no - don't do that" - and then when the meds started to wear off, he started to get all flirty with different staff members - heck when the x-ray tech came to do the x-ray after setting the elbow, he was REALLY flirting with her. It was actually quite hilarious and no one was able to keep the giggles in.

The great thing was that when he fully came through the haze, he asked "when are we going to do it" - I told him "dude, it's already done" - he didn't believe it, had a hard time accepting that but was completely ok with what we told him. He was so relaxed and cool. It was easy treating him.

Another day I'll let you know what else I was privy to. Completely blew my mind!

Tuesday, August 9, 2016

Anything less than boring around here

Well I called it... I put it out to the universe that I needed to stay healthy - like that term really means anything with regard to me. I feel like I'm in a holding pattern of stability - ill but not seriously so.

Last week I had to get paperwork to my family Dr so that I could start the process to go back to work. But work needed the Dr to fill out the forms and so I had to go see him. I was up til really late (~4am) and I noticed what I thought were hives - 2 of them - n my chest. Midline and slightly lower than the left sternal notch. I didn't think much of them - they were kinda burning and so I put some hydrocortisone on it and took a couple of benedryl and went to bed. When I went into the Dr's the next day (~3pm) we were about to wrap things up and I made the remark to him "hey, can you take a look at these, they're kinda burning - I thought that they were hives but what do you think"

His response - ya you have SHINGLES!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

So for those layman folk out there, that's the chicken pox virus that rears it's ugly head when you're older - as in mostly those who are ELDERLY!!! I realise that I got it because my immunity isn't what it's supposed to be, but geeeeeeze I feel like I finally get up on my feet and then get knocked down again.

I couldn't believe it and I had no filter at the time and said "are you fucking KIDDDING me?!!!!!"

Ya, he wasn't. To which he replied that that meant that I wasn't going to be going to work as planned. So he filled out my paperwork and off I go to give the pharmacy the script for antiviral meds & cream. I get there about 4:30 and tell them I'll be back to pick it up.

Well the pharmacy ppl didn't bother to say ANYTHING to me about the fact that they were closing in 30 min - b/c of the fact that it was actually a holiday here. Grrrrrr - I was rather irritated and hubby said that he would pick it up first thing in the morning after his night shift. Well I ended up being awake all night (doing that paper I told u guys about) and so I went with him to get the med - complained to the manager there that I should have been notified at least considering what kind of med it was for!

Anyways - so I take the first dose and put the cream on - OMG that cream was awesome! Totally took away the burning feeling!

So because it was now after the holiday weekend, Dr's were back in offices and so I figured that I would call the surgeon.... the one who said that I would have surgery by the end of May!!!!!! I got a hold of them immediately and they indicated that they were waiting on MRI reports that they had requested (which I completely understand that they needed) - but these were requested in FEBRUARY!!!!! So I tried to be VERY nice to the receptionist and was more than frustrated. I inquired as to why I hadn't been put on the schedule once they received them and she bypassed this with offering me the next available time slot - just over a week away.

Ok, sign me up!!! But I also told the receptionist that she needed to let the surgeon know that I was diagnosed with shingles and told her what medication I was on (I knew the surgeon would want to know) and left it at that. Wellllllllll..... it turns out that the surgeon didn't want me on the table that soon after having them and now I have to have it on the 24th - the day AFTER my LAST semester begins. UGGGGGHHHHHHH

I realize I need this surgery, hopefully it can be done in one fell swoop and I'll be good to go after that. Unfortunately, knowing my luck, I'll have to wait another six wks after this surgery to have the actual surgery to make everything right. Not encouraging!

I also called the immunologist office b/c I'm sick of being sick. I inquired about blood work and whether the receptionist can get the Dr to fax a requisition to my family Dr and hopefully I can get the necessary blood work done so when I see him he'll see just how crappy my immune system is and POSSIBLY he might actually do something about it! At this point, if he doesn't I'm going to ask for a second opinion b/c I think with everything I've been dealing with this past year, I need all the help I can get and if a Dr isn't going to help me, I need to find one that is!!!

So..... just as I was ready to go back to work, I develop shingles which delays things and then I find out that in the 3rd wk of the month I'll have surgery..... so at this point I have no hope of getting back to work until the middle of september I figure - and that's IF I don't have to have more surgery. Like I said, my life is ever far from boring!

Sunday, August 7, 2016

Goodness it's done

AAAAAAAaaaaaaaa I finally finished this stupid paper for my course. All 27 pages of it!!!

For the course we were expected to develop a "tool" and implement it then evaluate it. What I did was develop a family presence during resuscitation policy.... single handedly!

And holy moly was it more complicated than originally thought. Plus I had to make it aesthetically pleasing. So I ended up trying to figure out footnotes that were APA even though they're technically MLA.

We're seriously counting down the courses. Provided I pass this course (which I expect I will - just have to see how good the mark is), I will have 1  1/2 classes left.

My new prof sent me the syllabus today and the course looks intense. The last two courses I've had to come up with projects that require a boat load of research. Unfortunately, it seems like I have to develop another project. Oh my gosh I hate this!

I think I'm going to be up to my eyeballs in articles in this new class. Plus of course all the busy work. I don't think I'm going to have much time to devote to anything but this course, work, and possibly my family. But at least it's the last one (I hope!) and so I understand if it's intense, I wouldn't expect anything less.

I'm just thankful to have this last course over and done with. It was stressful at the end! Plus it didn't help that I've been fairly ill with my IIH and trying to get things even enough for me to be able to do the paper. I had to have an extension of an extra week after the course ended to finish the paper, I was having debilitating migraines everyday and it seems to have passed (thankfully!). I just hope that the medication I'm on makes it so that I can continue to function. I can't ask for an extension with this last course because it would cut into graduation and therefore I wouldn't actually be allowed to graduate. Sooooo.... I need to make sure that I stay healthy.