Last Shift is Finished

Yep, I survived my last official day of employment. It wasn't too rough, but again, as mentioned in the log of the final days, the last two weeks exposed me to some stuff I haven't done in quite some time.

1. Two weeks ago, was the night with 2 successive patients for Pacemaker Recovery, requiring a Code Blue and its equivalent Rapid Response, each getting airway intubation and heading to ICU emergently.

2. Two nights ago, the elderly really sick guy, being delivered to me for recovery, and he was purple, cold and barely conscious. A look in the Policy & Procedural manual, calls this Deep Sedation, which should be handled with an Anesthesiologist on standby; not in our unit. Heck, it was 9pm, we had 2 nurses, a total of 5 patients, and three had arrived in the past 2 hours!

3. Yesterday, (last shift), I get a guy who had a Diagnostic cardiac angio, with global arterial vascular disease............he had bilateral Femoral artery sheaths, plus a Left Femoral vein sheath. His BP was 187/88, and the the palpable femoral pulse, superior to each of those artery conduits, was hyperdynamic. Essentially, that means, stiff calcified blood vessels, not amenable to collagen plug therapy so me and my best buddy, do a tandem, Femoral artery sheath removal, where we both do the super-duper fist hold to the groin x 25 minutes, to obtain secure hemostasis. I was pretty sure the guy was going to "pop" one of those punctures, because he kept bending his legs, trying to sit up, roll over, and so on, but he managed to survive his non-compliance for 5 hours and not hemorrhage.

4. That same guy as described above was only 64 years old. His cath revealed that he needed CABG and Aortic Valve repair. He kept breaking into episodes of moaning / crying, having something to do with learning he needs surgery, pretty damn soon. Several times I go to the room, and he's sobbing, "I want to go to Paradise, I want to go to Paradise" over and over, the crying mantra. Oh I finally figured it out; he was beholden to one of those religious faiths so enamored with the Paradise theme.

5. I also had Betty Lou who needed 4 hours of bedrest after Atrial Flutter ablation, moaned and groaned about terrible back pain, which I medicated generously with Fentanyl and Dilaudid, hot-packs and towels. Both the Ablation doctor and Anesthesiologist came around later and asked "how has she been doing" and "Betty, do you want to go home?" I share that she has had a lot of back pain, probably from lying on the gurney for 5 hours. She practically yells out; "I don't have back pain!"

Her husband tells me several times about all of his herniated discs, and how sometime back, he was taking 280mg of Norco everyday, until he finally got Duragesic patches, and is doing much better. Actually, Betty Lou has been regularly dosing with (2) Norco 10mg's, every four hours at home, and some Oxycontin too. When I took her upstairs to her room, her new nurse asks, Betty, "How is your Pain". Her response; Well it's somewhat better, but it's not my back, its really because I have had more than 14 surgeries, and I have a chronic pain syndrome. Holey Moley.

6. The real highlight of my day, was the woman who showed up for a Cardioversion, because she was in Atrial Fib 2 days ago at the doctor office. I put on the Cardiac monitor and.............she is in Sinus Rhythm. Thus, no need for an IV, Propofol, shock or anything. She did get a new prescription for Amiodarone. We had a pretty good time talking about all the books we like to read, and I gave her husband an author recommendation.

7. Best of all, we had a little Retirement Celebration with an awesome cake from the best bakery in town, my pals gave me a very funny card, (all signed with nice stuff) and photo's were made.
Last week I had bought a major pile of Starbucks coffee cards for Xmas presents, and I finished handing those out. Then, one of the Cardiologist, bought us all lunch, so a good time was had by all.
At the end.............we only got out of work 15 minutes early (on a 12 hour shift). C'est la vie.