i've been remiss

I've got all these blog posts swirling around in my head but I haven't had a moment to type them out. Life is getting in the way, I'll butcher John Lennon's lovely quote 'life's what happens when your making plans' and say 'life's what happens when I'm thinking of blog posts' but the post are about life so it gets very meta? I don't know something that would have been masturbatorially discussed in one of my English theory classes in college. The endless litany of semiotics, signifier and signified and I just wanted to read and not let my love of reading be squashed with all the modernity bullshit.

Anyhoo, I've got big things to write about, not really BIG but the little big things of every day. But I can't do it tonight because I've got to take a chemo test in the morning so I'm chemo certified for hanging said cytotoxic agents.

But but but, I worked nights this weekend, trying to help out the team I switched from days because we were short staffed and let me tell you I had a moment on Sunday. I am no longer intimidated by the residents, in fact I had one arrogant son of a bitch resident that was giving me a hard time every time I paged him, which was often because I was having some issues with my patients. One patient told me they were hallucinating and I asked him to come up and assess her, 'What do you want me to do just sit with her? I can put in an order for Haldol.' No I told him I want you to come up and assess her before you decide to put in an order for Haldol. And I was firm without being bitchy. And he came up and wanted to give her Ativan, even though the nurse from the previous shift believed this medicine had caused her hallucinations. So I told him, no we're not giving her ativan. And then he's arguing with me that she can't possibly be hallucinating from Ativan and it must already be out of her system by now, blah blah blah I'm an MD. I agreed that it most likely wasn't the Ativan but the Ifosfamide that she had received as part of her chemo regimen (salvage ICE) because Ifosfamide can cause neurotoxicity. 'How do I treat that he asked?' Methylene blue I replied. And then he got mad because I had an answer for something he didn't know but I was quick to say, listen I'm new to this unit but I had a patient with Ifosfamide induced encephalopathy and he was treated with methylene blue, it's an MAOI strangely enough but does something very convoluted involving acronyms CAA & NADH that you can read about if you type methylene blue into wikipedia. I didn't tell him the bit about the CAA &  NADH and to look on wikipedia but everything else I did.

And then I called pharmacy, poor J- I was pestering him nonstop Sunday night, when he put in the Haldol order to find out just what the dose he put in was going to do to my patient, snow her which concerned me because then how would the morning residents, fellows, attending assess her for the neurotoxicity if she's out? I went in and she said she felt better and didn't want the Haldol so that solved that problem for me. But it's such a balancing act, nursing, ugh it's frustrating and annoying as hell sometimes. And I don't know if this patient's baseline was goofy (my euphemism for possible psych issues) to begin with, were there really hallucinations or was this attention seeking, maybe she needed a psych consult. And then there's the patient in another room that's had encephalopathy for how darn long and it still doesn't seem like it's being addressed, it was being blamed on acute kidney injury but that has since resolved but the patient, still very confused. And I'm thinking should I put a post it in the chart for the doctors to see saying 'Do you think an ammonia level might be a good idea?'. Because I don't have the patient right now but please they're testing for everything else maybe check to see if the ammonia is high, it could explain a lot. Well I've got to take my chemo test on the floor tomorrow at ten. Maybe I'll stick a note in there if I get a chance. They'd never know it was me and maybe that's the probably I could be the nurse equivalent of an elf, fixing things when others aren't looking. We'll see I've got to work on my math for this test first.