Now, don't worry. There is nothing wrong with my urinary system. But my mother, and others, are having a hard time understanding why I find it difficult to use the restroom more than once in a twelve hour shift. This is like asking why a basketball player doesn't have time to eat tea and crumpets during a game. Or why a marathon runner doesn’t have time to play a game of chess during a race. It just isn't possible.
Let me try to map it out.
6:00am - Alarm goes off. Depending on how tired I feel, I may or may not hit snooze... more than once.
6:30am - I trek to the bus stop in the dark (before daylight saving. after we can see the first tint of dawn)
6:36 - My bus comes. It should be more like 6:38 because it's always late.
6:50 - I arrive at the hospital. I join the general melancholy trudge of traffic as we make our way into the building.
7:00 - I get report from the off-going shift. Depending who is giving report and if I've had any of these patients before, it can take 30-45 minutes.
7:30 - I plan my route of attack on my unsuspecting victims...I mean patients. Depending if I work on the floor or in the ICU that route can differ greatly. We'll go with the ICU today.
8:00-8:55 - I usually have two very sick patients, both intubated (breathing tube), needing neuro checks every hour. This means every hour I literally have to yell at my patient to show me two fingers, or a thumb up, or a wiggle of a toe. Level of consciousness is what we’re looking for, and often, neuro checks can take 20-30 minutes each, if sedation needs to be turned off and they're slow to respond.
Then there's full body assessment, heart, lungs, stomach, etc.
Then it’s time to get morning meds, which invariably all need to be crushed and flushed down an NG (nasogastric) tube. This also can be time consuming, as each patient has 15 meds in the morning. And IV drips. And injections. And eye drops.
Then there is the writing down of the vital signs, which is usually every hour for both patients as well. Heart rate, temperature, respiratory rate, pulse ox, blood pressure (by cuff and arterial line), intercranial pressure and cerebral perfusion pressure are the main ones. Sometimes depending what they're in for, other things are monitored.
Also, depending on what type of drips their on, or a special parameter the doctors want followed, I’ll have to draw blood every 4 hours or so.
The first morning hour usually flies by.
9:00am - Vital Signs and Neuro checks all over again. Sometimes more meds.
9:30am - Sign off orders, look at labs, usually something comes up that I need to call the doctors for.
10:00am - Starts again. Oh, and every even hour I have to measure how much fluid I've given the patient, and how much they've gotten rid to make sure they're not getting too much or too little. I also forgot to mention that every even hour (at the very least) we must reposition the patient to prevent bedsores. (Our unit rocks at this, by the way) Not to mention oral cares. If a patient’s mouth isn’t cleaned frequently the risk of pneumonia increases.
11:00am - Okay you say, you probably could've gone to the bathroom around 10:30ish, right? Well, I reply, you're right, I probably could. But you're assuming that everything is hunky dory. But between the hours of 10-11am is where everything, inevitably, starts going downhill.
It's called the dreaded: NEURO STATUS CHANGE.
This cascades into a series of events that always leads to a stat head CT. ALWAYS. And, just last week, it happened to both of my patients, AT THE SAME TIME. This is every nurse's worst nightmare. It's okay if just one of your patients is having issues. But both at the same time makes you want to scream. Or at least get really flushed in the face. Luckily, we work as a team in Neuro Land. One nurse takes one patient, I take the other, and we have a race downstairs.
This is called: A ROAD TRIP.
These are not the breeze blowing in your hair, sun beating on your skin, sunglass-wearing types of road trips. This is a scramble around madly, unhook a bazillion cords from the stationary monitor and plug them into the portable monitor. Call respiratory to bring their portable ventilator. Bring the IV pole with the bazillion drips and cram it all into the tiniest elevator possible (that they claimed to have enlarged for us) type of road trip. The scan itself takes approximately 2 minutes. I'm not exaggerating! But to get down there and then back up usually takes an hour. And you're just praying nothing bad has happened, that you don't have to tell the family their loved one has just gone to the OR, or they've stroked again, or any of the numerous things that could cause a neuro status change.
So it's 12:00pm now. Maybe later. Depending on what went wrong during the 10am-11am hours of doom, you're either way, way behind with no hope of a potty break until kingdom comes, or you foresee a potty break at least before the angels start trumpeting. Don't forget, you have to chart absolutely everything. "Chart like you're going to court" is a favorite saying of ours.
1:30pm (or 1330 in military time) - I usually get to go to lunch. During which, I get to use the bathroom. Technically we get half an hour, but if I want to catch my 7:36pm bus on time, I really don't want to be gone that long.
2:00pm (1400) - It all starts again.
3:00pm (1500) - And again
4:00pm (1600) - Usually the time when lots more meds pop up. And when family starts to visit. This is usually my favorite part. It does tend to take up lots of time to talk with family and explain things to them, but if I can make things any easier for them, I'll take that time.
5:00pm (1700) - The homeward stretch, usually. Sometimes it's the "Holy Guac-the-moly, I only have two hours to get all this done!"
6:00pm (1800) - The final reposition of the night. If I’m lucky there won't be any little "surprises" under the patient, but one never knows. With all the medications and tube feeding we give these poor people, we either put them into a constipation or a diarrhea mode. Never a happy medium.
7:00pm (1900) - The on-coming shift arrives. Depending on whether they've had the patients or not, report can take anywhere from 30-45 minutes. And then I’m free! Unless I have last minute charting to do, which is often the case.
7:35pm (1935) - I'm running for the bus stop. If I'm lucky, the bus is late. But the bus is never late going home, unless I'm late getting to the bus stop. At least it seems to be the case. But let’s just assume for this little literary exercise, I get to the bus on time. It's crowded with weary workers such as me, but I can usually find a seat.
8:00pm (2000) - I trek back to my apartment in the dark, even with daylight saving. I take a shower, scrubbing off the hospital scum I know to be covered in.
9:00pm (2100) - I might waste a few moments on the computer or read a little to unwind.
10:00pm (2200)- I make sure my alarm is set. I am asleep before my head hits the pillow.