Remembering

           It's not that I don't enjoy my current place of work, but it can sometimes become predictable.  And I feel myself losing all of that ICU knowledge.  The skills I'm not really worried about, placing an IV, drawing an ABG, catheterizing, wound dressing, all of those things are motor skills and can be easily relearned.  But all of that critical thinking knowledge...I'm starting to feel it slowly ebbing away.  It's like when I stopped dancing.  I can still show you the moves, but the names of those moves I can't always remember.  And the sad thing is, it's something I did for years and years.  It's the same with working in the ICU.  I did that for years and years, and now just one measly year has gone by and I find myself wondering how much I remember. 
            Last night I couldn't sleep and started thinking about all the things I used to know...it went something like this: Okay, cerebral perfusion pressure is measured by subtracting the intercranial pressure from the mean arterial pressure.  The normal number for a CPP is 70-100mmHg.  It's an indication of how much blood flow is actually getting into the brain.  So the intercranial pressure may look great, but if the mean arterial pressure is really low then the brain isn't getting very much perfusion.  Brain perfusion is pretty important...yes, I think I remember that much.
            It's almost like that book "Flowers for Algernon" by Daniel Keyes.  He went from cognitively impaired to a genius and back again.  That is a perfect example of the flux I find myself in now.  At first, in nursing school, I most definitely felt cognitively impaired.  You put the what in the where now?  Um, how many chest compressions should I be doing?  What is the point of elevating the head with no hip flexion when trying to lower ICPs?  Is that atrial tachycardia or fibrillation?  What do those things even mean anyway?  I went from drowning, to treading water, to swimming with the best of them, to being a swim instructor.  Except as a nurse.  Because I don't know anything about swimming for real.  Just trying to fit in as many analogies as possible.  But since leaving the arena of critical care, just like Algernon, I'm losing a part of myself as the knowledge slowly departs.