House??

no.. not the kind with walls and a roof. Rather Dr. House.

Twas a night shift, early enough in the evening that there was a steady stream of people still coming through the doors. I was the float, meaning no assigned team, just helper of all, runner to codes, transport nurse and break relief. M. had two empty beds which sounds like a good thing but its not really because inevitably you get two patients at once. She did, so I went to check one in for her.   I must admit I took the easy looking one. I figured it would probably be a good thing for only one nurse to start and build a relationship with the teen who ODed on street drugs and deal with his mother (using the term loosely, sometimes families are so sad).  anyway back to my patient, not to sick looking middle/young aged guy.  Triage Label was Palpitations, Vitals Stable.  I walk in just as the tech is finishing up the ECG, She finishes it up and hands it to me and states - Had a run of Monomorphic Quadrigeminy but is now in Normal Sinus with the occasional Premature Ventricular Contraction(PVC). The patient looks at me, eyes wide, most certain he is dying with that multisyllable pronouncement. "Don't worry, your not having a heart attack". I reassure, "nor are you in atrial fibrillation" (the diagnosis the Walkin Clinic Doctor had told him he had without doing ECG and a rate about half that of a new onset afib, whatever). I did my standard cardiac admit- assessing him, asking about current symptoms, when the started ect. Doing all of the above while attaching him to the monitor and starting his IV. During pause in conversation while I was starting his IV, he looked at me and said.
Pt" this isn't exactly what I expected?"
Me: "Oh"  raising an eyebrow ( well both.. I wish I just raise one!!),
Me:"what did you expect" ( half expecting him to say something about how he thought he would wait for hours, and wow there was a lot people doing things all at once ( cardiac admits usually have the lab, ECG and nurse fighting for pt space in the first 5mins)
Pt "Yeah, its not at all like House or ER or any of the other medical shows on TV"
Finishing up on the IV tape job
Me "how so....?"
Pt: "There is no one yelling at each other"
Are you for real!!!
Me: ah.. well we don't actually yell, this isnt exactly TV, oh and there are no nurses on those shows. Pt ignored that..
Pt- I bet you guys just laugh at those shows..
Me- Actually yes.
Continued on with the assessment. Tracked down the start of the PVC's to a half hour after he drank a super caffeinated beverage. I print off a strip off the monitor, show him what the PVC is and do some nice teaching including hand actions to stimulate the normal beating of the heart chambers and what they were doing to cause the funny feeling. I restrained myself from doing this awesome full body interpretation of cardiac rhythms.  But thought I got my point across even tying in some vague diagnosis he said some surgeon had said he had.  But this guy unfortunately was not the sharpest knife in the drawer. As I finish up and am leaving the room he calls me back. 
Pt: I know we talked about this.. but I brought a coke with me, Can I drink it?
Me: Nope, here let me get you some water!!!  Did you not hear a word I said about caffeine!!!

PS.. we did have a little of a House moment a few nights before

Me: can I give the pt in 12 something for their pain
DR: Sure, I just went in to see her, and am ordering some xrays, which side did she fall on again?
Me: She didn't fall.
Dr: Yes she did.
Me; I asked her, she explicitly said she didn't fall
Dr: She lied
Me: Excuse me (raising an eyebrow,.. well two)
Dr. Patients always lie,
Me: Pardon me??
Dr: Well..  thats what House says.
And that launched both Drs into the woes of medical shows and who does really advise those shows!!

We did some pictures of Branson last week hopeing to get a good one for his birth annoucement. Besides the first minute he was WIDE awake for the entire thing and was not to fond of anysort of poseing or positioning. We still got a few cute ones, hard to believe he is one month old already!!

While babies are cute, they are not to much fun to play with. Emily and I however spent Sunday afternoon having an outside tea party.  Emily is so cute with the dogs.. bossing them around even tho they are twice her size.. but she was taking no chances with her tea cup!! a two handed hold on that.

Vague Patients

Twas an mid morning in RAZ ( our medium sick area), I saw a patient that was ready to come in on the tracker. The generic listed issue was a headache.  I popped them in a room and went to put the chart up on the rack. Normally I go in and assess the patient myself right away but since Dr Awesome was ready to see the pt right that moment we went in together to save the patient repeating everything twice (good thing we did). 

Dr Awsome: Hi, whats going on today
Pt Vague: I think Im sick
Dr A. Whats wrong?
Pt: I don't feel well
Dr A: How do you not feel well
Pt. I just feel sick
Dr A. Can you explain a bit more.
Pt:  I can't go to work.
Dr A. Why can't you go to work?
Pt: Because I don't feel well. Im Sick
(that reads quickly but really took about 2mins!!)
Dr A. So do you have a cough, a fever, throwing up, headache? Whats not feeling well
Pt. Yes
Dr A: Yes to what?
Pt. to all of them
Dr. So when did you start not feeling well?
Pt. Im not sure
Dr A. " Yesterday, last week, last month?
Pt:. last week, I think. I have a headache and feel dizzy when I stand up to fast
Dr A.- Examines pt. Asks more specific questions receives more vague answers
Dr A- you have to flu. Take tylenol and advil and drink lots of fluids. Melanie will give you some here to start.
I go and get meds and go back in to give to pt
Me- Here is some tylenol and Advil. (give my usual speil about the two)
Pt. Tylenol and Advil arnt the same thing?
Pt. Are there any food I shouldn't eat.
Me. You mean now, no whatever you want just make sure you drink lots of fluids
Pt. No, I mean are there any foods I shouldn't eat to not catch the flu?, How do you actually catch the flu? How do I get a BC healthcard?....

Two months later
Same Patient, Same Doctor Awesome, Same Me.
Generic Triage note is Chest pain, non cardiac.
I see that it is same patient, Dr Awesome and I chat, see that he has been here for minor things over the last two months, decide that we should also make sure things are fine at home and he is not seeking other help.
Dr Awesome: Hi, what brings you here today?
Pt Vague. I don't feel well.
Dr A- what doesnt' feel well? ( This time we only went 2 rounds of "Im sick", not 7!!)
Pt. My chest hurts?
Dr A- Where? When did it start?
Pt- All over, Im not sure
Dr A. Does it get better or worse with any thing such as movement, deep breath, cough?
Pt- Yes
Dr A. Yes?? Yes to what most people can say if it gets better or worse with something
Conversation Continues
Me- Here is some Tylenol and Advil for your pain
Pt- I don't want anything for pain, I just want the pain to go away naturally
Then why on earth did you come in!!!!

Welcome home

As a last hurrah before the moms came home from Holland we headed out to go kart racing in Richmond on the way to the airport. 

Every one enthusiasticly watching the safety video

 

Us in our very attractive headcovers.

 Cool dude racers (not sure why this one will not rotate for me)

Then it was off to the airport to await the arrival of the mothers!!

 The raffia on my flowers got in the way of this shot.. but I still love it

Ten on Tuesday

1) I once again take off my hat to mothers especially mothers who work. Managing two kids, two dogs, a household and fulltime + work is not for the faint of heart.  I last about two weeks, tops.

2) I am thinking of this for a bedroom color .. your thoughts?/

3)Since I am not a true mother, I am not above bribes. It is amazing the amount of housework you can get out of a 13 yr old if there is a promise of sticky rice and seafood at the end.

4) I put 49.3 L of gas in my 50 L tank yesterday. Definitely not a fan of that adrenaline rush for the 5mins that I realize that I am that close to empty and remember that filling up on gas was something I was going to do the day before.

5. Happy Birthday to my most special sister Amy, Her birthday was last week and did truly deserve its own post but it didn't happen I am sorry. I pray you have a fantastic blessed year!!

7. Yesterday Rosie and I took the kayaks out for the first time of the year, and the first time using my new kayak!! True to form it was pouring, but the lake was glass, the mountains were misty, we were the only ones out there, and there were two eagles in sitting in a tree.

7. Little Clarice does a fab job hauling the kayak, which is still nameless, around. I must admit it is a bit sketchy as it is about twice as long as the car!!

 8. So blessed to have such a fabulous friend to enjoy all things outdoorsy with.

9. My mom comes home tomorrow!!

10. You know your dog is still a puppy when it coughs and up comes a pop bottle lid!!

Grandkids

My mom and all of her sisters are in Holland and they were asking for some pictures on the blog of all the grandkids/family so that they could show family in Holland.  So here we all are



Snowy Week

This week was a full one. Lots of Emily time, bbsitting my little cousins for three days which included forays on the sky train to Science World, time spent in in door playgrounds and lots of Mac and Cheese =;)

 Snowed one and off this week providing us with the winter feeling, but not anyof the shovel work.  On nights on Saturday night at 3am we went sledding on garbage bags on the hill by the cafeteria, havnt had that much fun/been that cold in along time. Scrubs are not exactly very warm!! Derek spent time on Sunday making this snueewpop  (snowman). If you know dutch check out this http://www.youtube.com/watch?v=3gV6KpPd2wo if you don't know dutch Im sure it is on youtube in english but probably is not as funny =;)