Monday, January 2, 2012

Night 1: Neuro ICU & Night 2: Neuro floor

So, still in the ER, at 10:30 my nurse came to tell me there was a bed ready for me and she had given report to my nurse but per the ER policy any patient going to the ICU had to be transported there with the ICU doc...so we had to wait for him. Pretty silly since I'd been walking around all day but policy is policy, I know how it works. At 11:00 one of the NCCU (neuro critical care unit to not confuse it with NICU - neonatal intensive care unit) docs showed up so me, on a stretcher, and my entourage of nurse, doc and dad made our way to the NCCU. The doctor was updating my dad on the plan for this stay as we traveled which caused a bit of a debacle as I was admitted because in the adult world, unlike the children's world, visitors are to wait in the waiting room of ICU's until the nurse say they can come back so the secretary was chasing my dad down the hallway trying to get him out. Oh geez.

I found the whole ICU admission process kind of funny, just because it was so familiar but I myself felt so fine and all this fuss seemed unnecessary. There was my nurse doing all the routine admit stuff, the charge nurse charting, the ICU fellow who had come with me on transport, another nurse to start a 2nd IV on me(because ICU nurses always like to have more than 1 access point) and draw labs, and an RT doing another EKG. Then to make it fun an ICU resident showed up to practice his neuro assessment skills. Ahh yes, welcome to the ICU, lets make it as chaotic as possible. I also had to be "swabbed" and much to my surprise I didn't come back MRSA positive despite all the MRSA babies I've probably held way to close. Yay!

So the party finally ended and I was left with just my nurse. Sadly the only nurse whose name I can actually remember from either of my stays...probably because her name was Erin, but I was also most alert this time around. So she was pretty awesome but did break the news to me that I was going to be tethered down for the night. I was made NPO (nothing by mouth, aka no eating/drinking) "just in case" (just in case what?), so IV fluids were started, then I got the super fancy compression stockings AND SCD's (mechanical compression things, to prevent blood clots by squeezing and releasing your calfs, all night long). I thought that was silly, it was night time, I'm a thrasher when I sleep anyways, and I probably wasn't going to sleep much here, and I don't normally need "compression" at night when I sleep 8 hours, but alrighty. I also had the routine hourly vitals and I think the blood pressure cuffs in ICU's must be amped up compared to the ones in doctors offices because it HURT, a lot, every hour, no wonder our kiddo's scream every time we try to get a blood pressure. Finally Erin broke it to me that they had also ordered neuro checks every hour...great, really wasn't going to sleep at all. Oh, one last thing, apparently my labs had shown a UTI just to add to my problems, so five days of antibiotics for me.

The rest of the night was fine. My dad eventually went to his hotel since we got there past visiting hours anyways. I chatted with my nurse for awhile, about my job and hers, she did eventually have to leave me though for her other "real" ICU patient who actually needed a bit more attention. I catnapped between my hourly neuro checks which involved me reciting my name, birthday, today's date, where I was, getting my pupils checked with a bright flashlight, sticking out my tongue, smiling, frowning, shrugging my shoulders, pulling/pushing my nurse's hands, holding my arms out straight with my eyes closed, touching my nose, lifting both legs and flexing my feet. I could about do it without even waking up by the end of my second admission. At some point in the night I became more of an ICU patient when my nurse told me that my electrolytes were low and I needed both potassium and magnesium boluses...something I do just about every day in the cardiac ICU, but weird that I needed it. I remember being barely awake when she was telling me this and I didn't ask her what my levels had been but I do remember being concerned that I didn't have a central line and asking her how fast she was giving it...which seems kind of funny to me now (and I got them over four hours which is appropriate for a non-central line). It still burned pretty noticeably too.

5AM rolled around and I got my morning chest x-ray. I don't know why actually, and I forgot to ask. Probably likely that a resident somewhere was ordering them for all the other intubated/recently extubated patients, didn't know who I was and added me to the list (I've seen that happen plenty of times). That, or they wanted a pre-op chest xray and figured they'd get it while I was there. I did see my surgeon briefly again that morning (they always come when it's still dark, before you're awake enough to ask questions), he said I was fine to go to the regular neuro-unit but my labs had some definite abnormalities from the aspirin so as long as nothing changed with me he was ok with doing my surgery the next week.

Shift change came around and Awesome Nurse Erin had to go home (all nurses named Erin are awesome by the way), my day nurse was pretty awesome too but of course I can't remember her name. She had just me for the morning since I was going to be first transfer to the floor and she would get the first OR admit later in the day. We pretty much spent the morning chatting until she got the call that my room was ready. I was seen by the ICU nurse practitioner who gave me the all clear to go and the charge nurse from the floor came up to make sure I was "floor" material. Clearly I was, and she was nice enough to tell me they moved some people around to get me a private room...so nice of them! (maybe they felt bad about putting someone who looked so not sick in a room with a sick person, whatever the reason I wasn't about to complain!). I don't even think any of the ICU docs rounded on me that morning, my bed faced a clear glass door with not a very long curtain on it and I was awake after 5, I saw rounds go by but they never stopped by my room. Guess I had been officially signed off on early.

I was on the neuro unit by 11, my ICU nurse was sad to see me go (of course, she would have had the easiest day with me haha). The plan was for me to stay there overnight once more for observation and for the more in depth eye exam, to switch over all my IV meds to oral ones (ok so I can eat now I guess), make sure all went well with that and hopefully be discharged Thursday sometime. As soon as I got to my room I got myself out of that gown and into clean clothes...something about that hospital gown just bugs me, the less I had to be in it the better. I was taken for my eye exam pretty quickly, it was similar to one I had done on Monday, and had to have my eyes dilated again! Third time in three days, it's not a big deal, I just had trouble seeing well for a few hours after each time. The rest of the day was spent sitting, my dad stayed but he is impatient and not a good sitter, but there was nothing else to be done. I was there for observation, the surgeons were all in surgery so we weren't going to talk to one of them and there wasn't really anyone else following me. Nothing big was going to happen, no changes to be made, I entertained myself of course by watching "Friends" and eventually my dad found work to do on his computer.

The night wasn't so bad, I didn't sleep much, which I now know is a side effect of the Decadron (steroid), but I don't sleep well anywhere that isn't my own bed anyways. The next morning we were told that I would be discharged that day. Now when I hear that I think ok, late this afternoon. My dad hears "in an hour". Being a nurse I know how frustrated families get when they are told they will be discharged but it takes hours. It takes hours because a doctor somewhere has to finish rounding on all the patients for the day, write orders for all the patients that need immediate orders, deal with admits and transfers, and when they're done with all that then write out discharge paperwork for all the patients to be discharged, including prescriptions. It is a slow process and unfortunately the nurse is the one stuck in the middle who gets hounded at all day by families. So, while I was very nice to my nurse all day about it, I had to keep reminding my dad that it was not up to the nurse when my discharge would be ready. He did have reason to be concerned because he had a flight to catch and he wanted to drive me home before but again my awesome roommate Katie said she could come get me if it was too late for him to bring me home.

I was discharged somewhere around 4-5, right at the same time Katie got to the hospital so it was perfect timing. My dad left to go back to Massachusetts with plans to come back on Monday with my mom (my surgery was planned for Tuesday of the next week). Finally I was able to break out of there, a quick stop at CVS for all my meds (for my interested nursing friends I was on Decadron q6, diamox q12, keppra q6, protonix daily and bactrim q12...regular old NICU patient right there!) and back to my apartment to SHOWER! Yeah!

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