Saturday, March 31, 2007

Oh boy, another 12 hours done

A little sampling of the patient's I saw today...

A guy came in for a recheck of his buttock abscess. He was upset because we asked him to come back tomorrow to check it again. "I can't keep coming in for an hour everyday!" he said angrily. "Oh," I retorted, "would that be too much of a pain in your ass?". He paused, then laughed and agreed to come back in.

A seventeen year old girl came in with her mother. Her chief complaint was "I ate a pot brownie and now I feel lethargic and hungry." After the other nurses and I had a good laugh, I brought her to an exam room. She was covered in potato chip debris and couldn't make eye contact with me. Her mom looked equally embarassed. Our advice to her? Don't take what you can't handle.

A poor, harried mom whose toddler broke her nose by bucking his head backward into her face. Anyone who has ever had a toddler in their lap knows exactly how this could happen.

A perfect example of a nurse taking care of others needs before her own: A nurse came in with a painful, swollen foot after working two 12 hour shifts. She only came in to the ER after a doctor noticed her limping. We found she had two stress fractures in her foot (caused by an injury that developed into a fracture because she kept walking on it). Proof that nurses work too hard and don't get paid enough! And guess what, this was not considered a work injury! (What???)

On a serious note;
We received a young woman flown in from Nairobi after she had been treated for a gunshot wound to her abdomen. She was on vacation with her husband and was robbed in Tanzania. During the robbery, she was shot, with the bullet exiting through her lower back. As if this wasn't devestating enough, the 16 week old fetus she was carrying was killed. Yeah, fucking heavy. She came to us with a colostomy bag (a bag used to empty fecal matter when the intestines have been severely injured) but was, eerily and disturbingly, in great spirits. Obviously in denial. Who wouldn't be? It's hard, as a caregiver, to separate yourself from such tragedies. How do you relate to someone that has gone through something like this? And how to show compassion to the patient in the next room who is upset that they ate too many pot brownies and now "feel funny"? It's a delicate balance...

Wednesday, March 28, 2007

My nights as a domestic goddess...

I love to cook! My husband, a wonderful, professional chef opened my eyes to the fabulous world of food. A vegetarian for ten years when I met him, he has introduced me to ingredients and techniques I never knew existed. On one of our first dates I asked him to cook for me, it didn't have to be vegetarian. He made me a simple pasta dish with broccoli and spicy pork sausage. We sat on the living room floor of my small apartment eating from large bowls in our laps. I haven't been a vegetarian since.

On my nights off, I love to putter around the kitchen with a glass of wine, dicing and blanching and seasoning. I try to time it so that when Noah comes home from work around midnight, our dinner is ready to go. I watch cooking shows --not Rachel Ray or Emeril--but Nigella Lawson, Alton Brown, or a program on PBS hosted by Julia Child. I peruse Noah's extensive selection of cookbooks, usually guided by an ingredient I have at hand. Wednesdays is Farmers Market day. Noah comes home with all sorts of baggies filled with produce and I search them excitedly, picking one or two ingredients that I will base our dinner on. Today he brought home some Oregon morel mushrooms, asparagus, baby carrots, spring peas, fava beans, strawberries, and rhubarb. Spring is here! My favorite season for produce.

I went to the nearby seafood market and picked out a beautiful peice of halibut, wild caught from Alaska. I'm going to shell and blanch the spring peas, then saute them, with the morels, in shallots, butter, and a small amount of homeade chicken stock. I'll pan sear the halibut, put it on a white plate, then top the fish with the peas and mushrooms. I'll drizzle the juices all around the plate and add some chopped Italian parsley at the last minute to finish. This is how Noah taught me to cook. No measuring, no following a precise recipe, just taking what is in season and letting the simplicity of the ingredients create the dish.

Last night, I was heavily involved with a sewing project (simple but fabulous dinner napkins) and didn't want to spend a lot of time in the kitchen. I made a recipe that I learned on Nigella Lawson's show for times just like this. She seasons and rubs with olive oil two chicken legs (drum and thigh together) and places them in a shallow baking dish. Then she scatters a variety of chopped vegetables around the legs, chopping them to approximately the same size. For my dish I used potatoes, onions, unpeeled garlic, cauliflower, cremini mushrooms, and an orange bell pepper. But you can use whatever you have on hand, even apples, eggplant, broccoli, whatever. She tosses all the vegetables in olive oil and salt and pepper, then sprinkles dried thyme over everything. (I used herbs de provence.) I figured Noah was going to get home around 11pm, so I threw the dish in a 425 degree oven at 10:15. At 11:15, when Noah was already home and relaxing on the couch, the chicken was done. He taught me a trick to check if the chicken is cooked through: Put a small knife through the thickest part of the leg, then quickly touch the knife to your bottom lip (why there? I don't know). If the knife is hot, the chicken is done. We plated some vegetables in the middle of the plate, cut the leg apart where the thigh met the drumstick and placed that on the vegetables, then we drizzled the accumulated pan juices all around. The chicken was really tender and the vegetables were delicious, especially with the herbs. So easy, and it only took me about 5 minutes to chop the veggies and assemble the dish. I added the left over vegetables to scrambled eggs for breakfast this morning.

After we ate our dinner last night, Noah looked me in the eyes and said, "Naomi, you are a wonderful cook. I appreciate, and look forward to, coming home and eating a delicious meal with you. But...a man has got to have some sweets at the end of the day. You rarely make desserts!" He's right. I don't often crave sweets and I rarely order dessert when we go out to dinner. I prefer savory flavors. I would rather eat some cheeses at the end of a meal instead of something sweet. When we have ice cream in the fridge, I never touch it. Noah has the whole pint to himself. So, I am in the process of making some homeade vanilla ice cream and a rhubarb and strawberry compote. The cream, eggs, vanilla, and sugar have been boiled and tempered and watched very carefully and is now cooling in the fridge before I put it into our automatic ice cream maker. The strawberries and rhubarb will simply be cooked down with sugar and lemon zest until soft, then served warm on top of the ice cream.

I've got a lot to do tonight, finish my ice cream, start my compote, shell my peas...why am I still blogging?

What I do for a living...

I always walk through the automatic glass door entrance to the hospital with some anxiety. As I walk past the ER waiting room, I count the number of people in the chairs, hoping to gauge what kind of day I will have. How sick do they look? A mild cough? Are they holding a bloody towel to their hand or forehead? Does anyone look to be crying? Of course, I cannot hear them. My headphones are plugged firmly into my ears, hoping that music will calm me or wake me up, depending. I walk down the linoleum hallway in my comfortable nurse shoes, my scrubs, carrying a large bag filled with various snacks, and in my hand a cup of hot, sweet coffee, hoping these things will sustain me through the next twelve hours. I swipe my badge through the time clock and greet my coworker's in the Fast Track.

The Fast Track is a department that works directly with the main Emergency Department. We are a team of two physician's assistants and three nurses that see the non-emergent cases. While we take care of the migraines, the lacerations, and broken bones, the main ER can help the chest pain's, the strokes, and the drug overdoses. It's a pretty good system.

People come to the ER with non-emergent cases for a variety of reasons. Lacerations and broken bones make sense to me. I would go to an ER if I thought I broke a bone or needed stitches. But the other complaints baffle me. "I've had a cough for 10 days". "I've had neck pain on and off for a year". I always ask them, "Why did you come to the Emergency Room today?" I understand that some people do not have a doctor or even insurance. But I'm curious to know, why did they choose that today would be the day they decided to come in as an emergency? If you've had neck pain for a year, why not get it checked out six months ago?? My favorite non-emergent complaint of all time is the young guy who came in saying, "I smoked pot and then drank a Red Bull and now my heart is beating fast." My diagnosis: Can't handle his high. My cure: Sit him in front of the television with a bag of Doritos for an hour. He'll be fine. Instead, he pays a $500 fee just for walking in the door then the PA gives him another drug to help "calm" him which he'll probably just get addicted to. As he was walking out, I told him he shouldn't smoke the dank if he can't handle it. He said, "No, I'll just take this drug whenever I want to smoke pot." Great.

We do see a lot of drug seekers. Many claim they have been in car accidents or have migraines. This is usually a guarantee to get at least a shot of pain medication. But you get a sense of who is seeking and who is really in pain. The seekers will ask for their drug of choice by name and claim that they are allergic to over the counter medications or "those don't work for me". One kid who claimed he had been in a car accident asked me if I would give him a shot of morphine because he was "in such intense pain". He asked me this as he was spooning and snuggling in the guerney with his girlfriend. Ummm, no. Another guy was recieving a shot of Dilaudid (ten times stronger than morphine!) for his "migraine". He requested that I give it in his thigh (I would normally go for the glutes) and when I injected into his muscle he closed his eyes, started to massage his leg, and started making "OOOhhhh, AAAHHHH" noises like he was about to have an orgasm. He made me feel dirty.

But, today is a new day and as I put my bag away, check to make sure I have enough pens, some tape, alcohol swabs, and a pair of scissors in my pocket, I take a deep breath and greet our first patient with a smile. I know that in twelve hours I will walk out the door, tired, maybe a little bit sweaty, and climb into the passenger seat of mine and my husband's car. My husband at the wheel with a smile, a kiss, a "How was your day?". I can go home, put my feet up, sip a glass of wine, and comfortably discuss the day with my husband. We talk about his work....Oh, that's a whole other blog...