Sometimes work is a rest, sometimes not so much.

Three shifts down and done, and it was a mixed bag kind of week. My first shift I was floated over to the CCU, and it was a really pleasant day. Sometimes going to a different unit can be very stressful, but I certainly wasn't overly stressed in CCU. Everyone was so nice to me, and my patient was a breeze to care for; I had a fine day. Next day I was back in ICU, and it was a much more frustrating kind of shift. My patient was agitated and delerious, and hard to make comfortable, and had constant diarrhea on top of her agitation, so I spent the day cleaning and turning and trying to keep my calm and sense of humour. Reasonably successful at that, but still it was a day I was happy to have come to an end. One of the interesting things about the day was a visit my patient had from a community worker who knows her from the community centre; it brought home to me how little we in ICU know about the person behind the person lying in the bed in the unit. To look at my patient superficially, I would say I see a woman who has lived a very hard life, who abuses her body with alcohol and drugs, and who seems to have fallen between the cracks of society. What the community worker sees is much different: she sees a woman who is down on her luck, but a person who has a smile for everyone, a sweet temper, who is a valued member of her little circle of friends. It reminded me that it's important to look beneath the superficial facade and try to find out who the real person is; otherwise we miss so much, and perhaps don't give as much attention to parts of the person's psyche as we could.

I had her again today, and it was a busy day. We had to put in dialysis lines, new IV lines, take her to Radiology, start her on dialysis, etc. etc. I was hustling all day long. Almost got into a fight with the attending Intensivist, too. I have some serious issues around the ethics of some of our treatment for this person, and tried to get a sense of where we're going with her; she has so many serious issues, and her treatment is going to be long and costly, and her overall prognosis is questionable, and her support in the community is practically nil. I believe that sometimes we have to look at the big picture and think about the long term before we subject people to more invasive procedures; but it's often difficult to get that conversation happening because no-one wants to be accused of trying to ration care. However, there are times when I really don't think what we do is necessarily in the patient's best interest, especially when none of the treatments seem to be working all that well. The doctor in charge really jumped on me when I suggested (rather forcefully, I know) that we should be taking all these things into consideration before starting dialysis, etc. I should have saved my breath, because it wasn't going to happen. So, there you go..sometimes you just have to pick your battles, I guess.

Got home and started cooking to relax. Made a pot of creamy tomato soup, and a big pot of mac and cheese with fresh herbs to take out to the farm tomorrow. Had to do taste tests, of course.

Now it's midnight and I'm ready for bed. Of course the last thing I hear on the news is a piece on all the gross stuff that our pillows are harbouring! Dust mites, dead skin, etc. etc. etc...don't know if I want to put my head on my pillow now. Heh. Hasn't killed me yet, so I think I'll be fine. I'm more in danger of coughing up a fur ball from all the fur my cats shed on the rugs. LOL.