After we finished our assignment at the Y, the plan was to go to work up at Dartmouth in New Hampshire. Seeing that we ended up in Wisconsin, obviously that didn't work out as expected. A large part of why that didn't work out was because I had very little Neuro ICU experience. At the Big D, the only neuro issues I encountered were the crazy crackheads, and I didn't see any more neuro at the Y. So, while it was true that I didn't have true neuro experience, it wasn't my fault.
Well, working here at the Swiss Cheese has changed that.
The most obvious difference between the unit that I work at here in Wisconsin and all of my previous experience is that this is a trauma unit. Then there is the fact that this is Wisconsin, the state of flaccid attention to the relationship between motor vehicles on the melons that sit on our shoulders. Wisconsin has an odd oxymoron, emphasis on the last part of that word. People here have survived for the most part because of a governmental acceptance of lack of common sense.
See, in New York City, where there are multitudes more people and hence more vehicles, people tend to be very careful walking or biking in the road. This is because there is no law that gives pedestrians the apparent complete right of safe passage. I'm guessing that the officials in New York City assume that if you walk out into traffic and don't look, then it's your own fault that you get creamed by a bus. Ask me, I got a closer look than comfortable at the front of a bus there.
People don't have the same respect here. They assume that if they walk out in front of you, then you will be courteous enough to stop. Fair enough when the person driving sees them and has time to stop, but poor decision making at night when they are wearing dark clothing. Or when they are walking in the middle of the lane on a windy country highway. Or any number of other instances when it's just plain dumb to walk out into traffic. I've had to start taking a different route home from work, away from the university and its students, who apparently aren't enlightened enough to stay out of traffic.
Then there are the two-wheelers, a subject I've touched on before. There is a huge culture of mopeds and motorcycles here, followed by a huge culture of ignoring the obvious fact that the skull is poor protection against the hard concrete of the road at any speed. I've been going down the main drag in Madison at 6:30 am, to see a moped weaving amongst traffic, driven by some young girl with no helmet on. Am I supposed to feel badly for them when they show up a hour later in the ICU with a big, fat, swollen head?
It all pretty much stupefies me. There apparently is a sense of entitlement here, government sanctioned to boot, that has people thinking that it is ok to not protect their own lives on the road with cars. To me, it's a no-brainer; I'll pass on the sense of entitlement and stay alive, because when people get hit, they may have been protected by the law, but it didn't do much to protect their bodies. The person at the wheel of the car might be at fault according to this state's law, but all they get is a dent in their hood. Crazy.
Rant aside, my point is that my unit gets a lot of neuro patients. There is a neuro ICU in the hospital, but often these guys come in with all sorts of traumatic injuries, and neuro takes a backseat to the medical aspect of their care. After all, what use is the head when their body is dead? It sucks for these folks, but it has worked out pretty good for me, because I'm lapping up the neuro experience like there's no tomorrow.
This week has been particularly useful to me. I guess before on the rare occasion that I actually had a neuro patient (like the time that I got floated to the neuro ICU), I've just pretty much gone through the motions of doing the neuro checks and whatnot. Mostly, that means I look at the charting that the nurse before me did, then go do an exam that covers all of the checks that they'd done. Well, this week has been all about practice. Almost all of my patients have had some degree of brain injuries.
Two of them have had craniotomies, which is where they've taken out a piece of the skull to relieve pressure in the head, leaving the bone out until the swelling has resolved. This means that these two patients had an area of their head where there was no skull. Of course I had to feel that area, push on it a little bit. Yes, yes, softly! Geez. That was pretty interesting. I had to do my bi-hourly neuro checks, so I actually learned how to do them, and what to look for. A couple of my patients were really banged up, so I got some trauma mixed in there, with some fancy terminology to toss out at unsuspecting interns and new nurses. Even better, I had not one but two ventriculostomies, one each for Monday and Tuesday.
Essentially, these are drains that help decompress the pressure in the skull. They are the first line in surgical defense to do so, meaning that the person will require a craniotomy if it doesn't work. They are also a monitoring device, allowing us to measure the ICP, the intracranial pressure. They're fairly easy to deal with once you've become accustomed to them, but there are a lot of rules and stipulations that are involved, as well as measurements I'd never heard of before. Of course, I acted real nonchalant about it, using the classic traveler line: "Oh, I've never used the equipment this hospital uses. Do you mind running me through the equipment?" Hey, it beats sneaking off to look it all up on Google after report. Not to say I didn't do that too.
One of the big issues that Dartmouth had pointed out with my application is that I hadn't ever had a patient with a ventriculostomy. Well, the skills checklist has been updated, and I continue to heap scorn on the dungpile that is Dartmouth.
Oh, get this. One of my patients was a biker dude, you could tell by the cattleyard's worth of leather when his family came in. This guy will probably be sucking his meals through a straw the rest of his life, but guess what was on the cover of the guest book his family brought in for friends to write condolences? A big, chrome Harley, no helmet in sight. I didn't get upset, he had a ventric. Sweet!
My other ventric was a kid in his late teens who was doing some wicked trick on a skateboard and didn't make the landing quite right. I mean, he made the landing, but on his head. I guess having four wheels under you doesn't mean you shouldn't wear a helmet. Seriously, if he'd been protecting his melon, he would have had a stiff neck and a skinned elbow.
Anyhow, it was quite an educational two days for me. I even got floated for eight hours to the Burn Unit, which was crazy. They'd just gotten a fresh burn in when I arrived, which was fairly gruesome. It was very interesting to see, though, and I stepped right in to get involved. They even loaned me a pair of the unit scrubs to wear, so I looked like I was one of the group. My single patient wasn't a burn patient, but was instead, of course, a neuro patient.
Until next time, be safe.
