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February 23, 2009

Going To Nights In Tucson

Tonight is my first nightshift in a very long time. I did a four night stretch up in Madison, but before that, I hadn't worked nights since being at the Y in Connecticut in early August. So, it's a little strange to be up at this point (0230).

It's also hard to believe that I have been at this hospital already a month. I've decided to call this hospital the Thorn, in honor of the mulitude of cactus that surrounds Tucson. In one sense, it seems like I've been here for a long time, at least in Tucson, because I was here for three weeks before I started working. On the other hand, the last month has flown by, and now there is only two months left on this contract.

Nights here are pretty dull, I'd have to say. There isn't a whole lot going on. That might be because it is a Sunday night, but really it's a little slow. I have a stable double, so I've just puttered between the two of them getting things done. That's a relief from my last shift, where I took care of a patient who'd been in this unit for months. He ended up coding on me, and ultimately didn't survive. I felt pretty lousy about that yesterday, because it seemed like there should have been warning signs that I could have picked up on and didn't. In fact, he looked bad all day, and we (as a team) were dealing with that, but in the end, I guess no one realized how quickly he was going south. I ended up leaving feeling like there was something that I could have done differently, and that made me feel pretty bad about the situation.

At any rate, it's a little bit of a relief to just have a dull double tonight. My first month here has been a little stressful for me. Mostly, I psyched myself out a little about working in a CT-ICU, which is a first for me. I had myself imagining that I would be taking fresh hearts, straight out of the OR. As it turns out, that hasn't been the case, I've actually been taking care of the kind of patients that I'm fairly accustomed to. But then I've also been taking some pretty difficult pairs, to prove to the crew here that I'm up for it. It's been fun, but a little stressful as well.

Anyhow, working nights is nice because it allows me to consider our next assignment. Jess and I put in our applications for our Washington state licenses, which turned out to be very expensive ($330 between the two of us). It'd be great to head up to Seattle come May. The issue is that the market for traveler jobs is very tight right now. There are some jobs posting, but they are posting only a couple of weeks before the start date, and they are being snapped up quickly. My hope is that if we have our licenses when the time comes to get an assignment, we will be in good positions to take any jobs that open up.

If that doesn't work out, it's quite possible that we could end up renewing here in Tucson. My manager has offered to extend my contract for another 13 weeks (and a staff job if I want it). I told her that we hadn't made up our minds yet, and it seems like the offer will be there for awhile. This hospital is in a complete hiring freeze, so they like having me around, and I was told that they'd make an exception to hire an experienced ICU nurse. Still, if we took an extension, we'd be here in Tucson well into the summer, which could be brutal. It wouldn't be my first choice, but we may take the offer if Jess can get an extension and there are no jobs opening up in Seattle. That, of course depends on whether Jess can get an extension in the hospital that she is working in, which is smaller and has a less dependable patient population, particularly in the summer here.

Actually, I'm calling tomorrow to a couple of big hospitals in the Seattle area to see if they are hiring seasonal staff. That may be our redemption, if the traveler routes are all dried up. We are going to try every tool in our bag on this assignment, because the economy isn't so friendly towards us these days. I've heard a lot of stories about travelers having difficulty finding positions. I hope that doesn't stay the trend for long.

Until next time, be safe.

February 22, 2009

Outdoors In Tucson

We are finding that Tucson is a good place for ourdoorsy types. For the first time since the last half of 2007, I'm actively getting into shape.

Of course, it helps that there is a wide range of opportunities to be active outside. Last week, we tried out a nearby mountain biking trail. I haven't come across that many mountain biking trails, regardless of the immense number of trails that surround Tucson. Most of those trails seem to be exclusive for hiking. It could be that I haven't looked hard enough for the mountain biking trails.

Regardless, it immediately became obvious that mountain biking in the desert is its own unique entity in regards to doing it in other locales, say the Rocky Mountains in Colorado or in the hills of North Carolina. In Colorado, the big danger is that you are careening down the mountain, and it is important to watch out where you are going. In NC, you have to watch for all sorts of branches trying mightily to gouge out your eye. In both settings, though, it is important to draw a little blood, just to make you look like you were trying hard enough. This is simple to do, just ride close enough to a bush to get a little scratch.

That doesn't fly in the desert. Here, you must explicitly avoid drawing blood. In fact, you must avoid brushing up against anything along the trail, any sort of plant life whatsoever. That is because this is an extremely hostile environment, as survival of the fittest has weaned out the plant species that didn't come with giant thorns or spikes. In NC, you might brush up against a tree trunk in passing. In Tucson, that tree trunk is a huge saguaro cactus, and you'll regret that decision for the next week. Those aren't even the worst. There are pretty, fuzzy cactuses that look like bunches of big grapes scattered about, called Teddy Bear Cactus. Once a spine impales you skin, you can't get it out easily. It dangles and then another spine makes connection, then another, until you have your own bunch of grapes hanging on to your hide. Now, in the most sinister nightmare scenario, imagine flying off your bike into a big bush of those. Death might be preferable, at least in the short term.

So, it is very important to keep a very close eye on your riding. There are many parts in the path we rode the other day where there would be a sharp turn, only waiting right where you would have gone if not for the turn is a big barrel cactus plant, hook spines anticipating your bumbling flesh to careen into them. These spines are like fish hooks. I don't even want to imagine how badly that would go for you. Still, it all elevates mountain biking here to that much more of an intense sport. Here, you really have to realize that there are consequences for not succeeding in keeping your bike on the trail.

Of course there is also hiking and running. I've taken up running again, and have gotten myself up to 5-miles on a regular basis now. Our dog, Zuri, runs with me, and does quite well with it. In fact, she loves it, and pouts terribly if she gets left behind. She even knows the routes, and anticipates some of the turns. It's great now, but wait until the heat starts to return. Whereas our normal mid-day temperature is 75-80, in a month or so it will have climbed to 90, and by the time my contract is over at the end of April, it will be pushing 100. Apparently, in comparison to Phoenix, it tops out at around 110, which isn't that bad. It's at least better than 115-120 like in Phoenix.

Finally, oddly enough, I managed to get in some snowboarding right here in Tucson. There are a few resorts scattered around Arizona, the most known one being up in Flagstaff. However, there is a resort right up on Mt. Lemmon here in Tucson. As it turns out, we live on the road to Mt. Lemmon, and so it is only a 26-mile trip. Granted, the resort isn't that big. There is only one major lift. There is a trail along the top ridge where several blues and a couple of black diamonds drop off. I was with my friend Scott, who has only snowboarded in Ohio, which is actually a step down from Arizona skiing, so we stayed on the blue runs. It was fun. There wasn't a great base, as you might expect in the desert, and there were places where the ground was poking through, but overall, it was just fun to be snowboarding. We actually went all day, and it wasn't crowded at all. I didn't have any gear, it's all in Colorado, so I bought a pair of gloves, rented the board and boots, and instead of snowpants I just had on jeans, which worked out fine. No helmet or goggles, either, I just had on a bandanna and my sunglasses. Probably better than the actual snowboarding was the thought that I was snowboarding in Tucson, Arizona. Now, who would have thought?

Until next time, be safe.

February 15, 2009

Two Weeks And Still Keeping The Job

Well, I've survived the first two weeks of work, and they haven't fired me yet. Quite the contrary, apparently they seem to like me.

Really, the worst part was the first week. I had three full eight-hour days of orientation, and let me say that although being paid was a good thing, it almost wasn't worth the pain of those three days. My friend Scott, a colleague from the Big D who came here for his travel assignment only to be cancelled three weeks in and then rehired in the same unit as a seasonal worker, was in the orientation class with me. We figured out how much we were making for every minute that we suffered through the class, and that was enough to survive the experience. Rarely do people have to suffer such excruciating boredom, and even more rarely do they live to tell the tale.

At any rate, the three days finally ended, and then I was working on my own. My first two patients were quite easy, neither cardiac patients really. They had cardiac history, but they had respiratory issues that kept them in the unit, so it was like working in a MICU. That day went quite well; I even walked one of the patients several times in the hallway so that the boss could see that I was working.

Ah, then this week came along. It wasn't a bad week, by any stretch, it was just really busy. Perhaps the trauma unit up in Madison was a little more busy, but this unit is busy as well. Of course, working in a cardiac unit, there are a lot of patients that I'm not allowed to take care of. These are the patients that have all of the cardiac equipment, such as the LVADs, RVADs, BIVADS, Tandem Heart machines, balloon pumps, those sorts of things that require completion of a competency course and test just to even think about taking care of them. So, I end up getting the patients who have been in the unit for a long time. These are patients that I'm very familiar with, and comfortable taking care of, even with their cardiac histories.

Then again, sometimes these patients can be incredibly busy. My first day taking care of the particular double that I kept all three days, one patient was extubated and reintubated (the breathing tube was taken out and replaced later) during the course of the shift. This isn't normally a big issue, but when you are not familiar with all of the protocols surrounding such events for a particular unit, it becomes more stressful. I kept pretty busy that day.

The next day was only busier. The doctors decided that the patient who had been extubated the previous day needed to have a trachestomy, so we did that, at the bedside. It was really interesting to watch, but it set me back four hours, since they proceeded to replace all of the central IVs as the patient was already paralyzed anyhow. I ran around madly all day, my only comfort being that the boss was there and actually felt sorry for me, thinking that I would have a bad opinion of the place. Really, it was quite the opposite, I really like being that busy, I like all the activity and bustle and cool stuff going on around me. Plus, they let me be the stand-in anesthesiologist, and were even going to let me extubate the patient as soon as they cut the hole in the trachea (the tube in their mouth was being replaced by a tube in their throat), but the attending nixed that idea when she found out. Too bad…

I really ran that day. I only got to use the restroom twice in the 12-hour shift—at the beginning and at the end. I ate lunch at 5:30 in the afternoon, basically devouring a plateful of food in ten minutes. It was fun, though. Even better, I started to see a trend emerge around me. I started to notice that there are a lot of really smart folks on the unit, including the doctors, the PAs, and the nurses. They are a sharp bunch. Plus, they really back each other up. I'm not even a part of the group, and there were people asking me the whole day if I needed anything. I felt pretty inefficient, as I do the first week of any assignment until I start to get a real good feel for the place, but unlike at the Swiss Cheese up in Madison, they backed me up and I wasn't worried. It's a good thing when a unit cares enough for their patients that they wouldn't put them at risk by allowing someone to become overwhelmed.

The third day was much less busy, all the hard work had been done already in the previous two days, I was more in a holding pattern. These are long-term patients, once you've done the busy work, then you can ride that gravy-train for a long time. But the best part of the day was that the unit educator came around and offered to put me through their equipment classes. So, hopefully I'll be able to go through all the classes about the devices in use here. Apparently, the co-inventor of the artificial heart is on staff at this hospital, so it is a good place to learn about heart devices. This is turning out to be a big educational event for me.

Hopefully, it will stay that way.

Until next time, be safe.

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