Wednesday, July 08, 2009

Stretched Thin

The past couple of days have been pretty tiring. And it's become pretty clear to me that Martha is right. I think I'm over-extending myself.

I need to rethink how I am working because I'm doing way more than I probably should. I know that I'm not getting nearly enough sleep and I haven't had an opportunity to work out in a little over three weeks.

I don't like that. It has to stop.

So - I'm going to figure out how can work a bit smarter. Once August comes I plan to scale back the number of hours that I work. It's not that I won't work any extra, just not nearly as much. It will be difficult to follow through with that, but I owe it to myself and some others, notably my family.

All of that said, the past few days have been somewhat eventful. Since my last post I have encountered some interesting patients on calls I've done. One of them, for example, a 21 year-old female, had been to the Radiology department of one of the area hospitals for a CT scan of her neck. Contrast dye was used and there was a problem with the IV in that it infiltrated the vein into tissue. Subsequently there was extravasation of dye into the tissues of her arm. It was marked by significant swelling both above and below the IV site; her bicep looked like a tennis ball. Add the discomfort she was having plus some numbness to her right leg (her right AC was the IV site), pain to her head and some nausea, and she was pretty miserable. So she went to the ED with us.

I have no doubt that she was also pretty frightened about what was happening as there was a lot of anxiety present. I can understand why; after all, I think I would be updet if this happened to me. At the same time, I was worried about the possibility of a reaction to the dye because she was also flushed and complaining of being hot. So I treated symptoms:Benadryl as a prophylactic for reaction (I discussed that with one of the medical control docs and he was on board), Zofran for nausea, and Toradol for her pain. Whether it was the drugs or just the thought that she was getting help, I don't know, but she settled down and felt somewhat better by the time we got to the hospital.

As for the CT tech, I don't know if there was an inquiry, but there should have been. The patient told me that the tech saw the swelling, told her what it was, and sent her home.

I wouldn't be surprised if there is trouble on the horizon for the tech. That, to me, is poor care at best, and negligence at worst.

And now I'm sitting in the starting car in Salem. It's raining. Again.

This is nuts.


Karen Brook Westhaver said...

See what I mean? :-)(referencing email about the impact of your demeanor with pts). While I'm sure the meds were significant in this pt's improvement en route, I've no doubt it was the reassuring presence of her caregiver(s) which was even more significant in her "settling down". As you know, fear can override meds, necessitating higher dosages and even then perhaps a pt who's still miserable. Also glad you're thinking about ALL the work you're doing. Yow! Everyone needs to have other fulfillment which feeds their spirit in addition to the passion one has for their work :-)

Anonymous said...

And in addition to what Karen said, I would prefer not to see my brother fall over from a heart attack because he is puhing too hard and not sleeping enough...So please slow down!!

Karen Brook Westhaver said...

In response to "Anonymous", oh AMEN AMEN!!! Yikes. Thank you for mentioning that very important concept!!

Anonymous said...

Ditto on the above posts. My questions is why do you do this? Do you have some sort of death wish or are you just a workaholic? I think you must learn to just say “No” when asked to work above and beyond what is in your best interest.

TOTWTYTR said...

You guys have Toradol? Or was this in NH?

The CT Tech isn't supposed to diagnose, at least that's what I've been told. They are just supposed to take the pictures and then refer everything to the doctors. Of course many of them are probably better at reading the CTs than the doctors, so if they see something, they should report it to someone.

I understand about being behind because you couldn't work, let alone work OT or extra jobs, but you can't make up all of the lost money at once. Try to pace yourself a bit, especially with school coming up.