#micu nights

[skyloftian-nutcase]

(@hermitdrabbles56 I remembered to tag you this time! 😂👍🏻) @alasse-earfalas have Four dealing with stuff in the ICU :)

.

Four started the shift off well enough. He had a floor status patient and would be admitting a transfer who was a pre-op for a bilateral lung transplant. That meant he had a fairly independent patient in one room and… well he wasn’t sure what the other one would be like. If they needed a lung transplant they had to be sick, but they hadn’t gone through major surgery yet so they were likely not very unstable.

The only snag was that they were a transfer from the medical ICU, and we’re technically boarding on his unit. They wouldn’t become a surgical patient, and therefore be his unit’s patient, until after the surgery.

Which meant that the team he had to talk to wasn’t present on his unit. And the medical ICU was notorious for not communicating well. So if something were to go wrong, or if he needed something that wasn’t in the protocols and order sets… well. He’d cross that bridge when he got there.

In the meantime he got to receive report from Dot, which was always nice. And if they chatted on the phone a bit more than was strictly necessary, well, he wasn’t going to complain. To add to the fun, the patient was on high flow oxygen, which meant RT had to be involved, so he’d get to work with Wind and his preceptor.

Dot brought the patient over a little after 8pm, but Four had already done his assessment and drawn labs for the other patient, so it worked out well enough. The patient was very kind and clearly nervous, with supportive family to help as well. Four got everyone settled and then looked over his tasks on the computer to better plan out his shift.

Pre-op meant multiple baths with a specific antiseptic soap, as well as what felt like a million labs and an EKG. But one bath was now, the second in the morning. The labs and EKG were all due in the morning. Dot had mentioned something about a chest x-ray at 2am, but it wasn’t appearing on his to-do list, and she’d seemed unsure about it. Maybe they’d left it off, or they hadn’t ordered it yet. Chest x-rays could be portable, but she’d said something about going downstairs for it. Four hoped that wasn’t the case.

After planning out the shift, he told the transplant patient the general overview of how the night would go. Bath now, and then labs and bath and EKG at 4am. That gave her and her family time to rest.

Two hours later, Four had finally finished giving meds to his other patient, bathed the transplant patient, and charted all his assessments and actions, when he saw an order pop up for the transplant patient.

They wanted the labs within the next fifteen minutes.

“You’ve gotta be kidding me,” Four grumbled. His patient was likely asleep by now, so he’s have to wake her to get labs. None of her IVs were returning blood, so he’d have to straight stick her.

He was starting to remember why he didn’t like boarding MICU patients. He wish the team would just talk to him instead of throw him last minute orders.

After waking everyone in the room to get labs, and sensing their drowsy annoyance as he spent what felt like an eternity drawing all the necessary blood for the ten lab containers, he poked his head in on his other patient, who was sleep, and then settled back at the nurse’s station.

I don’t like your providers, he texted to Dot. How’s your night going?

Hepatic encephalopathy with lactulose, was the reply.

Four cringed. That… was unpleasant. He was thankful he worked in the surgical-trauma ICU and not medical.

After another couple hours, one of his coworkers walked up to him. “Hey, x-ray is on the phone asking if you’re ready to come down.”

Four blanched. “What?”

“Yeah, something about a dual-view chest x-ray for your transplant patient.”

Biting back a groan, he spoke with the technician on the phone and, after debating the matter with the tech, his charge nurse, and providers on his own unit, finally gave in and arranged to take the patient downstairs.

So much for letting the patient have a good night’s rest.

Wind was equally unhappy.

“This is so stupid,” the student grumbled as he and his preceptor gathered supplies. “Like… why at 2am?? And why can’t they just do a portable one at the bedside so we don’t have to drag her downstairs? Did you see how quickly her oxygen saturation dropped when she moved around??”

“They said for dual view it has to be downstairs,” Four sighed. “But I agree, this is stupid. Why couldn’t we do this at 4am with all the other stuff? What difference does two hours make on a pre-op chest x-ray?”

As the team grouching made their way to the patient’s room, woke the patient, and proceeded to rearrange the entire room to take her downstairs, they finally had everything ready to go and were leaving in thirty minutes.

When they got to the exit of the unit, the MICU provider walked up to Four.

“Is this the transplant patient?” He asked quietly as the team continue to walk.

“Yes,” Four answered evenly, wondering what this was about.

“Oh,” he said, a little put out. “I was going to switch the x-ray order so it could be portable. Oh well.”

Four stopped in place. He blinked. He took a deep breath. And then he smiled. “Well… we’re already here, so. We’ll head downstairs.”

“Yeah, yeah, of course,” the provider replied with a shrug and a smile. “Thanks.”

After that the team silently made their way to the elevator. Wind and Four eyed each other, both thinking the same thing.

I am a healthcare provider. I will not kill the other provider. I won’t. I won’t.

The string of cuss words that left Wind’s mouth did make Four laugh, though.

[burlveneer-music]

My WVUD playlist and stream, 12/25/2023

Kelpe - Carillon Chimes Joanna Brouk - Chimes and Bells Charlemagne Palestine - DINGGGDONGGGDINGGGzzzzzzz ferrrr SSSOFTTT DIVINI TIESSSSS!!!!!!!!! (excerpt) Rob Mazurek - Vassilios Filippakopoulos Smiles Ryuichi Sakamoto - Merry Christmas Mr. Lawrence Chassol - Water, Voices & Snow Nils Frahm - Nue Jamire Williams - Collaborate with God (feat. Chassol) [Miguel Atwood-Ferguson String Mix] Cate Brooks - Julmust Sven Wunder - Snowdrops Blackmore's Night - Winter (Basse Dance) Alice Coltrane - Galaxy In Turiya Barrett Martin Group - Enchantment Joys Union Group - Laughter In the Sky Daniel Herskedal - Ice Crystals Manu Delago - Alpine Brook Time Wharp - Spiro World Stephan Micus - Part 3: Tin Whistle, 3 Stone Chimes Hauschka - Snow Andy Bell & Masal - Tidal Love Conversation in That Familiar Golden Orchard Isao Tomita - Snowflakes Are Dancing

[musicollage]

Stephan Micus – White Night. 2019 : ECM 2639.

[anakainosis]

It would have been 71 years.

I know both sides to the story of how you met. It's as if God Himself wrote the story. And the one time you came so close to never meeting, there was an angel pulling for you just in time. You gave him the first kiss. A random peck on the cheek out of nowhere. You teased her with the bracelet before you pulled out the engagement ring. The priest asked if you attended church regularly, and to be honest, you barely made weddings or funerals, let alone holy days of obligation. The priest answered "Thats ok, Johnny, some of the biggest hypocrites sit in the front row.

You were married in her childhood church during open mass. Your uncle walked you down the aisle......and brought a rifle to the reception. For 40 glorious years, you both cleared the dance floor.

The last anniversary, you shared with me your childhood parish. I followed you to the balcony where you proceeded explain how you could shoot some quality spitballs at the people below.

I went to you. Sitting 7th row in the left side pew. Your face was sad like someone had ripped hope from you. I tried to tell you the church is being remodeled. They're not tearing it down! But your words haunted me-now seeing how you knew " I'll never see this place again.".

6 months to the date, I was at my dad's. I normally called you after mass, but something made me call again. Because it would be the last words I'd ever hear from you: "I love you too.". I had to say I love you. One more time. Just like you knew 6 months prior you'd never see your church again, I knew I'd never speak to you again.

In the MICU, watching the machine breathe for you, I asked you when it happened. "Shortly after you called." You said.

3am 6 months to the date of your last visit, you died from your stroke.

We can joke now that we should have known that something was up when you made chili instead of the Sunday sauce as per usual.

14 years later, I'm coming home, and you're in your hospice bed telling me, "There she is. There's your Nana. There's my 'Mreee!" The last night after that day, you drowned in your cancer. I knew what it felt like to be an orphan.

You're both clearing the dance floor in paradise. I still sit 7th row at mass, and I can feel you beside me.

Happy Anniversary in Paradise. I love you. Until we meet again. 🌲

[musicwithoutborders]

Stephan Micus, The Eastern Gate I White Night, 2019

[bamboomusiclist]

8/16 おはようございます。Stephan Micus / East Of The Night japo60041 等更新完了しました。

Sue Raney / All By Myself t2032 Carmen McRae Sammy Davis jr / Boy Meets Girl dl8490 Bud Shank / Bud Shank Quintet Nlp2 Marian MacPartland / the Magnificent volume1 Mg15021 Marian McPartland / plays Music of Leonard Bernstein 52013 Quincy Jones / Big Band Bossa Nova Sr60751 Art Pepper / The Way It Was s7630 Dizzy Gillespie / Big 4 2310719 Ben Webster / Blue Light 423209 Miles Davis / Steamin' prst7200 McCoy Tyner / Extensions bnla006f Frank Zappa / Waka Jawaka Hot Rats ms2094 James Taylor And The Original Flying Machine / 1967 est-2 Angelo Bond / Bondage abcd889 Ponderosa Twins Plus One / 2+2+1 h-5001 Stephan Micus / East Of The Night japo60041

~bamboo music~

info@bamboo-music.net  

530-0028 大阪市北区万歳町3-41 シロノビル104号

06-6363-2700

[skyloftian-nutcase]

Got floated to a unit I’ve never worked on and got formally introduced to the closet ghost and I’m not saying there’s a ghost but I am saying sounds like these shouldn’t come out of a supply closet

So anyway which of the healthcare boys believes there to be a closet ghost this is really important

Definitely Wind, Twilight, and Wild. 👍🏻 Wind swears the MICU is haunted, Twilight says he hears voices when he’s wandering the basement at night, and Wild is debating whether he has a ghost friend who talks to him or if it’s his head injury acting up. She seems nice, though.

[mrsballlegs]

Really changing my opinion on learning open hearts as I realize that the survival rate is extremely high compared to the conditions I am used to treating….. yes the patient may be extremely complex and unstable and require a lot of training BUT ultimately the reason the actual surgeons are so chilled about it all is the patient is basically going to survive. BUT more pressure to never mess up bc it is very technical and what you do matters vs it doesn’t even matter that much with some of these micu pts bc they’re gonna die no matter what. The hearts were relatively healthy before and only have one problem that has already been fixed, it’s just supporting the body as it heals & looking for complications… most micu problems probably have like a 50-90% mortality rate depending on the condition, from cardiogenic shock to sepsis with multi organ failure to ards…. And many of those who do leave have many comorvidities and will die within months anyway…. But you usually do have more time to think about each intervention with micu. However, it was amazing to admit an 80 year old from cath lab intubated w a balloon pump, and get them up to the chair for the first time 11 days later, kidneys still kicking even! BUT does that mean I want to do things like give 3 massive blood transfusions and shock a patient 17 times in a night like happened to my other one early in his stay. Lol!

[bettercareersguide]

Registered Nurse RN - Intensive Care Unit - Oxford, Alabama

Details Sign-on bonus: Up to $10,000 Department: MICU Schedule : Full-time Night Shift Hospital: Ascension St Vincent's Birmingham Location: Birmingham, Alabama As a military friendly organization, Ascension promotes career flexibility and offers many... http://dlvr.it/SmrgwP

[whitecoatdiaries]

In the same breath, I love my work as much as I’ve ever loved anything. 

I love being the resident. How, at the end of the day, everyone else goes home. Case managers and attendings and pharmacists and even nurses, at the end of their shift. But I don’t leave until the work gets done. I beg pharmacies and insurance companies, schedule outpatient appointments, arrange for transportation, talk down stubborn family members, write and rewrite prescriptions, as if by sheer force of will I can heal and protect my patients. I reason and plead and say it matter-of-fact. I am here, at the end of the day, to make sure that what needs to get done is done, to do the dirty work, to explain to an angry family member for the 10th time why the procedure has been delayed, to call with updates, to take a deep breath in and say that even though we did everything we could to avoid it, it’s time for the breathing tube. 

I’m tired. It’s hard to write because my thoughts come sluggish and slow. I forget the grace of language, its liquidity, how to find a feeling and encircle it gently without pinning it down. I don’t know the day of the week anymore, whether its night or day, early morning or late evening. I drift along, all brain and no body, falling into a dead dog sleep when my work is done. 

I fell in love with the idea of being a doctor the summer after college, when I was so full of despair that it was intoxicating to lose myself in someone else’s life. In the ensuing years I’ve created a life for myself that I have no desire to escape from, so this getting-lost feels good but in a different way than it did before. A. tells me to be careful, that the MICU is addicting. There’s nothing to flee, my life overflowing with love, but there’s something about dedicating one’s waking hours to a singular purpose that still quenches a complicated thirst, a long tongue on the salt-lick. 

I wonder if I belong on the face of this aching earth. My heart stays broke. But none of this has ever stopped me before and I’ll be damned if I’m not up early tomorrow, doing my stretches and saying my small and fruitless prayers and putting on my scrubs, swiping my badge and striding into the unit, my sleeves rolled up, ready to do whatever it is that needs to be done. 

[doctorspork]

Ran my first code solo because no one thought to grab the ICU fellow or attending. Oops.

[keeptheotherone]

Mecation: Day 1 

Thursday

I once read social media described as an indulgence of the fantasy that others are interested in the details of our lives. I’m indulging in that fantasy this week by blogging about my Mecation under the guise of travel blogging ;)

If you follow me in even the most casual way, you know I’m a nurse. While I’ve enjoyed the vast majority of my 23 years as such, I don’t recommend it during a pandemic. The last 18 months have been the second-worst mental health period of my life, demoted to that position not because of the mildness of my symptoms but simply because at 15 I didn’t have the experience or perspective to realize my life was not, in fact, ruined forever.

COVID increased my personal vulnerability as a high-risk patient and made my job immensely more difficult in countless ways both small and large, but the worst part of the pandemic for me (so far) is it took away all my coping mechanisms precisely when I needed them most. Massage, pedicures, dinner out with friends, travel ... all gone practically overnight. Pre-COVID I travelled all the time--home to my parents’, long weekends by myself (Mecation!), annual visits to BFFs, conferences, tourism, the beach, my birthday, writing trips, international trips ... I always had at least one trip in the works, usually one booked and one (or more!) in the planning stages. 

When COVID started, all my close friends and family except for two lived out of state. One of those two was out of town but close enough to get together, but the other was a few hours’ drive away. I’m single and live alone; it was the most isolated I’ve ever been in my whole life. 

With my bestest friends over 500 miles away, I still feel that way sometimes. I haven’t seen them in a year. If it weren’t for COVID, it would only be 7 or 8 months (I’ve gone every January or February since ... forever). Then again, if it weren’t for COVID, I wouldn’t have been there last September; one had been hospitalized and I needed to see she was all right with my own two eyeballs. I expect it will be at least another 7 or 8 months before we get together again, bringing the total to about 20 months. One year we saw each other 5 times in 9 months, our personal best since college. 

I was alone on Christmas. Oh, I’ve spent December 25th on my own before; I’m a nurse. I’ve worked the night of the 24th or the 25th (or both), or whatever combination that didn’t leave enough time off to drive home. But I’ve never spent the Christmas season without my parents. Sometimes the week before, sometimes the week after, sometimes at my place instead of home, but always together. But last Christmas COVID was raging, the vaccines had just come out but were only available to first responders (I got mine on the 23rd), and my elderly parents didn’t feel safe to travel. So I spent Christmas without family.

Travel was not just a break from my daily routine and the stress of nursing; in many ways, the biggest benefit travel made to my mental and emotional health was giving me something to look forward to.  Proverbs 13:12 says, “Hope deferred makes the heart sick,” and ohhh, I was so heartsick last year! Not being able to travel meant I couldn’t visit my best friends of almost 25 years (more than half my life!). Not being able to travel meant I couldn’t lean on my dad or be hugged by my mom. Not being able to travel--and not knowing when I could travel--left this gaping hole in my future, and I had nothing to fill it with. 

I tell you this not to throw a pity party but to explain the significance of the trip I’m on right now. It is only my third this year: my dad and I spent a week in the mountains in February (my depression and anxiety was so bad then that was treatment, not vacation), I took a friend to the beach over my birthday, and now I’m a couple hours from home at a nice spa hotel. (I’m not counting my nephew’s graduation, which was emotionally challenging for multiple reasons, or helping a friend move from Florida. Moving is never fun.)

I started planning this trip in the spring ... May, maybe? You know, after the vaccine rolled out to everyone and case counts were dropping and it looked like we were gonna lick this thing and have a quasi-normal summer by the Fourth of July (yes, I’m American. That date is a proper noun here.). I had switched jobs in November (don’t ask) and gone on mental health leave December 29th, so I felt I owed it to my unit to put in about six months of work before taking any significant time off, especially since I came back at 24 hours instead of 36. That meant September.

I knew what I wanted to do: 4 or 5 days at an all-inclusive resort in the Caribbean. I’d been before and loved the freedom of not worrying about every little expenditure (what can I say, I’m cheap), and a few days of Vitamin Sea sounded perfect.

Then came Delta.

All right, maybe going out of the country isn’t the best idea, I thought. Don’t want to end up with expensive reservations and then your destination closes to Americans, or you make it to your chosen island but can’t get back home. But I didn’t want to fly (ugh, airports!), I didn’t want to drive (rest stops and restaurants and gas stations), and while I thought about taking the train, it didn’t seem much of an improvement (and maybe a downgrade) on flying.

Then a friend mentioned a sleeper car, and I thought yes! That could work! I’ve never been to New England, I want to go to Boston, that area of the country has low case rates and the highest vaccination rates, this has potential! 

Then I looked at the CDC map. There were only four states that didn’t have high transmission at that time (early August, I think; I’d had to wait for confirmation that my time off had been approved): Michigan, Rhode Island, Maine, and New Hampshire. All four had substantial rates of transmission. Hardly ideal, but one thing I’ve learned this year is sometimes you have to make compromises to protect your mental health. It is true it doesn’t matter if you’re happy if you’re dead; it is also true it doesn’t matter if you’re safe if you want to kill yourself. (I’m not suicidal, I am receiving treatment, don’t anybody panic.)

So, now I’ve settled on Maine or New Hampshire by train via sleeper car (Michigan is too far for a 4-5 day trip and RI--meh). Well, as I got deeper into planning, turned out Maine or NH were awfully far too. Far enough I would have to overnight in a major city, which pretty much defeated the purpose of isolating in a sleeper car. Then I found out there were no sleeper cars on either train route.

So, now vacation is 5 weeks away and I’m back at square one. The Deep South, Texas, and Florida are imploding. Pediatric cases are rising--kids are sicker and make up a higher percentage of cases than they did last year. Scuttlebutt from my ICU colleagues is it’s bad--17/30 MICU beds are COVID and they’re all vented. SICU is being nicknamed “the ECMO unit.” The hospital has 18(!) ECMO machines and 12 are in use; the float nurse who tells us that didn’t even know we had 12 because she’s never seen that many in use at one time. Hospital-wide our numbers are equivalent to early February (we peaked in January). There were six--SIX--pediatric rapid responses in one day. 

And I’m going to travel.

It’s a big deal ... a big accomplishment, really, because of what it says about how I’m successfully managing my anxiety. April 1 was the first time I’d been inside a grocery store in more than a year ... and that wasn’t my idea. It was late April or May before I was comfortable eating in restaurants, even with the falling case count at the time. I’m still not sure if I’m managing my anxiety or reacting to the pressure by going to the opposite extreme (I have a history of that), but I know I’m less stressed, less anxious, have fewer obsessive thoughts, fewer physical symptoms, and am learning to live with this disease. 

So, here I sit at a marble-topped 5-foot-wide desk in my queen/queen hotel room at the end of a productive and enjoyable day. I slept in, completed the big goal of this weekend’s to-do list that I honestly thought would take several days, unpacked and organized my room (I arrived yesterday evening), reorganized my Favorites Bar and Bookmarks on my Mac, had an 80-minute aromatherapy massage, enjoyed a shower in the spa afterwards and even blow-dried my hair(!) before wandering around for a while to get the lay of the land and get some steps in (this place is huge!). Then I changed clothes and took myself out to dinner for my favorite food, Italian. 

That’s me in the picture up top, all dressed up :) Actually, I probably look pretty normal to y’all; like most people with depression, my personal hygiene sunk to new lows in the last year and a half, and as a low-maintenance person to begin with, that’s saying a lot. I bought that necklace as a bridesmaid and am not sure I’ve worn it since; this spring was her 10th anniversary. Yesterday I took out the cat-shaped earrings Dad gave me for Christmas. (Yes, they were gross. Yes, I cleaned them. Yes, I’m wearing them again now.) Just wearing a nice top, fixing my hair (no ponytail or claw-clip bun, my staples), and adding jewelry was a big deal ... especially since “no one” was going to see me. I did it just for me, to make myself feel good. And I did. (That’s another small pleasure COVID took away from me--lip gloss. If I wore any makeup at all, it was lipstick or gloss. Utterly pointless when you’re masked whenever you’re in public.)

I took my laptop to dinner and edited a couple chapters of my new Charlie/Amy fic (previewed during #ktoo turns 10), ran a couple errands, and headed back to the hotel since I don’t like to be out late by myself in an unfamiliar city. Forgot I put my receipt envelope in the backseat pocket and reorganized the glove compartment looking for it, then gathered a bunch of returns into a bag in the trunk. Hung out writing in the lobby until my Mac threatened to die, came upstairs and tidied up, put on my jammies, and talked to you guys :) 

[populationpensive]

Back

I am back on night shifts and the weekend was a doozy! I essentially had like 4 of my patients either going unresponsive randomly or not breathing randomly or complaining of numbness in areas that made absolutely no sense in correlation with their imaging. *sigh* It certainly kept me busy. Yesterday night wasn't nearly as busy. Just had to go help the residents in the other pods with admits and procedures.

We are seeing an uptick in COVID patients. Since my unit is specialized surgical/neuro, we typically don't get COVID patients unless our MICU is full. Well, that is happening. Our 30 bed MICU is full of 25 COVID patients. There are no plans to surge in the next couple of weeks but with school having started and people going out and such, I anticipate it to get worse again this fall/winter.

However, we do have 3 COVID patients in my unit right now. I admitted once a week or so again on 100% FiO2 with 40 L/min optiflow and they ended up getting intubated 2 days later. The patient was asking how long she would stay in the hospital and was hoping she wouldn't be there more than a week. I have a hard time when patients ask questions like that. I basically just be honest and say "hey, everyone is different. You are requiring a lot of oxygen and it takes time to wean people off that. You could be here a week or several weeks. It depends."

My hospital's COVID protocols with vented patients are essentially paralyzing the patient with nimbex, proning, steroids, and remdesivir. If they are actually synchronous with the vent and don't need a paralytic, we are using bivent with them. I've not seen much use of convalescent plasma or monoclonal antibodies at my hospital. Then again, my unit doesn't take care of COVID patients primarily.

I've got the neck couple of days off and then go back to nights later this week. I really need to clean my house. Like, badly. I'm just lacking motivation at present.

[hangrypa]

hangry’s paging etiquette

When I first started working as a hospitalist, I used to wake in the middle of the night, thinking that I heard my pager. To this day, I’m still jumpy when my pager goes off. 

During my first week of work, I did not have a pager. At that time, I learned about paging other people. More than once I made the mistake of paging someone to the incorrect phone number or forgetting to leave my name with the number. This rightfully annoyed the hell out of some people.

But I’ve since learned! 

There’s no class on paging, so I put together a mini guide.

1. Stay next to the phone after you page. If I page someone and they take the time to answer the page (sometimes pulling them out of the OR or an important family meeting), I better have my ass next to the phone when they call back. Otherwise I’m 1) wasting their time and 2) giving them a reason to be annoyed the next time that I page them. 

2. Leave your name and contact information. Occasionally I receive pages that do not include the name of who is trying to contact me. One such page was regarding a patient who was acutely short of breath. A text page will provide a limited amount of information due to character count. It is crucial to have a name and contact number to get more information, especially in emergency situations.

3. Provide 2 forms of contact. In several parts of the hospital, my ASCOM doesn’t work. Usually when I page someone, I sign off with both my pager number and my ASCOM number. If I have enough room in the page, I’ll also add the extension for the nearest landline.

4. Give pertinent patient information. Pages about patients should include the patient name, their MRN, and immediate concern. Ex: J Doe (MRN 123456) is having more chest pain, now with radiation to L arm. Hangry, PA, p1234, x123456 

5. Stating the urgency also can help. Especially during the hour before shift change, I can get 10 pages within 10 minutes. When trying to determine which to respond to first, it can be helpful to have a timeframe for when a response is required. For instance, a page regarding J Doe with acute chest pain could be prefaced with “Please contact ASAP,” while someone with unclear medication orders could have a page that ends with “please contact before 5pm meds are due.” 

6. Be mindful of when you page. If the issue is nonurgent and can be discussed during prerounds or rounds, it may be better to wait and discuss in person. If you know the provider will be in meetings or the OR throughout the afternoon (and the issue is nonurgent), try to wait until afterward to page.

7. Page the nocturnist for urgent matters only. When something would be better addressed by the day team, it’s best to wait until the day team arrives. Try not to page the nocturnist about laxatives, diets, lotion, updating the family (unless you’re upgrading a patient), cleaning up the chart, and other similar matters. 

8. Have relevant information available for a consult. When I first started working, this was difficult for me because I thought that everything was relevant. But the consulting service doesn’t need to know everything. For instance, when contacting Neurology for cord compression they likely won’t need to know that the patient has a poison ivy rash. Have the patient’s name, MRN, reason for consult, workup thus far (relevant labs, imaging, etc), and a clear question. Ex: J Doe (MRN 123456: 65M w prostate ca) has BLE numbness in the setting of L5 compression fracture. CT shows possible cord compression. Would you recommend steroids, AED, or further imaging? Thank you. Hangry, micu pa, x123456, p1234.

I’m sure there’s more, so feel free to comment and add to the list!

[smashing-teacups]

Atonement, Chapter 20

A/N: Helloooo, friends! Long time no see! I’m so sorry it took me so long to get this chapter up to you; real life has been particularly busy lately, and I wanted to take the time to make sure I got this chapter right. I know I initially planned to wait to post this until I had 21 and 22 ready to go as well, but I’m confident enough in the setup I’ve done with this chapter to go ahead and give it to you now, and make it a double-post for chs 21 and 22! 

Previously: Ch 1, Ch 2, Ch 3, Ch 4, Ch 5, Ch 6, Ch 7, Ch 8, Ch 9, Ch 10, Ch 11, Ch 12, Ch 13, Ch 14, Ch 15, Ch 16, Ch 17, Ch 18 , Ch 19

CHAPTER TWENTY: His

Claire couldn’t feel her feet touch the ground. 

As she tore across the salted concrete, her heart ceased to have any discernible rhythm; one frenzied beat slurred into the next until it had escalated to a fever pitch, a thunderous oscillation against her breastbone. The wind was at her back, roaring between the skyscrapers and propelling her forward until she was flying, flying…

And still not fast enough. 

Of course, the one night — the one fucking night she’d set her mobile on silent, crawled under the covers, and succumbed to a Benadryl-induced sleep… 

CLAIRE ANSWER YOUR GODDAMN PHONE

There were twenty missed calls, three voicemails, and five texts — all from Gillian — when she’d gotten up to use the bathroom in the middle of the night. 

CLAIRE I AM DEAD SERIOUS ANSWER YOUR PHONE!!!!!!! It’s an actual emergency 

She hadn’t bothered with a coat; had barely managed to slip on her trainers and snatch her keys and hospital ID badge off the entry table—

FFS I don’t want to tell you this by text! Pick up!

Barreled down the apartment stairs, slammed through the door and out into the bitter cold—

OK well… apparently not gonna have a choice here. You need to get to the MICU ASAP. Room 6. We just rapid responsed Jamie.

Took off at a dead sprint toward the hospital, the night around her blurring into smears of light as she ran as hard and as fast as she could.

He’s fucking sick, Claire. Think it’s meningitis. He’s seizing on and off. They were intubating him when I did handoff. You need to get here like now. Like right fucking now.  

Claire had managed to fire off a single, typo-filled request for as many details as possible. She could feel her mobile buzzing against her hip as she ran, promising answers that she didn’t have time to stop and read until she collapsed against the elevator panel in the hospital lobby, smashing her palm against the up button over and over again.

Last vitals I saw were temp of 41, HR in the 200s, O2 sats in the 80s. 

I know they were loading him with phenobarb and going to try to get an LP, then start IV abx and steroids. 

I can call down there and ask the charge for an update, but if you’re on the way you’ll probably find out before I do

Claire’s hands were shaking so badly that autocorrect struggled to fix both fumbling words as she tapped them into her screen: I’m here.

The light above the elevator door illuminated with a soft ding, and she drummed her palms restlessly against her thighs, hissing “come on, come on, come on” under her breath as she waited for the doors to open. Every fraction of a second seemed to take hours; it was like something out of a nightmare, in which a sinister, oozing black pitch had encased her organs and turned her blood to sludge, making her movements feel heavy — impossibly, infuriatingly slow.

With Jamie just out of reach, needing her.

And she wasn’t there.

She hadn’t been there.

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[burlveneer-music]

Jusell, Prymek, Sage, Shiroishi - Setsubun (節分) - they’ve tagged this as “ECM jazz” on Bandcamp, but it’s a throwback to a certain type of ECM jazz -- almost-but-not-quite-New Age -- that only Stephan Micus still plays, as far as I know (cachedmedia)

The season has changed. Chris Jusell, Chaz Prymek, Matthew Sage, and Patrick Shiroishi continue forward with what follows 2020’s Fuubutsushi. Here, it is a new year, and it is time to shake the demons off and make a fresh start. Setsubun is the Winter chapter in the cycle (yes, Spring and Summer will come one day), but don’t conflate this “winter music” with the holidays; this is music for the stretch between January and the first peals of spring. The days in this chasm that may be getting longer, however slowly, but the nights are still long. The air is crisp. The natural world lays dormant, but the imagination flutters. These four players have learned more about each other since the amber nostalgia of Fuubutsushi and here they are more comfortable taking risks, ramping up, and pulling back. Prymek’s guitar and bass lines offer a fundamental structure on many of the tunes, in his distinct style that is both uniquely folky but patiently soulful. He more often opts for electric guitar, slide, shimmering fingerpicking, and those touches feel like frost in an empty tree canopy. Shiroishi’s crystalline voice sets a tone on the first track, but from there, he spends his time painting scenes with his saxophones and clarinet. The departure from his more oblique solo works into harmonious melody in this combination showcases the incredible range and skill he possesses over his instruments. He is your breath on the air. Sage shifts from piano onto rhodes for this album, where he continues to split the difference between ambient minimalism and cool jazz vamping. His drumming takes a new presence here, with more pronounced rhythms, deceptive stutters, playful push and pull dynamics. He is the ice under your feet. Sometimes you almost have to catch yourself from slipping. Jusell’s violin continues to soar in the combination, often in conversation with Shiroishi’s horn. His playing is ornate but never flowery, expressive but never maudlin, sweet but never saccharine. He is that warmth we carry inside of us on those cold days. Setsubun is the Japanese new year. February 2nd. Traditionally people celebrate by screaming in the streets, shooting off fireworks, making a collective ruckus to scare the demons of the year past away. If there aren’t demons to shake off… you must be from a different timeline. So, here is something for you and something for your demons too. Something to keep you warm until Spring arrives. Something warm, familiar, friendly, but fresh and full of possibilities. Happy New Year.

Chris Jusell - violin Chaz Prymek - bass, guitar, synthesizer, clarinet, field recordings Matthew Sage - keyboards, percussion, radio, field recordings Patrick Shiroishi - alto, tenor, and soprano saxophones, clarinet, glockenspiel, samples, voice