The Magic of an Ordinary Day

Just  a few tidbits from our life:

• Hannah went to her bff's birthday party on Saturday, at a local bowling alley.  She had no interest in bowling, but had a great time with her little friend.
• The garden is doing well.  The spinach, chard and squash have all sprouted and the transplants are great. 
• Dwayne and I went back to the gym yesterday.  It was pretty fun, and I was feeling all peppy when I left and thought "I'll just run home."  Just. about. died.   I guess I'll have to work up to that running stuff.
• Of course, I'm sore today.  Dwayne helped me with an upper body routine for yesterday and today my arms are fine but my chest and shoulders are pretty sore.  It's okay, though -- if I wasn't sore I didn't work hard enough.
• I've got a prescheduled flight tomorrow.  Las Vegas to Boston.  It's going to be a long day.  In fact we are flying to Vegas, back to Albuquerque to switch out pilots then on to Boston (since they can only have a 14 hour duty day) and we have to go bedside on both ends (rather than have them transported to our plane by ambulance).  The danger of having your pilots time out is being grounded for the mandatory 10 hour rest time, wherever you may be.  And heaven help me, wheels up is 5:30 a.m.
• We were saddened by yet another Medical helicopter crash.  Although I fly in a fixed wing aircraft, the losses have been grim this year for medical transport teams. 

I am the Medflight Texas Queen.  Not as in beauty pageant queen, like I think of when I put the words "Texas" and "queen" in the same sentence together.  As in if there's a flight to Texas, Donna's going to be on it.  Especially if I left the house with pretty hair.

I went to Dallas yesterday, transporting a pediatric patient who, sadly, at the age of 17 was rejecting her liver transplant. Dallas, surprisingly, wasn't the dog's breath, humid hellhole that it was last time I was there.  Of course, it was 10:00 at night. 

And in all fairness to Dallas, it isn't as bad a Houston.  And I am developing quite an appreciation for the sweet tea in the Dallas FBO.  Yes, the sweet tea is swaying my opinion of Dallas and giving me a more warm and fuzzy feeling towards Texas in general, since it is ubiquitous in Texas.

We picked our patient up in Las Vegas, during which time I called Aunt Joan and had a nice long phone conversation with her.  I don't know why I don't call her every week -- we always have a great conversation.  I feel like I have  known her my whole life.   

While we were in Vegas I was chatting with the program director there.  Medflight has bases in Albuquerque and Las Vegas and he is currently splitting his time between the two places.  He offered me a full time flight nurse position in Las Vegas.

My dream job.  Living in a place where we have family.  Dwayne being able to spend more time with his cousins, who he was practically raised with.  Joan and Cooney.  My heart paused for a second. 

Then I thought of everything we have here.  Our beautiful home, living in the mountains and it's wonderful climate, a job Dwayne loves, our friends and neighbors.  So many reasons why I love the life I have now.

So I turned him down.  I've just got too much here that I love to make a move. 

It's been a busy week here. 

Wednesday morning I was at the office at 6:15, breakfast burritos and doubleshots in hand for the crew.  I was totally excited to be going back to Montana.  I'm also very excited about the doubleshots.  In a plane without a bathroom, getting the maximum amount of caffeine in the smallest amount of liquid is paramount.  The pilots loved them, too.

The pickup in Phoenix went well, then we got to Kalispell, where it was 34 degrees and raining.  My partner had strict orders not to let me get a crew car and go down to Moose's -- we had to turn around and get back to Albuquerque for another transport.  He was authorized by the chief flight nurse to physically restrain me if necessary.  So we refueled, grabbed a sandwich and were back in the air about 30 minutes after turning over the patient. 

So here are my fabulous photos from Kalispell.  All taken from the plane as we were leaving.

The cloud ceiling was really low and you couldn't see the mountains.

See the snow?  They had a heavy snow advisory for the Kalispell area the night before we left, but it had turned to rain by the time we arrived.  On June 11th.  I forgot what the weather was like in that part of Montana.

I did get this nice shot of somewhere in Colorado on the way home:

So, despite my unhappiness at not being able to take a trip down memory lane at my employer's expense, I have to say I'm pretty happy to have a Lear jet as my office.  So I'll quit bitching about Kalispell.

Okay, other than that I worked in the PACU for two day shifts.  Only eight hour shifts, so they went pretty fast.  I like the PACU, really, and it's kind of a break from the flight nurse and critical care work I usually do.

I got out a little early and went to the Greenside Cafe here in Cedar Crest.  It is so nice to have great dining in a small town. 

The next two weeks I am doing six shifts at Medflight, and certifying in PALS (pediatric advanced life support) on Thursday.  I'm still looking for that "OB for dummies" class.  The thought of birthing babies in the air scares the crap out of me. 

Another week at Casa Frijole

Hmm, let's see what we did this week.  The days and weeks fly by so fast!

I flew a patient to Lubbock TX.  He needed a neurosurgeon and either there were no neurosurgeons in Albuquerque who could accept him as a patient or there were no critical care beds in Albuquerque for him. New Mexico is horribly short of neurosurgeons, so I will suspect it was the former.  For a change, it was a non-eventful, normal flight.  Except that I was called at 1 a.m. and had to roll out of bed and be on the road in 10 minutes.  Thank goodness for the company issued baseball cap.

I certified in NRP at Medflight this week.  With our increase in transport of high-risk obstetric patients, I guess we need to know what to do if we birth a high-risk baby at 35,000 feet. 

I was sooooo stressed about this class.  Having not seen a newborn  -- fresh from the oven as it were -- since nursing school, much less a limp non-breathing baby I was just freaking out about it.  Thankfully, I had a work colleague and my brother Al to help peel me off the ceiling and I did just fine and am now certified to resuscitate a newborn. 

But if it's your newborn, I'd look around for someone else to do it.  Just a little tip from me to you. 

I am trying to get on a critical pediatric flight as a third crew member as well.  When we get a pediatric patient, it's kind of a judgment call by the coordinator as to who to send.  There is an "adult" team and a "neonatal" team and somewhere in between is pediatrics.  Some of the nurses have peds experience, and of course, the medics are all very well rounded as far as their experience.  I'd like to be doing peds but I'd also like to observe a peds flight before I have one of my own.

We found out that Jake has a a hypothyroid.  He had been panting so much and he looked a little chunky so we took him in for blood work.  So a couple of pills a day and he's good to go.  The panting has decreased and hopefully he'll lose that 5 pounds he packed on over the winter.

Hannah's done with school and we're going to just hang out and play until the "summer program" starts in June.  She would miss her friends too much if she wasn't getting to see them.  Summer program is three hours a day, twice a week.  Structured play mostly, but since it is run by one of her preschool teachers they will work on things from last year.

Now that we have the summer-like dirty feet/legs/arms every night Hannah has decided she'd like to take a mini-bath in the kitchen sink at night.  It is a wonderfully deep sink so I thought "why not?" 

Note the dirty knees.

PRIDE

Dwayne and I took some time out this week to celebrate his nomination for the Critical Care Pride Nurse.  Pride is an acronym for Presbyterian Recognition of Individuals Dedicated to Excellence.   You get nominated by a peer, and it is quite an honor to be nominated.

Thursday was the dinner, and it was great to hang out with the other  Pride nominees and socialize.  Here are some photos from our night...

Here are James and Marsha.  Honestly, is there a more beautiful couple?  They are the other husband-wife team at the CCU, and James and I do flight nursing with the same company.

And the newlyweds Brian and Cassy.  I didn't get a great photo of them but wanted to put one up of them anyway.  Sorry, guys.

And here's Linda with her adorable boyfriend -- who I am embarrassed to say that I forgot his name!  But he's very nice, a firefighter and apparently a good boyfriend.

I really had a good time, high heels notwithstanding.  It makes me think I should be a little bit less of a hermit sometimes.

Houston, again

Another run to Houston with a really sick patient.  This one had a balloon pump.   Same kind of team--two nurses and a medic, and I was brought in to be the balloon pump nurse. 

In my three trips to Houston so far, I've come to the conclusion that it's never going to be good when we go to Houston.

Without going into details (mostly because I'm just too exhausted!) there were all kinds of monkey wrenches thrown into this particular run...malfunctioning equipment, unstable patient, transportation problems in Houston (to the point where we had to call 911 to get to the hospital) and then needing to shock the patient in the rescue truck en route to the hospital in Houston.  Whew!

The good news is she was stable when we turned her over in Houston, and that is what it's all about.

What this ride was also about was teamwork.  I had never really met this nurse before, but had worked with the medic so we weren't an established "team" that was used to working together and knew each other's strengths.  So on the ride down to Waco we talked everything out and as a team decided on responsibilities and tasks.  As our perfect little plan broke down piece by piece we continually reassessed things and formed a new plan.  We all did what we did best, and although it wasn't by any means the smoothest transport ever we all came out of it with a true sense of respect for each other.

We all had a "debriefing" at the office the next afternoon with the Chief Flight Nurse, Medical Director and Assistant Chief Flight Nurse, in which we discussed the flight, the problems and things that were done well.  It was a very positive meeting, and at no time did any of us feel the need to defend ourselves from the day after armchair quarterback.  The bosses made it known that they were very proud of our responses to the obstacles we had.  I feel good knowing that our organization is that supportive of the staff.  That is SO huge, in my opinion: supporting your staff when they are making life and death decisions in the most unusual of circumstances. 

I love my new job.

Houston, we have a problem

I went on my first flight with a really sick, critical patient on Friday.  I lucked into it --  I wasn't even on call when the flight coordinator asked if I wanted to go on the flight as an extra pair of hands.  Anytime someone is that sick we send two critical care nurses and a medic.  And we sure needed all the help we could get.

When I got to the office we waited around for a couple of hours to see if he was going to live through the next hour, and then the next.  We were told that they expected him to die in the hospital in the next few hours or to die in the airplane on the way to Houston.  The only thing that was going to save his life was an aortic homograft, which no one in the state of New Mexico performs. He finally settled down enough to where we thought we could go in and get him to Houston while he was still relatively stable.  "Stable" considering he had coded twice that day and was on three pressors. 

It took an hour and 20 minutes just to get all his drips transferred to our machines and get him on our ventilator.  Then the transport to the airplane, and loading him... another 40 minutes.  He was doing okay, and our pilots absolutely busted ass to get to Houston in a quick hour and a half.  I had even weaned his epinephrine drip down a bit.  So far so good.

Then we got in the ambulance to get him to the hospital.  We went code 3 (lights and sirens) and busted ass at 90 miles an hour.  The patient dropped his blood pressure to the 50's.  I adjusted his drip, harrowing as it was with us going so fast and having to stand up and lean over the  patient.  Seriously, at one point I was airborne and just sort of floating around in the back of the ambulance.  We get to the hospital, and the Houston paramedic said "I'm sorry to tell you this but the CVICU is about a mile and a half through a maze."  And he wasn't kidding.

As we hit the emergency room, we weren't getting any kind of blood pressure from his cuff although he still had a pulse.  Someone from the emergency room escorted us through the --I kid you not!-- two sky walks and two elevators it took us to get to that damned CVICU.  And I'm feverishly trying to get a blood pressure reading, and check for a pulse.  Of course, paramedics are too cool to run, but we were walking mighty fast.  Mighty fast.

Fortunately, the epinephrine drip had kicked in by the time we got to the unit, and I had an okay pressure.  We got him settled and off our equipment and heaved a collective sigh of relief.  It was 2 a.m. and we headed back to Albuquerque, feeling pretty good that we got him where someone could hopefully help him.

I can't say enough about the crew I work with.  Being a fairly new flight nurse, I am amazed at how comfortable I was at 40,000 feet with a patient who was so sick, who hadn't been expected to live a few hours ago.  The nurse and medic I was with, as well as the pilots who got us there quickly and safely...I was really impressed. 

Man, I love this job. 

p.s.  The patient is still alive, waiting to stabilize a little bit more before he goes to the OR. 

hangin with the AFD

I don't know what I've been doing this week, besides not blogging.  Oh, yeah...I worked a little bit.  And (nice segue into the subject of this post) I did a ride-along with the Albuquerque Fire Department as part of training for my job with the Air Ambulance company. 

What? you say.  Well, our medical flight crew is made up of a paramedic and a critical care nurse, and as part of our training they want the medics to hang with the nurses for a shift, and the nurses to hang with the medics. To see how the other half lives, so to speak.

So I was scheduled to go ride along at some yucky ghetto station, when one of my colleagues, who is a lieutenant with AFD, said "why don't you just spend the day with me?"  SOLD!!  His station is much nicer, nestled in between the University and the airport.  And, believe it or not, I tend to be shy with people I don't know, so the thought of spending the day with 14 people I didn't know was a little unnerving. 

I ended up having a great day.  We didn't 't go on any spectacular calls, no heroic life-saving, no fires...but I really came to respect what the AFD rescue squads do.  Just dealing with the public is enough.  Dealing with all the stupid people with a smile on your face and a respectful tone in your voice is just amazing.  I'm ashamed to admit, I did spend some of my time at the scene with my back turned so I could roll my eyes unnoticed.  But Dominic and his crew were just as nice as could be.

So here are some random observations about my day with the AFD:

• they don't run anywhere.  that's only on TV.
• I liked it when we got to ride with the sirens on.
• getting called to the airport for a crying baby is a bullshit call.  Even more so when the Mother best described her baby's "episode" as "just like when someone is coming off heroin, you know?"
• little old ladies just love it when their room is suddenly filled with young firemen.  they actually twitter.
• I actually had fun helping cook lasagna for 14 firefighters.  and they appreciated the home made croutons for their salad.
• they don't normally eat salad.  I had to push that one on the lieutenant, explaining that having been a cardiac nurse for so many years, I just couldn't serve a meal without vegetables.
• chivalry is not dead at the AFD.  I never opened a door or carried a bag (even the groceries) once.  One very nice guy absolutely jetted across the garage to take my grocery bag from me.  I didn't tell him how many grocery bags I usually carry by myself after a trip to Smiths.  It was too nice to be treated like that, so I just enjoyed it.
• speaking of special treatment, I got to use the special bathroom with the door that locked.  score!
• there is a rescue truck and two engines.  the rescue truck (us) were a lot busier than the engines, at least on that day.  which made getting lunch  ready an extra challenge.
• just as the meal had been consumed and I was sitting there wondering "who's going to do all these dishes?" the rescue alarm sounded and we were off to save lives.  Gotta get one of these for home.
• I left for the day with a great sense of respect for my paramedic colleagues, and the firefighters in general.  What a great group of people.

More snow. I'm done.

I woke up on Saturday and found this:

Pretty, yes, but like everyone else in the country...I'm done.  No more snow, please.  I'm ready for spring and lilac blossoms and green. 

I had my first (non-orientation) call shift yesterday for Med Flight.  I was able to go on a flight from Las Vegas (hi Joan!) to Columbus, Ohio.  It was a nice flight, the weather was cooperative and the moon was beautiful!  On the way to Vegas we flew over the Grand Canyon and it looked amazing with the snow.  I was able to snooze on the way back to Albuquerque, and have put together a small pack with some comfort items that makes the trip back (which is usually at night) much more comfortable: a neck pillow, iPod and some noise-reducing headphones.  I can then just stretch out and relax.  I know that some of these long-distance flights can take 12 or more hours to complete, but the time I am with the patient is maybe 3-4 hours.  The rest of the time I am relaxing, visiting with my fellow crew members, reading, whatever.  I can't believe what a great gig this is.  I love it!

The high point of my night, however, was that when I came home Dwayne was home from Tucson!  We has been gone the better part of the week, and I really missed him.  We are all going out for dinner tonight, and the only other plans for today are for a nap for everyone.  (Late night in + Hannah crawling in our bed early this morning = two tired parents.  I wouldn't give up those morning snuggles for anything, though).

Changes in latitudes, changes in attitudes

I went on my first transport flight this week.  I think I'm going to like it!  It was a jaunt to Carlsbad to get the patient, fly them to Tucson and return to Albuquerque.  The Learjet 35 is a great plane: it is quick, comfortable (it's a bit tight with a patient and a passenger) and is so well pressurized that I hardly felt the altitude changes.  The only thing is that I was COLD on the way back (and the other flight crew told me it's usualy cold and to bundle up) so I'll have to get some tights or something to wear underneath the flight suit.  I went out yesterday and bought the requisite black leather oil and fuel-resistent boots.  They are comfy but very, very butch.  Oh, well. 

I am very excited to start working in a different field of nursing, and the people at Med Flight seem very fun to work with.  Five of the staff there are already colleagues of mine from CCU and I know they are competent and dedicated nurses, so I'm feeling good about the level of care we are giving to the patient. 

I am just so glad I took the leap to get out of hospital nursing.  I am sick of the politics, sick of the hoops you have to jump through just to do your job, and sick of doing the same thing I've been doing for 13 years.  I always swore I wasn't going to be one of those burnt out hags who stay at the hospital (hating their jobs the entire time) for their pensions, or because they are afrad of doing something new, or whatever the excuse is.  I hate those people.  The patients hate those people.  And I just refuse to be one of them. 

As the great Jimmy Buffet would say...There's just too much to see waiting in front of me, and I know that I just can't go wrong.

back to school

For Hannah and myself.  She's going back to preschool today after her winter break, and she is so excited!!  She kept asking "Am I going back to school today?" 

I am studying for my new job.  I ordered a textbook which came yesterday, and am going through it.  It's exciting to be starting a new venture.

Teaching an old dog new tricks

I picked up orientation materials from Med Flight last week, and have been studying to learn my new job.  There are a bunch of FAA videos to watch about air safety, decompression complications, altitude, hypoxia, survival, etc.  There is also a new patient population to learn.  Although I've been working CCU/open heart recovery for nearly 10 years, I've discovered I know a lot about a little.  I need to know a little about a lot.  Or hopefully more than a little.  Trauma, neuro, high-risk obstetrics, peds... I'll be taking care of all kinds of patients and I'll be the only nurse with them during the flight.  Scary?  Hell, yes. 

I am excited, though, to go on this new adventure, to coax my tired brain out of auto-pilot and be challenged again.  PACU is fun, quick-moving but not as challenging.  And half the time, we have a patient overnight because there's no room in the hospital, so I'm back to what I was doing before: one (or two) patients, me and a dark room for 12 hours.  Exactly what I was trying to get away from when I left CCU.

Speaking of CCU, I've decided to go back for 2 shifts a month.  I need to stay current with my critical care skills, and I need to be able to fill in shifts if I don't fly. The PACU manager is really chapping my hide (not transferring me to his department even though I've been working there for almost six months) but that's okay...I'll take my critical care trained, night shift working ass somewhere else (hard shift to fill?  have a vent overnight?  Too bad).   On good terms, of course.  Because I may want to work there later (when he's gone!), or fill in when it suits me.   

So that's my plan for the new year.  I feel energized and hopeful.  It's a pretty good feeling.