Tu Mama

Bathroom fun:
I guess someone forgot to flush!

Run Run

Today I ran and ran and ran. The End.

Juuuuuust kidding!

I was in fluoroscopsy/interventional today. Following around 3 different techs. Work started at 7:30am with 12 patients. Apparently this is a slow day. At the old job we did at the most 1 (yes, ONE)fluoro case a WEEK. And, as I usually worked evening shifts on the fluoro days, I haven't done a BE, UGI, VCUG, ect. for a loooong time.

Not that I missed it much.
People can keep their anuses and various bits to themselves, thanks much.
But it's part of the job.
And I wanted this job, at this big fancy hospital, so much.
The Rad was so nice. He talked to the patients! He explained the procedures! He was a normal person!
Amazing.
By 8:30am, when the pts start to arrive, there are 3 more add ons. By the end of the day there will be 2 more. Total pt exams =17
I assisted with 1 thoracentesis, 1 paracentesis, 1 abd mass biopsy, 3 UGIs (one on an 8y/o), 1 VCUG(where I was peed on) and 2 ERCPs.

I also watched a student x-ray a partial amputated thumb. She was hoping to test out on it, but couldn't remember how to do the oblique so I couldn't sign off on it for her.
I also did a lot of other minor things-like running around and getting things, finding people, transporting equipment, and running and running.
We didn't stop for lunch until 10 min. to 1pm.
Our next pt was at 1pm, so we had 10 min. to eat.

While we gobbled food, The Manager came up and asked in a passive/agressive manner if JCAHO allows us to eat in our dept. I'm guessing.....NO. Whatever, I'm the new employee, just following the others lead!

I have tomorrow off!!

Oriann Tation

I had orientation today for my new job. From 8am to 4pm. Now I'm at work(old job) until 11pm.
Man, I'd forgotten about how boring and repetitive all that orientation junk is!
The exciting highlights of the day:

• To find the elevators look for a picture of red poppies.
• If you don't find said poppy picture you will be lost forever!
• If you want police and security to come running dial 666 for assistance.
• Sugarcane skewered shrimp with couscous for lunch (fancy pantsy!)
• Prescription vending machine by the ER .

I know I will get lost all the time for the first 6 months. New job(NJ) hospital is soooo big. Everything is brand new and every hallway looks exactly the same. It's scary and super shiny at the same time. At old job(OJ) I know everyone by their first name. There are over 1,000 employees at NJ! Yikes!

I'm scared, but........I can't wait to start!

Something Small

So......................I had an interesting Sat.

My finally call was a 6:55am.
That's right, 5min. before my shift was done.
CT facial bones on a drunk guy, punched in the face.
Sissy posh kid, wearing loafers.
His skin wasn't even bruised. I've seen worse marks on the daily LOC-old-lady-bumped-head.
His friends were very funny. One was getting a facial lac sewn up when I brought Loafer Boy back to the ER.

LB's friend,whispering drunkenly:"Is he gonna stay OK?"
Me, whispering:"I don't know."
LB's friend, whispering to another friend, sitting in the corner trying to hold his head together with two hands(hangover, anyone?): "He look 'sa real bad, huh? She saysa he gonna not be good. Ouch, right?"
Crazy drunks. Home for Springbreak I suppose.

Lemonsucker Tech was late, so I ended up working 24 hours and 25 min. Lotsa money for me!

Dr. Shrug was working in ER again this week-end.
At 11am: A 74y/o man came in with chest pain radiating into his back. Dr. Shrug ordered a Port CXR. She talked to the Rad., Dr. Pissoff, about it. She calls in Dr.Tightpants and they admitted the pt.
I'm having fun naming everybody!

Anyway, around about 3PM the floor orders a 2view T-spine film for back pain. Ho hum. Boring.
When I get to the pt's room, Dr. Tightpants is telling the pt about a report she just recieved from another hosp.

3 months earlier the pt went to hospital Xxxx and had some tests.
Results: Thoracic aortic aneurysm (TAA)
Treatment: Um, nothing.
The pt. didn't even know what an aneursym was. Dr. Tightpants tried to explain it without totally freaking him out.
"Well, it's a sac, in your chest, full of blood, that bulges and if it ruptures (not that your's is!) it can be fatal. You can die."

This is the part where I jump in.
"Ah, Dr. Tightpants? Are you looking for a TAA?"
"Yes."
"Well, you know a T-spine x-ray won't really show that very well. A CT would show that a lot better."
"Mmmm, maybe, but Mr.CP here has an iodine allergy. Could we do it without contrast?"
"The images would turn out better with contrast, if you wanted to pre-medicate him? or I could do it without contrast. The images won't turn out as nice. It's better to do it with contrast, but..."
"No, I don't want to wait and do pre-medication. Just do it without the dye."
"OK"

Fastforward: CT done. I call the Radiologist, Dr. Pissoff.
"Hi, Dr. Pissoff. This is Katalia from hospital Xxx."
"Hello! Hello! How are you this fine day?"
"Great thank you. I have a CT chest that I just sent over. I don't know if you have the paperwork yet? It's a Mr.CP"
"Well, sure I do, it's right here. For TAA, hmm?"
"Yeah, that's right, um I just wanted to warn you, Dr. Tightpants wanted me to do it without IV contast.."
"ARE YOU KIDDING ME! That just PISSES me off!"
"..so I did it without and the pt has a contrast allergy..."
"I am so PISSED OFF right now! What the hell were you thinking! What the HELL!"
"...and so I did it without contrast."
"So PISSED OFF. GOOD BYE. whatthehell"
He slams the phone down.

It turns out Mr.CP had a ruptured leaking TAA. He was rushed to another hospital for surgery. I hope he is still alive. Only 20 to 30 percent of ruptured TAA pts survive.

Suck In

Reasons for holding my breath, while pushing a patient's wheelchair:

• vomit and nicotine
• greasy old man hair
• greasy old woman hair
• old woman butt crack
• rotting cast skin
• week old urine
• diarrhea
• full and leaking ostomy bag
• smoker's stench
• infected bed sores
• full diaper
• cow poop on shoes -came in from the barn stink
• drunk yesterday-tequila leaking out pores stink
• mouth breather with rotten tooth stumps
• football/hockey player locker room stench

Happy March

Happy March!
I turn 25 this month. Boo.

It's depressing. If I live to be 100 (ha,ha, not likely) 1/4 of my life is already over.

But really, I should look at it as 1/3, because statistically I'm more likely to only live to 75.
Sad.

I thought this article about hormone related side effects was interesting. I see anecdotal evidence of this when I'm doing mammograms on women that have taken HRT in the past. Their breasts are very firm and hard, so it's much more difficult to get adequate compression. We all hate doing HRT pts.

However, the worst are women with breast implants. We draw straws to see who has to do those.
One woman came in to the dept. and was suprised at how difficult her mammogram was now that she had breast implants. Her surgeon told her that mammograms would be easier now that she had the implants, because there 'wasn't as much breast tissue'. -Not true!

As you can see from these pictures.
First, standard mamm views are taken with moderate force to the breast and implant.



Then, implant displacement views are taken. The implant is pushed back against the chest wall and the breast tissue is pulled forward and compressed. Imagine a half empty tube of toothpaste. Just like pushing the toothpaste toward the cap, we push or squeeze the implant toward the chest wall. There are double the views(x-rays) = more time and more times compressing the pt.

Dump Run

I had my first dump 'n run a couple nights ago.

The front desk calls,
"Do you know about a pt. Xxxx, that's a direct admit to CT?"
"Um, No?" I want to say, 'Why would anyone be admitted to CT?", but whatever, the front desk wouldn't know that, anyway.

I warm the scanner up and wait. About 40 mins later 3 EMTs come racing into the dept. with an unconscious elderly woman on their gurney. They're shouting some stuff about low blood pressure, V-fib, O2, something, something - and they rush past me into the CT room.

What I see is a cyanotic old lady actively seizing.

I follow them into the room, "Um, she's having seizures.", I say.
They roll their eyes at me, like duh.
"Yeah, that's why she's here.", one of the EMT's says, while they're moving the pt. on to the CT table.
"Has the ER nurse looked at her?", I ask.
"No. Direct admit to CT.", the EMT says, while they're wrapping up their stuff and heading out the door.

OK - So here I am alone with a cyanotic, seizing old lady. The ER is on another floor. In fact the only other depts. on my floor are housekeeping and HR. They're all gone for the day anyway. There isn't any crash cart or even a blood pressure cuff in our dept. Not like I would know how to use one, right? Actually, for a Rad Tech, I'm very good at taking blood pressure by palpation. Thank you EMT training. Anyway, back to my story. Thankfully, the ER nurse came to my rescue and with her help I tried to scan the pt.'s head. CT and seizures don't really work well together. After the third try we gave up and the ER nurse took the pt. upstairs to be admitted to, get this, a real hospital room, where they gave her some nice Ativan. And I finally got the CT done.

Later on I went up to the pt's room to do a CXR and EKG and the pt's Dr. popped in.
I hate this Dr. Deeply, deeply dislike him. If I were dying, and he was the only Dr. that could save me, I would rather die.
I have the pt's chest uncovered to do the EKG and the Dr. waltzes in, flinging the door open and not shutting it. Granted, she's unconscious, so she doesn't know that her boobies are exposed to the world passing by outside, but gross!
I shut the door.
The Dr. snaps on a glove, "Well, as long as you have her gown open, I'll do a breast exam!" He proceeds to vigorously squish her sagging, floppy breast tissue. "Her family's very worried she might have breast cancer."
She's 88 y/o and unconscious. Hmm, breast cancer may not be her worst problem right now. Then the Dr. grabs my hand, "Here feel this! I think it's a lump. What do you think?"
Eww! I do mammograms, but I DO NOT grope unconscious old ladies!
So I say diplomaticlly, "I feel some tissue, but I don't know what it is."
He snorts, "Well, it feels like a lump to me."

Time Waster

The hopital admin. are instituting another time wasting protocol.

It's called SBAR. Anybody use that at their hosp.? Did it work?

SBAR stands for Situation-Background-Assessment-Recommendations

Basically, as they've discribed it to us, the pt's nurse fills out a 'ticket to ride' every time the pt needs to leave the floor for a procedure. The questions that they fill out are like,

Wheelchair? yes/no (duh, every pt gets a wheelchair ride)

O2 y/n

Circle O2 level: 1 2 3 4 5 6 7 8 9 10 12

circle one: pt stands alone, two person lift, pt immobile

Location of pt pain?:

Level of pain:

Does pain move around?:

Pt confused/disorientated?:

IV: y/n

IV Location?:

IV taped in place? y/n

IV gauge?:

Multiple IV tries?

If so, are repeat IV locations bandaged?

Pt wearing any jewelry?:

Pt provided with slippers and robe?

RN/LPN to sign:

RN to sign if pt changes noted:

OK this is silly!

Sure I want to know if the pt is on O2 or if they're confused. I also would like to know if they are a 2 man lift(so I can bring the strong man we keep in the hallway closet ha,ha), but I can ask the nurse these questions!

Also, I can, instead of reading a piece of paper that was filled out the night before, by the previous shift, talk to the nurse or aide or whoever and tell them, "Oh by the way I'm taking 314 for their x-ray. Do they need O2? Are they combative?" Ect.

That way they won't freak out when they see an empty bed and think the pt. has escaped!

It's not like we are a huge hospital - there are 21 beds in med/surg, 4 in Ob, 4 in ICU, and 15 in the locked mental health ward.

It's just one more piece of paper the nurse has to fill out.

And our hospital is supposed to be paper-less!

Why don't they put this info into the digital chart?

Then before we go to pick the pt up off the floor (sounds bad) we'll know that they need O2 , ect.

Snow Melt

I'm so sick of snow and winter.

Blah.

I just spent >$400 on seeds and plants. Is that excessive? One order from one catalog out of six I plan on ordering from? I need help!

I'll just keep telling myself it's OK. After all, it's my only real hobby. People spend money on hobbies. Deep breaths. It's OK.

Anyway, today we had a ETOH guy in his 40's come in to the ER for jaundice. The ER Dr ordered a chest x-ray. For jaundice? OK whatever.

When I bring the wheelchair into the room and tell the pt I'm taking him for his chest x-ray, he says, "Just an x-ray? I'm supposed to have something else. Like a cat scan (sigh, no cats are involved people! Too bad-it would make my job a lot more fun.) or something like that."

OK I'll go check with the Dr. I talk to the nurse. We roll our eyes. She tells him, 'No the Dr just ordered an x-ray."

I'm wheeling him to my dept. and he's totally obsessed with CTs. Every room we pass, "Is that where you do cat scans?" No. "Is this the cat scan room?" No.

Later on in the ER, I hear him talking to the Dr., "I think I really need a cat scan."

The Dr. (who is famous for ordering every scan in the protocol book) miraculously says, "Well, I want to get your labs figured out first and then we'll worry about that."

They admited him to the ICU for ETOH detox (?) and ordered an abd/pelvis CT for tomorrow.

So he'll get his 'cat scan' after all.

Rice Fire

I love Indian food!
Dum Aloo is my favorite. It's potatoes in a semi-fiery tomato sauce with lots of good spices. Mmmmm and samosas and naan.

I wish I could find a recipe for the red relish that's often served in Indian restaurants for an appetizer. I think it's made out of finely chopped onion and lemon juice, but what makes it red and gives it such a great flavor? Cumin? Annatto?-that would give it a bright red color. Hmmm. I guess I'll keep looking.

So far today at work I have done ONE, yes, count it, one Abd/Pelvis CT on a chemo pt.

My boss asked me today if I would be interested in working from 2pm to 2am x 3 days a week without week-ends and NO CALL!!!!
This seems like a pretty good deal to me. I'll have to see if it works out though. I don't think I would be interested if I still had to work week-ends.

I wish I knew what kind of shifts other x-ray depts. worked.
As I've just passed my Mamm boards (in Dec. score of 98, thanks very much!), it would kind of suck if I didn't get to do mamms at all. They only schedule mamms until 3pm, because there's only a staff of one(me!) in the dept after 3:30pm.
Ho Hum, have to see how it goes.

24 Down

Well, 1 hour down 23 to go.

It's 8:30 AM and I've already dealt with a stupid Dr. If the Rad dictated a report on the dictation line and I can hear it, why can't the Dr.?

'Can you send up a typed report?' - No.

'Why not? Can't you type up the dictation?' -No.

'Why not?' - Because I'm not freaking Med. Records!

'Well, I don't know the # for the dictation system. We don't have those #'s.' - Ok, sigh. Here's the #. (for the 50,000 time.)

How long have we been using this dictation system? For TWO YEARS!! Yes, it's true....they're stupid.

When I work a 24 hour shift, I work 4 hours at regular pay and then for the next 20 hours I'm on call. I live 30 mins. away from the Hosp. so I stay over night in the Hosp. and sleep on a little cot in the dept. - yeah it sucks.

What do they pay me to be on call and literally live at the Hosp.? $3.oo an hour. That's right $3 dollars. When I was a student 4 years ago at a different Hosp. I made $4.50 an hour on call.

At the school Hosp. they let students work nights, week-ends, evenings, and day shifts(on your day off). It was a lot of fun, at times, and really frightening, most of the time. Sometimes you would have a 1st year student playing tech., with a 2nd year and 1st year student assisting...and that was it. 3 students in charge of the whole dept. for a night. Surgery, ER, ICU, ect. We covered everything by ourselves. And this is at a busy Hosp. Not a city Hosp., but still - in a town of 25,000.

After graduation I felt like I already had 2 years of experience being a tech. So, when people still, after 41/2 years of working at this Hosp., ask me if I'm 'new'......I say no.

Surgery Sucks

I am soooo tired. I had to work a morning shift today. Last night I got off work at 11pm, drove home 30 mins., and then got up again at 5am and to drive back to work.
Started the day off with a mammogram. Did an awsome job - as always - nobody gets more breast tissue on a film than me! I get chest wall everytime, on every film.

At 9am I went up to surgery. The first case was a foreign body removal and the second one was a gallbadder. Easy-peasy, 2 hours tops, Right? Wrong! I was in surg. for four hours!!

Four hours wearing about 20 lbs. of protective lead. apron, thyroid shield, ect. Plus the ever stylish blue hair net and yellow face mask.

The for. body was a kid that was burning garbage, someting exploded and hit him in the cheek. Dr. T. dug around and around in the boy's cheek for like hours. Seriously, if anything happens to my face I'm going to a cosmetic surgeon. No scars for me! Thanks very much.

They usually use a magnet to suck for. bodies out of incision sites. The magnet looks like metal toilet paper holder with a metal tip on either end. They stick the metal tip end into the flesh, squish it around a little bit and sometimes that's all it takes. The for. body sticks to the magnet and sclushp it's out.

But not today. It wasn't ferrous. So it wouldn't stick to the magnet. And it was stuck it a chunk of tissue, so Dr. T just had to dig it out manually.
My job in Surg. is pretty boring. I stand there and push the C-Arm in and out of the surgical site. When the Dr. says x-ray, I press a button and take an x-ray.

The gallbladder took forever, because the Dr., thinking it was an artery, clamped a duct off and then tried to inject contrast. "Hmmm, the contrast isn't going anywhere?" "Maybe it's the big stain-less steel clip you just clamped there."

Most of the time I really like Dr. T.
He's quiet and he doesn't swear at me.
A+ Dr.!!