skillzzzzzzzzzzzzz

there is a certain feeling of accomplishment that comes from doing a job well. like when you have had to use all your critical thinking skills, maybe caught something about a patient that was a little bit off that ended up making a difference or saving a life. or making a connection with a family member having a hard time letting go of grandma or grandpa. or running all night transfusing units of blood trying to stay ahead of a bleed, and successfully 'reminding' the physician to order lasix in between units of PRBC's. sometimes the night is such a high i have a hard time winding down in the car on the way home. not a high like.....a good high sometimes, like you just finished a great endorphin-releasing run or a really amped up concert. but more like you just fought a good fight....or, i dunno, it's hard to explain.
on the other hand, i hate the nights when i get my ass handed to me. when your A game just isn't there and you miss stuff......as exhilarating as it can be to Find the Big Thing or Prevent the Tragic Mistake, that's equally how bad it can suck to MISS the Thing that Kills Your Patient. for the record, i haven't yet Missed the Thing that Kills my patient, but i've def come close a few times. what i have done a few times is not Miss the Thing that Kills my patient, but had my patient die or end badly anyway. that sucks. i'm not sure what this piece has to do with skills, (i think i had a different post in mind when i started), but there you go.

things you can't say to your patients #2

to the sweet sweet 60 some-odd year old lady with the silicone breasts of a 20 something year old hollywood starlet, 'wow, these are some very nice boobs. very symetrical, perky and firm. in fact, they are so firm, i can't even listen to your lung sounds to assess your pnemonia like i'd like to because they aren't sagging down under your armpits as your-age appropriate boobs should and would be.' what i can't help thinking about everytime i encounter a set is that someday, all that will be left will be a bunch of bones and two perfectly shaped, symetrical bags of silicone sitting in a fancy wooden box. that would make a fun halloween costume though, huh? i'd have to explain it to everybody however, and that would get old fast.

things you can't say to your patients #1

.......when you are placing a foley in someone's penis. 'hey man, you have a REALLY large penis. way to go. does it get even bigger when it's erect?' or to the girlfriend, 'wow, looks like you are one lucky lady.'  it wouldn't have mattered anyway, the kid was only 18 and probably a virgin anyway. that probably means he wasn't even done growing......geez, imagin that.