Neuro Checks

3 days. I'm off today--it was supposed to be my overtime shift. We are encased in ice. I walk on it and don't even dent it, it forms a plastic, samsonite luggage like dome over everything--my yard, the cars, the parkinglots. The dogs go skidding on it. Winter is here.
I've parked illegally every day, pulling into the CEO's spot in the parking garage--they haven't even ticketed me. I guess they're just glad staff made it in. Inside the ICU is a feeling of cold quiet, like we're in hibernation. I feel cool inside, and far away from things. There's a lot less flirting and joking, and the residents seem cranky, more inclined to blame nurses. I had to bark at Baggins the other day for it.
The only person who seems lit by this weather is Wiz, of course, who never works the way other people do. He's walking around singing.."you can hedge a bet on a clean corvette" His meds must be working.
I had good patients this weekend--patients who actually got better. My patient last weekend died. Not on me, thank goodness, but the next day. His family withdrew care. But this week, I had 2 head injuries--one an old man with alzheimers, and the other a woman. Head injuries require neuro checks every hour, which can be disturbing for family members--both patients started off vented, but my little old man was extubated the first day. My woman stayed intubated throughout the weekend. Every hour, you go in and you shout at the patient, and ask them to follow commands--"Squeeze my hand!" I say in my loudest, most shrewish tone. If they can't do that, I rub their sternum or pinch their toes with hemostats to get them to respond. You watch how they respond--do they try to fight you off? Do they curl their hands and toes in? (posturing-bad sign) I run a q-tip on the lower lid of their eyes to see if they have a blink reflex. And I deal with the neuro docs. Who are awful. Peremptory, demeaning. "We need you in here." the medical student accompanying them tells me. The neuros-I call them the neros--are in with the woman. The neuro attending is from Africa, with skin as black as wet bustelo espresso grounds. I have never seen skin so dark. He always wears a double breasted suit and he expresses all his opinions in a heavily accented shrill voice and all his opinions are expressed as commands. One time he told me, "Patients should never be intubated unless they have trouble breathing."
"That is very true!" I told him. "You are absolutely right!"
So he is standing in the room with his residents, all equally unpleasant.
"Why is this patient intubated!" he says. Like it's my decision.
"I believe because she has a paO2 of 66%. "
"She should not be intubated."
"Well," I say patiently, "the primary team is in the conference room. Dr. Spratz is attending on call this weekend. Would you like to discuss options with them?"
"That will not be necessary."
He proceeds to do a neuro check.
With the propofol running. Propofol, otherwise known as the "milk of dreams" is a very heavy sedative.
"She is not responsive! Has she been responsive for you?"
"Well, it is seven in the morning, and I have just walked into the room, so this is the first time I've seen her---so I can't answer that. The night nurse did get her to localize pain,(localizing pain is the nice way of saying the patient tries to hit you when you hurt them)"
"She is not doing anything."
"Would you like me to turn the propofol off?" I ask pleasantly.
"That will not be necessary!"
His Fellow, a stringy miserable looking polish guy tries his hand at an examination. I decide to shut the propofol off anyways. Instead of a sternal rub, he opts to twist her right nipple. Hard and nasty.
Fucker.
But she reaches for him. I hope she knocks his teeth out.
"Localizes pain,"he says triumphantly.
"What an innovative approach, doctor." I say.
The attending turns to me. "She needs to be extubated!"
"Dr Spratz is just down the hall...I can go get him..."
"Never mind!" He turns on his heel and walks out.
"they are all like that up here," I overhear him say to his Fellow as walks out.
Yep.

But at 1800 on Sunday, I got her to squeeze my hand in response. Then I got her to squeeze her daughter's, too. Lots of tears. She's going to be okay.

That's my 1/2 hour.