Oh, what a morning. I was sitting in the dialysis unit quietly writing a note (which I ended up finuishing about 1.5 hours later) when 1 of the nurses came to tell me that a patient we were dialyzing had a heart rate of 170. !!!! Luckily the patient was still awake-truly amazing what the human body can take, especially when it was not in good shape to begin with. So I rounded up the usual suspects-gave O2, stopped the dialysis, did an EKG and wrote an order for the medication I wanted. I also called up the nephrology fellow.
I'm now going to make a statement that won't make a lot of sense if you've never worked in a teaching hospital. And that is...it's August. Not quite as much of a statement as "It's July" but still. (If you've never worked in a teaching hospital the significance is that medical house staff all move up a notch. Medical school grads become interns, interns become residents, residents become fellows, etc. Imagine a lot of people wandering around with dazed expressions and you've pretty much got it.) I felt really bad for our fellow. He's from another institution, so all of our computer systems (which govern pretty much everything these days) are new to him. Huge handicap, and hardly his fault. Then follow it up with the fact that he still knows fairly little about dialysis...it's difficult for him, and I know that. But the thing is that I feel like I have no backup. However, it's wonderful what you can do when you have to. I took care of the patient, slowed down the heart rate some, made sure that the blood pressure was something that didn't make me shudder when I looked at it. And it turned out that no one (even the 2nd year fellow) really had anything to add. They just agreed that I had done what they would have done. And even when I made a suggestion about what the EKG rhythm might be, they thought that I might be right. And the patient's family member thanked me and said what a good job I had done.
Because the thing is that even though I've been an NP lo these many years, a lot of the time I still feel like I don't know what I'm doing. And that I'm going to make some big mistake. I mean a BIG mistake. But maybe that's what helps keep me safe. I need to think about this some more...