Today's evening shift marks my 6th day on the unit (Only? Wow!). It would have been 7 except I had to miss a day for flu-related conditions. This week has been interesting.

I've been assigned one patient for the last few days - a lady in her 70s who presented to Emerg with a big DVT in her leg. A CT found AAA as well as an aneurysm on her common iliac. They decided to remove the clot and repair the aneurysms at the same time, landing her on my unit after some time in Intermediate Care. Turns out she has developed a major complication from the AAA repair, ischemic colitis. They put pictures from the scope into the chart.... that was a sight to see. The colon is pale and there are patches of necrotic tissue. There are what seems like grey perforations in the bowel and a lot of mucousy yellow slough. It's crazy to think that's going on inside her body.

Right now, I think they are managing her symptoms and trying to ride it out and see if the bowel will recover some function. She's on TPN and a couple of antibiotics; pretty much everything else is from pre-existing conditions.

So, she's a pretty sick patient, and it's been a busy few days for me. I have been able to hang IV meds & TPN to my heart's content and provide pretty much total care for her, which I have been enjoying immensely. It's like all the good stuff from 1st and 2nd year, plus being able to do almost everything for my patient, with a cosign of course.

"Can I have a shower today?" she asked, squinting up at me in the afternoon sun.

She had been looking kind of, uh, smarmy and I was elated to hear her awake enough to request a shower. It was a hell of a production. The primary nurse and I (despite my protests - I definitely could have managed, but she wanted to be there too) brought the patient into the shower room along with her smart pump. We cling-wrapped her PICC and peripheral IV. We put bags over the pump. 20 sweaty, humid minutes later, we had her scrubbing under the showerhead, and her relief and sighs of satisfaction made the whole thing absolutely worth it. She said it was the best shower she'd ever had. lol :)

Unfortunately the pleasure of providing her with a much-needed shower was tampered by a very unfortunate mishap involving incontinent ischemic bowel... everywhere...

That makes my Code Tally 0 code blues and 2 code browns. They are smelly but no one dies.

So, after having such a crazy start to my shift, the rest was absolutely slow. My patient slept most of the evening, barely waking up for meds, and then zonking out again.

Finally, after I awoke her for 2200 meds and HS care, she popped back to life and asked me what was on the menu today. "Nothing," I smiled, "you've had quite a day; it's now 10 PM and it's night time."

"Oh. Were [unintelligible]?"

I leaned closer. Come again?

"Were those yard apes here?"

I laughed. Yes. "Your family was here. They watched Ellen."

She shook her head and smiled. She picked up her toothbrush and examined it. I waited patiently, watching her for signs of agnosia. She felt the handle and brought the bristles close to her glasses.

"Modern science!" she proclaimed appreciatively, and then proceeded to brush her teeth.

Just after I set up her sidestream nebulizer, and before I turned off her light, she turned to me and asked.... "So, any chance I can have that shower today?"