Because working on it consumes your thoughts entirely. I have been working on the CNSA website, forums, and social media pretty much non-stop since I got admin rights. I just LOVE it. I love playing with the code (although, admittedly, I am entirely self-taught and barely know anything), I love improving the site nav and content, and I LOVE seeing the numbers climb after I installed Site Meter Pro.

I had some struggles with the old forum software (phpBB 2.x) and not having access to the database so I could mod the registration page to at least semi-prevent spambot registrations. I ended up manually adding approved posters to a group, and then giving that group permission to post. It's not ideal and I am worried I may have killed the forums, but they were pretty much dead anyway. One page worth of posts in a year...

I sent emails to the CNSA web host, Director Communications, and President of CNSA to try and persuade them to upgrade the entire site platform to vBulletin. From what I've seen, people either love it or hate it, and the people who hate it seem to be developers who are looking for ++intensive modifications, which doesn't affect me. I played with a demo version of the admin panel and I am pleased with vBulletin's community-centric nature. I WANT Regional Executives to be able to upload their own content and maintain a web presence for their community. I want the BoD to maintain blogs and reach out to the members. I want people to visit cnsa.ca and want to BE a member.

I'm also intrigued by the calendar functions, the events manager (hugely important for an organization which exists primarily through conferences), and social networking integration such as Facebook Connect. If we make it easy for our members to get involved and stay involved, they might actually take an interest in it - particularly those members (such as myself) who live in areas where CNSA has no physical presence.

Anyway, Reading Week is drawing to a close and I am scrambling to finish the major adjustments to the website so that, by Monday, I have my head back in the clinicals game ;)

I got the keys last night to the CNSA.ca website so that I could finally get started in my new role as Informatics Officer. One of the big jobs I see is improving the navigability, content, and transparency of the CNSA website. My term hasn't officially started yet (it begins on April 1) so I am just puttering around until the new Board of Directors begin their terms and I can harass them for additional content.

I would really appreciate if you could take a little mosey over there and tell me what you think about the current website. Be honest and give me some constructive feedback. I won't be offended - I didn't make it :) But I am looking to improve it.

It's a good thing it's Reading Week right now. I get so excited over web projects that I tend to stay up all night working and forget other commitments.... wait, did I feed my bird today?? ;)

-- from the cellular desk of undergrad RN

It was right around 1800 and I was in the middle of spiking new bags of TPN and lipids. I had forgotten the PICC IV adapter and was halfway out the door to grab one when her visitor peeked around the corner.

Before me stood a woman about the same age as Mary, my patient. She held her purse with both hands and peered at me questioningly. I paused and smiled at her, told her she was welcome in the room - Mary was awake for a change and watching TV.

She hesitated and looked at me again, eyes darting briefly between me and the room behind me.

Eyes wide, she asked it:

So... how's she doing?

Whoa, loaded question.

My mind lurched briefly and then started racing. Who are you? What do you get to know? How much do you already know? What do I know? Where's the line supposed to be, and how do I draw it?

Mary was not doing particularly well. She was currently weak but stable. The severe ischemic colitis was a major complication; if it turned gangrenous, the mortality rate could be as high as 50-75%. At this point it was a wait and see game, to determine whether she'd recover some bowel function and be able to live a normal life, or perhaps her bowel might perforate and she would have to be treated for life-threatening peritonitis. Surgery could entail resecting the bowel, or even removing it entirely, and creating an ileostomy. Mary was also experiencing some mental status changes, had pitting edema to one leg, and was becoming increasingly gaunt.

So *I* knew all of this. But I was also acutely aware that this visitor would hang on every word I said, and I would have to be as diplomatic as possible, but there was no time to really think about what I would say because every moment I hesitated she grew ever more concerned. There were also concerns of who was she, and what was she entitled to know. What was I entitled to share? How could I put it?

So, with my heart pounding in my chest, I asked the visitor who she was. Mary's best friend since we were in high school, she told me. We go way back.

'Okay,' my mind raced, 'a friend. Good friends, by the sounds of it.'

I took a deep breath.

"Mary's surgery is healing well, but she has developed a complication with her GI system." Her eyebrows raised and I cringed internally. GI? Who the hell says that?

"Her, uh, bowels are having some problems, and we are, uh, keeping an eye on her." I winced inside. It was extremely hard for me to find the right words that would simultaneously protect Mary's privacy, avoid false reassurance, and also respect the friendship of these two women; made harder still as she watched me, nodding carefully and hanging on every word I said. "She is doing well today and you are welcome to go and visit her."

"So, when will she be able to leave the hospital?"

Good question, I thought, I have no idea either. "When the doctors feel she is strong enough."

"So we are just waiting for her to get strong enough, and then she can leave?"

Yes, if she doesn't perforate and go septic... or lose her bowel function entirely and need major abdominal surgery to create an ileostomy... and if that surgery doesn't develop complications too--
"Pretty much. She should be discharged then."

"Okay, thank you." She smiled at me, and I smiled weakly back at her as she walked into the room and gave Mary a big hug.

I let out a huge exhale. My heart was pounding. They never taught us how to deal with that in school...

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?"