Since They Don't Pay Me to Watch Movies....

great day at work. i've been really enjoying it lately. i'm attempting to be more useful by learning some new stuff.

i'm now doing feeding tube placements where, for patients who are unable to eat, we place a long thin tube down the nose, through the esophagus and the stomach and with a GPS-like tracking device, we aim to get the tip into the small intestine. although we are using numbing lubricant, this is about as unpleasant as it sounds and often results in bloody noses and patients gagging and cursing us the whole while. it's hard to do (i didn't go into this to torture people, i swear!) but by the time they order this tube, these patients are often wasting away and desperately need the nutrition. that's what we try to remember...although i was helping with one a while ago and the patient (in a thick eastern block accent) kept asking us "what deed i ahver do toh yoh?" good question, buddy.

..also i'm learning (finally, again) to do peripherally inserted central catheters which is an IV line placed in an upper arm vein that tracks to larger and larger veins up the arm and finally lands in one of the veins that feeds into the heart. we use PICC's for long-term antibiotics or for patients who will require IV access for a long time- things like TPN (total parenteral nutrition), etc. we use an ultrasound to find the veins and to watch our placement and then snake in a guide wire before placing the catheter in. it's pretty neat. we do it at bed side and we're able to get a lot done without much disruption to the patients. in interventional radiology when they do one they use sort of moving xray picture so they can see exactly where the tip of the wire is, if it coils, if it goes up the neck instead of down toward the heart, etc. we have to trust the fuzzy ultrasound and our "feel" that it's in the right place (obviously, must be able to draw blood from it and flush saline through it to show it's at least functional) and then we confirm which vein it's in by xray afterwards.

so even though it's february and OR case load is down, i've been staying busy and enjoying the new challenges.

and so far nobody at work in this weight loss competition has started a riot or anything, but i've been hearing a lot of grumbling. paczki day came and went and most people refrained with difficulty. my own weight loss efforts with this crazy diet are sort of meh. energy level still good, but i'm tired of all the food prep and some of the food still tastes like dirty cardboard. just a few more weeks until the half marathon, then we'll ease off a bit.

cheers!