Last Clinicals

Nine weeks left of classes. And clinicals. I don't think I will have to persuade anyone who has donned the purple scrubs and big white shoes to come to a scrub burning party on December 10th, but I have to admit, I've done some pretty good things in that blaspheme of a nursing outfit.

This semester, I have Saturday clinicals in a transplant center. Most of it has been spent in the ICU, with one patient assignment. Over and over, I am amazed at how it is possible to stay busier with one patient there than 3 or 4 patients out on the floor. The patients with new transplants have lists of medications that go on by the pages, many of which are entirely unfamiliar to me, so preparing and giving meds alone can take me a good part of the day. Vital signs are every two hours and nursing notes every hour, which adds up. Drainage tubes. The Jackson-Pratt, I love. It's like the turkey baster, the way you empty out the drainage and then squeeze it before reattaching so that it continues to suck out the...juices. I'm still a little frightened by T-tubes though. Two weeks ago one got detached and all the bile spilled on my patient's bed and gown and I thought she had exploded until I found the source of the brownish yellow liquid. Sutures and staples are not so scarey of anymore, which is good because the usual surgical procedure of a transplant is to cut in a pattern that looks like a giant Mercedes emblem without the circle around it. They even call it a Mercedes suture line. It must turn into a very impressive scar.

And that's the nice thing about the transplant ICU. Patients usually come in jaundiced and delerious and leave with a new liver and a cool scar. The outcome isn't always positive; sometimes an organ isn't available and they die waiting. It's really an amazing priviledge to work with several of the 6 ot 7 thousand yearly liver transplant patients in the U.S. And in purple scrubs too. I just looked it up, and there are roughly 18,000 people waiting for a liver transplant in the U.S. right now. Moral: hepatitis C is a big problem. And don't become an alcoholic either.