i am a shell

I am a shell. From me you shall not hear

A strident voice, fierce and clear,

Hanging in the air once I’ve spoken.

My timbre is the merest token

Of tones light, barren, scrubbed clean.

I am not heavy with authority—

I am a whisper. No sonorous tones, mine.

My voice far too rapidly declines,

Drifting among the stones of the shore

Until it fades. There is no more

Except as the beats of the seas endure,

So shall my echoing song waft pure.

As suffering of the waves resides in me,

My hollows roar dimly with the passion of the sea.

something completely different

I’ve been intending to update for awhile, but haven’t. Sorry.

I’ve been depressed. I’m not talking about the kind of depression where you’re bored and vaguely dissatisfied. I’m talking about the kind where you can’t sleep, where you lose all interest in the things you love, where people you don’t even know can tell something is wrong. The kind where you break down sobbing while buying dinner for your family and the person at the checkout line calls 911 because she doesn’t know what else to do.

I was sleeping a few hours a night–broken, fitful sleep–waking to the same dream over and over. My mind couldn’t lay it down. I was carrying the problem with me everywhere I went.

The problem. It wasn’t a problem. It was a person.

I can’t tell you her name, or even promise the person is a she, because of the privacy restrictions we work under as medical professionals. But I wrote a thing about her, a thing I can’t share yet, and the writing did not have the effect I anticipated.

I thought it would be cathartic. I thought it would be like burning a memory, transferring the hurt to ash to be carried away by the wind. Instead the writing ensured that her name is burned on my heart.

So I don’t give two figs for the concept of preload. I have half an article written on something else and I simply cannot make myself write it. I do not care. The only thing I care about is finding some way to honor her memory. To do right by her and thousands like her.

Her memory haunts me. When I go to bed at night. When I rise in the morning. When I go throughout my day. She’s right there, at my shoulder, as I work and I think and I write and I start IVs. I missed two shifts on different floors because my mind is consumed with her.

If this story resonates with you, please–seek help. Find someone who can understand. Talk to them. Tell them your story. Don’t try to bear it alone. The weight can crush you, and you matter too much for that to happen.

 

breathe in, breathe out

We measure all hemodynamic variables (CVP, PAs, PAWP, CO/CI) at end-expiration, because exhalation is usually the longest period of the respiratory cycle. Inhalation increases systemic venous return, but also decreases pulmonary venous return, which in turn decreases flow to the left side of the heart.

Here is that mechanism at work with bolus thermodilution:

IMG_3191

This image demonstrates the high degree of variability from respiratory artifact. Trials 1, 3, 5 were performed at end-exhalation. Trials 2, 4, 6 were performed during inhalation.

feedback

I had some feedback from nurses on my home unit—I need to put together a critical-care basics course to teach some things we all had in human physiology or pharmacology, but have forgotten. For those new to critical care, I offer this as explanation:

There is an assumed body of knowledge within the ICU, an unspoken tradition of ways and means and facts. Some standard acute-care traditions: full moons mean a busy night, always draw a type & screen and make a patient NPO if surgery has been scheduled for the morning, give the meds scheduled for 8, 9, and 10 all at 9, always hang the fastest-infusing antibiotic first.

In the ICU we have our traditions, too. Traditions like always know who’s on call for all the specialties (determines whether you call or wait), when you get report on a post-surgical patient always ask who ran the gas (will you need to have fluids hanging to infuse or will you have time to prime), weebles wobble but they don’t fall down (#teamneuro).

Respond in the comments, either on Facebook or A Tangled Web. What’s basic knowledge to you? What do you need to remind you of the basics?