1930 hours - I have two patients, one who is on a ventilator and will probably be bleeding all night since a drug she has been taking for migraines (methotrexate) has eliminated more than her headaches… it has eliminated the ability of her blood to clot. Oh, and her mouth is filled with packing material. My other patient weighs about 300 pounds, has pneumonia and is in the second stage of lung cancer. How in the world am I going to turn her over?  I should tell you that despite my height (very tall), I weigh slightly more than 100-pounds.  I also have wires in my neck (no, you can't see them) that connect a pacemaker to my brain.  These wires are not industrial grade…they can snap.  This would not be a good thing for me, my patient or my famous neurosurgeon, who happens to resemble a black panther.  I will deal with this issue later.  I have work to do.
 
1945 hours - I review the computerized Order Checklists to make sure what medications are due at 10 p.m.

1950 hours - A family member asks for coffee. This is not a big deal except that walking with a steady, even gait is not my strong suit.  With a rather interesting weave (not ever to be confused with a runway model stroll), I deliver hot coffee.  No spills, no burns, no thanks.

2030 hours - I stop in to see patient #1. The oral packing is bloody. The bed is bloody.  It's time to call the Ear, Nose and Throat (ENT) residents. Her platelet count is only seven. Luckily, she is sedated (with IV Versed and IV Fentanyl) and her vital signs are holding steady.

2050 hours- I see patient #2 and hear gurgling sounds. She is not gargling Listerine. This is not good.
You do not have to be a medical whiz to know that this is not a good noise.  Should you have a medical background, you might recognize the sound as a signal that there's water in the lungs.  I call it a "wet" sound and since this patient has also refrained from urinating for most of the day, I'm betting that she will be much, much happier if I suction her.  I do.  She is…and I even hear a faint, "Thank you."  I like this lady (but please, please don't fall on the floor). 
 
2100 hours - The ENT residents have ordered platelets for patient #1. Does that mean that I get them ASAP?  No.  That means I now have to call the blood bank and grovel. "I need them in a hurry." Translation to their reply of "Yeah, yeah" (and in a Jamaican accent it sounds like "Ya-di-dah"): "You'll get them when I get to you on my list of things-to-do, people-to-see and dinner-to-order."  Am I happy?  No.  Is this stressful?  Yes. Does this make my straight hair curl and my dystonia symptoms go away?  Guess?

2130 hours- I have got to work on my begging and pleading skills. They do not teach this in nursing school. The platelets have yet to be delivered and no one has even called from the blood bank to say "Come and get them" or even more unlikely, "We're on our way." So, I call them again.  Were they (a) Delayed or (b) Forgotten?  My hunch is that the order was still sitting on the "to do" pile.

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