12 Days of Christmas

I completed the song with a minor adjustment:

On the first day of Christmas my charge nurse gave to me:
12 cancer patients
11 septic grandmas
10 alcoholics
9 with pneumonia
8 end stage livers
7 renal failures
6 GI bleeds
5 on CRRT !!
4 trauma patients
3 guys on vents
2 ODs
and the bastard with DTs !

Who decides?

So we have a 40-year-old male in our unit right now who is homeless and was found in a gas station bathroom after an overdose. He was brought to our unit with a GCS of 3. Currently there is decerebrate posturing. EEG shows anoxic brain injury. He is on the vent, overbreathing the rate by about 2-4 breaths per minute. Apparently, he has no family. He is "brain storming" and has seizure-like movements like I've seen with anoxia. So who makes the decisions for this patient? Our attending wants to trach and PEG him, which a lot of the staff feels is inappropriate. The ethics committee is looking for a conservator through the courts, but we aren't sure how long that will take. Who decides whether to trach or PEG this patient? The PICC RNs won't put in a line because there is nobody to consent and he is not critical enough for a doctor emergency consent. Situations like this make my job in the ICU very difficult. What is done at other hospitals? What kind of quality of life will he have with a trach, PEG, and vent dependence? Please share your opinions.

ICU Christmas song

To illustrate a typical week in our unit...

On the first day of Christmas my charge nurse gave to me...
5 GI bleeds !
4 trauma patients
3 guys on vents
2 ODs
and the bastard with DTs !

Sound familiar to anyone?!

For starters

I'm new to the world of blogs but saw an article about emergiblog.com and thought it was a great idea - thanks Kim! Nursing is a great career - it can make you laugh or cry, make you humble, or bring out the advocate inside you never knew was there. I was always a quiet, reserved person until I became a nurse and had to advocate for my first patient - assertiveness is essential. As nurses we have days where we just can't wind down and feel the urge to share - thus comes this blog, to which I hope nurses, students, and medical professionals everywhere will read and contribute. I welcome anyone to share their experiences - we can all learn from each other.