RAMBLINGS OF A MIND UNTAMED

Haven't written in so long in here (or so it feels like, but it's realistically been less than a month) so I'm at odds at where to start. Too many things to say but which first?

The last women at SSH
I hate when they change the allocation. This is my new pet peve. Forget double admissions, forget double discharges. Forget both a double discharge followed by a double admission. I truely truely hate when they just change the allocation over and over again in one shift.

I started the morning at bloody 6am because I was an idiot who in my non wisdom decided to try and see if that would be better, because who has anything to do at 6am? No one. So starting earlier might be better because its not like I could go to an excersize class before work anyway. No it's not better, its crappy.

Anyways. So I rock up - and get given a GDM lady who was stated to be on 14 U insulin but when I quesioned her properly actually she was on 18 units novorapid 3x a day. Only novorapid, and no protophane and generally normal fasting results. And the carb amounts she said she was eating sounded fairly reasonable. I wonder how much she had to change her lifestyle to achieve that. But no protophane also makes me suspicious, its like .. how are your fasting levels normal? anyways. What ever she's on a butt load of insulin.

And no canulas in, and nothing charted from the doctors, and they called this poor lady in at 1am to like, get started. And now its 6am and we've just done and admission CTG and twiddled our thumbs/been busy with other cases- oh and by the by she's a p0 and didn't have a foleys because "she didn't need one".

Really? We've been doing foleys on p5s so... anyways -- later on in the day, I found out that yeah she didn't need one. What do you know aye?

30 mins later they decide to change the allocation - and decide first to put me on the c -section list. I hand over. But just after handover, the allocation changes again and t I'm given a postnate to take - for now- and then be on standby for whatever is next.

The c-section list can be done by just 1 person today, they'll just not do skin to skin. We are not a baby breastfeeding friendly hospital. And it shows. Like at another larger hospital down the road which is - they have 2 x dedicated skin to skin midwives. I think we used to have that but then due to funding and I'm not sure what else, they have been cut and I haven't seen them replaced by anyone.

Anyways so then I help this P2 now, very large lady, who doesn't want to breast feed (her first was a preterm and she formula fed that one) formula feed her 2nd baby. Man that kid chugged down 20mls of formula like next to nobody at 7am. It's like people don't realise how newborns need to be paced. I forgot to tell her to switch arms mid feed to help brain development, so what you could do is like say if its a 20mls feed, 10 mls on one side, then swap and then give them 10mls on the other side.

Like yeah its a chunky baby but on the centile chart he was really normal -- like 85th or something centile. And her BGL results did not show any GDM despite being a BMI of 50 or something. Some people just don't get GDM. They must have ridiculously strong pancreases. Or ridiculously beautiful insulin. Who knows.

This baby also had a large mark on its head from the FSE. Poor baby. Was it hard to screw in? Probably... (likely due to body habitus as they say).

Anyways.

Then I'm informed to start up another induction. Its a nurse from cardiology with a sister from ED at the other hospital I work at in ICU - shes for an IOL for decreased fetal movt. 3rd presentation. Its 40 weeks, and she's clearly anxious. I do the VE - and the head of the baby is super flush and I have no bag to break. I'm like shit what do I do. I try poking around further up - and there's just nothing. I didn't try to tip the head out of the pelvis as everyone I consulted afterwards was asking me if I did do, but in all my poking about i think basically that is the gist of what I was sorta doing - but I'll know for next time. I pestered the in-charge and she came and repeated the VE and got ... the same result. But she somehow managed to scrape something and we started the induction. Cept even 2 hours later there was barely any water coming, and the contractions were still like tightenings.

I handed over around 14:00

I managed 1 proper break, but having my work squared away (notes and all, the postpartum lady needed her paperwork done so that took some time also, and the baby needed a cap gas etc)is worth more than a full lunch break and I managed to leave just on time - because I re mentioned to the incharge that I was a 6am starter, like ya know, remember me I was here early...

anyway.

That was Tuesday.

Childcare
Is closing fully next week. It was a bit of a shock coming in this week and finding all the cupboards bare in the office. All those piles and piles and folders of paper, all had been recycled weeks ago - their metalic clips taken out.

As much as I am sad the community is getting broken up, it is good that everything is getting a good clear out. There are toys in there from god knows when and just -- some stuff is just old. It's a problem with staying in one place for any length of time. Like my house, having lived in here for 8 years. Sometimes I just want to "move" so that I can be forced to get rid of things. Like just to experience the "empty".

Not sure which staff are staying - 2 are said to be staying, but they gotta staff the new place that's moving in, right. And which kids are staying, there are some. So clearly there are potentially a bunch of new kids coming in, right? I wonder if for the first few weeks it'll be like. Dead zone. Or if they actually have arranged for more kids to start up, and more staff. I literally haven't seen any new people or kids looking to tour the place or whatever. When I was paying the deposit and talking to the new managers - they did say like I could delay paying, until it was all like. sorted and then come in and tour. But like then I feared loosing the spot. Like even though I don't know the new staff, I'm weirdly attached to the building and I had barely looked around at any other childcares -- I had my eye on one other place, and I've booked it for May may , but that's about it really.


Besides in 1 year, Wenderpoos will go to her public school full time so really, she won't need childcare anymore. So I just need to fill in the gap.
I don't know why I'm holding onto the old place. I wasn't ready to quit I think, is the reason, like I haven't got a clear plan of exactly what I need and when I need it. I'm not very good at planning. And the fridge and pantry show's it. Well. Pete helped me clean the fridge yesterday so that's currently okay but the freezer is literally a nightmare of wtf. It's seriously gotta get cleared out this weekend. Gotta let things goooo or make something out of what is in there.

It's the end of the year. End of 2025. The radio is starting to do those year in review clips again and that's nostalgic.

May may is still a veggie baby. Yesterday I put some over cooked cauliflower down on the table thinking its a chance in hell anyone besides me is going to eat it, I gave a piece to wendy telling her its a "snow tree" she looked at me like I'm an idiot and May2 grabbed piece by piece and literally chugged them down like her life depended on them. I was trying to get her to try a piece of really nicely cooked beef mince patty I made, and she kept batting my hand away and getting angry. 10 mins later after I smushed some into her face she cottoned on to the fact that beef mince tastes amazing and she had a few bites but she was already pretty full from the cauliflower.

She is my veggie girl born of the genes of her old grandmother. It makes me wonder about all those kids they say "don't eat vegetables" like, I'm fully waiting for the day she turns around and says nope I only eat fruit or whatever - cause that's defiantly a thing that happens, but so far, she's just so into her vegetables,... like some people just never give their kids the chance. They don't like eating boiled cauliflower so why would they buy it and cook it and serve it. So how do they know their kid doesn't eat it... Because maybe they do? Lols. So you can't say your kid doesn't eat vegetables.. cause I never thought May2 would be such a veggie eater. Cept she always from day one took a full liking to roasted vegetables.

Wendy dresses herself from head to toe. She might need a little bit of help but now she gets mad if you do help her and she hadn't asked for it. Sometimes she's too tired to do it and just says she can't. But for the most part, after I told her she has to dress herself so she can go to preschool, cause otherwise they'll send her back home -- she's gone on and done it. For example today May2 wanted boobs and we needed to get out the door, I used that time to Get wendy to go choose her clothes, and she put them on in front of me while the already dressed May2 had her favourite drink of the year (still nen nen). And after a wardrobe change for May2 since Wendy picked a dress for which I had 1 same for May2 - we were off. Into the rain, in raincoats for the girls and none for me because I was expecting light rain. Wendy refused the larger raincoat which was new, preferring her older one. So May2 went in size 5 (lol) it was ridiculously large.

Christine one of the lovely educators who always loves to chat (and is looking to get out of childcare) had to help me tempt May2 with another toy called puppy at school to take off her new giant coat.

She's a spicy one May2 is. She knows what she wants and she's reluctant to let go. Not as Easy breezy as Wendy whom you can bend with some simple words.

Although re: food, May2 is the easier one. Eats most, eats veg. if you think she won't eat just put some steamed vegetables in front of her.

Also I think May2 has flat feet like mine. And Wendy doesn't. May2 has the chubby feet that doesn't fit in some of Wendy's old clarks. I thought maybe its because they sorta shrank in the washing machine but I think no, her feet are defiantly fatter. And when they print you can already see there isn't an arch.

MMH
I'm not on leave this week but I've only got one shift in ICU so it feels like I am on annual leave. I guess it's the calm before the storm of no childcare, and Christmas. We agreed to host a cousins sleep over at our house on Christmas night, heaven help us. lol It'll be ok I think. The parents are dashing off to play their magic the gathering and somehow we will put the unruly mob all into Wendy's room. May2 can sleep with us in a port-a-cot and Nonnie will be around to help out.

My last patient in ICU was ... a man who had a liver transplant 6 months ago but hasn't been able to leave the hospital due to complications on and off. And just as he was turning the corner upstairs to look at rehab he went into APO on the wards and landed in ICU, ventilated and the lot- back on dialysis.

I managed to keep his dialysis machine happy by the skin of my teeth overnight, changing all the bags. Tending to the alarms.

And then came 8am and I did the walk home only to realise about 25% of the way home I had taken my bag but not my handbag home.

I have one more shift on Sunday night so I will once again lead a double life, of stuff on Sunday but then stuff on Monday. I tried to book an extra day of childcare on the Monday thinking it would be nice to have one more day at the old place only to be told by the manager than sorry, they reduced staff for the last week and the accountant had squared everything away so no extra days allowed. Oh boo hoo. It is what it is...

Things come to an abrupt end and that's life.

Here is your parental crisis for the week.

You went out to a really nice rock crevice mountain pool location - and when you left, the last time you saw your cat who lives mostly indoors was at the front door, and when you were leaving the neighbor came with his rabbit to say hello to the kids, and then you didn't see the cat again. Waste approx 10 mins looking for said cat who had already been fed. But to think this could go all of 2 ways:
keep searching and not find her even though shes in a perfectly fine location somewhere in the house.
or. just leave and hope she sorts herself out.

I picked no.2 and made sure there was fresh water available outside because
- it was due to be 38 degrees that day also.

So here I am driving off worrying about the cat and then the car has auto brake holder decided to stop working.

We manage the 50 or so km there without it hoping it'll turn back on - on the way home - (which it did. Scary kinda but there is also the manual handbreak which: IS A BUTTON)

Had a fine time at the pool worrying about the cat a little -- to then arrive home with Wendy not having peed in the pool (sighs. its a natural pool and there are no toilets but I guess once you train them not to pee in the swimming pool its hard to backtrack that) having slept in the car. Meanwhile No2. hadn't slept the whole way babbling off to herself (strangely) - to then when Im removing her from the seat, realise she'd pooped through the nappy and since I was an idiot and didn't put her in pants - the poop went to the seat and onto the seat belts and now my hand was in it.

To then also realise we were all locked out of the house and i had roughly 40 mins to get down to Wendy's future potential school (and definate preschool) for a parent meeting.

Luckily theres a front yard tap where I could wash my hand. Left poor Aunty sally at the front of the house with the poo baby and Wendy who was half asleep - then starts peeing on the front porch -
while I go to the back of the house and figure out how to climb over the fence (which is about 2m in height. To do that you need to climb onto a bin and then over the roof of this makeshift bin shed we have.

I'd done it before but not for 2 years. and I'm fatter and way more cumbersome now, so I manage but not without a minor fall. Second of the day (the first one was tumbling off the front porch ... which was okay too somehow.

Then I opened the door, to a wet Wendy and a poo soaked baby - left the car to be cleaned later(and I kept seeing roaches walk around the car too which was frustrating cause lack of time to fix it - yes I've cleaned it with a vaccume recently - thats when i saw the roaches but then you need to go get the roach stuff - and online doesn't have all the info you want. I just need to get to the store and see what they have for myself...


Anyway. So. Today is fixit day. clean the car etc. Put the roach killer stuff into the car. Get on top of laundry ...

speaking of laundry...

(24.09.20)
Never too late to return to an old friend.

Journals are like best friends who never grow old, never married or have children, never have careers with commanding time, energy, space.

Like gold they hold their value. Waiting for your return.

This journal has chronicled my senior high school years, my university years. Then my journey to professional HCP, The beginnings of new grad, and then radio silence.

Let's pick up the story.
There's 8 years worth to tell.

In the spirit of confidentiality:

MICH major inner city hospital
MSH major suburban hospital
SSH small suburban hospital

sections inside MICH:
small ICU [where I currently work]
big ICU
neuro ICU (where I worked blissfully from 2015-2019)
cardiac ICU
covid ICU (actually no longer open because Australia is an island and a very wealthy nation).

Running list of frequent acronyms I will use

NVB - normal vaginal birth
G - Gravida (how many pregnancies in total: which includes miscarriages, stillbirths, neonatal deaths)
P - parity (how many babies born)
IOL - induction of labour
pt - patient
ICU - intensive care unit
Em cs - emergency cesarean
El cs elective cesarean
LSCS - lower segment cesarian section
GDM Diet - gestational diabetes diet controlled
LGA - large for gestational age
SGA - small for gestational age
ART line - arterial line
MAP - mean arterial pressure
Mec - meconium stained liquor
VE - vaginal exam
OT- operating theater

What values do you consider most important in life (honesty, justice, altruism, loyalty, etc.)? How do your actions align with those values?

Thought I'd start with a big one.

Functionality over beauty.

Why would you want to put lipstick on a pig. Just plastic surgery, the removal of our identities to all look like barbie dolls on the outside. when really we could be using the money for, our own financial security : hey the pension might not be there for you ladies, for the betterment of our society -- or even just for the genuine pleasure of travel or relaxation (like massages or, gym memberships, or even brunch with your mates). Like i'm not against ... feeling good about yourself- but feeling good shouldn't come from a need to buy makeup to put paint on your face, to like hide your true appearance. Your friends should love you for you. Your colleagues should admire you for how well you do your work and help out and comeserate in bad times. Not because you have 1 less foreheadline on your forehead.

Like what are we as a society when we can't just look like how we look the way nature intended?
Botox for migranes or contractures, totally understandable.
But a wrinkle isn't going to ruin your ability to work or have fun.
like come on.
Who are we kidding here? That we aren't all getting older?

Like sure. Special occasion comes up, someones getting married, put on some lipstick and foundation and get your hair done at the hairdresser. Or hey starring in a movie, like I get it.

But in the every day doldrums of life, the just going to the shops or writing a novel or taking the kids to school or whatever you do. Just, Lets be real people.

This is what makes us human I suppose, as opposed to being primitive animals in the bushes but we are literally killing ourselves for the superficial nature of it all.

What elderly person ever says "I wish i had gone to the hairdresser more and used more make up when I was younger" or "I wish I had gotten botox and some liposuction like, 50 years ago."

Said no one ever, and you'd have to think why. Because when your on your death bed your going to be wishing you climbed that mountain or went on that holiday with your mates, Not.... .... buying that bag that cost $7grand yesterday and oh now it's gone up in price cause some very clever person is trying to take advantage of our weakness as humans to value what other people covet. We should be valuing substance instead of superficiality.

Loss of filter
Do we loose our filters as we age? My mother must be so used to just being at home alone, that she just can't stop herself picking her own nose in front of her own grand children who now, also just sit there doing the same.

Sighs. The price of free childcare.

Considering what they charge for a meal outside at a resteraunt, childcare seems cheap in my opinion in comparison.

Today's patient
I drew the lucky straw having the morning shift. The pt family who was described to me as "intense", were planning to come for a family meeting at 1pm which as usual always means they start trickling in around 12:40pm.

The family, was so large (only 1/3rd arrived) ish and they had to open up the education room which is 3x the size of any of the family rooms available.

lolz. I was late to the meeting and the poor social worker is so young and just, inexperienced - that I only found them because I bumped into her in the hallway looking for tissue boxes and she said "the doctor doesn't seem like he's doing a very good job of selling what was happening" but when I went in, it really sounded like a very reasonable and normal conversation that is often had, and was being done well. From what I've seen before - and there's quite a variety in how they all like to do it. This consultant was taking the Dr W approach. He was saying this is what we should do (Extubate) and its unreasonable for me to ask you to decide about what we should do, but I would like to inform you of what will happen after it happens. And that keeping him on a ventilator (the patient, that is) is really doing a disservice to his progression. It will make him get slowly with time more weak and then dependent on the machine, While if we remove it now we can see if he can get better on his own (unlikely but not impossible) or if he will at some point pass away - of which we cannot tell when this will be.

It's a ?lebanese muslim family and so I thought they held it all remarkably well. I probably missed the worst part of the meeting and so here I am unfairly judging the social worker as inexperienced. Although she does look all of 21. Maybe 25. But I'd doubt she'd be older.

I was trying to explain it to her earlier. That you know- he's a strong looking guy - he might do just fine off a ventilator. Like maybe not. But maybe yes. Although in hindsight like he was on 18 of single strength norad and frequently apnoea alarming lol. But he did responde when I told him to breathe.

They wanted the 2nd book in the quran played over and over again - and I was so bored , and slightly curious so I looked it up. It's basically a longish text (the thing took youtube 1.5 hours to read out to this poor man) and one of the main stories is that about a cow, -- Here is my 1 min summary from a 2 min time I had to read--

There was a bunch of people, and they were told to kill a particular cow, and they laughed at the man that told them to do it - but they did it anyway, they had to discover this cow - and then they took a peice of it and touched a dead man and he came back to life and said who his murderer was.

And this was meant to be some sort of display to show that God is like, mysterious and we shouldn't question what he wants us to do or something.

I was Haram and played some coldplay to the poor man inbetween the quran stuff because I was literally falling asleep with the lulling quality of the chanting. Surely it cannot be a sin to take a break? Who knows. Terrible I am.

When i left he had a Sp02 of 100% on 40% FiO2 via HFNP but his noradrenaline requirement was up to 25 and they restarted argipressin. I think they need to put a ceiling on the noradrenaline. He's going to max out at some point. He looked crap and I don't think he would have made it much more past the night.


I also rushed my handover to the next staff cause I was hoping to make the family meeting. She was mildly late because of parking. One of the super oldie staffers who lately, started to get a tremmor in her head and hands so I wonder how long until she can't work clinically anymore. She's lovely though.