Good morning!
I'd like to take a break from the themes as of late, and take you on a walk with me--virtually--with my work.
The surge hasn't hit, yet. ICU isn't overflowing. Our routines are a little different, and since we aren't supposed to talk to you about anything and people are watching, I'd like to share with you about what our routines normally are. Add to this a little about hospitals in general so you can recognize and understand what it what.
And let me tell you, this photo above is a whopping bunch of no-no's in it. It takes years of training to learn. I started with a lecture from a nurse as a third-year medical student, just an informal one in the O.R. at UCSD. But what she said was true, and I've followed her directions for many years ever since.
This is a gurney. It is a nice gurney. A gurney is a bed you lay on that's kind of temporary. Maybe in pre-op or recovery room. Possibly in the Emergency Room. This one is adjustable at the head, some are at the knees too. And the padding is thick. I've slept on these in the recovery room when I've been on call.
This is an ICU room and bed. Usually the beds are a little higher quality and have advanced technology in them for example, to weigh the patient in it, or to alarm if the patient tries to get out of the bed. Here you can see the continuous monitor as a black square, and this has a shadow screen at the front desk with the same readings. This way someone is always looking at your EKG and knows when you are in trouble.
Just below it is the ventilator. This one isn't like my anesthesia one, although my anesthesia machine has a ventilator in it. The hoses are on that bendy arm which connect to the patient's breathing tube.
Waste gases--exhaled from the patient--don't go to a scavenging system like in my O.R. So a room like this is very concentrated with infectious agents.
On the i.v. poles are pumps. These we use to run infusions of 'pressers'--very strong medicines which help raise the blood pressure and cardiac output when people are very sick. As a rule of thumb, the more 'drips' (pumps on poles) the sicker the patient.
With the ventilator, a last ditch resort with ARDS is to flip the patient prone--on their stomach--and after that severe respiratory failure, the only last option is to go on the heart-lung machine like cardiac bypass the perfusionist runs in the heart room during surgery. We call that one when it's outside the heart room, ECMO (extracorporeal membrane oxygenation).
ICU takes care of very sick patients, and are just next to the O.R. in understanding contamination and sterile technique. Here is a video to give you an idea of the kind of training and 'surgical consciousness' you need to work with wounds and not contaminate them:
See how the surgeon or scrub tech rinses the soap off so the hand is above the elbow and gravity washes the water down the arm away from the hand?
This is the kind of training that is drilled into you and you follow the rest of your career. It takes a lot of detail, and wanting to learn and to excel at this. The little picky details can escape someone who isn't really interested or is tired or has their mind on other things.
This is a hospital bed. You can stay in one of these for days, and it's okay, as long as you turn from side to side a lot in it. There's risk of bedsores but much less than a gurney.
Often there's a buzzer button to ring the nurse draped on the side of it too.
Sometimes even in the best of times, it takes a long time for a nurse to come when you ring it.
So an upgrade in our current way is to have cameras in each room, and a monitor watcher at the desk, to watch if anyone has anything happen to them. It's an old technology used for neurosurgical wards for the epilepsy patients, just changed a little to keep up with the times.
The responsibility on this nurse or watcher at the screens is HIGH. You can't turn away for a minute. And if a patient falls while it's on your watch, that's really bad for you.
This is the surgical technologist, or 'scrub tech' or 'scrub nurse' because in the old days nurses used to do that. Loretta Swit's character, Hot Lips Hoolihan in MASH was one of those. People in this job call the shots for sterility and sterile technique. They are the ones who make sure everyone is following the rules, and when there's a break in the rules, they speak up and make sure it's fixed.
If you were worried about a pandemic, something very infectious, this person would have the best ability to instruct others on how to keep contamination at a minimum.
However, you would have to balance that risk with their personal health status, as well as the risk of them not being fresh and ready for their role in the operating room.
This white thing is a gauze sponge. It's made of cotton. Scrub techs and nurses count all of the packages before surgery, in the middle of surgery and make sure at the end all of them are outside the patient. If one is left in, terrible infection happens because even though it's sterile the body will think it is an invader and try to get rid of it. This is why someone will lose their job as a scrub tech if the counts are wrong and anything is left inside a patient.
This is a horrible gurney. It's painful for me to look at. I think perhaps when I was in high school they looked like this but not any more. These hallways remind me a little of the hospital footage I've seen from Wuhan. The important thing is when the regular care areas are overwhelmed patient care will take place here. And in Italy, I've seen patient beds lined up even outside the hospital--not even in a tent.
This is why I'd like you to understand a little bit about sterile technique and contamination. Just the basics of the hospital. It might be just you in there or if you are lucky, you and a loved one, and you need to be able to speak up to protect yourself.
This is what it looks like when it's done right--mask already on, gown totally sterile in the front (masks are not sterile), and the cuff of the glove completely covering the cuff of the gown, and overlapping it.
The O.R. is a special place and a lot of us consider the people who work here to be family.
We know how to protect one another and protect the patient and insert portacaths like this in a way that the infection rate is low. They can stay inside the cancer patient for chemotherapy administration to go through it, for a long time.
From the inside they all look more or less like this, with the exception that this one looks like it's just been through the Joint Commission inspection, because there's hardly any equipment in the halls!
Yesterday I worked. There were free sandwiches and salads for the teams. I took one but didn't eat. I went through the whole day in my itchy and hot protective gear. I need glasses to read, and my goggles hiked them up just enough that it was hard to see out the bottom of my eyes, it wasn't clear. And the shield over the goggles gave me lots of glare with the computer.
I would have liked a PAPR, but there's only one assigned to the unit, and my colleagues always take them first. It looks like I'm going to have to fight to get one for me--for every shift. Then I can see with my glasses. Number one guy took ours, number two made the O.R. borrow one from somewhere else for him, and I had all the layers but my neck was exposed.
It's so much more stressful for me. You know when you go to the grocery store how you're not sure if you touch your face you're gonna die? It's like that and more for me at work.
I know in our Operating Room which rooms share the ventilation system.
They have designated five of our rooms to convert to ICU patients. GI lab is in one of our rooms now because their area is converted or soon to convert to ICU. We are fortunate that anesthesia machine ventilators have the waste gas blow out up and over the top of the hospital. But the break room? With the workers not so used to ICU or ICU RN's in there, how will there be prevention of cross contamination outside the rooms?
I've heard stories, I won't share them, but I'm thankful my friend in China has advised me on how to protect myself.
Anthony has had a bad cough and sore throat, but didn't tell me. He's had aching muscles. I do too. I feel hot. I'll need to tell my boss because like this I won't be admitted to the front door for work, the screeners will block me. I think we are going to have to quarantine for fourteen days, and hopefully, we will be okay.
My guides told me to relax, and just be in love energy. It is the most protective. Ross told us to drink as many different kinds of tea as possible today, to keep something warm always flowing. I just gargled with hydrogen peroxide, it didn't help. If you wouldn't mind sending us Reiki, I would appreciate it. We have been sick so much, for so long, from my pneumonia last year to all of these viruses and Anthony's RSV where I took him to the ER...I don't know how much longer I can handle it with these lungs of ours. My favorite Gastroenterologist, I saw the name on the ER roster. It's starting to affect us more here at the hospital. I think about my life, and I hope I've done a good job at what I was sent to do. There's so much more I would like to do. I've heard that the combination of azithromycin, plaque nil, and tamaflu got someone -- a doc--who was really sick better in one day.
Time for tea, and for enjoying being home.
Ross wants me to write about the mass meditation. I was told that if that's what it takes for people to feel like they are helping, then let them do it. Lots has been going on behind the scenes for years--I've seen and I KNOW the Galactic Central Sun. Gaia is connected to Spirit. And before any of this meditation began, perhaps a little before 4/4 for the international date line, communications were sent, Gaia signaled she's ready, and whatever else happens is outside of her control. She doesn't feel anything. Nothing at the moment, not even a blip. So perhaps it's something more to do with the people than the planet. We'll never know until all the truth comes out in the end.
I don't know why but I just don't trust Cob-Br-uh. And here is the new Gaia Portal which correlates with it. They used to follow me and everything I did--that's how I knew they were legit. But I don't feel like this has much to do with me, so it makes me sad. I remember being a bride, and on my wedding day, feeling very lonely, as if the world was far more concerned about themselves as guests, than about me. It's like that, how I feel, and I guess the only way to get through this is to give thanks for the brave soldiers (we had three earthquakes last night near Palm Springs--tunnels, right?) and the brave angels who are taking Gaia home.
Until then, we wish you our best, and I just remembered Ross wants us to have honey with our tea.
clap! clap!
Aloha and Mahalos,
Namaste,
Peace,
Ross and Carla
The Couple who love EVERYONE
