A day in the life . . . .

This week is Diabetes Blog Week, the brainchild of Karen over at BitterSweet. Kicking off D-blog week is supposed to be a "day in the life" post relating to my diabetes and how it touches different parts of my day. And it will be. But 8 days out of every 14 are "weekend" days for me. Don't get too excited. . . because it means that I work 24 hour shifts for 3 days every 2 weeks and when I get home after this marathon-of-a-shift I'm exhausted and sleep the better part of the next day away. But it's a nice trade-off for having so many days off in-between.

Anyway, since my job as a Neonatal Nurse Practitioner is so unique (and is a job that tends to wreak havoc on my blood sugars) I decided to chronicle what an average day at work is like for me. Beware: This is loooooong. Because my shift is looooong. You have been warned.

5am - Hit snooze.

5:09am - Hit snooze and curse the alarm clock.

5:18am - Turn the alarm off, sit up in bed and seriously consider quitting my job. This is an un-Godly hour to be awake!

5:35am - Always in this order, I have peed, brushed my teeth, gotten dressed (thank God for scrubs), done my hair, tested my blood-sugar, kissed my husband goodbye and climbed in my car. Off to work in less than 20 minutes! Morning routine? Down to a science.

6am - After I'm on the road a little bit, I usually crack open my fiber bar. I have found that if I don't eat something before work (especially on my drive in) I'll crash half-way through morning rounds.

7:30am - After a 2-hour commute, I pull into my parking space at the hospital. I bring out my meter and test before going in. Usually I'm high 100s, low 200s. I used to have oatmeal before work but my Endo was convinced it was to blame for these spikes at the beginning of my day. Since switching to the fiber bar my spikes are lower (they used to be high 200s), but still there. Maybe it's the stress of the long shift ahead, or the irritation of morning traffic, who knows? I deliver whatever correction is needed, I pin my hair back (because I don't like driving with it up) and scroll through my pump menu screens in order to change my basal rate to the "work" basal program. It's on.

8am - I've finished getting report on the kiddos in the NICU. Usually I'm familiar enough with them that I just get the updates, but occasionally there will be new happenings or new admissions that I get the full scoop on. Once I'm up to date, I print out my census report (list of all my patients) and head over to the NICU to check labs, look at x-rays, examine my kids and determine what needs to be done for each one of my patients that day. (No, I'm not their mother. Yes, they are "my kids.")

10am - After gathering all my info for my kids, morning rounds with the attending physician usually starts around this time. Unless the attending is seeing his patients . . . . or is late to work, or busy with something else, or is cranky, or has just decided to do something different that day. Ya know. If the attending is ready to round, the practitioner team (myself and 1 other nurse practitioner that covers the more stable patients) work our way around the NICU with the attending, stopping at each bedside to discuss the patient, his/her progress, setbacks, labs, ventilator settings, etc. I review my plan for the day with him, ask his preferences on certain things and discuss options for our plan of care.

11am - Oh shit! My fluid orders are due by noon! Total parenteral nutrition (or TPN, an IV fluid that has electrolytes, sugar, protein, and fat) is given to infants who are unable to feed enterally (or via their stomach). A premature baby's intestines are also premature and often unable to digest food properly. As we slowly work up on enteral feeds, we give babies TPN so that they have the nutrition they need to grow in the meantime. What goes into each baby's TPN is calculated based on their lab results and clinical status and these orders need to be written by noon. Sharp. Gotta hustle.

12pm - After writing fluid orders and getting maybe one or two notes written, I'm freakin' starving! By this point my blood-sugar is usually low, usually 60s or 70s. Normally I don't feel too symptomatic. Again, I always plummet after getting to work. Used to blame the oatmeal for spiking me and them dropping me but obviously that's not it. So I grab the other practitioner I work with that day and we'll drop by the cafeteria, grab food, drag it back up the the call room and nosh on it while trading gossip and other fodder. (What? Like you don't do the same on your lunch break?)

1pm - Now the official note-writing begins. My LEAST favorite part of my job. Remember how I was talking about all the information I gathered earlier. Labs? Exam? Xrays? Plan of care? Orders? Yeah, well all that has to go into the daily progress note on each patient. Not. Fun.

3pm - Deliver printed and signed progress notes to each patient's bedside, check on them, see how they are doing, write any languishing orders and answer any questions that the nurse has about the baby.

3:30pm - About this time everyday starts the quiet time. The other practitioner on with me has usually finished her notes and orders and is ready to go home. She checks out to me and lets me know if there is anything I need to look out for with her kids. (Since she sees the less-sick babies, usually this isn't an issue.) Usually around this time, there is a lull. A peace. If any baby needs a procedure done, this is the time I have to do it. Place a PICC, adjust umbical lines, pull out central lines, do an arterial stick for labs, re-intubate, etc, etc. If there is nothing like this that needs doing, I can read my work email ::cough:: BLOGS ::cough::, watch TV in the call room, call Brad, or read a book. This time is my own. I might get paged for a delivery. Or if I'm feeling the need to cuddle a baby, I'll find a cute (stable) baby to hunker down with. (This is the BEST part of my job and makes me wonder how I could ever consider quitting!) Sometimes I go down to Labor and Delivery (L&D) to see what's on the board but usually that's just asking for trouble. So I stay away. Trust me . . . they'll call if they need me!

6pm - Usually it starts to pick up again about this time, the nurses are ready to change shifts and want to get everything squared away with their patients before handing them off to the night-shift. I'll get calls for orders, updates, etc. Occasionally a parent will stop by and I'll go into the unit to given them an update about how their baby is doing.

7pm - It's the nurses change of shift. Best advice I ever got? Eat dinner during change of shift. Then nobody will bother you! Brilliant. It took only once for me to test and bolus for dinner and get paged or called away for an emergency. Big-time low blood sugars and no dinner in my belly equals a serious bummer. So I eat when I can and hold bolusing until I'm finished or get called away. Amen.

8pm - The night-shift nurses are there, so I make the rounds to see who's on and usually end up answering more questions about the kiddos. Also, the attending down in the newborn nursery has gone home which means I have to attend all high-risk deliveries. If a baby arrives via C-section, if there is meconium-stained fluid (dangerous because it can lead to meconium aspiration syndrome), if a vacuum or forceps are required for delivery or (of course) if a baby is premature, I will get notified via my Nextel walky-talky-thingy . . .and I'm off.

FYI: The NICU is on the 6th floor. And L&D is on the 3rd floor. And hospital elevators are really slow. So 9 times out of 10, I end up flying down the stairs. And maybe you are wondering why I get low at work? Hmmmmm. . . .

10pm - Usually at this time I start trying to lay down and get some sleep. Sometimes it works and other times, not so much. And there is no telling when a busy night will hit you. The calmest of days can be the busiest of nights. The other weekend there were only 2 babies on the board in L&D and both delivered before 10am and it was relatively quiet in the NICU. I thought I was in the clear. Then at 9:30 at night, a woman walks into the ER, not knowing she's pregnant and precipitously delivers a very premature baby. Hello! Admission time! Time to resuscitate, intubate, gown up, place umbical lines, start IV fluids, adjust ventilator settings, check labs and write it all up in the admission note. Other times, it's a nice relaxing night, with a few calls from nurses regarding residuals (GAH! Residuals! The bane of every neonatal NP's existence!!), blood gases, ventilator changes, or other abnormal findings. Ya just never know.

If I get low at work, this is when it happens. My lows at work happen before lunch and throughout the night. I have a stash of juice packs in the fridge in the call room and bring extra snacks with me for lows. Occasionally, I'll get low during an admission and have to excuse myself, but not often.

6am - If I'm actually sleeping (YAY!), my pager will go off about this time so that I can get up and check labs. AM labs should be ready by now and I look them over on all the babies on my team and enter them into their records. I'll also check out any blood gases or xrays that were taken. If any changes need to be made, I'll make them before the next practitioner comes on.

7:30am - My relief is here! I give report and I'm out! Usually I drop by the cafeteria on my way out to get a Diet Dr. Pepper for the caffeine . . uh, I mean the drive home.

8am - I check my sugar before hitting the road (usually it's good, low 100s) and about a third of the way through my drive I'll bust out my other fiber bar and bolus. I may have been known to, you know, in the past, grab a Krispy Kreme donut along with my soda at the cafeteria. Just because I'm low. And I'd forgotten my fiber bar. And they taste good, dammit! But only on special occasions (read: really bad nights). ;-)

10am - I am finally home. I stumble in the door, drop all my work stuff and walk the dog. Then I change into my PJs and test again. Usually I'm 150s-170s. But I don't correct because I tend to drop right after I get home from work. I climb into bed and my "nap" usually lasts 2-4 hours, depending on how much sleep I got the night before at work. But since I'm sleeping through lunch, my sugar tends to drop.

2pm - Wake up and check my sugar. Usually I'm on the low side. I'll eat a large snack/small meal to cover my low but no so much that I'm not hungry for dinner at a normal time when Brad gets home.

I told you. Long. Freaking. Day. But the babies make it all worth it. ;-)

~Layne