The Supply Room

Taking inventory for both floors.

One of the biggest tasks my mentor entrusted me with was the organization of the supply room closets on both Intensive Care Unit floors. Each room was to be organized similarly so as to avoid any confusion that may hinder the doctors, nurses, and nursing aids from retrieving their desired items and other patient treatment necessities. I was told that I had the whole summer to complete such a task, but I didn’t have all summer and I managed to finish the job in less than two weeks. Organizing the supply room exposed me to the different types of IV solutions, needles, tubes, toiletries, gauzes, dressings, ointments, gowns, chemicals, containers, and many other items that are used in the hospital. It was an arduous as well as tedious task. I started by writing down the items and what order they were in on each floor and moved to make one floor similar to the other. Working in that supply closet allowed me to point out a lot of the items that the nurses, doctors and nursing aids were looking for. I’ve learned to tell the difference between many butterfly needles and IV packet solutions and proved to be of much use to the nurses. Completing this task would be, I would say, one of the greatest accomplishments I’ve ever completed.

Organizing the Supply Room.

Free Samples?

Patient Urine Sample.

I was sent on a rather interesting errand today. My coworker and I embarked on another delivery trip. Our destinations were the blood bank and the blood lab. Yes, there are differences between the two locations. As I’ve explained in an earlier entry, the blood bank is the place to go to when you need to retrieve certain aspects of the patient’s blood: platelets, red blood cells, and the like. We went there to return a pack of red blood platelets because a consent form was not signed. What piqued my interest the most about our trip was our delivery item to the blood lab: urine. Blood samples are only one of the many things that are examined at the blood lab. Specimen samples such as urine, mucous, and much to my chagrin, even feces are brought to be analyzed for sepsis and other complications. Most of the time these samples, for sanitary purposes, are transported through a tube system very much like the drive through system when you withdraw from a bank. The samples are placed in these well padded, tube-like containers and with the push of the right combination of buttons; your sample is shipped without the tedious walk downstairs.

Tube Transport System.

There Will Be Blood

Dealing with blood is by far one of my most favorite tasks at my internship in the Intensive Care Unit. Being entrusted to deliver such important and even potent packages is such an honor compared to the mundane and monotonous filing and office work I am normally put to do. Each time a patient is admitted, blood is drawn for a great number of purposes. As mentioned in my earlier entry of my trip to the blood bank, blood is drawn for future treatment use just in case the patient is dwindling in certain components of blood. These components are stored in the blood bank and come in different packages: packed red blood cells, platelets, autologous blood, leuko-poor packed cells, washed red cells, fresh frozen plasma, pooled, leuko-poor pooled, HLA matched, cryoprecipitate, and RH immuneglobulin.

Delivering a blood sample to the Blood Lab.

Another purpose blood is drawn for would be for tests. On one occasion, I was to go to the blood lab to deliver a patient’s blood sample to be tested for any sort of disease or sepsis (infection). The samples are placed in test tubes and placed in biohazard bags. For deliveries such as these, it is normally required to wear gloves for safety measures against the sample’s potency. In my case, it was not that serious.

An ABG sample.

Blood is also drawn for an ABG. ABG stands for arterial blood gas. An ABG is a blood test that measures the level of oxygen and carbon dioxide in the blood. The blood is withdrawn from a small artery and then analyzed by a special machine that records the amount of carbon dioxide and oxygen in the patient’s blood and helps determine how well the patient breathes. Occasionally I would be asked to deliver the ABG sample to the ABG lab. The package is placed in ice and it is imperative that it gets to the lab as soon as possible before the ice melts.

Special Delivery!

Retrieving our order from the Dietary Department.

Other than the same old file work I have to do, I’ve been sent around the hospital for numerous errands. One trip was to the Dietary Department in which the meals for the patients are prepared and delivered. In other words, the Dietary Department was the hospital’s very own Publix. My co-workers and I were sent down there with a cart to retrieve the ICU’s order of juices. We were to restock the refrigerators for both the 6 and 7 Greene Intensive Care Units. Going to the Dietary Department was unnerving because we found that it was located directly in front of the morgue which raised a lot of unanswered questions as to why such an arrangement was made.

Getting ready to sort out the juices.

After retrieving our order we assisted the nursing aides in organizing the juices and prepared for our next errand. Our second trip was to retrieve the unit’s orders of patient gowns and restock each patient room with an ample amount.

Retrieving our order from the Supply Chain Services Department.

For the gowns, we ventured to the distribution center located in the Supply Chain Services Department which is where orders for medical supplies are delivered to stock each unit’s supply room closet. In other rooms, the Supply Chain Services Department was the hospital’s very own Office Max. After retrieving the order, we helped the nursing aides restock patient gowns in each patient’s room. Though these errands were simple tasks, they gave us the liberty to explore the hospital and learn more about the other departments as well as how everything in the hospital is a well organized system.

Specialties

Stroke pamphlets I helped set up.

I believe I forgot to mention in my earlier entries that the majority of the patients admitted to the 6 and 7 Greene Intensive Care Units are stroke patients. As a matter of fact the unit, in general, specializes in caring for stroke patients. The registered nurses who work there are required to recognize all the different symptoms and varieties of stroke as well as other major syndromes in order to determine the most beneficial method of treatment for the patients. My mentor had asked me to help her cut out and laminate stroke pamphlets, reminders, warning signs, schedules, and other pamphlets for her to post on the unit’s bulletin boards. I gained a lot of knowledge from laminating these pamphlets. I learned about symptoms not only for stroke but also for Hemorrhage, typical cerebellum signs of lack of coordination, typical brainstem signs of cranial nerve and other deficits, the five major syndromes and their typical signs, as well as the functions of the Cranial Nerve section and limb section. The information I had acquired from laminating these pamphlets will be most beneficial to me for future use if and when I do pursue a career in the medical field.

Expectations

The book that contains the patient labels.

The majority of my hours in the Intensive Care Unit are spent labeling twenty four hour critical care patient flow sheets as well as confidential patient records and charts. Though it may just seem like busy work, it is absolutely necessary for these flow sheets and patient charts to be labeled. Labeling these documents help doctors, nurses, nursing aids, technicians and nurse secretaries differentiate the records of each of their patients. Through labeling these charts and flow sheets, I am able to gain an ample amount of knowledge regarding the conditions of the patients who surround me as I work. Labeling these charts and flow sheets also give me an idea of what I would have to look forward to upon taking up pre-med in college.

From left to right: patient label book and 24 hour critical care flow sheet.

The flow sheets are sixteen pages long. Each page requires the nurse to write in reports of the patient’s condition, EKG levels, blood pressure, IV drip, amount of medication, and much more complex requirements. I’ve always enjoyed labeling patient medical records not because I find it fun to stick stickers on paper, but because the information contained in them is mind blowing. In these records, doctors write consultations. These consultations remind me of chemistry lab reports and English research papers combined. Each consultation contains the conditions, medical history, progress, and a thoughtful biography of the patient. Through reading these consultations my medical vocabulary has expanded and I realize just how ill these patients were. It’s also through labeling these charts and records that I know what to expect when approaching to become a doctor.

Settling In

My working space.

After two to three days in the ICU, I became accustomed to answering phone calls. The ICU runs on a lot of these important calls. Phone calls usually mean someone on the unit had paged another department or a doctor needs a report on the patient he is monitoring from his nurse. Phone calls could also mean that a visitor needs me to buzz them in for a visit or a patient’s relative would like to speak to a nurse. Above all, it is my duty to get these calls to their respective owners.

My trip to the Blood Bank.

Answering phone calls was not the only thing I had been allowed to do. At one point, I was able to run to the blood bank to retrieve red blood platelets. I am given a slip of the checked item I am to retrieve and present it to a blood bank worker. There, they give me a pack of the order I needed from a refrigerator and carefully wrap, label, and place the packaged blood in a biological hazard bag for me to give to the nurse who had asked for it. The blood was to be used for a transfusion that took place later that day. The transfusion was successful and I believe the patient was discharged two days later.

Day 1

On June 9, 2009 I began my internship at Mount Sinai Medical Center. I had been placed to work in the Intensive Care Unit located on the sixth and seventh floors of the Greene building. After meeting my mentor, Nina Santos, and the majority of the ICU team, I was set to do paperwork. I was informed that the nurses were almost always short on patient application forms and so I began to assemble them. Each form contains intricate charts and checklists that the nurses need to document. These include:

* Patient diagnosis
* Nutrition
* Problem lists
* Interdisciplinary patient/family teaching
* Kardex,
* Admission medication reconciliation
* VTE Prophylaxis
* Vaccine screening
* Ventilator management
* Sedation protocol
* NCI Checklist
* Patient education/ acknowledgement for
o Stroke
o pneumonia
o CHF
o MI
o SCIP
* Patient belongings/valuables.

Here I am assembling the patient application forms.

Although making these forms was an imperative albeit mundane process I, unfortunately, got to witness my first DNR. As many know, the ICU is a unit in which extremely ill patients are placed and sorry to say, do not always survive. It was on my first day of internship that I witnessed a death. DNR stands for Do Not Recessitate. This means that the patient requested that if he or she were on the verge of death, no life support or medication was to be used that ensured physical stability. Later, the nurses wrapped the body up and transferred it out of the room while I continued to put together patient application forms. It surprised me how a death seemed so habitual. I guess after so many deaths, it becomes easier and easier to not feel anything.