Saturday, July 20, 2013

A Long Time Coming

Yeah, not that it'll be a surprise, but I think it's about time to shut this thing down.  At least for a while.   For one, way the hell too many real world folk know who I am now, which is pretty astounding for a blog I basically told zero people about when I started it.  The more common knowledge this thing is, the higher the likelihood that it will cause me problems.  Paranoid? Probably.  But shit, guys, I don't really have many other skills than being an ER nurse, and I got bills to pay.
That's really not all, though.  This might be harder for me if I was even getting the same things out of it as when I started, but it's different.  I'm in a different place now than when I started in that the challenges in my career are not so much needing a place to vent as needing a place to reflect.  And while I'm sure that heavy shit I occasionally put out here is super fun to read all the time, it's about equally fun to write (i.e. not at all.)  As much as the times I manage to put my doubts out there tend to clear my head; as much as the feedback I get from all the wonderful people that read this blog tends to give me a new perspective and heal my wounds and help me to forgive myself, I can't help but feel like my struggles are essentially the same ones over and over again.  Plus, it isn't like any of you are getting paid to be my therapist or anything.
When I started in the ER I really just needed to relay and almost confirm that the alternate reality, the moments that if I didn't know better, I would think were staged by some tru TV camera crew, that it wasn't just me getting shocked out of my suburban white girl shell, but that this shit actually was crazy. Some of it's still a little funny.  Sometimes the alternate reality confused me, or made me angry, and I kind of just needed to way to make sense of it all.  It's an interesting position to be in, though, when the emotions that you have basically based your writing on are really no longer your own.  What I once would have considered shocking or funny worthy of my ire just simply is now.  Combative drunks and drug seekers are my day to day world.  For the last couple of months, I've felt like I've actually struggled to make jokes about some of the things I see, to keep up my snark and cynicism about things that when they happened to me, elicited little more than an eye roll.  Things that were mildly annoying that I would certainly forget about were it not for me trying to drudge them up and force myself to feel something about them one way or another.
And ultimately, trying to drudge up snark is a very troublesome thing when it comes to my other struggles.  The struggle to be kind, to be nonjudgmental, a good Christian- one that puts living the way I'm called to live above people thinking I'm funny or smart.  I've been- I'll say reading- struggling- through Dietrich Bonhoeffer's Discipleship over the last several months.  For those unfamiliar with Bonhoeffer, he was an incredible German theologian and modern martyr, that regardless of your religious affiliation or lack thereof, is worthy of endless admiration.  Bonhoeffer lived and wrote about the Christian life in a way that is more challenging and demanding of action that anything I've ever encountered.   His adherence to his principles and his faith ultimately lead to his death at the hand of the nazis in 1945.  
The point of all this is that his works have really caused me to look at myself and see the hypocrisy and my own ongoing willingness to try to be kind and gentle in some facets of my life and judgement and hateful in others.  I have a big problem with making observations and forming immediate judgements.  It's in my nature.  I know this is always going to be a point I struggle with.   The way Bonhoeffer talks about it, though, is enlightening.  If you'll humor me, he says "Judging is the forbidden evaluation of other people. It corrodes simple love. Love does not prohibit my having my own thoughts about others or my perceiving their sin, but both thoughts and perceptions are liberated from evaluating them. They thereby become only an occasion for that forgiveness and unconditional love Jesus gives me."
I know this is right.  I know that what this blog- maybe what it started as, or maybe what it's become, has been a platform from which I've judged others very harshly while ignoring my own piles of bullshit. I do this plenty at work and at home without having yet another outlet in where I feed off my own negativity. I just feel like stepping away right now is a necessary step in cutting ties with some of the things inside me I don't like
I'm sorry if this doesn't make sense, or if it seems like I've gone of the deep end.  The one thing I will truly regret about leaving this behind is all the kindness and grace I've received from so many of you in my times of need.  So many of you have really embodied the spirit of this "simple love" that I'm striving for with varying degrees of success (mostly very little) as of late.  Hopefully I can get better at this, and maybe find a way to talk about what I do from a more positive place.  Until then- thank you all for everything.

Friday, July 12, 2013

Chief Complaint of the Night

"I just got out of jail, but they threw away my shoes".
It probably goes without saying that chosen mode of transport for this complaint was bambalace.
Also, guys, I know. I swear I'm still alive, and occasionally blogging. Sorry.

Friday, June 7, 2013

I Love it Here, Because Something Is Wrong With Me

I've been rather ambivalent about my job for the last few months, wistfully dreaming about going to a fancy, slow ER, or oncology or hospice or bar tending, grateful for my occasional nice, normal patient but pretty much completely and totally over all this other bullshit.  I shared my "I'm not quite sure how much longer I'd really like to be doing this" sentiments with one of my medic friends at work, who promptly blew me off.  I was a little bit butt-hurt about it, to be quite honest.
"You'll never quit.  You love the madness too much.  You'd miss it."
"Nope.  I really don't.  I'm tired of this crap.  I'm just done."
"Nope.  You'll never quit.  Secretly you love it."
I walked away further convinced that no one really gets me here and I could walk away any time and miss absolutely nothing about this place except....ugh.  He's totally right.
You guys, I am a twisted individual.  Obviously I became a nurse to help people and touch lives and make the world a better place, but I also sort of became an ER nurse to see the hilarious shit show circus that unfolds before me every night.   Nights like tonight where it really goes above and beyond the everyday ridiculousness really reinforce that fact that, yep, secretly I love this crap.
There are few things funnier than listening to the things someone yells at the hospital police while high on PCP.  It is ten times as funny when two patients high on PCP, both restrained and in rooms next to one another, start tag teaming it and yelling at one another and the cops. Especially when one of them spends the night telling anyone who will listen that he is a werewolf while growling to drive the point home while the other falls asleep, snoring heavily and occasionally ripping massive farts that ring throughout the entire unit.
It's funny as hell when the two chronic drunks that come in via EMS for cc: found passed out somewhere in public serendipitously find themselves next to each other in the hall beds.  It's even funnier when they become best friends and creepily hit on every woman within eyesight together.
Even the WTF moments are hilarious, like when my (non-critical) stabbing victim reveals to me that the  argument that preceded his injury was him yelling at his girlfriend about how she would have a home-cooked meal on the table if she "wanted to keep her a man" or when I find my patient on BIPAP trying to sneak Raisinetes through her mask.
This place is ridiculous, and it's an ass-kicking.  I held my bladder for 8 hours tonight before I remembered to pee, and I went nearly 12 without eating. But in it's own weird way, it was really fun.  As much as it would be fulfilling to work somewhere else, I would really miss how hilarious this place is.  It's like my own personal trashy reality TV show that I get paid to watch for 12 hours a day.  I'm sure I'd actually be really bummed if it got cancelled.

Tuesday, May 28, 2013

To Elaborate....

I posted on twitter earlier this morning about a phenomenon that, due to my lack of self-awareness, probably happens to me way more frequently than it should.  Sometimes, I start telling what I think is a funny work story, and about ohhh.. halfway through, I'll look at the face of the person I'm telling it to and notice that they look shocked and horrified rather than amused.  When people hear I'm an ER nurse, they always want to hear my craziest/ funniest/ weirdest ER story, but I've found after four years here and I don't really notice weird that much anymore, and I have trouble differentiating crazy/funny from terrible/disgusting.
What's worse than realizing this is happening is realizing it's happening and then trying to explain why, YES, you don't understand, this totally is funny, for real.  I had one of these moments with my husband this week while trying to tell him this story-
Lady comes in post-CPR, not doing so hot.  Like, not if but when she's gonna go type of thing.  We're trying our best to keep her alive while explaining stuff to her large family- while this is all happening, one of our medics is trying to keep the lady's three year old great-grandson occupied by letting him take his pick of stickers at the charge nurse desk.  The inevitable finally happens an hour or so later and we give the family some time to talk to the chaplain and view the body.  After they leave, we go in to take her down to the morgue and notice she is covered in Batman stickers.  Everyone I work with, myself included, thought it was hilarious.  I tried to recount it to my husband, and yeah, not so much.
"So she died? Man, that's really sad."
"Yeah, but, I mean, they were all expecting it, and they were actually dealing with it really well."
"But, I mean, so the little kid saw her and stuff? That's pretty messed up."
"Yeah, but he put Batman stickers on her! It was weirdly kind of sweet and I don't know it was just really funny at the time okay?"
"Yeah, I guess kind of, but it's mostly just really messed up."
Fair enough.  I guess such is the nature of the ER.  I guess from the outside, it seems like we're laughing at the death of someone's granny and it seems really terrible.  I wish I could adequately describe what it feels like, after several years, losing count of how many dead people you've seen, how much blood and pulmonary edema you've wiped away to make someone sort of look like the person their family once knew, trying so hard to get their eyes to close, the familiar plastic smell of the body bag, looking down in the midst of it all to see a crude collage of superhero stickers.  It's really not funny.  But at that moment, it's the funniest shit in the world.

Friday, May 10, 2013

Pot, Meet Kettle

Overheard- charge nurse discussion with an irate patient who was offended that, after curing her pseudo seizure with an ammonia cap, her nurse told her boyfriend "some people do things like this for attention". 
Patient: "And when I was unresponsive, I heard that nurse say 'some people'.  What's he mean some people, that shit is racist!"
Charge:"Okay ma'am, can you tell me which nurse said that?"
Patient: "Yeah, it was that Mexican son-bitch right there!"

Monday, April 29, 2013

ER BFF sent me this the other day:

And all I have to say is YUP. Working at a trauma center has really opened my eyes to the depths of stupidity to which the human race is capable of going.  I really thought I had seen it all working at Hood Hospital, what with some of the insane complaints people used to check in with, but obviously I wasn't anticipating taking care of those same people on Friday night, after they'd been at the club and had a beer or six and ended up in some kind of unfortunate situation requiring trauma services. 
I still don't agree with it, but it almost makes me understand the attitudes people up here have a little bit better.  There's about an equal amount of stupidity, but since alcohol seems to be involved more often here, it's kind of like a more aggressive variety of stupidity with less of the redeeming human element. Although the worst cases aren't the ones with people operating automobiles/motorcycles/bikes/motorized wheelchairs/whatever under the influence of some unadvisable substance, which could be somewhat attributed to impaired judgement related to said substances.  Nope, I'm talking pure, organic, unaltered poor decision making skills and what we in the medical community refer to as being really, really dumb. 
For example, I took care of a guy a couple weeks ago who wrecked his car into a stationary object, and like so many others before him, came to the ER back boarded, c-collared and acting a complete fool.  Just by the nature of the accident, we all assumed he was on something to be acting this way and to, you know, have a collision with something incapable of swerving into his lane, but the tox screen was negative for everything.  We were all confused and thinking about calling in Dr. House or whatever until I heard him talking on the phone while I was walking by the room.  
"Huh?  Haha, yeah bro, you know what happened?  So like, I was tweeting, right, and then like BOOM! I like, ran into this pole, yo!  HAHAHA I know, right! Yeah, it's fuckin' crazy man!  So like, hey, do you think you can pick me up from the hospital?  HAHA yeah dude, and like, my nurse, she's pretty hot, I think I'm gonna try and get her number bro.  Ha. Yeah man, Twitter. It's like, so crazy."
Ugh.  
The scary part is, I'm sure he operates a condom probably about as well as he operates an automobile, so I'm sure he's out there.  In the gene pool.  Tell your descendants I'm sorry when the world become the movie Idiocracy but in real life. 

Monday, April 15, 2013

Tag

No one can do this alone.  At any given point, one of us is going to have more on our plate than we can handle, patient-wise.  My attitude tends to be that I should help whenever I can, because just maybe that favor will be returned when I really need it later.  Plus, the time passes a lot faster when you're working hard.  A couple of people out there tend to abuse this mentality, though.
 I distinctly remember the first time it happened to me as a new nurse. I had just been released from my internship at Hood Hospital.  Super awesome preceptor number #2 had instilled in me the importance of teamwork from the first day she worked with me, so when I noticed my partner got an ambulance,  I hopped up to help him start it.  He hopped up, got a cup of coffee, and sat back down at the nurses' station.  At that point, I was already in his room getting report from EMS.  I was utterly shocked and appalled by the whole situation and recounted it to ER BFF in the break room later that night.  She nodded knowingly. "Yup.  Some people like to play that tag you're it game.  Oh! You're in the room?  You're it! Your ambulance now! Nope.  I don't play that shit.  I don't help those people unless they're drowning." And after that day, I became a slightly wiser nurse and learned to let the lazy people screw themselves.  
I've pretty already much figured out who is and isn't safe to help out at the new place.  If you're on your iPhone dicking around on Facebook at any point during the shift unless the place is just dead, you're pretty much on your own.  However, I picked up a mid shift the other day to bail out a friend, and they apparently decided to pair the night shift girl with the tag champion.  I've taken report from this guy enough times to know that he's lazy, but I found out that day that he is a special brand of ballsy lazy.  Most run-of-the-mill lazy people will at least make themselves scarce and hide out in the break room or the bathroom by CT or some shit, but ballsy lazy people will straight up stare at you with their feet on the desk and watch you do single-rescuer CPR.
Yeah, well, maybe that's an exaggeration, but only a little bit.  I'm charting when I see an ambulance roll into his room- this patient is obviously FUBAR.  Like, look of impending doom on his face, diaphoretic, pale, no IV, oh, and covered in some really c-diff-y smelling poo just for good measure.  At this point it's about an hour from shift change. I immediately go to work looking for IV access while EMS gives me a report I'm taking down in my head.  I grab a frightened EMT student walking by to start vitals and an EKG.  Monitor shows an OMG WTF looking rhythm, alarms are dinging all over the place, this dude has crap for veins, and demanding family member shows up making demands about us getting the patient water and cleaning up the poo immediately, as if it hasn't been there since yesterday. Tag king walks back and forth several times throughout this fun process, watching the madness unfold. He looks at the monitor, looks down to avoid eye contact with me, and keeps going.  In any other case, I would probably walk out and tell him off, but I was legitimately worried that this patient was going to die.  Luckily for everyone, one of the medics walked by, saw the chaos, grabbed a doctor and we all collectively got the dude somewhat stabilized.
I walk out of the room sweating to find tag king giving report and texting.  I immediately walk back into the room, grab two packs of wipes, drop them on the desk in front of him, and say, "C'mon tag king! I've got your ambulance started, but I'm gonna need some help cleaning him up!"  Homeboy sure did end up staying about 20 minutes after his shift to clean up the c-diff assplosion, too.  I helpfully turned the patient and made sure he didn't miss any spots.  Tag, bitch.

Friday, April 12, 2013

Struggling

I feel like a broken record apologizing for being gone so much.  I'm just having a hard time lately.  Work has been shenanigans heavy.  It's frustrating, because on one level it's funny stuff and good blog material, if I was somewhere else in my head.  My eyes are just wide open these days, to the debauchery and the awfulness and the misery of what I do.  Of the sadness of laughing at things that aren't really funny.  I can put on a brave face at work, but at home I stew over what the hell I'm actually doing here.  Most of my coworkers, even the nice ones, have given up on people a long time ago.  I somehow still haven't, and I almost think it makes it harder for me sometimes.  I pray, I push myself to be kind and open-minded, even when my brain and gut are sending me all these signals that I should just put my guard up and shut down.  I'm still getting burned after all this time, but I still don't want to change. In fact, I'm beating myself up about not being better.  About having to think about being nice. Making myself sick over the times that I'm not perfect.  
It's basically the same old struggle that I find myself more or less aware of from day to day.  I've always had insanely high standards for everyone around me and even higher standards for myself to the point that I'm usually at least a little bit disappointed. Usually it just means I try incredibly hard and take pleasure in little accomplishments while constantly pushing to do more.  Usually I can see the the good through the ugliness in the world and accept it for what it is.  But occasionally I just get so overwhelmed by it all that it just seems pointless.  How can I be more than a drop in the bucket when everything is already so wrong? I alternate between feeling like part of the problem and feeling so alienated from everyone and everything that I question whether there is anything I can do to help. 
I grapple with this every few months at least- teetering between maintaining my borderline unsustainably idealistic worldview and going completely over the edge into frustration and hopelessness.  Taking an honest inventory of myself and questioning whether I really have what it takes to make anything better.  So far adulthood has meant that I don't allow myself to constantly get overwhelmed and saddened by the challenge at hand like I did when I was younger, but the expectations stay the same. With age I've gotten tough enough deal with it, to push the critical narrative out of my head long enough to get things done, but it's still easy to get stuck inside my own head sometimes.   
Anyway.  I think and I hope that I will push through the other side of this soon.  I have in the past.  I just wonder now if this is something that I'll always be dealing with, or if at some point I'll start seeing things like everyone else seems to.  I'm really not sure which one I want. 

Wednesday, March 27, 2013

Screaming

Okay, I shouldn't say this is my pet peeve, because I think a lot of things qualify, but specifically,  OMG you guys I just cannot deal with screaming.  I try really, really hard.   It's mostly not my fault- when I was little, my parents and doctor thought I was maybe autistic there for a little while, partially because excessive auditory input stresses me out hardcore.  So, yeah, obviously this issue has not been resolved in adulthood and whenever I am around someone who is screaming constantly I pretty much want to either lose my shit and scream back or run far, far away.  
Don't lecture me.  I know it's wrong.  I legitimately cannot help the feeling, and I've learned to override it for short periods and then I'm like "OMG I NEED TO GTFO OF HERE YESTERDAY" and then I basically just have to run away.  One of the many reasons I could never work L&D.
But, I guess my point is, despite my intolerance, I want to understand.  I've been in pain, but I guess in not enough pain? When I hurt, I just want to curl into a ball and try to breathe and just hope I pass out maybe.  Screaming, at that point, seems like a lot of energy.   Are there studies about this? Does this help anyone? Am I the only crazy person who literally cannot deal with this?

Saturday, March 23, 2013

Scariest Privilege EVER

So, apparently when Hood Hospital 2 was like "we might give you an intern" the meant TOMORROW. So I have a baby nurse with me now guys, learning all my profanity laden hood rat ways.   Oh man.  I tried to be professional for like, 2 hours, and then the floor was giving my intern crap about taking report and I was like "put those bitches on the phone right now, I will go up there and cut them if I have to" and just like that, the facade was OVER. Luckily, my intern is amazingly super awesome.  Like so much smarter than I was at that stage in my career.  But she doesn't know how awesome she is, so she is still super cautious and humble, which makes her ever more awesome.  And she has some life experience and isn't totally naive and dumb like I was when I started, so she doesn't mind the fact that I'm potty mouthed and ghetto. I almost feel like it's making precepting too easy for me.
But I get to teach her all the experienced RN type of nuggets.  Like, we're working on doorway assessments, the right stuff to say to patients and docs to make them happy, and charting tricks to cover your butt.  And I see the gears turning in her head and it makes me super happy.  It helps that she actually has clinical experience, so I don't have to try to find the words to try to explain how to start an IV or something.
I was so stressed out about precepting a new grad after my own experience.  My first preceptor gave up on me so fast, and she was so hardcore and so unhelpful that I worried I would swing the other direction with my own new grad and help too much and be a huge softie, and end up releasing somebody who wasn't ready or wasn't cut out for the ER.  Although I may still be a bit of a softie, I have no doubts that this gal can handle it.  And somehow I feel a little more confident in myself being able to verbalize what exactly to look for when dealing with a sick patient.  I'm glad I've waited this long- I'm not sure I would've been ready when Hood Hospital 1 started throwing this out to me as an option.  So yeah.  Precepting is rad.  And I'm making an effort to help out the on their own baby nurses, and another friend is coming over from Hood Hospital 1, so maybe we'll just take this bitch over.
I know my optimism may be silly, but it's how I do.  I just miss the strange tough positivity and kindness that shaped my nursing career when I started.  I'm gonna sneak in here and make it happen again.

Saturday, March 9, 2013

But We All Still Have It Great.

You know.  Working in the ER sucks and stuff.  I had a total shit, frustrating day- new hospital has finally caught on to my foot dragging and forced me into triage, I had my first night up there since forever, And it still sucks, but it sucked extra tonight.  Andd I'm just about to lose my shit on a couple people here who apparently think I don't notice that they're talking to me like I'm an idiot.
But.  I went home, and got a beer, and I'm going through my blogroll, and I've come to the conclusion that I really just need to shut the hell up.  I've been an intermittent lurker on Learning to Hope- if y'all aren't familiar with Tashi's story, she just lost her husband about 5 months ago to brain cancer. The post I've linked to in particular ripped my heart out even more than everything else because it reminded me so much of my own husband.  Not even just the fact that we're about the same ages, married about the same amount of time, but reading Tashi's story about falling in love with Wash. She expresses so perfectly the feelings that I had at a younger age- I accepted that I would never get married, that I would always be alone- that I was difficult and weird enough that no one would ever understand or tolerate me, and even if that did that I could never tolerate them.  And the feeling of being so pleasantly surprised when someone was actually out there- someone that I not only felt at ease with but someone who was everything missing from me that I wanted to be.  Someone that was my best friend and forever companion that I just take for granted every day, my token partner in all the mundane high points of daily life- going out for tofu noodles, a DVR full of shows we can't watch without each other, making stupid references to things no one else would understand.  And just the thought of losing that, in such a painful and cruel way, knots up my stomach and brings me to tears.
I've read her stories and I've met people in her position and in Wash's position.  I want so badly to have something to say and to contribute to people forced to face such emotional devastation, and I come up with absolutely nothing.  As much as I like to think that I'm tough and resilient, the truth is that I've lived a cushy ass 26 years and there is nothing I can offer any of these brave souls other than the same compassion and platitudes as any other person who hasn't been there.  
The sickest part of it all is how many people hurting just as deeply probably cross my path whom I fail to offer even my inconsequential gestures of kindness. The ER in particular is a unique combination of high volume bullshit and utter chaos that empathy almost has to be cut away sometimes for the sake of effectiveness.  We train ourselves to be so detached that even in the quiet moments, we don't feel as we once would have.   I occasionally find myself really thinking about what it must actually be like to be the one in the bed, or the one freaking out worrying about the person you love more than your own life, or the one who has just lost the world that they know, and I bewail all the people I've been short with, all the people in need that I've had to run out on because someone else needed me.  I beat myself up about the stupid things that cross me, and about all the beautiful things and people I am surrounded by all the time, who I fail to be thankful for, who I fail to tell how much I adore them every single day like I should.  So I go off to shower and to go to bed, swearing that I will remind myself that I never know who among me is living the nightmare, and to try and always be kind. Praying that I'll do better tomorrow. I do this knowing that I will probably fail, probably soon- but it's the only thing I can think to do to start helping.

Sunday, March 3, 2013

How to Make an Arrogant Doctor Do What You Want Them To Do

Let me preface this by saying that for most of the doctors I work with, these tactics are unnecessary.  Before this turns into a butthurt shit show, let me acknowledge- yes.  Most adults will usually listen to reason from another adult with similar experience, even if one of those adults went to school for less years. Some of the doctors that I have a really good report with the respect me as a nurse will actually solicit my opinion just to get another perspective on a patient. Unfortunately, others seem to think more experience makes them the one smart person in a sea of bumbling idiots, which... good for you, let's see how that works out.  In my experience, there are a couple of young, cocky doctors out there who still haven't really gotten much real world experience, but won't take any input from anyone ever, especially not a lowly nurse and especially especially one that looks like a high school kid.   I've dealt with several of these guys in my career and watched some of them make some pretty catastrophic decisions in relation to patient care.   Like, shit that'll get you sued decisions related to patient care.  Anyone can miss something, but most people are humble enough to think twice about it when faced with overt concern.  The ones that won't- well.  That's where the power of manipulation comes in, which I am really just kind of sad to say I've mastered at this point.
The key to all of this, sadly, is to feed the arrogance.  Gross.  I know.  But let's say, for example, you have a patient, who is, say, obviously septic.   Their vitals aren't in the shitter yet, but you know they're headed in that direction.  If Dr. Arrogance is taking care of your patient, you can usually gauge how seriously he takes this in proportion to how many billable procedures are done on the patient/ how many times he actually goes back into the patient's room.  When I know something legit is getting blown off, I usually try to nip it in the bud by trying to intervene/test the waters early.  This is the important step- planting the seed without blowing your cover.  It may seem to make more sense to just go on the record saying, "this dude is totally septic and shit's about to go down", but with people like this, that can very easily backfire.  See, the Dr. Arrogants of the world have to be right about everything, and nothing feeds their egos more than shooting you down when you throw out a medical diagnosis like "septic"or "anxiety" or "A-fib with RVR".  Nope, with these people, as a nurse, especially a young one, you have to trick them into thinking it was their idea as to not disrupt their fragile self-image.
I generally start by touching base before any kind of decision has been made, because it's a lot easier to subliminally steer them in another direction before they publicly proclaim a decision, say to discharge a patient you know is sick, than to convince them to go back on it.   I'll usually catch them at a stopping point and pretend to pick their brain.  "Geeze, Dr. Arrogance, what do you think of that patient in bed ten?" If the response they give me is obviously not the one I want, I usually put on my best worried/sad face and act like I'm trying to do long division in my head.  Then I'll say something like, "Man, I don't know, I just have a bad feeling. "  At this point I will drop all my empirical evidence in the form of a question and be like, "Yeah, like, he got that fluid bolus from EMS, but his blood pressure keeps dropping a lot from when he came in, and he's real sleepy and just acting different and I just don't like how he looks." At that point I usually bite my lip and shrug, and ask "What do you think we should do?' This performance 90 percent of the time gets me what I want. When it does, I nod my head emphatically and run off like I'm going to do something that I've probably done anyway.  If it doesn't, I usually just stall discharge until the vital signs are actually abnormal enough to get an admission and then play stupid like I didn't know I was supposed to let them go, or I'll play the "patient wants to talk to you" card to trick them into going back in the room and seeing how shitty they look now.
Part of me feels disgusted with myself for playing dumb, but I take comfort in the fact that 1- I got shit done for the patient that needed to be done- and 2-that I have the ability to play an arrogant douche into being putty in my hands.
So, there it is guys.  The power of tricking someone who doesn't listen into doing what you want.  Only use these tricks for good.

Wednesday, February 27, 2013

I'm Pretty Sure That's Not Correct

I have a trick for keeping a pretty good report with most of my ER patients by responding to the really off the wall shit the way they taught us to talk to psych patients in nursing school.  Basically, no matter what someone says, I just nod with wide eyes like I understand and am taking everything in, and then I basically reword what they just said and ask if I understand correctly.  This is also pretty much how I dealt with all the complaints as a charge nurse, except add "I'm sorry that happened to you" on at the end.  Anyway, I pretty much always manage to listen and act like what people are saying is totally run-of-the-mill and not crazy. 
But the other day,  I'm triaging this girl with a totally unrelated, non-life-threatening complaint when she just mentions in passing, "Oh yeah, and I think I like, died last night." So I kind of look askance at her baby-daddy who's with her, and he's like, "Oh, uh huh, yeah, she like, wasn't waking up, so I called my mom, and she came over, and she did CPR, and she woke up."
I physically could not bring myself to nod.  Like word vomit, I just blurted out, "Um, wait, TIME OUT. So, last night, you DIED, and YOUR girlfriend was just laying there DEAD until however long it took you to call your mom and for her to come to your house, and then after being dead for 15 minutes, you just woke up, but didn't think it necessary to seek medical attention for this until nearly 24 hours later while being seen for something completely different and less serious?"
Both of them just stared at me blankly.  
I mean.  Look, if we're going to have disclaimers to not eat the pellets that come in your shoes or not to try the stunts seen in commercials and warnings not to smoke around gasoline, maybe the TV shows where people get CPR for a bit and then hop up and stroll along their merry way need to put warnings at the bottom of the screen that read DISCLAIMER: THIS IS NOT HOW CPR ACTUALLY WORKS PLEASE CALL 911 IF YOU HAVE ZERO TRAINING IN CPR.   Because apparently the shoe pellet eaters are out there somewhere, performing CPR on their deep sleeping family members.

Wednesday, February 20, 2013

From the Comment Wall of Fame

Hood Hospital 2 has a bulletin board in the doc's room, which is a place where various notices are kept, but it has also become the official patient complaint hall of fame.  Any surveys or comment cards with particularly colorful language can be found there for the staff to enjoy.  I was in there talking with the one of the docs the other day when I noticed possibly the best comment card I had ever seen, written about one of my favorite ER doctors.  It read:
"Cool lady ER doc was the best.  She treated me with the utmost respect and care, even though I accidentally cussed her out."
WHOOPS! Don't you hate it when you accidentally cuss someone out?  It's like when you're trying to hold a fart in but can't, but instead of stinky gas from your bowels, it's verbal abuse and profanity.   Any diet suggestions to keep this from happening again in the future?

Thursday, February 14, 2013

Secret Code

Over the years, ER BFF and I have developed numerous discreet ways of alerting each other to patients/coworkers foolishness while they might be in earshot, some more successful than others.  Yeah, in retrospect maybe suggesting we activate the pillow team was not one of our better choices. Our discretion is now especially important now that we're in an ER without doors. But dude.  I have a new system that I'm pretty sure is actually bulletproof in it's deniability.
The ER term of the moment is troll, also extended to trololol if I'm feeling silly.  Which always made me think of trololol guy.  If you have somehow sheltered yourself from the internet this much that you don't know what I'm referring to, you're welcome/I'm sorry:
So, anyway, I'm actually embarrassed I didn't think of it sooner, but now, if I want to alert ER BFF or anyone else around me that someone fits troll criteria, I just hum the trololol song. It's perfect.  Anway. You're welcome to use it, if you can keep it on the QT guys.

Bonus material:
THANKS INTERNET

Monday, February 11, 2013

WHUT

Ermagerd Serenity Now Hospital is back.  It's on, bitches.

Friday, February 8, 2013

This Is Definitely a Bad Sign

Yeah, it's never good when you go to wash your hands and notice in the mirror that your badge has a big smear of blood across it, and you can't even begin to narrow down whose blood it might be because you have multiple patients with blood shooting out of multiple orifices.
The ICU hell streak continues. I'm considering holy water as a viable option at this point.

Wednesday, February 6, 2013

A Study in Opposites

Look, I know the phrase "squeaky wheel gets the grease" and all that other bullshit, but when the squeaky wheel is a douche mcgouche, it really shouldn't.  This happens in the ER, like, all the time though.  If you're demanding and rude, I'm going to work on getting you everything faster simply because I don't want to deal with your shenanigans when you have to wait.  Meanwhile, if you're nice and patient and generally a stand up member of the human race, you're going to wait a little longer for everything because we can get by doing it that way.  I hate it.   
I had a side by side example today, though, and it really kind of broke my heart.  Two ladies came in for the same problem, and I was taking care of them both.  One was super nice, grateful, and polite, while the other was demanding as hell and all up in everyone's business all night.  I asked for pain medicine for the nice lady, except the douchiest PA on the planet was taking care of her, so I was ignored obvs.  The other lady thrashed about and acted a complete fool, so she got a dose of pain meds.  And then another. And then another, AND ANOTHER.  Yup. One of those waking up from your slumber to tell me your pain is a ten type of situations.  Meanwhile, nice lady is not upset by the lack of orders, but thinks I must be the second coming of Florence Nightingale since I got her a pillow.  
Both of them ended up with test results and discharge papers at approximately the same time- can you guess which one of them actually had a real reason to be in pain? Not the one who had actually received anything for it.  Can you guess who got sent home with a prescription for something you can't buy over the counter? Yeah.   
Yet when I went in and explained all the home remedies and the schedules and doses she could take on every OTC pain killer in the book, she was still all smiles and thanked me tons of times for taking such great care of her.  Right as lady #2 was totally wigging out on one of my teammates about her the NUMBER of narcs she was getting sent home with, sweet lady was heading out while she walked up with a comment card about how great her care was, thanked me again and waved goodbye.   I could have cried.   I hate that people like this get the shaft.  I felt super guilty about the whole thing, even though I wasn't in a position to do anything.  I hope I remember this crap if I ever get through enough school to have prescribing rights. 

Sunday, January 27, 2013

When You're Right...

 I don't know what the hell is wrong with me but the black cloud has followed me from Hood Hospital to new hospital in a big way, to the point that everyone here just makes fun of me now because everyone I touch ends up in the ICU.  The charge nurse tried to do me a solid today by sending me a toe pain via EMS to my hall bed...except the dude also happened to be in A fib with RVR.  Oh, and he had bilateral giant ass DVTs to both legs and no one could find pulses in his feet.
Oh, and yesterday my girl who came in for "abdominal cramping" sure did deliver a 19 week stillborn in her MF-ing panties 10 minutes after I walked into the room while I was starting an IV on her. YUP.
So, yeah, I guess this is my life now, every day is a shit show, all day. So I'm busting my ass, it's my last shift in a long stretch of crazy fuckery, and I'm taking care of a super cranky frequent flyer who is chronically ill but wants to complain and cuss at you about any interventions you might attempt to make him LESS chronically ill. I see his call light on and run into his room to ask what he needs, when he tears into me about how long he's been waiting for me to bring him some juice and why I can't make jello magically appear in the ER at 11PM so he can eat some.  I apologize and tell him I have several other patients who all need my help, that I'll get to his juice as soon as I possibly can.  This is the conversation that seriously transpires.
Pt:"I can't even believe this place. The service here sucks so much. You guys are seriously terrible."
Me (trying to hold back tears, because I am so pissed/frustrated at this point): "I'm sorry.  I'm really doing the best that I can,  I wish I could get everyone what they want right when they want it but there's only one of me."
Pt:"Well, I know you can't do anything about it but your service still sucks.  You don't suck as bad as Hood Hospital, but you're not that much better.  You're pretty close actually.  You guys are terrible, but they're still worse than you."
Well, yeah.  Even though he was kind of a dick about it, he was also kind of right- this place does suck, but not as much as Hood Hospital.  But- hooray for sucking less! Upgrade!

Tuesday, January 15, 2013

But the Good Days are Great

I guess I'm a little better?  ER BFF talked me down off the ledge.   I'm so freaking lucky to have friends and family that get me.  Her reaction when I told her I was thinking about applying at some slow country club ER or maybe just going to work at Starbucks and moving back in with my parents- "Seriously? God, you need a break, bad.  Seriously.  Take some time off, because if you are really talking about quitting something that is obviously your calling that you're obviously meant to do then something is wrong.  And what are you gonna do at some posh ER? You'll hate it and it's gonna make you stupid, and you know that.  You can do this.  Just take a break."
And she's totally right.  Hell.  I was seriously one more bullshit remark away from walking out the other night, and then I took care of a bunch of sweet, awesome people tonight, and damn.  The level of human connection that I'm able take from this job is unsurpassed by almost anything in the world.   I hope I don't lose everyone here,  but I'm like crazy obsessed with the Keirsey temperament sorter.  You can read more about it here and self test, which I recommend because it's at least in my case, frighteningly accurate and amazing. Anyway, the temperaments are basically divided by your life focus and worldview.   I'm an Idealist (counselor), the crazy hippies of the personality world who obsess day and night about their purpose in life.  This is me to a T- obsessing about making a difference and finding my way and becoming the person I want to be.  Constantly dealing with the gnawing feeling that I should be doing something more, that there is something bigger that I'm supposed to accomplish.  Even at rest, I'm not at rest.  My mind is racing all the time, and my dreams are just as hectic.
But when I'm taking care of someone, and I know I've actually, really helped them, and made them feel better.... I'm at rest.  It's like the world that's flying by me all the time stops and I know I'm in the right place.  I took care of a sweet little elderly cancer patient and his adorable family today.  He was couldn't talk,  but I got him some pain medicine and stood there for a while talking and explaining things to him and his sweet family, and I was able to ease their anxiety and make some jokes with them.  As I went to step away, he grabbed my hand and squeezed it, looked me in the eyes and smiled.  It was one of those moments where the journey could have stopped, where I could have stayed forever and known things were going to be okay.   Where I knew for sure the universe was not random and awful and that I really had the power to bring peace and serenity to someone who needed it desperately.  
This is my purpose in life.   I'd still consider going to work on an oncology floor, but there's something about having the opportunity to have the right presence, and to say the right words in the middle of someone's worst nightmare that is so unique and wonderful. I just can't give it up yet.

Thursday, January 10, 2013

I Need an F-ing Vacation


Ugh.  I hate to say I'm burned out, but I might be burned out.  I'm at least on the crispy side.   New job is overall a better run operation in terms of moving patients and generally getting shit done.  In my opinion, ratios here are still insane and border on dangerous for a nurse with my experience level.  I feel some genuine fear for the new nurses here, especially with the hubris that some of them have, which is a whole other post.  Add to the mix that I seem to be a massive shit magnet ( I can't remember the last shift that one of my patients hasn't ended up in critical care-usually it's multiple) and I'm in staffing getting my ass handed to me every single day and I'm starting to ask myself what the hell I'm doing here.  
I mean.  I started in the ER because I wanted to push myself and I wanted to learn.  I've learned a lot, and I'm still learning, but I'm starting to wonder at what point subjecting myself to this amount of physical punishment no longer worth it.  I know flu season is going to be rough- I feel like I'm back at Hood Hospital what with my lack of lunch and pee breaks lately.  The frustrating thing is that if this place was staffed appropriately the burden wouldn't be nearly as heavy on everyone, but they've made it pretty clear they're done hiring for the time being.  The sure do keep filling up the beds regardless of the amount of nurses, though, hence the unsafe ratios.   
 I don't know.  I'm not actively looking and part of me wants to wait until I can actually get some trauma experience- I kinda want to muscle through the worst season and then reevaluate after that.  The other part of me says screw you guys, don't have to take this crap.  I don't have to work at an inner city hospital.   Making the switch has made me realize I can work just about anywhere.  I think I probably have figured out the people skills part of this job enough to go work at a fancy pants country club ER where my patient ratios are actually guaranteed and based on acuity if I want. I might end up being bored, but maybe I wouldn't be day dreaming about quitting nursing and becoming a bartender.  
I'm really torn.  I really love working in the area where I work, and I want to keep fighting the good fight.  But I can't keep getting my ass handed to me on a daily basis with no relief in sight.  I've done this once already, and it isn't worth it. 

Sunday, January 6, 2013

Stupid Days

I know I probably tell stories here in a way that make me sound badass or whatever, so let me just clear the air and admit that sometimes I am really, really dumb.  Like, yeah, I can recognize a sick patient across the room on most days and I pride myself on saving multiple doctors from central line insertions by finding IVs in ridiculous places. BUT.
Some days I'm tired, or hungry (usually it's because I'm hungry and if someone checked my blood sugar it would most likely be a critical low), or the tides are aligned wrong, and the synapses are not firing the way they're supposed to be firing.  I got a critical patient today and had to set the doctor up for a procedure, and basically couldn't find my ass from a hole in the ground the whole time, despite the fact it was something I've done before and showed other people how to do before.  Nope, it was derp city in there.  So then it's time to take this dude up the the unit, I'm supposed to take him by for a CT, I get distracted by looking for portable oxygen tanks (a very mentally taxing activity) and I sure did bring this patient up to the ICU sans CT.  No, they weren't happy.  That was a fun phone call. "Hi, sorry, I swear I'm not lazy, I'm just a complete fucking idiot, thanks, bye"
I actually felt a little better talking to my new coworkers, because while I bewailed my own stupidity, they were all like, no, I've totally done that before and I have days where I'm a complete moron, too.  So, it happens.  I guess I'll try to be more forgiving the next time someone says something really ridiculously stupid.

Thursday, January 3, 2013

Ew.

I'm dealing with the same generalized abdominal pain with no distress in an otherwise healthy 20-something gal (aka disposition 99% of the time= you probably need to fart) but, okay, sure, maybe you really have ruptured appendicitis with peritonitis and that's why you're talking on your cell phone and you keep asking for a sandwich tray.  Anyway.
I send this girl off for a urine sample, come back and pop an IV in her real quick, draw labs and label them, and I go to look for her urine.  Um, hey lady, where is your urine?
"Oh, yeah, mmmhmm," she says, pausing her conversation on her bedazzled iPhone while DIGGING INTO HER PURSE AND PULLING OUT HER SAMPLE CUP that was also overflowing with urine BY THE WAY.   What the hell? And it wasn't even like a crap canvas bag from target or some shit like I carry around, no, this was like, a coach bag that was probably equal to 2-3 payments on my car. "Self pay" patients usually carry bags like this to the ER because they are all independently wealthy entrepreneurs that don't NEED health insurance.  Or something.  But anyway, gross.  
Girl, I sure hope you throw away all of the makeup that was touching that cup because when you come back in here next week for some eye infection secondary to what you just did to all your shadows and liners down there, I absolutely want no part of it. What a waste. She probably had nice makeup, too.