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. 

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.

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. 

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?

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.

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.

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.