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.

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.

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.

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!"

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.