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!

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.

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. 

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.

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. 

I'm Not Sure That Applies Here

So, a one of the cooler people at the new job was taking care of a level one trololololol the other day, and homeboy was getting shut the eff down.  Hi, if you want to keep getting a bunch of narcs and benzos prescribed, by all means, keep returning to your source, but keep in mind that if you keep returning to the same bird feeder, one day you're going to find it empty. Or something.
Delivering the news that you'll have to find a primary doctor (or you know, another ER) to prescribe loads of  controlled substances is a pretty hard sell for a patient like this, so I played mean nurse to her nice nurse as we tried to get this dude out sans his usual parting gift.
He went through the exhaustive list of excuses about why he was already out of pills, went through the stages of grief, started making threats and heading into agitated crazyville when I was like, "Okay, no. Here's how this is going to work.  No one here with prescribing rights is going to give you what you want, regardless of what you say to either of us.  So you're going to leave now, and you're going to leave without a substance for controlled substances.  That's how it's happening today.  Here's your discharge papers."  Through the entire saga of why I need another prescription for oxys and Xanax, homeboy had been struggling with shaking hand to write his name on the discharge papers. As soon as he heard the definitive, hell no, GTFO, he finished signing, wrote the date, and in all caps, wrote UNDER DURESS below his signature. LULZ.  Yeah, I guess not giving you narcs falls somewhere between the iron maiden and water boarding on the continuum of torture.  The ER is a cruel, cruel place.

The Burden of Proof

Maybe I should just start calling this blog "things that suck about being new".  Ugh, but really, you know another thing that sucks about being new? Doctors.
There's a pretty limited number of docs that work the night shift at the new hospital- most of them are amazing and we already get along really well and they listen to me and recognize that I generally know my shit. I think it helped that a couple of them worked at Hood Hospital as well, so they already knew I was at least competent and stuff, and I guess the word spread among them. Most of them.
But the thing that's a bummer is for some of these people, the burden of proof is completely on you to prove that you're not an idiot, and you're a moron until proven otherwise.  Which, great, fine.  Talk stupid to me.  I'm a girl, and I look twelve, and I don't back down when someone's obviously trying to bulldog me, and duh, I work in the ER, I'm kind of used to being treated like shit.  This particular doctor strikes me as someone who I am probably not ever going to mesh with anyway- I'm pretty sure he's Hood Hospital's Dr. Stick-in-the-Ass' long lost twin- people who take themselves that seriously generally don't like my style and vice-versa. So, anyway, treat me like crap.  I can handle it.  But maybe  set aside the douchiness and your personal shitty biases against nurses for a minute when a patient's safety is concerned.
Elderly dude came in the other night that had some pretty vague, questionable complaints about dizziness- some random aches and pains-nothing too major.  Family provided most of the history and weren't really great at it- the patient seemed confused at first, but would provide information if he was prompted repeatedly and was oriented and lucid, but was just hard of hearing and didn't seem to want to be bothered. The elderly weakness workup proceeded, labs and scans were normal, Dr. Stick-in-the-Ass 2 gets ready for disposition, and something changes.  This guy is just not resounding the same way any more.   He looks like he's in pain but won't talk, he gets really diaphoretic and starts having weird runs of PVCs, is still awake but just won't follow commands or talk.  I drag him in to see the patient, he glances at him, rolls his eyes, and orders pain medicine.  Two minutes later as I get ready to give it, the patient is now drooling with snoring respirations.  I tell the doctor he needs to come in there, yeah, now.  His response?
"I can't even deal with you anymore with this patient. You're killing me. Seriously." (with a disgusted shake of the head)
He takes a look and begrudgingly orders a repeat scan.  I run the patient over, and oh, guess who now has a massive fucking head bleed?
Yeah.  I wish I could say this is the first time something like this has happened to me, but it isn't.  At all. I hate how in situations like this when the doctor knows he was wrong and fucked up, there's never any acknowledgment that a mistake was made or that he was being a massive douche canoe, but there is an abrupt 180 shift in the way I'm being spoken to.  Like now all of a sudden we're using our octave higher soft and gentle voice that we use with the patients, and I'm being thanked and fussed over every nursing intervention no matter how mundane.  Not like I need a pat on the back or acknowledgment every time I catch something, but I'd really almost just deal with these guys continuing to be asshats than suffer through this mister nice and respectful routine that we both know is fake.
Whatever.  Hopefully this situation has placed me in this guy's not an idiot column and he'll actually listen to me the next time something like this happens, but I kind of doubt it.  People like this seem to have a pretty short memory when it comes to their own fallibility.