Sunday Sublime

Conversation

Call me back when you're not driving; I have questions to ask.

The brain runs along facts like the tongue runs along teeth: a middle-aged man (when did we get to be middle-aged?), not in the best of shape (who is?) has clots in his brain that are affecting his sight and giving him headaches

(How could my friend, who is seventeen forever in my mind, with a bad 80's haircut, have clots in his brain? We swam together during summer camp when we were both eight. How could he have grown up so fast?)

The brain runs along the facts: a week's worth of headaches, a visit to the emergency department when things suddenly got worse, with loss of vision. CT scans and an MRI (MRIs freak him out; yes, they are freaky, I think I know, I think I know) and the discovery of clots in his brain

In his brain. One of my dearest friends, long-lost and finally found, now with clots in his brain that threaten his sight and his mind.

(I know all these things; I know how things tend to end. I know about the Decadron and the pain medications and the nausea and dizziness and the exhaustion at the end of the day after being asked sixteen times, "Tell me where you are." I know the high-pitched, slightly-too-loud voices of the nurses, alert for any change. I know the pronator drift test that you hope they'll pass every time, and the sudden lurch in the stomach when they're too tired, or too sleepy, and the arm drifts down)

And the IVs, and the feeling that this room is the world for you. Did you know that your vision shortens after five days in a hospital room? Oliver Sacks wrote about that, quite movingly.

(Tell me how he is. Tell me he is giggling over the things he reads on Facebook. Tell me his mind isn't gone, that he remembers what the neurosurgeon told him. Tell me he is just the same)

I have never been on both sides of the bed at once. This is terrible, in the old sense of the word: as in, inspiring terror. They have questions, and I have questions, trying to tease out what actually happened and what the plans are, and they want answers.

So do I.

That was the internship that was, or: Not with a bang, but a whimper.

Well, it's done. Six hours of testing and a whole lot of sitting-in-class, working-with-preceptors, learning-new-things, tearing-my-hair-out, but it's done.

The class portion of my internship, that is. I still have two more weeks of clinicals in which to screw up in some unimaginable fashion and be asked to pack my bags. Unless I knock over a ventriculostomy, yank a bolt out of somebody's head, or disconnect some incredibly essential line while dancing naked through the nurses' station, I think I'll be okay.

Don't relax, people. I am more than capable of shedding my scrubs and doing something really, really ridiculous.

For the last three months, I've lived on about a third (actually, it's closer to a quarter) of my usual income, without a set schedule (more on that in a moment), doing things I'm not used to doing, like sitting on my ass for eight hours at a stretch, listening to droning people talk about The Contagious Disease Du Jour. It's been stressful. In fact, I was driving in the other day, watching the fog come up off the farmland, and realized that there is not one single part of my life that hasn't been stressful lately.

I wonder if *that's* why I needed the Zantac. Ya think?

Anyway. These last two weeks about did me in. They're a perfect example of why, though I love guys in general and the two guys who've been arranging this internship in particular, guys should not be allowed to run things. Listen, children, and I will tell you a story:

We interns have to have a certain number of class hours and a certain number of clinical hours to make everything copacetic with Sunnydale's requirements. Earlier in the internship, we would blaze through classes in about half the time allotted and all be let out early. That was hard on the ol' paycheck, but nice in terms of having time off to study.

Suddenly, though, one of the Sumdoodz who run the program looked up and realized that we, as a group, were short some huge number of classroom hours *because* they'd been letting us out early all along, and that we had to make those hours up. There was much panic and many cries of distress and the Doodz ran around with their collective hair aflame for a day or two, then made a decision:

We'd make up all our shorted hours in two weeks.

Which meant that, for two weeks, we all sat. In a classroom. Or a lecture hall. Or a lab. Sat. Sitsitsitsitsitsatsatsatyawnsitsitsit. By golly, we were making up those classroom hours, but that's all they were: hours spent in a classroom. We were well on our way to making it all good with the powers that be at Sunnydale... ... ...except somebody mentioned that, if we continued like this, we interns were going to accrue some fairly substantial overtime in the process, which is a no-no.

More hair aflame, more screeching, more frantic emails from the Doodz, more drama.

Eventually, I don't know how, they got it all worked out. We all got an unexpected day off today to keep us from running into overtime, and somehow we all ended up with enough classroom hours. Except that now, since they cancelled clinical hours in order to *get* us those classroom hours, we're on clinical rotations for two extra weeks. To make up the hours we lost these last two weeks. Because we were short on classroom hours from being let out six hours early every day.

Yep. Five minutes' planning early on would've saved a whole, *whole* lot of burnt hair. But, at the end of the day, it's not my problem; I just show up when and where I'm told to and do what's expected of me. (Mostly, lately, that's been sitting. Have I mentioned that?) When I'm on the floor, my standards are a little higher, but when I'm listening to some guy from Backobeyondistan talking about how, exactly, a novel drug I'm never going to use interferes with protein synthesis in the yammagobble whingding wahoozit, I just show up.

(To be honest, the doc from Backobeyondistan was quite a good speaker. Charming accent, concise way of laying out information, and he managed to make a pharmacology lecture about whatever the hell it was funny. When he put up an LOLcat slide, I knew we were in for a good time. But it still took five hours.)

So. Just after Christmas, I'll be starting as a real, fully-fledged nurse in the CCU. I'll be working nights (which will be fodder for a whole lot of new posts) and trying to get my feet under me.

Scary as it is, it sure beats sitting for eight hours.

As Pens the Lotion Slut says, "I AM DRINKING BEER."

It has not been a beautiful day in Nurse Jo's neighborhood. Not at all.

Because the person who directs my Clinical Experience is a little.... .... ....well, she's weird, I had got to go to a two-part ACLS class this week, rather than renewing in April at the six-hour test-and-megacode extravaganza that I'd normally do. That meant two days of long classes covering things that I really don't ever want to have to deal with, and then a megacode at the end of the day today.

Followed by another megacode.

Yes, my friends, we tested *twice*. Once on a nice, boring, nonanimated dummy, and once on an animated dummy that costs a gazillion bucks and has no bones to speak of (the dude running the lab got really exercised when I bent the dummy's leg backward and said "Look! Osteomalacia!") and could speak and blink and breathe and all that happy shit. This was because the group I was in got selected randomly for a study on who did better in a code--a group with a nonanimated dummy, or a group without.

My hands and shoulders are sore as hell, because there were two very capable women in the group who were both unfortunately the size of my little finger, one guy, and me. Guess who got to do most of the compressions on both code tests? If I tell you that my private nickname for the guy is "Mister Lazy ThinksHe'sAmusing," will you guess right?

And if I tell you that I was, at one point, stuck for more than an hour and a freaking half in a room with Mister Lazy ThinksHe'sAmusing and another classmate whose nickname is HandsyMan, will you pity me? Will you hand me another beer? Please say yes.

Oh, never mind. I just got one on my own.

For some reason, since I've been single again, I've been attracting the sort of men one usually only sees in sitcoms and bad Craigslist ads. If he's got a girlfriend, he's hit on me. If he's an instructor in a nursing program and has a Marine Corps symbol (although if he's been any closer to the Marines than I've been, I'll eat my socks) dangling in his chest hairs, right above where his potbelly begins, he's said something inappropriate to me. If he's married but handsy, I've had to duck out from under unwanted shoulder-rubs, Angela-Merkel-style, more than once in the last month. And the topper came, as I was telling the Brother in BFE the other week, a couple weeks ago at my favorite bar.

My favorite bar is a class establishment that attracts only the finest folks--dames like myself. I was minding my own business, tucking into a poblano-stuffed chicken breast or some of the shrimp enchiladas that Antonio makes, or maybe it was a burger, when a drink appeared next to me.

I looked across the bar. There were three possible drink-senders, none of whom looked real promising. So I asked the bartender, Ray, who'd sent it. "The guy with the bad hair" she replied.

"Which one?" I asked.

"The one who doesn't look like he's bathed for a week."

Yes, fiends and neighbors, the dude with the bad greasy black hair, the corduroy Sansabelt-wannabes with the patch pockets on the front, and the reindeer sweater had sent me a drink.

He'd asked Ray what I was drinking. She'd told him single-malt Scotch, so he'd sent me Maker's Mark.

Oh, dear.

Ooooohhhhh, deeeeaaaaar.

I smiled, toasted him silently from across the bar, and returned firmly to my book. A few seconds later, somebody cleared his throat right next to me. Damn. Sansabelt Reindeer Man. So I thanked him politely and looked interested politely as he proceeded to try to make conversation. After all, they know me there: if anything untoward were to happen, Ray and her barback would throw the guy out on his ear. And he was really sweet, if kind of inert in a geeky way, until--and here you have to take a deep breath--he comingled the Star Wars and Star Trek universes in a way that showed me he was ignorant of both.

The way I figure, if you're living in Mom's basement, you have time to study these things, to work them out. Don't try to impress the girl who knows Yoda's middle name (it's Heironymous). Don't try to snow me with yammering about how we could go where no man has gone before if I'd just take hold of your lightsaber. Okay, it wasn't quite *that* bad, but it was close.

I've learned a lot of things in nearly forty years. I learn a lot of things from each guy I date, and I learn a lot when I'm single, too. And I've learned a lot--a lot--from this internship.

What I didn't expect to learn at any time was how to avoid weirdos in bars and how to avoid ass-pats while doing compressions.

*sigh*

Things I need to catch up on, if I ever get a day off:

1. ACLS protocols. They've changed. I think I can squeak by tomorrow, during the megacode (is it just me, or does that sound like some sort of large Precambrian fish species?), but I really need to brush up.

2. Dad's new book. It got a good review in the Seattle PI. My dad has his own Amazon page! Wahoo! Welcome to the 20th Century, Sainted Father!

3. Cleaning the bathroom. The new mascara I'm using leaves little....flecks everywhere.

4. Buying a Christmas tree, dog food, a new curtain rod, a splashguard for the shower, and some dried beans.

5. Sleep. I must catch up on sleep. Five (or maybe six! They haven't decided yet!) days of classes this week will kill me.

Why you should never lean on a counter at Jo's house:

Courtesy of Sister Rat, via her Crackberry.

Sunday Housecleaning Selections:

Found completely by chance

In Which Jo Feels Like A Real CCU Nurse.

Yank the blood out. Put the blood back in. Hook up the machine that scrubs the blood and yank out more blood. Make sure it's going back where it belongs: you don't want the patient exsanguinating all over the bed! God, lungs sound like crap. And sats are crap, come to think of it. And the vent's yowling at me.

Fiddle with the vent. Call RT. The vent won't stop alarming; could you please come help me out? The marvelous, marvelous RT department at Sunnydale dispatches one of their folks. She fixes the problem in about two seconds, helps me turn the patient, suctions him, and disappears in a golden cloud, angels following. (Have I mentioned how much I love respiratory therapists? Their motto should be: Removing Asses From Slings, One RN At A Time.)

Patient is hypotensive. Drop rate on bloodscrubber. Still hypotensive. Reposition patient. No go. Up the pressors. Hmmmm....better, but still not great. Best call the doc while I'm dropping the sixteenth blood draw of the day off at the lab. How the hell do you end up with a stage IV ulcer *there*?

Doc has no freakin' clue what to do; tells me to figure it out. Uh...yeah. Okay. *deep breath* Drop rate further, up that other rate a little more, cut back on this one and raise that one just a titch. Voila! A MAP of 68, just where I want it! Wow. This pressor stuff really works.

Wups! Bed and scrubber are alarming at the same time. Check scrubber first. Reposition patient. Figure out that their access is wonkily positional; deal with that. Deal with bed. Deal with cooling blanket. Deal with IV pump that has suddenly blown a gasket. Draw more blood.

Change a couple of ew yick dressings. Meditate on the enormous *thing* coming out of my patient's head and be glad they're not awake to worry about it. Wonder why the notch has suddenly disappeared from my A-line tracing. Discover that that, too, is positional. CVP and MAP look good, CPP is right where it should be.

Lunch.

Pee.

Up the rate on this drip, drop the rate on that one, change a bag on the scrubber, hang a new bag of stuff here and there. Check insulin drip. Check potassium drip. Check the anticoagulant infusion and the calcium infusion and that thing that's supposed to keep my patient calm. All good, all serene.

Don't kick that machine. It will make whooping noises for several minutes if you do that, and you won't be able to turn the alarm off. Wups!

CPP's okay, but MAP is dropping again. Am I more worried about kidneys or brain right now? Kidneys, actually (how odd, not to be worried about the brain). Cut back here, reposition there, up this, drop that. Patient suddenly isn't moving his right side. Well, that sucks rocks. Call doc. Too unstable to go for a CT; we can't do anything about that. Keep monitoring.

Right side comes back. So does bowel function (the patient's, not mine). Deal with that, change a dressing again, reposition. Make sure the wire coming out of the head isn't kinked. Pupils are still happy and reactive, right side seems okay, all good on the technical front. But those pressures still aren't where I want them. Fiddle some more.

Now patient drops *left* side. It's not ischemic, and I've never seen a bleed in an anticoagulated patient that simply resolves. In fifteen minutes, left side is back.

Docs rounding. Answer myriad questions, some of which are actually not covered by the paperwork they're holding. Get new orders. Change drips around. Change settings hither and yon. Make a couple of jokes with the pulmonologist. Glance out the window: when did it get dark? Grab lab results out of computer, ponder.

Charge rounds. Quick report, interrupted for bag-changing. Make sure all tubings are fresh. Make sure everything is clean, neat, stocked, and generally shipshape for oncoming shift.

Night relief arrives. *whew* Thank Frogs she's had this patient before. Head-to-toe together at the bedside, go over settings for one-two-three-four-five-six holy cow machines. Sign off. Remove self from computer.

Burger. Beer. Bed.

I feel kind of sorry for my preceptor.

Preceptor The First, that is. Because it's obvious our personalities don't mesh. At all.

Not that we don't get along; we do. She's a very good, very competent nurse. She's excellent with the patients, she never misses a trick, she can be relied upon in a crisis. It's just...well, she's from Venus and I'm from Mars. Or she's from Dubuque and I'm from Dubai. Or she's from Van Alsteen and I'm from the Van Allen Belt (holla!). You get the idea: both of us are pleasant, rational people, but we simply don't click.

Which means that in addition to those long, uncomfortable silences after which both of you turn to somebody else with a small-talk remark, there's a total lack of telepathy.

Those of you who've been nurses (or students, actually) for more than a week know how important telepathy is. It's the thing that keeps you from running into somebody who's helping you set up a monitor; it's that indefinable *something* that lets your coworkers know that you are totally in the weeds and good Frog could you use a hand. That is missing.

So, after I took on a third patient (sometimes they get tripled in the CCU, if one or more of the existing patients isn't complex), I was completely swamped. And the usual wild-eyed looks toward my preceptor as I was tied up on the phone or chasing down a doctor weren't working.

Finally, I went to her with a couple of requests: could she please take X, Y, and Z into room 4 for that patient, and please please pretty please could she do A and B for the patient in 6?

(For the nonce, Patient Number Four was uncomplicated but liked to chat. And Patient Number Six was stable, but had one of those oh-God-please-don't-let-the-pump-fail drips that you have nightmares about, with the extra added bonus of side effects like orthostatic hypotension combined with explosive diarrhea.)

She looked at me for a moment, her forehead wrinkling. "You want me to do *what*?" she asked.

"Take XYZ into 4 and help 6 to the commode. Please."

Another long moment's silence as she studied my face.

"You know, it would've taken you the same time to do that as it took you to ask me to. I thought you wanted some real help."

The new, snark-free Jo did not point out that the fifteen seconds PtF had just wasted in contemplation and in pointing out the obvious made the first part of her statement indeed true. Nor did the new, snark-free Jo retort that this *was* real help; that getting a hard-to-move patient with a tendency to crump while vertical was about the most important thing on my to-do list, lest I spend the next 45 minutes cleaning up one of the side effects of that drug.

Thankfully, another nurse had overheard that conversation and rushed into 6, managed to get the patient up and steady, and worked it so that I only had to scrub down part of one wall when that poor guy's bowels cut loose. (Note to self: explore side effects of any potentially life-saving drug before deciding to take it.) PtF then, to give her credit, hustled away to take care of Miz Chatty in 4, but yeah, that was thirty seconds wasted and another layer of stress I didn't need.

In short, I am not in the mood for philosophical discussions of time management when I ask for help. I *know* I'm snowed; if I weren't I wouldn't be begging.

At the same time, pity the poor preceptor who has to deal with me. I get scatterbrained and stressed easily, and my tone of voice at those times makes some people think I'm dealing calmly with a crisis. I tend to forget obvious stuff at weird times. I'm easily distracted by shiny objects and minor problems. I have a very, very short temper. And, worst of all, I get frustrated--quickly and seriously--by the fact that I don't know as much as I want to and can't do as much as I'd like to as well as I think I should.

So basically, what we have here is a failure to communicate. It's not anybody's fault; it's just the way PtF and I are wired. I'm sure she'll be as happy as I'll be to have the precepting part of our working relationship over and done with; things will be much easier once we don't have to be joined at the hip for twenty-four hours in forty-eight.

Meanwhile, back at Casa del Gato, I just spilled a half-cup of coffee everywhere and have to keep the gatos from drinking it. There's a crisis I can handle.