Never, ever, evereverever....

Drink with a fireman.

Especially a fireman who's just gotten off his 24 hours. An English fireman (that is, an Englishman who's here fighting fires) at that. Perhaps especially, never ever drink with an English fireman from Islington, a place that apparently endows its children with heart of oak and liver of stainless steel.

If you do decide to drink with a fireman, do not trade stories about work. If you do decide to trade stories about work, do it somewhere other than a quiet pub. Otherwise, people might start to look at you funny.

At least I know that my job, whatever its adventures, is not so bad. "What's the hardest thing you've done lately? Trauma?" I asked. "Oh, no" he replied. "Trauma is easy. CPR on a 400 pound corpse is hard." "How corpsey?" "Very, very corpsey."

In other news

We have four ICU overflow beds on our floor. That is, when the intensive care unit is tippy-top full, the Powers That Be send the extra neuro ICU folks to us. I worked a shift this weekend in the overflow unit, with--thank you, God--only one patient, and her with only one drip.

Having ICU overflow beds on a regular floor is a bad idea. The number and type of monitors, drips, and tubes your neuro ICU person has wired into his head or heart requires that the room be set up differently and that it be out of the way, in a place surrounded by signs warning of the Dangers of Cellphone Use. That means that the only practical place to put overflow patients on our floor is in a suite of rooms off in the boonies where nobody can hear you scream.

More importantly, we are not ICU nurses. Hand me a patient with a nicardipine drip (used to control blood pressure) and I can handle it without too much trouble...but I don't like it. I'm not in practice for it. Telemetry, while not a completely closed book, is not something I do every day. I can bumble along, true--but bumbling along is not something you want for a person who's sick enough for the ICU.

It was lucky for everyone involved that my patient was stable.

How to be an addict

If you're poor, you'll have to get your hits from the street or a series of ERs. If you're rich, you can milk a few months out of various hospitals with a series of ever-more-complex problems that require Demerol and Phenergan to treat. If you're rich and well-connected, you can find a doctor who will diagnose you with a rare disorder, one that requires diagnosis by exclusion, and you can run with the Dilaudid for years on end.

One of our pet Hospital Hobbyists came in three weeks ago and is still with us. This patient is still getting various fun narcotics to control pain that's caused by a rare disorder--one that allows a significant amount of activity in the hospital but apparently renders one inable to go home to perform the same activities. Dilaudid every two hours, nausea medications every four, and a tea-time dose of some sort of tranquilizer is helping the Hospital Hobbyist get through the day, see friends and relatives, and take a little vacation from real life.

I had another of the Hobbyists a few months ago, with the same attending physician, and got into an argument with said physician over my unwillingness to push 50 milligrams of Phenergan and 8 milligrams of Dilaudid every two hours. For those non-nurses in the audience, these are drugs at doses that would knock down a small hippopotamus for several hours. Yet the Hobbyist in question was still happy and conversant, completely sane, and relieved that the withdrawal symptoms had stopped for a bit. Not that any Hobbyist would ever admit that, of course. Nor would a Hobbyist appreciate the observation that their hospitalizations tend to come over holidays and other high-stress times in their lives.

Don't ask me why people do this. Don't ask me to speculate on how they get this way or why their physicians allow the behavior to continue. I swear that when my liver decides to cut out the middleman and hop out of my body to find a bar on its own, it won't have to go past hospital security to do it.