God, I fucking love my job.

I mean, really. What could be more perfect than CCU? Well, watching an intubation in a controlled setting was almost more perfect, but I'll get to that in a second.

Critical care is *so* different from floor nursing, even acute floor nursing. There's less downtime, there are sicker patients (duh), there's a whole lot more for a nurse to do, and the interventions have immediate, tangible results. I'll admit to being enchanted with the whole immediate-gratification thing, but I'm also reassured that the people I'm taking care of have been recognized to be actually, really and truly, no-foolin' sick. I no longer have to go head-to-head with residents who don't know me, trying to convince them that their patient really doesn't belong on the floor. There's also more autonomy in this job than I ever dreamed of.

We have a whole hell of a lot of freedom for two reasons: first, Sunnydale operates on a series of protocols. We've got protocols for everything: magnesium or potassium too low? Sodium too high? Is the patient sitting up on 50 of propofol and gesturing wildly? We got a protocol for that, son, and you can just go 'head and implement that sucker. (This, of course, requires that a nurse actually pay attention to what's going on, something I'm still working to perfect.)

Second, Sunnydale has a lot of residents. When you have a resident who's post-graduate year two and is on her second round of critical care rotations and a nurse who's got thirteen years of CCU experience, the nurse is going to take the lead. The women and men I work with are not shy about this; I watched twice today as nurses led residents through sticky situations and everything turned out fine.

And the teamwork with this group? Is outstanding. I say that as somebody coming from a floor that's recognized as not only being the nuttiest, most loose-cannon floor in the system, but as the floor with the tightest teamwork outside of the CCU. This CCU group makes my old coworkers look like a bunch of slackers.

For instance, (and here's where I get to talk about the intubation, oh boy!) we had a patient who needed to be intubated for something like the fourth time today. I stood around and watched, taking mental notes, as recorders cycled in and out and another person ran for a bag of dopamine and somebody drew up and labelled all the paralytics. It was like a code, in that everybody automatically fell into position and started marching, but much calmer. Grim, in fact. (It was grim because the patient should've really been intubated at 0700, but that's another story.)

Something that never would've happened on the floor: Junior Resident was trying to pass a #7 ET tube, and the attending gestured to me. "Come over here" he said flatly, and showed me where to squeeze and press on the patient's neck to make the vocal folds come into clearer view for J.R. Check that out! Mashing on the larynx can really make a difference!

Something else that rarely happened on the floor: I heard an attending read a family the riot act today, concerning their behavior to the nursing staff. Mostly, the residents just let us on the floor deal with touchy situations on our own; here the attendings draw themselves up to their full heights (in this case, it's something over six-foot-four), stroke their beards thoughtfully, and then go lay down the law to the obnoxious parties in such a way that no stone is unturned and no ass un-remodeled. It's impressive, and it certainly does make the job easier.

Which brings me to two points I never believed until now: that the relationship between doctors and nurses in the CCU is different, and that CCU nurses are different.

I had good collegial relationships with all the guys and gals up on the floor, don't get me wrong. Ricka and Skippy and Ray and Wolfie and Jack and I were on first-name bases with each other, and we bounced ideas off each other and didn't hesitate to admit when one or the other of us were stumped.

This is much different. Not only am I working much more closely with Ricka and Skippy et al, there's a different feel to how they treat me. Instead of simply asking for information, they want information and input. I'm seen much more as the go-to person for whatever question they have, and I'm expected to have not only the answers, but a rationale for anything that might be going wrong or anything new I want to try. It's intimidating and exciting and very intellectually challenging.

Plus, the nurses are different. It's something I never really understood until now, but it's true. If you want a drug-guide-style run-down of anything you're putting into a patient's body, and how it might work differently if given by mouth rather than intravenously, the nurses I work with now will do that for you, off the tops of their collective heads. They're very, very sharp. They're incredibly bright. Even the dumb ones are brighter than the brightest people I worked with on the floor. They're completely in control of what's going on at any given time, and are the calmest, most no-drama bunch I've ever worked with.

Plus, and this is something specific to our CCU, they all love each other--really and truly. There are no cliques, no backbiting, no competitions over this/that/the other thing. Disagreements--and I've seen a few, on both patient-related and personal matters--are brought out in the open and dealt with right away, and not given time to fester. The folks who precept the noobs like me are obviously enjoying it and fight for the chance to do so.

I ran into a woman I used to work with last night. I hadn't seen her since before I started the internship, and the first thing she said to me was, "Jo! You've lost weight!" She immediately backtracked from that, furrowing her brow, and said, "No, maybe not. You just look *happy*." She said that last in a disbelieving tone of voice.

I *am* happy. I'm very thankful I chanced this, and I wish I had done it years ago. I'm still worried that I won't measure up in class, but I feel like I'm getting a handle on the practice just fine. I'm excited, rather than scared shitless, when I think about finally being let out on my own--it's like walking out on ice you know is safe, but you've convinced yourself might not be: a combination of scared-but-comfortable and pure-dee excited. Every day on the unit, not to put too fine a point on it, is like a first date with somebody you know you already like and click with: all the niggly stuff is already taken care of; you just have to figure out how best you fit together.

Man, I fucking *love* my job.