Monday, January 25, 2010

I need some friends in Japan.

Seriously.

I've adjusted well to this night-shift thing, but it's frustrating to be awake at 3:30 in the morning and not be able to interact with anybody else. Normally, I'd spend days off at the used bookstore or the coffeeshop or at the dog park, but all of those places are closed overnight (except the coffeeshop, and who wants to be in a small room with hookahs going at oh-dark-thirty?).

So I've worked up a couple of projects to keep me from going stir-crazy. Nothing like painting the kitchen cabinets (sadly) or mowing the yard (more on that in a minute), but projects. To wit:

First, a review of basic A&P. I've been doing brains and spines so long that I've forgotten what happens in the belly and kidneys. The review we got during internship classes was nice, but not enough. If anybody has any good A&P books to recommend, please leave them in the comments.

Second, physics. I was reminded tonight of the fact that subatomic particles that have begun to dance with one another will continue that dance, even if they're separated by the length of the universe. That fact blew my mind the first time I heard it and charmed me this time; I've decided to start on basic physics. And re-read Bill Bryson's book on Everything while I'm at it. (I only got three-quarters of the way through the last time.) Please do recommend physics-for-the-general-reader books in the comments as well.

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The funny thing about working nights is that you discover how many people have done it, and how many people are willing to give you advice about it. Pastor Paul next door did an overnight shift a year ago on a crisis line run by his church; as a result, he has lots of tips on how to get through hours of boredom punctuated by moments of intense activity. He offered to lend me his miner's helmet-with-light so that I can mow the lawn in the middle of the night come summer. He did it last year; we both have Neuton mowers, which sound like nothing more than a large box fan on "high", so it's not going to annoy anybody.

The Brother In Beer is working nights these days, too. It's harder on him than it is on me; he's got a crazy schedule that alternates short shifts with long ones. The nice thing about that is that when I get home at 0730 and crack open a pale ale, he's got his chat window open and is doing the same thing.

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If you need a giggle, check this out: Medical Acronyms and Doctors' Slang. I snickered most of the way through the page, then came out with things I plan to use at the first opportunity, like "acute lead poisoning" and "foreverectomy".

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In non-nursing-related news, I have birthday plans thanks to my pals in BFE. The way I spent Thanksgiving will be the way I spend my 40th, huzzah, with the addition of a space heater and a down comforter. The cabins out at La Ranchita Skankola are unheated, and it gets cold at night way out west of here. There will be a barbecued goat, some tiramisu, probably plenty of tequila, and possibly some dancing. I plan to stay up late, sleep late in the morning, and drink boiled coffee. The Brilliant Friend has promised much fun; her boyfriend cherishes hopes of setting me up with his brother. It should be a good weekend.

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Finally, finally, one of my patients was allowed to die this week.

I understand that families have a hard time letting go--that is, I understand in an intellectual way, not having been there myself yet--but this time was horrifying. When you develop a syndrome that barely has a name and that has only been recorded four times previously, all four of which have been fatal, the assumption should be that we 1) won't know much about what's going on, and 2) won't be able to stop it.

It's bad at any time to not be able to help, but it's worse when the person who's sick is eighteen and full of promise.

We ran every drip we could think of to keep her pressures up, coded her seven times in one shift, reset her vent every two hours or so to keep her tidal volumes up, and finally were allowed to extubate her. She died in less than three minutes.

I heard a poet say tonight on the Beeb: "It's difficult to write about a cataclysm and be convincing." The same handicap applies when you're trying to tell the story of somebody young and brilliant and vivacious, who's hit by an unfortunate over-reaction of her own body to an infection that she got when she was a child. I could tell you about how her sense of humor disappeared as she got sicker, or how she got more and more worried about her mother coming to visit, or even how her father and mother--estranged for a decade--sat together on the couch in her room, but it wouldn't be convincing.

At the end, when she was still able to talk (before she was intubated), she was earnest. Everything she said was without unnecessary verbiage or drama; every word counted. Movement was a luxury, so even lifting a hand took on a significance it wouldn't have in the Well World. Yet she still thanked us for little things, like fluffing a pillow or turning her when she couldn't do it herself. She still had the strength to be concerned about her mother seeing her this sick. She still said, "Goodnight" and "Have a good nap" when I went home in the morning.

Sometimes the smalltalk, the passing remarks, become so important. They're the things that keep you connected to a world you no longer live in.

Goodnight, child. Have a good nap.

17 comments:

StorytellERdoc said...

Great post. I have to laugh about who to talk to at 3:30 in the am...we use Radiology Nighthawk for overnight reads, and you can always call them in the middle of the night to not only talk to someone, but also close your eyes and soak in that accent! LOL

Good day, mate!

pelican said...

I haven't gotten to this yet

http://dogphysics.com/

but I've read Chad's blog for a couple years, and he's a good teacher. It's next on my list.

Brian said...

For physics book recommendations: have you read Stephen Hawking's books? "A Brief History of Time" is the famous classic; I think everybody should read that one. "Black Holes and Baby Universes" is less well-known but is still well worth the time.

Another favorite of mine is Feynman. If you want the physics, read "Six Easy Pieces" and then "Six Not So Easy Pieces," which are layman-friendly chunks out of a larger set. (The full thing is "The Feynman Lectures on Physics," but that's a full-on textbook so you probably don't want it.)

For less on physics and more about the physicist, read "Surely You're Joking, Mr. Feynman." It's semi-autobiographical, and awesome.

me said...

I'm so sorry about your young pt. ~ that always sucks big time... Bless you for the little things.

Have a wonderful birthday!!

Chef Green said...

Heartbreakingly beautiful, Jo.

Rebecca said...

Give the strange night-shift hookah people a chance... I'm one of them. :) Seriously, we're not that bad. The place I go is on a college campus, so most of us just sit and study.
Then again, I was made for night shift. I'm just weird to begin with. I hope you get something worked out that makes you happy though!

Julia said...

Have you read any Neil Degrass Tyson? Astrophysics for masses!

CervixenVT said...

How often have I used the words "allowing him/her to let go" with families...explained that if there is going to be a miracle it could happen irrespective of our vents and drips and scans, so could we just stop already...only to have trouble seeing the road on my way home that morning for all the tears clouding my vision.
As a PICU nurse, I was present at the death of more children then I have seen born in my rome now as a L&D nurse. And I still remember the beautiful souls I got to meet inside some of those very sick little bodies. Nicely put, all of the above. You honored the spirit of the one who is gone beautifully.
And, as someone who has worked nights for 13 years, let me tell you how to do it: however the hell you want :-). I took up knitting, which allows me to be productive and connected to a new community. Also, I had two kids which provided me with a plethora of laundry to deal with at 3am. Oh, and I like a good Rx for Ambien.

Anonymous said...

Physics book: A Cartoon Guide to Physics ... I believe that is the correct title. Helped me through General Physics I & II when I thought a Calculus based biochemistry and molecular biology major was a good idea many moons ago. Too bad I changed my mind many times and never finished college. Once again downsized & unemployed I do enjoy your blog and I am inspired. The high unemployment and "recession" may actually help send this single mom to nursing school. (I told my counselor at the state reemployment office if she approves nursing this is a career that will keep me employed for at least the next 30 years)

Nancy said...

I recommend this site: http://twistedphysics.typepad.com/

It's very well written and goes to places you'd never expect.

Kimberley said...

One of my favorite novelists claims that the key to great writing is to: make em' laugh, make em' cry, and they always come back for more. You managed to do them both in one poignant post. WOW!

I am a free-lance writer turned brand spanking new nursing school student! (I'm only in my 3rd week of A&P 1!!!!) I stumbled across your blog when I became obsessed with all things nursey,and I'm so glad I did...even though some of your terminology evades me--for now...:)

Looking forward to learning more...

rosmarina said...

My physics teacher husband recommends Brian Greene's books and NOVA special. He writes about subatomic particles and string theory in a way that's accessible and accurate.

Feynman's books are really entertaining, but from what I remember (it's been a while) are more anecdotes from his life than physics per se.

The Cartoon Guide to Physics (Larry Gonick?) is also one my husband likes. There's also a few volumes of The Cartoon HIstory of the Universe by the same guy. Very fun to read, and you learn a lot. I teach Greek and Roman history and liked the way he handled those periods.

Maha said...

If you're looking for a really good, comprehensive A&P book, give Fundamentals of Anatomy and Physiology by Frederic Martini. I have the 5th edition and have been using it since my undergrad days. I keep going back to it over and over again. The text is straightforward, the diagrams are extremely detailed (but aren't overwhelming) and the end of chapter reviews are very helpful.

I've always been a night person so I get a lot of my workouts in at around 0100! A lot of cooking and cleaning gets done in the middle of the night as well. Keep connected to your fellow night shifters. They'll keep you from going completely insane (though not partially insane).

I'm really sorry to hear about your patient.

Loki said...

I'm a nursing student who also loves particle physics. I recently decided to understand quantum interaction and the Standard Model. The book "Deep Down Things - The breathtaking beauty of particle physics" written by Bruce A. Schumm is an excellent work for the non-field individual. It explains in clear language the theory behind and interactions between subatomic and subnuclear particles. Its an awesome book and is well worth your time, by page 58 I finally had a grasp on quantum field theory. The book is an awesome look into the beauty and simplicity of nature.

P.S. Very light on the math, as in, you needed to have only completed algebra 2 to get most of it, and what requires more is explained adeptly.


As for your patient, huge bummer. I hope her family remembers her fondly.

JacquiBee said...

We here in New Zealand are up now, does that help? We are 17 Hours behind the US west coast. Have fun with your efforts to understand the mysteries of the universe. I do like Bill Bryson :)

Mr. C. said...

I am just one hour ahead of Japan here in Saipan. Feel free to write, or whatever. Geeze, I can't remember the name of the book...too tired... but go to ICUfaqs.org and get that book. It is AWESOME plain talk for those just getting into the units... "Notes on ICU nursing" is the name of the book. Zzzzzz

GingerJar said...

Things to do at 3 a.m.:

WAL-MART. I actually used to think up things to buy ... just so I'd have a reason to go to the only place open at 3 a.m. Now face-book , myspace, and blogospere are good. I'm always up on my nights off...and I think nothing of having a breakfast beer.