Friday, April 30, 2004

Some about work, but mostly not

As of today, I am now ACLS qualified. ACLS stands for "Advanced Cardiac Life Support" and means, in English, that if you were unlucky enough to suffer cardiac arrest in my presence, I would (theoretically) be able to bring you back from the brink. Truth is, it's another fancy-schmancy card in my wallet, the fulfillment of a requirement to work on my floor, and license to run around like a headless chicken, but look official while doing it.

Arlene lent me a videotape of Jon Stewart's commentary on the March for Women's Lives. I tried to give it back to her today, unwatched, because I didn't get a chance to see it last night and figured she'd be gone by the time I get back to work on Wednesday. She told me to keep it. "I'll be here in three months anyway," she said, gesturing to her latest surgical site, "getting this stuff...fixed. Watch it. It's not to be missed." She then slid back into Dilaudid-fueled dreamland. I shut the door quietly and went on home.

In non-work news, I (theoretically) have two dates this weekend with Two Different Men. Given that this has never happened before in my lifetime, I feel it necessary to warn everybody that the Apocalypse is coming. I'm also doubting my ability to date more than one person at once.

It's not that I'm crazy about monogamy. After better than a decade of that, I'm running from the word like a rabbit. It's not that I have moral objections to dating around; I figure that if you can manage seeing more than one person in an adult fashion (ie, not playing them off one another in hopes of more stuff or greater protestations of affection) you're free to do so. It's the logistical angle that's worrying me.

My schedule is nuts. So are the schedules of both (presumptive) date-ees. Trying to see them both this weekend while still retaining time for myself started to resemble one of those GRE word problems that involves four people who can't ride the same train at the same time. "If Woman W must see Man A between the hours of ten and six on Sunday, and Man B has only the hours of nine to four on Sunday free, how will Woman W work in a sailing date and brunch? Man A must not be trodden upon by Man B, and Woman W must wear the same clothes for each outing. Show your work."

At least there's no chance of getting them confused. Man A is small, funny, intelligent, and brews his own beer. Man B is immensely tall, funny, introspective, intelligent, and eats mostly raw fruits, vegetables, and soy.

Still...what happens if Man A or Man B gets his schnozz disjointed because he's not Man Only? What if, God forbid, *I* should get my crinolines in a whip because one or both men also wants to date around? Is there some evil lurking vein of jealousy in my nature that didn't show up the entire time I was married? What if I turn into a shorter, less-buxom version of the Woman From Hell? We all know one of her: she's the one who plays our male friends against one another, considers it a point of victory to get new clothes from each of them, and professes herself respectful of all of them, even as they cry on our shoulders about her.

*sheesh* Good thing this didn't happen while I was still in my twenties, or I'd be making rotten stinky mean decisions about everything rather than waiting for things to play out.

It's going to be interesting to see what develops. Perhaps it's a good thing that I'm now ACLS certified. It might come in handy in the future, knowing how to restart your own heart.

Wednesday, April 28, 2004

Things that go squick in the night

Mostly I don't get weirded out or disgusted by anything I see at work. Not any more. I no longer have nightmares about things I've seen.

There are still things that squick me out, though. It's not blood or vomit or the thought of disimpacting somebody who hasn't had a bowel movement in six weeks. It's the little things.

Two days ago I stopped by Arlene's room. Arlene is one of my favorite people. She's the sort of patient you never dread seeing come back; the sort of person you hug when you see them just because they make a balls-out dreadful day much better. She doesn't whine, she's not a junkie, and she sends me funny political cartoons in email. I've never once heard her complain about the complex and long-standing problems she has as the result of being run over by a truck.

I was standing in her room, examining a dressing more out of curiosity than anything else, when she asked what the weirdest thing I'd ever seen was.

"Weirdest looking, or weirdest squicky?" I asked.
"Either, I guess."
"Um....the weirdest was probably the guy with a brain worm."
"What does that mean?"
"He had a worm in his brain."
" actual worm? In his brain?"
"Yep. Encapsulated parasite. Very nasty. They're a result of improper treatment for some sort of parasite that you get from living where there's no water treatment."

I watched as a fine shiver passed over the woman who's had multiple surgeries and joint replacements and borne them without any evidence of squick. I guess different people have different triggers.

One of mine is eyes. The other nurses know not to assign a patient with, say, a fungal infection of the cornea to me. They will, of course, if they have to, but they know I hate it. It's not the every-half-hour eye drops that gets me; it's the appearance of a cornea with a fungal infection. Don't ask me to be more specific.

Another is injuries to the ends of fingers or toes. Chop off a hand in a combine and I'm your pal. Stick a staple under your fingernail or avulse the end of your toe somehow and I'm in a swoon in the corner. My least favorite thing that involves toes is probably bunion surgery, since that entails checking the circulation and health of toes with big pins sticking out of the end of them. I have to steel myself before I walk in the room.

And bone flaps...oy. "Bone Flap Out" is a nice medical way of saying "We did surgery on this guy's brain, and for some reason we had to leave a chunk of his skull out, so don't whack him on that side of the head or let him lie on it for very long, okay?" People with bone flaps out have either very little deformity or huge sunken areas in their skulls--there's hardly ever any in-between. The weirdest *looking* things I've seen involve bone flaps. You'd think there wasn't that much space between the outside of your head and your brain until you've seen somebody who's forehead slopes back, Neanderthal-like, because his frontal skull is in a bucket somewhere.

I have one nurse friend who passes out at the smell of blood. It's a good thing he doesn't work trauma. Another can't stand anything having to do with face lifts. A third flips out and becomes incompetent in the face of rashes. It's amazing to me, sometimes, that we can handle so much and still get stuck on the smallest, strangest things.

A day in the life

Every once in a while I get those days that make me wonder if Mercury is in retrograde, the Moon is in Klutz, and the Universe just generally has it in for me. They're the sort of days that make old nurses cynical. The sort of days that make young nurses stare hollowly at the wall in the bar. The sort of days that, in short, I had two of this week.

Given that I've only worked two days so far this week, I'm not thinking this is a good thing.

I honestly don't remember much of Monday. It was busy--no busier than usual, really--but things got complicated by the one shining thing that stands out in my mind: a patient I got at 1645 from post-op.

Now, normally, people stay down in post-op recovery for several hours at a stretch. They're brought out of the OR to the recovery room, extubated there, and stay there until they're stable. It might be two or three hours before that happens, so there's plenty of time for the recovery nurses to get things done. It's SOP for a patient to arrive to me with a unit of blood hanging and one course of antibiotics finished--at a minimum.

Instead, I got somebody who hadn't had X-rays post-op. Nobody had ordered them. She didn't have any blood running, and no antibiotics. Nobody had gotten that stuff from the bank or pharmacy. She didn't have an ice pack on the operative extremity, anti-DVT booties on, nothing.

When I called the post-op nurse to ask what, exactly, she had done with the patient for almost four hours, she told me she had settled the woman in and then gone to lunch.

(Picture Nurse Jo with her head thrown back, silhouetted against the moon, howling.)

1645-1900 is the busiest time of day. I barely have time to breathe during those two-plus hours, let alone run blood, which requires close, hands-on monitoring. Nor do I have time to call the pharmacy and harass them about antibiotics.

Let's just say I was a Jo-shaped blur for two hours and leave it at that.

Yesterday was no better. I had one patient who couldn't move much and was incontinent, one who couldn't think much and was incontinent and trying to pull out her lines, one who was continent and could think but couldn't talk and couldn't walk, one who was breathing eight times a minute when I walked in to her room (you try it; it's not good), and one who was waiting for surgery and nervous.

Oh. Did I mention that these patients were spread out all over the floor (roomwise, I mean; I didn't just line them up in the hallway, much as I would've liked to), necessitating much walking?

And did I mention that the incontinent, non-moving patient also weighed over three hundred pounds?

So my day went a bit like this: Run down hall. Get Narcan. Administer Narcan to slow breather. Slow breather comes back. Run down hall. Get five other people for lift help. Change bed for 300-lb. non-moving patient. Run down hall. Try and fail to keep confused patient from pulling out her own catheter. Run down hall. Reassure nervous patient. Lather, rinse, repeat. Lather, rinse, repeat. Lather, get the idea.

Here's a tip for all you non-nurses out there: any time you meet a person who works in a hospital in direct patient care, whether they're a patient care tech or an LPN or an RN or whatever, thank them. Don't say, "Gee, you must make a lot of money." We don't, and anyway, it's never what we're worth. Buy that person a drink if you see them staring at the wall in the bar. Offer to rub their feet.

And for God's sake, if you happen to be talking to me, don't pee on yourself.

Sunday, April 25, 2004

Things people say

When you work with sick people all the time, people that don't have the tendency to say things that either bring you up short or make you wish you had a skillet close at hand. Ergo:

A neurology nurse? Boy, you must be really smart.

I put my underwear on backwards today. How smart does that sound?

Seriously, there's nothing about neurology or neurosurgery, from a nursing standpoint, that requires one to be brilliant. Flashes of brilliance and the ability to memorize huge amounts of information help a lot, but you don't have to be consistently amazing.

It takes a special person to be a nurse.

This one always stumps me. If I say, "Yes, it really does" then it sounds as though I'm being snarky, or at the least expecting the other person to bow down and worship my specialness. If I say, "No, not really" then I'm going against the Cult of Nurse, which says that All Nurses Are Special and that we have the Hardest Job In The World.

I'd rather be a nurse than somebody who fixes computer hardware, a veterinarian, a telephone lineman, any flavor of customer support person, a parole officer, a flight attendant, or the person at the other end of the suicide hotline. Those are, to me, the really tough jobs.

You must see a lot of people die.

No, not really. Next question.

Don't you hate the hours?


What about the blood?

There's surprisingly little blood--unless you count the dried kind--in modern floor nursing. This, of course, does not hold true for trauma nurses or for ER nurses. Generally speaking, by the time some poor sot gets to me, the worst they've got is dried ook around an incision line.

Now, the spinal fluid and urine and other, less-nice-things component is still there. We do a lot of work with people who have to have cerebrospinal fluid drained out of their bodies for one reason or another and people who have to have non-healing wounds vacuumed and packed.

But blood? Nah.

I've been having this headache/rash/tingling sensation/other that I'd like to ask you about.

Here's where I need the skillet. It's difficult to explain to people that no, I can't diagnose them; no, I will not take a look at those bumps; no, I will not give them the last of their Hep B vaccinations; and no, I don't know much, if anything, about cardiology.

What I love about my job is the variety. I love the feeling at the end of the day that I've dealt with a number of problems or potential disasters in a competent way. I like knowing that at least once a week, somebody feels better when I'm done with them. I like watching people get better. I love working with very smart, very funny, very dedicated people--attendings, residents, and nurses.

What I hate about my job is that sometimes, despite everybody's best efforts, you lose a patient. When that happens, you do what you can for the body and the family, since you feel like you've somehow failed the person. Sometimes I hate the scheduling: three or four days in a row of this can make you crazy. Most of the time I'm grumped that my work schedule conflicts with that of the man I'm seeing, leading to not-enough-time syndrome.

It balances out. I'm no more special than someone who has a knack for gardening or the person who fixes your car. I just happen to have a knack for joints and brains.

And no, I will not look at that rash, even if you ask me nicely.