Monday, July 27, 2009

It's a weird job.

Fears. Everybody has them.

My pals at work and I agree: if somebody has an aneurysm blow right there on the floor, we're not coding that person. We'll simply step over them and complain about being short-staffed again. If I'm unlucky enough to be "saved" when whatever I have in my brain goes kaplooey, then there're a couple of sympathetic MDs I work with who'll be up to the plate with morphine, potassium, benzos, and insulin--and a score of sympathetic RNs lined up behind 'em with pillows in case that doesn't work.

We do not kid about this. I am deadly serious about wanting to go toward the light when my time comes, and the friends I have through work are deadly serious about it, too. We see enough people who are kept alive after something catastrophic happens, only to die of something infinitely worse, like bedsores or pneumonia or just plain boredom.

The one fear I do have, even after all this time, is a glioma. I guess it's not as bad when you're going through it, since by the time you know you have one, it's pretty much too late. Your brain just sort of...goes, and eventually you quit caring, or even knowing that you ever cared about what's happening to you. I still am scared shitless of glioma, though, to the point that I have nightmares about people I love getting them, and I'm unable to take care of them.

Jokes. Everybody makes 'em.

We joke about everything. It's a running gag on the unit that anybody who tastes my cooking will immediately get in line to marry* (or at least discreetly support) me; I am the Butter Whore. It's also expected that somebody will crack a joke in the wake of a failed code ("What's green and fuzzy..."). The jokes mostly have to do with sex or addiction or a combination of the two. If a resident asks how I'm doing as I walk on the floor of a morning, the answer is always "Drunk. What do you think?" If we don't have the correct size gloves for a particular procedure, the gag is that the nurse is hung-over... ... ...AGAIN.

And, when one resident complemented me on having the entire setup for an emergency skull-drilling set up the first time out, he phrased it as, "Gosh! It's always so easy with you, Jo." To which I replied, not being a slouch, "You're not the first man who's said that."

Probably would've gone over better had his attending not been in the room, but whatever.

It's a weird combination of mid-twenties residents and perimenopausal nurses that sets up this dynamic. It's also something you won't find in most other hospitals; from the stories other nurses tell me, any given interaction between a resident and a nurse at our facility would result in a lawsuit at any other. The only rule is No Touching, and even that is broken when a patient codes unexpectedly and you need a hug.

Complexes: we nurture them.

I work with an incredible bunch of people. Everyone is at least very, very smart; the people who are geniuses outnumber those of us who are simply brilliant by at least three to one. Yet, in all the people I've worked with over the years, I've only come across one case of Insurmountable Ego, and that wasn't a neurosurgery resident.

As a result, we foster complexes among ourselves. Am I good enough? Am I fast enough? Can I get faster? Can I get smarter? What am I missing?

If you're the nurse for a patient on whom any service is rounding, be it otolaryngology, neurosurgery, or general surg, you'd better have every single bit of trivia about that patient on the tip of your tongue. Not just the potassium levels and hematocrits from the last two days, but everything from the last week needs to be on your mind: "This patient's sodium was 119 on Thursday, but with a fluid restriction of 1 liter and a free water restriction of 300 cc's, we've gotten him to 133 as of this morning at 0500."

Outstanding work: We reward it.

The most outstanding work you do on our unit won't be compensated with a raise (in these tough economic times) or a TEAM PLAYA pin (since that went the way of all flesh); rather, you'll hear an attending say, when he's not aware you're just outside the room, "I have no worries about you when Jo is taking care of you. She's one of the best nurses I've ever worked with."

My own complexes lead me to dispute that, but it was nice to hear anyhow.

And it's also nice that the surgeons see us as people, and we them, and not just as professionals. When Kim's wedding invitation went up on the bulletin board in the locker room, we all gathered 'round to jibe her about how we were going to caravan to New Mexico in hippie vans and crash her reception. When BoBo's mom died, far too early of something we ought to have been able to fix, we all rallied 'round with casseroles, cards, and a money tree. (That last is a Southern thing.) It's because we work together well, without ego or bullshit, that we can do that.

It's marvelous beyond expression when the patient we helped heal from something awful remembers us every year on the anniversary of his discharge and sends us flowers (one bunch for every nurse on the floor, zut alors!) and a tray of deli meats and cheeses. It's equally amazing when a former patient sends us the birth announcement of the child we all doubted would ever be born.

If you're a new nurse, or an old, bitter nurse in a crappy situation, look at how the people interact when you visit a possible employer. Notice if they say hello and ask when you might start. See if they look happy. Ponder how they address each other.

In ten million lifetimes, I could not have wished for a better work environment. Even with the cliquish, crappy behavior of some of my coworkers, even with Manglement screwing up our best-laid plans, it is still the best. place. ever. to work.

Now, if I can just net me a bottle of vodka and an empty elevator shaft, with that cute new guy from Orthotics... ... ...

(*line forms to the left. No pushing, please. And the first spot is already reserved.)


Reality Rounds said...

It does sound like a great place to work. As corny as it sounds, the "culture" of your unit is set up great. Bad cultures, like nurses not helping each other, doctors demanding to be called "doctor", management being unsympathetic, etc, are very hard to break. You should thank your lucky stars.

Nurse Sourcer said...

This sounds like a dream place - like a fairy tale we all know exists, but is so hard to find! Cheers, Julie

Joy K. said...

I can't make "what's green and fuzzy..." fit into an addiction joke, but trying to make it the beginning of a sex joke is pretty horrifying, too.

chris t. said...

I've worked at a place like that. New management and an influx of drug addicted nurses ruined it. All the great nurses left. my best friend, a nurse co-worker, had a "fell right there" aneurysms. she thankfully survived with no long term deficits at all. Back to work and still the best nurse ever. The only problem she had was for about a week she could only say "fat fucking bitch". It was her answer to every question posed. Come to find out it was because the nurse who witnessed her fall to the floor when the aneurysm burst kept yelling at her to get up off the floor and quit faking. We laugh at her all the time about it now. anytime stress hits, we just say f-f-bitch.