Friday, August 13, 2010

Fools! I'll destroy them all!*

"How'd you feel when you finished your internship?" the new girl asked, a little cautiously.

"Like a complete moron," I said. "Like I didn't know shit and I was a danger to myself and others."

It's true: no matter how experienced you are at Thing One, when you start doing Thing Two, you go from being a light in the field to being a mud-covered, vaguely clumsy, not-terribly-smart lump of nurse-goo. There are some things you can do well because you've been doing them for years, but everything's all mixed up in your head, and suddenly you can't remember how to start an IV.

It's an interesting sensation, when your brain starts to slot new information in with the older stuff. You realize not only how much you've forgotten, but how much *stuff* is in there in the first place. The sheer complexity of what's in your brain-box becomes more apparent. It's a little disconcerting.

We've all been doing that a lot lately, that genius-to-lump transformation. Because of that bugaboo, Staffing Issues, everybody's been going everywhere and doing everything. Why on earth any Mangler thinks it's a good idea to send a neuro nurse to a heart transplant unit is beyond me, but it's happening now, to fill gaps in the CVCCU's staffing. (I haven't gone--yet--thank God.)

I've been working for the last five days in both the neuro CCU and the surgical CCU. The latter is much more fast-paced, being an established unit, and you really have to be sharp to keep up. I had forgotten how much *stuff* I had to fit into my head in the course of a day there. Just remembering the drips I have to remember is challenging. Esmolol? Er, okay. Vec? Sure....let me just, uh, get this quick-reference sheet over here.

At the same time, I've been watching my colleagues who are used to dealing with people who are immediately post-craniotomy feel off-balance when they deal with an acute embolic stroke, because the protocols are completely opposite. If you bleed into your brain, we'll keep your head high and your blood pressure low. If you've clotted off a distribution of your MCA, we'll do the exact opposite. (I remember the first time I saw another nurse drop the head and raise the legs of a patient who was having TIA symptoms. It was as though I was in a different universe, and I felt like an idiot.)

Perhaps the biggest difference in my unit is that you can't rely on machines to tell you how a patient's doing. If you have a post-op patient who's intubated, paralyzed, sedated, and on a vent, you spend a lot of time titrating this or that drip to keep their heart rate and blood pressure within defined limits. A CT scan will tell you that X or Y is healing well and that there's no acute bleeding into the neck/abdomen/brain. An arterial line and a CVP line and a Swan will let you know if something is going wonky before the patient even feels it.

In my unit? You have to use your eyes, and your ears, and your hands. CT scans won't tell you much about a clot-ridden brain, except that there's no free blood in there. MRIs will, but nine of ten of our patients can't tolerate an MRI. Subtle changes in hand and foot strength, differences in the level of ataxia, new speech changes--those are what you look for when you're on my territory.

A machine won't tell you if a Star hasn't held closure, or if an angio site's gone bad and has put the patient's leg in danger, but you can look and touch (with ungloved hands, even, to get a sense of temperature) and ask and observe.

My shrink, Doctor Dink, once said that he went into neurology and later psychiatry because it was the closest he could get to Ye Olde-Tyme Doctoring. Well, it's the same with nursing.

And moving from Let Me See You Do This Ataxia Test and Repeat After Me to Titrate That Drip and Level This Line, Willya is like trading your horse-and-buggy for a racecar.

It's fun, and I'm certainly not bored or tired, but I have three more days of this to go this week and I'm not sure how much more moronic I can feel.

*You'll note that the title of this post has nothing to do with the content. I've just always really, really wanted to use those words as a title, is all.


Anonymous said...

Ref title, there's a t-shirt for that...

I really enjoy your blog, thank you!

Susan said...

I'm about to go from my first job on a med/surg unit to my second job (15 months later...) on a burn unit. I finally feel like I'm not a total idiot (always I certainly have my moments and don't know much at all in the grand scheme of things), and now it's time to knock myself back down the totem pole again. Should be exciting and just a tad bit terrifying...but like other nurses have told me, if you don't have that little fear in the back of your head, you may just be a little too confident.

Jenn said...

And that is why it is a great title!

RehabNurse said...

Jo, I'm with week only has four more days.

messymimi said...

Glad you're enjoying/enduring the change and the pace, and hope you get back into your own territory soon, practicing medicine with your head and heart, not just technology.

Urbie said...

Hi, Jo -- I don't do health care, but some of what you describe sounds familiar, from being a professional trombonist (in the sense that I get paid to play, not that I make a living at it) taking beginning piano lessons, and going from being a senior tech writer to an entry-level bookkeeper! Moronicity prevails! :-D