Saturday, May 19, 2012

I'm all right; don't nobody worry 'bout me.

Well, not really.

This week we had a party for Neuroscience Nurse's Day, or Week, or Something Along Those Lines. I was interested to see that the woman who holds herself out as the Director of Neuroscience Nursing (a few years' experience as an ortho rehab nurse, followed by a decade in manglement) wasn't there. Ironic, fitting, all that stuff.

I was more bitter than usual these days. *Everything* pissed me off, even stuff that could've worked to my advantage. Good things pissed me off just as much as bad things, and wishy-washy things pissed me off most of all.

For instance, I work with two mid-levels. One is fantastic. The other is a clueless tinpot tyrant with an ego problem. Fantastic Midlevel and Fantastic Case Manager and I had been working on med-surg to rehab placement for a patient under a return agreement with another hospital (his case is complex) since the patient was admitted almost a month ago. It had been arranged that Sweet Complex Guy would go back to his original hospital, since he's a resident of that particular county and can therefore get services for which bill collectors won't hound him. (Some counties in Texas do it right.)

At the absolutely last possible second--and I mean after the ambulance had been arranged (difficult, because he required vasoactives while en route)--Clueless Tinpot stopped Sweet Complex Guy's transfer. The reason? He was afraid that "SCG would end up rotting in a med-surg bed and his family wouldn't be taught what they need to know." Clueless Tinpot decided to try for a "charity bed" in our facility.

As Fantastic Rehab Manager said, "No bed here is a charity bed. I have explained this to Clueless Tinpot Tyrant over and over. Even if that patient meets all of our specifications for discount services, he'll still have people calling him constantly, and his credit will be ruined by the bills."

None of this, I just realized, will make any sense to you unless you're one of the medical club, so let me put it in English:

We had a patient transferred to us by a county facility. That hospital paid all of the patient's bills while he was with us, with the understanding that he would be sent back once we were done with our peculiarly specialized care. The sending facility has systems in place to provide free, quality care to this dude, provided that we sent him back needing specific things.

And Tinpot Tyrant fucked it up. Not only will my nice, sweet, complex-but-promising dude be two hours from his family, he'll have to deal with the demands of our billing department (not fun; I can testify that they screw things up fairly regularly) for the next two years or so.

And I have to deal with this guy daily. Between making sure that he actually writes orders that he's going to yell at us later for not carrying out and being certain that his orders don't suck, I'm already tired. He's slated for a manglement and marketing job soon, and I hope his transition is smooth and speedy.

Seriously: If you have somebody on a high-sodium diet and six additional grams of sodium tablets a day, and they drop their sodium from 139 to 135 after you lower their hot-salt drip for six hours, would *you* write an order discontinuing that drip immediately?

I thought not. Especially if you want to keep their sodium between 140 and 150 to keep their brain from swelling. Three-percent and 23% saline are useful in limited amounts, but they're useful.

Okay. Enough with the overmedical jive.

I miss my dog. He wasn't my baby, or my furbaby; he was my buddy. We were intellectual equals, no question. He was a stubborn asshole at times, but I never knew his judgement to be off. It's very weird, being here without him snoring and shedding and licking Flashes all over. I step over a body that isn't there, in the middle of the night, when I have to pee. My brain twitches toward the back door every day at dinnertime.

I haven't had the vadge yet to go out to the back yard. Yesterday, I thought maybe I could do it today. Now I'm thinking I could maybe manage it tomorrow.

Thank you all for your kind thoughts. They're a huge, huge comfort, even if I can't respond to everybody individually.

Now Flashes wants 'tentions. I'm going to give him some skritches and heat up beans for dinner.


Lynda Halliger Otvos (Lynda M O) said...

So, I wonder if your idiot doctor went to the same school as Amanda Trujillo's hissy-fitting surgeon !~!~

jimbo26 said...

Sounds just like my sister ( God rest her soul ) , a pain in the arse but with a heart of gold ) . Lol .

thirdDegreeNurse said...

I can't offer anything stronger than a "hang in there, Jo." My docs are 99.9 percent fantastic and they listen to nurses' advice. I'll light a candle for you. Keep the beat. Those patients need you.

Anonymous said...

Thinking of your and your doggie. And sorry about the midlevel tinpot.

rebekah said...

I don't think my post below ever made it on (probably because I can't read those stupid security words!), but know that I'm sending heartfelt thoughts to you. After Foto died, I would constantly check the water bowl that wasn't there, and imagine clickety-clack toenails on the hardwood floors. They are such HUGE parts of our hearts, and it godblessed hurts like no other pain. Hugs to {{{{Yo}}}

Allison said...

The level of ass-hattery in the world just never ceases to amaze me. After spending years with those people, who invariably are promoted up the management chain to so they can spread misery everywhere, I can only offer my sympathy. The part about the high sodium to keep brain from swelling was interesting. Thanks for that.

Jen ♥ said...

Ditto on 'anonymous' above me.

I hugged my pup extra tight this weekend & spoiled her a little more than usual.

Hope things get better on all fronts.

Just My 2¢ said...

Sorry to hear about the idjits at work. At my employer, I thing it's a requirement that you be an asshole to make Vice President.

Max left a big, empty, quiet place in your life. My dalmatian/pointer is 14 years old and way overdue for departure. I'm hoping and praying that he dies as easily as Max. He was a Good Dog. BTW, there's very good theology that all dogs really do go to Heaven.

Penny Mitchell said...

I'm so sorry about the crap at work. "Sorry" doesn't even begin to cover your Max-less heart. ((((((((((Jo))))))))))

Middle-aged Diva (Carol) said...

I can't look at that photo of Max without tearing up. What a gorgeous, proud dog he was!

My older dog is 14 and just got over 3 weeks of intestinal stuff. Last year our other 14yr old was dx with liver cancer and told us it was her time.

Max deserved his peaceful passing. They all do. Including him in my doggie prayers. And you in my human ones.

Rosanna said...

When the Staff Nurse can clearly see that the light at the end of her patient's/patients' Situational Tunnel is a TRAIN (*duh*, haha!!); but the Nurse Manager, (or, in your legitimate case, Mid-Level), either can't............ or, worse, flatly effin' refuses to!!............ well, Jo, what should we say again, "HELLO, NURSING!!"??!! (This definitely is *not all* Nurse Managers or Mid-Levels, though, of course).

So, our large Clinic workplace had only #1 EKG machine, which normally would (but not really) be "cope-able," except that sometimes middle-aged males, (i.e., employed and working on/in the surrounding grounds/buildings), would "wander in"............ clammy............ ashen............ and with chest pains. Fortunately, during those rare times, our one EKG machine was always in good working order; and we didn't have to use our Crash Cart before *STAT* Ambulance-w/-Paramedic Transport to the nearby Medical Center.

The time our one EKG machine WAS "down," however, was when............ a Varsity athlete, (i.e., on Full Scholarship), needed an urgent, but non-emergency, EKG. The physician *D.E.M.A.N.D.E.D.* to know WHY, exactly, I "couldn't do an EKG."

Soooo, when I i.n.n.o.c.e.n.t.l.y. said to him that we nurses were TOLD, in no uncertain terms, that............ *W.*E.*............ should just "make do"............ with only #1 EKG machine............ Mt. Vesuvius E.X.P.L.O.D.E.D., for the second catastrophic time since AD 79 ............ not 5.6 miles east of Naples............ but *IN* the~~~(totally unexpecting, amazingly, because I had given her a gentle, "Generic Pre-Strike Warning," but I was condescendingly discounted, though!!)~~~Nurse Manager's Office.

Subsequently, there was never even "one single word" said to me by the NM; but............ "f.o.r.e.v.e.r.m.o.r.e."............ (and after we Staff Nurses had cleared-out the acrid smoke, and dealt with the lava flow comin' outta our NM's Office, haha!!)............ we always had **#2** working EKG machines IN our large Clinic!!

This type of Action Plan really isn't my "style," you know, but when all............ (and I *do* mean A.L.L.!!)............ else has failed; then............ "SOME times"............ (i.e., actually~~sadly~~more than "some times" in Nursing, as you know, Jo)............

terri c said...

Pissed-offness and fatigue are normal responses to (1) being forced to deal with blithering idiots and (2) grief. You are batting two for two. I'm so sorry. Your idiot du jour is SUCH an idiot. Hang in there.

danielle said...

I still see my Jack in dark corners of the house in early mornings, and 'hear' him click clacking around....the same with Althea. But that is getting ok to deal with as each day goes on. As will yours. What I do miss is the absolute un-equaled happiness that these family members showed when I walked in the door....altho hubby is usually glad to see me, it is still not quite the same!

TheSchaft said...

The good news is nothing lasts forever.

The bad news is nothing lasts forever.

Hang in there.

Anonymous said...

I look forward to your next post........................
I like the idea of hanging in there! Kent

Middle-aged Diva (Carol) said...

You have had one bitch of a year. I know the feeling of missing a furry buddy. Once in a while I look at my current two and dread the day. Grief: Aint no way around it but through and I sure am sorry for that. Blessings to you from me, my hubby and my two furbabies.

Anonymous said...

Have you given up your blog ?