Welcome, new residents!

He came out of the isolation room in full isolation gear, strode to the nurses' station, removed one glove, and began to return a page.

"Hey," I said, "Take off that gown and glove and wash your hands before you use the telephone."

"I don't have time for that" he said. "Besides, I took off this glove." He waved an ungloved hand at me.

"Dude. You're not Michael Jackson. Get that gown off, go wash your hands, and don't come out of an isolation room with gear on again" I said, feeling a little growly.

"They let me do this on the cardiac floor!" was his parting shot.

"You gotta be a grown-up over here!" was mine.

*** *** *** *** ***

The neurosurgery residents aren't bad at all. Neither are most of the other residents. All of 'em have been on our unit before, because of the weird residency program we have. It doesn't matter what service you're with; you're going to round with psychiatry, neurology, neurosurgery, or internal med at some point, and that means you'll end up with us.

The two exceptions to that are urology, for some strange reason, and cardiology. And, given that the head of the urology department was a nurse before he was an MD, we don't have too many problems with those residents and things like respect and infection control and signing orders in a timely fashion.

Cardiology, though? Makes me want to tear my hair out.

They're nice people. Really. They're not the arrogant assholes portrayed on popular TV shows. There's not a prima donna in the bunch. They're very hardworking (almost as hardworking as the junior residents on neurosurgery), polite, knowlegeable, thoughtful folks. But they've been spoiled by the nurses on the cardiac unit, who don't care what you do as long as you keep the patient alive.

I, personally, care a whole lot what you do. I'm not going to go through every chart you've touched to make sure you didn't rack an order; I have better things to do, and besides, that's on your watch. And it doesn't make much sense to me to keep one patient in isolation alive if you're going to transfer bits of that isolated bug to other patients and the nurses' station. By the same token, I know a little about drug interactions, but it would probably be a fine idea to consult the pharmacy if you have questions. And, for God's sake, don't attack me because a patient's on a particular antibiotic for which you have a personal antipathy. (Not coincidentally, that was the same resident who didn't take off his isolation gown. Hmmm.)

*** *** *** *** ***

Other than that one service, whom we thankfully don't see much of, things have gone smoothly. We have two new residents in surgery and two in neurology. The surgical residents look, as they all do, about twelve years old. One walks with his arms straight down by his side, peering short-sightedly through granny glasses, with his shoulders a little hunched. I want to feed him sandwiches and pinch his cheeks. The other has such an unfortunate surname that a nickname is superrogatory. That'll save us some time, at least.

The neurology residents may take some getting used to. The senior this time around is a brilliant woman--one of the smartest, most well-rounded people I've ever met--and a total bear to work with. Like a lot of geniuses, she's impatient with us normal folks and doesn't bother to try to hide it. The junior will be a whole lot more pleasant to work with once he gets over his shyness. Speak to him and he jumps. With the patients, though, he's great--he's careful, friendly, explains stuff in English, and never seems to be in a hurry. He's also trilingual in Spanish, Arabic, and English, which will be a huge help. He speaks a smattering of French, Farsi, German, and Russian as well. He's promised to teach me how to cuss in Farsi, which'll be my sixth obscene-word language.

So. All things considered, it's been a better week than I could've hoped for. Nobody's gotten horribly sick, my dehydrated patient with CHF didn't fill her lungs with fluid, and the number of racked orders hasn't been so large that we've had to mount a full-on offensive.

*** *** *** *** ***

In non-work-related news, it's one hundred and bloody four degrees here just now. The projected high for today is 106 to 107. The only things moving are the cicaidas' vocal apparatus. Max is sacked out on the kitchen floor, just in front of the air vent. For those of you without a good idea of what 104 feels like, I offer this: I just went outside and hung up a load of wash on the line. It was scrubs and jackets. After I finished hanging up the last pair of scrub pants, I went back to the first ones I'd hung up and took them down. They were bone-dry.

The kittens, apparently unaffected by the general heat-related malaise, have destroyed a makeup box, my CD player, two shelves full of books, a hot-pan-holder, a box of drill bits, and two stuffed animals (those last are theirs to destroy) in the last three days. I'm going to have to bolt the bookshelves that my grandfather built to the walls, as Notamus is such a fatass he's going to bring them down one of these days.

Friend Elizabeth has a 1949 stove to get rid of. Does anybody want it? It lacks a thermostat for the oven, but is otherwise in good shape. It weighs about three hundred pounds and is currently in Manhattan, Kansas. Anybody in the area from Wichita to KC who might want a vintage stove and oven, please let me know. We'll work something out.

Think you have what it takes to be a nurse? Let's find out!

I've come up with a list of things a person ought to have if they're going to be a nurse. They're not the qualities you'll find in your average Introduction To Nursing Practice course, no--these are real-life skills and personality traits that'll actually help you keep your sanity and your job.

1. A nurse must have the ability to call bullshit without making a Federal case out of it or getting into an argument.

This is a skill that's developed over time. Once, many moons ago, a resident berated me in the presence of a patient. Unfortunately for the resident, he not only flipped his lid, in a "you're going to kill this patient!!" sort of way, but he also was dead wrong. 

What I would do now is take said resident out of the room and tell him once, firmly, that a) he's not to talk that way in front of a patient; b) he's not to talk that way to me again, ever; and c) he read the tubing wrong and was mistaken. Instead, what I did then was try to be a Good Nurse.

I didn't do it over the patient's head, but I tried to somehow make up for the resident's mistake by double-checking everything and then gently approaching him about his mistake. That trick never works with people who are willing to accuse you of incompetence in front of a patient. Calling bullshit immediately, calmly, and without room for argument would've been a much better decision.

2. A nurse must have an unlimited tolerance for management's good ideas.

Which, let's face it, are rarely good ideas. Take, for instance, our TEAM initiative, which I've not talked about much lately. I haven't talked about it much because, frankly, it was a flaming failure and a giant clusterfuck, and pretty much has sunk below the surface.

Anyway. TEAM is an acronym that stood for "Together Everyone Assmunches Management". Or something like that. I don't recall. The purpose of the TEAM initiative was to recognize Stellar Team Players in the Hospital System, especially as it related to Customer Service. 

What actually happened was this: certain players solicited positive comments and notes and surveys (filled out in-house while the patient was still there) and so got good CS reviews regardless of their actual level of skill or competence. Other players made pacts with employees on their own and other floors to fill out surveys and send nice notes to Management whenever one of their bunch did something even vaguely out of the ordinary ("She didn't spit on me when I was lying in the ditch! What a doll!"). 

Management, being intelligent, took only a year and a half to notice that the same people who kept getting really, really crappy performance reviews were the ones who got stellar TEAM scores...and that the same people kept winning the TEAM Player awards over and over. So TEAM quietly went under after Management's attempt to clean it up failed.

3. A nurse must have a tin ear and no sense of smell.

This is becoming much more important as the focus on Customer Service increases. In an attempt to make hospitals less hospital-like, Muzak is now piped in to most patient care areas, all lobbies, and three-quarters of the cafeterias in hospitals across the country. If you think competing television shows at electronics stores are bad, try competing Muzak in the lobby/cafeteria area/outside patio at Sunnydale General. That stuff gets stuck in your right temporal lobe and replays until you want to take a DeWalt to your own head.

Also, in an attempt to make hospitals less hospital-like, a number of places, Sunnydale included, are laying carpet in the hallways and rooms of the acute-care floors. Now, I don't know about you, but my first instinct when it comes to places that people are likely to poop, bleed, barf, and pee unexpectedly is not to carpet it. Cover it with plastic, maybe, or tile, but not carpet. Besides the smell factor, the carpet will hold all the nasty bacteria that you can drop on it, and breed more--and make it nearly impossible to disinfect an isolation room. 

Which means that we're now getting designated isolation rooms. See number two above.

4. A nurse must be unafraid of bladder rupture, megacolon, or severe dehydration.

Let's face it, people: as the economy continues its slow slide into chaos, even nursing will start being a non-growth career. As such, hospital managements will work out ways to get even more work out of fewer people. Some of my colleagues at other hospitals already have designated times for bathroom breaks and little tags on their IDs that allow them to be tracked (just in case they cheat and go pee early, I guess). Pretty soon, just having a big bladder won't be enough. You'll have to court infection and rupture with a devil-may-care attitude and a smile, all while attending to the Customer Service needs of your Guests.

5. A nurse must have a cast-iron stomach.

As the focus on budget increases and costs rise, what's one of the first things to go (besides staffing, supplies, and support)? Food. And not food service for patients--which is a good thing, as you kind of need to eat when you're recovering from surgery. Instead, food service for employees gets more expensive and less reliable. I recently paid seven dollars for a salad that was brown in spots and rotten in others. When I took it back to the cafeteria, I was told that I couldn't get a refund; instead, I could take my pick of other salads on the salad line. 

I'm brown-bagging it from here on out.

So: Can you do it? Can you be a nurse? Do you have the skills, the balls, the brains, and the patience? Or would you rather go into accounting, or waste management, or hooking, or--worst of all--be a hospital manager?

Jo Muses: The Love/Hate Edition

I'm reading Heat by Bill Buford right now, partly because I mistook "Buford" for "Bryson" and thought, "Wow! Bill Bryson's written a book on learning to cook?" and partly because it sounded interesting--a blow-by-blow account of learning to be a chef by doing, rather than by schooling.

One of the most interesting bits in the book describes the process of learning to use a knife as though it's an extension of your fingers rather than something you pick up and put down. ChefBoy has, of course, this talent. I have the same talent--all nurses do--but in a different way.

Think of how you learned to start an IV. (New nurses and students, listen up! This will be heartening, I promise.) At first, you had to think about every step in the process, and things like tape felt foreign--getting stuck to every conceivable surface except the one you were aiming for; flushes went on the floor, gloves seemed too thick or too loose. Then, one day, it all came together, and what's more, the IV needle itself suddenly became something you could feel *through*--you could tell when you hit the vein dead on or when you'd scooted to the side of it.

Buford describes this as analogous to the process of learning to throw a ball--learning like a child, he calls it--and that's exactly what you're doing when you learn how exactly to juggle IV bags, tubing, medications, piggyback setups, needles, flushes, and everything else as though you've grown a third hand. It's visual and physical rather than primarily about reading and memorizing, and it uses a totally different part of your brain. 

I love that explanation.

Something I hate: Being tossed--lobbed, really--gently under the bus by somebody who's made an amazing, stellar, incredible, obvious, historical, unbelievable screwup. I won't go into detail, but suffice to say: Doctor ResidentBoy, if you fuck up and expect to blame me for your fuckup, not only will my boss not believe you, but *your* boss won't believe you. I know what you did was embarrassing, but it's not nearly as embarrassing as knowing that I know what you tried to do. 

I know what you did last weekend. And I will continue to smile and be helpful and pleasant and take care of your patients the best way I know how, but if you dance too close to the cliff again, I will not haul your ass back from the precipice. Have a nice day!

The first rule of nursing, after "If you have to jack with it, it's wrong" is If You Screw Up, Admit It And Move On. People screw up, okay? Nobody's going to remember that particular screwup in a year--or if they do, they'll remember it in a hazy, amusing, gosh-wasn't-that-funny kind of way. 

That is also the first rule of medicine, right after "Do no harm."

Another thing I love: Waking up in the morning on the first really cool day of fall, with all the windows open, and dogs and cats sprawled everywhere on and off the bed, and realizing that I do not have to get out from under the covers and work out or go to work. It's totally different from checking in the mirror to see exactly how far down the tire tracks from that bus go.