I Pity The Fool: A Team versus B Team

Movin' Meat has a post up from a week or so ago about what it's like to work with the B Team of nurses.

It got me thinking about the differences between the B and A teams. I've been travelling a lot this past month to different units as staffing gets and stays wonky, and I've definitely had to adjust to the B teams on my own and other units. (Everybody thinks they're on the A team, but I think perhaps I'm not too far off-base with my thinking.) Some of the differences I've noticed:

1. With the B Team, shit simply does not get done.

Illustration: Two weeks ago I floated to another unit. Two hours prior to shift change, one of the day nurses had called in, and the night charge had not called anyone else to try to fill the spot. That's the charge's responsibility, working in tandem with staffing, at our facility. So I showed up, the floor was short-staffed as hell, and we all started with eight high-acuity med/surg patients.

Illustration Numero Dos: While on yet another unit, I got report on a postop patient who had a hemoglobin of 6 and a crit of 24, a blood pressure of 80/48, and a temp of 94.3F. The reporting nurse said, "You'll have to run two units of blood, stat." Uh, no, I replied, since the patient doesn't meet transfer criteria; you'll have to be the one running the blood. "But this guy's been down here four hours already, and I have two more patients coming in!" was the reply. (crickets...crickets) Quick cluebat: If you're postopping a patient for four hours, and he's your only patient during that time, and he's not stable, you have time to run blood. No, really. You do. Trust me.

Illustration Number C, or How It Should Be Done (The A Team): One week postop, a guy who'd had a radical prostatectomy showed up on the floor hemorrhaging from his penis, sweaty, with a temp of 95, HR 126, BP 90/50. By the time the resident had been able to cut out of surgery (half an hour later), I had drawn a rainbow of labs, typed and crossed two units of blood, started a saline bolus, administered a total of twelve milligrams of morphine for his excruciating pain, and started two large-bore IVs. I had a coudet cath set and urinometer at the bedside, along with dilators and lidocaine jelly and Versed.

I could not have done this all myself; the other nurses on the floor did things like start one IV while I did another, called the blood bank to give 'em the heads-up on the patient, and ran supplies back to the room. *That's* the A Team for you.

2. Attitude is everything. With the B Team, the attitudes suck.

Illustration: B Team tech/unit secretary/charge/staff nurse comes in, snaps the heads off co-workers, throws tantrums at the lab and radiology staff, belittles the respiratory therapists, and refuses to provide lift help. She or he spends most of the day on personal phone calls and surfing the Web. There's always a personal crisis that either takes up hours of the workday or necessitates the person leaving early. Best example? A secretary I'm fortunate enough not to work with all that often walked in and announced she'd have to leave mid-morning to attend the funeral of a relative, shot during a bungled drug deal.

How It Should Be Done (The A Team): Everybody on the unit shows up on time, clean, not hung over. Perhaps without the shiny-happy attitude that characterizes Disney employees who are still on the clock, true, but with coffee in hand and ready to work. Personal disputes are relegated to the back burner for twelve hours and cell phones are on vibrate. "Cute Overload" is checked for therapeutic reasons only. This is, thank God, where I work.

3. That certain indefinable something: The B Team Ain't Got It.

I don't know if it's experience (though newbies can certainly be A-Teamers) or perceptiveness or initiative or what, but the A-Team has something the B-Team ain't got. You'll notice that there are some nurses who rarely have patients go bad, unless circumstances are extreme. Some nurses seem always to be a step ahead of the docs when it comes to changes in their patients' conditions. Some nurses rarely if ever have patients who end up with decubitus ulcers or constipated. Those are A team nurses.

4. Humility and the ability to admit when you're in the weeds: See Above.

I work with really, really good people. Therefore, when I'm totally rag-assed and overwhelmed, I can ask for help. When any one of us doesn't remember what the hell a lipase value means or what a particular surgery involves, we ask about it, and nobody laughs. If somebody's in a bind with some procedure or other, or doesn't remember exactly how to level a ventriculostomy, we all are willing to help. And we're not afraid, any of us, to admit that there's somebody better at starting IVs or running NG tubes or putting in a catheter.

God help the nurse who works with the B team: she's on her own.

5. Finally, professionalism and calm: Not To Be Found on the B Floor.

Illustration: Fed-up attending throws temper tantrum at nurses' station. Charge nurse responds by getting in his face. Situation escalates. Nasty words fly. People start waving their arms around. Security is called to de-escalate the fight. (Yes, I've had a fun month, thanks for asking.)

How It's Done On the A Team: Fed-up attending throws tantrum at nurses' station. All the nurses stand around watching until he runs out of steam, then charge nurse remarks calmly that she's glad Attending feels the same way we all do, and why doesn't he write an email to the Carpeted People about it, since our complaints haven't made any difference? She then shows him how to operate the email system and thanks him for his concern. No longer fed-up, the Now Abashed Attending apologizes for his behavior. We accept the apology as a group and all go on taking care of business.

No screaming, no freaking out, no security, and everybody involved understands how professionalism was breached, how it was restored, and where we all stand individually and as a group. We're working together rather than at odds with each other.

Even A teams have B days, for sure. Sometimes everybody's a mess, or getting sick, or a mess *and* getting sick. The A teams, though, pull out of the weeds and keep going, while the B team floors fall to hell. I'm lucky enough to have landed on the A-est of the A-teams at our facility, and fortunate to be able to keep up with my coworkers. After the last few weeks, I am not going anywhere else. Ever. Period.

That's the kind of loyalty the A team inspires.

Change O' Shift is up!

Here.

'Twas the day after Xmas; all over the yard

A lone dog was chewing his prime rib bone hard.

He didn't believe when I gave him the bone;
He thought he'd spend Christmas night cold and alone.

But I came home at seven and gave him his treat,
Something better than kibble and raw egg to eat.
What a sight! Big brown dog-eyes with all the white all around,
As he went off to bury his bone in the ground.

Now it's the day after. His joy undiminished,
He searches for bits of the bone that aren't finished.
I have a surprise for him, here in the kitchen;
Two other prime-rib bones. Max's Christmas is *bitchin'*.

A Chrissolstikah Story

We were sitting around, doing nothing except trading stories of Irritating Family Christmas Traditions.

Munoz and Galindo had nothing to contribute, as Christmas Eve in Miami is celebrated (at least in their families) with huge pitchers of sangria and a slightly tipsy midnight Mass. Porchevsky likewise spent thirty years in the USSR keeping his Christmas traditions under wraps--and Possible Detention By The KGB is past irritating and on into scary. The one Jew in the room, a neurological oncology resident from Israel, was ignoring us and reading the paper. That left only the American nominal Christians to complain.

Becka started: "My mother makes us watch 'A Christmas Story' every year on Christmas Eve. I hate that movie. It annoys me. The business about 'You'll shoot your eye out' makes me pray every year that the kid actually does have some horrible accident and has to spend the rest of the movie in the hospital."

"You think that's bad?" responded James. "My family refuses to acknowledge that I'm gay, and I keep getting books on how to meet women, and free subscriptions to online dating services." He slumped in his chair. "The worst was when the family brought three different girls to meet me at Christmas dinner. They probably hoped I'd marry one of them by New Year's."

I knew I had the ace in the hole, so I waited until everyone else was finished, then cleared my throat.

"My father," I began, "has collected over thirty different singing, dancing, light- and motion-sensitive Christmas decorations."

The room was silent except for the scrape of the neuro resident turning pages.

"Every room in the house, and some of the closets, are fucking deathtraps. If you go into the bathroom on the ground floor, there's a wreath that sings to you. The kitchen is inhabited by a plastic Christmas tree that sings and dances and *tells jokes*. You can't cross the living room without something starting to whirr, click, and recite 'A Visit From Saint Nicholas.'"

"The only thing they lack is a dancing Menorah that sings 'Dreidel, Dreidel, Dreidel.'" I finished.

The neuro resident looked up from his paper and fixed me with a stern eye. "That is *not* Kosher," he said. "Hannukah is for making donuts and lighting candles. It is not about dancing Menorahs. Besides," he finished with a wail, "I HATE THAT SONG!!"

"No disrespect meant," I said, "But you have to admit that a toy fat guy in a red suit kicking his feet as he hangs out of the chimney isn't exactly embodying the spirit of Christmas, either."

"In fact," I said, struck by a sudden thought, "The only thing my folks lack, besides a dancing Menorah, is a Nativity scene in which the Virgin sings 'Papa, Don't Preach.'"*

That did it. Everybody, including the neuro resident, collapsed laughing, and then we all had some donuts.

Happy Holidays, everybody. Whether you spend it drinking sangria, praying in an onion-domed church, dancing around a fire, or eating potatoes in various forms, I hope it's a good one.



*I post this thought with some trepidation. I'm sure Dad will start looking for a singing Nativity now.

Blue

A bouquet of roses on the thigh of a woman who'd been a whore in Paris during the second world war.

A shirt and shorts of Japanese history on a pierced guy about my age in for back surgery. "Will the incision mess up my art?"

The names of three children arranged in a biohazard sign on the bicep of a Marine.

Tiny parachuting stick figures and a crudely-rendered plane on the upper arm of a man who'd been a Russian paratrooper during WWII.

Four dots on the foot of a woman with a huge brain injury.

A teardrop on the left cheek of a man who'd been shot in the head.

Two, in the same week: one on the inside of the left forearm, from Monowitz. One, upper left chest, tattooed all at once earlier in the war, from Auschwitz I.

Umpteeen trails of barbed wire around biceps.

A dragon over a mastectomy scar.

The names of four children, all born dead, winding around an ankle.

One very well-padded woman on the chest of a Korean war veteran. He was embarrassed to let me see it, thinking I'd be offended.

I wish I could take a camera to work.

When it hurts, I cuss.

Prodigally. Fluently. Creatively.

When it hurts a lot, I just make a sort of "Ehnnnggaaaahhh" noise

Today, because I know how to have fun, I stepped on a needle. It was large, but there's no such thing as a small needle when it's going through your foot.

It went straight through the ball of my foot, between two bones (thank FSM for that), and tented the skin on top of my foot, just north of the second and third toe space.

The going-through wasn't as bad as the tenting, and the tenting wasn't as bad as the pulling-out. Like babies and bad oysters, that sonofabitch hurt more coming out than going in. But, after I'd made the requisite "Ehnnnggaaahh" noise and sat down heavily on the side of the bed, there was nothing for it but to pull the damned thing out.

[My earliest memory is of looking through the French doors into the dining room of The Old House at my father as my mother rushed me upstairs. Seems I'd stepped on a needle at whatever age it was (two? Three?) and the needle had gone into the bone of my heel. I have vague memories of watching her pull it out as I sat on her lap in the rocking chair, but the strongest memory is of Dad looking up from his desk in the dining room (which was then his study) and seeing his face go slack.]

This was not that bad. In fact, the worst part of it was momentarily feeling the lump in my skin where the needle eye wanted to break through (because I had, of course, stepped on the thing wrong-end-up). Chef Boy was right there, grabbing my arm and keeping me from becoming hysterical. Bravo, Chef Boy.

So, after a moment for contemplation of the possibilities, off I went to see my friendly neighborhood Doc-In-A-Box. The MD entered the room with the words, "How's the seamstress today?"

Everybody's a comedian.

I have a tetanus shot in my left shoulder and 500 milligrams of Keflex to put in my belly thrice daily, as it would be a bad thing (as the MD pointed out) to get an abscess in my foot just before Christmas. Silly me, I thought an abscess was a bad thing at any time.

I also have about 300 ml. of Pommery POP champagne in my belly. Yes, it's only 13:24. Yes, it's a weekday. But dammit, I finished my Christmas shopping after getting a tetanus shot and stepping on a needle; I'll be damned if I face the rest of the day without help.

So I'm weird. What's it to you?

I find plumbworld.co.uk the most fascinating site on the Internet.

Macerators? Power showers? Bathrooms en suite? It's a whole new world.

Things I have learned on my winter vacation:

1. I am a cheap-ass S.O.B. Instead of dropping twenty-eight smackers on an in-drawer knife holder from Williams-Sonoma, I cut off part of the cardboard center from a roll of shelf liner and cut slits into it. Insta-knife-holder, for free, which not only keeps the knives from getting dull, but also prevents unwitting finger amputation! (I also use magazine subscription cards and those "Have You Seen Me?" things as coasters. Yes, I suck.)

2. I am a clumsy mother(shutyomouth) as well. Friend Pens the Lotion Slut and I were exiting the local shop-n-snack when I tripped and fell. Spectacularly. On dry, flat pavement. That was probably the highlight of Pens's trip, sadly.

3. I am not as good a cook as I thought. Friend Pens and I visited another friend of ours, who made such wonderful food I felt thoroughly spoiled in less than 12 hours. Of course, any recipe that starts with butternut squash and 3.5 cups of half-and-half will be good, but still. Plus, Bek and her husband live in a pastoral setting just up the hill from the Brazos and have a firepit. It was a perfect visit. Perfect.

4. Lane Bryant *rocks*. I went there just a few days ago for the first time and was amazed. I'm technically (in Big-Girl Speak) a "tweener"--somebody who can wear a 10, 12, or 14 depending on the cut. LB specializes in Big Girl clothes, and man, does their stuff *fit*. Every shirt I put on fit my lats and shoulders. Every pair of pants and skirt I tried fit my weightlifter's thighs and butt--*and*! you can buy pants with smaller or larger waists, so those of us with a size 10 waist and size 14 butt won't go naked! They're having a huge sale right now, so go. Seriously. I'm still not mentally over not being a size 6 any more, but the staff and clothes at LB made me feel normal and sexy and stylish.

5. My dog rocks more than I ever thought possible. Hanging out with Max for two weeks uninterrupted made me so grateful to have him around. He's smarter than most people I meet and better-lookin' than all of 'em.

6. I am capable of heretofore-unimagined feats of laziness. The first five days of vacation? Couch. Chair. Eat. Sleep. Beer at noon, with pizza. Couch again. The only time my metabolism got off baseline was when Atilla the Cheerleader showed up to make me run and lift weights. I have no memory of my first week off, and it was heaven.

7. I don't miss having a TV.

8. Not working is highly underrated. The most I did regarding work was to visit my work email and read the occasional, short email, then delete it.

9. If they'd pay me regular wages for staying home, I'd consider it.

10. I am going to be very sad to go back to work. Very sad. Especially when the alarm goes off at oh-dear-thirty on Monday.

11. But I still have two more days!

(Insert clever title here)

Change of Shift is up at Doctor Anonymous's place right now. Yes, yes, I'm a couple of days late. What's new?

Announcement:

I am going on vacation for two weeks. That means I may or may not be blogging. So if I'm not here, don't panic; it's just that I'm napping or walking the dog or something.

It's about damn time, too. I think this is the first real (read: no plans) vacation I've had since before I started nursing school. I didn't have ten full days off during those two years, let alone two weeks without homework. The last time I took time off was for Beloved Sister's wedding, which was lovely, but a house full of my family is not exactly relaxing.

So. I'm going to paint my nails. I'm going to wear my hair *down* for a couple of weeks, rather than *up*, and possibly wear high heels during the day, just for fun. I plan to un-stick the drawers in the kitchen and scrub the house top to bottom and rake leaves. Friend Pens the Lotion Slut is coming to visit for a few days, so that'll be a nice interlude. I might even go shopping. And, of course, drink champagne for no reason, eat artichoke hearts, and do silly crafty things with paint and glue.

I'll see you guys in a few days to a couple of weeks. If I remember something that happened that I simply have to talk about, I'll talk about it...but otherwise, Head Nurse will be Nap Nurse until mid-December.

You must immediately click the following link...

To Digital Cuttlefish.

Immediately.

I don't know how I lived without the Cuttlefish's blog for so long.

(Be certain to read the poem linked as Cute-Cute-Cute.)

Woo doggies.

I do brains. Brains and spines. It's what I do. It's why I titled my blog "Head Nurse." Because I do brains. And spines.

Except lately I've been doing a lot more than brains and spines. Kidneys, for instance, and intestines. And weird plastic surgery dealios that involve, like, seven incisions in somebody's head, all intended to rebuild bits that have been lost to gunshots or cancer or accident.

So I've found myself having to do things that I'm not exactly comfortable with lately, and I've come up with some new tips and tricks. They're old news for those of you who handle a lot of bizarre surgery patients ("bizarre" in this case modifying "surgery"), but they're new to me.

Tip the First: Label IV drips in more than two places.

The rule is to label your pump and your IV line if you're running, say, chemotherapy or total parenteral nutrition, two things that should not be combined with anything else. Normally those lines are labelled on the IV pump itself and then below the IV pump in one spot, using fabric tape and permanent marker or a pre-printed label in yellow or red.

I've found over the last couple of months that that is not enough labelling for somebody like me. I now label TPN and Weird NonMixable Drips in four or five places, running those labels straight down the line. It's not such a big deal if you're infusing, say, normal saline and IV immunoglobulin, but if you've got a four-channel pump with four fluids plus piggybacks, it helps.

Tip the Second: Label the drains coming out of your patient.

Again, I'm used to three or four drains at the most, and those well-spaced: maybe one at the head, one in the belly, and one coming out of the person's lumbar spine. I was confronted late last month with a patient who had ten (10) drains coming out of her belly alone. I'm not counting the ones coming out of her back, or the ones attached to the Wound-Vac.

None of the drains were labelled, yet there was an order that said, "Flush PAD with 30 ccs NS q 8 hrs, dwell for one hr, drain." Um. Lessee...three PADs there and no clue which one to flush. Flush 'em all? Flush one every eight hours? Or ask the resident? I went with door number three, then labelled the drain we were supposed to be flushing. I also labelled the lines with where they went (JP, Jvac, Hemovac, Wound-Vac) so there'd be less tracing back. It also helped differentiate the two drains that had exactly the same tubing but different uses when the only distinguishing marks were covered by tape and connectors.

Tip the Third: Warn the next shift about that abscess.

If you know your opposite number on the night shift will have to irrigate and re-dress an abscess or undermining decubitus, have the Vicks Vaporub right there at the door when they walk in. This is one of those "do unto others" things I wish somebody had done for me. There's nothing quite like encountering a fist-sized hole in somebody's belly or a stage IV undermining bedsore without proper preparation.

Tip the Fourth: Warn the next shift about that resident.

We have our residents trained well. The same can't be said for the residents who are, for our unit, off-service. It's only politic to warn the oncoming shift about the resident who's paranoid, suspicious, and has a God complex. I was the first person to encounter him and thought he was being ironic. Wups.

And, finally, Tip the Fifth: Iodoform, Aquacel, and various other specialty dressings never go as far as you think they will.

Let's say you've got a wound that's just about big enough to swing a cat in. Let's further assume you have to pack that sucker with some sort of wound-packing material. If you already have three containers of that packing in the room, take in a fourth. If there are already four in there, take in a fifth. Have an extra in your pocket just in case. This is especially important if your patient has a live flap from, say, their shoulder to where an ear used to be that has to be wrapped with petrolatum gauze, as that stuff's a beast to work with.

It's been an interesting couple of months. Things'll probably start getting back to normal soon, as the construction that's sent Bizarre Surgery Patients to our unit is almost done. I'll miss the variety. I think I've grown a third hand through dealing with all this new stuff, and I'm hoping that sticks around. What I *won't* miss is seeing patients with half a face, or faces that are attached to arms or shoulders or chests.

Who knew that a subtotal lobotomy patient could seem so peaceful and normal?

With regards to Jill Sobule

I once saw a photo of a poster, somewhere online, that showed a large Malamute and the words "LOOK AT THIS DOG."

The text below read like your typical Lost Dog advertisement, except that it consisted of things like "Isn't this a MAGNIFICENT FUCKING DOG?? I love this dog. He is so damn cool. Last seen being COOL in my huge-ass backyard, which is what he does EVERY DAY."

I am totes in love with my dog.

He grumbles. He dances. He makes "hmmmMMMMmmmrrrgh" noises when I rub his ears. Sometimes he invites me outside to play by bringing every single damn chew toy and rubber ball and bone and bull penis (dried) and stick and rock in the back yard up to the door and dropping it, then looking hopeful. "Herd Ball? Can we play Herd Ball, please? Pleeeeeeez?" (Thanks to Kris for the name of that game.)

He has enormous shoulders, big brown eyes, and blond hair. What more could I want in a male that takes up most of my bed? Yeah, he's got a hairy back, but hey. He only eats once a day and that's dry kibble, so I know he won't drink the last beer.

And he likes me to scratch his belly. There's nothing better after a long day than coming home and letting him in and having him roll over with one paw up, asking for Belly Rubs. Rub Mah Belly, Human!

He has a magnificent bark. I love to hear him bark, unless it's at 2 am. And we're having a problem with the "bark when people come to the door" thing, as he normally barks as they're driving away. Yeah, the Mansons could come in and he wouldn't mind, provided he got Belly Rubs, but he's learning.

He doesn't chase the cat. He doesn't chase squirrels. So far, he has not peed once in the house (we'll see how that goes once I get a Christmas tree). He's nice to strangers, unless they're skeevy. If they're skeevy, he stares at them with his ears pricked. If they're not skeevy, or if they're friends, he lets his right ear flop over or to the side. He's completely smitten with the pug next door. He licks my face when I'm feeling bad.

I am totally, *totally* in love with my dog.

LOOK at my dog. Isn't he magnificent? He is. Yes, he is.

Holiday recipe #1: Stuffing for Residents

Chop two white onions and five stalks of celery. Sweat in half a stick of butter until soft.

Dump into a large bowl. Refill the saute pan with a pound of chopped mushrooms and melt them into a stick of unsalted butter.

Boil six cups of chicken stock. Add one stick of unsalted butter.

Toast one pound of chopped pecans at the same time you cook one pound of lean bacon in the oven.

Open two of the largest bags of Pepperidge Farm stuffing mix you can find. Use the homestyle stuff, not the cornbread stuffing, which is too sweet.

Dump them into the bowl on top of the onions and celery.

When the bacon is crisp, drain it. Add bacon, mushrooms, and pecans to the bowl of stuffing. Be glad you got the largest mixing bowl Target sells.

Pour chicken broth mixture over your stuffing and mix well. Bake for an hour or so in a casserole pan or six, until the top is crispy and the house smells marvelous.

Will feed sixteen nurses, twenty normal people, or three and a half residents.

Burnt. Out.

It's that time of year again. I'm feeling burned out about my job.

What do you do when you feel burned out?

The eleventh hour of the eleventh day of the eleventh month.

Wilfred Owen

Dulce Et Decorum Est

Bent double, like old beggars under sacks,
Knock-kneed, coughing like hags, we cursed through sludge,
Till on the haunting flares we turned our backs
And towards our distant rest began to trudge.
Men marched asleep. Many had lost their boots
But limped on, blood-shod. All went lame; all blind;
Drunk with fatigue; deaf even to the hoots
Of disappointed shells that dropped behind.

GAS! Gas! Quick, boys!-- An ecstasy of fumbling,
Fitting the clumsy helmets just in time;
But someone still was yelling out and stumbling
And floundering like a man in fire or lime.--
Dim, through the misty panes and thick green light
As under a green sea, I saw him drowning.

In all my dreams, before my helpless sight,
He plunges at me, guttering, choking, drowning.

If in some smothering dreams you too could pace
Behind the wagon that we flung him in,
And watch the white eyes writhing in his face,
His hanging face, like a devil's sick of sin;
If you could hear, at every jolt, the blood
Come gargling from the froth-corrupted lungs,
Obscene as cancer, bitter as the cud
Of vile, incurable sores on innocent tongues,--
My friend, you would not tell with such high zest
To children ardent for some desperate glory,
The old Lie: Dulce et decorum est
Pro patria mori.

White girl, white rice, white wine edition: I threw away my TV, so...

...I can't watch Grey's Anatomy any more. Therefore, a list of things I do when I'm sick and tired of being a nurse.

Surf YouTube for Harry Potter tribute videos. Love that song. Love it.

My jeans are falling off of me, thanks to weeks of getting the yard in shape, so I might not qualify for Manolo for the Big Girl any more...but it's still a good read. You might see someone you know in the postings.

Gala Darling. Still my 3 a.m. fix for things to make me cheerful.

I own one bag for work, one for not-work, and one for play. Why, then, do I read Bag Snob? For the writing, friends.

No, you can't wear most of the makeup to work, and the latest mailer is silly beyond belief. Still, Sephora has the best deals on good soap guaranteed to get the smell of formalin/blood/poop off'a ya.

No, you can't wear these clothes to work, but when is a girl's life ever all work? StyleBites.

Dumb Little Man is not.

Canned goods are always a good investment: the story of my life! Frugal Fag has the lowdown. Or the down-low.

Food. Or not. The Food Whore is always a good read.

She's like me. Except she's a doctor, and all.

And this is what I do when I'm not at work. Or walking Max, or washing the car, or making salmon with cream-garlic sauce.

Change O' Shift!

Right here.

Nursing Students: A Love Letter

It's that time of year again. We're getting three days a week of nursing students. Some are experienced, some are not. Some are sure of their vocation, some are not. Some look like they're going to vomit on my shoes, some...wait. They all look like they're going to vomit. Or pass out.

Nursing students, take heart: that nauseated, faint feeling does not last past the second year of nursing. At least, not consistently.

I love nursing students. The longer I'm out of school, the more I love them. I love that they're willing to put up with two to four years of unmitigated hell in order to enter a profession that is, mostly, rarely-mitigated hell.

I love that they think they know nothing, when in reality, they know quite a lot. The students who overcome their terror long enough to open their mouths always end up asking some interesting, baffling questions. The ones who advance theories are more often right than wrong, and even the wrong theories are logical.

I love how hard they work. With one exception in five years, every class of students we've had has kicked ass on the floor. They come early and stay late, even after a night of doing care plans. Nothing is too dirty, too boring, or not-nursey enough for them to do. They know their theoretical stuff backwards and pick up on the real-world stuff fast.

I love how they keep me on my toes. When I have two or three (or more; word's gotten around) students following me, I am extra-careful to explain everything, both to them and to the patient. I triple-check rather than just double-checking. I wash my hands longer.

I love that they're enthusiastic. We have very few nurses working at Big Bob's Brain Barn that don't love what they do, but we do have a few. Working with them is poison to the soul. Working with a nursing student is the antidote: everything is new and fun and exciting.

I love that they make me see the patients in a whole new way. You get so used to people who've had horrible disfiguring things happen that you often don't think of how little things could make their lives harder or easier. Case in point: One of my patients last week was a dwarf (not horrible or disfiguring, but wait...). I hadn't thought of how, without a step-stool, the guy couldn't adjust the shower head to hit him and would therefore be bathing in backsplash. The nursing student shadowing me picked up on that right away and fixed the problem before it became a problem.

I love how they make me see the profession in a new light. Some nurses get ground down and start referring to themselves as waiters. The students I encounter are more often than not active in student nurse associations, volunteer work, and political stuff. They see the profession of nursing as not just a service profession, but also as a scientific and activist calling. I am heartened and impressed by how much thought they've put into their choice of careers.

Thanks, guys. You can round with me any time.

PS: Don't steal my pen.

What Not To Do, Part Eleventy-Seven.

1. 55 in the left lane. Never a good idea.

2. Disconnecting yourself from your insulin drip.

3. Disconnecting yourself from your D-10 drip after you've come in with a blood sugar of 17. Yes, seventeen.

4. Saying to the patient's family member, after said family member has suggested that a chest X-ray might be a good idea, as patient is choking on his own lung goop, "You're not a doctor! *I'm* the doctor here!" (Which led family member to retort, "Really? Gosh. Learn somethin' new every day, I guess.")

5. Suggesting, because *you* can't add, that *I* have made an error in recording the ingo and outpee of a patient with a continuous bladder irrigation. Or, rather, suggesting that loudly and abusively in the middle of the nurses' station. (See: Never a Good Idea.)

What To Do, Always and Forever:

1. If you are a nursing student, ask questions. I had three sets of students in three weeks, all of whom asked really intelligent questions. One woman asked me a question (this happens at least once a semester) that made me say, "Uh...buh...uh...I dunno..." which leads to many fun hours spent with books and Google and the unit educator. I love that.

2. Let me know if you're taking your family member off-unit in a wheelchair. That way I won't alert security when I can't find or reach any of you. Boy, were our collective faces red.

3. Bring an extra set of scrubs to work. I learned that lesson the hard way--for only about the fourth time--last week.

4. If you're a patient or a family member, ask questions. I don't care if they have nothing to do with the subject at hand; just ask. It is what I am here for.

5. Please check with me before you get out of bed. This holds true especially if you've just had a femoral artery puncture and are supposed to stay flat for six hours. That way, I won't be so surprised when I walk into the bathroom to find you sitting on the john, spurting blood like a fountain from your puncture site. (See #3 above; also see What Not To Do At Shift Change.)

What I wish I'd said.

The woman waved me down as I was heading to the hardware store. She was pushing one of those brightly-colored plastic toy cars and had a Chihuahua following her, so I figured she was looking for the dog's owner.

I stopped and rolled down the window. She came over. She was neatly and appropriately dressed and seemed friendly enough.

"Hi," she said, "I'm Sheri. I was wondering: do you live around here? Have you seen any unusual cars in the neighborhood, cruising?"

I allowed that, having lived in the neighborhood for only a few weeks, I hadn't noticed which cars were usual and which weren't.

"Oh. Okay." She looked over her shoulder. "I've been noticing a lot of strange cars lately, and I was wondering where they were from."

Crack houses and meth houses have a way of springing up here and there in this town, but I hadn't noticed any weird smells or late-night activity, and said so.

"I didn't mean that," she said, "I think it's the FBI looking for me."

Uh...

"I'm a paranoid schizophrenic, but I've been on my meds, and my symptoms are controlled, and I really think the FBI is following me. See that Audi? That car doesn't belong in this neighborhood. I think it's FBI."

I did not point out that with the volume of college students in the neighborhood, at least one would come from a family capable of affording an Audi.

"See, I've been working on this research on diseases, and I think the FBI knows about it. Al Gore and I are working on visceral leishmaniasis. I picked up some larvae in my back yard, and I kept them in a petri dish--except it wasn't a petri dish, it was an old pitcher--and they turned into black flies. I'm trying to get the university entomologists to take a look at them, but I can never get through. Anyway, I'm losing the sight in this one eye, and I think it's connected. And then there's that respiratory infection that's been going around--I think there's more to that, too. I'm giving a talk on it next Saturday at the library. It's invitation-only. It's for the children, you know, this awareness of coming plagues."

*boggle*

Just then, a car drove around us and honked. She flipped them off casually and, turning back to me, said with a laugh, "You don't want to mess with me. I'm a direct descendant of Genghis Khan."

I made some noncommittal remark.

She asked then, "What do you do for a living?"

I told the truth.

I wish I'd said "I work for the government."