This is the tale of the toughest man I ever met, a 90 something who fell off a ladder. Yes, a ladder. Why a 90 year old would be on a ladder defies the imagination as well as gravity, but understandable knowing that he also still rides a motorcycle. He was in amazing shape, a wiry muscular frame and sharp as a tack. With piercing blue eyes, he saw everything and used everyone's name.
The fall dislocated his shoulder. After a difficult series of manipulations with minimal medication, at his request, he shrugged the whole thing off like it was no big deal. He was chatty and engaging. He wore a WWII service cap. My partner asked him about his service, and he told us the where and when he had served. Her recounted the story of his most memorable WW2 experience like it happened yesterday, and not over 70 years ago.
"You see a lot of things. You think about them every day".
I was riveted as I rested my arms on the side rails and leaned in to catch every word. B, my partner, was on the other side of the cot, equally attentive. Without taking my eyes off him I slowly reached my hand toward the monitor to silence the alarm as he quietly told about his closest call, an explosion that destroyed his hearing but left him otherwise physically intact.
"The other man (note he did not refer to him as the enemy) was as close as you and I were. I had my gun. He had a grenade. We looked each other in the eye, that look... we each knew what the other was thinking. In that second we both knew that he had to kill himself to kill me. As he opened his hand, I launched myself backwards. It was miraculous, I came out of it not hurt...but with a lot of him on me."
How do you get past something like that?
You live to age 90, being grateful every day for your life, and living it to the fullest by riding motorcycles and falling off ladders. And teaching life lessons.
Because no employer is going to own me, ever again, I work a couple of jobs per diem.
Because I choose what days and shifts I work, I have ALL the control.
Because one of the jobs is a busy ER with lots of millenials and plenty of call-outs, I could work 16 hours per day if I wanted to. Because I have I life, I don't
Because last summer I was feeling sassy and clever, I decided to just work a couple of 12 hour shifts a week in order to have more time off. Because my boss put me on a lot of weeks with 2 shifts at the beginning of one week, and 2 shifts at the end of the next, I had me some 6, 8, 10 day-off stretches at a time.
Because 12 hour shifts are Satan, and because it just reinforced that I really am too old for 12 hour shifts, I went back to 8 hour shifts.
Because my boss appreciates my flexibility, she is fine with my working 8's. Because there aren't many per diem's who work straight evenings, it gives her more flexibility in covering short shifts.
Because I am planning to retire in the next couple of years, and I have downsized my living situation, I am also going to downsize the number of hours I work.
I think this summer I will do 2 shifts per week. 8 hours. No weekends. No commitments
Hannah is a superstar nurse also with big brass balls. Once, during a code the patient had no IV access. She said "I'll just put in an IO", picked up that IO drill and in less than a minute the patient had access. It was her first time. Ever. And she got it true with no coaching. Every time I saw her for the next month I raised my hands in a "big ones" gesture. She's also a nice person. I mean, really super nice. Everyone loves her.
One of my favorite docs will get right in there and pitch in, often doing stuff she doesn't have to do. She will do IV starts, get meds and fluids, transport patients to CT if the nurses are busy. She has been known to put patients on the commode or bedpan. She is a doer. Some nurses take it as a sign that they are not doing their job fast enough to suit her, but it's really not that…she just doesn't see the benefit of sitting around waiting for shit to get done if others are busy and she has the time to do it.
I ran into her in the med room, pulling stuff out of the Pyxis.
"Oh there you are, doing everybody else's job again"
She turned and smiled, leaned against the counter and said, "You know, there are times when I would have been very happy to be a nurse. But it would not have worked. I'm just not a nice person"
I laughed. "You are so!" She is a straight shooter, is not all fuzzy and warm, but I like and respect her a lot.
"Not really, I want to be like Hannah. She talks to every patient like they are cupcakes and fairy dust, no matter what evil thing they say to her. Same as you, you're nice".
"What I am is a good actress".
"Well, then you are a GREAT actress".
Happy Hallmark Holiday Nurses Day to me, and to all the nice nurses out there. Also to those with big, brass balls. And a huge thank you to all those individuals, in every corner of the health care universe, who support us so we can get the job done.
Most of the ER docs will just tell patients to take mag citrate and get on a regimen of Miralax, but Gil ordered an enema.
"There is a special place in Hell for ER docs who order enemas", I said darkly. Worse, it's not even an ER anymore.
I really didn't put much effort into it to be honest.
But after her special treat, Enema Woman gushed about how wonderful Gil was, what great care he gave, how much she appreciated such a warm and feeling humanitarian, and how she would pray for his long and healthy continued existence.
Later I told Gil in detail just how much Enema Woman enjoyed her visit and and expounded on the wonderfulness that was Gil as he beamed in happy warm fuzziness.
Until I told him that I had given Enema Woman his home phone number so that she could personally contact him, as well as his address so that he could enjoy annual Christmas cards and gifts for years to come.
A bad day, or two, or a few you can cope with. Shrug it off. Find some distraction with family and friends.
But recently the bad days at work had been ongoing for weeks with no relief. Bad shifts, bad outcomes, bad people, bad, bad, bad. There was no additional help for the increased volume. Exhausted and frustrated, nurse call-outs were at a record high and we were all getting 3-4 requests a day to come in on a day off or a vacation.
With the relentless strain at work, I also had a lot on my plate at home. Just after the holidays we put our house on the market, downsizing into our dream home condo in less than 2 months. If you've ever sold a home, I don't have to tell you how nerve wracking that is…we had a LOT of showings before getting an offer less than 2 weeks on the market. It certainly seemed much longer. My husband took on the lion's share of responsibility, running around with the dog during showings, coordinating inspections and repairs. He went well above and beyond his fair share and coping with the idiotic demands from the Buyer's Agent from Hell (please, rot there. You know what you did). The final straw was the one thing I had been looking forward to. I had booked a weeks' vacation 7 months prior, before we had any thought of moving whatsoever. Instead it was another source of anxiety with the mechanics of moving house a couple of days after we returned home. I was overwhelmed. Every day brought a new problem to be dealt with at home, and I was brining my work home with me. I didn't complain much, but felt angry and sad and withdrawn.
After a particularly horrific night, staying two hours after the end of my shift with a critical and dying patient, I didn't sleep well. I was up early the following morning, mechanically let my dog out, set out her food, made coffee. I was in another world with my still-racing thoughts when I realized that she didn't come back right away as is her habit. I saw her out in the marshy area behind our house, circling, wagging her tail, darting about. She had found something...or something had found her. "Please let it not be a skunk" I mumbled as I set off through the brush in pajama pants and rain boots to retrieve her.
What had captured her interest was a deer. She was lying in some brush behind a log, sitting up in plain sight. She looked at me, back at my dog, then at me. "Well, she is either hurt or protecting a young one" I thought. I ordered the dog home.
About an hour later I went out to see if the deer was still there. It was. This time it attempted to get away and tried to jump over the log, but was stuck half way across it. I could see it had an injured leg and knew I had to contact someone to take care of it.
I started with a call to local police, who suggested I notify Fish and Game. This was no easy feat on a weekend. About 1/2 dozen calls later I managed to find a number for dispatch.
The warden who returned my call said he would be there in about an hour.
In a little while I went back out to check on the deer. She had settled back into a spot near the log. Unspooked, she gazed at me steadily. I felt very sad as I stood quietly watching her from 20 feet away. We were both helpless. She, injured and in pain, me unable to help. "I'm sorry," I whispered. "It will be over soon".
When the warden arrived I led him to marshy area. The deer was still, lying in the brush, alert, wary. She did not try to run. "I'm going to have to put her down, she's got a broken leg at least and is not in good shape. I'll have to shoot her"
"I know, it's what I expected. It's for the best"
I didn't want to, but felt a responsibility to stay where I was. I was not ordered away. The warden walked back into the brush; he withdrew his handgun and fired two shots. It was over.
I got a good look at her injuries as he dragged her to his truck. Not one, but two broken legs, clearly not new injuries. She had suffered a long time. "There are people in need who can use the meat", he said, glancing at me and seeing my eyes were shiny with unshed tears. "She won't go to waste".
"That's good", I choked out. I thanked him and stumbled back through the brush as the deer was loaded into the truck.
When I returned to the house, I buried my face in the coats in the hall closet and sobbed. Sobbed out all the emotion I had been suppressing for weeks.
My husband didn't understand. It was not about the deer. Not really. I felt like I owed it to that deer to be with her when she died. I do it for people all the time.
I'll be winding down this nursing thing in a few years. I am looking forward to retirement but have a long way to go. In the meantime, I still have to do all of my certifications in order to work in the ER. Some are every two years, some every four. There are also classes to attend in order to maintain my biannual license renewal. Add to that the annual hospital competencies, and that is a lot of stuff to repeat, same shit different….year. Nothing much changes, yet another tick mark in the administrative Big Book of Checklists.
I just took the 2 day TNCC for about the 6th time, renewable every 4 years. It will be the last time I have to take it before I retire.
Always stressful, I approached this recert with a true "I don't give a shit" attitude, and it served me well as I was relatively stress-free. It helped that I knew two of the course instructors quite well, and I was taking the course with a lot of first timers as well as a few PACU, OR and ICU nurses who were unfamiliar with a lot of the ER stuff. Plus the kids from my own department had been ER nurses for less than 2 years. They were a lot of fun and even insisted I join them for a drink after class.
This time around I was pulled for the clinical testing on day two by one of my fav people. One on one with the instructor, you get a scenario, then have to go through the appropriate steps in the proper order. Of course in an actual trauma, all these steps are accomplished simultaneously by a number of people, but it is the thought process that is important here.
She gave me the easiest scenario, since I got the pregnant trauma victim as I always do in the practice session and did it effortlessly. The savvy instructor can tell nerves from lack of knowledge. As I rattled off all of the major testing points as my instructor cut off any in depth explanations (to prove I knew what I was doing), she impatiently waved me ahead to the next point with a "yep, you got it, next?", and was out of there in under four minutes.
Since this is an odd year, I have yet to do PALS (or ENPC if I can find something before August), ACLS, and of course, BLS. My other job back at the Bait Shoppe only requires that I have BLS because, you know, we can always just do CPR in an urgent care while we wait for EMS. SMH.
Some time ago I posted a list of stupidly spellled names. Since then I have been collecting them and sharing them with a couple of friends. I don't see these friends much, but the magic of technology allows us to keep a running dialogue. We shake our heads.
I get that people want their children to have names that are special and unique. But some of these take it to heights of stupidity, I mean, seriously? These are names that are going to be asked the spelling for life. LIFE.
If I do 10 at a time every week, I have enough to last months. Or until I forget about it or get bored. Likely the first one. So, without any further ado, this week's list:
Deserey, and Dessert. Both pronounce Desiree
Jammie. Pronounced Jay Me
Taylier. Pronounced Tyler
Alyjx. Extra stupid. I called "Ajax", assuming the "l" was silent
I have always believed the ER is not the place for brand new nurses to try out their wings. Too stressful. Way too much to learn. Sets them up for failure. Better to have some med-sug experience under their belt before jumping in the frying pain with both feet AND their hair on fire.
All of the new grad nurses who have started out in my ER are on their 2nd or 3rd health-care related career. Some have been paramedics who have gone on to nursing school. Some are EMT's, or paramedics, LNA's, and a handful of unit coordinators who have done that job while in school. These here are the Sacred Cows with varying levels of knowledge, hands-on training of some kind, skills not necessarily achieved in nursing school. The "have to hires", their orientation is very, very long, and includes months of training wheels. It's really an extra six months of nursing education, as they are nurtured, supported, mentored, watched, encouraged, allowed to take baby steps until they are fully mobile, upright, standing-on-their-own-two-feet nurses. They are not merely loosely supervised and used as additional staff. Some do well, some do well eventually.
Every once in a blue moon, though, there comes one new nurse so rare, so extraordinary you wonder if they have been reincarnated from a previous nursing existence. The total package, equally comfortable with the providers, nurse colleagues, and patients. Confident. Makes good decisions and, most importantly, asks great questions. Takes great care of patients.
It has been about 16 years since I recognized a brand new nurse with such excellence. She was an EMT, then paramedic, to RN. Got her BSN, MSN and is now working on her PhD in nursing. She was a great nurse right out of the box.
Now, in my department, I have met such a Unicorn. Marvel at the beauty.
I was invited out to dinner with some folks from the department, including a couple of nurses and one of the resident low-level paper pushers who is also a nurse. She is a nice person, but has more interest in paper pushing. Plus yelling at all of us when our BLS is about to expire. I call her Bean, short for Beancounter. Every day there is another directive or rule change. Or a new "checklist.
Bean was bemoaning the fact that people were not compliant using the newest checklist devised for stroke patients. I found stacks of them placed in specially labeled folders at each triage desk, in the critical rooms, and at every single computer in the department. Yet nurses were not using them consistently and Bean was frustrated.
"What can I do to get people to use these checklists?" Bean asked plaintively.
Ok, since you asked:
"It's another stupid thing, Bean. Just another thing to do that takes the focus off the patient places it on the paperwork".
Bean (horrified): "But these are so important, like doing neuro checks every 15 minutes!"
Me: "Bean, seriously? Do you really think these things aren't being done for the patient? Do you think we aren't assessing continuously? Shouldn't the focus be on the what's going on with the patient and not simply writing it down and wrapping it up pretty?"
Bean (piously): "If it isn't documented, it isn't done".
Me: "Right. I've seen you doing the postmortems on all these checklists, and never in recent memory can I recall anyone being told that they have done a good job, either with the patient or on the checklists. Each time we get a STEMI, stroke, trauma in which the paperwork is more of an issue than the care of the patient, we grab the paperwork and say "yep, wonder how long it will take for someone to yell at me for what I did wrong, or I get a nastygram from administration". See, we're damned if we do and damned if we don't. There is little motivation to get the paperwork done to order. We're beat up with this shit, Bean".
Bean: (stunned): "You don't understand with pressure we get from above…"
Oh, please. Boo fucking hoo.
Me: "I get that you take heat from admin, and then you have to torture us. I do. It's a suck job I wouldn't want, but you asked how to get people to fill out your checklist; I've merely told you we do the best we can. But what you haven't asked is how to help us be in two places at once, doing paperwork in real time and being at the bedside. That's all"
Since I appeared to be ready to get on the table and jump up and down, one of the other nurses agreed with me then promptly changed the subject.
As we all know, cubicle-dwellers at the semi-administrative level generally have little in common with us clinical-types. Jean spends a lot of her time in the office, although she spends a significant allotment of her day sitting at the desk in the clinical area. Taking up space. About 7 feet from most patient rooms. Which is kind of scary when you consider that she is responsible for educating the young'uns about policy, procedures, and definitive form completion. Aside from an occasional couple of hours in triage, I haven't ever seen her actually commit any patient care.
The other day Jean gestured for me to come over to her as she sat at the desk. It was apparently not clear that I was busy, I guess I appeared to be loafing as I stood warily watching a ranting heroin overdose who was, through the miracle of Narcan, now insisting on leaving, unfazed by his brief episode of death and "had things to do". Security was in the room trying to reason with him, I was poised to run, or at least yell for back up.
I indicated to Jean with a terse shake of my head while giving the 2 finger "I'm watching" sign. She stood up, walked over to the adjacent med room door, which connected with the room I was in, and locked both, effectively cutting off any alternative emergency exit. WTF.
"If the patient decides to go into the med room, now he can't get in"
Me: "So what?"
Jean: "Well, the med room would be safe"
Me: "Did you consider that it might be necessary for ME to have another way to get out of the room?"
We are deep in the bowels of winter, cold, stormy, piles of snow, no sunshine. No place to walk. No place to park the car at work.
And sick folk. Soooooooo many sick folk.
My ER, nay, the entire hospital, has been bursting at the seams for weeks on end. Not with flu, although there is plenty of cough, cold, sore throat, etc. It's chest pain and abdominal pain and COPD. Plus falls, elderly gone to ground humans who have apparently been targeted by Gravity as easy marks.
The waiting room has looked like Calcutta, without Mother Theresa, for days on end.
We have had three times the usual number of psych patients. These aren't in-and-out depressions or quick psych admits; they are psychotic or suicidal. They are lining our hallways. Some wait a week, two weeks, almost three weeks for a commitment bed. They are acting out and who can blame them, it is not a therapeutic environment and their soul-sucking behaviors not only distract us from legit sick people, they make it dangerous for the staff. The screaming, cursing, button pushing, stretcher banging, shit throwing behaviors….I can't concentrate. The patient load has increased, management could care less that the work assignment is sometimes doubled because "they aren't much care". The fuck? They need meds, make endless demands, and with each request the patient sitters pass it along to the nurse. I am concerned about making mistakes because of the distraction. They have added a part time psych nurse practitioner during the day, but are not staffing the night shift with social workers at least 3 nights per week. If you come in suicidal at 5 PM, and there are a couple of people ahead of you for evaluation, forget it. You will be medically cleared by 7, but after 10 they won't see anyone else and YOU will have a cozy bed in the hallway for the night listening to the cacophony.
I get that there is an opioid crises, but we are seeing one or two heroin overdoses a day, about 5 drunks, a sprinkling of people looking for detox, and 9 or 10 depressed patients with suicidal thoughts at minimum. Add in a couple of actual psychos off their meds and arriving with cops and commitment papers and we are well over the edge. I am not a psych nurse, I don't have the temperament, I don't enjoy it, I'm not trained for it.
I can't wait for retirement and it is still a few years away.
This is winter. It's here and it's not going away.