Saturday, December 16, 2017

Ghosts of Christmas Past

It's not that I lack the holiday spirit, most years I just don't have the time.

Last year was a stressful time around the holidays.
My tree was barely up, and if not for the snowy day that kept me indoors it would probably have been naked through Christmas.  I spent the day preparing the house and all, so it was spiffy and festive.  Then the whole business came down New Year's Eve day.

We had been doing the necessary prep for putting our house on the market right after the new year.  Oh, yeah, we moved.  Downsized.  To our dream house in our dream neighborhood.  I just wasn't into  the added burden of making the house show ready.

My friend (you know who you are) has her holiday home set up just after Thanksgiving.  She is a decorating genius, and although that is not what she does for a living she definitely should.  Gorgeous.  She puts a lot of thought, time and effort into her decorations and changes them up a lot from year to year.  Her house is a wonderland, something beautiful in every corner. Nothing too big or too small, everything is perfect.  Really, it's so good you have to just say "YES, this is it, this is exactly how I want my house to look at the holidays", and then you just give up because it's just too much pressure.  But you're ok with just your own inexpert attempt at decorating.  She amazes me, really, good at everything she does.  And I don't say that just because I know she will read it.  Anyway, her house was still beautifully festive at Little Christmas.

I did all my shopping online 2 weeks before Christmas and not one minute before.  Including a kitchen table and chairs for one of my kids, why the hell not, free delivery.   No need to go to the mall,  I made that mistake on a Wednesday about one week after Thanksgiving.  A week day.  It took me a long time to find a parking spot, and there were too many people inside anyway.  I can't stand crowds and have no patience.  I just left and found a spot to eat my lunch before heading to work at 3PM.    I can't even remember what I wanted there so I must not have needed it too badly.   I spent one day running around for odds an ends I needed 4 days before Christmas and went to all local stores.   I wrapped and was ready 2 days before, never have I ever.

And I had a week off.  That was nice, not working Christmas.  So I said to myself,
"Self, you have worked it for over 40 years, saying no from here on out.  Deal with it, bitches".

So this year I said no to working Thanksgiving and took another Christmas week off.  And I don't feel one bit guilty.

Tomorrow I will get my tree up.  I have some stuff left from my old house but have some ideas for decorating around the new one.  Snowy day today, after walking the dog I spent the afternoon gluing sparkly embellishments on some mantle decorations and futzing with the twinkly lights.  Very Hallmark.

My wacky ex neighbor always has his ridiculous lawn display up in time for Thanksgiving. Last year he barely managed to get his light-up menagerie set up about a week before, and only did  about 1/2 of the lights.  I still couldn't figure out if there was any uniformity  or theme.  And I did kind of miss the one-eared moose.  Oh, sorry that was his wife.  I passed by last night to discover that his menagerie is now one hundred percent dogs.  I had no idea there were that many decorative light up dog displays to be had, but he managed.  Fascinating.

There will be no display my new neighborhood.  Just quiet, tasteful window lights (white), mine are on order.  Door wreath, of course.  Some have a little tree or festive greenery in an urn on the front porch. Very low key.  Yesterday I came home from work at 1 AM to discover that someone had placed identical red bows on each of the 18 identical light posts in the neighborhood.  Today I discovered that one of them was blue.  One.  I wonder if it is an acknowledgment of a non-christian belief system, or a random act of rebellion.  Don't ask, don't tell.  It is a condo association, they are mostly older than I am except for the Asian family across the street who have the only child on the street.  They have a red bow.  Not that it matters.  The phantom bow-er knows, which is important information for clandestine midnight bowings.

I worked a few hours at the Medde Center this past week, and the Christmas Madness Project continues.  It's just as out of control, only now with fewer contributors.  They are still asking people to give more while providing less to staff.  I was handed a hospital "Christmas Gift".  A $15.00 gift card to a local supermarket.  In past years they gave out free turkeys, a $25 gift card, and a $50 cash gift from the physicians.  It's a sign of the times for this hospital.  At my main job at Pseudocity, I was handed bonus check for several hundred dollars and a gift card for a free anytime meal at the cafe since I'm not working Christmas.  I'm so excited I might even make the cookie exchange this year.

Wednesday, November 15, 2017

Forty and fabulous

Musing on 40 years since I graduated from nursing school.

What a different world that was.

Nurses caps required at my first job. It sailed off my head when the day supervisor left for the day.
Also a white dress, white stockings, ugly Clinic shoes. Hair up and off neck.  Just like nursing school, only without the striped pinafore.
Metal bedpans and urinals.  Bedpan washer.
Glass IV bottles.
Smoking allowed in patient's rooms.  Emptying the ashtrays part of PM care routine, along with back rubs and changing pillow cases.
Smoking allowed at the nurses station (at night)
No wearing gloves except for sterile procedures, or possibly for a gone-by-the-wayside iced saline lavage for  a GI bleed.
Stryker frames.
Paper documentation.
Med carts and bottles of pills.
Narcotic count.
3 bottle chest tube drainage system
Setting up a science experiment to determine glucose levels in the urine on the ward.
clinitest tabs would turn 10 drops of pee blue, for no sugar or on the normal side.  I loved doing those.
Eyeballing the number of drops per 15 second for a 100 ml per hour IV drip rate. (6, for a 15 gtt tubing by the way).  No pumps.
Patients needing post op narcotic pain meds were given IM injections.  Think about that and the current opioid crises.
Admitting next-day pre-ops between 3 and 5 PM (for cholecystectomy, hyst,  or TURP,  for example), then pre-op teaching, prepping (enemas, shaving nipple to knees on abdominals)
Waking surgicals at 5:30 AM for IV starts.  Or more enemas.  Good morning!
Verbal report from charge nurse.  Led to taped report, and you had to listen to the report on all patients. In a smoke filled room, everyone smoked.
Being forced to take a 30 minute meal break AND a 15 minute coffee break.  Actually go to a cafe or sit down in a nurses lounge and have a break.
The night supervisor was a battle axe.
Being a brand new nurse and in charge of a 40 bed floor 3 months after getting a license.  Because I could.  And I was incredibly lucky.
Being a new ER nurse with 18 months of nursing experience, 8 hours of orientation,  alone on 11-7 with a doctor who was allowed to sleep.  And expected to register patient's to boot.

No wonder I'm tired.

Wednesday, October 18, 2017

Name Game, vol. 3...or 4...or 3. Can't remember

Eyden (pronounced "Aiden")





Kylla (no, it does not rhyme with "Thriller", or "Thrilla" if you are from Massachusetts)






Kimmberleigh, Kimberlee, Kymberlee.  Ach.

Tabbethya (I pronounced it "Ta-BETH-ee-ya" just for fun.

Please, please, new parents of America, stop this trend.

Monday, October 16, 2017

Nuggets of Awesomeness

There are usually two nurses in triage but I am frequently alone.  Just me against the world.

"You are out there alone again?!", gasps the Queen of Fast Track as I pass her station enroute to the triage area.  "Unacceptable!" she exclaims.  She is there every day.  She sees all, knows all, and it makes her crazy that anyone has to triage alone, especially when it's really busy.

Me:  "Walking the Mile, walking the Green Mile".

After triage each patient is escorted to an open room….as long as there are rooms open.  Thereafter the charts go into the rack for the charge nurse to room, pending bed availability.  I like this system a lot.  But it adds a layer of responsibility for the triage nurse, aside from finding the elusive open room,  to a). assess the acuity level (in general) of the department and find an available nurse who is b). in the rotation for, and willing, to take a patient (another post in itself) and c). provide a bullet report.  This occasionally works seamlessly.  More often than not there is a bit of salesmanship involved, such as, "You love to take care of sick babies!", and "I already did the EKG, and I put in a chest pain order set".   Sometimes nurses just check the board, anticipate the arrival of the patient, tell me "I read the triage note, I've got it".  This is a rare but most welcome occurrence.

My coworkers are a curious bunch and just can't help asking "why".  The most often asked question "why didn't they call their doctor?" The answer to that is one of several stock responses,  1. "they did and were told to go to the ER", 2. "they don't have a doctor", or 3. I respond with a rhetorical question of my own, or create a diversion, such as "Look!  Hayely's Comet!" and then sprint back to my box.  Sometimes I just say, "Why ask why?", usually accompanied by  slight shrug of the shoulders and a wry smile.

Occasionally I say it in French for added amusement.

Often there are requests for "nuggets", little bits of information about patients that aren't really all that important for triage.  Mostly patients are anxious to share every aspect of their illness and when I am really interested/amused/intrigued I like to pass on said nuggets of info.

Like, what was the kid's temperature at home?
"She felt warm to the mother, but I didn't ask to what she compared it.  Warmer than toast, perhaps?  Puppies?  Day old rice?"

What was the exact dose of Tylenol?
"Some.  A bit.  A bunch.  I'm pretty sure there was no tylenol given, actually"

My personal favorite is, "What does the urgent care expect us to do about that?"

Duh.  We get probably 40-50 phone calls daily from various free-standing urgent care type places, Convenient Doc in the Box, Drive Through Care, Taco Doc, etc.  There are lots of them in the area, some are good about faxing such important information as EKG's,  which we repeat anyway, and occasionally we are offered some amusing zebras to ponder.  But our docs like to make up their own minds, perhaps fashion their own zebra hunt.  They are funny that way.

Famiy members love to chime in with nuggets of their own, which is particularly frustrating when they contradict each and every statement made by the patient.

Me: "Do you have any allergies?
Patient: "No, I don't have any allergies"
Well-meaning family member:  "Yes he does, to key lime pie, birch trees and Legos".

Me:  "When did the pain start?"
Patient:  "Oh, about an hour ago"
Well-meaning family member:  "He has had this pain for 6 months!"

Me:  "I see that you have a history of opiod addiction, are you still in recovery"
Patient:  "Yes"
Well-meaning family member:  "No, he is not, he took 4 oxy's today and drank 12 beers".

With these nuggets comes a good bit of he said-she said along with the inevitable arguments, as you can see.

Sometimes I  manage to come up with few bite-sized nuggets to pass along.  Mostly I just give a bullet and run back to my cube to start the next one.

A young girl was sent from an urgent care for a cast on her broken tibia-fibula.  She arrived in a wheelchair.  With the leg hanging.  I was confused and asked the mother why she did not have a splint, an ace wrap, or even a piece of cardboard.

"They don't do casts, that's why they sent us here".  Like I'm the idiot.   Helpfully (not) they sent along a disk with a single view film and not so much as a Tylenol on board.  Poor kid.  Our PA called their PA to rip them a new one and suggest that they need a tutorial on splinting, or failing that  perhaps simply using an ace bandage, a pillow and some duct tape.  Well done.

Here is one more nugget:

"Why is the patient soaking wet?"
"She was having a seizure.  The family poured water on her to stop the seizure"
"That actually works??"
"Only if they are faking a seizure.  Then it works quite well".

Sunday, October 15, 2017

Put That Pig on a Leash…. a phrase coined by the husband of a friend of mine.  She had been mowed down at the skating rink by a gal larger than she, thus inflicting bodily harm and a trip to the ER requiring sutures.  He was referring to the mower, not the mowee.  That was about 12 years ago.  It's still funny.

Today I use the term to refer to the pigs who inhabit my world, the patients as well as their families and visitors, cousins, neighbors, acquantances, etc.  Basically anyone who dwells in any part of my ER.  All pigs.  And it's not just the blood and gore, spit, vomit, piss, shit that has turned me into a germophobe.

The waiting room is littered with trash.  Trust me, it's not the staff who does this.  The leavings of fast food fine dining are left on the floor, empty chairs, windowsills.  Coffee cups, soda cans.  Trash bins are apparently sacred oracles to be avoided at all costs.

Masks that coughing patients are asked to don are crumpled and left anywhere.  I can't even speak about used Kleenex and used (usually empty) vomit bags.

We clinical staff , because we don't have enough to do, disinfect and clean the treatment rooms after the patient leaves.  This should only take a few minutes although I try to do a through job cleaning up after my pig patients to make it spiffy for my next pig patients.  But the rooms are generally disasters.  In addition to the aforementioned trash will also be used bandaids and used gauze, used Kleenex and paper towels strewn about.  Meal trays.  Each of 12 EKG electrodes and at least 3 monitor electrodes are  stuck to the bedside table or side rails because the trash, all of 2 feet away, is just too much of an effort.

 I disinfect all the moving parts that touch my patients.  We use the environmental staff only if there is debris on the floor such as body fluids, mud,  or an infestation of bed bugs.  Once it was necessary to have environmental steam clean a room after one of my patients arrived with 3 different infestations of insect and covered in poo.  The poor old soul.  I discarded my scrubs and demanded new ones.  Then I had them steam clean my clogs, otherwise I would have thrown them away.

This is why the germophobe in me gets worse all the time.  I compulsively wash my hands because of people's piggish habits.   I am protecting myself from their germs rather than the other way around, despite the admonitions for staff to do so.  Cute little posters that invite the public to put us on the spot and ask if they don't see us doing so.  Yes I use sanitizer, but consider it a stopgap until I can get to hot running water and soap.  To me using hand sanitizer is the equivalent of taking a deep breath and holding it until you can get away from a stench and take a deep breath of fresh air.

 Unless you live in a permanent bubble, the world is full of germs, every surface you touch in the real world.  In a medical environment where people are casual about excreta it is worse.  And lets just say the bathroom habits of the general public is less than optimum.  There are a LOT of people who don't wash after using the toilet.  Shudder.  Many and many a time I am approached with a proferred full specimen container.  Sometimes it is damp, sometimes it is wet.  In a damp bag.   And people expect me to accept it without putting on gloves.  NOPE.  I disinfect with Lysol any pens  which people sign their admission or discharge patients because scrupulous attention to hygiene seems to have gone by the wayside.  If people are truly disgusting I throw them away.

OK, now I am going to turn you into a raging germophobe too.  After exiting the bathroom, handing me a warm, wet cup of pee (or whatever), people are perfectly happy to go and sit down in the waiting room.  In chairs that are never disinfected.  Eating their doritos and drinking their lattes, handling money, going in and out of the cafeteria.


Now, what else are they touching?

Sleep well.

Thursday, August 24, 2017

Science is my religion (or "your delivery sucks, man")

I am not anti god.  I am not anti religion.

Heaven or hell?  Not so much.

I don't praise god for good weather, getting into the college of one's choice, surviving a heart attack.  Neither do I blame god for tornadoes, losing the state championship, or childhood cancer.

Good shit happens, bad shit happens. People are great, or they suck.

There is life.  There is death.

To me, any religion involves drinking the Kool-Aid, which has never been my drink of choice.  I can swim but don't dunk myself in just any old river.

If religion is what floats your boat, gives you a reason for living, brings you comfort,  or helps you cope,  I'm fine with that.

Do I walk out during a Last Rites ritual? No. Do I act insensitivity when my patients ask for clergy, or say "God bless you?" Of course not.  If a patient says they will pray for me, I say "thank you".  If they ask me to pray with them, I will hold their hand.  I have even been known to say "God bless you" when someone sneezes.

I have no problem whatsoever with Nativity scenes on public town squares.  I think saying "Happy Holidays" instead of "Merry Christmas" is PC bullshit.

 I respect that this great nation was founded on Christian values.   I am fine with "one nation, under God", or "In God We Trust".  These mottos are important to the history of the US.  It's not with the Christian values that I have a problem, but with some so-called Christians.

I'm fine with talking to you (but will not debate) about your religious rituals, holidays, beliefs.  It's interesting to me.  I have a problem with people getting all judgey and assuming that theirs is the only point of view that is correct.  Usually it spills over into other aspects of their daily life and belief system, but that is a post for another day.  All I ask of anyone is that you not ram your religious beliefs up my ass.  Or want to chop off my head because I don't believe what you believe.  Mostly, I'm fine with whatever you believe as long as you keep it to yourself and don't come knocking on my door looking for donations or insist that I need saving.

Here is the point of my preamble.  One of my mother's close friends died.  At home, comfortably, with her family surrounding her.  Enviable.

I accompanied her to the funeral and the collation.  Mom is the only person I know who refers to the funeral after-party as such.  I had to look it up, thinking for sure she had misappropriated the word, but nope.  It's a word.  My mother is a Scrabble whiz at 85, and regularly kicks my ass.

If I did believe, I would probably thank god for  the end of the most excruciating homily of the most painful funeral service of my lifetime.

Her friend was a parishioner of St. John of the Autobahn, practically a four lane highway.  Very busy and difficult to park.  I hate to be late to shit, especially funerals.

 The priest was admittedly out of mothballs retirement for the Catholic Mass,  He did not know my mother's friend, and clearly never bothered to ask the family about her.  It would have helped enormously if he had even bothered to read the obituary.  Lots of good stuff there.  He could have extrapolated a minimum amount of information at least.  He never used her name.  Ever.  Not once.

It started badly.  "Funerals",  he intoned, "are the time when we should examine our relationship with God".

Um, well,  me and God broke up when I was 12 and he killed my only sister  took my newborn baby sister home to be an angel.  I just could never see a cold patch of earth in a place as dismal as a cemetery as a better place.  So consider my relationship examined, found wanting, and terminated.

The homily went on and on.  And on.  No mentions of my mother's friend, no friendly words of comfort for the family.  "You must live the life of the righteous, and the kingdom of heaven and eternal life in the house of the lord will be yours.  If you do not feed the hungry, house the homeless, and clothe the naked… will dwell forever in darkness and in sin. "

I distinctly heard a quiet, but audible, "What the fuck?', and had a moment of panic when I thought the words had  escaped my thought bubble and exited, unbidden, through my lips.  But no. It was the guy behind me, as gobsmacked as I.

Later, at the collation, the old ladies buzzed about what came to be known as the "Fire and Brimstone" incident.

I felt bad for the family, whose devout wife/mother/grandmother/aunt had done such lovely things in her lifetime had such a crummy sendoff from a church she loved.  Mom said, "She would have been pissed."

Friday, May 12, 2017

Another one bites the dust

You might recall Lazy Nurse.  Well, like all lazy nurses, she left to take a job for better pay.  Buh-bye.

She will not be missed, and I doubt that she will be rehired when she quits her current job at Big City Monster ER, where she will not last long, I'm betting.  

They will eat her for lunch, she and her Lazy Nurse ways.  

Wednesday, May 10, 2017


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.

Tuesday, May 9, 2017

Name game, vol. 2

Ok,  some additional head shakers:




Jasiyah  (Josiah??)











Ileenee (the 2nd e on the end is silent)

That's all for now.

Monday, May 8, 2017

Just because

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

Because it's time.  Because I can.

Sunday, May 7, 2017

Thank you

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.  


Go read this.  Right now.

Well said, my friend. Well said.

Saturday, May 6, 2017

The USS Constipation

Meanwhile, back at the Bait Shoppe:

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.

I get even.

Wednesday, May 3, 2017

Bad patch

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 just don't always cry for them.

Monday, April 10, 2017

Odd-year blues

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.

Sunday, April 9, 2017

Name game, volume 1

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

OK, more to follow

Sunday, March 12, 2017

Magic is for real

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.

Saturday, March 11, 2017

That's all I have to say about that

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.

Probably won't be invited to dinner again.

Friday, March 10, 2017

On prioritizing

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?"


Sunday, February 12, 2017

Winter is coming

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.