Monday, November 19, 2018

Dear Nurse-to be......

I recently took care of a high school student, mom confided that she wanted to be a nurse.  I was curious what attracted her to nursing.  She replied (monotone, and without eye contact):

"I want to be a  nurse because I want to help people"

I love that response, but it's a knee-jerker.

So did I.  I still do. So did we all.

If I knew then what I know now, I would say nurse candidates should be prepared for a different mind set.

Along with the mushy feels, having a sharp, inquiring mind, excellent critical thinking skills and an ability to problem solve is essential.  Nurse Nancy expectations is a good start only.

I wanted to be a pediatric nurse.  It seemed cool, helping sick kids.  When I decided that I was, like,  7.  I wanted to be an LPN.  I liked the caps.

My parents wanted me to go to a 4 year college and be an RN, but I never thought I had the right stuff  academically.  Also, they didn't really have the money to waste on an average, unmotivated student who would probably drop out when there were a couple of genius siblings coming along. As the family was stretched kind of thin in spite of the earnings from my lucrative after-school baby sitting and pharmacy clerking, we compromised on a 3 year diploma program.   I applied too late for the fall class after my high school graduation (ok, I procrastinated), but was immediately accepted for the following year.  I took a six week nurse's aide course and did that at a busy city hospital for the year.  Well, 11 months.  I worked as a lifeguard for the next summer, it being in my DNA to sleep until 9:30 and be on the beach all day.

The three year diploma program  prepared me very well.  In my senior year  I was,  prophetically, voted most likely to be an ER nurse.

Which I did, about a year after I graduated, and I did work in pedi.   In the last 40 plus years, I have worked in myriad other areas in addition to the ER. In the medical tent at sports events in my town.  Giving flu shots.  Lots of teaching.   CPR, EMT's teaching first aid classes.

I burned out on teaching, but I still like the helping people part.  I have become a bit more discriminating about the kind of help I provide because I am so inundated with tasks.  I am really, really tired of the constant concierge demands.  People are so grabby.  Cab vouchers and gourmet meals do not exist in my realm.  The drunks and constant psychiatric holds are tedious.  We generally run out of turkey sammiches by 7 PM, and I refuse to make toast.  Too many steps.

I never, not once, sought a degree in hospitality.  My degree is is a BSN....bachelor of SCIENCE.

I use science every day.  I dig it.  I like  how chemistry works, the human body is amazing. I like puzzles and problem solving.  Human illness and injury present endless opportunities to figure out what makes them tick...or stop ticking.

Math is important, without solid math skills there would be medication errors galore.  People would die. We convert pounds to kilos to ensure safe weight-based dosing.  We figure stuff out like how to convert mcg/kg/min and how fast to run drips.

Thanks to relentless drilling from grade one, I can effectively utilize vocabulary and  grammar to create coherent documentation.

I freaking love technology.  I love computers, machines, gadgets, monitors, pumps, you name it.  I'm always willing to learn new programs.  I have fun figuring out work-arounds and trouble shooting.  Vents are fun.  New central monitoring system?  New med pumps?  Sign me up.

Am I a people person?  Not so much.  I like people less than I used to.  It's not natural for me to put myself out there,  unless a sense of humor (mandatory for a nurse) is deployed as an ice-breaker.  I don a nurse-persona when interacting with patients.  I've said it before:  I am a good actress.  More importantly, I am good at what I do.

Is it necessary to have empathy?  Absolutely.  But know that little pieces of your self (or soul) will be chipped away.  Small bits of your humanity will be left by the wayside like breadcrumbs.  I don't know for sure if these bits die, or will someday be reassembled.   Maybe time simply blurs the painful memories.  Its kind of like a hard candy shell forms, born of frustration, anger, and because of people who don't do your job constantly telling you how to do it.  But mostly because of the hopeless cases, each drug addict you can't help, every sad, neglected, and pathetic elder alone with no family, every senseless death. You will weep buckets.  It will change how you view illness, life, and death.  And when you think you can't take another day, you will weep when someone survives against all odds...or someone says thank you for caring, and means it sincerely.  You will bask in the glow of that save, that thank you, that hug,  for days, weeks,   You will come to know that is why you put up with so much bad.  That one good thing that keeps you coming back.

After you've done the job for awhile, you will not be the same person.  Do you have the stuff, dear high school student?  I hope you do.  But know that the stakes are high.  The potential for doing for others?  The sky is the limit.  So is the potential for harm, not only to your patients, but to yourself.  It's not easy.  I'm not sure anything that important should be.

Sunday, November 18, 2018

Progression of Manbaby, an anecdotal study

Within one 5 hour shift, I had the entire spectrum of Manbaby stages:   infantile, toddler, school age, adolescent and grown-ass adult.    It is interesting to observe the progression.

1.  The infant was 11 months old.  A third child with a "really high temp, and going up and up" in spite of basically a topical spritz of Tylenol at 99.5 degrees.  No other symptoms, yet the parent was beside herself, screaming on her phone about the catastrophic medical emergency for which she nearly called 911.  I had to tell her to put the phone away and tend to the already walking
child, who looked like a rose, as he attempted to climb up an IV pole.

2.  The toddler with a head bump, no loss of consciousness, no visible injury.  He screamed and screamed as the mother loudly explained every second of the terrifying vital signs I was doing.  She helpfully conveyed fear with every word instead of distracting with the phone, a song, or book.  She demanded a pediatric neurologist to be called immediately as she rocked the shrieking child, smoothed his hair and kissed him repeatedly.  Feed the frenzy.

3.  Young school age kid (on the cusp between toddler and school age) with a simple forehead laceration.  Parents demanded plastics in triage (they don't take call here, and don't answer our calls) and asked when they would see a pediatric neurologist (never.  What is with the pedi neurologist demands?  Some Dateline episode I missed?).  Insisted on over-explaining everything to the kid, offering information he didn't need to have, talking incessantly about needles.   I put topical  numbing medicine on, much wailing and gnashing of teeth from both parents, hand holding, repeating over and over "it's not going to hurt", (it probably will.  I don't lie to the kids.  It stings).  The kid was too absorbed in an iPad game to notice.  5 minutes later, I heard blood curdling screams, a harbinger of good times to come.  Dad had used hand sanitizer on the kid and he had a paper cut.

We had to wrap the kid in a, "Bat Man cape" (arms in pillow case then burritoed in a sheet) and 2 people to hold him down for sutures.  More blood curdling screams.  Dad repeatedly saying "I know it hurts, daddy's here", drowning out our usual successful diversionary banter, while mom sobbed and rocked in the corner, wailing "it's almost over".  No attempts at diversion.

3.  School age kid, (age 11) hopping on two feet, with a knee injury sustained about 3 minutes prior     to arrival.  Hopping.  Two feet.  Mom immediately commandeered a wheelchair, of course, and harangued the registrar until I finished with the tiresome chest pain patient.  Within 5 minutes asked for blankets, pillows, juice, "some kind of splint", ice, pain medication, and for the orthopedic to be standing by to care for her precious little guy because "nothing is too good for my son".  She, too, smoothed his hair and told him how it was all going to be ok, don't be afraid, mommy's here.

4.  Adolescent male.  Age 16.  He's been here before as evidenced by mom's chummy "we know our way around" banter and checklist of what makes her special lil' guy better with his cyclic vomiting.  A liter of fluid and some zofran, and could we please get started on that because I have another kid at home whose plans were cancelled because of the patient's visit to the ER, and younger bro is NOT happy.  Mommy made sure to let me know that baby boy doesn't like needles, and could we please use the smallest size, and this arm, and not to try unless I'm sure, and he has persnickety veins, and could we draw the blood at the same time so he doesn't get too anxious.  Although I found a vein immediately I spent a good 10 minutes pretending to find one while Mommy cooed and cuddled.  Gag.  The kid didn't vomit once in the ER. Demanded juice and crackers after about 20 minutes and wanted to go home soon after that so they could get on with their evening plans.  I didn't hurry as I had other things to attend to.  This was a textbook example of novice Manbaby.  I suspect many, many issues at home.

5.  The  55 year old came in with his mother for....oh, never mind.  It makes me want to vomit.  I've covered Manbaby, both the gloriously single and the married kind complete with Mommywife in the past.

This is really a recipe for creating steel reinforced apron strings.  I don't care if it's not politically correct

Saturday, November 17, 2018

11 years

Hard to believe that this is the 11th anniversary of this blog.
That I'm still working at the bedside.  That I still have something to say.
That people still read anything I write.

Boggles the mind.  Or Bloggles.

Don't know how much more I have left to say, but sometimes inspiration strikes.

So many of the blogs I loved back in the day are no longer around.  Madness.  Nurse K.  GuitargirlRN, to name a few favorites.

I wonder what all of them are up to, if they are still working in the ER.

If you are out there still, stop by and say hi!  Miss you all!  

Thursday, November 15, 2018

Lake-sword autocracy vs. autonomous collective

My ER did some remodeling and created a locked area  for dedicated psych hold beds.  Now, because the patients have a nice, warm, safe, cushy bed with a TV, they wait much longer for a commitment bed.  'Cause, you know, they are in a safe place.  I refuse to work there.  The days holding routinely number in double digits. Weeks.

Two of our old psych rooms were turned into medical rooms.  There was no increase in staff to reflect the increased acuity.  The assistants are routinely taken off the floor to watch the suicidals which are now in overflow hallway beds with the drunks, and the beds are always filled.  We have more psych patients than before.  Many.

Sometimes it gets loud there, in the hallway, what with people trying to walk, steer stretchers, move X-ray machines, stuff like that.  There are 10 computers at that end of the ER.  It is loud.  Phones are constantly ringing, alarms always dinging. There is no privacy for the patients, and no privacy for us.  People are always hanging on the desk asking for things.  You can barely hear yourself think.

Often, the patients talk to each other, complain to each other, and get each other all ramped up and agitated.

One night was particularly wretched.  The patients were heckling, actually heckling, security, nurses, docs, anyone who walked the gauntlet of hallway dwellers.

Security and the assistants were beside themselves trying to keep things calm, but they had a job of it.

After a couple of hours I went out to dwell in triage, happy to get away from the cacophony.

One of my zone mates had PTSD from the events of the remainder of the shift.  She was wild-eyed, her usually flawless bob sticking out all over from many frustrated passes.

"It was awful.  It was really hard trying to take care of actual sick people, they just wouldn't shut up, they kept at it and at it.  "Nurse! Nurse!  I need, water, I need food, this sucks, I want to see my lawyer".  They were all trying to outdo each other in the asshole department.  Then they started to organize themselves.  They had a list of demands!  They were there so long they established their own form of government and elected a representative.   Possibly a king!”

Happy I am closer to retirement with each passing day.

Supreme executive power derives from a mandate from the masses, not some farcical aquatic ceremony.