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.  

Brilliant

Go read this.  Right now.

Well said, my friend. Well said.

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.

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.

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.