The view from the other side

I'm five weeks into this new hospice gig that I'm doing, and although I'm still on orientation, I am here to report that I'm pretty sure I really love it. I almost admit that hesitantly, because I'm doing things that I always swore I'd hate, things I scoffed at, things I mocked and derided others for doing. Okay, maybe that's a little harsh, but you get the picture. Those things include: sleeping during the night, waking up early each morning, working five days a week, having to do errands and shopping on the weekends...I could go on. Because to be honest, I LOVED night shift. I loved only working three days a week, and I was giddy over being to go shopping or do errands in the middle of the week. The middle of the night, even. I could avoid traffic and most of all, CROWDS. I did the nocturnal thing really well, and the few early mornings I've been forced to contend with have left me grumbly, crabby, and generally miserable. To be fair, I probably induced the same feelings in those unfortunate enough to be around me in the early mornings.

Well, nothing drastic changed...I'm still not a morning person, and given my druthers (what the heck are druthers, and why is someone giving them to me? Like a present?) I'd be staying up late and sleeping in till past noon. Oh well. But I've adjusted to this new schedule, in part because I'm a creature of habit...I ADORE habit. And routine. It's just so comforting. So the regularity of this new schedule fits me well. And I guess I'll give Matt a little credit...since I've moved in with him, my old night schedule got progressively more annoying and inconvenient. I was only home with him a few evenings a week for dinner, and those nights weren't the same week to week, and it was frustrating. Now I get to be home every night, and every weekend, and it turns out that five-day-a-week things isn't so bad when the shifts are only eight hours long, leaving me with plenty of time after work to walk the dogs, cook an Indian feast, plant some vegetables, whatever strikes my fancy. I'm not advocating either schedule/lifestyle over another, I'm just saying you gotta find what works for you at the right time for you.

At this point, you'd be forgiven for thinking that I changed jobs simply due to shift and schedule concerns, and while that is a huge piece of my overall contentedness, the nursing aspect of what I'm now doing versus what I was doing is the main thing. But that's a big topic for another post, and right now it's easier to write about and be silly about simple things like sleep schedules.

I'm sort of concerned that I need to rename the blog, or start a new one...since I'm no longer literally "knitting in the dark." Now it's more like "driving during the day" but that isn't too catchy...I'll have to ponder that.

And now for something completely different...

I quit my job. I got a new job. I start next week.

I will be an outpatient hospice case manager nurse. I will be working Monday through Friday, daytime hours, no nights, no weekends, no holidays. I have heard rumors that this is the schedule that most people keep, being up and about during daylight hours, sleeping at night, and keeping somewhat "regular" hours. I haven't lived this way in nearly eight years, since I started nursing school, so this may be an interesting, if possibly difficult, transition. I actually feel completely ready and excited for this schedule change however, which is something I honestly never thought I would ever say. I loved nigh shift, I was a great "day sleeper," I loved having three to four days off a week, doing my errands in the middle of the week, going to the grocery store at 2am. But I sort of over that now. I'm over working interminable, often-grueling 12 hours shifts, the sore back, the aching feet, losing half my week to the sleep/eat/work routine with no room for anything else. I'm over inpatient-unit manglement policies and procedures and decisions, isolation gowns, and short-staffing headaches.

I'm excited for the new job, both for the schedule but even more so for the hospice work...more on that transition later. Maybe I should start a new blog, chronicling my adventures as a visiting hospice nurse, interspersed with my attempts at photography, my foray into vegetable gardening, and my efforts at cooking 660 different curries? Or maybe this is all just a natural continuation of Knitting in the Dark...?

job opening

So, last night. Blah. It was my first night using the brandy-new computer charting system recently unveiled at work. It wasn't too bad, but added a lot of time and confusion and discomfort to my charting process at work. I didn't have any huge problems with it, although I'm fairly sure I only charted about 12% of what I was supposed to. In the midst of the confusion, and the weirdness of no longer having paper MARS (it's all electronic now) I missed my patient's chemo dose. So it ended being about three hours late. In the morning when the managers got there they all flipped out and I stayed late writing an incident report and feeling like the sloppiest stupidest nurse ever. BUT by that point in the morning I was numb and sad and annoyed and just sick of looking at computers at all.

My patient died last night...not the missed-chemo patient, a completely different patient. A young man I'd cared for over the past several weeks. I wasn't his nurse last night but spent some time helping the family and was able to have a nice talk with them before I left in the morning.

Meanwhile, the ICU admission that I got was the furthest thing from the cakewalk DNR/DNI hemonc patient that I expected. What exactly do you do when your patient rips her leads off, smacks you out of the way, and insists on leaving the unit to smoke despite the fact that her lips and hands are blue and her oxygen saturation is 68%? I wish I could just say fine, go ahead then, and come on back when you're ready to accept our help. Uff.

Anyway. Tonight is definitely a Pagliacci's night. Yes, I use food as a coping mechanism. Is that so wrong? It's cheaper than crack.

...

On my unit, we rarely see the newly-diagnosed cancer patients. By the time they arrive on our doorstep for transplant, they've been through at least a round or of chemo, sometimes even a prior transplant, and definitely been indoctrinated by the Clinic with at least a rudimentary knowledge of self-care and a set of expectations for their transplant. Many patients have done their own extensive research on their disease, the treatment options, facilities, etc. So while I still answer a lot of questions and do a lot of patient-educating, it is usually from a very matter-of-fact place. It may sound cold to say this, but in reality, my patients are cancer patients first, and then become real people to me second. It's inevitable...the first thing you learn about someone is their disease, their treatment, their lab values. You focus on this and then later the details of them take form...they are also someone's mother, or sister, or teacher. In their 'other life' they spent the majority of their time gardening or traveling instead of getting chemo and puking.

Last summer, working in another medical-surgical ICU, a young woman was admitted and immediately assigned to me, as I happened to have a lot of oncology experience. She showed up at the ER with some vague complaints, nothing too troublesome. She had hoped for some pain meds and a comforting, routine explanation for her headaches. After all, she was young and otherwise healthy. She was starting a new job the following week and wanted to be ready to jump into it. Then a routine blood test revealed a type of blood cancer in an advanced stage of crisis. Within 24 hrs, she had been admitted to the ICU, had two invasive central lines placed, undergone a procedure which removed all her blood from her body and separated the white blood cells, and heard words like "cancer," "leukemia," and "chemotherapy" thrown around.

By the time I meet her, she is feeling okay but her eyes are nearly swollen shut from crying and her voice is hoarse. I tell her the experience I have in oncology, in particular this type of cancer and treatment, and ask her if she wants to talk about anything or ask me anything. She mutely shakes her head, then whispers, "I don't even know what to ask. I just have stupid questions,"
"There are no stupid questions at all," I say.
"Well, I don't even know how to act. When other patients find out they have cancer, do they just cry all the time too? Is that normal?"
"Oh my god of course it is!" I told her. "It probably wouldn't be normal if you didn't cry!" Later, she asks me:
"Will you tell me something? No one else will tell me this, but have you ever seen anyone with this disease get better? No one will tell me if I could die. All they tell me are numbers."
How do you tell someone who is barely in her mid-20s that yes, she could die? That unfortunately, you see more people who die from this than who get better? That some of the things she is going to go through are going to make her want to die?
"It's cancer. The treatments for it are really really hard. Yes, you could die. But you could live, too. People do, and I've seen them. It's one day at a time, sometimes one hour at a time, and sometimes that's the best we can tell you," and I even get a bit teary as I squeeze her hand, till one of us makes a silly joke to break the mood and laugh a little. I tell her what I often tell patients, how I've seen how amazingly strong she is, and how much love I've seen surrounding her from her family and friends, and that more important that any medicine we could give her. When I say this, I believe it a little more than I usually do. I think I say it almost as much to comfort myself, and to give myself hope, as much as I do for her. She is a person to me first, and a disease second, even incidentally. She worries about losing her gorgeous long hair and makes jokes about the revealing hospital gowns, she wears funny socks just because she can and her friends start a blog for her. And knowing how dangerous it is, I let myself hope. Really hope. Some people do get better from this. So why not her? It has to be her.

After our initial meeting last summer, I could count the number of precious weeks that she was actually out of the hospital versus in it. She died last week, in my ICU. I wasn't her nurse but I don't know if I could have been. Even though I feel like I should have been. For her. I had trouble even helping her nurses with her, because I found myself just staring at her face, her swollen-shut eyes and her bald head, searching for traces of that brave, funny girl I met last summer.

Scaredy-cat nurse

I'm not one to wax philosophical and claim that I live my live by nebulous quotes and cliches, but I recently read that Ralph Waldo Emerson said, "Always do what you are afraid to do." And I was just thinking that maybe I've unintentionally done that.

I was a wee young nurse tech buckaroo roundabout five years ago, wide-eyed and scared to death just to walk into a patient's room on the oncology unit I just started working on. I would rehearse to myself how I would greet the patients and introduce myself, just so I wouldn't sound silly, and I lived in fear that eventually a patient would say to me, "What are you doing here? You obviously don't belong here, you don't know what you're doing." Mercifully, and shockingly, that never happened. I would walk past the ICU rooms and glance furtively in, trying to discern the actual patient from the spaghetti-tangle of wires, lines, and blippy-beepy machines, and shake my head. Scary. Crazy. If asked to assist an ICU nurse with turning or cleaning her patient, I remember gingerly lifting lines or wires simply to hold the patient's hand, always keeping one eye-ball glued to that ET tube as if a hiccup might dislodge it, causing the patient's untimely and messy demise and of course it would all be my fault. I imagined that I could never work in the ICU, I didn't have the knowledge, or the drive, the stamina to handle being that on-edge and stressed out all day long.

To make a long story short, I of course ended up as one of those crazy ICU nurses. I guess it was a combination of being fascinated by what I didn't understand...the physiology, the pharmacology, the intensity of the human situation, that drove me to want to figure it all out. It was probably a little bit of, "Hey, if Nurse XYZ can do it, then so can I!" And maybe you could boil it down to that little quote, "Always do what you are afraid to do."

And now tonight I'm going to be in charge...not a huge thing, there are no special classes or knowledge or certifications required, and the amount extra that I'll get paid will barely pay for my end-of-stretch pizza. But something makes me want to try it. I think it's a little bit the sense of ,"Ok, what's next?" I attribute that to the fact that I am an eternally lazy person, and I must always be working towards a next big goal or my motivation falters and I slip into a boring rut. So, after RN, ICU RN, what was next? Charge RN, I guess. And of course, CCRN ICU RN, coming soon :) I used to think I would hate being in charge, and there's still a chance that I might be right. After all, I don't think I'm a manager-type person...I don't like organizing things, I don't particularly like telling other people what to do, and although I've been working on, I'm not as assertive as I'd like to be. I'm much more content to remain quietly in the background, mostly doing my own thing. But hey, it'll be an interesting change, a new perspective at work, and at least I can say I tried it.

Dog hospital

Something strange has been happening in my wiener dog family... when Ted went to the vet to get his teeth cleaned, Tessa got sick with some nasty GI virus. When Tessa went to the vet to get her teeth done, Ted got sick with some nasty GI virus. How weird is that? What is going on? My normally healthy little dogs are rarely sick, despite the nasty bits and pieces they occasionally try to snack on during our walks. So, yet again, I am making boiled chicken and rice to sooth the tummies of my little dogs, giving them lots of cuddles, very frequent trips outside, and washing the rugs. Tessa is doing better after her dental surgery and it appears that she can still keep her tongue inside her mouth (one worries about these things as the old girl loses more and more teeth).

Puffy eyes

I have lots to say, its swimming around in my head and as soon as I have a little time off I think I'm gonna spew it all on here.

I've been working a lot. My patients are young and they are dying. I cried last night at work, for only the second time in five years there. Of course, I've cried on the way home plenty of times, I've cried during Dawson's Creek and Law and Order cathartically for my patients, but sometimes...even if you try to be professional and do you your job and keep in inside, it creeps up on you. Thank goodness for kindhearted colleagues who simply pat you on the shoulder, make you a cup of tea, hand you a box of tissues, and tell you to walk and away and take a little break.

More later. When the eyes are a little drier so I can see what I'm typing.

Hellooo *echoechoecho*

Remember me? I don't post around here much anymore. I would make excuses that I haven't had much interesting or exciting news to report, but as evidenced by past blog posts, I seem to have been quite capable of posting about completely irrelevant or boring topics in the past.

Maybe I'm a little burned out on writing about nursing topics, or about my patients. There's something so private and intimate about the situations that I'm sharing with my patients, they're experiencing such painful, terrifying, or life-altering experiences, that it often feels like a betrayal or even just a belittling act to write about them in my blog. They own their illnesses and their experiences, its not really mine to share with anyone. And of course we are all intimately familiar with HIPAA...I would always change any revealing details of my patients and most of the time anyone I write about is a composite of several patients. But it is often those small, identifying details about someone or their story that makes the story special, or interesting, and to change those details simply for the point of sharing the story takes something away from it. Of course I realize nursey blogging can also be about the nursing experience, and being a nurse, rather than the patients' stories, but it is also pretty hard to separate the two...one experience is defined by the other's, and vice versa.

So...on to the nursing content...I'm taking a CCRN study course this spring so I can take the exam in early summer. I'm not terribly excited about the study course except that I get paid for some of the hours and it is essentially the external motivation that I need to make myself study to take the exam.

Tonight I'm off work but I'm playing nurse to a sick little dachshund...she seems to be suffering from some kind of GI upset...frequent bouts of emesis and liquid stool through the day today. In laymans' terms, I'm discovering puddles of poo and puke in various corners of my home, and now both the kitchen and the bathroom rugs are in the laundry. But our favorite Auntie to the doggies delivered us some dinner, so I wouldn't have to leave the sick puppy alone, and I cooked up some extra bland chicken and rice dinner for her. She seems to be tolerating the dinner so far...and sleeping comfortably on the couch.

Seacaucus, sawcaucus.

I'm going to caucus for Obama because I don't believe there should be a woman as president. They are too emotional and generally have bad judgment. Not to mention, they are terrible drivers.

I.Am.Totally.Kidding. Well, except that that driving thing. Women suck at it.

Does anyone else remember back in the day, when it was considered rude to ask someone who they were voting for, that it was none of their business? Because I'm not sure why the phlebotomist who drew my blood today felt like it was totally okay to ask me who I would vote for. So I told her that convicted felons aren't allowed to vote, so at least I don't have worry about it. Because I'm too lazy to look it up, anyone have any good links that help explain Obama's policies/plans for healthcare reform? Sure, he may be inspirational and full of hope, blah blah changecakes, but I'm too cold and dead inside to be swayed by a moving speech or a touch of inspiration. I want plans.

And also...I am NOT defending the misogynistic theocracy of Saudi Arabia, but I have to play devil's advocate on this article, "Saudi Cops Grab U.S. Woman..."

Sure, it might be a bit crazy to a lot of the world that unrelated men and women cannot be together in public, but thems the rules over there. So this American woman knowingly broke the law, and goes to jail for her offense, and uhm...? Sorry. Maybe I just have a problem with her because when the power goes out in your office, you GO HOME for the day. Whee! Day off. What was she thinking? You do NOT break the law simply to get a little more work done for the day. Sheesh. Maybe a night in jail helped loosen her up a bit. Kidding. Again. Totally. Kidding.

And, Mr. Restoftheworld? You do not get off poking fun of Saudi's silly laws against women or highlighting an amusing anecdote to show how "backwards" those people are. In the same article, substitute "woman" for "racial minority"...are you still scoffing and smirking and shaking your head? Or are you sending in UN Peacekeeping forces and demanding universal human rights? Anyway. But at least they don't let women drive over there... IAMKIDDING! Get a grip.

Let's see...here is where should apologize for not updating lately. I'll try harder in the future. But to recap: Love my "new" job again, nightshift rocks, TESOL class lots of fun, cancer patients depress and inspire me. I'm considering taking the CCRN, being charge nurse, going to Turkey, making mini Turkey meatloaf muffins, going to Egypt and Jordan, and a retirement plan. I knit Foliage from Knitty.com (and I love it!), a feather and fan pattern baby blankie and matching hat, and I'm working on a long grey scarf and another baby hat. I'm totally addicted to Law and Order, it's like TV crack, and I can't turn it off. Ever.

Just something to make you smile on a Sunday morning...

I've been seeing these Alli ads on TV for a while now, and of course, like the skeptical nurse that I am, I've been doubting how 'easy' and 'wonderful' this drug is. Everyone knows there is no miracle drug for weight loss. Except the millions who spend billions on them every year. But anyway. As soon as I heard the description "blocks fat from absorption in your digestive track" in the advertisment, I knew this must pharmaceutical doublespeak for "shitstorm." I became determined to get my hands on a package insert from this drug in order to translate the side effects into layman's terms, since I was fairly certain the more accurate and descriptive words like "bowels let loose in your pants" and "buttmud" and "wet farts" would not be listed. However, someone beat me to this, and you should read it too...

Alli Side Effects in Layman's Terms

More knitting, less nursing

I do fully realize that this is supposed to be a nursing blog but it's fairly devoid of any nursey content. But in between calling off sick with nasty colds and being cancelled due to low census, I haven't really worked much lately. And I actually miss working. My bank account really really misses me working, but that's another story. I was really hoping to go to work tonight but whatever crawled up my nose last night has set up camp in my head so I had to call in sick. And since this is my second cold in a month, I wonder if I have a compromised immune system, possibly secondary to leukemia? I'm not a hypochondriac, per se, however being an oncology/ICU nurse I tend to look for zebras. That's one of my favorite sayings, by the way. They say it to med students, when they are diagnosing patients. "When you hear hoofbeats, don't look for zebras," or something like that. Just meaning that always rule out the most likely scenario first. Anyway, I digress. Because I took cold medicine and my head is cloudy.

Last night I went to Pizza Hut because I suddenly needed to have me some stuffed crust pizza. And it was the most bizarre experience ever. I ordered online, and the email reply said it would take 20 minutes. So I went to pick it up, 20 minutes later. After a few minutes, someone finally comes to the counter to acknowledge me, and says it'll be a few more minutes. How magical that he knows that, I think, considering he didn't even ask my name for my order. Then a guy in mismatched navy sweats comes in, and the same thing happens to him. In the meantime, while he is waiting, he gets a call on his cell phone.
"Really? So he had another seizure? You're taking him to the hospital now?"
It was bizarre, hearing his end of the conversation. I stared at the Mountain Dew in the locked soda case and pretended I was not a nurse. After hanging up, Navy Sweats starts getting anxious and demanding to see a manager, because his food was supposed to ready 10 minutes ago. By this point, two more people have come in, are waiting for their orders, and the phone is ringing constantly. No one at all is approaching the counter to let us know where our food is. Some employee calls to another, "Can we stop taking orders?" Uhm, can you do that? I can sympathize, when things are crazy in retail or food service, you totally want to lock that door and stop customers from coming in because you don't give a shit if more money is to be made, you are making minimum wage and you are miserable. But anyway. Navy Sweats is getting all indignant and ranting about how he had better be compensated for his wait. Some woman in a crazy hat and a knee brace is trying to sympathize and make jokes. A 12-year-old employee comes out to explain that they're really backed up, running out of stuff, etc. Navy Sweats is not mollified. I'm thinking that at this point, Navy Sweats should just pop next door for some teriyaki then head home to his seizing friend. But anyway, no one asked me. Finally, his pizzas come out and the manager is all, "Uhm, just give me ten dollars." I finally got mine and was only charged half price, but then went to my car only to discover that Crazy Hat Knee Brace Lady had blocked my car in with her 1982 white Buick. Seriously. I felt like I was back in Pittsburgh for a little while.

Here's a funny story my dad told me. He was in Canada, at Immigration trying to get his work permit. Ahead of him in line was some strange looking older guy. He couldn't hear what the guy was saying, as he was kind of mumbling, but he could hear the customs agent's end of the conversation. The customs agent looked at the guy's paperwork, and said, "It says here you have a couple of felonies." The guy mumbled a little. The agent continued,
"For weapons possessions?" Now, at this point, one would assume the customs agent should merely stamp a big fat red "denied" on this dude's paperwork and turn him away. However, this particular agent is too intrigued...
"They were assault rifles, you say?" Mumble mumble.
"How many?" Mumble mumble mumble.
"Wow. That certainly is a lot, sir. Did you have permits for those, uhm, assault rifles?" Mumble mumble.
"Hmm. I can see how that caused a legal problem for you." Mumble mumble.
"No, I'm sorry, I cannot allow you to have a work permit to enter Canada with." Mumble mumble mumble. STAMP.

Thanks, Canada. On one hand, kudos to you for policing your borders. On the other hand, maybe you could have referred him somewhere else? Instead of back to the US.

...

Woke up to this headline this morning: Bhutto Assassinated in Attack on Rally.
Admittedly, I didn't even click on it right away because in my blurry coffee-deprived eyes I thought it said something about another attempt. But this time they did succeed. She was the daughter of a prime minister of Pakistan and twice prime minister herself, one of the first to be democratically elected in an Islamic country. But you can read her obituary here for yourself.

While upsetting and sad, I am nearly as disturbed by the fact that this story ranks number 10 on the NYTimes "most emailed" stories list this morning...just below "100 Simple Appetizers in 20 Minutes or Less." No, I'm not worried or appalled at American's knowledge of world events or priorities. I am currently investigating which countries will accept my application for political asylum. On the grounds that if I have to remain in the USA I will be clinically "annoyed to death."

Ok, back to nursing content. Later.

*sniffle*

I'm sick. I've spent the past several days on the couch, making sure that my tissue box, tissue disposal system (brown paper bag), TV remote, computer, and phone are all in a lovely semicircle arms-reach. This is chiefly because once the dogs settle in on me under the brown not-real-fur pimpin' cool blanket, it is very difficult to shuffle and shift them around simply to reach the phone or throw away a tissue. And also because I'm a little bit tired and lazy. Although I prefer the term 'efficient.' So I won't bore with you a litany of complaints or a disgusting barrage of my symptoms, because I just have a cold. A bad one, but a cold. So the chances are pretty good that you either have it, have just had it, or know someone who's had it. And the only thing worse than being sick is hearing someone complain about being sick, or list the details of their illness for you. So I'm sparing you. Before you get all worried and ask, "Wait, aren't you supposed to be a nurse? Don't you listen to sick people for a living?" Yeah, yeah, yeah. I am, and I do, and I actually enjoy it. But unless I am wearing scrubs, have a stethoscope around my neck, and am getting paid hourly (plus night differential!) I don't want to hear about your post-nasal drip or hang nail. I like to think of it like I'm a sort of super-hero. At night I put on scrubs, go out into the dark, minister to the sick, clean up their vomit and their bottoms, hold their hands, dry their tears, keep them breathing till the sun comes up. Then during the day, I put on a fleece jacket and comfy tracky bottoms with an elastic waist, curl up on my couch, think snarky mean thoughts about my neighbors, shout obscenities at women drivers who don't use turn signals, and generally practice being lazy and self-indulgent and somewhat bitter.

Whatever. I'm sick, indulge me.

Oh! The whole point of this post wast to highlight the difference between my old job, at the Place I Would Rather Chew My Own Foot off Than EVER Return to, and my current job, The Place Where I Learn Theres-no-place-like-home... So when I used to call in sick to the old job, here's how it went:
Me: Hello, is this the charge nurse?
Charge Nurse: Yeah.
Me: Hi, this is Rosebuttons. I'm not feeling well, I'm calling in sick for my shift tonight.
CN: *Sigh*. Uhm, ok. Fine.
Me: Uhm, ok, well, thanks....bye?
CN: *click*

Here's how it went when I called in to my current job:
CN: Hi Rosebuttons! Are you calling in sick?
Me: Yeah, I'm still not feeling much better yet...
CN: Aw, I'm sorry. You don't sound great, I'd probably send you home anyway if you tried to come in to work! Now listen, you stay home and rest, just take care of yourself. Hope you're feeling better soon!
Me: Aw, thanks, Charge Nurse! Hope to see you soon.

Granted, these different conversations could be attributed to either a.) differing personalities of the charge nurses, or b.) the fact that the first hospital does not have a resource pool or agency nurses they can pull from to cover absences, but I would like to attribute it to the fact the unit at the second hospital actually cares about their nurses, their well-being, and values their contribution to the unit as a whole. And therefore this attitude and culture carries over into individual interactions between staff, and greatly affects their attitudes towards work. Anyway. Carry on with your gift-wrapping or cookie-baking or whatever you people do around this time of year. I've got cable TV and knitting waiting for me.

Note to self

Personal reminder to Rosebuttons:

Reality just called, it wanted me to tell you that...you are a nurse.

Contrary to evidence of recent activities, you are not actually a member of the jet-set idle-rich who have nothing better to do than jet around the world, hang out in world-class cities, wander aimlessly through museums, and take three-hour lunches with copious amounts of wine or ridiculously named cocktails.

Starting tonight, you actually have to go to *work*...you know, that place where you attempt to earn a laughable piece of paper some call a paycheck? Because traveling is not actually free, as much as you may be certain that it should be, as it is definitely one of your inalienable rights as a human being and apparently as necessary to you as air, water, and caffeine.

And also, at this place called *work* you actually have to do stuff, like show up at a certain time, and stay for a prescribed number of hours, and complete eleventy-bazillion tasks. But wait, here comes the scary part...you also have actual responsibilities. Like monitoring invasive lines and equipment with the purpose of keeping a human being alive. And delivering important medications, and assessing problems, and communicating with other people (whether you want to or not). It is wise to note that these responsibilities and tasks are a bit harder and more important than the tasks that you've most recently been doing, such as trying to decide between the chicken or the fish, or if you should nap before or after dinner, or if you should hop on the metro or just walk through the streets of Paris to get some falafel. Because no one probably died if missed the metro train or if you accidentally napped for two hours instead of one.

So anyway, I know you haven't really forgotten that you are a nurse, but sometimes it is much more pleasant to avoid reality for a while. Sorry. Hey, wait, where are you going? I'm talking to you, Rosebuttons. What are you doing on that computer? Is that the British Airways site you're looking at? Are those little numbers and letters flight times and dates? Seriously, Rosebuttons. Wait, how much? Seriously? Well, London is wonderful this time of year...

Wanderlust

As if I need a reason, I'm leaving town. I'm going so far away from the MICU that rectal tubes and being kicked at and poo-covered will be distant memories.

But don't worry! You won't miss me too much, I'll be right over here for a little while :)

Seriously.

Seriously. Are you tired of my whining, I-hate-my-job, my-job-is-sucking-the-life-from-my-weary-bones posts? Because, seriously. Last. Night. Sucked.

I don't even know where to start, except to make sure emphasize the fact that I am sick and tired of trying to take care of ETOH-w/d GIB with ESLD, encephalopathy, confusion, and of course nutso. And because that alone is not fun enough, the doctors like the write orders for me to give them either lactulose or Golytely because nothing makes a nurse happy like cleaning up liters and liters of liquid poo. So yeah, that was my night, times two, since I had two patients, in the same situation.

To save you time, I'll sum up the highlights:
- Wondering why his oxygen levels dropped a bit on the monitors, I checked in on Loony #1, only to find him and his bed covered in feces. Patient had a feces-covered washcloth in his mouth, shoved into his mouth, and refused to part with it when I tried to take it out. A brief struggle ensued. Not pretty. And also, my internal nursey filter for How to Speak Therapeutically and with Empathy to Patients at all Times has officially gone south. I now find myself saying things like, "You cannot have poop in your mouth! Open up!" I believe I also heard myself utter, "Seriously. Because it's just gross."
- Wondering why Loony # 2 was not mumbling for a few moments, I checked in to find him attempted to pull out his IV lines and any other tube he could find. When I tried to thwart his efforts, he grabbed at the IV line and pulled the entire IV pump and pole into his bed. Then, since I'm such a party-crasher, he got really pissed off and tried to push me away and wave his arms and hit me.
- When I called out for help to restrain Loony #2, the other nurses ran into Loony #1's room, assuming that's where I was. I'm all, "No, I'm in the OTHER crazy room!"
- During restraint process, involving 5 RNS and a boatload of Ativan, Loony #2 creatively called us all every obscenity he could find. It turns out he's quite an angry misogynist, as he declared that we were all dykes. Big nasty dykes. My neuro assessment was further complicated by his answers to my questions..."Do you know where you are, Mr. Loony?"
"Yeah, I'm at Dyke Central!"
"Do you know what day it is, Mr. Loony?"
"Yeah, it's the Day of Dykes on Trikes!"
There is no checkbox for those responses on the CIWA protocol (alcohol withdrawal) flowsheet, however.
- Loony #1 exercised his lungs for at least two hours by constantly yelling, "Help me!" then claiming that he would be telling his lawyer all about this.
- Later on, Loony #2 earned himself ankle restraints after I dodged several feet and leg kicks aimed at my head. And that internal nursey filter? It didn't stop me from telling him, "Seriously. Just stop talking. Stop talking now." But I could honestly think of no empathetic, therapeutic way to get him to stop spewing every nasty word for women's private parts along with a description of them.

So seriously. At least I feel completely justified when I say, "I need a vacation."

Word.

With apologies to Head Nurse, what she says explains a lot...

Nurses believe in God, I think, primarily to have somebody to blame. All I can say is, when God and I meet up at the end of my life, we are gonna have one Hell of a Come-to-Jesus meeting.

Things that are funny...

There are certain things that seem hilarious at four in the morning, that sort of lose something during the "real day" when normal people are awake and the sun is shining.

Last night at work the palm of my hand kept stinging every time I put alcohol gel on it. I noticed I had a tiny divet in my palm, the shape of a fingernail, I must have been clenching my fists while sleeping again. So the following conversation took place:

Me: This little cut on my hand is killing me! Stupid alcohol gel...
RN Friend: Weird. What's it from?
Me: (examining hand closer) Not sure...strange place for a cut...must be stigmata.
RN Friend: Cool. You should use that as an excuse to call in sick.
Me: Ooh! Good idea! 'Hi, Charge Nurse? Yeah, this is Rosebuttons RN. I'm calling in sick for my night shift tonight, maybe the next few nights too...yeah, I've got the stigmata.'
RN Friend: Perfect. They can't argue with that, you know you can't come to work if you can't control your secretions.
Me: Total infection risk.
RN Friend: I gotta get some of that stigmata.

So on my handy List of Excuses for Calling in Sick, I shall add Stigmata right after Scurvy and right before Pink Eye.

Again, apologies for insulting any more religious groups, as I probably did in my previous post as well. But what good is an organized religion if they can't laugh at themselves too?

Bloodless

Last night I took care of a patient who had recently undergone chemotherapy and radiation, and was admitted to the MICU with severe anemia. Specifically, his hematocrit on admission was 14. Then the next day it was 13, then 12, then 11. That's what we call Super Low (or critical, whatever) since the average male should have a hct of at least 45% and we would nearly always transfuse for hct of less than 25%. But this particular patient, due to his personal religious beliefs, refused any transfusion of any type of blood products. He was not confused, and quite oriented, and understood that he could die without a blood transfusion. His cancer is still treatable, but he could not have any more chemo or radiation until his blood counts were back into a safe range. I think I am usually very nonjudgemental of my patients lifestyles, religions, or personal beliefs, but I am having a lot of trouble with this one.

His wife stayed overnight in the room with him, despite it being against our unit policy. But other nurses had previously allowed her to, and once the precedent has been set I hate being the bitch who suddenly enforces the rules. So I agreed to it, but with the warning that if her presence interfered at all with nursing care, I would have to ask her to leave. She put his side rail down and pushed the chair-bed right next to his bed, but I constantly had to wake her up and push the chair aside in order to be able to access my patient. Since he had just received four liters of Golytely and required very frequent cleaning up, I needed to make her move quite a lot. Freakin' Golytely. At one point, upon seeing the entire bed transformed into a lake of dark brown foul-smelling liquid, she sighed and said, "Wow. Awww. Wow. I'm just so surprised, he's only had one little Ensure shake in the past few days." Umm...four liters of Golytely go in, four liters of Golytely must come back out. And then some. I wondered if dayshift had silently administered the Golytely into his feeding tube without explaining the outcome? And she hovered around while I cleaned him, at one point even patting me soothingly on the shoulder and saying, "Aww. Wow, you poor thing. Wow." I bristled. Good thing the lights were dim in the room, or she may have noticed me narrow my eyes and the little hairs on the back on my neck stand up. I'm a nurse, a highly trained and well-educated ICU nurse, this is my job, this is what I do, I'm being paid for it and I chose to be here. Don't pat me on the shoulder.

The patient was pale as a ghost, lethargic and very weak. I didn't draw labs on him since the docs didn't order any, and they want to minimize blood draws as much as possible, for obvious reasons, so I don't know what his hct was this morning. The charge nurse and I discussed possible transfer out of ICU to the medical floor...after all, what could we do for him? Yes, he was full code status, but we could not transfuse. We cannot treat his life-threatening anemia, except with epo shots and iron supplements. He is not a surgical candidate. He is not intubated and his other vital signs and pressures are stable. So it sort of makes sense, he doesn't need to be in the ICU. But it struck me that his status would be downgraded, to a different level of care, essentially because of his religious beliefs. Is that weird?

I'm still thinking about this one. I'm still having trouble with it, because it doesn't make sense to me and I have trouble accepting it. Sure, a lot of religious convictions and beliefs don't make sense to me, but usually I can accept the differences in belief and move on from there. But this just doesn't sit well with me. I can't wrap my little secular head around it. Why does that one specific thing in the bible, regarding blood, get translated and adhered to so literally? Why do they accept all of our other medical advice and interventions without investigation or comparison to scripture?

And I'm confused by myself...I left the same t-shirt (his garments?) on a Mormon patient in the ICU for days and days and worked around it, I carefully wrapped and re-wrapped a head scarf around a young Muslim woman each time before a male physician entered her room, I timed certain medications around prayer times so a Muslim patient could pray, I made fifteen-minute checks on a my Hasidic Jewish patient because after sundown on a Friday she could not use the call light, I've bent the unit policy and allowed more than the requisite number of visitors into a patient's room so they can pray together, and not one bit of any of these actions bothered me. Rather, I consider it to be a crucial part of a nurse's job, since I am caring for the whole patient. But at the same time, I guess none of those things ever compromised a patient's care or well-being, either.

So anyway. This is just a big old can of worms I might be opening. Perhaps this is a controversial topic, maybe I seem callous or judgmental. I sort of feel that way. But I just don't get it.

Overheard at work...

Chipper Dayshift Charge Nurse: Good morning, Susie!* How was your vacation?
Dayshift Nurse: It was wonderful, I had a great time. Until I had to come back to this hellhole.
Chipper Dayshift Charge Nurse: (nervous giggle) Oh, haha, it isn't that bad, now is it?
Dayshift Nurse: (without a trace of irony) Yes, it is.

I promise, the above conversation was overheard at work, and I also promise, it wasn't me. Not yet anyway. I suspect that I will actually have to return from my Grand Adventures, however. So stay tuned.

To anyone out there who is not a nurse, or a travel nurse, or in a job or field where it may be difficult to find jobs, and if you hate your job, and every cell of your body cringes at the thought of starting yet another 12 (or 8) hour shift, I heartily sympathize with you. Because just this morning I realized that if I didn't have just a few weeks left at this hospital assignment, and if I didn't have a bazillion other nursing job options to pick and choose from, I would be even more morose and depressed and whingey than I already am. And that's saying a lot.

I've had four days off of work, and it felt absolutely sinful and delicious. I slept late every morning (I love you, Mr. Melatonin and your little buddy Benji Benadryl), I cleaned my house (even the bathroom floors!), I cleaned out my closet (must make room for Paris shopping!), went to the grocery store, and dropped off the clothes at Goodwill. I also made it to the pharmacy because unhappy stressed ICU nurses must NEVER run out of migraine medicine.

And oh! The best part. HBO and Showtime On Demand. My thoughts so far? The Tudors: Showtime should probably have left the period piece to BBC or A & E. But I will continue to watch it. Because it's Jonathan Rhys Meyers. I'm obsessed with all things Tudor-history, as geeky as that may be. Weeds: Love it, but maybe a bit too much cops/gangsta drama this season. Californication: So far, funny funny. And pretty well-written. And David Duchovny? Yes. Just...yes. I have loved him ever since the days when I would have given my right pinky finger just to be the Agent Scully to his Mulder, and he rocks in this show, as a drunk and drugged-out bitter divorced misplaced New York writer bitching about living in LA.

So that's what I've been up to lately. Sorry, not much nursing content in this post. Mostly because I've had a few days off, but also because I hate my job. Which makes me sad, because I used to love being a nurse, and I've even had jobs where I would truly look forward to starting a shift. I want to love nursing again. I miss you, nurseywork.