And on the Seventh Day...

....Jamie went to work, and saw that work was good.

I had a good day at work today.

No, I really mean it. Sincerely. It was good.

I had three nice, normal patients. I didn't have to admit anybody, I didn't have to discharge any one, I didn't have to pick up extra patients. Everybody had issues I could handle, and the attendings who rounded were superbly nice people who actually talked to you about their orders, like you were a sentient human being.

I even stayed four hours extra (I was only working a four hour shift to begin with) to help out as our numbers dropped at 3p.m., and it still was a nice, normal day. I almost felt I had an office job. it was almost relaxing to be at work today.

Meanwhile, I'm trying to find a new job. I mean I should be. And will.

Tomorrow.

How To Be a Yes-woman

Here's another fun conversation I had on the same patient as below. I'm running around going crazy, when I get a call from the attending. The patient didn't so much fail a barium swallow test from the day before as remain so lethargic no one could do much of anything except sternal rub him with barely visible response, much less complete a full test.

ATTENDING:
Hi, there. I know Pt blah blah blah failed a barium swallow test yesterday, but I was wondering if you could, you know, maybe just sit him up a little bit and see if he'll take sips of water.

JAMIE:

[playing along like a smart nurse as she is now playing a dumb nurse]
Oh sure, doctor, no problem!

ATTENDING:
You know, make sure that you sit him up at a 90 degree angle and just see if he can wake up and take a couple sips of water.

JAMIE:
[finding this very funny, somehow]
Oh yes, doctor, will do. 90 degrees. Gotcha!

ATTENDING:
[now satisfied with self]
Well, great, thank you then!

JAMIE:
[hamming it up, as she has no intention of trying to arouse a lethargic patient to do a dysphagia consult she isn't authorized to do, and wouldn't do as per ordered in her nightmares]
Oh, you're so welcome, Dr. Blah blah blah!

[Time passes]

JAMIE:
[as a joke]
So his attending wanted me to sit the patient up "to see if he could take a couple sips of water." Whaddya think?!

SPEECH THERAPY/JAMIE:
[both break down into gales of laughter]

Crazy Talk

Here's a sample of me getting report from the float nurse on a "heavy" patient I haven't had yet this admission: keotube feeds, IV heparin drip (not on the right IV pump, but whatever), wrist restraints, lethargic yet combative and howling when not lethargic, going for a PICC this a.m., blah blah blah blah blah.

FLOAT NURSE:
So this patient is MMSA positive.

JAMIE:
Uh? Sorry? Is that like MRSA? I've never heard of MMSA.
[asks another nurse standing by]
Have you heard of MMSA?
[talking to float nurse again]
Do you know what it means, is he a contact precautions guy or...?

FLOAT NURSE:
[in tone that suggests it really isn't a big deal, can we please move on now?!]
I don't know. He doesn't seem to be on contact precautions.

JAMIE:

[not trying to be bitchy, but thinking This is starting to piss me off a little bit, maybe I should just read through his chart instead of getting this lame ass verbal report]

Uh. Did you check his labs? Did he have a MRSA swab done or something?
Did they tell you what it means in report or maybe it's in the chart?

FLOAT NURSE:
[listlessly]
I don't know; that's what I got from report. last night

JAMIE:
Uh huh.
[now totally pissed, as she realizes she's going to have to treat the patient as contact precautions even though he hasn't been all night/whenever and it might take half an hour of research to figure out what MMSA means]

Okay, so I go into the room because his tube feeding pump is alarming, and notice he's not on the right pump for his heparin, and it's been running all night/for God knows how long. I have no idea if this guy has a nosocomial infection or not, and now I'm going to have to 1) fix the tube feed pump 2) find the right pump for his heparin gtt 3) figure out whether or not MMSA is some new scary disease that will render you blind or something, in which case I can file a lawsuit against the hospital, or at least fill out worker's comp papers.

I'm not even half way through report, it's 7:30 a.m., and already I have three issues to investigate and correct on one patient, plus I've got to hang two units of FFPs on another patient I haven't even seen yet. I'm way passed pissed off at this point: I'm angry, but in that muted, repressed, teenage angsty, "Whatever" way I've gotten about shit like this.

Like, okay, I'm not Supernurse. I pass on information that I haven't had time to properly research. But I like to think that when I pass this info on, I'm usually pretty confident that whatever it is I'm passing on is real, legitimate "stuff" and not just "I don't know, someone appears to have made that up and I had eight hours on the floor and didn't bother to check it out. because I was too busy improperly hanging his tube feed and continuing his IV heparin on the wrong IV pump." But maybe it would be valuable to know if the guy has a superbug, as he did present with bacteremia and a UTI for which he is currently receiving, and will continue to receive, IV antibiotics."

Luckily, we had a clinical nurse specialist there to lend a helping hand, and she said, "You mean MSSA? Methallicin sensitive staph aureus?" So she went and researched his labs to find the answer, while I ran around doing other things, acting like a brand new nurse two days off orientation with her head stuck up her ass. (I found it ironic she had to go through all his blood cultures, and it looked like this information was eight days old, and wondering for how long had we been passing off MMSA bullshit in report and everyone just shrugging and going, "Uh, I don't know. Whatever." And the next nurse going, "Okay. Whatever.")

But seriously, with nosocomial infection rates soaring nationwide, you'd think you'd take the time to check to see if the guy had some superbug we don't want giving to every other patient we touch, right?

Whatever.

A horse! A horse!

A kingdom for a ten cc syringe (or horse, if you're Richard III).

So, how's about this: we're down over a dozen nurses, down two unit clerks (meaning we work days and evenings without one) and now we've gone through a third float unit clerk (she fell at work yesterday, and being quite pregnant, wasn't allowed to come back, poor thing). Nothing gets stocked in the med carts, and today I ran around trying to find 10cc syringes to push fucking Lasix.

I can't even tell you what wandering around and around and around and around the floor like some poor lost soul trying to find a chart that wasn't put away properly is like.

Actually, evening shift has been quieter without our regular unit clerk (who responds to the phone ringing with a frown and a raspy, "What's the noise?! " or "Oh that phone! I wish it would quit ringing!" This is the same person that every time you ask her how to use the fax machine, or some unit clerical duty, she frowns (again) and says, "Oh, I don't know." This is an employee of [community hospital] who's worked here for 27 years, interestingly enough.

We don't actually pay people to do their jobs as stated in the company manual. We pay them to do "other stuff" like chat on the phone with family members and close friends, make coffee, watch t.v. in the solarium/family room, etc. etc. We also pay them to say, "Oh, we don't do that."

Nurses are also, ironically, paid to do things that likewise seem out of our scope of practice, like answer phones, put together charts, mop floors, and strip beds of dirty linen (we've actually had umpteen conflicts with Housekeeping over whose job it is to strip beds after a discharge. Housekeeping likes to think it's our job.)

I'm getting to the point where my response to anything short of a real code is, "Whatever." Because basically, when I get someone on the phone to deal with the issue, their response is "Whatever."

Fruit Loops

I've figured out all my frantic posting today has to do with sublimating my fear at going back to my job. Sad, pathetic, etc. etc. Not only am I afraid I'll get run down and sick again, but I'm also not looking forward to interacting with management over my absences. Being legitimately sick does not constitute valid contrition so that one's transgressions against management will be forgiven, apparently, as discussed in depth elsewhere. So I have to run around and get more paperwork to prove "See, I was really sick!" so some bureaucrat paper shuffler can have a job to do and I can continue in my current "grovel and supplicate" act of perpetual contrition "job" until I find something "better." Or different, at any rate.

I'm convinced the same "people" who spend their days making up reasons why you can't have your vacation and sick time, and why your FMLA papers are invalid so the hospital is going to fire you for being legitimately sick are in actual fact descendants of the same demon spawn exorcised from hell by Lucifer (in a story related through some hitherto unknown apocrphyal text hidden somewhere) because they were just too much of a pain in The Dark Prince's arse and he had his hands full designing his subterranean immolation theme park (known popularly as "hell") and punishing regular, well-intentioned human beings for all eternity, thank you very much.

So now I'm doing the "gerbil-on-speed-scrabbling-blindly-at-the cage-walls in a fruitless attempt to break the bondage of slavery" routine. Hmmm. Must have forgotten to buy my quart of lamb's blood and paint it on my doorsill this year. Damn. Gotta remember to write that one down on the list next year--I totally keep forgetting.

Any way. Not looking forward to another Grow Your Own Twelve Hour Shift Human Eating Plant wherein a twelve hour shift grows up into a big, bad fugly Fourteen Hour Shift. Just provide minimal to inadequate hydration, don't feed it, add a couple of change of shift admissions, and poof! You'll have a fourteen hour shift before you know it, money back not guaranteed, sick time definetely not guaranteed, vacation time... ha ha ha ha! You think you get vacation? What does this look like, America?

And please God, no more codes for awhile. I really can't handle it right now. It's okay if you want to send a couple shitty DNR/DNIs my way as compensation, but no actively GI bleeding, hypovolemic, de-sating COPD full code demented ninety year olds, please. (One of my friends says she dreads the month of June because historically she always has a run of crumpy patients, so she's trying to counter-jinx herself so as to have a crump-free June. So you see how living in Harry Potter's world could help us out a lot.) And this week, if you could just give me some pleasantly confused patients who don't get out of bed and wander around, and some nice ambulatory sane people, that would also be really nice. Thank you. Jamie.

Rites of Passage

I haven't read my Durkheim or Geertz in years (try fall 2003) but the whole idea of rites of passage in nursing kind of interests me. What are they for us? Do we have them? Doctors have it formalized, right down to the hazing, with the whole internship/apprentice medical model.

But what makes a nurse go from grad nurse to RN to experienced nurse? Nursing school loves to get hot and bothered about "From Novice to Expert: Excellence in Clinical Nursing Practice" by Patricia Brenner. I should read it, because I'm probably not saying anything she hasn't said already (dammit isn't there something interesting out there that hasn't been "done" to death that I can get published in popular press and live off the royalities? HUH?!)..

Any way, my random survey of my own brain came up with a couple obvious ones, like pulling your first "double" (two eight hour shifts back to back, or sixteen hours straight. I've done two in my career--one as a nurse from 3pm til 7a.m. the next day. It was to help out, because they were going to do another famous [community hospital] 3 way swap and leave us with a tele float and a non tele float nurse, plus one original staff member, which is a very unsafe situation as each night shift nurse takes six patients.

The idea is basically, as tele nurses, we can float to any other medical unit in the hospital except acute ICU (we can do sub-side, or sub-acute ICU because we are critical care level I and telemetry certified). ICU nurses can float any where within their speciliaty (medical or surgical). Some units only float to a sister unit. However, medical, non-tele nurses can't float to sub-acute ICUs, but can float to telemetry units. Think about it. It doesn't make any sense, does it?

If we were to play this line of thinking out to its logical conclusion, then tele-nurses should be able to float to acute ICU, too (thank God they don't make us do this, by the way). If a med-surg nurse, who doesn't know, much less is certified, in telemetry, can come to our floor, then we should be able to float to acute ICU, because we aren't Critical Care level II certified, right?!

Any way, they send us non-tele nurses, and then we have to "cover telemetry" for them. Which means, depending on how bitter and lazy the float is (most are good; some are downright scary), you could be just about taking over the patient's care yourself, as I did one night, paging the HO half a dozen times on a patient whose "telemetry I was covering" while the other nurse read a magazine for half of her shift.

You think that's scary, wait until you hear this story. So, I'm working an evening, and we get a float. One of the other nurses tells me the non-tele float came up to her and asked, in one of those "Is that a question or a statement?" ways, "So the monitor says asysotle?" And so the tele nurse says, "Uh, I'm assuming your patient has a pulse and is breathing... did you check the leads?" And then she asks the tele nurse what an "ablation" is, because that's what her patient had, and she has no idea what it is.

Ten minutes later, the nurse we later dub Scary Asostyle Nurse comes up to me and asks me the same thing about the bedside monitor, about how it says "Asystole" and then she went on to ask about what an ablation was. I was like, "Is he off bedrest, how's his groin site look?"

Okay, so this isn't really to diss that nurse. I think she was a rehab nurse, and to be fair to her, it's a completely different skill set. Pop me up to an ortho floor and I wouldn't know how to set up Buck's traction if the equipment came with instructions. (I would, however, figure if the patient was set up to equipment and clearly had a pulse and was breathing, that "asystole" on the monitor means the monitor and leads aren't set up properly. But who knows. It can be very disconcerting to float, especially out of your speciality in an area like cardiac.)

The point is: you shouldn't float non-certified nurses to units that aren't within their speciality and skill set. Like I said, this could happen to any one of us. It would be as silly as sending me to MICU acute side and knowing how to deal with vent settings and multiple cardiac drips.

Okay, so all that prelude is neither here nor there.

I was talking about Rites of Passage. And I'm trying to think of positive ones and I really can't, sadly. Most of what makes you a good nurse are some pretty crappy situations, actually.

Like working doubles, first codes... I had some other points before I got off-topic.

Whatever. I'm going to get a DVT by sitting on my ass for about five days straight.

St. of the Absurd

In another random, free-association moment , I started to think about Simone Weil, a French non-practicing Jewish intellectual who spent her young adult life in the shadow of the Second World War. She had a fascination with Catholicism, and eventually her arduous academic work compounded with frail health drove her to exhaustion and eventual early death in a hospital (I believe she was in her early thirties when she died).

While she wrote no major works, she did amass a collection of essays and letters to a priest with whom she was close, all of which are quite provocative and yet with so little to work with, most scholars pass her over as a footnote in the history of ideas. I find her fascinating, but I was actually thinking less about the things she had to say about Catholic theology and more about her plans of parachuting herself out onto the front lines of the war as an offering of " womanly solidarity" or whatever, and her childhood self-sacrifice of sugar and sweets "because the soldiers in the war had none, either."

Okay, so mostly I was just thinking about the exhaustion and death part in the hospital, and the similarities between hers and Marie Curie's self deprivation, (she was said to have lived off a handful of dried cherries and nuts per day while conducting most of the research for which she became famous, but don't make me foot note that tidbit, because I don't remember where I read it). Of course, Curie eventually succumbed eventually to radiation poisoning, but, yeah, we know the end of that story pretty well.

I can't wait to go on holiday. I am so very, thoroughly tired. The hell with the St. of the Absurd imagery, I should go find my St. Judas Patron of Lost Causes pendant (note: I don't have one) and do some bended knee begging to find my strength to go on for another week.

I need to go to one of those sanitoriums, with fresh air, fresh food and trips to the seaside. I think that's called "home," actually.

Recipe for disaster

I should totally be looking for nursing jobs, but I just can't get my act together, and here it is April already and most of the GN's have probably already interviewed for ICU positions, so I'll probably be stuck on some telemetry floor again. I can hardly wait.

I'm so burnt out from working telemetry understaffed that the thought of being a brand new ICU nurse (who's had a year's nursing experience and will be expected to pretty much pick up and go with it, detailed orientation or not) makes me almost want to cry. And not in a happy way either. 3:1 ratios are common now (that's three patients to one nurse) in an ICU (yes Virginia, there is such a thing as ugly staffing numbers).

Sadly, most ICU nurses look back rather fondly at the days when ICU = 1:1 care was the norm. I mean, it does sound right, doesn't it? I mean, if you're so sick that you can't breathe spontaneously or your heart can't beat on its own, wouldn't you like someone watching all your drips and vent settings pretty much continuously, especially if you're say, fresh post-op? I would.

Six years ago on our sub-acute cardiac floor, we took 3:1 on days and everyone got all bent out of shape if they had to take 4. Now we routinely work 4:1 on days, and it's always 4:1 on evenings (that's when most of the new admissions come up) and 5:1 isn't as uncommon as it was even 8 months ago when I came off of orientation. Ratios at night? 6:1. And that's on a sub-acute floor. You don't want to hear what the numbers are in plain old med-surg units.

Then I started thinking about something that happened when I was two months off of orientation, and discovered another layer of wrong about the situation. They send a patient down to an emergency non-invasive procedure with transport and the primary RN, right? So okay, the patient goes down on a monitor/defibrillator and a med box. The RN stays with the patient.

But then I started to think about something a former ICU nurse told me about their vented patients going down to a procedure manual bag only, and how it was basically between the RN and RT (bagging the patient) to code the patient until help comes.

Uh. So I'm not sure where you hit the code button in the middle of the hallway; I guess you just scream really loudly like a maniac so at least security comes?

Any way.

So then I started thinking back to my patient, and how they sent me, a new grad, fresh off of orientation, down with the patient and transport (who quickly left, leaving her alone with her patient in the hallway. I didn't think about it at the time (or tried not to, any way) but now I'm wondering about a few things. Like how a BLS certified, non-ACLS certified nurse is supposed to perform BLS in a hospital without an ambu bag, and what in the world good a med box does for a nurse who isn't certified to push the emergency meds any way. I'm not even sure we can push them ourselves without a PA or doc in the room/hallway, ACLS certified or not.

And how long would it take the code team to get to the code? (I remember once having heard a code called twice because apparently no one came the first time, and another nurse and myself watching the ICU interns down the hallway from us stumble out of their respective units looking completely clueless and like, "Uh, so where's the SICU?" or wherever they were supposed to go.) Not only was it not particularly reassuring to me that half of the code team didn't even bother to respond to a code call the first time, I started wondering how you'd designate which hallway you were stuck in, all alone, doing BLS, until they came. Code-calls aren't optional, "if you have the time, come up and check this GI bleeding patient, pretty please." kind of thing, people.

Not only that, transport was nowhere to be found, and I wanted to get my patient back up to the floor without waiting around, so I transported the guy back. Alright, so leaving alone for the moment the whole "nurse does everything" thing, how safe is that? I'm supposed to be watching the patient and the monitor and yet I'm acting as transport?!

HUH?!

Sounds like a recipe for disaster to me, dear.

Free-association moment.

I have this habit of free-associating everything; I listen to a lot of music (wow, there's a statement that should put me right up there with 99.9% of the American population) and have randomly connected the line from the Talking Heads, "Psycho Killer, Qu'est que c'est? Fa fa fa fa fa fa fa fa far far better /Run run run run run run run away!" with Ludacris's "Move, Bitch!" and thought... hmmm, my music choices are giving me advice and counsel on my own life. What does this say about me? Am I having auditory hallucinations?

Okay, so the Talking Heads are talking in my head telling me it will be far better to run away, away, and Ludacris is bitch-slapping me out of complacency with his more urgent and violent, "Move [back south already] bitch."

Coincidentally, just as I began writing this blog, the church bells somewhere (I'll have to investigate exactly where) started playing the theme to Beethovan's last movement of the 9th, commonly known as the "Ode to Joy" so I'm going back now to my highschool days when most of the music appreciation class went around muttering the Schiller poem in German because they were supposed to remember the refrain, or first stanza, or I can't remember, wasn't in the class. "Freude Schoner Gotterfunken, Tochter aus Elysium" is about as far as I can get offhand without cheating and googling it (and shut up, I haven't learned how to do HTML umlauts, so shut up, already.)

Shit. Now I'm going to have that stupid refrain stuck in my head all day. And it's very frustrating not to know any more than the first line of the poem, which is probably why they tortured highschool kids with it, right? (Probably not, but I wasn't in that music appreciation class, and I still learned, well, a sentence fragment of it.)

Also, prior to this whole musical melange, I was also just thinking about how adult life is like highschool, with its own versions of stupid hallpasses and condescending requirements like sick notes. Then I thought, "Wait, but you did really well in highschool, what happened?" And then I realized I must have matured, unlike a lot of the people who now control the size of paycheck and so forth.

Oh God, this is sad.

Now I'm thinking of that little Hoops and Yoyo card I sent a bunch of people with one of the little characters sitting in an office cubicle screaming hysterically "I'm in a CAGE! THIS IS A CAGE!"

Which, incidentally, is exactly how I feel when I have to go to work/am at work.

You ain't nobody's 'ho, yo!

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It Burns!

or, "In which we discuss, yet again, Jamie's hatred for corporate policies and those that make and enforce same."

Alright, so I did some calculations (as in counting on my fingers, because remember, I'm just a stupid nurse and therefore don't have the brain matter required for advanced math) and by my estimate, we've lost ten nurses in under one year, not counting maternity leave people, which brings us up to twelve. All but two of these folks are nurses with more than 5 years of practice as a nurse. Factoring in those who went on maternity leave, went per diem/asked to work less hours and you're looking at probably fourteen or fifteen folks.

Apparently the nursing shortage is (like everything else) the nurse's fault. Management doesn't seem to get that if one wishes to retain his or her staff, a better way than laying down Draconian law regarding sick leave and doing the Houdini "now you see it, now you don't" game with people's vacation time is to actually give people a break once in awhile.

Ask any one on the floor--we're burnt out, and still burning the candle at both ends. I think that those that remain do so either because they have to, or because they feel some loyalty to their comrades-in-arms. It's certainly not because we like the way we're treated.

I mean, look at me, I hate the thought of doing nights, but I felt bad because we're so short staffed on nights, so I agreed to do some nights in May when I go per diem. Yeah, I'm stupid.

I won't even get into the metaphysics of the 9,999 t tiddly-winks mind games we have to play to get our sick time, vacation time, whatever. They don't even accept a doctor's note from one of the hospital's own attendings as valid proof of your illness-they rack it up against you and can fire you for being sick too many times. Seriously.

I also love the Catch 22 admonishment: "Don't come in if you've got diarrhea because you could be contagious and we don't want that here on the floor." Then you call in, explain you've got diarrhea and have been up all night, and they say, "Well, if you call in, it still counts against you."

Gee, thanks, I'll try to feel better in the meantime.

I know of nurses who have dragged themselves into work with fevers, chills, congestion, diarrhea, and all sorts of stuff that should be properly left at home so as not to further endanger the health of our already immuno-compromised elderly. Why did they do it? Because they were told if they called out "one more time" in the next X months, they'd be written up, lose their bonuses, etc. etc. These aren't slack-off nurses I know who call out just to go on vacation or whatever, these people were really, legitimately sick.

I've only been off of orientation for eight months, barely, and I'm already succumbing to every little bug out there because I'm so run-down and dehydrated all the time. And I don't have kids or a super huge house to take care of, either.

I probably shouldn't even go back to work until next week, considering what kind of shape I've been in for the past five days, and how I fear if I go back I'm just going to end up sick again and not be able to call in and/or get fired.

Good golly, Miss Molly.

Signs

To be filed under, "My favorite allergy symptoms" as noted by patients. Drug, percocet. Allergy symptoms? "It makes me go crazy."

Note patients can't qualify their statements any better than 'it makes me go crazy.' They can't state whether or not the drug makes them actively psychotic, with visual and auditory hallucinations, or makes them feel anxious, or whatever "it makes me go crazy" means to them. So we just write down, "It makes me go crazy." I think if i'm ever admitted to a hospital somewhere, I'll make someone write down "hospitals" as an allergy with the symptom, "They make me go crazy!" I'll have to wait until I'm about eighty five to insist though, because I wouldn't want to buy myself a psych consult for pulling that shit.

I feel slightly better today. I suppose drinking 4L of po fluids in twenty four hours has done me some good. Now I'm fluid bloated and look and feel 3 months pregnant, but whatever.

I don't have the energy to be productive, but I can (and have) sat up, walked around a little bit, and as far as the illness goes, this is a good sign. I've been up for a whole nine hours today! Amazing!

I do have an amazing headache, which is probably a tinge of whatever Ibrahim got (he's got congestion so we can't figure out if it's allergies, a cold, or both). The Walgreen's brand of Claritin-D seems to be taking care of the headache fairly efficiently, though.

The only thing is now I'm addicted to Gatorade, and won't be able to function without it.. I should try to drink some lemon water though, to combat the bloating. This illness is getting ridiculous.

Drive

I'm wondering what happened to "me," or what I thought was "me"?

The culture/reality shock of real life hospital nursing is settling home now, and that's fine. I know I will still continue to be outraged by the apathetic anti-care we give, but things frustrate me less, on some days, maybe because I have more experience, and certain things are not quite as scary once you've been through one or two, or a dozen.

Any way, I wonder what I'm doing with myself. Most people who know me think I am underutilizing my potential, even if they don't exactly put it that way. Part of this is because people think nurses are, on the whole, bimbos, whose main job (aside from luring doctors into marriage) is to fluff pillows, bring water pitchers, and scrub out bed pans, which is actually not an entirely inaccurate picture of part of what we do (the fluff and puff stuff). And I have met nurses who are scary bimbos, or just plain scary. But that's kind of besides the point, because I've met bimbos and scary people in all walks of life.

Unfortunately, I'm just tired right now. Too tired to think about hanging another millstone of debt around my neck and go back to school, too tired to think about suffering through endless papers and classes and crap just to get another degree that will prove "I'm really good at school." I had a fleeting thought about going back to school, getting my JD, and getting totally Jack McCoy on hospital administrations' collective asses. Unfortunately, law is probably not as fun and sexy as they make it look on Law and Order, just like ER, while probably remaining the most accurate made-for-t.v. portrayal of medicine, still rings hollow in a lot of ways. (Which is too bad, because it would be great if everybody really cared that much about their patients, clients, whatever. And also, I really like the time-speed-up thing, like how a Law and Order murder trial takes about 5 days from start to finish, and how no one bothers to send any one to surgery on ER, they just do whatever major surgical procedure in a trauma bay, with the family watching, because who cares about such silly things as sterile fields.)

I've also thought about writing a book, but not a real academic book, just a funny one. Kind of like Jack Handey's Deep Thoughts, or something. I'm much too lazy to write an entire book, though. Maybe some nursing haikus:

Stupid attendings
Patients bleeding out their ass
No one gives a fuck.

Oh that's all for today. Too spent to think up something more creative. Maybe I'll have a book of haikus in another decade or so.

How about I'll just live in obscurity, like everybody else, and make fun of people and stuff at whatever stupid job I get hired to next, and complain about how crappy my life is, just like now, except I'll be in a different, but similar, environment.

Note to self: orthostasis and nausea are not good for creativity. Must come back to this topic later, when feel less like wretching for physical, as opposed to philosophical, reasons.

Somebody's Gotta Do It

Somebody's gotta be there when it gets ugly
Somebody's gotta be there when it gets bloody
Somebody's gotta get their hands dirty
Yo, it's a fucked up job but somebody's gotta do it
Somebody's gotta come up with a plan
And be there when the shit hits the fan
I hope ya'll out there understand
Look man it's a fucked up job, but somebody's gotta do it
-The Roots


Oh yeah. Gotta credit Katy (again) for turning me on to The Roots. Any way, interesting how hospital health care and drug dealing/gangsta lifestyles have so much in common.

Meanwhile, still spending my day alternately orthostatic and nauseous, with frequent trips to the can. Enjoyable. Spent time in MD's office to confirm that I have a GI virus, but mostly to get a note for work so I can get FMLA and not get fired, because I need the money. Sigh. Otherwise I'd kind of enjoy being fired at this point.

My BP was 80/50 in the doctor's office, which explains the dizziness and general feeling of crap. The doc was like, 'Did you go to the ER this weekend?' I kind of chuckled, because I know he probably has to ask that question, but seriously, the only time I want to be taken to the ER is if I'm so sick someone else has to take me. In an ambulance. And only because I'm a major trauma or death-bed ill, in which case, leave me on my own bed at home, thank you.

He also asked what I'd been doing to treat the GI virus and I was like, "Uh, nothing? Rehydrating?" I almost thought of telling him my plan to go into work and hook myself up to a fluid bolus, but I didn't know if he'd think I was being funny, pathetic, or simply another wack job patient. He was like, "Yeah, rehydrating as about all you can do in a case like this."

He gave me a prescription for phenergan for the ungodly nausea, which I think is frankly dehydration related. I also think I'm probably slightly anemic and have a crap potassium level, but these are just speculations.

Egh. I was up for two hours and now I feel crappy again.

I suppose I should go back to Walgreen's and pick up my prescription, maybe then I can keep some food down, and not feel like hurling like a pregnant chic.

Oh god. Not that.

Blame It On The Rain

I do not like thee Dr. Fell.
The reason why, I cannot tell.
But this I know, and know quite well:
I do not like thee Dr. Fell

I do not feel well today. Nor yesterday. Working 28 hours in two days sapped every last bit of health I had left, I think. The sad thing is, they weren't even bad shifts (floating to another unit and bleeding out PICC/Vaxcell sites at change of shift don't even make it any where near the shit list these days). They were just typically endless, scut-work filled shifts, with me running around dehydrated and without food for 14 hours, and having techs who have only been there 1.5 hours of their cushy four hour shifts complaining about "needing help" when I've been there 12 hours already and can barely sit down for five minutes to do some charting. And then have to stay an hour and a half past change of shift to help the oncoming nurse with change-of-shift patient issues.

I've spent the last two days recovering: sleeping almost non-stop, feeling like complete crap when I do wake up. At one point I begged my husband to come home from work and feed me chicken soup, because the thought of ambulating my pre-syncopal 90 lb ass all fifty feet to the kitchen just sounded like way too much effort--I've felt dizzy for the last three days, ambulating and talking to people for five minutes makes me feel lightheaded. I think I'm on the edge of some severe fatigue/generalized weakness diagnoses. I tried to take my own BP and got a reading of 90/50, so add hypotension secondary to the dehydration to the list of bogus telemetry floor admission dx's.

Hey! I could probably get a bogus admission for "generalized weakness and hypotension!" I could be a really bogus telemetry admission for the hypotension, and they'd have to put me on telemetry and watch my non-ectopic, normal sinus rhythm and chart it q shift, listen to my absolutely clear lungs and document my positive pedal pulses, no edema. They'd even have to do a bogus "integumentary" care plan r/t my BLE bruising. Maybe they'd replete my 'lytes and put me on po iron for a slightly crappy 'crit. I'd probably get a nutrition consult for a BMI of 17.4, though. I think I'd also demand a social work/continuing care consult and see if I can get a health aide to come and feed me, and help me around the house, because I don't seem to be able to do those things for myself these days. I feel about ninety-five-years old.

I actually thought about just skipping the whole admission part and simply drive into work, get one of the nurses to put in an IV, hook myself up to a liter of normal saline and run it in wide open, and go back home. I wonder what my blood sugar was. Probably like 50. Hey, maybe I'll just run in some D5NS instead, or just give myself an amp of D50. Also, I'd take some Tylenol for the headache, Maalox for my tummy pain and some Lomotil for the diarrhea. I could just sit in the med room while I fluid bolused myself, or they could stick me back in angioplasty since it's closed today. I'm sure I'd have to replete my potassium, so I'd pop 40 mEq KCl po before I left. Then I could come into work Tuesday and not syncope into someone's GI bleed, or something.

As it is, I'm going to have to go to the doctor tomorrow. I hate going to my doctor, because he's gonna really think I'm hypochondriac yuppie scum; even I know I sound like a ridiculous whiner, but it's not normal to feel this way after two days of work, is it?!

Nervous Prostration

I want to be diagnosed with some antiquated name for a disease, like consumption, or nervous prostration. Just because it'd be funny, and future PMD's would ask, "Who was your former primary, and what's with the "consumption" dx?"

I swear I need a pre-syncopal work up, even though it's because I'm probably constantly hypoglycemic, eat less than 1000 calories a day on a normal work day, have lost my appetite, and work 12 hour shifts dehydrated with probably half a liter of fluid intake if I'm lucky.

Today at work I had stomach pain all day long, diarrhea, and every time I turned my head around quickly, my vision went blurry and I felt dizzy. If I stood up too quickly, I felt faint and saw blotchy spots in front of my eyes. A couple of times I thought I might faint.

I also weigh now 92 pounds with clothing on, which means I've lost three pounds in the last couple of weeks. I'm in competition with the thinnest person on our floor, a slim, tiny framed, pretty Vietnamese nurse who has two children and yet looks completely nulliparous. She weighs four less pounds than I do, and she's tiny. I look like a normal sized human being next to her, and I'm small framed to begin with, so weighing less than 100lbs = not healthy.

I need a PEG tube and feedings, stat!

I also run into things a lot at work, and have five large bruises on my bilateral lower extremities. I look like a victim of some odd form of domestic abuse.

I want to eat, sleep and drink like a normal person!

Incidentally, speaking of normal, on my float yesterday, I had a woman who was admitted for "mental status changes," which basically meant in her case she was dying, and her poor son was there with his head in hands, because mom was basically aphasic, and lethargic, except when you touched her. Then she'd scream and punch you. It didn't hurt, because she wasn't strong enough to do any damage, but every time we had to turn her and such, it sounded like we were flaying her alive from the screaming.

There were student nurses on the floor that day, and one them had another one of my patients, and she kept running into the screaming, dying lady's room with these wide, anxious eyes. And I'd say, in a deadpan, disinterested you'll-get-used-to-it-too voice, "Yeah, she does that. She's out of it." The student kept looking at me like I was some kind of hard-hearted, cruel bitch, the kind of nurse she'd never be, thank you very much.

I felt bad, because I wanted to explain the thing that you can't explain until you've been there for awhile: you get desensitized to the suffering. The screaming, the agony, the hellish noise-- you hear it, but it phases you a lot less when you realize there's not a goddamn thing you can do about it, except say pointlessly in a soothing voice, "I'm sorry, dear, I know this hurts. It'll be over soon. I know it's horrible to be here in the hospital."

Even her son said to me in this despairing kind of voice, "She doesn't even know where she is any more. I don't think she has any clue what you're saying." I think he thought I was nuts for even talking to her.

The thing is, I even talk to my deceased patients. I probably sound like a nut case, but I still believe that they deserve to be treated with respect, like the people they once were. I remember doing my first post mortem care ever, I think right before I became a nurse, and taking out the IV, and cleaning her and turning her and talking to the patient as if she was still alive. The tech looked at me like I had lost my marbles.

I'm not religious, I'm not even very spiritual, but I believe in respecting humanity, even if it is the memory of humanity. It's important to me. I would never want my parent to be gawked at by a bunch of bystanders as they are dead, naked, and about to be toe tagged and zipped into a plastic bag. I would never want them to be treated like a dead slab of meat, even if that's technically what they are at that point. I would want their nurse to treat them like the humans they were in life, even in death. Wouldn't you?

I remember the first patient of mine that died, and how a student wanted to come in and "see the dead guy." I didn't say anything, because I didn't have the balls, honestly, but I really wanted to say, politely, "I'm sorry, but this isn't the time for a learning opportunity for you; someone's father and brother just died. Please just let us take care of him now."

Dead is dead, I know that.

Still, the absolute worst part for me is after the family (if there is family) comes to view the patient, you have to tag and bag them, and zipping up the body bag feels antithetical to everything you're taught as a nurse. I keep thinking irrational things like, "Oh my god, they're going to suffocate in that thing! What am I *doing*?!"

I guess I'll get used to tagging and bagging one day, too.

Just like every time I see a copious, nasty bleed these days I just go all reflexive and immediately start holding manual pressure and get into "where's the sandbag? and who can page the HO for me so I can get them to come up and look at this guy?" mode. If it ain't arterial, or a massive GI bleed, it doesn't phase me any more, even though it can be alarming to see venuous oozing. Sometimes I pull IVs and the patients don't hold pressure long enough on the site, and start freaking out at the sight of 30 ccs of blood. They must think I don't care, because I act like it's no big deal, tell them to hold pressure ("What?! I'm BLEEDING HERE!") and glove up and grab some 2X2's and hold pressure myself. The family and patient usually look horrified, like I'm trying to kill the patient, but it would take hours for you to bleed to death that way even if you didn't coagulate normally.

Here's the irony, and why I am really a hypocritical bitch:

You know you're becoming a real nurse when someone finds out they've got cancer and they start getting all anxious and horrified and needy, and you go outside the room and immediately complain to the next nurse you see, "Good GAWD that woman is a pain. I mean, yeah, she was diagnosed with cancer and everything, but geez, she's fifty years old--there's a lot of treatment options out there nowadays, and I've seen a lot sicker people, I wish she'd stop whining." And the nurse replies, "Yeah, if you ain't tubed and vented, you just aren't sick enough to complain."

We don't mean it literally, of course, but it just proves the dichtomy of caring and desensitization that goes on in this field.

In the meantime, I suppose I should get used to students looking at me like I'm some uber-bitch when my demented, dying patient starts screaming, swearing and kicking all I say is, "Don't worry dear, this will just take a second and then we'll be done." And then I walk out of the room and go onto the next thing looking as unphased as if I'd gone into the room and had a nice, normal conversation with an alert and oriented patient. Meanwhile, the student is standing there with big round O-shaped eyes like, "OH MY GOD! YOUR PATIENT! DON'T YOU GIVE A SHIT?!"

Yes, I do. But in order to care, sometimes you have shut down the part of yourself that reacts emotionally. Emotion has to come later, which is why I'm such a mess. You're not allowed to feel things on the job, at least in front of the patient. To them, you have to remain calm, reassuring, I even talk to them about what's on t.v. at the moment to distract them from whatever blood is oozing copiously out their new dialysis catheter, or whatever.

All the emotional shit hits you later, around 2 a.m. at night, when you're wondering what else you could have done for someone who was dead-in-the-bed the minute they hit the floor.

Health is Not Wealth

But it would be a nice thing to have. (Actually, illness is wealth, at least at our hospital, where we will provide you with a pacemaker worth some people's yearly annual salary which still doesn't keep you from dropping your pressures every time you stand up.

I've never been so drained in my life. I fear aging rapidly, and dying in a padded cell somewhere, babbling incoherently about Jesus my hamster, when I really did have a hamster named Jesus, but no one believes me, and I'm sad. But not that sad, because apparently no one at work believes me when I call them and alert them to a patient condition and so I'm used to being ignored.

I love paging different folks who treat you with mild contempt like, "Why did you call me about this copiously bleeding patient? WHY?!" I'm thinking, Well, I just paged your lazy ass because I like having to spend time trying to con you to come up to the floor and just look at the patient, who's actually just fine, no medical problems whatsoever, that's why they're in the hospital, you see. Because they are healthy, well adults who just like bad food, being confined to bed and subjected to cruel and pointless medical procedures to make the hospital rich. Nah, nobody's sick here. I just called because I like to crank call obsessively about nonexistent problems. I'm just making this all up. Thanks for humoring me, buddy!"

Flying Over the Cuckoo's Nest

I think I've mentioned before, somewhere on this blog, about how bad morale has gotten on the floor.

It's gotten so bad, people I've never seen angry or snap in the nearly three years I've worked with them are so stressed out and shit on continually that they've actually started cracking, as evidenced by the fact that they're snapping left and right in situations when formerly mostly they'd just be convincing and nice and supportive and move forward.

I'm really not shocked by this behavior, because staffing has gotten so horrendous it gives everyone nightmares just to come into work, because we know we're going to be either working short staffed, floated, or both. The attitude shift saddens me greatly, because these are people I admire and respect for their good sense of humor, constant ability to move blithely forward through catastrophic staffing, and offer morale support and advice to new grads like myself. And I realize you can't always be nice--every one has their breaking point, and administrative policies and the constant fuck you, fuckover attitude towards our staffing ratios has always been bad, but now it's reaching in, grabbing ahold of our psyches and we're down for the collective count.

The floor used to be so much more cohesive and supportive, and now everyone's so stressed out and snipy and bitchy--these aren't the folks I remember working with as a new student. I still think highly of them, and I like them a great deal, but it just sucks to see everyone so angry and pissed off and distressed every single day. Every day is a bad day. And we go in knowing it could always be worse, and it usually does get worse, like the newly placed Vaxcell bleeding copiously in one room, with a newly placed PICC line bleeding two rooms over, simultaneously at change of shift.

All my work was done at 7p.m., I'm all trying to give report and get the hell out, and all of a sudden, I'm there until 8:30p.m. running around trying to get someone to care that my patient is bleeding through layers of bedding through a newly accessed site. And everyone's like, "Yeah, let's watch it for a half hour." As if it's going to spontaneously stop copiously bleeding, magically, on its own? Really? Where can I get that Harry Potter spell and wand, please, because I'd like to own one for situations like this and say, Reducto Hemmoraghia! or something pseudo-Latin and have the problem solved, without involving house officers that really don't want to come up on the floor and do anything, because we at [community hospital[ like "watching our patients" instead of treating them. "Watching our patients" is the preferred modality of treatment, apparently.

I've watched a lot of patients die this way. It's not fun.

It's like watching an ant colony being picked off slowly by ant eaters. Oops! There goes another one! Oops! And another!

Bleah. At least the deer ass carcass story was funny. It still doesn't ammeliorate being at work for 14 hours today, but whatever.

Like A Deer (Ass) Caught In the Headlights

We got a patient on the floor today, a transfer from another hospital who quickly ingratiated herself to the staff by complaining about how much better Brand Name Hospital was than this shit hole.

Okay, so she probably had a point, but...

She was also a crazy bitch.

A crazy bitch whose crazy husband started raving psychotically to the unit clerk about how crazy the sister was, and how if she should just call to ignore her! She's crazy! Really, Really crazy!!

Okay. We get that's she's crazy.

But if the sister is "crazy" then what would you call the following story:

Bitchy Crazy Lady starts talking about how her dog brought a deer ass carcass and put it on her bed. And she's apparently proud of this behavior, and thinks it's funny, but in a completely different way than we think it's funny, because now we really think she needs a rubber room.

I had to ask twice about the "deer ass carcass," because, dude did the nurse and tech just tell me she said "deer ass carcass"?

One of the nurses commented on the layers of irony in this story and references to pop culture, like the head's horse in the Godfather.

And we all thought: Wow, what a brilliant dog! What a way to say "I think you're an ass! And not only an ass, but a carcass of an ass!"

As I'm laughing my ass off, I'm also thinking the lady has got to be paranoid delusional, possibly schizophrenic with visual hallucinations (which she may well be, since she's on about half a dozen non-formulary pain medications and muscle relaxers) when the nurse and the tech say the husband confirms the carcass-ass-bearing-dog story.

Wow. I couldn't even remember which DSM IV psych diagnosis would be pertinent in this situation--but looked it up on a google search and found DSM-IV Diagnostic Criteria for 297.3 Shared Psychotic Disorder to be pretty close to what seemed to be going on with these folks.

I wonder what a psych consult would make of these folks.

And they aren't geriatric, either. Nor are they strangers to the psychiatric world, because the husband actually said the sister (the crazy one, remember, as if that qualifier means anything significant in this context) was dystonic and nobody without some kind of contact with psychiatric services knows that word, unless they like to read the dictionary for fun. Or maybe if you're these people, the dictionary reads to you and does a little song and dance at the end.

Yellow Fever

So I get home from another 13 hour day of worky funness, including floating to another floor from 7-3 (which wasn't so bad, folks were nice, patients were decent)....

Then I open my e-mail, which is still my last university account, even though I dropped out two semesters ago. So via this e-mail account, I've known for a few days now that the President of China is coming to this particular uni (I don't want to give it the power of ownership by calling it "my" uni) tomorrow.

Apparently, despite all their goodwill-efforts to make nice with the Chinese (whatever, there's something nefarious going on, I can just feel it) it's gotten around campus that some sophmorically titled uni rags, one of which is cleverly called "Rumpster" has taken racism to a whole new level of completely boring.

One of the feature stories was entitled "Me Love You Long Time" and then went on to discuss, in depth, "Yellow Fever," or, from what I could decipher from my 0 .5 second scan of the article, the sexualizing and objectifying Asians as hot campus commodities. Oooo! Interracial dating! Now there's a topic that was big news in 1955!

Complementing the article: a large photo of an otherwise nude reclining white male with a Chinese food take-out box over his (probably limp) dick. He appeared to be eating something out of a bag, which may or may not have been fried noodles, I didn't really pay much attention, because I didn't think it was all that special, funny, clever, or even all that scandalous.

Bad health care, now that's a subject of controversy and scandal. Asians?! Interracial dating?! This shit is generating controversy?! My thought would be to ignore it, because clearly the intention was to scandalize, and I'm sorry, but making fun of Asians is really passe, right up there with the Electric Slide and parachute pants.

My immediate thought was Yawn. How fucking boring can you be, white racists?! Edward Said had this all figured out decades ago. Nobody thinks you're interesting, nobody thinks you're "scandalous" and no one needs to "dialogue" with you, as suggested by one of the Nursing School's "diversity committee" professors.

Incidentally, I distinctly remember boycotting "Diversity Day" at this particular uni, even though it was "mandatory" because I think it is very condescending for white people to assume that everybody needs and wants to get along, and we should all be tutored in how white people think we as a population should cooperate and have group love-ins or whatever. Yeah, okay, so you feel guilty about decimating the native populations of our continent, enslaving blacks and Asians (not to mention throwing the later in concentration camps), but don't let your guilt be my fucking problem. And definitely don't make me come to school and read books about different cultures so I can empathize more with myself, because I'm the minority here, you fuck-heads, and don't you think I know what it is to be me and thank God every day I'm not you?!

I mean, do racist white people really think they're the only people who think they're racist!? Come on! You white people suck as racists. You're just not cool enough, you don't slam us chinks and gooks with enough style or verve for me to even be vaguely annoyed. In fact, I'm more annoyed with the fact that you couldn't come up with something more clever and therefore befitting of a 100K education. Come on, you can do better than pseudo-coining the phrase "Yellow Fever," can't you? I'd expect Ivy League students to do better than that pile of dogshit. I wouldn't even call it "racist," I would just call it, ummm... lame.

At least come up with something new, different and inventive if you're going to try to put people down, because otherwise, those people you are trying to insult have a tendency to think you're really silly and stupid, and need to grow up and get a real job, instead of living off of Mommy and Daddy's Platinum Visa at an expensive school that produces presidents of the dubious caliber of George W.

It's not an affiliation I was sorry to eschew, and I can honestly say people pretty much had to pry the information from me in tacit bits and pieces when they asked where I went to nursing school, as in, first I'd say "the Northeast," then I'd have to admit the state, the city and finally, I'd be wishing I was a better liar and just say I was going to local community college, because I would actually be prouder of that statment than revealing my ex-university.

Any way, stupid white youngsters, please, next time you try to insult Asians, take some notes on gansta rapsters, who have "in yo' face, motha'fucka's" down to an art form, and they are brilliant, even when they are self-effacing, which is part of why I love gangsta rap as much as I love Mozart or Bach.

Like, if DMX or Wu-tang Clan came out with a rap song dissing Asian bodega/dry cleaner/grocerystore/gas station owners, I'd probably find it very funny and very clever, because in a way, they are also making fun of themselves, even when they are at their most angry, pissed-off, "fuck you mothafucka's" I mean, haven't you ever noticed the irony in rap? Do they not teach the concept of irony at Ivy League Schools? Or demand that their students be literate?

If I'd protest anything, it's not that they called me "yellow" (I've seen yellow people. they have liver and renal disease. Most of them have been white people), it's not that they tried to scandalize the uni community... it's how miserably they failed at their objective.

Besides, I work around a lot of products of that kind of mindset, and you know what? A large percentage of them have poor peripheral vision, run into doorways, printer tables, spill dozens of charts onto the floor, and aren't very funny at all. What a shame. If you're going to be a dickhead, at least be a funny dickhead.

Caveat: This blog post was written by an Asian woman who is friends with white people, too!

Geriatric Jesus

Heh heh. So I suppose it might have been funny (weird, but funny) if the hamster's name was Stalin, or Cesar Chavez, but it's Jesus, so to me, it's particularly funny that pretty much the extent of Jesus's activities during his awake time don't stray very far from a cushy wad of toilet paper upon which he's plumped his fuzzy arse. He waddles out for some hamster seed, a sip of water, and then, back to the toilet paper wad.

I'm guessing he has three, maybe four months, tops left of Mortal Coil. But that's okay, because we all know the Jesus story ends happily, kind of, except for all the people that were killed in His Name, Amen.

Any way, that's the nurse in me, with the uncanny sixth sense of guessing correctly, within days and hours, how long it's going to take someone to die. I have to get out of nursing, I'm becomiing the Grim Reaper.

Non sequitar.

The people who live downstairs are bona fide white trash, which is ironic, because we basically live in a very nice condo filled with retired elderly people and their fat little lap dogs, and single young work-a-day people.

Any way, Easter was spent screaming at each other, which is an activity that I am sure is not exclusive to just white trash, but it annoyed me enough that I finally put on Morales very, very loud. Well, not loud, but loud enough to block out the cursing teenager screaming at mom, "Fuck you, bitch!"

Ah, if that ain't birth control, nothing is.

Also, either they are yelling at one another, or the kid has about fifteen friends over, all of whom sound exactly like Beavis and Butthead, or they're watching t.v. At least, I think they're watching t.v. It's weird t.v., though, it always sounds... seedy. Like, I can never figure out if it's t.v., or people having weird sex. I think it's t.v., but it always sounds so weird, and vaguely unwholesome. I really don't want to think about it, actually, but I don't have much choice the way the condos are constructed.

Goddamn it! All I want is to live in a normal place with normal neighbors, for once!

So back to my day.

I spent the entire day drafting a CV and cover letter. It was tedious, and depressing, but sort of like writing a school paper or doing a wet-to-dry dressing on a stage four pressure ulcer (you don't want to know what that looks like, trust me); there's an odd sense of triumph/relief/pride in having accomplished something tangible.

The depressing thing is realizing that I look very lame on paper. It's like "Hi, I am a nurse. I went to a bunch of schools, and didn't really do anything notable except graduate, sometimes on schedule, and I've only been in this profession for eight months, so uh, I haven't like, won any employee of the month awards because we don't have employees at my hospital, we have indentured servants."

Of course I cleaned it up a little bit, but basically on paper you could distill a description of me down to "a highly educated fuck-up who has self-diagnosed anxiety/panic disorder over going to work in the morning." Because people die at my job, and I haven't gotten used to working as slave labor for a CEO who makes about 700K a year salary but swears he can't afford more nurses.

Hey! I've got an idea! The CEO claims a salary that is worth, let's see, the starting salaries of eighteen graduate nurses, and probably at least a dozen experienced nurses. So why don't we slash the CEO's salary to something worthy of the kind of leadership we're getting (I'd say minimum wage would be generous) and hire more nurses? Likewise I'm sure the executive cronies' salaries are all probably worth about twenty to thirty more nurses.

On our sub-acute critical care unit, we lately have been working one nurse to eight patients, all cardiac post procedure, post operative, sometimes, with management telling us "I'm sorry, that's the best we can do." I'm telling you this so that you will go write your Congresswoman and tell her to please enact legislation that mandates safe staffing ratios for patients.

Please.

We don't mind saving your life for the modest sum of $25/hour, but it would help if we had enough staff in order to do so. It's very helpful if say, you are dying, and require the immediate attention of your nurse, that she isn't stuck somewhere on a phone arguing with staffing to please not float her nurses, or chasing down dietary to give a tray to a cranky patient, or mopping crap (and I mean that literally) off the floor because housekeeping refuses to do so, instead of monitoring her patients, doing rounds, administering medications and all the other stuff we're supposedly hired to do.

The next time you're in a hospital, request to talk to the CEO and demand to know what the nurse/patient ratios are, and why they suck so badly, and how the hell one nurse is supposed to take care of eight post procedure/operative patients safely. Then threaten to write your Congressperson, and follow through.

Incidentally, can you tell I have to go to work tomorrow?

Face/Off

Alright, I'm dating myself here (and also proving how truly tasteless I can be when it comes to movies) but did any one else ever watch that truly bad John Travolta movie (I know, I know, is there such thing as a good John Travolta movie?) Face/Off from about 1995 or thereabouts?

It involved some lame plot involving face transplants (thus, the clever name!), so I think there was the Good John Travolta and the Bad John Travolta, and a subversive plan to Take Over the World And Kill All The Good People or Kill The Good John Travolta, or his family, or shit, I don't remember. I thought the movie was stupid then, and don't ask why I went to see it in theaters, either. Any way, killing the good people is really quite shortsighted, because then who are you going to ensalve to pick your grapes and play the harp for you as you sit around and eat all those grapes. Evil people? They'll just try to to kill you or make you be their slave. Or Morlocks? Huh? HUH?

Okay, so we've needlessly wandered off into more over-charted territory of the B flick (namely, Planet of the Apes, which is now giving me a free-association movie moment about that Mel Gibson movie Ransom and (evil) Gary Sinese doing the Distorted Kidnapper Voice Thing and talking about how he's a Morlock [insert evil chuckle here].)

I'm not on illegal drugs, I swear.

Any way, I had a facial today. It felt sooooooo very good. But the disturbing thing was, as I was lying there, listening to New Age, pan-flute-and-seashore-noises music, having my face alternately steamed and shiatsued into a pleasant pulp whilst my zits were professionally picked at with what felt like a steel toothpick, I kept thinking about my patients, and whether or not I'm giving them good enough a.m. care. Do I protect their modesty enough with the towel layerage? Is the water warm enough? Too warm? Too cold? Do I rush over things because I've got three or four other patients who need me, too? Do I forget to comb their hair and brush their teeth and they're too afraid to ask because "they don't want to bother me"? Should I learn shiatsu massage or would that merely break their osteoporotic bones and cause them further skin breakdown? How about playing New Age music, or would that be too freaky? Should we have a meditation session after I give them a heparin shot in the morning?

Alright, so I didn't go that far, but I did start to do the downward-spiral-I'm-a-shitty-nurse thing. Again. In the middle of a facial for god sake!

So here I am, supposedly being pampered, the entire point of which is to not think about shitty work, and relax so I can go back and do a half decent job at work, and yet, I can't stop thinking about work.

I am warped.

Very, very warped.

Sometimes, I wish there was an on/off switch in my brain, or at least a slower/faster speed control. Then I could make a movie, Brain/Off. Starring me, on lots Versed and Fentanyl, or maybe even Propofal.

Man, I need to get a less stressful, more wholesome job, like maybe being a drug mule, or being a double agent for Canada, or fire-eating, or being a liason. I've always wanted to be a liason. It just sounds very sexy and French, and can mean any number of things, really. I could liase as a job description, and make up all kinds of nifty sounding crap for my CV. Kind of like I'm going to have to do now, actually, in order to get another job somewhere else, so I can continue my OCD trend of neurotic guilt and needless worry.

Nashville

So I'm sitting out on my porch in the waning sun, listening to my friend Katy's most excellent cd mix entitled "Cube of Human Dignity"--which was one of our inside div school jokes. We often had the same level of distain, loathing and rage when placed in inane and tortuous classes like "Reformation" and "Ethics" taught by some PhD candidate who basically read (badly) the "real" professor's notes verbatim, with really bad inflection. (As a side note, the Ethics professor at our school was often found passed out drunk at various parties held at Christian denominational housing. We used to have some very drunken-ass parties for people claiming to be Christian, actually. Lots of alcoholic ministers out there, so don't let their holier-than-thou act fool you.)

Any way, his lectures in particular were like listening to a Chinese-speaker read a Volvo manual in Swedish, having never learned the language. Katy and I would sit near enough to each other to pass notes like the completely mature graduate students we were, and hers often said things like "cube of rage" or "cube of despair" next to a 3-D cube. We also wrote things like "this fucking class sucks ass" in French. Unfortunately, she studied Hebrew and I studied Latin, so we couldn't get all old school, but it was still funny, and I used to scribble Latin phrases on my notes when I got bored.

We'd also spend hot, sticky interminable Nashville summers making cd mixes and at her house, and yes, I'll admit it, making construction paper jewel case designs. Once we cooked fortune cookies, and brought them to a party, or gathering of some sort, I can't remember any more. I hope this doesn't embarrass my friend, by it's a fond memory for me.

And right now I'm doing something very dorky and eleventh grade, staring at the floating clouds and setting sun, and imagining the day when I'll fly away (not like the t.v. show with Sam Waterston playing... I don't know what character actually, because I never really watched it, but any way.) Fuck this shithole! I'm getting out of Dodge, man. I just need some money, and I'm outta here. Which is kind of the root of the problem. The money thing. Again.

I'm thinking about my Nashville days, and how those were such days of hopeful despair, if that makes any ironic sense, which it probably doesn't. I mean, I was in poor, I was in debt, I was living on ramen noodles and sometimes, oatmeal. As in, for breakfast, lunch and dinner. Kind of like now, except back then I had a future, or dreamt of a future, any way. Now I just have present-day reality, which is some kind of crappy life sentence of workplace drudgery/insanity. I finally get why people become alcoholics and abuse drugs. Grown up life sucks. And there's no escaping it. And after that, there's old age, which, from what I can tell, sucks even more, because suddenly you don't even remember your name, much less how to control your own bladder and bowel continence.

Back then, however, I lived in a tiny studio apartment which was noisy and constantly dusty, but it had a nice view of a tree in the spring and summer. I whined about school (but couldn't kill any one by misquoting Kant, so the liability was pretty much nil) and cried about boys who had broken my heart (but never about human beings I had taken care of the best I could and had died nonetheless).

But I also had good friends, who rallied around me in my depression, held my hand when I was sad, and we had a barrel of fun. We went downtown one April and got riproaringly tipsy at various pseudo-swank lounges and a honky-tonk bar for Katy's birthday, then came back to my apartment and drank the crappiest wine I've ever drank in my whole life. Peruvian wine, as if that's even a real kind of wine, Danny. (Inside joke there for you, Katy.) I woke up to the sound of the dog drinking wine out of a wine glass mistakenly left on the floor. Needless to say he was a little drunk off his furry ass for the rest of the day, too.

Once, Katy and I went with a couple friends of ours to a gay bar, hoping to hear some good music, and dance. We went with this new guy, and I think another one of Katy's good male friends. Any way, New Guy had been a monk proselyte (or whatever they call them) after having given up a career in computer programming. Any way, I went to a movie with him the next day, ("Signs" as in "This is a sign I should run and hide from this guy." And did, but it took a while of coldly dissing him before he got the message.) So we were talking about the bar, and I was saying you know, for a gay bar, it really had sucky music, and he said, "That was a gay bar?" I guess when you live with a bunch of men, sequestered away from the rest of the normal world, things like gay bars don't register properly as such, or something.

Any way, I don't know. I had a great job as at a knitting store. I was paid like $9.50 an hour and I loved my job. Sometimes I taught knitting for $20 for a half hour lesson. I don't even make that much overtime now as a professional. I basically helped people pick out yarn and needles and it was one of the best fucking jobs I've ever had. I stocked yarn and sometimes just got to sit and knit with my customers.

Customers were nice, they never sweared or yelled at me, threw things at my head, tried to kick, punch and bite me, nor bled, puked and crapped on me, ate their feces, required assistance to the bathroom, their diapers changed,or to be fed and bathed. Never once did I have to wipe up blood or feces off the floor because housekeeping wouldn't do it. I never had to beg my bosses to please, please, please do something NOW to keep someone from dying, and then get screamed at because "You're just a nurse, I'm the doctor, what the hell do you know about taking care of my patients?!" I never had to watch people die agonizing deaths, or listen to their family members scream and cry in utter grief watching them die.

All I did was stock yarn and help people knit. It was a nice job. It was civilized. I forgot I had a job like that, where I actually got more respect as a yarn store clerk than a registered nurse. Dude, I wish I could live off of $9.50 an hour, because I go back and do it again in a heartbeat.

Life was good. It's too bad I didn't know how good it was at the time, you know?

I'm Ready For My Close Up Now, Mr. DeMille...

This is the artsy-fartsy picture, the one I had to screw around with on iPhoto because the original picture was actually pretty blurry. Our digital camera has seen better days and we need a new one, but with my loss of will to live (or be gainfully employed, any way) it's probably not going to happen soon. So like everything else we own, we're going to have to use it until it absolutely falls apart and can't be salvaged out for any useable parts.

Any way, check out the crack 'ho visible collarbone look! Tres chic!

I swear I'm not as narcissistic as I seem; I had one of the dog (who loathes being photographed, and so I had to be cruel and lie to him and say "Wanna go for a walk?!" so he'd perk up and look at the camera. Which is like, animal abuse, I know, but he won't look at the camera any other way. ) Any way, that one turned out all blurry too, and iPhoto isn't cooperating with his million-dollar (okay, five cent) makeover photo either, so it'll have to wait.

By the way, if I were a Sunset Boulevard character, I'd definetely be the guy they find face down floating in a pool.

Vanity Fair

Alright, so since you're all probably tired of whining about my stupid life, I thought I'd give you all a Gallery of Jamie. This is not for you folks who see me every day at work (or whenever I decide to show up, lately) all disgruntled, scrubs bagging around my knees like some school uniform reject, petulant look on my face, stethoscope slung around my neck like a millstone, feet shod in dansko clogs breeding MRSA as we speak. Or maybe it is, because this is me, the slightly cleaned up version (eg not up to my elbows in poop disimpacting the latest nursing home dump with an admitting diagnosis of "constipation." No seriously. On a cardiac floor.)

This post is for you guys who haven't seen me in awhile, like maybe six months to a year, or even longer, except through blog pictures. For those of you folks who knew me during my divinity school/New College days, I've lost a lot of weight. Like fifteen pounds. I went from a comparably svelte 107-109lbs down to my current 94-97lbs. I'm not saying this to be an arse, I'm saying this because nursing has basically stressed out me out that I can't/don't eat properly. I once had a shift that started at 11 a.m., ended at 3a.m. the following day and the last thing I had to eat was before my shift at 11am.

I've never been so skinny in my life, and it all happened in the first three months of my job, and try as I might, I haven't been able to gain any weight since. I've even tried those geriatric dietary supplements and they didn't do anything. I'm about to ask my PMD to put me on Megace, a BRCA drug that is also being used as an appetite enhancer that unfortunately also happens to be cytotoxic, but hey, what's a little cell death between friends, huh? I have size zero pants now that have an extra 2-3 inches around the waist and don't have belt loops, so I just have to wear longer shirts to cover up the belly, because I'm not like, Britney Spears, or whatever. I mean, for the record, my dog doesn't go traveling around unrestrained in my lap when I'm driving a car, okay? He travels in the passenger side unrestrained, thank you very much.

Ergo, the collarbone poking out and then hollowed out neck and gaunt looking failure-to-thrive look. I also cut my hair off, because it bugged me, and because I don't know, I thought it would improve my life. And it has, slightly, in that I'm not constantly pushing it out of my face as I'm suctioning Copious Sputum Producer Of the Year.

Now if only I could get a job making obscene amounts of money giving flu shots (as suggested by a former teacher of mine), for say, two hours a week, I'd be all set.

What I really need is a vacation on a sunny beach somewhere, just soaking up cancerous UV rays and not caring about malignant melanoma, sipping pina coladas out of coconut shells and dreaming about the days when keeping old people alive so they can die agonizing deaths some time later is not a part of my job description.

Why The Science Channel is Funny, Yet Also Sucks

Okay, so my husband has this annoying habit of constantly watching The Science Channel. Last night, for instance, I was subjected to an hour of Volvo Crash Tests And Space Age Improvements, or some such shit. Not that I don't appreciate that Volvo is tring to make a safer automobile riding experience for all, but come on... an hour of watching perfectly good Volvos being destroyed just to see how badly we can fuck up crash test dummies is a little much.

Any way, it was apparently marathon Science Channel watching night for Ibrahim, and the Crash Test Extravaganza was preceeded by this really dramatic, very silly exploration of the Dead Sea Scrolls and Apocryphal Gospels and some bullshit theory about Jesus and Mary Magdalene being husband and wife and how some wack job (from France no less) was claiming to be a decescendent of Jesus/Mary copulation.

The guy was totally serious, too, and what's more, the program took him seriously, in this very reverential, awe-inspiring tone.

I'm not saying Jesus didn't have sex, or wasn't married, or whatever, because hey, I didn't live with the guy, okay? All I'm saying is that it's a well known fact that Mary Magdalene was not the prostitute that washed Jesus's feet with her hair and all that, and I don't remember anything much sexy happening her way, but then again, I forgot it was Easter this weekend, so I may not be the best source for these sorts of judgments.

Any way, as my husband was glazed-eyed, completely absorbed in this shit, I was over in the corner snickering, wishing my friend Katy was here to witness this utter tripe, just so we could be snotty intellectuals pointing out the inconsistencies and outright fallacious theorizing spun as "truth" (she's a real intellectual, getting a proper PhD, actually, while Im just a poser who can't remember major holidays I studied in graduate school.)

Of course, to other normal folks, we'd sound like Trekkies quibbling over the real canonical dialects of Klingon, or something, but seriously, I hate to burst the producer's enthusiastic bubble, but uh, the Dead Sea Scrolls aren't exactly groundbreaking, newsflash type news. Like try 1947, when they were discovered, people.

And then there was this advertisement for The Gospel of Judas. Lions, and tigers and bears, oh my!

Frankly, I know I'm being a snotty prat about this stuff, because, yes, it's interesting when you sensationalize religious historical mysteries in progams designed for people who read the Davinci Code or watch "National Treasure" and think "Wow! Cool!" but real academic work is actually comprised of very very tedious and dull scholarly work that spans decades of one's career in one small, esoteric area of much larger compendium of issues. It takes dedication, and a good antidepressant/supply of methamphetamine to continue with scholarly work past master's level, I'm convinced.

Thankfully, there are only a handful of people who get all hot and bothered over tasks like indexing, footnoting footnotes (I did, once! It was fun!), spending thousands of hours writing sniping commentary in scholarly journals over academic minituae (while the rest of the world is making millions off of worthless tripe like American Idol Meets Survivor spin offs).

But I feel sorry for the intellectual types, because then all their hard work gets distilled into some godawful half-hour badly-reenacted Spanish channel drama quality "documentary" about "discoveries" the intellectual community has known about for half a century or more. I would feel very, very indignant about my life's work being so summarily misused.

But then, I'd also have to laugh, because seriously, a Frenchman claiming to be the distant, dsitant progeny of Jesus and Mary Magdalene hooking up? Like, how do you prove a claim like that? And was this guy committed to a psych ward at the time of the interview?

(I once had a psych patient who claimed she knew the secret to the end of the world, and had special knowledge of the mysterious language of the documents that revealed when and how these supposed events were to occur. She was a bipolar, paranoid schizophrenic who had her first psychotic break in medical school and everyone had lost count of how many times she had tried to off herself, including one interesting attempt during her most recent ward admission involving dismantling the clock from her cell wall, breaking the face of the clock, and attempting to slit her wrists with the broken shards. But who the fuck knows. Maybe she really does know the secret of the end of the universe, and we're all fucked and only she knows it. After all, everybody thought Jesus was a wack-job, too, and look how his career took off posthumously.)

If you've never watched the Science Channel, I recommend it. It's great for shits and giggles. (Like the one special they did on the Coliseum, in a manner that suggested no one in the history of humanity had ever noticed or studied the Coliseum before.)