In Which Our Hero Revisits Junior High

Posted on February 6, 2012 at 10:53 am by Abilene Rob

Most of my female patients are 80-year old ladies who flipped into a-fib during a bout of potato-flinging senile dementia. If not, it’s a sure bet that they’re middle-aged women with the massively-high blood pressure, peripheral vascular disease, cardiac complications, and uncontrolled chronic conditions that are the free bonus gifts you get with a lifetime of morbid obesity. Occasionally, they’re on my floor so we can make sure their blood pressure doesn’t bottom out when they get up to crap a half-gallon of GI blood into a bucket.

Decades of naughty-nurse porn would have you believe otherwise, but the truth is that hospitals are not sexy places. Trying to maintain an appropriate demeanor around beautiful patients is a problem I just don’t generally have to worry about, so I can forgive myself for being caught a little off guard the first time I did.

She had the kind of brain problem that can lead to sudden heart problems, but looked and acted exactly like a late-20′s graduate student would look and act in any other circumstances. I was, frankly, surprised to see a patient so young and attractive, but all she meant to me was an extra hour of paperwork and scrambling, right at the beginning of my shift, when I could afford it the least. I just wanted to get her situated, get her vitals, and get her on tele, in the desperate (and probably vain) hope that I might somehow get my charts checked and my 2100 med pass done before midnight.

I’ve got the routine down, complete with the patter.

“While you’re on this floor, we’ll be keeping you on a heart monitor.” The aide has the top leads, and she’s reaching in under the gown. Alcohol wipe to both shoulders. Electrode placed on the right shoulder. White lead attached.

“We’ll be constantly watching your heart rhythm, so please don’t leave the floor. If you do, your rhythm drops off the monitor and everybody freaks right out.” She chuckles obligingly. Electrode placed on the left shoulder. Black lead attached.

I’ve got the bottom leads. “I need to attach a lead to the center of your chest, and one to each of your sides. This may get a little personal.” She nods. The wiring harness is threaded through the hole above the pocket of the gown. I thread the red lead into the neck of the gown, trying to guide it down to her side, getting it pre-positioned as close as possible to where it will ultimately need to be. I do the same with the green lead, on the other side.

The brown lead goes in the fourth intercostal space, at the margin of the right sternal border. “I need to undo your gown a little to put this lead on your chest.” She nods. I unsnap the shoulders of the gown and begin to expose her.

“What the hell?” I think to myself. She has some kind of elastic compression rig strapped tightly across her chest. The ER nurse didn’t say anything in report about it, and I can’t remember ever seeing a similar device in clinicals or on the floor. My mind races to figure out what it might be. Is it there to limit rib cage expansion? To hold a prosthetic? Why wasn’t I told about this? Since when does Nike even make medical equipment?

And, of course, the light comes on for me at the exact moment she catches me staring at her sports bra.

Fortunately, my hair is long enough to hide an embarrassed flush. Hopefully, I won’t lose my license for charges of gross pervery.

 

 

This is a live version of one of the songs on Leonard Cohen’s incredible new album:

 

 

I stumbled across Charlotte Shane’s blog while nosing around the Good Men Project. It’s a brilliant, fascinating look at life through the eyes of a professional escort. Obviously, some of it’s dirty, but not gratuitously so. I’ll be thinking for a while about her ideas on male and female sexuality, and of the relationship between sex, intimacy, and companionship. Recommended reading.

 

 

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I worked a lot

Posted on January 26, 2012 at 10:22 am by Abilene Rob

Then spent the proceeds on an iPad.

It’s rad.

20120126-092207.jpg

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Sometimes Death Wins

Posted on January 10, 2012 at 11:03 am by Abilene Rob

 

 

I hate that.

 

 

 

 

 

 

 

 

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It’s hard to write about nursing when you’re actually nursing.

Posted on November 6, 2011 at 1:50 pm by Abilene Rob

At least when you’re new-nursing, anyway.  I spent somewhere in the neighborhood of 75 hours clocked in this week. It would have been 74, but Daylight Savings time scootched me over the edge.  I clocked out this morning and drove immediately to an $11 breakfast that I ate while staring blankly into a room filled with Sunday morning dress clothes wrapped around happily chattering people.

My vascular space is now 74% filled with white gravy and black pepper.

I’m totally okay with that.

Random notes:

When I’ve spent 12 hours priming you with heart rhythm pills and carefully weaning you down off your cardizem, don’t flip immediately back into A-fib ten minutes after I stop the pump. Just… don’t do that.

The PCA bag is 100 mL of some kind of saline stuff with (this is important) 2 mL of actual dope added to it. If you don’t start your calculations with 102 mL total, you’ll spend way too much time you can’t afford snapping freshly-sharpened pencils in two and reworking the same dosage calculations over and over like a moron flunking a first-semester dosage calc test.  There are some times when you’re going to lose that to priming your line, but this isn’t one of those times; I want to know where that 2 mL went, damnit. The universe demands order (in everything but the verb tense of multi-clause run-on sentences.)

Working five nights in a row will make you stupid. If you know that you’re going to be stupid, you will anticipate your own stupidity and compensate accordingly.  You will double check everything, and then you will triple check it, and then you will ask your Charge just to be sure. What you won’t anticipate is the fact that your emotions start to get raw. If you are a low-life (like I am), you will curse viciously and audibly when the beeper goes off for your next admit. You will despise the call-bell. Your shoulders will tense and your nails will dig into your palms when the pulse-ox beeps. When you’re getting report and the day shift tells you that family in room 3 gushed about how much they appreciate the care you gave to their grandma, you will get misty eyed and have to clear your throat and you will hem and haw and look down at your brain sheet while you try to regain some measure of bearing and professional demeanor.

Frequently-Confused-Asshole-Who-Treats-Everyone-Like-Garbage: “Are you a man or a woman?”

Me: “I am a man. Another deep breath, please. Good; let it out.”

Lung sounds: clear in all fields. Good deal.

FCAWTELG: “Your hair looks like a woman’s.  Why do you have a woman’s hairdo?”

Me: “I think it looks good on me. One more deep breath. Good. Let it out. Are you having any trouble going to the bathroom?”

Bowel sounds: present x4. Continuing my assessment, fully cognizant of leaning over the guy who took a swing at one of the kindest female nurses on our floor.

FCAWTELG: “You’ve never been in the service, have you?” Audible sneer in his voice.

Me: “I served four years in the United States Marine infantry. Did a year in Guantamo Bay, then deployed with the 31st Marine Expeditionary Unit, special operations capable. Just breathe normally – I’m listening to your heart.”

Apical pulse: regular. No murmurs or adventitious sounds noted.

FCAWTELG:  Proceeds to tell me “war stories” of his time in the service, brags about his Marine son, and then becomes one of my easiest patients of the week.

Moral of the story: Semper Fi.

The picture on the Me Cam is what was going to be my Halloween costume. I made a paper mache cow skull. I was gonna carve some kind of creepy-looking glyph into its forehead and light it up with a red LED, but I ran out of time and just wore a Guy Fawkes mask and tuxedo jacket. Not sure what to do with it, now. I’m leaning toward painting it with a Day of the Dead motif and using it as a wall decoration.

Until then: blessed sleep.

(You know you’re a night shift nurse when you’ve put away three double Wild Turkey and Cokes by noon on a Sunday.)

 

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Somebody

Posted on October 8, 2011 at 9:31 am by Abilene Rob

 

So, the phone rings. And, because I am a dumbass, I answer it.

Two of my coworkers have sick family members. They’re not coming in to work.  It turns out that, shockingly, there are some sick people at my work, and Somebody needs to take care of them, which means that Somebody needs to come in.  As the dues-paying FNG, I know that Somebody should probably be me.

I say, “Yes.”

I say, “Yes,” despite knowing exactly how sick those people are, and exactly how much care they’re going need, and exactly how woefully unprepared I am to be the Somebody providing that care.

Didja hear the one about the nurse that died and went to hell?

It took her two weeks to figure out she wasn’t at work.

So, I did five nights. Four nights of, “Really? REALLY? Damn, REALLY?!?!”  Four nights of coping with an INR that, if it were a GPA, would have earned a very nice lady instant admission into an Ivy League university where, if her PTT was converted to a percentage and used as exam grades, she would have passed with flying colors. One of those flying colors being red. Lots and lots of bright red. Four nights of mental status changes and on-the-fly NIH stroke scale assessments. Approximately five thousand IV pushes, all appropriately diluted and administered very… very… slowly.  Four nights of, “Whoah. I didn’t even know that medicine came as a drip.” Four nights of Campbell’s Chunky Colon Soup. Four nights of fumbling for pulses that really should be there but somehow just aren’t.  Four nights of calling Pharmacy to learn that X can be piggybacked into Y, except after C, or when sounded like “A,” as in neighbor and weigh.  Bladder scans. Standing scale weights.  Jammin rubber into urethras, then irrigating said jammed rubber when it inevitably decides to quit doing what it oughta be doing. Four nights of random madness like that nice dude, who is just chilling for a few days while we finish out some antibiotics, suddenly going all respiratory with no warning, or an alert and oriented patient suddenly going all crazy eyes and ripping out her treatments (cause, ya know, why bother being NPO and on a Cordarone drip when you can get the same effect by walking out AMA and taking some Tylenol on the couch at home?)  Little green lines that look far more like seismograph readings than heart rhythms.  37 acres of old-growth forest that died to print one twelve-pound MAR. Obsessing over 50 mL of urine the way crazy people obsess over tea leaves. Redrawing samples because Somebody was too much of a dipshit to stop the pumps when Somebody pulled the first round.

Four nights of constant anxiety about what you’re missing, what you haven’t done, what’s not in the Pyxis, what you missed, who’s looking at you, what you can’t remember. Four nights of the mocking laughter of precious seconds and minutes and hours fleeing down the hall, taunting you, staying just out reach when you need them most.  Several days of the Day Shift looking at you with a mixture of pity and scorn as you finish your charting on the beat-up old computer in the Cubbyhole of Shame, an hour and a half after your shift should have ended.

Four nights of the callbell and the monitor alarms and the callbell and the pulse ox alarm and the callbell and the bedcheck alarm and the callbell and the dynamap alarm and DEAR SWEET JESUS IS THAT THE @#$%ING CALLBELL AGAIN WHY WONT IT JUST STOP DEAR GOD PLEASE JUST MAKE IT STOP MAKE IT STOP MAKE IT STOP FOR TWO DAMNED MINUTES I SWEAR I’LL BE GOOD IF YOU JUST PLEASE PLEASE PLEASE MAKE IT STOP MAKE IT STOP MAKE IT STOP.

And then, on the last night, everything lines out.

All the MARs you checked remain checked, and you can whip through them. The docs wrote orders based on the labs you pulled, and some shit got handled. Patients can breathe. Their hearts beat. They sleep. The pain you had to address every hour on the hour can now be handled every four hours. You know to crush the pills and bring some ice cream, and you know that it has to be chocolate ice-cream, and your med-pass takes a quarter the time it did on the first night. You stay almost even with the game. You finish report by 7:10 and walk out at 7:15.

You walk out knowing that Somebody is going to have to do it all over again next week. What’s really terrifying is discovering that if that Somebody has to be you, you’re actually okay with it.

 

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I am Stupid Sleepy. Possibly Just Stupid.

Posted on October 1, 2011 at 3:11 am by Abilene Rob

 

I’ve got that groggy, sluggish stupid feel from sleep hangover. I’ve gotta force myself to stick to my sleep remediation schedule when I come off four nights working. Otherwise, I wind up blathering on the internet at 2:30 am, foggy and lethargic, oriented to person and place, but not to time and barely to situation.

My fuel pump has been dead since last winter, rendering my car useless when it’s not blisteringly hot out, forcing me to rely on a $50 bicycle, generous friends with slightly-more-functional transportation, and lots of walking. When summer came and the weather got hot, the car ran fine as long as I parked it nose down on inclines and made a weekly sacrifice of chicken and rum to Papa Shango, the voodoo god of fire and iron.

When the weather got all autumny a couple of weeks ago, the car stopped working again. Fortunately, I don’t have school anymore, so I was able to move easily into a nice routine of just walking to work and walking to the grocery store, both of which are within blocks of my home.

I put my car in the shop last week and just got it back on Wednesday, in the middle of The Work Week From Hell. The less said about the Work Week From Hell, the better. Suffice to say that if I happen to hear the sound of a callbell during the two nights I have off, I’m going to dive under a table and sit there rocking and shaking and screaming and sobbing incoherently until someone calls 911 and the fire department and a nice lady from MHMR have to come drag me out and ship me off to Big Springs.

So, on Thursday morning, I walked home from work, as is my custom. Feet aching, back screaming, knees sore, mind and spirit bruised, needle barely twitching on my giveadamnometer. I got home to discover that there was no longer any dog food, and I had used up the last can of emergency cat rations. I was not at all keen on the idea of walking back to the grocery store, but I was even less keen on the idea of the police breaking down my door in a week and discovering my fat and happy pets grinning stupidly and feasting on the remains of my half-eaten corpse, so I resolved to go to the grocery store.

When I stepped out of my front door, I saw my car sitting at the curb and, well, you know what happened next.

I turned around, grabbed my keys, and drove myself one block to the grocery store.

“One block” is not hyperbole. At the far end of my block is a street. On the other side of that street is the grocery store. To which I drove. And here’s the thing… that’s not the most shameful part of this story.

I bought my stuff. Came home. Fed the animals. Tossed my scrubs on the floor. Crashed hard. Woke up. Showered. Shaved. Put on clean scrubs. Loaded up my pockets with nursey stuff. Walked to work. (I always walk to work, even when my car’s working. It’s only two blocks.)

To get to work, I pass through the parking lot of the grocery store. As I was walking, I thought, “Huh. That Mustang looks just like mine. They’ve even got the same Marines sticker, in the same place on the back window. Weird.”

It took me another five or ten seconds to realize that the reason that car looked like mine is because it was mine, at which point I stopped dead in my tracks thinking, “Who put my car here? What the flying hell?”  It took me probably a full 20 seconds’ worth of standing in the middle of a parking lot like a slack-jawed, dumbfounded moron to put all the pieces together.

I had driven to the grocery store, forgotten that I drove, and just walked home. Upon arriving at home, I failed to notice that my car wasn’t at the curb, and then failed to connect the act with anything meaningful when I took my CAR KEYS out of my pocket and threw them on my desk.

Hi, there. I'll be titrating your cardiac drips this evening.

At least now I know that I should never do anything important between 0800 and 10 am.

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The Things I Would Like to Say

Posted on September 24, 2011 at 4:45 am by Abilene Rob

 

When I first started working, The Hospital was having a softball tournament, and my floor was fielding a team. I wanted to fit in and be one of the cool kids, so I joined the team. I went to a couple of the practices, which were attended by two girls, two burly dudes from another floor, some kind of little terrier-thing dog, and me. You will probably not be surprised to learn that the burly dudes were a lot better at softball than I was, and probably not really surprised to learn that even the girls were better than I was. Also, the dog. The dog was better than me.

 

I would like to say that there was an inspirational montage set to 80′s pop music where I became a great softball player. I would like to say that our team, coached by a cowgirl in a giant pickup instead of coked-up Emilio Estevez, went on to heroically win the tournament like a scrubsed-out Bad News Bears, but that didn’t happen. The team just kinda fizzled, and for a year I’ve had a softball mitt and some neon-yellow softballs rolling around in the trunk of my car for no good reason.

 

So, a couple of nights ago, I was walking back to my floor after picking up “lunch” (“lunch” is in quotes because it’s always, like, 1 a.m. when I eat it.) It was after hours so the hallway was dark, and I saw the silhouette of Burly Softball Dude #2 walking toward me.  I said, “Hey, man,” and he said something very improbable:

 

“We’ve been reading your blog.”

 

At that point, the nurse he was walking with said, “Oh, you’re Rob. I’ve been reading your blog. It’s nice to meet you,” whereupon she gracefully extended her hand.

 

I would like to say that I handled the situation like this guy would have:

 

 

I would like to say that, but I can’t. I mean, I guess I could say that, but it wouldn’t be technically true.

 

The reality is that I kind of limply shook her hand and rudely didn’t even think to ask her name or make a proper introduction. I’m usually not totally socially incompetent, but it was so jarring to come face to face with people who had read my site that my treacherous brain just vapor locked.  I just stood there with my jaw agape, hoping not to fumble the styrofoam container loaded precariously with three pieces of pizza standing in mute testimony to the sickening reality of my pasty, greasy dorkiness.

 

 

When I float down to that floor, and I will, I’ll have to wear a fake mustache or something. Otherwise, everyone will know that I’m that nerdy dude from the internet…

and that I cringe like a girl when someone throws a softball at me.

 

 

 

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You’re Not Gonna Believe the Crazy Way I Used Duct Tape

Posted on September 16, 2011 at 2:00 pm by Abilene Rob

WACKY!!!!

Yeah, that’s right. I used it to tape a duct!

Crazy, I know, but it works.

I made it through my first week on my own. Even with relatively easy patients, I ran pretty consistently behind and had to stay late charting. I mostly carried a full patient load, though, and got through it with only a couple of bonehead newbie mistakes, so I guess I came out okay.

I’ll take what I can get.

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The Training Wheels Come Off

Posted on September 12, 2011 at 6:23 pm by Abilene Rob

I’m off orientation. This is my first night as a real-deal, all-on-me, no-preceptor, rockin’ the floor, Registered mo-freakin’ Nurse. Flying solo.

I took a long, hot shower. Broke out a brand-new razor for that extra-sharp shave. Fresh scrubs. New kicks. Gold watch. Cufflinks. I ain’t missing not a single thing. Did the pre-shift gear check:

  • Name badge – clipped.
  • Three black pens, one sharpie, one highlighter – clipped.
  • Locater – clipped and tucked.
  • Little nurse holster with my scissors, penlight, penknife, and ruler – riding in the cargo pocket.
  • Fat sheaf of alcohol wipes - check.
  • Handful of the little blue plastic dealies for capping loose I.V. lines – check.
  • Chapstick – check.

Ready to roll. Ready to rock.  I got this. I’ve worked years for this moment. Now that it’s here, I realize that I’m not scared. I’m anxious, but I’m not scared.

I am a nurse, and these are my patients and on my watch, it’s gonna get handled.

And then the phone rings.

And then I’m low-censused and put on call.

It looks like, on my watch, a cheeseburger and some fries are gonna get handled.

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Ughh. Rough week. Rough night.

Posted on August 8, 2011 at 2:52 am by Abilene Rob

I got a little bit better at managing my time this week, but it’s still going to be a long, rough road. Even with reasonably-stable patients, I still feel like I’m constantly behind the 8-ball. I’m running like hell (sometimes literally), and always unable to keep up. I can’t ever catch up on the progress reports, can’t get ahead of the game on meds, can’t keep my charting caught up. I find myself at 0645 still hammering away at my handoff reports in a cold sweat, feverishly pounding out the bare minimum so there’s at least something on the sheets, then just filling in everything else verbally when I give report, and finishing up the last of my charting once report is given. Which is not a huge deal – the experienced nurses do it all the time when they’ve had a bad night – but this isn’t after a bad night: this is after a normal load of relatively-easy patients, and with my preceptor’s help.

 

I did get my first atta-boy, though, which was nice. A patient told the day nurse what a really great job I did, and told her that she felt like I really cared. That was nice to hear, because I was really frustrated with the patient the previous night, and I was afraid I’d let it slip. I’m finding that compassion and empathy are the first casualties of stress, a tendency that I think I’m going to have to watch very carefully. When one patient is having chest pain and the other just peed on herself and the pump is beeping in 12 and the incessant whine of the monitors is drilling into my head because 7 has leads off and it’s 2130 and the 2100 meds aren’t completely passed and the damned line isn’t flushing (oh-please-oh-please-oh-please-oh-please-oh-god-just-please-let this stay patent,) my mind starts interpreting patient needs as patient demands, and that’s dangerous territory to be heading into this early in the game. The whole reason I got into this gig was to help people. If that slips, I might as well go work at a burger joint.
 

Also, I envy the nurse brains that everyone around me seems to have. My preceptors (I get bounced around like a red-headed stepchild) are trying to stay as hands-off as possible, to let me learn on my own. It’s the only way to really learn, and I’m more than a little flattered by their confidence in me, but it feels like I’m the slow kid in class. I’m doing the assessments and the charting and the passing of meds, pretty much everything, but I still can’t manage the effortless, totally comprehensive mastery of every relevant detail of the patients’ condition that they have. They’re constantly reminding me of little details I’ve forgotten. My forehead is getting concave in the place where I keep slapping it and saying, “Oh, yeah. I knew that.”
 

I know it will all come with time, but it’s frustrating because it matters right now, and I feel like I’m flailing.
 

At least I’m (mostly) remembering to keep a pocket full of flushes. That’s saved me about 2 miles of walking and several hours per shift.
 

In other news, I did a thorough cleaning of my bedroom tonight. One of the hazards of being a terminally-single dude with few friends is that I descend quickly into catassery, so my bedroom had turned into a horrible nightmare of laundry and crap that I was totally going to put away… later. “Later” turned out to be today. I cleaned out my drawers, bagged up about 2/3 of my clothes, and got rid of all the shoes and belts and horribly-patterned boxer shorts that I will never wear.
 

While digging, I came across a couple of things that my ex left behind, which started me on the downside of the roller coaster. Then I used carpet powder that smelled like her, which sent me completely off the rails. She’s been gone for three years, and my dad has been gone for ten, but the people who are gone from our lives always leave landmines. When I least expect it, I get rocked and wander around concussed until I can get my wits about me. My friend Hurricane calls it “The Pain of Living,” which I guess is as good a way to describe it as any.
 

I’m off to get some sleep. Tomorrow is a new day, and I’m back in the trenches. Since it’s now technically Monday, here’s some Musical Monday fodder: some genius remixed Fugazi and Wu-Tang Clan, and some other genius set it all off with clips of Omar from The Wire. It’s brilliant. Brilliant.
 


 

Good night, internet.

Posted in The Life, The Music, The Nursing | 1 Comment