A Year in the Life

Five Hundred Twenty-Five Thousand Six Hundred Minutes.

I have never seen Rent, but my (former) mechanic was astute enough to point out that at 8am tomorrow will be a year from the day my base was shut down. Most people have moved on.... effortlessly in some cases. Most are stil flying somehwere. Thats a hard realization for me. I think I probably took the closing a little harder than everyone else and have spent the last year just trying to get over it. I feel like there are still scars there.... just not as visable as they used to be.

So maybe that will mark the end of my getting over it and start the moving on process.

HBIC (Head Bitch in Charge)

I am still completely fascinated with the idea of 'Emergency Hair.' Seriously, is this some shit that was just made up? I asked the charge nurse as I was getting charge report last night and she had an epiphany. (this from a blonde hair/blue eyed Scottish girl) Emergency Hair: when you have your hair weave/braid put in you get extra little braidy things to sew in if one falls out. Wow, that makes a lot of sense! I tried to confirm on Wikipedia, but no such luck. My only confirmation is from the weirdo white clerk who randomly got braids put in a couple of months ago.


Being in charge always stresses me out a little bit. It really does depend on who you have on your "side" and how well they all work together. Last night in green I had an incredible group. They were all strong, nice people who worked well together, especially when it was hitting the fan. The way staffing fell, there was a Sausage-Fest (all boys) in Yellow... and only a token boy in green with me. We started out ready to prank them all night... as they have done to us in the past, but unfortunately it was just too damn busy!


Someone explain this to me..... 65 year old lady with MS, CVA HTN, lives in a nursing home with a PEG, colostomy, decubs everywhere and contractures. Are we getting the picture here? She is usually completely with it (yeah right) and became altered 36 hours before she showed up. The staff sent some labs and waited. It became an emergency at 0215. She arrived with a temp of 103, tachy and (THANK GOD!) not hypotensive. The staff at the home refused to give EMS any more info.... but they were more than willing to call and question when we were going to admit her. The nurse refused to talk to them (she was Sooooo pissed) so as charge I got to tell them that she was being admitted and then promptly hung up on them.


While MeeMaw was sick, we were keeping a lady up on CPAP and tubing another asthmatic that wasn't moving any air. The asshole husband of some abd pain patient had to be told to get out of the asthma patient's room, and the crazy psych patients were moving in. Seriously, some girl went to the bathroom, put on PJ's and slippers and was reading a book instead of talking to the psych doctors.

Some people just irritate the hell outta me. The attending last night was the only real downside. He's a jerk, plain and simple. The highlight was when the resident walked in to the tubed patient's room to tell us what a dick the attending was!

Emergency Hair and the Crazy Check

I made the mistake of telling someone that I don't need a great night's sleep before being in the trauma room simply because I don't HAVE to think very much when I'm in there. Things come naturally to me and it just flows. Unfortunately, last night flowed a little too well. I am dog-ass tired and my feet are killing me. Multiple GSW's that (even though they were nice enough) just fucking sat there. Nada acute going on with them so just in a holding pattern.


What really chaps my ass is that while I was full in the trauma room, there were multiple open beds out in the treatment area. Nurses were out there shooting the shit and chilling while I ran around like crazy with 2 GSW's, a self-inflicted slice to the arm (hypotensive) and a BIG FAT MOMMA 82 year old with oozing leg ulcers. Don't ask me how the last one got stuck with me, she just did. Once I got everyone stable I went from bed to bed drawing all of the repeat labs, cleaning, getting people off of wet gross sheets, into gowns and under warm blankets. All the while my faboosh colleagues were hanging out with empty rooms. I should have said something to the charge nurse, so I guess it’s partially my fault. However, she is a little flighty and one of the lazy bitch nurses (who I have mentioned before on here) was out there and wanted to do as little work as possible. She has recently left the ED full-time, thank god, and will now come work 8 hour shifts from time to time. This change has done nothing for her attitude. So she had open beds all night and just watched me work. I could strangle her ugly neck!

Ok Ok, so this comes across a little bitchy, but I am tired of telling people to do their jobs. Not even HOW to do it.... but just to motivate people to fucking work in general.

I also heard a couple of new terms this week. 18 year old girl is under arrest for assault. She is getting medically cleared before going to lockup. The officer went to check her purse and asked what was in there so he didn't have any surprises. She rattled off the normal purse-stuff and then said "my emergency hair is in there too." WTF?!?!?! Emergency hair.... seriously? The officer reached in and pulled out a couple of little plastic braids. ........gross.

One of the housekeepers has a son who is in jail. He is getting out in a couple of years and she mentioned that he needed to apply for his "Crazy Check." Again.. what the fuck is that about? It sounds like the excuse is that he was in jail so now he has PTSD and needs disability. Why the hell does a healthy 25 year old need disability? Does anyone have the answer to that?

So my exposure to big momma crotch and the emergency hair has caused PTSD for me... can I apply for a "crazy check" and retire in luxury at 31? Just checking.

.

Bimbo?

You know what tweaks the hell outta me? The fact that I can walk into an interview, know all the answers, but cannot make the words leave my brain and spill out of my mouth. I had yet another interview today. It went ok, not a slam dunk. I know I wasn't a complete ding dong, but not as strong as I wanted to be. I just wanna call back and say "give me another freaking chance!" Even better, come watch me work. See me in my natural habitat.

Is it a confidence thing? Maybe. Where does the confidence go when I leave the bedside, put on heels and sit behind a table? How do you overcome that? Fuck if I know. I guess the more you interview the better you get??? Grrrr..... back to the trenches tonight. Trying not to think or worry. Again, thoughts, prayers, VooDoo, reptile sacrifices (frogs scare the hell out of me) and anything else would be appreciated.

Me and my Karma

So I'm about ready to cash in about 75% of my good karma. Have spent the past week and a half splitting my time between work, class and studying. 0930 tomorrow will see if the hard work has paid off. Thoughts, prayers, bribes and whatever else you have to throw in would be greatly appreciated.

My medic class stated a few days ago as well. What can I say other than nurses are some high maintenance bitches. Seriously, what part of "work with us and we will work with you" do these people not understand? Many are downright pissed that they have to come to my ER to do clinical shifts. Apparantly BFE memorial hospital should be more than adequate ER experience. Ummm..... because I'm sure this is a common occurance there.

Yeah... thats me on the right. Will keep the medic updates coming... am curious to see how this class goes. As I said, these are some high maintenance chicks and they just LOOOVVVEEE to hear themselves talk. I told one that "my filter is comin' off in 20 minutes" (I had worked a 12 the night before and had been up 22.5 hours at that point)   she had NO CLUE what I meant. OMAA!!!

Back to the books (and a great glass of 2007 Reisling).

Eyes, Ears, Mouth and Nose

Yup.... thats exactly where the septic patients vomit went. Mouth open (EWWW), glasses on (thank God). Vomit all over me. Gastrocult positive, MRSA confirmed. I brushed, rinsed with peroxide and changed my scrubs. I wanted to gargle with bleach but that wasn't exactly recommended by the dr. I also stuck my bare hand into a puddle of still warm urine and had yet another patient vomit on my arm. ** This last one was a bachelorette party gone awry. The MOB and groom were unthrilled that the bride got that shit faced!

Last night sucked ass. Can you tell? Any time you but 100,000 drunken partiers together with an urban environment, a warm day and a Saturday night you know you are royally fucked. I also have a big belief in the radio on the way to work. A little Marley and Buffett, things are mellow and chill. Last night was "Highway to Hell" and "Its the End of the World As We Know It." The green mile was not the place to be... thats for damn sure.
I didn't make it into the trauma room, but the notables were...

*T-bone MVC trauma code. The driver was HIGH and had neat, individually packaged pouches of "baking soda for my teeth" in his pocket
*Dude man who was robbed and then throat slit ear to ear. DAMN!
*House fire, 60% third degree burn

WTF?!?!!? I am soo very happy to be home. Trying to decide between food and sleep. I think sleep is winning!

Something to believe in

I have been on a bit of an 80's wave here recently. Not sure what has brought about this trip down memory lane, the 80's were most definitely NOT the highlight of my life so far. I find myself humming along with the familiar songs from back when.....


I keep waiting for some inspiration. Something that leads me back to why I love ER nursing and re-lights the proverbial fire under my ass. I look to others for guidance and direction down the right path. When I'm in charge and my feet (and ass, head... hell my whole body is to the fire) I try to channel one of the nurses who I have the deepest respect for. She is calm, competent and rarely loses her cool. I try to keep it together until I am out of view.... then the full-out jumping up and down temper tantrum begins. A solid minute of breakdown followed by a good ol Namaste and Whoo-Saaa, often in Tree Pose and I am back at it. I try to take care of my folks they way I wish others did with me. I try to still mentor the younger nurses and medics (especially those who are so interested in "doing it right" versus just getting by).

So where is the mentor for me? Even on the, hopefully, short road to the next step (flight). Who do I look to for that simple gesture of pointing me in the right direction, slapping my ass and letting me go? I guess when I look for someone to mold myself after I simply see the mold, not everything else that is mashed into it. Some people can effortlessly juggle the personal and professional making life in general look easy. Some are experts at maintaining the spotless veneer on the outside but inside are a big ol mess. I have found that those are more prevalent than I even knew. Am I wrong for expecting more from people? People who have the job I love and are, in some respects, squandering the opportunity? I just want to scream "I expected better from you!!!!" Get it together and live your best life. Make it worth something.... there are people who look up to you watching.

As described... consider this my minute in the back room, jumping up and down screaming.

Deep cleansing breath, hands to heart-center. Breathe.

Namaste
Thanks for listening

Just call me Chuck

When you nominate enough people for the Darwin Awards you get to call him by his first name.... when 90% of your patients are nominees... well, Chuck and I are now old friends. A complete shutout in the trauma room Monday night. Very surprising I must say. I guess the rain kept most of the morons inside. However, let me mention a call we got from our communications room.

45 year old man, unrestrained versus a wall at 30mph. Did I mention that he was in a lawn chair in the bed of a pickup truck? There was definitely a disparity in the teeth to tattoo ratio and there was a death in the vehicle. Yes my friends, I regret to inform you that the Miller High Life did not survive the crash. After x-rays, CT scans and multiple sutures in the face/mouth area he was ready to go. I identified a good "teaching moment" and asked him what he had learned from this experience.....

His response...? "I won't ride wit my brothers no mo."
Oh my lord.

Let me also point and laugh at one of my favorite residents. He is a third year, is a great doc AND treats the nurses really well. The ER was dead.... nada going on. Again, very surprising for a Labor Day Monday. A patient is brought back from triage with 3 days of abdominal pain. On further evaluation we find out that he is a heroin addict (her-on for those of you watching pronunciation), and has chronic pain issues, takes methadone and God knows what else daily.... are we getting the flow here? No BM x 3 days, walking like he was in labor. The resident wanted the nurse to give the guy a fleets or milk and molasses (anyone else have to do those?).... the nurses voted that we just give him one and send his ass on his way. No No No... he must have it done here.... so the charge nurse took him to the bathroom where he hollered and grunted without results. Did I mention that the resident was laughing at the charge nurse as he took the guy to the bathroom?

So after no results guess what.....???? The resident got to gown up and manually disimpact him. Let me have the honor of announcing the birth of a 2lb, brown hair, brown-eyed hunk of shit! We are going to name him Dr Junior after this resident.

Disillusioned

When I started in the ER (almost 8 years ago!) as a new grad I was convinced that I was hot shit. The ER had not hired new grads in years.... I was fresh out of nursing school and had been offered every job (all 3) that I had applied for. All I wanted was to play in the trauma room... that's where my love was. 8 years later I sit and wonder what the hell has happened? I have seen more tragedy and gore than more people do in a lifetime. I have literally clawed my way as close to the top of the ED as I am willing to go. I have no aspirations of being a coordinator or management in the department. It seems like as soon as you leave the bedside that all sense of solidarity with the nursing staff is lost.

Case in point.... We are seriously up to our assholes in patients. The acuity is way up. Patients that usually get put in rooms and monitors are in the hallway. There are NO inpatient beds and the traumas just keep coming. Given the situation the charge nurse called the coordinator (its becoming well past unsafe here) and is promptly hung up on. It wasn't until the house administrator came down to investigate the 4,000 trauma pages and saw the zoo that we finally went on diversion "for 2 hours to decompress."

I also noticed that the ED education staff seems to think that this is a democracy. Everyone should be equal and allowed to "do everything." So folks that can't handle a 4 patient zone are being trained for triage, charge and trauma. One refused to check the airway cart because 1) its the dr's job and 2) I don't use any of that stuff. Many don't know how to care for a mechanically ventilated patient (100% fiO2 and pO2 of 430 is not really a good thing!) and ACLS is no longer a requirement.

I am starting to feel like a rat in a sinking ship (again). I want to stay because I know this is what I am good at. I doubt that I will leave the ER completely, but I need something more challenging that makes me think. There is no way in hell that I am going back to neuro. I will kill the troll and they really dislike my use of the f-word. Ugh... don't know where this restless feeling is coming from.

Had to work with one of my least fav doctors the other night. He is the quintessential community doctor who has blessed us with his presence in a level 1 teaching hospital. He is a "white collar worker" who looks down on everyone else. Seriously, he called nurses blue collar workers with no integrity or work ethic. When he starts talking with other "colleagues" you WILL NOT get a word in. I had a patient that was not doing well but could not get his attention to tell either he or the resident about it. He is one of those doctors that will be nice to the patients face and completely bash them as soon as he leaves the room.... no matter what their injury or education level. They are below him. He is also the medical director for our special forces medics.... so when they are around he is all about teaching and being involved. As soon as those guys leave.....he doesn't give a shit. So to my dearest Dr BORED....

FUCK YOU.

love.... one of those blue-collar-nurses!