save patients! win prizes!

So yesterday, I come into work in a patented Jamie Foul Mood.

I wasn't about the work, the bullshit, the work, more bullshit, more work... you get the idea.

On days like this, even when a very nice patient asks, "Oh, and could you please rearrange my bedside table so it's parallel to the bed, not perpendicular, and all the items on it are arranged in strict 45 degree angles in relationship to each other, and there's only 3 inches of water in the cup, not 5, and oh, I don't like paper cups, could you get me a real glass cup..." ad naseaum...

I want to scream.

And scream I do, silently, in my head.

Over and over and over again.

On days like this, when you just can't get it up for the job, figuratively, and you're like, growling under your breath about the needy, annoying post-op open heart surgery (Dude! It can't hurt that bad!) the minute you get out of the room...

Well, those always seem to be the days in which you receive a major reality check.

Not that you wanted one, mind.

Not that you needed one.

You just get one.

It's like, the cracker jack prize-in-the-box for nurses who wake up on the wrong side of the Clinitron bed.

Mine, yesterday, was a fake-out respiratory distress situation on a patient, who was actually just having some kind of weird COPD exacerbation. Apparently I appeared to the rapid response team as if I were having hallucinations, a mild TIA or complete lapse of professional judgement (or all of the above)--so I'm telling you, gentle reader, so that someone knows: Dude, it looked exactly like she was about to respiratory arrest.

Trust me, you get a feeling about these kinds of patients after awhile. The ones who look okay at 3p.m., maybe slightly wheezy, but nothing that makes you go, "Oh, crap," and by 4p.m., are a little huffy and puffy, so you keep a close eye on them. You've got enough experience under your belt to know you don't want to run and call the PA yet, who isn't going to be impressed by your Fakey Nursing Skilz if you haven't given the Lasix or tried breathing treatments on yet, but you've also done the job long enough to know that This Could Be A Situation.

However, as I'm sure most nurses will agree, no one is gonna take your Special Nursing Intuition, "I Gotta Bad Feeling About This One" seriously if you don't back it up with some mega-shitty ABGs or crap chest X-rays, even if the patient turns out not to respond to mega doses of diuretics, or like three breathing treatments, and by 5 p.m. is wheezing so badly you can hear it across the room without a stethoscope. Especially if you're some new-to-the-floor nurse who no one knows from Adam. (The political and social hierarchy of nursing is a whole 'nother game, probably a post or six, but I digress).

Any way, I knew no one was gonna take me "fo' real" when they heard the numbers, and I was gonna get some variation of: "But dude, she's like, sating 95% on 2 liters! What the fuck did you page for, you fucking minor league bitch?!"

I mean, they won't come out and say that, outright (although I've had doctors at other places come pretty damned close) but, you know that's what they're thinking.

In nursing, this is called The Dreaded Numbers Game, in which the nurse is actually tempted to fake pulse oximetry readings to get someone to care that you know, the patient looks like shit and can't breathe worth a damn. But, since "looks like shit and can't breathe worth a damn" isn't an actual diagnosis, you gotta dig for proof to back up your shit nursing claims.

Because, you know the minute you say "She's sating fine, dude, I have no idea what the problem is," you're totally gonna be blown off as some total amateur crappy stepdown nurse who clearly is overreacting to some minor, bullshit situation that's gonna blow over if you give it enough time.

And, even when the respiratory therapist is urging you to call a rapid reponse team (which, as charge pointed out later "wasn't all that rapid") you know the next few minutes are gonna be devoted to the weird pissing match thing ICU nurses do when they come up to a stepdown floor and decide the stepdown nurse is full of shit and can't manage own her patients.

I don't know if this is a good comparison--it does, however, speak to the fact that I'm watching way fucking too much late-night t.v.--but, dude, I felt exactly like Jimmy Smits' character in those NYPD Blue episodes I saw a couple of days ago, where he spends his entire screen time getting his balls busted by the Special Task Force, who come in on his turf and keep trying to show him up on a serial killer case. His Captain keeps telling him to take one for the team, and Jimmy Smits, who's done all this snazzy detective work and knows deep down inside he's got some good leads, man, gets all pissed off and slams men's restroom doors in frustration, because he keeps getting railroaded by the Special Task Force.

Jimmy Smits, man, I feel your pain, bro', I feel your pain.

Because it was like that, with me as Jimmy Smits getting silently pissed off and thinking thoughts of slamming heads into walls, and the ICU nurses as Special Task Force, all huffing and puffing and stomping around because "Oh my gawd, you floor nurses don't run your own ABGS?! What do you mean, stepdown nurses don't have an I-stat to run ABGs? What kind of a floor is this?!" etc. etc.

Yeah, it was like that episode, except without the serial killer (unless you count COPD as a serial killer, which it kind of is, actually) and there was no vindication on my part, as there was, eventually on Jimmy's part, and no slaming of men's restroom doors, either. (Well, the patient did pull herself out of this godawful respiratory distress, apparently responding to, uh, no acute interventions whatsoever other than ICU nurses kind of rolling their eyes and going, "Oh yeah, this patient. She does this. She like, did this on your floor a couple of days ago and went to the unit where we did nothing for it. She'll pull herself out of it.")

Like, you know, information that might have been nice to know when they transfered her at 2:30p.m. to stepdown.

Any hoo, despite apparently annoying people into doing their jobs with the false alarm, I felt okay about the situation, even if I was made to feel like a big goofy moron who might well be a first-day-nursing student. I mean, I like to think I've Learned Some Things in two years. Not everything, but you know, some things. And one of the things I think I've learned pretty well, is recognizing the basic signs and symptoms of patients when they can't breathe.

But, I've also learned other, more difficult lessons (which I conveniently forget from time to time prn.)

For one thing, I kept my big mouth shut. (And if you know me well, you know how desperately hard this is for me to do, especially in situations where I Think I'm Right; harder still in situations where I Know I'm Right.)

This has been one of the hardest of all the transitions to make from years of schooling to Wurk: in school, you're supposed to know the right answers, and you are encouraged to give these answers. You're even rewarded for these answers. In Real Life, you may know the answers, you may even know the right answers--but very few people are going to want to listen to them.

So, recognizing the latter situation for what it was, and realizing these were colleagues who, like it or not, I was going to have to endure and/or outright need the assistance of in future situations, I bent over, and took the passive-aggressive abuse, because well, whatever, it wasn't nice, but it also wasn't the time to start bitching at people who could like, do important stuff like intubate my patient and help out in real codes.

And, it was kind of funny, because at the end of the day, one of the floor nurses, who's like, the cheerleader for the floor, except in a good, non-fakey way, was like, "So, you saved someone's life today, huh?"

It struck me funny, because dude, that's the last thing I would have thought about or called that situation. I actually kind of felt like the moron who keeps insisting they really did see Elvis or a UFO or something, and every one else kind of humors them like, "Sure, sure, Jamie. Sure it was a COPD exacerbation. Sure." It was less medical heroics, a lot more like throwing a big surprise party complete with a cake-popper, and the wrong person walks in on it.

I laughed, and genuinely surprised by his response to my Big Ado Over Nothing, said, "Dude, no, I don't think so. She pulled herself out of that one--so I guess she kind of saved her own life."

And he kind of laughed, and gave me a thumbs up sign.

So, yeah, I guess felt all warm and fuzzy inside for a quick second, kind of like I'm sure Jimmy Smits's character did at the end of that NYPD episode, when Dennis Franz's character says all gruffily, "Good work, detective."

Some days, that's about as much validation in this often-shit job as you can hope for.