devolution.

It was one of those kind of weeks at work where I congratulated myself at the end of it for not becoming an alcoholic, narcotic drug abuser, or convicted of murder one.

I've had a headache for six days.

And, considering I'm going back to work tomorrow, I'm likely to have a headache for another six days.

Goddamn fucking job.

apocalypse, yesterday

I've come to the conclusion, based on the last two years of a Real Job, that I was never meant, on any level, to be a nurse.

I keep thinking there's something wrong with me.

Like, I'll be thinking, "Dude, I should like cleaning shit up off the floor more!"

Or, "Come on, Jamie, isn't lifting a 300 lb woman with weeping bilateral lower extremity cellulitis back into bed the highlight of your day!?"

Or the classic, ever-popular: "What don't you like about shitty power-play games with ingrate coworkers who don't want to do their jobs?"

But, mea culpa to all my peeps out there--I just wasn't cut out for this continual barrage of crap, burn out, endless demands, and pithy rewards ("Oh fucking yey, some person finally said 'Thank you.' You know what? That would mean a lot more if I got a big salary bonus and promotion at the end of the year like most people when they worked their fucking asses off.")

The way I know this simple truth is that I continually think longingly of Yesteryear Jamie, and how she used to be Good At Stuff, and now all she feels good for is wiping ass and running her own off.

Back in Ye Olden Days of Grad School, I never had back pain. I didn't have IBS. I didn't have frequent anxiety attacks, borderline anorexia, headaches that last for days, chronic insomnia, and a slew of other physical problems that have cropped up since I became a nurse.

I feel like I've aged about ten years in a mere two and that just can't be right, people.

It's like, you shouldn't spend three days at work and feel so burned out by the end of it that you need a two week vacation just to recover from your fucking stupid ass job.

And, I hate to say it, but I frequently miss Smug Academia Land, where people, are you know, continent of bowel and bladder, and if they aren't, they don't shit all over the bed, all over the floor, proceed to roll around in their own filth, and then request that you "lift their folds and look at that itchy rash down there."

Also, people in University Wurld are cultured, and learned, and stuff I really miss about people.

Because you see so much ugly and plain annoying about people in nursing, not to mention deal with so fucking much stupidity on a daily basis, that it can make you really miss when people made annoyingly erudite jokes about Derrida and told funny little jokes, the punch-lines of which were in Latin (even if when you graduated, you thought you'd never miss the snotty little gaggle of geeks with whom you matriculated.)

My academic training was focused on issues very different than the ones I find in nursing. For example, in college, I learned how to concentrate, and focus on textual analysis, and suffer through very long, very dry, and mostly completely incomprehensible English translations of complex 19th century German philosophical texts. I'm not saying I was great at it, but it's what I was used to doing, and I did it very diligently, for the most part.

Then, I became a nurse, and realized dude, none of these skills are necessary to be a nurse! Like, none of my patients want to learn about the Kantian phenomena/noumena dichtomy or make fun of the French language, or laud Latin! What the fuck?!

This revelation has come as a fairly large epiphany in some ways--because if you come from a background as self-absorbed in its own minutiae and esoterica (yes, I said esoterica, not erotica, people) as academia--you are always faintly aware that most people don't think like you've been taught to think. But, you also have this fatal Achilles heel: that stupid humanities-schmanities idea that you're gonna be the one to finally convert the American Idol watching slobs of the world to your own unique set of pedantic ideals, which includes forcing every one to read at a college level before they go to junior college and take remedial reading courses and making Rhetoric and Logic required courses in kindergarten.

And then you get on the floor, and all that learning just goes to complete shit. All your years of precious extremely expensive education is wasted on little old people who can't hear you any way, or young people who feign deafness whenever anyone tries to tell them simple truths like: 'crack use is really bad for you,' or'you shouldn't sleep with men twice your age and except they'll stick around to raise the resulting babies you make with said idiots.'

Your colleagues are pretty much all nice, sometimes very sharp, smart people, but generally too busy and fucked-up-the-ass with their own crappy nursing assignment to talk to you beyond some perfunctory shop talk, and most doctors don't think you're really worth talking to, except as a piece of furniture in the room, or they do so in very condescending teacher voices, possibly with hand puppets and some pantomime thrown in for good measure, because nurses are obviously too retarded to be talked to directly and plainly as free-thinking, educated adults, or something.

If I sound bitter, it's because I am. Of course, I have no one to blame but myself for choosing such a fruitless, frustrating career, but it doesn't mean I can't bitch about it, because by God, I will, until I've finally, at age 96, become the oldest person to earn a PhD in Career Regret.

Oh wait. I already have.

the fray.

I've taken care of more than my fair share of open-heart-surgeries-gone-badly-wrong lately, and I'm burned out.

Not only is is physically exhausting (Jamie the 95 Lb Weakling Vs. 250 Lbs of Dead Weight Patient) but it's emotionally gut-wrenching too. People walk in, looking forward to getting this crappy heart surgery over and getting on with their lives, and they end up lying in bed with tubes shoved in more places than G-d created orifices, not getting on with anything.

Some of them can't talk to you any more. You ask them questions, and they just stare at you. And it's like, you don't even want to know what they're thinking, and you're not even sure why the hell you're asking the Aphasic Stroke Guy how he feels, because you're pretty sure if he could tell you, which he can't, he'd say he felt like shit.

What I've noticed, is these stroke patients all have the same look in their eyes. If you look in their eyes long enough--and it doesn't take very long--you notice that same, haunted, fearful look.

The look that says, "Oh shit, am I gonna be like this forever?" and "Please fucking take me out of my misery."

I can't bear that look.

So, I have to cope with my role, which is in theory, to help rehabilitate the patient to their highest level of functioning, or whatever.

Usually, though, we "rehab" them to the whatever stage of prognosis, and they stay for weeks or months on the floor, flopping around like mop dolls when we turn them, diligently, every two hours. They're unable to speak, unable to move themselves, unable to enjoy real food or tell their family how much they love them.

And it sucks.

So, I cope with my role by looking at the patient as a series of tasks to perform, a set of vital signs, labs, meds, and assessments.

I stopped a long, long time ago looking at the patient as a real person, because if you stop and take a look at the pictures the family brings in of dad with the kids at a baseball outting, in some pre-stroke, pre-crap life, all of them smiling obliviously into the camera, their future as-of-yet-unknown fate hanging right around the other side of that shutter click, it can drive you crazy.

And I'm crazy enough on my own.

I do not need that shit. No one needs that shit. Because the reality is, it could be anybody lying in the bed like some helpless overgrown baby. Anybody.

The nursing role, personally, gets harder when I have a family member--a well meaning, concerned spouse or partner, or kid--who insists I see the patient as a person with acute thoughts and feelings and a personal past.

It's like, I want to do that bullshit holistic thing they teach you in nursing school, but I can't. Because if I did, I'd have nothing left not only for the other three or four or five other people I have to take care of that day, and I'd have precious left for myself and my people on my days off.

So you let the wife sort of micromanage your care of their spouse, because you kind of get it, that to her, your patient is That Guy who eventually became The One, even though to you, he's literally just some room number and diagnosis.

But, you also feel kind of annoyed and wish you did nursing tasks in a bubble, without family/friends intervening.

At least, I do.

Some nurses are very good at the talk and teach thing.

Being distractable, and a basically misanthropic person, I hate doing the talk and teach thing.

Give me labs, give me diagnoses, give me clinical signs and symptoms and I'm usually pretty good at putting the pieces of the puzzle together.

I just know I'm not going to put the person--or his life--back together again, so that's where I stop, and I know it shows sometimes, and family members probably think I'm as much of a burned out bitch as I feel.

But to them, this medical calamity has just happened: the stroke, the massive MI, the septic shock, the respiratory arrest.

It's personal to them, and it should be.

But it's not to me. It's just work.

Because for me, "this"--stroke, MI, septic shock, whatever--happens almost every day I go to work.

I'm not superhuman. I just can't be warm and receptive and endlessly patient and understanding when I have a multitude of other things to get done before I clock out. Some nurses are very good at hand-holding and coddling family members; I tend to be the sort of nurse that isn't. Some days, I'm not even all that good at faking care and concern. I feel bad about this tendency, but I also am trying to learn to live with it.

I'm not an ogre; I understand these people want the best care for their family member, and I do my share of comfort measures throughout my shift.

But catering to every goddamn request--be it from patient or family member--can be agonizingly annoying to a nurse, and I think I can say that without invoking too much name-calling and demerits on my Good Nurse badge.

The job often feels like playing nanny/mother to a bunch of grown adults who should damn well know better, and it really feels that way when I need a break from the whole kit-and-kiboodle.

I try to look at this way, in order to minimize my own feelings of guilt and job inadequacy, not to mention overall personality fault-finding:

I do my job (whatever the hell that is supposed to mean).

At the end of the day, I've done whatever it is that I can do, and that just has to be good enough.

Does it work?

Nah, not really.

But nothing else seems to, either.

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.

nursing: it's not a job, it's a fricking endurance trial.

You may have noticed my absence from my own blog.

Or, you may not.

Or, you may have noticed, and simply been relieved, because my last posts have been even more inane and pointless than usual.

This is due to a scientific, poorly understood but common occurence called Wurkus Schmurkus, in which the brain is so pummeled by annoying patients and their family members that one's grey matter oozes out one's ear, rendering one incapable of even the simplest tasks, like blogging.

Last week was so crappy, between Multiple Wound Rotting Full Code Nightmare and Three Hundred and Sixty Lbs of Schizoaffective Hypertensive Yeast Infected Abdominal Folds Thoracic Aneurysm Double Nightmare, that Jamie, who generally loathes being floated, was, if not ecstatically happy, majorly relieved to be taking care of nauseated status post laminectomies and nauseous, vomiting fresh post-op carotid endarterectomies.

Yum! Happy goodness!

Well, it was better than 360 lb guy puking up his entire, and enormous, dinner, which also happened, and makes me never want to eat egg salad sandwiches ever again.

The people at work are very, very nice, but I decided it's floor nursing I dislike. It's boring, and when it's busy, it's often tedious and insane, not fun and challenging.

I'm misanthropic on a good day (have you noticed yet, in two years of bitching about crazy people?) and it pushes all kinds of the wrong buttons when I have to deal with needy family members. It's bad enough when the patient is a whiny little shit. (Shock! Horror! Yes, it ain't a pretty truth, it's not even particularly professional, but behind closed doors and on very public blogs, we do talk about our patients in less than complimentary ways at times--hopefully while abiding by some semblance of HIPAA.)

I'm not very good at the Nurse Friendly schtick, especially when I'm tired of them already, the patient is really sick, or even not that all sick, and you've got some freaked out family member who's demanding, during some annoying, self-entitled McTantrum, that you page the docotor right away, and Where's the doctor? and What are you doing with that medicine? etc. etc.

In fact, based on my random sampling of patient family members and psycho patients, people, in general, totally creep me out now. I try to avoid all eye contact in elevators or out on the street, because I'm desperately afraid someone's going to confront me like they do in a hospital. I'm also not joking about this phenomenon, and it worries me a little bit, because I feel kind of insane myself, because it's not like they know I'm a nurse, or something.

But, it's clear that this job kind of intensifies those social phobia tendencies I already have.

I also tend to think I chose the wrong profession, and it would have been loads better if I had gone with my original inclination in high school, which was to become a medical examiner, and I could skip the niceties of "Hi, my name is Jamie, and I am going to perform your autopsy today." I could also skip the bullshit waitress part, because no needs ice water or "a little something" to move their bowels when they're dead.

You know it's a bad week week at work when you wish all your patients were dead, but then you don't, because that means even more paperwork and bullshit than if they weren't.

dawg.

I actually wish Piper had looked more surly and annoyed--as per his usual camera mugging--because he would have looked a lot more thug in this shot, especially with silver chain around his neck:

I don't know. Maybe he's Stoner-Dog, or something, with that vacantly happy expression on his face.

It's all about the love, dawg.

mom hair cut.

So, Piper got a "mom hair cut" today. He submits to these rather docilely, and he doesn't know what a mirror is for--thank God.

Piper's post-walk-post-hair-cut-look-of-non-plussed-mild-befuddlement:


He seems to be saying, "Where's my cookie, woman?!"

three questions

If you've wondered where I've gone... well, predictably, it's not far.

I've been spending a great deal of time this week thinking about these questions:

What can I know? What ought I to do? What may I hope?

(For all you Kant geeks out there, you'll recognize those questions as part of his treatise on the categorical imperative.)

So far, these are my answers:

What can I know?

Uh, not a whole lot, apparently.

What ought I to do?

No clue.

What may I hope?

Ditto above answer.

Today is one of those "I don't feel comfortable in my own skin" kinds of days. The kind of day I wish I were my dog, who doesn't have philosophical plights to ponder, or have to get off his ass and pack his own lunch.

Oh, the mundane banality of it all!

oh, the decisions.

Or, "In Which Jamie Waffles On Again About Her Boring Life."

I am not complaining about my job. The people are great, the work is usually not too bad, and the doctors are some of the easiest I've ever worked with, on the whole.

In fact, as stepdown jobs go, this is as cushy as it's ever gonna get.

So, it's a hard to face the fact that stepdown is starting to bore the hell out of me.

My Inner Geek wants to know more.

Unfortuantely, my Outer Geek is getting tuckered out.

And, my Inner Geek is so f-ing indecisive, it's a wonder I get out of bed in the morning.

My Inner Geek, truth be known, is also a huge job-commitment wuss. It doesn't like the idea of committing to twelve hour shifts as staff, at a job that might just be its complete undoing.

In fact, I would go so far as to say My Inner Geek is doing a very good job of balking at labor negotiations with my Outer Geek, the part of me that actually has to get off my ass and start figuring out the logistics of all this crap.

Oh Inner Geek, you were such a font of knowledge back in the day, when equivocal responses to professor's essay questions got you out of more tight spots than you can remember! How you curse and taunt me now, oh turn-coat Inner Geek!

Sigh.

sweet.

I had a little old patient today who was talking to her husband on the phone while I was in the room.

When she hung up, I said, conversationally, 'Was that your honey?'

'Oh, yes!' she said, and her eyes twinkled brightly for the first time that afternoon. "And he is a honey. He is the sweetest man, ever."

'How long have you been married?' I asked.

Beaming at the thought of him, she said, 'Well, it's been sixty-one years of honey.'

And I thought, 'Ain't that just the sweetest thing?'