bullet proof bullet points

1) There is snow. On the ground. With ice. In Seattle. It was 16 degrees Farenheight when I woke up this morning to walk the dog. We are to have more snow tonight.

2) I have been sick with a head cold all week long, meaning I am literally snotty.

3) I am working virtually all of the coming holiday week.

4) I am moving on the following holiday week.

5) Then, work again.

6) Did I mention it was snowing, I'm sick, working the holidays, and haven't packed for a move that's less than two weeks away?

Guinness: It's a meal in a bottle! (or, Testing a Theory)

It's a sad day in the history of my refrigerator when I realize that in order to nutritionally supplement my dinner choices, I have to crack open a can of Guinness, because I just don't have enough in my cupboard to cover a full meal.

On the other hand, I guess I could just call it for what it is: an excuse to open a can of Guinness.

Early Christmas Gift (Or *Really* Early April Fool's Day Joke)

Because I value things like the ability to keep my job--and sometimes, and probably to a much lesser degree, my self respect--I've been deliberately keeping certain things on the DL around here on the old blogger.

Happily for me (and you, dear blog faithful blog reader, who has probably wondering what obscure little cubbyhole I've walled myself in this time) I can now reveal at least one of the "somethings" about which I've been prudent enough to keep my public yap-trap (eg blog) shut.

Really. I promise I've only been holding out on you guys because, well, I needed a couple of days to actually come to grips with my own decision, and you know, it's not like my boss even knows I have a blog, but it's kind of lame to tell The Internet At Large you've accepted a job when your boss doesn't even know it.

But, seriously. I've been fairly bursting at the seams to tell you about the New And Improved Job Offer for like, days, and now that I've officially accepted said offer and given notice on my current unit, I can--without compunction and with reasonably less fear of having to retract and redact the following statements at a later date--happily and freely announce that my tenure as The Unwilling Trauma Nurse is coming to an end at what feels like, but in reality really wasn't, long last.

As of next February, I'll be transferring to Trauma Center's Sister Hospital and working in Big University Hospital's Cardiothoracic Surgery ICU.

Naturally, I couldn't be happier, professionally. Or more relieved to get the hell out of trauma, which was starting to make me feel all kinds of dead inside. (You know it's time to get out of a job when you start listening to Johnny Cash's "Folsom Prison Blues" in order to stomach one more day at work, and actually begin to identify with the protagonist's plight of serving hard time.)

Pretty soon, I can all but eschew all the crap I hated about trauma: pelvic traction, halos, cranial bolts, Licox monitoring, Jones splints, multiple ex-fixes, abdominal traumas, big, messy, massive fluid resucistations.. you are dead to me now!

Likewise, I can soon kiss a blearily drunk good bye to the endless succession of patients with C-collars and on super-confusingly written orders for partial (or full, or whatever the fuck the resident actually meant, we're not sure but we'll clarify, ASAP, promise!) spine precautions. If I never have to do another full spine turn or put someone in a Miami J collar, it'll be too many times.

Having said that, let us not pretend I'm some ICU Icarus cockily sallying forth into yet another scary speciality in critical care as blithely as shooting Swan numbers (which I can't do even remotely blithely, yet, by the way).

I'm basically scared shitless to be returning to cardiac, after a year of being out-of-touch with even basic telemetry rhythms, on a unit that doesn't know what to do with a cardiac problem other than give it another fluid bolus. In fact, I feel like I've forgotten how to be a good cardiac nurse, and I'm once again afraid of looking like a class-A moron. Like, I can just hear these CTICU nurses snickering behind their backs: "This bitch claims she was a telemetry nurse for two years, and an ICU nurse at a level one trauma center for four states? What planet is she from, Planet Asystole?!"

Plus, recovering open heart patients is not the same thing as taking care of open heart stepdown patients. And I've never had to deal with heart/lung transplant patients before, so the learning curve, again is gonna be steep, and I'm gonna need to actually pay attention and get my shit together, and get all hardcore again, which just sounds fucking exhausting to me, considering this whole entire year was about me trying and essentially failing to get all hardcore about trauma.

I'm also not saying I'm completely happy to be leaving the trauma unit. As with most transitions, I'm a little more than sorry to be leaving my colleagues. Even with the clusterfuck that was adjusting to night shift, plus the move to the Big New Unit this summer, not to mention the weird social dynamic that was merging a tiny, marginalized cubby hole of a unit (surgery, which was my initial home unit) with the glamorous, bad ass hospital show case unit (trauma)--I've gotten used to all these people. I consider them my peeps. My homies. My fellow comrades-in-arms.

It's hard to know I'm leaving an established core of really fine trauma nurses, who, like me or hate me, know their jobs like the back of their hand. At least on the trauma unit, I know who'll have my back in a shitty situation, or even in a good one, and that goes a long way in feeling marginally okay on a hardcore, scary unit, especially when you're brand new, and aware of your suck-shit, subpar critical care skills.

Pretty soon, I'll just be The New One again--an unknown quantity adrift in a sea of other unknown quantities. And being The New One is hard, especially on an intensive care unit, where nurses are generally more critical of their peers and are apt to watch you like a hawk to make sure you don't fuck up and kill your patients. (I'm not saying I don't need that kind of babysitting. I'm just saying it's hard to be new when most people are gonna assume flat out you're a dangerous idiot until you prove otherwise.) It's an intimidating environment to begin with, and often, I've found, in terms of survival and job satisfaction, the social dynamic can make or break it for you on these kinds of units.

And, I feel guilty, leaving. Yeah, I know I'm replacable, and all, and I'm sure my manager could find a much more competent trauma nurse than myself. You know, one with actual, fully developed critical care skills. I just feel bad, because for the first time as a staff nurse, I actually have a decent manager who doesn't say things like, "Staffing is your problem, bitches, deal with it!" and actually gives a shit about managing her unit. And does it extremely well.

On the other hand, being "stuck" in a speciality you aren't all that stoked about isn't really all that fun, and I can't say I'd be super happy staying on indefinitely, good colleagues or not. I liken it to being stuck doing, say, Patristics, when what I really wanted to be doing was Contemporary Theology. It's like, yeah, right on, I'm working my ass off learning Jerome and Augustine when what I really want to be getting into is Hegel and Schleiermacher. It just gets lame after awhile, being stuck in the 4th and 5th century when you really want to be like, say, in the 19th or even 20th.

Likewise, it gets lame, after awhile, taking care of the Diffuse Axonal Injury Not-So-Jet Set, with the ridiculously poor prognosis and all, when what you really want to be doing is taking care of super sick heart patients. Sure, at the point your heart is so crappy you need a new one, and have to live on a heart machine until you get one, it's a pretty ridiculously poor prognosis, too--but it's one I have interest in learning about, and that pretty much makes the difference between feeling like your job has meaning for you, and feeling your job is going to eventually crush your will to live into oblivion.

But, I have to say, as scared shitless as I am to be transfering to a new unit, working with new people, in a sort-of-new speciality--I'm also more excited about this transition in some ways than I was about going into trauma. Cardiac surgery ICU is what I've been wanting to try for a year, and I'm hoping it just doesn't come back to bite me in the ass.

And, if it does, I hope I can supplicate my way back into the trauma unit, and maybe people will just think I took a super long vacation or something, and not razz me too badly for flunking out of Cardiothoracic ICU.

folsom prison blues (lego style)

i-pod

As the daylight hours compress upon themselves and the weather gets steadily chillier, I find myself wondering why I can't just hibernate, or become a spore, dormant until the spring time.

This option of dormancy comes at a time when I'm riding a particularly high wave of ironically low gloom about work. I think in fact there may be some kind of connection between the lack of light, my increasing desire to hole up in my apartment and cease to function for a few months, and my complete apathy about work.

To wit, I watched Mike Judge's Office Space last night, a movie which I had successfully resisted the impulse to view for years. I couldn't help but cheering on the main character, whose main desire was not to go back to work, and simply do nothing.

It's not that I want to do nothing, exactly, it's just that I resent being forced to do something when I feel this way. I remember feeling this annoyed and burned out with my job last year at precisely the same time, and it precipitated yet another lateral move--this time to ICU--in an increasingly pathetic attempt to pretend I'm supposed to be furthering my career in bedside nursing.

My fantasy is to quit my job and work in a knitting store. Things I dig about the scenario? Well, for starters, in a yarn store, as a opposed to an ICU, no one is shitting, puking, bleeding out, or dying. Family members aren't snottily insisting you suctioning trached and PEGed Timmy Patient q2min when if they'd been to school and earned a degree and license and all to practice nursing, they'd realize wasn't necessary to do that fucking frequently because a) the patient's coughing and oxygen saturation of 100% means they are protecting their airway and oxygenating properly and b) the fact that you're not Yankuer-At-The-Ready Suction Girl today and are running around with a harassed expression on your face might just mean that you're actually kind of busy trying to save the life of someone who can't and isn't maintaining their ABCs (airway, breathing and circulation).

To continue with Why I'd Rather Work At A Knitting Store Than in An ICU: your job as a clerk in a knitting store, as opposed to a nurse in an ICU, consists of schmoozing about yarn and patterns, enthusing about your hobby, and knitting on your latest project. Occasionally, knitting clerks have to ring up a sale, show you some yarn or patterns or needles. At most, the biggest crisis you'll have to deal with is you don't have an exact match of dye lot in someone's chosen yarn, or maybe undo a couple of mis-knit rows on a distraught newbie's First Scarf project.

There's no, "Uh oh. We gave that person waaaaay too much yarn; now they'll never be able to knit all that yarn and die of yarn-sepsis!" or "Oh shit! We just gave that customer five skeins of the wrong dye lot; call the yarn bank STAT and find out what we need to do to reverse the damage!"

In conclusion, I need a different job.

Wait, no scratch that. I need a different profession.

hiatus: a brief retrospective.

So, let's start with the obvious: I haven't posted to The Scutmonkey for awhile.

Long story short: I've been busy. Making plans, revising plans, executing plans, repeat ad infinitum.

But, never fear--I'm still rattling around, like so much change in a Belltown panhandler's insistently ubiquitous cup.

I'm in a rather odd mood right now--must be the infusion of caffeinated beverage and the fact that the sun is descending earlier and earlier these chilly early winter nights.

Off-kilter would be a good way to describe it. Just ever-so-slightly out of focus. Or, off balance maybe. Yes, that's it. Off-balance. Which I guess is the same thing as being off-kilter, isn't it?

The Hipster Dude's Guide To Dating (Or Not).

We know. You might seem like a chill dude on the exterior, all rockin' out to Pink Floyd --and rhapsodizing, repeatedly and at length to any one and everyone within a five mile radius of your King County Metro busline stop--about your latest awesome kiteboarding exploits and that new Kurt Cobain memorial built by some old geezer in Aberdeen.

But we know it can be an uphill slog, maintaining that attitude of vacuous enthusiasm for esoteric watersports in the face of a censorious, non-hipster public.

Like, dude, we feel ya. Totally.

We here at Ennui Publishing House (recent purveyors of the highly erudite textbook, "My Translation of Kant's Critique of Pure Reason is More Rigorously Footnoted Than Yours," by Professor P.J. de Sloghard) realize that sometimes, it's hard to live in Hipster Land, what with the ever present pressure to be au courant with the latest in Hendrix biographical research while at the same time maintaining your Most Orcas Sighted While Kiteboarding Record (zero!) amongst fellow stoner aficianados.

Furthermore, we know you're a busy hipster who's smart enough to realize that a dude has to have his priorities, especially in these tough economic times. You have Seattle indie band records to buy and old Subaru hatchbacks to run into the ground in search of new kiteboarding waters. Who has time to figure out women, or what to do with one who isn't trying to sell you pot, a top-of-the-line kiteboard or a vintage, restrung Stratocaster signed by Jimi himself?

Relax! (Oh wait. You already are, dude! We forgot! You're a hipster!) We here at Ennui are striving valiantly to fill that glaring gap in hipster how-to literature--and that's why we created this gratuitous guide to dating, expressly for you! (Ever-so-faint taste of mockery absolutely free!)

Enjoy, and remember the hipster's number one motto: no worries, it's all good.

Chapter One: The Dating Cycle of a Hipster.

Hipster Date #1: The Coffeehouse Crawl (Gift of Gab Method)

Level: Easy to Advanced

Prep time: Varies. Ranges from five minutes spent on Yelp(!) triangulating the closest place between your studio apartment in Fremont and her digs on Capitol Hill, to forever stuck in a penitential cycle of pretentious local hipster dives whose forebodingly tattooed baristas glare at you balefully and claim to be out of brew if you indicate you did not, in fact, bring your own mug created on your very own pottery wheel, fashioned while teaching women's correctional facility inmates lifeskills as part of your weekly slew of Seattle public volunteer work.

Advantages: It's only coffee. Which can be spilled conveniently to get you the fuck outta there, if your date starts talking about her Roth IRA options or how much she just loves Sarah Palin's updo and her politics and hopes you do, too (wink! wink!).

Hipster tip! If you choose a place that has a great bakery, you can not only drink overpriced coffee, but you can also eat overpriced tasty baked goods, which has the added advantage that it'll decrease the amount of time you need to make boring, pithy conversation that's not about Jimi, your Subaru, or your fascination with Orcas' totally amazing sonar capabilities.

Hipster tip! If you choose a place with a band, and it's live music night, you might not have to do much talking at all!

Disadvantages: See last half of notation under "prep time."

Seattle Hipster Dude's Mini-Guide To First Date Conversation Topic Do's and Dont's:

-Jimi Hendrix (but not Woodstock)
-Pink Floyd (but not Syd Barret)
-Kurt Cobain (but not Courtney Love)
-current, obscure Seattle indie rock bands (but not Pearl Jam)
-the STP ride (but not your slavish participation in the annual Turkey Trot)
-Subarus (but not how Dave Matthew's Subaru is the same color as yours)
-living in a t.v.-free household by choice (but not your resultant, pathetic codependence on internet social utilities like facebook and couchsurfing.com, for human interaction)
-taking the bus to work (but not riding the shuttle van from the parking lot)
-kiteboarding (but not how you looooove kiteboarding sooooo much that you wish you could have sex with kiteboarding, or something, dude.)

Hipster Date #2: "Either/Or" (aka The Pseudo-Philosophy Excuse, or The Dawning Realization That "Damn, this dating shit is taking away serious kiteboarding time, dude!")

Level: Intermediate-Advanced.

Prep Time: Ranges from fairly minimal, to months of reading philosophy Cliffs Notes depending on the circumstance, and who you're trying to bullshit.

Method: Requires, at minimum, binary decision making skills (eg, "Yes, I wanna nail this chic." or "No, I'd rather smoke weed/kiteboard.") May require in-depth knowledge and high-level manipulation of pseudo-philosophical concepts, grammar and syntax beyond the 6th grade level, and a certain amount of guileless charm. Not recommended for beginners. Warning: may require an actual conversation with grown up sounding diction if the addressee in question buys into your crap.

Advantages: If you can remember the word "Kierkegaardian," you might even get away with standing up a chic on a second date.

Disadvantages: You probably won't remember the word Kierkegaardian, or mistake it for the word "kiteboarding" and piss her off, no matter what else you do or don't say.

Sample hipster ready-made excuses:

Do say: "Like, I had this Kierkegaardian moment of Either/Or, you know? And I decided I had to like, go with my "leap of faith" that you'd have a "leap of faith" and understand my need to kiteboard for like, five days straight. "

Don't say: "So, like, I'm reading this book written by this guy who's last name sounds a lot like "Kiteboarding." Well, it starts with a K, any way, and it's called "Repetition"? And I thought that's what it was telling me to do: go kiteboarding, again. Hey, man, what can I say? This philosophy stuff is deep."

Hipster Date #3: The Would-Be Hippie-Dippie Hook Up (aka Granola Crunch Method, or "Dude, I guess I need to at least pretend I did more than talk about going somewhere with this chic if I wanna get past second base.")

Level: Intermediate to Advanced

Prep Time: Minutes to weeks, depending on the excuse needed, current level of THC in the bloodstream, and how hipster-hot the girl in question is.

Method: Start talking about nature. Add the words "Thoreau" and "transcendental" in there, somewhere, after claiming to have been some outdoorsy-type local place that sounds plausible for you to have visited via the metro busline (even if you were, in fact, smoking a joint in a friend's damp, mildewy basement pad while listening, in a very unhipster fashion, to Alanis Morrissette's "My Humps" cover.)

Intimate you would have loved it if she had been there, and you should both definitely go to this magically awesome, super cool lake/slough/mountain/shoreline sometime(!) Smile and look her directly in the eye as you say this, but be deliberately vague about when "sometime" actually might be. Be sure to gently remind this chic, if she starts whining about how you never spend any time with her, that duuuuuude, you're a hipster, not a soulless automaton ruled by the ruthlessly artificial and ultimately meaningless modern concepts of timeliness and social convention!

Hipster tip! Try not to talk about the drugs you did while "hiking" or "rock climbing" at said location, even though you're dying to mention Syd Barret's unfortunate relationship with LSD for the fifth time today.

Advantages: If you can pull it off, you might get off the hook about standing your date up to go kiteboarding, and get laid.

Disadvantages: If you fuck it up, well, can go back to listening to Hendrix and kiteboarding in peace. Oh wait. We forgot. To you, that wouldn't be a disadvantage.

Examples Of How To Use Your Words To Fake The Illusion You're Gonna Take This Chic Out Somewhere! Soon! Really!:

Do Say: "Oh, dude, sorry I missed "Dances with Knives: Interpretative Dance Recital By Former Psych Trauma Patients" at the Langston Hughes Performing Arts Center. But, like, check this out, man! I was out on Mount Si doing a wheat germ fast and reading Thoreau and thinking about transcendental stuff. The mountains out there are amazing! We should go some time!"

Don't Say: "Oh dude, sorry I missed going to that sold out performance of Common and Erykah Baydhu at Fremont Abbey, the one you worked overtime to afford and stuff. But dude! Check this out! Me and a buddy were chillin' in his basement, trying to see if that bumper crop of 'shrooms grew or not in his mom's vermicompost. You wanna trip? It's some awesome shit, man!"

Hipster Date #4: Sheer Avoidance of Any and All Reality (or, The Wake and Bake Break-up)

Level: Easy

Prep Time: Varies, depending on amt of weed required, method of consumption, i.e. joint vs. bowl, etc.

Method: Self-explanatory.

Advantages: Wake and bake, man. Does not require verbal communication. Plus, you should have already had lots of practice with the skill-set necessary to pull it off.

Disadvantages: You may accidentally set fire to your recent copy of "Kiteboarding Today" if you fall back asleep before you're done with your last joint.

canto

Every time I am feeling fucked over, I get this line from Dante's Inferno in my head. Don't ask me what Canto, because I don't remember, but you know, when Dante's cruisin' around hell with Virgil and all, and he meets this Italian military strategist, the once excommunicated Guido da Montefeltro?

And Montefeltro, who's probably not having such a great time in Hell after all these years, laments, "Promise great things, promise, but do not pay." (Referring to the advice he gave to Pope Boniface in dealing with the Colonna family who had contested his power; Montefeltro advised Boniface to grant them amnesty in return for their surrender, and then reneg on the promise once they had left their fortress. And, also maybe he's pissed, because the Pope promised him absolution, and St. Francis even came to collect his ass after his death, but some Black Cherub from Hell--and here I have an incongruous, anachronistic image of Jimi Hendrix, with a smokin' Strat strapped across his front--came to claim him on a superior, a priori claim. So, that's about how much money'll buy you, people, in case you're wondering in advance how much money you should spend on buying yourself out of Hell.)

Any way, I read Dante's Inferno the summer before 9th grade (no, it wasn't required reading. I was a weirdo back then, too). And that line struck me so much, I wrote it down, and memorized it. And from basically that time on, whenever any body fucks with me--or I fuck them over--I think, "Promise great things, promise, but do not pay."

I'm not sure who else goes around quoting Dante when they're pissed off, but, that's about where I am right now. That, and wondering how many limited edition Stratocasters you'd have to part with to stay outta hell.

perishable goods.

It occurs to me that if my job was more about things I like to do (such a reading and writing) and less about things I don't (life and death crisis) I would probably be better at my job.

And as for the supposed character-building, and inane, servile humility associated with the job--I find I need neither in remedial dose, or, as so often the case at work, in the prophylactic proportions in which they are doled out (liberally and generously and often, in other words). In any case, it does not pay any better to be truly insulted than falsely praised.

I find my burn-out with nursing is reaching a new, somewhat disturbing plateau of benign indifference, the sort I associate more with a desk-and-cubicle sort of job than a job in which mortality mingles precariously (as it tends to do) with the mundane. The sort of burn-out, in short, in which you've not only capitulated your hopes at becoming The Best At Whatever, but you no longer believe that if you did become the ultimate (or even penultimate) Best At Whatever, it would really matter at all, to any one.

Let me attempt to flesh out this Sweeping Statement. (If I am accused of anything at all, it is making Broad, Generic Claims-often with the certain religious conviction of the damned).

While there is a great deal of expecatation that a nurse perform under a high degree of stress, often in a severely limited amount of time, I find that less and less often do I care whether or not the patient lives or dies by our collective hand (except perhaps I care in the most self-preserving, litigious sense) or still less whether said patient has the miraculous desired outcome promised by Our New Moderne Medical Technology and Advances, or else has a dismal, lingering, liminal fate (and so many of them do).

I have even started to care less about whether or not I am ultimately perceived as a smart nurse, let alone a good one, except in a strictly egotistical way (and in that sense, I care very much about what others think of me, especially my colleagues; you'll have to forgive my flaws and inconsistencies that way. Or perhaps you do not have to forgive. Perhaps it would be better if you simply threw stones. People have a way of making you pay dearly for forgiveness; there is a reason purgatorial favors were once called indulgences. Stones, on the other hand, are quite free, at least for now.)

But, on a deeply fundamental level, I have less and less attachment to my job as a profession. In other words, I perceive it to be the vehicle through which I bide some of my time, make some of my social contacts, perseverate and lose precious sleep over, and pay my rent and bills.

I am, however, more and more disengaged with the job as a personal challenge or even a moral one, still less do I care about those those social accoutrements accorded with such lofty associations as "bettering one's self" and "going forward with one's career." Except as some self-flagellating, penitentially driven exercise in self-mortification (and unfortunately, I am prone to excessive bouts of this sort of thing) I have no desire to go back to school, obtain my master's in nursing, and be consigned, ultimately, for even longer shifts of nightmarish, endless medical tedium and the fulimant agita which comes from dealing with crisis, both imaginary and real.

The job--and the many unpleasant tasks associated with it--is less something to be engaged with and more something to be tolerated and pacified, like someone else's whining child, or a perpetually apopleptic spouse.

This sounds very navel-gazing and adolescent and whiny in the face of an economic (what's the word they're using these days?) downturn. I have steady, gainful employment, benignly endowed by the frugal but ever flowing coffers of The State. I should be thankful.

Let me explain still further, however. ( I am nothing if not gifted at the art of Detailed Excuses and Plausible Explanations. In fact, I believe I could make my living from this talent, if only I could find a way to market the skill without receiving more useless formal training or teaching. Or unnecessarily whoring myself. Although, I am not above necessarily whoring myself. Whoring is, as implied, necessary, at times. I would be far less feckless a wretch, in fact, would that my talent for whoring myself were exponentially more refined. I suppose I can whore myself, and do, occasionally, to some degree, but I also suppose by the same token, that I must do it poorly indeed. I deduce this, of course, because whores and thieves, by all accounts, do very well in this world. Select saints and the masses of menial, mediocre sinners such as myself, not so much.)

To wit:

My initial, perhaps overzealous anger and reactionary fury at The System has shifted, ponderously, but surely, into a lugubrious sort of dolor.

It is not precisely disillusionment; I never had high hopes for The Profession, nor did I ever see myself as being a martyr, patron or redeemer for The Cause; for one, I am too selfish and self-absorbed, and two, I do not believe in over-romanticizing and exaggerating one's professional disquiet to the point of public self-immolation, or, as is the popular term today refers to it, "political activism." (In private, immolation becomes an entirely different matter, of course, but that, for now, is out of bounds for discussion).

In fact, what I have found, as the pieces of self get chipped away in Prometheian fashion, is not so much an unearthing of the revelation of the Evils of Capitaliasm And The 12 Hour Work Day, and all that (because that much was made clear to me at the get-go) but is, rather, the seedling that grows through the chinks in the sidewalk, that altogether more prickly inkling that I am not cut out for the job, and yet, am fit for absolutely nothing else.

I am a Vocational Albatross in any other field, in other words.

And, I'd not only rather do something else (a sentiment which seems frivolous in a time of banks crashing stupendously, people out of home and job, etc etc) but I'd rather be doing something I'm quite sure has nothing to do with what I'm doing now.

(Again, I am a Vocational Albatross in any other field, if you skipped over that sentence the first time, thinking, rightly, that right now is not a good time for the word "albatross." )

Perhaps it is the nature of the job that has given me this festering sense of dread and dismay--a prism of tragedy through which glaring possibilities of ruin and decay never breached are now made possible.

Fundamental Truths must now be spouted. (It's part of The Spiel. These things must be said. Even proclaimed, if you must).

Shit is shit. Dead is dead.

There's nothing philosophical or poetic about it. Death, in particular, can be a nasty, brutal, and unfortunately protracted and lengthy process. Messy, in other words. Not neat and clean and full of last minute, cleansing confessionals and teary-eyed reunions with long-lost loved ones like movies and soap operas would have us believe.

But, every time I confront death on the job, I find a little more of humanity--or what passes for it in the most socially acceptable sense of the word--gets stripped away. In the beginning, I used to feel sorry for the patient. I don't any more. Now, I feel sorry for the family, if there is any. In time, I'm sure I'll lose my compassion for them, and be silently grateful when, by fateful design, they no-show . It will be one less act of contrition I'll have to fake in what is turning out to be an endless parade of fake-gasms on my part.

I've shellaced a look of benign concern on my face so many times I feel my face is going to crack. But my eyes have dulled, and my voice has that tinny, rehearsed sound that might come out of a mannequin if she could talk.

Mostly, though, I apologize.

(And thus we move on to The Confessional. Shouldn't all melodramatic and self-indulgent pieces of crap have a confessional? You are quite right if you protest they shouldn't. But, I am nothing, if not dogmatic in my application of form, however ultimately useless and outdated. We must have our relics. And perhaps some incense. Corpses tend to smell after awhile, and the hospital has quite a few of them. Then again, the more, the merrier.)

I apologize to the family: "I'm sorry he's sick." "I'm sorry, he's very sick." "I'm sorry, he's dying." "I'm sorry, he's dead."

I apologize to the patient, "I'm sorry, I have to stick you with a needle." "I'm sorry, this is going to hurt." "I'm sorry, I have to shove a tube up your ass." "I'm sorry, you're dead."

What I really want to say is, "I'm sorry, I'm too tired and have done this too many times to even want to look you directly in the eye, let alone reassure you everything is going to be okay."

I suppose in essence, I really am sorry, but not for the reasons I give to patients or their families.

I am sorry I ever chose nursing, and even sorrier I chose bedside nursing. I am sorry I failed to find a better, more suitable career for myself. I am sorry I am stuck, night after night, caught in a lassitude of indifference on one hand, and indecision as to what to do about it on the other.

To be liberated from this job would be a bit like being liberated from prison, or a loveless but reasonably financially secure marriage. (The problem being, of course, that a Hospital is not so much a Doll's House as a Shop of Horrors).

My choices aren't all that clear to me. Daydreaming about what life could be quickly becomes the stuff of nightmares, when yoked with the burden of reality.

(We are missing the Beatific Vision, as an astute reader might have noted. This is not so much because we have stopped believing in them, as much as it is we have lost the capacity to see them. There is a difference, but this is for the talkers-of-God to debate. Having lost our capacity to see, we insist on brisk discussions of our other God-granted faculties, do we not? In the beginning was not, after all, The Vision--it was The Word. )

late night living

Even though I've been off this week, I haven't reverted back to a day schedule, which I had been doing, more or less successfully, on some of my weeks off prior.

Hence, I haven't gotten a lot done, and have been keeping the hours of a vampire. A vampire who, coincidentally, has been living off of take-out and utter crap foods up until today, when I finally had groceries delivered (I am not only a vampire, I am a vampire princess.)

Considering the Cirque du Soleil acrobat-like contortions it takes to park my car in the pixie-garage, and my general state of somnolence between the hours of about 6a.m. and 5p.m., I decided to take advantage of the local Safeway's home delivery. Yey for indulgent laziness--I now have a super-stocked refrigerator and pantry!

I haven't been a very productive member of society on my days off, however, and therefore have dreadfully little to report in the way of "news." It feels very strange to sleep the day away, and then be up all night, a strange prisoner of your own home. I'm not complaining, exactly--it's better than being awake all night and at work, but, this late night living does have its disadvantages, the chief one is that you start feeling like some weird social leper.

Meanwhile, as inquiring minds want to know--the worm bin is going better than expected. No weird smells, no massive hari-kari worm suicides... compost is happening! Likewise, the bokashi bin is behaving itself in admirable fashion--smells faintly vinegary and sweetish, but not malodiferous--and without the magically-impregnanted-with-microbes bran, it would smell, I imagine, exactly like a putrid corpse, as I dumped everything in there from some iffy pad thai, to chicken bones, to moldy onions and cheese.

Pictures to follow, when I get off my ass and take some.

The Silence of the Worms

It puts the worms into the bucket or else it gets the hose...

Haven't really been up to the task of updating this blog, although in my crazy tiredness have gotten rather obsessed with home vermicomposting these days (more on my specific 'worm bin' later, when I actually get two synapses to fire properly in sequence). A good, fun, clean way to hooked/learn more about the wacky-sounding concept is to watch this video:



I also like this guy, mostly for his name, "Sustainable Dave" and the vaguely creepy "Silence of the Worms" basement thing he's got going on:



Did you notice the sign? "Support Global Worming." WORM POWER, bitches!

Now, lest you think I am alone in my craziness, I have to tell you--I just met another nurse who's into vermicomposting as well, and bought her worms from Seattle Tilth, just like I did. (And, she confessed to having run into other nurses who claimed to worm compost as well. It feels as if we're going to be headed to a very special kind of 12 step help program soon: "Hi, my name is Jamie, and I'm a vermicomposter.")

Any way, both of us found the Tilthers quite militant about vermicomposting. My "Tilther" (the one who sold me the worms) made me feel guilty about buying a commercial worm bin ("Why buy more plastic in order to recycle?" she said, disdainfully, quelling my desire to inquire about the posh worm bin they had for sale). I felt so guilty, I actually went out of my way, to another store, to buy the same worm bin for more money just to avoid the embarrassment and displeasure of the uber-eco conscious Tilther.

Likewise, my friend was telling me how the Seattle Tilth person that sold her *her* worms quizzed her about her worm bin set-up before she would sell her the worms, and very displeased at the idea that my friend was going to use peat moss ("a non renewable resource!" admonished the Tilither). Cowed, my friend had to defer and tell the woman, apologetically, that she had bought it for another gardening project, too, before the Tilther would sell her the worms!!

I have even taken the bokashi plunge, and actually went slumming around Belltown like the Crazy Homeless person I'll no doubt be in a couple of months, trawling for free plastic 5 gallon buckets. Then, I borrowed a drill from a friend to drill holes in the top bucket for my own version of the fancy-ass, expensive commercial bokashi bucket.

(I scored the drill; my friend now thinks I'm nuts).

For those of you who want to ponder the depths of my increasingly-deeper downward spiral into Seattle Eco-Madness, I give you the instructional version of How To Make Your Own Cheap-Ass Fermenting Compost Bucket, Like a COMPLETELY CRAZY PERSON:



Are you still with me? No? Good. Here's another bokashi video from an equally enthusiastic nutcase who has self styled himself The Compost Guy and has multiple websites (which of course, I have bookmarked, because I am going insane):




I've also been proving to myself I have other talents in addition to mewling pointlessly about my sleep-deprivation and developing bizarre hobbies involving annelids and garbage, and to that end, I managed to read a 300+ page book (online--which means I'm likely to suddenly experience complete and total blindness due to eye fatigue any time now) last night in under three hours. Try Neil Gaiman's spooky modern day gothic Neverwhere for free, online (limited time offer expires Oct 3, 2008, I believe.) If sewer-dwelling angels, assassins who enjoy staging a good old-fashioned underground crucifixtion for their victims, and/or simply not being able to access your own monetary funds via ATM sounds like the stuff of novella nightmares most notorious, then this book's for you!

(By the way, if I start going on about composting toilets, it's time for an intervention.

time in a bottle

It was very nice indeed to have the week off. My activities, in loose chronological order, were as follows:

First was the Marathon Sleeping, which was greatly needed.
Then came the Lolling About, which was also not to be missed.

After that was a a smidge of Self-Indulgence, followed by various and asundry Epicurean Delights.

Now I am dreading Week O' Work (having more or less cycled back to being a Marginally Functional Human Being During Daylight Hours).

Am also, somewhat randomly, contemplating urban composting techniques, namely vermiculture/composting vs. Bokashi vs. the oxymoronic electronic composter.

The latter is shamelessly attractive in this Jetsons meets hippie love-child kind of way. (If you investigate the website, I will have you know I draw the line at composting Piper and Flip Flop's poo--at least as an indoor activity, although the Pet Friendly NatureMill assures me it is "ideal" for the waste products of "up to 2 large dogs, or 4 cats, rabbits, hamsters, snakes, ferrets, or other small animals," while cautioning me quite rightly, I think, that should equine poo-composting be for you, this is not the machine. I mean, thank goodness they made that clear. I'm also rather glad they added this helpful caveat: "Pet waste not recommended indoors."

I'm sorry. I can get down with worms hanging out under my kitchen sink happily and organically digesting yesterday's carrot tops--but I just can't see myself running home from a Piper-dog walk, all charged up about recycling his freshly-made turds.

Like, putting my dog's poo in a fancy, eco-friendly version of an compost-generating Easy Bake Oven is where I draw the line at crunchy granola, folks, sorry.

The vermiculture thing interests me from a "keep it fairly simple" perspective, and indeed, some of the information makes it seem like your average eight year old, with appropriate adult supervision, could keep one running. On the other hand--other websites I've perused in the last twelve hours makes me feel as if vermiculture is sort of composting's answer to gourmet baking--get one ingredient or variable out of wack, and you're doomed to micro-ecosystem failure. I mean, they have these Master Composters floating around, instructing people on the fine art of getting worms to do their stuff with your garbage. That's kind of hardcore and intimidating, in some ways. I mean, I'm new to this stuff, and I find out there's a league of Jedi Knight Mater Composters out there somewhere in Greater Seattle? Scary! And, I'm not sure I can be trusted, either, in my intermittently sleep deprived state, to keep up with the worm farm as I should.

The other option--Bokashi, basically works off the principal of pickling your waste--and has the added advantage that you can pickle not only fruits and veggies and paper, but alo meat and dairy products, a huge no-no in Old School Composting. It's got a self-contained, relatively small system, doesn't require the constant monitoring of a worm farm, and seems to keep the smell to a minimum. The drawback for someone living in an urban apartment or condo, is that one does not generally have a plot of land to then go and bury the results--which do not fully compost until that step is finished.

While I do have friends who would probably like the Bokashi almost-compost product, the problem is then getting it do them on a regular basis, as the system seems to cycle about every month or so.

And if my activities as of late (scouring the internet for interesting ways to help food rot!) aren't strange enough, I cooked this egg bake recipe this morning. I added potatos, a walla-walla onion and tomatos from Nancy's garden, and substituted sausage for bacon (and no, I don't have an alternate identity as a SAHM who cooks for her kids--I just happen to share my name with the owner of the blog.) It was spongy, and sort of like a poor man's quiche, but having never had the stuff before, I have no idea if I "did it right." I'm always vaguely suspicious of my cooking efforts, any way.

In fact, I'm very suspicious of just about anything I do these days that isn't involved with sleeping, or developing a plan to obtain still more sleep, as the neurons do not seem to be functioning optimally.

Be forewarned, folks, if I break out the crystals and a Dog Psychic in the next couple of weeks, please stage an intervention, STAT, okay?

psycho killer. qu'est-ce que c'est?

I figured out my life is basically about two things lately: terror, and trying to get enough sleep to survive the terror for one more shift.

Terror = work. As documented elsewhere, work is really scary. And, as fun and smart as the people who I work with are, they are also extremely intimidating. It's like working with the Green Berets of nurses, or the Marines. These nurses are hardcore, and if you're new, you're likely to be fodder for a lot of disdain, both explicitly expressed and implied.

It's hard to go from feeling competent and secure in your job skills to feeling like you just stepped off the S.S. Clueless (or onto it, or something). Plus, did I mention the terror of crashing patients, and the chilling numbness that descends after each death? While it doesn't happen every shift, it's happened enough in the last sixth months that I've sort of stopped counting how many deaths I've witnessed at work. It gets depressing, and the fact that you start shutting down over other people's untimely demise is, I think, probably not particularly healthy.

Plus--I'm no fan of trauma, as a speciality. No pun in tended--but my heart longs to get back to cardiac nursing.

Working day shift, ever elusive, might help some of the brain freeze I'm experiencing as well. As the weeks wear on, my sleeping pattern gets more and more erratic, and my waking hours--daylight or nocturnal--are infused with a sense of exhaustion which precludes any meaningful functionality, intellectually, and sometimes, emotionally. I feel drained and slightly low-grade unwell, constantly.

Night shift is fucking with me, in other words.

double your fun

Last night at work we had nearly two simultaneous codes going on--both crashing trauma OR patients who didn't make it.

The code I worked was the result of a fairly young guy chasing after his dog across a street and getting smacked by a car. Dubious silver lining: the dog is fine. I sternly informed Piper this morning that if he runs out in traffic somehow, dog, you's on yo' own.

The patient's tragedy did, however, remind me to change Piper's address-of-record on his microchip, and city dog license. When I called the microchip company, however, they were trying to sell me on paying for the microchip service, and making it seem like I needed to, because their old service was obsolete.

Smelling a rat, I steadfastly probed and poked holes into this story, and flatly refused to pay fifteen bucks a year for services I don't need. I pointed out I had paid to microchip the dog back in 2003, and I wasn't about to pay again for random "services" that are basically covered by his Seattle dog license and basic, "free" microchip non-annual fee.

I mean, the whole point of the microchip is that if your dog is found, sans collar, by a vet's office or a shelter, they can wave their magic microchip wand, contact the pet service, who will then call you. And any way, if some non-magic-microchip-wand owning person finds your collarless dog, they'd probably bring it to a shelter any way, right?

The guy pointed out if the dog was wearing his collar, with the microchip tag on it, that if someone found him cum collar, and called the Home Again number, that the company "would not be able to release any contact information" to that person.

Personally, I'm not convinced I'd want my contact information to be released to a stranger who might then come over and kill me and my little dog, too.

Plus, in a time of economic downturn, people get a little incensed when forced to pay for mysterious 'services' that defeat the entire purpose of having bought or invested good money a thing in the first place.

It sort of feels like having to buy and install digital cable in order to get any t.v. reception at all, doesn't it? Or having to install that box-thing (I'm very high-tech, you know, with my electronics jargon) and then pay more money per month to get the high-definition to work on your high-definition capable t.v.?

(Incidentally, what was wrong with regular old t.v.? Maybe I'm getting blind in my old age, but I don't really see much of a difference between HD t.v. and non-HD t.v. images unless you have a trillion-dollar t.v. set, and if you had a trillion-dollars to spent on a friggin' television, you'd probably be out buying other planets for sale in the universe or actually running your little Evil Empire off of the backs of the rest of us working slobs, not watching On the Record with Greta Van Susteren and counting her chin hairs.)

Any way, this is not to say I don't love Piper and wouldn't spend the money on him if I thought it was necessary. I mean, obviously, I thought it was necessary to microchip him because I love him (except perhaps not enough to want to take a car vs. ped accident for him).

In conclusion: I'm not a heartless cheap-ass who wouldn't care if Piper got lost, I just don't think it's necessary for me to lose a dog and get ripped off, is all I'm saying.

blue's clues

I'm really sad today.

Mom visited for six fun-filled days (okay, some days were filled with multiple trips to home improvement stores and painting 8 hours a day) and left yesterday, which always leaves me feeling a little verklempt, especially since she lives on the opposite side of the continent, a fact she keeps pointing out all "hint hint, move back, my offspring" sort of way.

Plus, mousie was put to sleep today, and I am still rather ridiculously weepy about this, considering my entire repertoire of interactions with her over the span of her two years on the planet was chasing her out around and scooping her out of tank with a cardboard tube on Cage Cleaning Day, as she detested and feared being handled at all.

And, I don't think it helps I'm going back to work today. We moved to the Shiny Brand New Unit while I was off , feverishly comparing paint samples and swaths of fabric as if I'd entered some Designing With The Stars contest. This means while I got to escape the Yuck Factor of the merge, I now have to go in and try to find where they put the twomey syringes and 2X2 gauzes and stuff that's not likely to be where it was before, considering we're in a new building.

Since we merged with another unit, I'm also going to have to figure out More People, And Who They Are And Of What Use They Are To Me.

So, what little comfort zone I'd eked out on SICU has been ripped away, and I'm feeling very much wrong-footed and whiny about the whole thing, as in, "Why can't everything just stay the same for like five minutes, so I don't have to keep taking notes on where to find the staff bathroom or where we keep the linen cart, for Chrissake?!"

Plus, I still fear work, especially after a comfy stretch of days off, hanging out at home painting my apartment with mom and feeling all happy not to be at work being scared shitless by some crumping patient or other.

I also really haven't slept at all properly the entire week, and didn't get in any marathon sleeping ventures prior to this start of the work week (the weekend, for me) due to Mouse Crisis 2008. So, I'm tired and was tempted to call out and sleep, but then wussed out, as I felt it would be difficult to justify a call-out related to mouse grief later on in say, winter, when I'm hacking up a spare lung during a real illness.

Maybe it's better I have to go to work and be forced to interact with people today, however, since I'm kind of morose and depressed about having to put the mouse to sleep, etc.

Oh well. There's always time for sleep. Tomorrow.

mostly martha

There is tons new to tell you. Tons, I say.

But, this post will be brief and, as the title suggests, mostly about Martha, my late pet mousie.

She was blonde, svelte and a bit bitchy at times, and her two favorite subjects in life were food and nesting--so I named her after that Maven of Most Meticulous Homemaking, Evah, Martha Stewart. But, I called her Martha for short (and sometimes, perhaps uncharitably in light of her recent passing, "the Fat One").

She lived a good old life, eating roughly twice her body mass in cheerios and Life cereal per day, and creating all sorts of Interesting Nesting Textiles with various bits of kleenex and fluff. In fact, if she would have had opposable thumbs on her paws, and itty-bitty knitting needles, she would have probably out-home-afghaned even yours truly.

Unfortunately, due to some Moste Mysterious Mouse Malady, Miss Martha ended up turning her meticulous attention to detail upon herself, and was grooming herself into nonexistence.

Not a pretty thing to watch, so I chose to let her go quietly, into that great mouse house in the sky, with the aid of some very nice ladies down at the veterinarian's office (not to mention a happy overdose of anesthetic gas and a liberal dose of phenobarbital).

Goodbye Miss Martha, we will miss you and I will always think fondly of your determination to make a tuft of kleenex and a roll of cardboard tubing a proper mouse residence, not to mention your amazing ability to eat your entire weight worth of whatever oat-based cereal was on hand at the time.

day is the new night

I am consumed by this ridiculous schedule, and it is bunging up everything from getting a proper night's rest to even eating. Now my body has lost all sense of when it's time to eat, as opposed to sleep. For example, it is 6 a.m. right now. In The Normal Universe, I'd still be sleeping, this being my day off. But, in Parallel Hell Universe, I wake up early in the a.m., hungry and unable to go back to sleep. Not to mention my stomach is pissed off about the random eating changes, too, and has gone on "I'll make your life miserable if you do try to eat, my pretty" strike.

Likewise, most of my days off are being sucked away by a tiredness or outright exhaustion that precludes doing anything meaningful and/or creative, but I try, and end up stumbling around, feeling annoyed that I have have to break every rule of sleep hygiene and common health sense in order to make money at work. For about one hundred dollars extra per week, they can keep their fucking night shift is all I have to say about this crap.

I'm getting more and more annoyed as the weeks wear on, not the least of which that I'm missing out not only on the last sun and warmth of the season (which means I forfeit the last of summer, essentially, and therefore it'll be a year before I see sunlight again) but that I'm destroying the delicate internal workings which are mine own circadian rhythm.

God, I really hope I don't have to stay on nights for a really long time, because I think I'm going to go insane from not ever sleeping properly. How do people live all tired and cranky like this for years at a time? This overwhelming sense of bitterness at having had my life go from "pretty much regulated the way I wanted it" to this "I dunno, I guess I'll be compelled to sleep sixteen hours a day and still feel tired" crap-o-la is making me nuts.

I need an easier job, with banker's hours.

I am getting in the odd outing here and there, however. Kitschy Seafair/Torchlight Parade on Saturday, dinner in the International District and then a visit to Community Hospital to visit my friend (who works in the hospital and not a patient) on Sunday, and fun (if dusty and slightly overwhelming) Magnuson Park outting with Mister Piper and his new friend, Taylor's Mochi, followed by Intensive Bath Therapy for both Piper and Jamie.

Now Mister Piper is thinking quite a lot of himself, and designating all sorts of Self-Selected As Piper Appropriate places to sleep and lounge, like the bed and couch. These are not, however, Jamie Approved so we have been having a bullshit battle of the wills at present, with Piper generally winning out as I haven't the strength or consistency to really be a stickler for making him move unless I want the spot.

tired of being tired

When I said last post that night shift was the least of my problems, I probably didn't really mean that.

What I meant was, "It's a big problem, but not as big a problem as being dead (like my patient.)"

I'm trying to experiment with Ways of Dealing, like Sleeping When I'm Tired (difficult, because I'm always tired) and Pretending Night Shift Is Like A Form of Camp (yeah, like Camp Sleep Torture).

I think I feel today like I'm tapping on my reserves. Whereas the first week I couldn't sleep during the day (and ended up exhausted) my problem now is that I can't cycle back to sleeping during the nights on my days off, or do so inefficiently. I haven't slept decently in three weeks! I'm tired all the time and have to resort to exclamation marks to spice up my writing, because I can no longer think properly!

Now I sleep during the day, the evening, everything but at night when I'm supposed to, like the good God-fearing woman that I am. Instead, I wake up from my "night time" nap, if I'm lucky, thinking, "My God, what is this unnaturalness?!"

Or I come home from work to this pleasant permutation: sleep, get up, force myself to mingle with the Living for a few hours, then come back home, and wonder what to do with myself until 3a.m., or sometimes 7a.m., when I am finally at that brink of exhaustion which means I must sleep the entire rest of the day away.

When I finally get up and walk the dog, I envy the normal people with their normal schedules, who are all going home now, because it is 5p.m., and that's what people are supposed to do. I have a feeling this Work Shift Envy is going to multiply exponentially as the months go by, until I'm finally caught outside someone's ground level condo window, gazing in rapturously at those lucky people watching the evening news and eating dinner and getting ready for bed at 8p.m., rather than just waking up for a greuling 12 hour overnight shift.

Meanwhile, my internal clock, which was never quite programmed right for healthy sleep any way, is screeching all sorts of alarms like, "This is bad for you! BAD!"

I can tell I'm starting to lose functionality when I am awake, too. I'm clumsier, and my capacity to think quickly (which, you know, is a charming feature in critical care hospital work) is dulled. Mostly, I'm jonesing for a good night's sleep, or at least not try to program myself to be awake when I'm supposed to be sleeping, which is exactly what night shift does to a person.

Add forcing yourself to be awake all night to a neurosis about trying to get to sleep, and watch me progress into the same cranky, constantly sleep deprived wretch I was during the last assignment.

Because yeah, while sleeping during the day seems to be coming slightly easier than it did last time (in large part due to the Pharmaceutical Wonders Available In Our Modern Era), I can't pretend that it's not been three weeks since the last time I slept in an initial stretch longer than four hours, and did not wake up every hour or more from that period on, confused, wondering if it was still today, or did I sleep through both tomorrow and today, which is now actually yesterday?

How do people on submarines survive without killing each other, I wonder?

And all for what? Two hundred dollars more per paycheck? My next paycheck looks sweet, due to weekend and nights premium (and a holiday, too!) until you rip away the taxes, insurance, and all kinds of Working For the Man goodies, and then you just want to boycott working ever again, especially when rent sucks up most of one of your paychecks.

I must also add: I don't think being sleep deprived, on top of being new, is good for my patients. The nature of my job forces me to be quick-thinking and acting, and how can I do that if I'm not sleeping properly?!

I'm talking (writing) myself into tiredness, here, and I have two more shifts to go this week. (It also sucks that they scheduled me three on, two off, three on. My saving grace is that I then have a long stretch of days off afterward, but I must say, these next two days are going to kick my poor little sleep deprived ass.)

crash course.

For the record: the least of my problems is adjusting to night shift.

Sure, I don't really sleep as well during the day, but I also really never slept well at night, so things run about even. I now don't really sleep at night, but somehow, I'm finding this less problematic than last time I worked nights.

My first night off of orientation we had a patient come up from the OR basically dead, with a pH of 6.88 (incompatible with life, to say the least) an INR of 10 and blue and mottled. He'd already been coded four to five times in the OR and why they brought him up to be worked over some more was anybody's guess.

By the time we were done, there was blood on the bed, splattered on the floor and cabinets two feet away, and over our scrubs and shoes. Blood oozed out his abdomen as I did compressions. I've personally never been in a code that bloody before, but ICU veterans assure me that's not the bloodiest they've ever seen it.

Into the same bed, I admitted a cantankerous guy later on that shift, who was walking and talking (although quite ill) on admission but by that same time the next night was also for all intensive purposes, dead.

When I took him back the second night, I predicted the biggest thing all night I'd have to do is get him intubated, and after that, he'd be ever so much easier to manage. Of course he had the potential to tank, but even the most stable-seeming patient in the ICU can crash. I didn't think he was ultimately going to make it, but I did think intubation was going to give us some more time to figure out palliative treatment.

He wasn't so lucky.

By 11:30p.m. that night, he was mottled, purple, clamped down, intubated and his pH was in the toilet, along with his blood pressure and heart rate. And no one--not the MICU team, not the surgical chief resident, not the cardiology fellow, could figure out why he had dumped so badly, nor what the acute cause could be.

We spent the rest of my shift barely keeping him from coding, throwing lines in and bolusing him and almost maxing out his pressors. By the 0600 last-ditch-diagnostic emergency run to the CT scan, he was and had been so unstable I insisted the resident come down to CT with me (I'd already been down to OR for an emergent induction intubation earlier that night) because I was almost certain he was going to code and was surprised he hadn't yet.

At 0730 that morning, I was calling his elderly, frail mother to tell her she needed to come in and prepare herself because her son wasn't going to make it.

I left at 0745, having helped day shift set up for the code we knew was coming, and about fifteen minutes later, as I was on the bus riding home, thinking about that horrible phone call, he coded.

I was scared shitless the entire night, but eventually, I had to turn down that part of my brain that was insisting, "Run away! Run far, far away!" and get the job done. The charge nurse's patient started to crash, too, so after about midnight, I was essentially on my own, in a room full of docs unable to figure out why the patient had tanked so quickly.

At some point that night I realized based on his clinical picture, that he was eventually going to die, no matter what we did. It didn't make it any less scary or surreal, but it gave me an ironic determination and calm born of futility. When you're back is up against a wall and you have no choice, you can surprise even yourself at what you can do in a shitty situation.

Of course, there is no consolation prize for working to save someone's life when that goal is impossible. You feel like shit the next day. After all, I'd admitted this guy and developed a rapport with him. He was talking to me at the beginning of my shift, and by the end of it, he was almost dead. But, you also realize you can only do the best you can do, and some patients are so sick they are going to die whether they are in the hospital critical care unit or not.

I think the scariest thing for me was that I'd never had to manage a crashing patient without help. You can have all the orientation in the world, and nothing is quite like that moment when you're on your own, and your skills and quick thinking and ability to remain calm are the only things between what is often in an ICU not the patient's life or death, but "dying now or dying later."

It's a strange rite-of-passage ICU nurses go through, but the old cliche is quite true: there is only one way out, and that is through to the bitter end.

"seat belts save lives." discuss.

So, last night I took care of a patient who'd been ejected from a car and thrown down an embankment of some sort.

The day before, I'd taken care of a nearly-dead patient who unfortunately still had one, last primitive reflex left, and therefore was not a candidate for brain-death organ donation. (In actual fact, I took care of the multitudes of family, who were grieving).

By the time I got to ejected-from-car-thrown-down-an-embankment patient, I was exhausted, mentally and physically, as the day before that I had two tasky, but stable patients with Lots of Concerned Family. Also, I hadn't sleep properly for a couple of days, and could barely remember what the date was myself. Unfortunately, by day thr, I really had nothing left for this patient's family, who were also traumatized.

Sometimes, I wish I had a bit more character and could make myself give more than I have, emotionally, but last night I was so tired I couldn't mold my facial muscles into anything that resembled an expression of benign concern. By 5 a.m., I was so exhausted that whenever I had to go into the room and the family was there, I just looked elsewhere and pretended they didn't exist, because I was literally too tired to talk to anybody, much less get into an emotionally draining, "There, there, it's okay to cry," bit.

Somebody asked me how he was doing--as if there'd been any changes in the last fifteen minutes--and I snapped, "Fine." It must have come off pretty brusque, because I wasn't asked again, but at that point, I'd already had half a dozen conversations with the family About How The Patient Is Doing, I was frazzled to the point of not being able to think clearly, and I just wanted to go in my patient's room, undisturbed and do the patient care for which I am paid.

Of course, I could have been less of a bitch about my response, but I was cranky and functioning way, way beyond my usual hours-of-sleep-to-hours-worked tolerance ratio. And, really, with the dawn of this patient-family-centered care crap, we're supposed to allow families to be at the bedside pretty much whenever they damn well please, and sometimes, I just figure, while I'm working, and I can't be expected to spend all my time coddling the family who chooses to be there, pretty much in my way, when, you know, my job and primary responsibility is to the patient.

I usually adjust my attitude to fit the circumstances--for example, with a patient who's dying and we're withdrawing care from, I allow family to be near the patient even if it impedes me "caring" for the patient, because I personally feel it's more important for the family to be near the patient than it is me.

But, you know, when a family spends pretty much the whole frickin' night at the bedside of an intubated, sedated patient who can't talk to them any way (and then wakes them up after you've just gotten them all nice and sedated and pain controlled and, in doing so, makes a full-spine precaution patient twist his neck around in his C-collar, despite you having patiently explained to the family just minutes prior about how that's not good thing to do) it starts to piss you off a little bit.

You feel like a mother who has just spent twelve hours washing and waxing her floors, only to have kids and pets come running in fresh from a mud-puddle fest five seconds later.

Oh, and another note: while I think in general, I won't be ditching my seat belt any time soon, the admission we got last night was wearing her seat belt, and although I won't post any identifying details here (really, too gruesome) I have to tell you, my faith in mechanical restraints has dropped to an all time low.

I was also thinking, "Damn! If my seat belt saved my life in that collision, I'd be pissed!"

do androids dream of electric sleep?

I made it through three night shifts, although, just barely.

By the third night on about four hours of non-restorative sleep, I was so exhausted I couldn't understand English, which is my first and only language, for God's sake:

CT Tech:
[incomprehensible mumble]

JAMIE:
[grumpy, clueless silence, imagining self tucked away in bed, as it's 1:30a.m.]

CT tech:
[louder, incomprehensible mumble]

JAMIE:
[still orbiting Planet Clueless]
Sorry, huh?

CT tech:
[same incomprensible mumble]

JAMIE:
[wishing she was in bed, asleep, and not looking like a deaf, demented person who clearly shouldn't be licensed to provide health care services to others in need]
WHAT?

CT tech:
[completely annoyed]
Never mind.

I don't think I've ever been so tired I couldn't understand my own frickin' language, when spoken to me by an equally native speaker, but that's how tired I was.

I mean, in my favor, her head was turned the other way, facing the scanner, but I doubt lip reading would have helped me any way at that point.

I was okay the first night, but after two days of complete shit for sleep (eg fall into bed, exhausted, only to wake up, even more exhausted, at 1:30p and not be able to gt back to sleep) I was feeling both murderous and completely foggy at the same time--a bonus, as surely it's more difficult to pull off homicide when one is too uncoordinated to do much more than stare blankly into space for long periods of time.

Plus, the first night, I hadn't been able to nap before my shift, so by the time I got off shift the following morning, I'd been up for nearly twenty four hours straight, and certainly had been up that long by the time I went to bed.

Today, I toppled into bed in the middle of writing an e-mail. When I got up, I realized I'd also inexplicably popped some popcorn, which was left in the microwave, bag and all. I only have a vague memory of popping the popcorn, and am certainly glad I didn't decide to bake a cake and fall asleep with my head in the oven, or decide to use the toaster in the shower, to save time in both eating and daily hygiene routines.

I'm beginning to think those "sleep-walking" murder trial defenses aren't so hokey after all.

g'night.

With much trepidation, I start night shift tonight.

With even more trepidation, I'm off orientation next week.

The latter is enough to give me pause, because despite having been at this ICU gig since February, I really don't feel like I'm ready to be doing this on my own. I mean sure, on a good unit, you have your peeps, your back up, your whatever... but I just don't know if I'm ready. It doesn't feel like it's been five months, and sure, I've learned some skilz and stuff, but how can they just let me off on my own like this?!

Wailing and gnashing of teeth does nothing to persuade people I'm Not Ready And Need More Time, however. Again, it's sink-or-swim time. I remember being a new grad, fresh off of orientation, and going to work actually was scary. While My First Nursing Job (tm) was legitimately frightening, there's also that spankin' new green feeling I have to deal with again, and it feels almost precisely like being a new grad. Except there's even more pressure, because I've been a nurse, and I'm supposed to magically know this stuff.

I do admit it is somewhat less difficult now to be The New One than it was really being The New One back in February. (Especially since no one's really thought of me as the new one for months, and people kept asking, "When are you off orientation? Why aren't you off orientation yet?!" and I kept having to explain how I was new to ICU nursing, and then they'd look at me puzzled and say, "Oh, but you know this stuff. Why aren't you off orientation?")

I wasn't sure how to feel about that. Like, did people think, "What the hell is her problem? Is she like, the Special Needs Orientee From a TRY-CU, who clearly isn't up to our world-class standards of bad-ass ICU nursing and needs the Remedial Orientation Version 2.1?" Or were people trying to give me a compliment, as in, "Wow, you're an awesome nurse. What's the bureaucratic glitch holding you up from being One Of Us?"

I certainly don't feel like an awesome nurse. I feel like a brand new grad, right off of orientation, who thinks these people are crazy for letting me practice nursing without a preceptor. I feel like I should be on at least two more months of orientation, or should be allowed to go back to stepdown, where I clearly worried way too much over patients who were stable.

I'd be great at stepdown now. I mean, seriously, what's the worst that can happen? You get an unstable patient you have to manage until they go to the ICU? Big deal.

It's much different now. While every once in a while we do a lateral transfer in an ICU, it's usually to get a much sicker patient instead of the stable ones.

Any way, back to this "Am I ready or not to be off orientation?" internal debate. After about three months or so, my main preceptor kept saying, "Why aren't you off orientation yet?!"

Well, first of all, no seasoned nurse worth her salt is gonna pass up the opportunity to have another nurse ready to back her up if she needs help--I don't care if I was working the floor, I'd still grab the chance to have a "preceptor" for weeks and weeks if I could.

I mean, yeah, the last couple of months have pretty much been me, taking assignments more or less by myself and having my preceptor act as back up/resource when I needed her. And it was a great set up. I loved it. Some days were better than others, of course, but on the whole, I knew one of the reasons I stopped getting so stressed out about work all the time was because I knew I could never get into a situation where I'd be pushed to the brink of fatigue, anxiety, or cluelessness and not have someone help me.

That's where a large part of the burn-out comes from in nursing, any way--feeling (and in some cases having) to do everything all by yourself. I've worked a few of those kind of nursing jobs--and they are brutal pyschological torture at best.

In fact, I think this is how the floors should run: more seasoned nurses acting as back up to the younger ones who need to learn this stuff.

People keep telling me I'm ready to be off orientation, but I think I should feel more ready to be off orientation.

However, like going to nights, I don't have much of a choice. I have to learn how to cope. That, and maybe figure out who I can sleep with to get to the head-of-the-list to go to day shift.

Just kidding.

belltown

So, what of it if I have moved three times in about about 14 months?

WHAT OF IT I SAY!

Last week, between being Death Shepherdess and Semi-Death Shepherdess (note to self: ending argument with one's significant other by jumping out of car is only reasonable if said car is not moving, as opposed to going forty miles an hour on asphalt) I found a new place to live.

Glossing over for the time being why I found a new place to live, I must say I felt rather like one of those poor saps on HGTV's House Hunters. Will Jamie take scary ghetto apartment with high risk for break-in and become Seattle's next victim of violent crime? Will she take the shoebox in a beautiful building that says "I can't really afford to live here?" Or, the one with the great layout, quiet building, but pathetic, pixie parking spots?

What I quickly realized is that staying within my price point (roughly $700/mo) was going to leave me options that I might have dealt with in college or grad school in order to save money, but wouldn't now. I was gonna have to pony up a large amount of my working wage, something I was not prepared to do. However, as I am a huge homebody, it seemed very silly to rent a place in which I was going to be totally miserable until some psycho stalker came and put me out of my misery.

In fact, studio I lived in whilst attending Divinity School was a big studio, and, had the building been completely up to code (which I maintain it patently wasn't) and had a few extra renovations (bathrooms and kitchens entirely gutted, for one) I think they could have commanded much higher prices. As it was, with the "scrubbed away porcelain" charm of the tub and single kitchen sink with no garbage disposal, it was still a deal for $450/mo, as I could walk to class, and not bother with my car.

However, now that I am Gainfully Employed and aware of exactly how many stupid and scary people exist in the world, I want a place that is quiet, up-to-code, and after years of lugging my laundry into foul, smell, and rather scary basements, only to have the whole mess unceremoniously dumped onto the dirty floor or dusty tables if I didn't get there before Fellow Tenant Did, I have long since decided having washer/dryer in the unit is one thing I can't live without (3 years and counting, in-unit washer and dryer proud!)

I mean, I saw one of those condo conversion places charging $1300/mo rent for a one bedroom apartment without an in-unit laundry. There was a shared set down at the end of the hallway, but I'm sorry, what kind of person pays over $350,000 for a 700 sq foot piece of property on which you aren't even able to wash and dry your own clothing?

Probably the same crazy people who bought condos in the building I'm living in now, with the parking spaces which would barely be adequate if you drove one of those toy Matchbox cars, let alone a full sized vehicle.

I admit it, I had to compromise when it came to this place. I didn't get the furnished apartment (ergo, I'm sleeping on an air mattress. And also sitting on an air mattress. And eating on an air mattress, as I haven't a shred of furniture besides a glass sofa table David donated to the cause). But, the furnished apartment (in the same building) came at a price, too: apparently, the guy who lives above the apartment likes to dribble a basketball at random hours of the day and night. For hours. And, the all-in-one-washer-dryer doesn't exactly dry your clothes, and I don't have an airing cupboard (do they have those in America? I feel this is a strictly British term). Also: no balcony.

Granted, in Seattle, you need a balcony to enjoy the beautiful warm weather about as much as you need a swimsuit to bathe in Elliot Bay in December. It's damned chilly most of the time. However, psychologically, living in a 400sq ft space with one window might feel slightly depressing at times, and I hesitated, feeling I might do better in a unit with at least a faux-sense of connection to the (urban) out-of-doors.

So, I passed over The Furnished Place.

A few days later, I looked at my place, which is in the same building, but is slightly larger, has a "sleeping nook" for the bed, and California closets (in the bed "closet"). It also has a sliding glass door that leads out onto a common patio which I feel has "O Come, All Ye Stalkers" written all over it, even if it isn't on the ground level floor.

I'm in the corner of the patio, where NO LIGHT SHALL PENETRATE, but seeing as this is Seattle, I think that hardly matters.

One of my thoughts is to paint a wall in the living room a tasteful robin's egg blue (and then accessorize with chocolate colored accents) to mimic THE BLUE SKY I CRAVE DURING FALL WINTER AND SPRING WHICH HERALDS DEATH TO ALL COLORS GREAT AND SMALL.

Other bonuses of the place: a dishwasher (the house did not have a dishwasher, which I learned to deal with, but dishwashers are really nice for people who procrastinate, like me).

The location is much better than the previous place, which was residential, and not very walkable. I've lived in far scarier places (downtown New Haven comes to mind) but being able to walk to shopping, downtown, and even just going 'round the corner to the oh-so-Seattle coffee shop will be a nice change. Also, it's within walking distance to a bus that will take me practically to Work's doorstep in one fell swoop, therefore obviating the need to drive all the time. (Work is also now much, much, MUCH closer!) I am glad of this "I don't have to drive" bit, because the parking situation here is really enough to give me fits.

Granted, Belltown has a grittier feel to it than its urban sophisticates would like to believe, but it's not quit as gritty and grungy as Capitol Hill (I saw a really gorgeous apartment there, but I thought the unsecured walk out to the nearby secured parking lot might do me in one night.)

I've been here a whole afternoon, and people seem friendly enough. The women here sort of ignore each other, but the guys say hello and seem like the Seattle Guy With a Bike type, not the Microsoft Corporate Spaz type. Yesterday, two women had a strange elevator conversation in which they both tried to subtly brag about owning their places as "pied-a-terres" rather than primary residences.

I could barely surpress my gag reflex, and hope for the most part, ironically, that's true: means less folks around during the weekday. I'm guessing not all of the units are bought or occupied, as it seems unnaturally quiet. Or, it could just be good building construction, unlike in Florida, where I could hear pop music through the vents every morning.

I can't complain. After all, THE MONORAIL flits by the building, and the Space Needle is blocks a way. Sure, I can't see either of these Seattle treasures from my own window (I can see right into my neighbor's living room if they decide to open the vertical blinds, however!), but I KNOW THEY ARE THERE. Such reassurance!

little black ache

Every once in awhile I get this idea of how my ideal Fantasy Life would go in, you know, Fantasy Land.

It pretty much goes like this: I would be able to go to work and not pull my back all the time, I'd be able to eat a full meal and not get an upset stomach or other GI upset, and I'd be able to fall asleep within fifteen minutes of my head hitting my pillow at night.

Plus, when I went to the doctor because I couldn't do one or some of those things, that doctor would actually be the doctor I made an appointment with, not I Just Got Out Of Residency Five Days Ago McSmarty Pants MD, and then that doctor would docilely just prescribe what I need, not make useless little patronizing speeches about sleep hygiene.

I mean, "If you can't get used to night shift, you'll probably have to find another job," is not helpful when probably 90% of the hospital nursing jobs are night shift, especially if you have to start all over and find another job because your first night shift job was killing you.

I was almost sorry I brought up the fact that my back has been hurting for two weeks straight. I can't sit or lie down without LOTS OF PAIN, and it is sort of starting to wear on my temper just a wee bit.

Apparently, even though it is my job to control my patient's pain, when it's my turn to be the patient, I'm just supposed to suffer in silence.

Well, maybe not in complete silence, but wholly unmedicated, any way.

I guess that doc was right in a way, though, I could potentially solve all my problems if I just got the hell away from bedside nursing.