son of "as seen on t.v."

FAMILY MEMBER OF PATIENT WITH MASSIVE HEAD TRAUMA:
Well, ain't you gonna fix his head?

NURSE:
[empathetically as possible]
No, I'm sorry. There's nothing we can do. The patient has died.

FAMILY MEMBER:
[stubbornly]
Yeah, but I seen it on t.v.! They take the patient to surgery and fix 'em! And he ain't dead!

NURSE:
[sympathetically]
I'm really sorry, it's not possible.

FAMILY MEMBER:
[incredulously]
But, it was on t.v.! They take them to surgery! Y'all can't just leave it like that! You gotta fix it!

NURSE:
I'm really sorry. There's nothing more we can do for [the patient].

FAMILY MEMBER:
But they fix them all the time on t.v. What's wrong with you people?! You people are all wrong for that!

Frankly, I think this was one of the saddest interactions I've ever witnessed in my career.

zen and the art of motorcycle maintenance.

You know you're having a bad day when the transporter brings up what's left of one of your feet in a cooler. Specifically, what's left of your foot bones.

I'm not saying "Kids, don't ride a motorcycle, ever, because you might live to regret it."

I'm just saying, if someone handing off someone else's fragmented foot bones in a cooler at change of shift isn't an indication it's been a crappy day for some poor schmo' out for a spin on the ol' motorbike, then, dude, I dunno what is.

(Plus, waking up to find you have only 1.5 legs when just yesterday you had two fully functional lower appendages isn't a predictor of a happy fun day, either. Neither is the painful screaming associated with same.)

ba da bing. ba da boom.

Overheard in the ICU:

MAN:
[As a way of greeting to a relative he hasn't seen in years. Cue thick Northeastern accent.]
Jesus, you look like crap!

God bless those friendly people from the "right side" of the country. I guess honesty is a virtue with these people. One serious motherfuckin' virtue.

I was waiting for someone to cue up Alabama 3's "Woke Up This Morning," on the overhead pager, no kiddin'.

That, or have someone inform me I'd been teleported back to Noo Haven.

be on time. do not be drunk.

I read these sage, fortune-cookie-esque words on a website giving tips--presumably for those recently incarcerated at length--on that knee-knocking, sweaty-palm inducing first date.

I think this is great advice for anybody, at any time, not just first dates. Check it out:

Going to work? "Be on time. Do not be drunk."

Going to church, mosque or synagogue? "Be on time. Do not be drunk."

Prosecuting a major criminal trial? "Be on time. Do not be drunk."

Planning a robbery or major kidnapping? "Be on time. Do not be drunk."

It's advice that works for nearly everybody, in nearly all situations.

I like it. I think I'll start using it as my signature line, especially when I'm applying to a new job, because I failed to take my own advice in showing up to work sober. (Just kidding).

no news is good news

A few pithy notes: Piper's Dogster website has been updated with fabulous new pictures. Because I have nothing better to do with myself, I even created a nifty new blog button to Piper's Dogster Homepage (see said niftiness under "Push My Buttons."). If that's not gratuitous, I don't know what is. At least he doesn't have a Dogster diary. Yet.)

Other avoidance-of-real-life-responsibilities today came in the form of updating some new blog links.

Honest, it was more fun than watching paint dry!

But just barely.

occupational hazards

I don't really understand this following link's relationship to charity knitting at all, but apparently, there's something called the Minnesota RollerGirls.

And they knit for charity. Or somebody does, according to their website.

I wonder if nursing is considered a service industry? If so, I could have also showed my paystub for a discounted roller derby experience.

(Alternately, I could have gotten two dollars off of admission if I showed my union card at the door.)

Maybe they knit while they roller derby?

For once, I'm at a loss for words.

top ten things never to say your first year in ICU

Stripped of my nascent sense of adequate job performance since entering the hijinx, high-stakes Death Match Area of Critical Care, I find the one (admittedly petty) way I have to bolster my ego is making fun of others with even less experience than I do.

Yes, this means mocking new grads, and yes, it's completely immature and hypocritical of me, because I'm supposed to be a mentor to my peers and all that crap. (Which I am! I promise! I'll be really, really, nice to you, newbie grads, and maybe even bring you treats laced with anti-depressants to keep you from killing yourselves when you realize your career is going to be as financially successful and professionally rewarding as the DVD release of Paris Hilton's The Hottie and the Nottie (also starring Joe Moore and Christine Lakin!)

I'll be nice (or at least not spike your treats with horse laxatives) if you refrain from the following statements/faux pas:

1.) Never call a 3.2 second pause "sinus arrest." First of all, everyone will laugh at you. Maybe not to your face. But laugh, they will. Second, you may not ever recover fully functional hearing capacity if you call an attending at 2 a.m. for a patient you claim is "Going in and out of sinus arrest of 3.2 seconds." Because there will be a lot of yelling (and possibly swearing) coming from said attending. (If you work on a cardiac floor, I promise you that you would rather digitally disimpact everyone else's 88 year old, bowel obsessed patient than call a "pause" an "arrest.")

2) Never ask "Where do I put the EKG leads on a fat person?" Your patient may sit on your skinny little white punk ass if you do, and your nursing colleagues may claim "you called in sick" even if the nursing supervisor realizes you are missing at change at shift and inquires after your whereabouts.

3) "Push the code button?" is never the right answer when your preceptor asks you what to do in a code. Corollary: Neither should you answer, "Stop, drop and roll?" In general, it's a bad idea to make up an answer. If you really don't know, just say you don't know. Ironically, other nurses will take you more seriously and not be as afraid that you'll kill their patients as soon as you fess up to how little you really know.

4) "I think restraints should never be used on patients!" is a nice theory in the Happy Land of Fairies and Elves. In the world of patients suffering from dementia and ICU delirium, you are likely to wind up with a STAT psych consult, four point restraints and fed a Zyprexa and Haldol cocktail if you utter these words to more experienced staff nurses. (Oh yes, and did I mention? We will laugh at you. We like to laugh, you see. It makes our miserable lives briefly more tolerable. At least until we can get home and drink Draino to dull the pain and the homicidal voices in our heads).

5) "I saw a code, and it was sooooo cool." I shouldn't have to explain to any one why a patient with no pulse and no respirations is like, sooooooo the epitomy of "not cool."

6) "Does the heart really have four chambers? No really, does it?!" I'm not saying you have to be up on the latest electrophysiology buzz, but for the love of God people, I'm pretty sure a fourth grader with minimal anatomy and physiology knowledge would at least have the sense to keep their mouth shut if they didn't know the answer.

7) No one cares how many questions you answered before the NCLEX shut off. Really. I promise. No one.

8) "Don't help me! Seriously, DON'T HELP ME!" If you say this to another nurse who is, you know, trying to help your lame ass, which is quite obviously in a whole boatload of trouble, you quite obviously need help. Asserting you "don't need help" is, paradoxically, a cry for help. Same goes for asserting "Shut up! Let me think; I know this!"

9) "I don't understand why that nurse was freaking out. How was I supposed to know it was Torsades?" Hint: recognizing lethal cardiac arrhythmias is now your job.

10) "I love nursing!" No you don't. You just don't know that, yet.



N.B. These are real quotes from real new grad nurses. I weep and gnash my teeth, etc.

sedation vacation

Day #1 on the Surgical ICU of Inner City Hospital. We should talk about it.

For starters, we can talk about how early 5:30a.m. is for someone who likes to stay up until 3 a.m. in the morning. (Hint: it's extremely early).

And later, we can have a stimulating discussion on how starkly painful/humiliating it is to go from moderate competency in one's profession to Complete And Utter Stupidity And Denseness literally overnight.

Then, we can move on to Jamie's work-to-sleep-hour-requirement ratio, and how I've magically and literally instanteously regressed not only in job performance, but also, in bedtime ( was in bed and asleep by 9p.m. on Friday after a twelve hour shift. This, my friends, is called "pathetic.")

Happily, although I know nothing about surgical neuro/trauma patients (where, oh where, did my sick hearts go?!) and even less about all the goobledegook they're hooked up to, my previous life as a stepdown nurse gives me the instinctive knowledge that all of our patients range in prognostication from "mildly fucked" (not intubated, but with 8 different drains coming from one area of the abdomen) to "severely fucked" (intubated, brain dead, and waiting for the organ donor people to come and harvest organs).

My patient was "moderately to severely fucked"--with a huge brain bleed requiring her to be vented.

And me? Well, I'd say I'm veering on the edge of "severely fucked" diagnostically myself. I've spent the better part of three hours tonight scouring the internet for ABG interpretation quizzes and mechanical vent setting information--desperately clinging to any little piece of information I can shove into the one or two brain functioning cells that remain in my dull little cranium that might provide me with an "out" when I get pimped mercilessly by my preceptor tomorrow about auto-PEEP and metabolic acidosis with compensatory respiratory alkalosis, or whatever.

I'm told they don't "expect anything" of me, but that sounds more to me like "you poor dumb bastard" than "we're the kinder, gentler ICU experience you've been pining about since you were a wee lass!"

dis-oriented

Me no like orientation.

Week #2 commences with fun topics like Computer Charting, taught by a lady who seemed twice her age, what with the pedagogical style that assumed we were all thirteen year old hooligans. (I've never actually been chased out of a classroom and scolded because I had to answer a cell phone call. An important cell phone call, that involved a lawyer on the opposite coast of the country. No, I'm not involved in any hospital law suits.)

It was not a fun morning/afternoon.

Orientation is promising to be grueling, what with two eight hour days of class per week topped off with 2-3 twelve hour shifts. The pain.

I'm already taking up collections to tithe St. Jude (patron of lost causes!) as I was told by an inside source that my preceptor is "old-school" and "uh... very organized." These are usually euphemisms for "hard core" and "bitchy." I'm very afraid she will hate me and try to poison my pets through psychic mind-melding. This opinion, of course, is totally justifiable given I've never laid eyes on the person.

In conclusion: me no like orientation.

not smelling like a stanky ass bitch is the best thing about orientation

The best thing about general hospital orientation is that, unlike a day spent on a hospital unit, I come home and I don't smell like ass.

(What I'm saying is that I've realized that "not smelling like ass" would be the nice about an office job, or at least a job in which wiping puddles of poo off the floor wasn't a regular gig). And, for what it's worth, if such a survey for nurses were out there, I'm pretty sure more nurses would choose "Not smelling like ass" than "Getting the respect we deserve" as a reason to switch to say, semi-pro female mud wrestling.)

In addition, I've noticed that when I come home after a day not being a nurse, I'm not all that tired, and I don't feel the need to commit suicide or homicide, nor do I feel the need to remove the top two layers of my skin in order to rid myself of nasty microbes and (literal) shit, all of which are regular, standard-feature parts of my usual post-shift experience.

And did I mention, I don't come home smelling like ass?

the early bird not-so-special

So one thing I do not like about the morning is the earliness.

Or, more precisely, the tiredness associated with the earliness.

It is wrong, people.

Wrong.

It causes inveterate sleepers-in like myself to indulge in risk-taking behavior. I'm not talking about impulsiveness, higher-risk sex, spending or gambling sprees, here, either.

I'm talking about "risk-taking behavior" in the way it refers to dorky uncoordinated people who like to sleep until the sun rises, so you know, they can at least see what they're about to run into. (By the way, these people of whom I speak would be people like me.)

This risk-taking behavior would be summed up best as the following, namely: getting out of bed and driving to work, which causes stupid, vile, nasty and very expensive things to happen, like scraping the hell out of your car on a concrete post in the parking garage (true real life story!) and dressing up helpless dogs in unflattering costumes. (fake, made-up story for comic relief.)

Yes, if you click on the link, it says Big Daddy Pimp Costume, and yes, that is what appears to be a labrador retriever decked out in some purple pimpin' togs. I like how the caption below the picture gushes: "This Big Daddy Pimp Costume is just as adorable as it is funny."

This is funny in an ironic sense, if you think about it, because "adorable" usually refers to things like teddy bears and cute baby seals before they're clubbed in the noggin', not effete men named Purple Pappy Paulie G-ride Bouncer who profit off of their stable of hookers. (Also of note: the XL size of this costume is sold out! which means people are actually buying this garbage for their poor unsuspecting pet.)

So what I'm trying to tell you is: getting up and driving to work in the wee early hours of the morn is very bad and very wrong for people like myself.

Indeed, making people subsist on schedules not of their own biorhythmic makings may even be wronger than forcing your dog to pimp bitches (get it?! Har har!) at next year's Halloween party, but I'll leave you to be the judge of that particular conundrum.

older, yes. wiser, no.

My orientation group as a lot of shiny minty new graduate RNs, some of whom literally just took their boards last week, and are so fresh off the S.S. Clueless, they're still dropping hints about their test-taking acumen and Total Bad Assness since they "passed in only seventy five questions" (the minimum number required to either pass! or fail! the exam. Yeah, I don't have a PhD in statistics, either, and I just chalk the computer based test scoring yet another highly mystifying and anxiety-provoking aspect of being inducted into the gang of thugs and mercenaries who will be your coworkers.)

(I'm totally convinced, by the way, that passing your nursing boards has nothing to do with answering any of the test questions correctly or incorrectly. My belief rather, is that somewhere deep in the American heartland, there resides a drunk monkey who chooses your licensing destiny based on some Pavlovian alcohol-based reward system dreamed up by the creators of evil, dark magicky things like Press-Gainey scores, Alka-Seltzer tablets, and the presidential nominee bid of former Arkansas governor Mike Huckabee.)

Any way, I'm not feeling so bad ass myself at the moment. Case in point:

Someone today asked me if I was a "trauma junkie." (A phrase, note, I hate with all the witty and urbane disdain of a Frasier joke).

I was like, "Huh? Uh... no. I'm, uh... a cardiac nurse."

I don't understand these people who get off on codes and bloody bits of human hamburger scraped off the road. I mean, okay, the blood and guts I can deal with just fine--I don't like it sometimes, but it doesn't bother me.

But, I hate codes. They're scary. And this is why: not only is your patient dead, but there's a chance s/he might stay dead. Which means not so much fun for you, the patient's family, and presumptively, the patient.

I know you're wondering, "Then why are you working at a level one trauma facility, in a Trauma ICU?"

Well, first of all, I'm not really working there yet, because in order to actually work there, you must be subjected to orientation, which not only wastes a lot of paper, time, and brain cells, but also is probably the only work-related thing I'll ever get paid for (at least in this profession) whilst I sit on my ass for an entire eight hours, five days a week.

Any way, at first glance, my decision to do TICU is really bizarre. I mean, dude: I really like cardiac, and I really, really hate ortho and neuro (read: the bread and butter of trauma patients).

I'd much rather be in a CVICU being hazed for a year on post-op day two scut while I wait until one of the Cardiac Bitch Goddesses decides I can handle recovering a fresh open heart by myself, or can take an IABP.

So, I don't know what I'm doing, exactly. But, I figured this would be an interesting experience, and if I hate it, I can always go back to CV Land and torture myself needlessly there. That's the great thing about nursing: If you don't like one specialty in nursing, you can always invest more time and energy in hating another.

However, deep down inside, I'm afraid to admit that the reason I took the job is that I'm crazy. On the verge of burn-out, most people would choose instead to do something lower stress, like being a school nurse, or shoving punji sticks underneath one's finger nail beds. Instead, I decided to tackle my fear of Superbad Emergencies (like codes) by placing myself directly in the line of fire, so to speak (all of which, note, creates more stress and panic, not less).

See? Crazy.

Crazier still, I have gone so far as to rationalize my craziness:

My hamfisted theory goes like this: by placing myself in a unit where shit hits the fan on a fairly regularly basis, I will sharpen my skills from butter knife bad to special ginsu telecommercial, limited-time only pure awesomeness. Thus, the benefit to the patient (or patients, generally, I should say) is that I will get better at codes, and therefore, my patients will have better outcomes. Or, should I say, since there is usually a dozen people involved in a code--I will feel like I contributed to a better outcome for my patients, rather than standing there numbly in abject terror and getting in the way of more useful people whose primary instinct is not to run far, far away and change one's identity so as to be less likely to be found if ever a wrongful death lawsuit is filed against the hospital (which is how I feel now about those kinds of situations, frankly).

Or, you know, we could just stick to the original, simpler and therefore more elegant theory, which is that I am crazy, and therefore richly deserve the punishment of total work scariness I am about to undergo.

waking up is hard to do.

The bleary eyed existence of the damned: a week of hospital orientation.

To be followed by Son of Bleary Eyed Existence of the Damned: eight hour consortium ICU classes twice a week plus two or three twelve hour shifts. For three months.

And so it begins!

as good as a hole in the head

Overheard today in the hospital lobby:

MALE FRIEND OF PATIENT#1:
So, like dude! They had to do a craniotomy and take out a part of his skull to let the fluid leak out!

MALE FRIEND OF PATIENT #2:
[chuckles like Butthead]
Dude, no way! That's like, so cool! Did they get it on video?

MALE #1:
Dude, I don't think so. But, that would be awesome, wouldn't it?

Ah, reality t.v., you've done so much for the imaginations of so many.

on the 3rd evening.

On the evening before I start my New Job, I find I can't really get to exicted about any of it, from the 5 a.m. cattle call, to the cold dark blustery commute, to the soul-sucking hours of paper processing.

Saddling up and headed toward the battlefields, I feel numb. Anticipating no glory, just the bitter burn out, boring its insidious way through my capacity to feel happy or feel content.

A funeral pyre of hopes and dreams wends its way past me, alight with a halo moldering of poems unwritten, songs unsung, voices too tired to carry on in pain or exaltation.

Pretty soon I get to watch hearts and bones break that are not my own. Floors bathed in blood and shit. The dead have it better than the livin'.

I'm just the messenger woman.

Don't kill the messenger woman.

Even if she don't got nothing good to say.

All American Girls.

Overheard at an overcrowded Cheesecake Factory in Middle America yesterday:

GIRL #1:
Like, oh MY GOD. I'm not like, saying he drives people around like, Bill Gates or anything, but like, people almost like Bill Gates, or you know, the guy who like, owns Microsoft.

GIRL #2:
Like, no way!! That's like, sooooo cool! Like, I can't believe he actually like, knows those kinds of people. Like, that is just soooo awesome!

JAMIE:
[inner monologue]
Isn't Bill Gates and "the guy who like, owns Microsoft" technically sort of the same person? I mean, I know he's a "philanthropist" now, and retains the title "chairman" really only as a formality, but my guess is these distinctions are lost on the Amy Fischer Wannabe crowd in any case.

GIRL #1
[switching topics]
Like, did you ever hear what happened to that one chic? Like, apparently, her baby daddy caught her cheating with this other guy. Like, he walked in on it, or something.

GIRL #2:
No, WAAAAY!

GIRL #1
Way. Like, I didn't hear all the details, but I heard she wasn't working, or anything, and staying at home, and having this guy come over and stuff, like, all the time.

GIRL #2:
Like, OH MY GAWD! Can you believe it?!

GIRL #1:
Like, my kids are the most important thing to me EVER. You know?!

GIRL #2:
You're such a good mom! You're awesome! Your kids like, totally love you, you know?

JAMIE:
[inner monologue]
They did not just say "baby daddy!" Am I stuck in some white trash suburban version of Sex and the City, and no one told me?

GIRL #2:
Yeah, my career's like, important to me too. I'm like, into having goals and stuff? Like, I've got four more classes before I get my associates degree at Local Community College!

JAMIE:
[inner monologue]
Let me guess. Your major is "interior design" or "informatics." No wait! I know! Don't tell me! Your major is "communications!" Unless, of course, Baby Daddy is in the picture. Then I'll bet it's "cunning linguistics."

GIRL #1:
Wow, that's so amazing! You're like, awesome, girlfriend! You go! I'm waiting for my kids to grow up. But like, that scares me and shit. I mean, like, what am I gonna do without my kids?!

JAMIE:
[inner monologue]
Learn to read and focus on proper syntax and grammar, perhaps? Possibly take intensive English as a First Language classes and rectify your annoying habit of peppering every sentence with the word "like."?

Entree arrives.

GIRL #2:
Wow! We're gonna be here for like, another three hours! We're gonna be ordering our coffee at like, 10 p.m.! This is like, the hugest meal I've ever had! I've never had a meal take like, six hours to eat!

GIRL #1:
[laughing, as if this is a huge inside joke]
OH. MY. GOD. You're sooooo right! Totally! It's like, the six hour meal! I've never had a meal take so long, either! This is like, crazy, isn't it?!
Let's call our baby sitters right now and be like, "Uh? We're not gonna be home until like 12 a.m., because like, we're gonna be having our coffee at 10!

GIRL #2:
And our dessert at like, 11p.m.!

GIRL #1:
YOU ARE SO FUNNY!

JAMIE:
[inner monologue]
Must. not. vomit. in. own. plate. Must. think. about. erudite. and. highly. amusing. episodes. of. I, Claudius.

America, how I weep in my plate of over cooked transfats for thee.

You know,