Hell is For Heroes

I saw the title to an old Steve McQueen movie, "Hell is for Heroes" and I thought that was a very appropos way to approach ICU nursing. My "in" as it were.

(Bonus: I get to gratuitously mention Steve McQueen in my blog. I really feel there was no other way to link "Steve McQueen" and "ICU nursing." And Steve McQueen = RRRAWR. I'm just saying, okay?)

Okay, moving on.

If you've noticed, I've sort of skirted around the issue of How I Feel About ICU Nursing Now That I'm Actually Supposedly Doing It At Work.

I'm deep in denial mode, actually.

This reticence to discuss my job stems largely out of the sheer mental trauma I'm being subjected to on a daily basis, and I don't mean this in a typically snarky, cavalier way (okay, I sort of do). I'm much less articulate about this particular facet of Heart of Darkness-type work angst, precisely because there's very little that can be made light of some of the kinds of issues I've come across in less than a month on the floor, and yet, it's easy to melodramatize same, and that gets all crusty and old and boring.

Only, what I realize is that there's no way to access the root of all of this without sounding like I need large amounts of psychoactive drugs and talk therapy, myself. So I have to kind of make it funny, so I can survive the daily browbeating of my profession.

But then writing about some of the stuff that really bothers me about working in the ICU--most of which is genuinely as unfunny as it gets--turns out to be funny in a way a Nazi Puppet Show would be funny, which is to say, not funny at all. Largely inappropriate satire, maybe, but not truly "ha ha" funny (unless you're talking Hogan's Heroes. I mean, what's not to like about kitschy inappropriately-themed 1960's comedies, I ask you?)

So, any way, what I'm saying is that I'm Still Working Stuff Out, and Having Issues, so what you're really getting is this hamfisted version of what I'm going through, and it's not really very accurate.

Okay, pointless preamble done.

So, what's it like to be a new ICU nurse?

I think my first, honest and uncensored comment about my new job is "ICU nursing is hard." The follow up comment is, "And no one gives a shit." Sure, we get more respect from our peers and docs, but honestly, at the point you're taking care of brain dead people or people for whom recovery means "we might at some time put a less invasive device in your body in order to continue mechanically ventilating you, but your prognosis essentially remains pretty crappy at best"--who the hell cares?

My days are now spent trying to remember which way to turn eight hundred stopcocks attached to various life-support devices so that I don't inadvertently kill someone by administering a dose of the wrong vasoactive medication, or introducing an air embolism, or haveingthem bleed out, or any one of about five thousand new ICU-specific things I now have the legal capacity to be sued for in a court of law. It's fun times, I'll tell you! In fact, I'm writing a new screenplay for a new ICU nursing themed soap, "As the Stopcock Turns."

Sure, I like the new challenges ("Let's try to keep this poor person hovering between life and death pretty much indeterminately, not because it's the right thing to do, but because it's possible! And look at all the pointless numbers and data we can generate in doing so! Generating numbers in the name of patient care can't ever be pointless, can it?") And the newfound job "status" is swell! It's like I woke up, and the worst bosses of my career converged into one fire-breathing hell demon cackling maliciously, as per Mr. Burns: "You've been promoted to Head Kappo--sure, you're just as disposable as you were before, but now you have even more latitude to brutalize severely incapacitated people pointlessly on official orders before we send you both to your untimtely deaths. Good day!")

On the whole, I'll rather be looking forward to the day when I return to Grumpy Old People World (okay, so Vented, Sedated Grumpy Old People status post coronary artery bypass) because heart surgery, is at least usually, you know, a planned surgery, and I'm finding out there's really no such thing as elective "trauma."

So really, part of what I'm telling you is that taking care of people who resemble Hamburger Helper wasn't really what I signed up for, mentally. In my deepest professional heart of hearts, I signed up for Grandpa Joe Needs His Heart Valves Replaced. Well, He Really Doesn't, But Look, We Just Did it Anyway, Neat, Huh?

And if Grandpa Joe doesn't make it, or develops post-op complications, well, we kind of expected that, because Grandpa Joe had a few years of Methuselah. We weren't expecting much.

I think in nursing, it really all boils down to which kind of futility of care you can wrap your mind around being a willing participant.