why I heart hearts.

As if to mock me, the poor soul being damned to night shift (because I'm sure the weather personally cares) it's turned summer 'round these parts, replete with the loud various landscaping power tools and ubiquitous siren song which is the hallmark of the drunken and disorderly.

The beds at work are crammed full of summer's first blush of warm-weather-related traumas. In fact, Work refers to summer as "trauma season." And, one supposes they might as well, as how else does one differentiate summer from any other season around here, other than the sun comes out, people mistake it for Armageddon, and immediately commence shooting and stabbing each other.

I'm also convinced that Seattlites mistake "sunny" for "hot," as they are well-acquainted to neither. Yesterday, everyone I knew at work complained of it being "hot"--including visitors--yet when I was finally released from Haus of Payne (or Chateau de la Pain-in-the-Ass, alternately) I found it only mildly warm, and nothing I would change into hot pants and a tube top for, even if I were going for the Slutty Seventies look.

In any case, after working three-days-in-a-row (my most dreaded schedule, as there can be no pain like the pain of knowing you've just gone through some of the worst work-crap of your life, and yet somehow, you're still not allowed to go home) I have some observations and pithy trite sounding maxims.

Maxim #1: Even if you're feeling lots of annoyance and bitterness at say, Piper (value neutral as I can get, right?) always say good bye to Piper and at least have something marginally friendly to say before you leave, even if he gives you a mildly puzzled look which conveys he's utterly nonplussed at your solicitous overtures. Sure, he might have left you feeling a bit cold the night before when he snubbed you for the couch, a six pack of milk bones and Bad Bitches of Animal Planet Gone Wild, or some such, but god forbid you come home and find him "down for an unknown length of time" which is medical-jargon for "you're fucked."

I'm not saying I always practice this maxim, because in a lot of cases, I don't. Have I bothered to reach out to family or friends who have taken the high road and left for greener pastures? No. So one day, this maxim is bound to hamstring me with deep guilt and shame at my own hypocrisy.

But, I did just that yesterday before leaving yesterday, and was glad I had, because the first five hours of my shift was spent withdrawing care on a patient who had suffered a devastating injury only the night before, and watching his partner grieve openly at the bedside while his loved one died right in front of him.

Observation:

Every time I have to take care of a brain dead patient or dying patient or what not, I totally lose my appetite.

It's not because of the dead part. Really, at that point, the patient isn't feeling any pain. It's about the grief and suffering I witness from the family's end.

It's like taking a detour to hell for a few hours.

Even more jarring: half an hour later, you're admitting a new, living patient into the same bed and taking care of a whole new set of issues and family who expect you to give a damn.

And you're just supposed to process all of that, because It's Your Job, and you'll be branded as a wuss if you can't take it.

I have a weird job, really.

Observation:

I think I decided a long time ago I trauma really isn't my bag. Sure, it's fun to look up the daily horror show of local news and know what you're day is gonna look like, but I don't really like it. It's just a constant reminder that your life could be all happy and then complete shit five seconds to the rest of you life later.

However, I really like the people on the unit, and the way it's run.

But, I think I belong back in the world of elective heart surgery and interventional cardiology, so I don't know how long I'll stick with this trauma gig. Long enough to get some real experience and feel comfortable as an ICU nurse, but I think at the very top, two years is about all I can handle of level one trauma without becoming a traumatic brain injury case myself.

Observation/silliness:

As a resident so pithily observed yesterday when teaching another doc how to pronounce death legally (almost as bad as filling out one's taxes), "Think about it: everybody dies of cardiac arrest. Don't use it as a cause of death."

Point being: this is the third patient of mine since I started ICU whose cardiac death I've watched on the monitor. Reading cardiac monitors is like reading the language of life, if I may be so floridly purple prose about it.

It's one of the things, philosophically, that I love and prefer about cardiac nursing: reading telemetry is like being able to read a foreign language in some ways. (Unfortunately, it comes with the caveat that a lot of the times, what you're reading is, "Uh oh! Danger! Bad!")

Any way, every time I've had the misfortune to be stuck being Death Watch Nurse, I've always marveled at how stubborn the heart is. I'm tempted to call the heart blindly optimistic; even if it isn't pumping blood any more, it's still trying to do it's sodium-and-potassium-pump channel thing, busy organizing an electrical impulse, and while I suppose physiologically this is no more than brain-dead patients "posturing" due to random spinal cord firings--there's a certain kind of ironic optimism about a dying heart.

I mean, I think if I can indulge in one more irritating reference and make a lame joke, I'm rather tempted to believe, based on my preference for the cardiovascular system over the neurological one, that G-d spent a great deal of time designing the first, and rather had to gloss over quite a bit when it came time to give us the latter--especially the brain. I mean,if you follow that whole seven-day biblical creation story bit and follow it out to its logical conclusion, I'm assuming G-d had to cut corners on some stuff just so that He didn't disappoint His inaugural Monday night bowling team date with, like, the Holy Rollers, or something.

I've always held the cardiovascular system to be rather more well-thought out and practical, and, in an optimal state, I really think quite proletarian and puritanical in its work ethic, whereas the neuro stuff I've always kind of thought of as the product of what would occur if you married the physiological equivalent of the Crazy Darkly Artistic One with the Brilliant Mad Scientist One and The Megalomaniac Control Freak One and then they had offspring: no one really understands a damn bit of the science part, so then the artistic part takes over and makes up a bullshit, impressive sounding reason that in actual fact no one else really gets, either, but since Meglomaniac Control Freak One says that's the way it goes, nobody argues. On top of that, this brilliant brood is saddled with being responsible for an entire group of physiological systems it rather thinks of as its servants, servants it would rather just eschew altogether if it could, but is unwilling to abdicate its coronal powerhouse, and thus...

Also noted: for all of the reverence we accord neurosurgeons (bless them, for they spend their lives digging around in other people's noodles for a living) most of what I heard in rounds is, "Well, we really don't know what the outcome is going to be," which I always interpret as not only the truth, but also, a thinly veiled, polite way of saying, "We think your loved one is really very fucked right now, and we don't know enough about the brain to say otherwise."

Yes, if I had to compare physiological systems to philosophies, I would call the cardiovascular system Kantian (plugging away in its little self-contained universe, stubbornly doing The Right Thing when all hell is breaking loose around it and all evidence points to imminent doom no matter what the heart does or doesn't do).