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.
Tuesday, July 29, 2008
Wednesday, July 23, 2008
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.)
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.)
Sunday, July 20, 2008
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.
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.
Sunday, July 13, 2008
"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!"
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:
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.
[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.
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.
Thursday, July 10, 2008
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.
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.
Monday, July 07, 2008
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!
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!
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