The Scutmonkey

Red Scarf Project

2009-11-30T13:35:00.002-08:00

I'm not gonna mince words, here. For a lot of us this year (myself included) has more or less sucked balls. People lost jobs, loved ones. Shit happened. A lot of shit. And just when you thought you couldn't take one more ounce of crap--it poured buckets from the sky.

And yet, I had family and friends to bolster me, and vice versa. What it would be like not to have that scaffolding of love and acceptance, I do not want to know.

So, this holiday season, in the spirit of combating A Lot of Things Sucking Really, Really Bad, I am donating to this charity, The Red Scarf Project.

The charity benefits orphaned teens and young adults who have grown out of the foster care system, but still need support as they attend college or vocational school. What's not to like about it, eh?

You don't have to be a knitter to donate a red scarf (unisex please, if you do). You can donate money (duh), but also gift cards from major retail store, or call them up and ask them what they need.

If you do knit, and plan to donate that way, the deadline is December 15, 2009. I went out to my local yarn store (a tempting block away) and bought a skein of superwash and cast on right away in a seed stitch ribbing pattern I can do with my eyes closed.

I'm hoping, whether or not you donate your time and efforts to this particular charity, that you consider donating to one that has meaning for you. I don't mean to get all Preachy and Sanctimonious, or all Cloying "God Bless Us Everyone" Tiny Tim--really, I'm the last person to shove sunshine up anybody's ass, as most of my friends and family will heartily attest to.

I'm just saying, this year has sucked for a lot of the people I care the most about, and one of the more redeeming ways I'm choosing to deal with the Suckitude of Great Magnitude (aside from the usual bitching and spewing doomer magic eight ball predictions, of course) is by giving myself a laudable way to escape my dreaded knitting projects, aka Blanket of Blocking Hell and Man Ski Socks of a Colorless Blah Which Hath Rendered Me Blind... and oh yeah, maybe helping someone who isn't coding and whose ass I don't have to wipe if they make it.

Top Ten Signs You Might Be Living in the Tri-State Area

2009-09-09T14:31:00.001-07:00

10. Someone named "Tattoo Tony" wants you iced.

9. You want someone named "Tattoo Tony" iced.

8. Everyone from New Haven pretends they're from Brooklyn.

7. Everyone from Brooklyn pretends they're from Manhattan.

6. Everyone, regardless of where they're actually from, really wants to be somewhere else.

5. The statement "Jesus! You look like crap, you sonuvabitch!" is actually considered a compliment.

4. It makes the evening news when Ziplock bags are used for the intended purpose of storing food, not crack-cocaine.

3. No one has a clue what you just ordered when you say, "I'll have the manicotti, please."

2. Re: #3, you get smacked in the face for saying "please" because the waitress assumes you're being a smart-ass, not polite.

1. "Gun control" means the Mayor doesn't wave around his own .38 Special during town council meetings.

screw that!

2009-09-08T16:02:00.000-07:00

Tattoo, on penis of patient: Fuck this.

The Curious Incident of the Fake Wife In The Nighttime.

2009-09-08T15:52:00.002-07:00

Scene: night shift, intensive care unit at a large county teaching hospital; surgical resident attempting to elicit information from haggard-looking woman at patient's bedside.

RESIDENT:
(with faked air of pleasantness)
So, you're his wife?

WOMAN:
Well, yeah... I mean, we've been together for six months!

RESIDENT:
(increasingly dubious)
Yes, but are you his legal spouse?

WOMAN:
Well, I sleep with him. We have sex. I'm as good as his wife.

RESIDENT:
(patience wearing thin)
I don't think you're understanding me. Did you get married? Do you have legal document saying you are his wife?

WOMAN:
(agitated, emphatically)
You don't understand! We've been together for six months. We have sex and stuff! He don't got nobody else! I'm his wife!

beginning, middle, end.

2009-09-06T20:10:00.003-07:00

Beginnings are easy. Endings are, in some ways, even easier. But the middle? It's the hardest part.

Middles are murky, untidy, full of bluffs and blind alleys. Nobody can say, in the middle of something, what or when the End will be--it just is. The End might sideline you, it might knock the wind out of you, or it might be a gentle passing into nothing--but it's certain. But the Middle of Something? Impossible to say, how long it'll last, how far it's got to go, how much more you've got to endure.

After the fine, heady rush of a Beginning, with its newness and shiny glamour--the Middle comes as a bit of a nasty shock. It's the unexpected wrinkle in a clean linen tunic, the missed stitch in the knitting noticed three rows too late, the running-out-things-to-say on a first date, and the oh-fuck-I-just-said-too-much-and-too-loud of an argument in the calming lull after the first thunder of anger and passion, it's the bland, boring and scarily undefinable center of a Twinkie.

The Middle: it drags on. It doesn't know what to make of itself--is it the end of the beginning or the beginning of the end? The Middle questions its every choice, its every move. It squints into the future, blinded by sunspots of brilliant dreams yet tangled in the kudzu of fate. It is a lazy day dream, distracted by what might have been and what will be.

The Middle second and triple and quadruple guesses itself. It fucks up, makes the wrong the decisions. It fucks up some more. Sometimes, it rights itself--more often, it stays off-balance, like some pathetic leaning tower of Pisa. It is caught in the cat's cradle between hope and despair.

I am good at beginnings--those require only a bit of arrogance and the mad assumption whatever I'm doing might be The Right Thing, at long last. And I am very, very good at endings: a needle full of dull numbness and the thing--whatever it is or was--is done.

But the Middle... ah, the Middle. It confounds, it buffets, it lulls, and then it dares belligerently to take it--to take you--to the edge of the end and throw it--and you-- off the cliff.

And I absolutely suck at it.

a day late and a loonie short

2009-07-02T13:06:00.004-07:00

What happens in Canada, doesn't, apparently, stay in Canada.

And yes, it's knitted. Ca c'est l'amour, non?

Happy Canada Day, people, albeit a day late.

Big T's Resume and Cover Letter Service.

2009-05-26T12:47:00.002-07:00

There comes a time in every working stiff's joyless, overtaxed burden of an existence where one gives in to the sublime temptation of writing a cover letter detailing exactly how they feel about supplicating for another lousy job.

And thus, the moment has come, dear friends and readers, to unveil to the cover letter everybody has fantasized about writing (and sending!) at least once in their career:

Objective: Get a Job. Make $. Pay my fucking bills.

Dear Sir/Madam:

I think your institution is lame and all I've ever heard from my colleagues and the community at large is how sucky it is to work there, but frankly, I'm desperate to pay my bills. Sure, I'll take a job at your crap facility if it means I can make rent for another month. And sure, I'll even pretend this letter is about caring, and furthering my job skills, but we both know that's a joke. You need someone to wipe and kiss ass and take the fall when a big lawsuit happens, I need to pay off my student loans and eat ramen for the rest of my life.

So, let's make a deal: you pretend to give me a real job that treats me like a sentient human being, and I'll pretend to work and give a shit about your company values. You pretend to give me money for the job, and I'll pretend I can actually make a living with your sucky wages. Capeche? If I don't hear from you, well, let's just say Big T's Resume Service has a sister company called Big T's Wrecking Service. (And we don't wreck cars, if you catch my drift).

Sincerely,

Your future disgruntled employee

cc: Big T.'s Resume Service.

shit never dies.

2009-05-09T21:02:00.001-07:00

At its best, critical care is a heroic illusion, at its worst, it is an empty promise. And all too often, it is one and the same.

This Is Your Brain: An Illustrated Guide For Trauma Patients and Their Family Members

2009-05-09T20:48:00.004-07:00

Welcome to the ICU. We understand this is a scary, stressful time for you. There are many different machines and lots of different equipment that may look overwhelming. Doctors and nurses may speak in medical terms you do not understand. In order to facilitate your understanding of what is really happening in plain language, we've created a little guide to help you process things you may see or hear on the unit.

We hope this is useful and encourage your family members to resist the urge to annoy the medical team and nurse with many redundant, repetitive and inane questions about your care, and instead, please sit down, shut up, and refer to the handy guide, as per below.

(Note: Because you are no doubt intubated, restrained, and in a chemically induced coma, the staff here will share this sensitive booklet with your loved ones so they, too, can understand exactly how fucked up you are.)

Thank you, and have a wonderful day!

--The Staff In The ICU

This is your brain.
This is your brain splattered all over a King County highway.

This is your brain.
This is your brain with a bolt in it.

This is your leg.
This is your leg ripped off and in a cooler for transport.

This is your other leg.
This is your other leg amputated at the knee.

This your arm.
This is your arm in yet another cooler for transport.

This is your other arm.
This is your other arm with a couple of digits missing which, alas, were not retrievable at the scene.

This is your pelvis.
This is your pelvis in an ex-fix.

This is your airway.
This is your airway with a tube shoved in it.

This is your nose.
This is your nose with a tube shoved in it.

This is your dick.
This is your dick with a tube shoved in it.

This is your ass.
This is your ass with a tube shoved in it.

Any questions?

Sartre Kiteboards

2009-03-16T16:45:00.004-07:00

With all due credit to the original author of "Sartre Cooks," Marty Smith, I present you, Gentle Readers, with my version, "Sartre Kiteboards."

Jan 15

Malraux suggested rather than pester him with my political ideals of revolution, I write an essay on kiteboarding. At first, I scoffed at such a notion. Now, I am intrigued by the possibilities of floating off into the void on such a contraption.

March 1

After much effort in vain to secure such a piece of equipment in early 20th century Paris, I have fashioned my own kiteboard, consisting of an old crucifix and six pounds of plaster. After allowing my masterpiece to weather for a few months in the bitter spring rains, I showed it to Gide, who pointed out the thing will not float. I am well pleased.

March 5

Feeling alienated by my futile attempts to gain knowledge of a subject that does not yet exist, I took a hammer to the whole project. When Gide returned, he pronounced it "an acceptable rendering of bourgeois derealization." Feeling mocked, I ushered Gide out the door, having first filled his pockets with crushed plaster, then sat in the dark and wept profusely.

April 1

Have been ruminating on Gide's statement for almost a month. Consumed an entire carton of cigarettes without lighting them and dashed off telegram, ranting "you can always make something out of what you've been made into." Have heard no reply thus-far. Am bereft, but resolve to do better next time.

May 15

Further attempts at realization of the physical form of a kiteboard have not gone at all well. I have decided to abandon my project and instead ponder the phenomological ontology of something which has not yet been called into being. de Beauvoir has stopped by to say that, while she is pleased I am working so feverishly, the last time I showed up at one of our Socialisme et Liberte meetings, I appeared to have had my entire left sleeve gnawed off by a resident rat. Furthermore, she relays that Merleau-Ponty claims I am unwittingly referring to myself as "Dude." Flustered, I claimed this was a nom de plume of mine, and hurried her out the door with protestations that my cat needed to be fed. Before I could dispose of her, Beauvoir pointed out that if I had a cat, I would not have a vermin problem. I had no answer to that.

June 3

I grow weary of this endeavor. I suspect Malraux only suggested this project to staunch the flow of my rabid political desires. Nonetheless, I have written a six word treatiste called " "Le Board de Kite" and submitted it to the French press. I have heard nothing back about its publication. I refuse to clean up the residual plaster in my flat, much to the distaste of several of my mistresses, who felt slighted when I railed at them for being overly-bourgeois. The decay and ruin of my life's work haunts me.

July 25

Still nothing from the French press. My attempts to relay my masterpiece were met with dismay and looks of shock from my colleagues. After much gastric distress and consumption of ersatz war coffee, I have therefore decided, instead of 'kiteboard' to use "paper-knife" as my metaphor for essence-before-existence. I have self-loathing and resist this inauthentic expression of selfhood, but alas, I bow down to the concept of "Other as Kiteboard." It has defeated me at last. I suffer as I inhale the last of the plaster dust and float off on the seas of eidetic reduction. I am, at least, finally free of this kiteboarding nonsense.

in which I labor under the delusion "everything is fine."

2009-03-15T14:25:00.004-07:00

Work, for reasons I am not stupid enough to discuss on this blog, feels more like a life sentence than a job at present.

Working night shift is helping absolutely nothing, either. I'm back to living life through the prism of utter exhaustion, vampire sleeping habits on my days off, and supplicating to St. Jude with a special prayer asking for a city bus to hit me on the way to work, so I'll at least look as bad as I'm currently feeling.

My self-esteem having plunged to an all-time low, I have taken to the obnoxious habit of droning endlessly on about going to grad school again. I feel like some second tier rock star past her prime campaigning her publicist for a "come-back tour." Unfortunately, a return to academic ensconcement probably creates more problems than it solves, what with the economy spewing toxically bad consequences for university funding, and my general impression that no one, six years post divinity school, is going to remember me well enough to write me a recommendation. Not to mention my not-so-secret fear that the admissions committee won't just take one look at my application, titter politely into their sleeves, and move on to the next one after stamping a big red, "What the fuck was this one thinking?!" advisory on the top of my underwhelmingly pathetic little file.

The good news is that this much anxiety and depression about work usually diminishes my appetite, and so with any luck in a few months I'll look about as nonexistent and marginalized as I feel at present.

in defense of academia

2009-03-10T01:20:00.004-07:00

My recent experiences in my current profession having reached an all-time personal bizarreness, I have once again retreated into fantasies of academic splendor.

Alas, I'm about the only one in this household for whom a return to academia is a rapturous thought.

On some level, I can't help it. I'm a really big nerd. The kind that would go to school forever, if "student" was a full time occupation (that, you know, paid a living wage, with maybe some decent medical insurance thrown in there for good measure).

I would love to go back to school and, for instance, take an entire course in Latin. Or really punish myself and attempt doctoral studies in... well, whatever program would accept me (as opposed to laugh me out the door).

And, if I had to do it all over again, I probably would have majored in English (arguably even "softer" than majoring in religion!) and gone off to graduate school Determined To Be A Poet, Dammit, or something frowned upon by those who contribute to society in a quantitative way (that is, make a living wage doing Something Useful).

I may not be up to my usual standards of elocutio (I believe evil night shift is largely to blame) but after several revealing conversations with various persons regarding The Meaning of Formal Education, I feel I have to defend my own position contra that of, say, the modern university as contrived by the free economy. Or at least just bring up various loosely related points, and ramble on in a semi-coherent way like Grandpa Simpson.

To this end, my smart and insanely clever guy made a comment that revealed to me A Sobering Truth--that the purveyors of formal education are more than willing to sell you an education for which, in the end, there is naught to be returned employment-wise.

This was a depressing bit of horse-sense which, although it thoroughly annoyed me to attempt to contradict at the time (pragmatism and my own educational goals have rarely been happy bedfellows in my experience) also threw into clear relief exactly how this country generally "thinks" about its professional thinkers and academic elite.

I often forget that modern education to many is a means-to-an-end, and as such, is a commodity, bought and sold in as ruthless a market as oil and God knows what else. It's a harsh reality--like realizing that health care isn't so much about saving lives as it is getting medicare to cough up for the CT scan we just did on a brain dead ninety four year old (completely made up example, by the way) or whatever.

On the other hand, I am a huge champion of education for education's sake. To me, learning for the sake of personal enrichment and knowledge is practically a noble virtue. It's like saying, "I take a stand against learning useful skills that I can use to earn a living!" (Just kidding!)

Sure, part of me wants to return to the halcion days of my earlier youth, when all I had to do was show up for class and write papers, and no one died or was consigned to existing on life support if I screwed up a footnote.

But there is also a part of me that deeply values a liberal arts education and feels that there is something wrong with a society that invests in education largely to promote their educated class as free market labor (as opposed to a society which envisions education as an enriching activity necessary unto itself).

I also think it's sad that we largely consign our most highly educated to the ranks of the unemployed, and yet spend hours gaping slack-jawed at entertainers whom we willingly shell out millions so that their antics might effectively numb and deaden us to the possibility of, oh I, don't know... an actual intellectual heritage, critical thinking, self-discovery, and appreciation of the worth of others, maybe?

I mean, what would our intellectual landscape look like if, instead of promoting ridiculous showcases like American Idle (sic) we poured that money into grants and fellowships and education?

I'm just saying, it's not like popular culture has shed an overabundance of attention or recognition on the lives of many intellectually gifted people in this country, and I think it would be refreshing--although frankly I don't hold my breath--if we shifted our values and made academia and academics more of a moving force in this country. What would it look like if we actually paid highly qualified doctoral candidates for their very big brains and their ability to use them, just like we paid entertainers and atheletes all that ridiculous money? It is a fantasy I indulge in at least once a day, partially because of my own biases (I'd give anything to be one of those very big brains, and have many friends and acquaintances struggling in this piss poor economy to find work--persons who I feel should be more protected and have more employment options and simply don't, even when the economy is booming).

Yeah, I know, not all entertainers and atheletes get paid millions. But when's the last time you heard of professors of philosophy signing on multi-million dollar contracts, even to work at places like Harvard or Princeton?

I'm not even saying we should reward the Big Brains With Big Degrees with lots of money.

But, some money, and some recognition, and so forth? I don't think that's a lot to ask for their unique skill set and extra special secret super powers.

Meanwhile, I'm heartened to know even people like Martin Luther suffered from Anfechtung and am hoping one day I can refer to it in some footnote, and feel like I should probably try to coax some sleep out of this fast waning night.

Icarus be damned or "Back in the saddle again."

2009-02-08T16:28:00.002-08:00

I started on the floor last week, and much to my relief, feel much more confident and happy as a cardiac nurse than a trauma nurse.

In fact, despite having worked with very sick patients with complex care needs (Swanned, a dozen drips, intubated on nitric) I feel I was able to teach (if not to the patient, to the family) more in the last week than I did all year long as a fake trauma nurse.

What can I say? I'm sure I'm gonna be in some scary-ass, balls-to-the-wall situations and just like in trauma, I'm gonna feel green and new and scared shitless.

On the other hand, I feel much more engaged with my work, much more personally invested in the challenges, and just generally all around happier to be working a specialty I had the temerity to leave.

Meanwhile, being on orientation means a month of days--which is absolute heaven. Sleeping at night, and working during the day is a lifeline for me, and I absolutely dread the thought of working nights again. I wonder how long I'll be able to last this time until I reach my breaking point again.

In other news--I purchased a real wood bookshelf (bah! particleboard, she says) and, now that my books aren't in tottering piles all around the living room, and I can see what tomes I actually own, I've actually decided to pick up a few and see what I can make of them.

So far, I'm slogging through Oliver Davies' "A Theology of Compassion" and riffling about in Etty Hillesum's letters/diaries. Also musn't forget the pulse-quickening (ack! bad, bad metaphor!) "Hemodynamic Monitoring." It's been awhile since I've had a patient sick enough to need a Swan-Ganz catheter, and let me tell you--all those numbers and drips and shit? You'd better have a vague idea of what you're doing, boy howdy.

Charmed life, indeed.

begin the begin.

2009-01-26T18:34:00.005-08:00

when you're absolute beginners
it's a panaromic view
from her majesty mt. zion
and the kingdom is for you.
-M. Ward "For Beginners"

I don't know if you've looked at a newspaper lately (because that might be something you'd have done in like, 1985, before the Internetz and all) but no matter what outdated mode of information you've been sourcing these days, you've probably read enough to realize that the Financial Situation Around These Here Parts Is Dire.

It's so dire, that even a little scutmonkey like myself is somewhat worried that I'm gonna show up to work one day, ready to code patients and wipe ass like nobody's business, and get a pink slip for my effort. And then I'm gonna be shit-out-of-luck like the thousands of Americans right now who are being summarily handed their walking papers.

And that is a chilling thought, indeed.

On the other hand, having recovered from Brink of Exhaustion Expo/My Own Private Night Shift Disorder Hell 2008, I'm feeling very lucky, and... dare I say it, happy.

Yeah, this Cardiothoracic ICU thing could totally come back to bite me in the professional ass. I mean, I remember how terrified I was of crashing trauma patients--what makes me think patients crashing in a cardiac unit is gonna be any less scary, pray tell?

Well, it's not gonna be any less terrifying, and I'm probably gonna go through the same, I-can't-believe-you-thought-this-was-gonna-be-cool soliloquy some blustery April morning, having spent a 12 hour shift keeping some unlucky soul from the brink of coding, or coding, or whatnot. I'll garner stares from curious passers-by as I publically document my own stupidity at having stayed in critical care, and not gone back to the known hinterlands of stepdown.

And I'm probably gonna feel like a crappy cardiothoracic nurse for awhile, just like I felt like a shitty trauma nurse, for just about the entire duration of my (admittedly short lived) career in that field.

So, what's the difference?

I think the difference is I really, really like cardiac as a speciality. Maybe not as much as I prize my sanity, and definitely not as much as a cherish a good night's sleep, but still, as specialities go... I'm all rainbows-and-unicorns-and-sunshine-up-your-ass about cardiac.

My hope is that this will translate to Pure Intensive Care Goodness.

And so, I "begin the begin." (After I sign my name to human resource documents in triplicate for five days, which is apparently what they mean by 'hospital orientation.')

possession

2009-01-19T17:03:00.006-08:00

First things first. Observation: Now that I'm on a brief hiatus between jobs, I find that sleeping at night, like human beings were intended, puts a new spin on life.

For starters, I'm not nearly half the bitchy crank-pot I was working nights. It's amazing, not to be reduced to the emotional lability of a toddler when confronted with super human choices like, "Should I have peanut butter and honey, or peanut butter and jelly on my sprouted grain bread?" (Let alone, "Fuck, I have many life-saving decisions to triage rapidly as a critical care nurse at 2a.m. in the morning, which one of these life-saving skills is the priority at this particular moment?")

Ah yes. Sleeping at night. Awake during the day. It's such a simple joy to work within nature's own biorhythms. People who bitch about waking up at 5a.m. to work during the day (and I was/am one of them) should be forced to work nights for six months and re-evaluate how shitty waking up at 5 a.m. really is compared to having already been awake for ten hours at that point, and still having two more hours to go before the pleasure of death is ushered forth, or you get off-shift, whichever comes first.

I just can't tell you how much I needed to SLEEP AT NIGHT, FOR THE LOVE OF ALL THAT IS COUNTING SHEEP AND WARM MILK AND COOKIES AND TRYPTOPHAN.

There is nothing like realizing instead of running around ragged saving other people's lives for twelve grueling, largely thankless and often smelly hours, you actually get to crawl into bed (clean and sans someone else's shit spores floating up your nostrils) and save your own soul from being torn to pieces from lack of sleep.

In any case, I was obliged after my Last Shift In Trauma (a shift which, incidentally, made me wonder, "Since when are teenage kids unsatisfied with snorting good old fashioned cocaine?!") to board two buses, and two planes--again, on no sleep!--arriving finally in Florida. At that point, I had been up a full twenty six hours, looked like something out of a freak show and still needed to drive 28 miles from the airport to my parents' house.

All without the benefit of a car I had reserved days before.

Sample conversation, confirming, should there ever be an inkling of a doubt in future times, that we indeed live and work on Planet Bizzarro, Amidst a Population of Total F-in' Dullard Douchebags:

JAMIE:
So, what you're saying is, you don't have a car, even though I made a reservation?

CLERK:
Yes.

JAMIE:
So. What was the point of making a reservation?

CLERK:
Well, we overbook. We don't have the car you want.
[with unconvincing note of fake concern]
We've got a minivan, though, or an SUV.

JAMIE:
[feeling the last strings of her already tenuously-threaded sanity snap]
Uh, no offense, but, I don't want an SUV or minivan, and it's clearly not what I reserved. Just so we're clear, you don't have the car I reserved, correct?

CLERK:
[as if it's just the most insane fucking thing she's heard since Britney went 'round the bend, these crazy-ass patrons reserving cars at a Car Rental Establishment and then expecting to have same at the ready, because, you know, they've reserved one!]
Nope. No car.

JAMIE:
[resisting the urge to turn around and look for "Candid Camera" host]
That's unforunate.

I then spent the next week or so dealing with a Sanford and Son-esque pile of my stuff I'd stored months prior to trekking out to Seattle. While fortuitous circumstances and some enterprising mice meant there was exponentially less bullshit directly pertaining to said venture, it was still a complete money hemorrhage (how much do you suppose half a ton of moldering theology books are worth to the general public, let alone ship across the continent to yourself, I ask you?) and general allergy inducing chore.

It also meant quality time bonding with The Paper Shredder, and questioning my own sanity for inexplicably saving five years worth of Act Now! Don't Wait! Credit Card Offers (my best guess is I was waiting for an opportunity to, you know, bond with a paper shredder).

Having dumped and shredded a ton of absolute crap, donated my massive furniture to a worthy cause, and shipped the remaining Questionably Useful Crap to Seattle, I feel a certain sense of peace. Finally, after wishing, numerous times, that I had my beloved copy of Wheelock's or Kant's Critique(s) at hand--I will (at the USPS's Media Mail shipping's mercy and reliability, of course) finally have My Most Valuable Crap, aka, A Bunch of Books and Yarn, here in Seattle.

If ever there were a milestone for "You have now officially moved your crap to Seattle," I guess this would be it.

If I can just get to the milestone that reads, "You never have to move your crap ever again, any where" I'd be set, but I suspect that particular milestone would be of the "free epithet with every fifth granite headstone purchased!" variety, unfortunately. (Or maybe fortunately. At least when you're dead, other people are forced to deal with your crap.)

the bladder scanner as postmodern metaphor

2009-01-09T13:18:00.004-08:00

When I was staff at Hospital of Doom, we had this bladder scanner. And when I say "we had this bladder scanner," I mean we had one bladder scanner for 511 beds. That's right, folks. One.

It was old and I thought of it as a useless generator of random numbers from 0-900. Not only that, the sheer effort it took to locate where in the hospital the bladder scanner might currently be hanging out (never mind getting an order to use it in the first place) added such exponential layers of exquisitely soviet redundancy and bureaucracy to an already frustratingly pointless undertaking, that it was often easier to weasel one's way out of Bladder Scanner Limbo, pretend you did it, and just make up a number, without bothering to locate the damn machine in the first place.

Lately, I feel like that old, much-maligned bladder scanner--broken, overworked, and yet still shimmied and jostled endlessly from place to place, obliged to spit out useless information in a reliably imprecise and inaccurate way.

I'm so tired, and have been running on empty for so long, that I feel like the bladder scanner and I, metaphorically, are one: both symbolic and symptomatic of the American working class and their damnation to an eternal redundancy, inconsistency and arcane uselessness--hopelessly overworked, reliably ineffectual, consistently broken, and endlessly ridiculous.

plus ça change...

2009-01-03T19:09:00.003-08:00

Because I am apparently a staunch proponent of self-torture, I moved, lock, stock and barrel o'monkeys, on New Year's Eve (and spent the two days prior to that packing up my place, having worked the holiday week).

It was an ironic mix of grim puritanical roll-up-your-sleeves-and-get-the-job-done-sleep-and-sanity-be-damned on the one hand, and the blessings of friendship and kindness on the other. (Friends who help you move more than once every ten years? Amazing people! Ply them with lots of good wine and give them lots of hugs!)

Top New Year's Resolution? To NEVER MOVE. EVER AGAIN. (At least not this year.)

Put another way: If there were an Olympic Sport called Moving Way Too Much-- I WIN FIRST PLACE! I WIN THE GOLD MEDAL! Shoo-in! No contest!

Any way. There are still Issuez which are making me contemplate living as far away from urban claustrophobia as possible, which I can't really blog about as They Are Being Sorted Out Right Now and would bore readers silly any way--but at least my stuff is all in one place. For now.

Switching jobs (and facilities) made the move virtually a no-brainer, and the New Place feels like a luxurious palace in terms of space and light (windows! natural light! WINDOWS!) compared to my little shoebox of a studio in Belltown. The studio was wonderfully close to my old hospital (walking distance!) but so is my new apartment (relative to my new hospital)--and it's within half a block to trails, parks and quite a lot of other Stuff To Do. I am well-pleased.

There is also the wonder of a GAS FIREPLACE, which warms the place so efficiently it almost overwarms the place, and this is saying something, coming from The World's Most Perpetually Chilled Woman.

Of course, I am not allowed too much of a rest, and all this idyllic surveying of my domain would, in theory, at some point cause terminal boredom. My last week on the trauma ICU commences tomorrow, and I am chomping at the bit to git-her-done, have a couple weeks off, and start on the cardio-thoracic ICU.

bullet proof bullet points

2008-12-20T12:40:00.003-08:00

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)

2008-12-03T19:05:00.002-08:00

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)

2008-12-02T13:05:00.005-08:00

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)

2008-11-23T16:57:00.004-08:00

i-pod

2008-11-23T09:30:00.007-08:00

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.

2008-11-18T17:24:00.003-08:00

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).

2008-10-21T17:45:00.019-07:00

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

2008-10-21T11:03:00.003-07:00

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.

2008-09-28T00:00:00.010-07:00

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

2008-09-25T20:55:00.004-07:00

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

2008-09-19T13:49:00.005-07:00

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

2008-08-31T07:49:00.002-07:00

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?

2008-08-24T05:29:00.002-07:00

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

2008-08-11T19:45:00.003-07:00

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

2008-08-08T17:36:00.002-07:00

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

2008-08-08T14:24:00.002-07:00

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

2008-07-29T06:12:00.003-07:00

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

2008-07-23T16:51:00.002-07:00

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.

2008-07-20T05:07:00.006-07:00

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.

2008-07-13T22:08:00.003-07:00

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?

2008-07-13T21:49:00.003-07:00

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.

2008-07-10T15:32:00.002-07:00

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

2008-07-07T18:41:00.003-07:00

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

2008-06-30T20:05:00.002-07:00

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.

why I heart hearts.

2008-06-28T08:39:00.003-07:00

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).

misery hates company

2008-06-26T05:31:00.002-07:00

Have you ever had the unpleasant experience of swallowing all of your anger for somewhere around two weeks to two years, and finally, one day at work, you realize, "Boy, am I miserable!"?

At the time, you'll be tempted to blame it on work, which seems the most likely suspect.

But then, you go home, and sit down, and expose yourself to relative quiet and sounds that don't mean, "Someone might die if you don't do something about this all quick like!" and realize it wasn't work that was making you want to throw things and use profanity in the manner of a sailor. I mean, yes, in a general sense, work absolutely sucks, and it's a good target to blame, but then you take a good look around your surrondings and realize it's not all work's fault. In fact, you make the almost-awful true discovery that indeed, work has picked up the scapegoat slack about a hundred times for something/someone at which/whom you're exceptionally pissed off.

Not that it makes it any easier to go to work when you're mood smacks of a sort of Goodfellas goomba, "I wanna smash your face in, Paulie, etc." (And, in my line of work, people come in with faces already smashed, thank you very much.)

In fact, I feel particularly cranky at the fact that I now have to to go to work having spent half the night up in a miserable, seething kind of emotional detritus, the kind that then can't sleep because of all the snoring going on right next to it.

While I can assure worried readers of this blog that anything as sensational or cinematic as Michael Douglas's baseball-bat-in-commuter-traffic performance from Falling Down will happen today, it seems to me modern life leaves little civil recourse for the kind of pathetic angst it inspires.

If revenge is a meal best served cold, what of piping hot anger?

I could spend a good part of my morning drinking beer and throwing the bottles at the tile fireplace, but then that would only inspire more anger, as I'd then have to clean up the mess. (I mean, I could if I had Jeeves, and also, if I didn't have to show up sober to my workplace in an hour).

I'm clearly in the wrong profession. I should be a rock star, for whom regular hooliganish behavior is not only tolerated, it's expected.

However, I think my temperment is far more of the Suicidal Dark Poet, somewhere between the pop cultural phenom of J.K. Rowling ("I did want to kill myself, but then I made more money than God, and now, funnily enough, I don't.") and the guy who does those travel shows about food ("I'm angry and hate things in a snide and sneering way, but I sure do eat a lot of tasty meals for absolutely free!')

Any way, it's not so much as being morose right now as it just feeling large amounts of resentment and the urge to slam cupboard doors and primal scream in the closet until hoarse.

I feel like that robot with his vacuum-piping arms flailing madly about, screaming "Danger! Danger!"

If the human soul comes free with an anger compactor, mine is on overdrive today. I hope work is a perfect steady state of whatever I need to keep my fingers from randomly scratching out my eyes in sheer frustration.

bright copper kettles and warm woolen mittens

2008-06-09T13:46:00.002-07:00

For the record: it is JUNE and I am wearing a wool sweater and double knit wool cap.

I am also just on the other side of being rather sick (eg getting better) and still a bit fuzzy headed. I still sound convincingly sick. All I want to do is curl up and rest, but I do feel better than even a couple of days ago.

It is grey and damp and chilly. I wouldn't be surprised if the suicide rate spiked in Seattle this month.

Reminds me of JK Rowling's Dementors flying around in London circa Harry Potter book #6, producing all that unnatural mist and cold in July.

Oh God. Please don't let this weather wind on into July.

sickness unto death

2008-06-07T09:50:00.003-07:00

By crikey, I am sick.

I had a preview of what I was in for as D got all sick and cough-y before I did, but either D is more stoic than I am about The Pain, or else I got a more virulent dose of The Plague than he did--in any case, what a gift that keeps on giving!

Unfortunately, I make myself worse with the hackity-hack when I lay down, so this cold has a bit of a medieval-morality-play-Dante-in-yo'-face quality to it. I have self-exiled myself to the couch so as not to reinfect D or keep him awake with my dreary litany of "cough cough hack hack, moan, cough" repeat ad infinitem.

Meanwhile, it also heartily sucks to live in Seattle at present, with the gloom-and-doom, ever grey, damned cold weather (it is 47 degrees right now. Evil and wrong, I say!)

I am knitting D a warm woolen cap out of leftover wool from his much-hyped hybrid sweater (which sounds energy efficient, but refers in actually to the shoulder shaping--a piece of knitting trivia that I doubt interests anyone but a knitting geek like myself), which he may as well wear now as in December.

As for myself, I am craftily awaiting a surreptitious stash of good old fashioned Shetland wool, etc, for my wool self-swaddling. I am finally going to attempt the Henley Neck Fair Isle in Elizabeth Zimmermann's Knitting Around. And a Moebius scarf, which never appealed to me before in the slightest, but now comes to the foreground as An Objet which I must knit. And if I may be so bold, a Snail Hat, which no doubt will make me look like a right old frigid sno-cone in winter time. (Again, more knitting esoterica which makes no sense unless you are a big a fan of Zimmermann's knitting patterns as I--and approximately a million other knitters globally--am).

In other news of the inane (very hard to write of anything of universal interest when the whole of one's senses is narrowed to "my damned head is full of snot!") Piper finally got his teeth cleaned on Tuesday last (right as I thought I was getting over my cold--useless prediction that was) which left him stoned and rather a wobbly-on-his-pins treat to watch for a couple of days. This, I'm afraid, was a rather expensive venture, and one I have been putting off for more financially fair-weather times, but alas, dental hygiene, even from a dog's perspective, cannot be neglected, and the dog really was starting to suffer.

I am not much good for conversation these days, having lost my voice about Thursday. I retreat to a pile of knitting and the hopes I will turn a corner in this dread disease soon-ish, rather.

batteries not included.

2008-06-02T18:27:00.008-07:00

(Overheard)

SURGEON #1:
...So this guy comes in, right, and he tells us he's got a vibrator lodged somewhere up his, uh... colon.

SURGEON #2:
[chuckles]
Really? He told you the truth?
[muses]
Usually people don't, you know.

SURGEON #1:
Yeah, well, we asked him if when we go to retrieve it, if he actually wanted it out, or just have the batteries changed.

[General mirth at expense of patient who, thankfully, is several floors below and can't hear the above conversation].

most of what i know.

2008-06-02T17:21:00.003-07:00

Most of what I know, I can't believe. -Richard Swift.

It's been awhile since I've blogged. I've been saying that a lot, because I've been working a lot, and lately that tends to mean a lot sleep on my days off.

Plus, I inherited a cold from D, which has us both sycophantically hacking up a lung all night long.

Swell.

Any way, I find lately, along with a strange suspicion that God is mocking me from on high not only with Seattle's crap weather (am I really still wearing my down jacket in the mornings in June? Why yes, Virginia, I am!) but also with a somewhat nagging suspicion that my metaphoric brains have leaked out of my ears almost entirely.

I seem to be caught in a middling storm of mediocrity, in which I can still manage to chuckle mirthlessly at Marx's criticism of what he calls Hegel's "logical mysticism."

(Try explaining to those in the nearby vicinity why you're laughing while reading Marx's Critique of Hegel's Doctrine of State sometime, and you'll find yourself feeling even more ridiculous than usual, I promise. )

In any case, coming up at the fifth month mark of what is beginning to be a strangely interminable orientation (not that I'm complaining) I seem to be feeling a sense of accomplishment on the one hand for having managed to survive the front end of an exhausting introduction to the world of critical care, and a sense of dull, glazed-eye fear at the thought of being finally kicked out of the nest on the other.

I'd say I'm in an awkward holding-pattern of an ICU nurse's professional adolescence--a bad combination of knowing just enough to be dangerous and yet still tell-tale klutzy and overly green in ways I can now recognize in those with even less experience than myself. When, oh when, do I get to grow up and become one of those cool, sophisticated paragons of ICU nursing--those nurses for whom even the scariest of bad scenarios is handled with swift, skilled professional aplomb?

I get the feeling it's going to be awhile before I shake off not only my underwhelming sense of confidence in my skill set, but also that nagging sense that everyone else in the vicinity is not secretly sneering into the sleeve of their white lab coat and thinking, "Amateur!"

I'm also faced with the bald, inelegantly trite fact that there's no way through this mess except directly through it and have resigned myself, if somewhat sadly, to this fate.

My world as of late feels achingly lower middle class and I can't shake the feeling that I'm slowly physically going to seed. Two colds in the span of two months? This is a record,for one who typically succumbs to GI Infestation of the Month, but not the common cold.

Feel pasty and soft, although I've tried to start a half-hearted walking/jog regimen on the streets of oh-so-safe (not) Rainier Valley. Annoyed my attempts at getting in shape have been thwarted by lame-ass cold, which is of the half-assed variety, but will probably hang on in tenacious fashion until mid-June. (Tune in next time for Pointless Predictions of Pestilence with Peevish Patty!)

I think, however, the simple solution to all this mealy-morass would be a steady infusion of sunshine.

Seattle Weather Gods, what say you?

k.c. and the sunshine band

2008-05-19T18:17:00.003-07:00

Feeble (but photographic) attempts to show this blog isn't all about work, I give you The Backyard in Summer. Or Spring, or whatever season this is supposed to be.

lost

2008-05-12T16:21:00.003-07:00

I've been absent for a little while on El-Bloggo, not that anyone's been missing my semi-daily dose of bitching.

Mostly, I've been wrestling with work, catching on to the whys and wherefores of intensive care, and gettin' toughened up to death (and medical situations arguably worse than death).

Last week, for instance, I had an hour long code on a patient who everybody was pretty sure wasn't gonna make it, and she didn't. A few hours later, I admitted a lovably crusty old guy status post AAA repair. It was like clockwork, or a factory, or whatever. Clock in, code patient, put patient in vinyl bag, send patient to morgue, admit new patient, clock out. I didn't have nightmares or suffer from caregiver's fatigue over the code. She was sick, we did our best, she died.

Back in February, when this ICU gig started, a code, even one where we knew the patient was pretty much gonna stay dead, would have sent me straight into "What am I doing here?!" crisis.

Now I'm finding I'm getting oddly used to crisis, suffering and death. Granted, there are moments and shifts that really do bother me--for instance, taking care of brain dead patients as a result of homicide still freaks me out--but, in general, it's started to feel much more routine.

I feel on some level continued desensitization along these lines probably is not good for me as a person, but it's necessary to compartmentalize your reaction to the suffering of others if you have to work around/with it on a daily basis. Then again, I was watching an interview of a serial killer who talked about his ability to murder without conscience was predicated on being able to successfully compartmentalize his feelings, so I'm not quite sure what all my ability to emotionally check out more often than not says about humanity and health care.

shit never dies.

2008-04-24T21:50:00.002-07:00

Work, after muddling along in quasi-stepdown land for week upon plodding week, has suddenly become a macabre parade of Stupid People Tricks, to put it very mildly.

Homicide victims sandwiched between the homicidal, with a big juicy topping of would-be-suicides rounding off the whole sordid lot of human anguish and detritus.

Not a fun week by any means.

But I learned a lot.

Mostly, about how not to attempt to do in yourself or others.

(Hint for those evading police custody: do not shoot yourself in the ass, even if you can't tell your head from that of your posterior.)

Random REM

2008-04-14T18:54:00.000-07:00

Last night I inexplicably dreamed I was staying in the basement of a family of Indian strangers (I can think to say it no better way, and as it's seven thirty in the morning, and I am categorically NOT A MORNING PERSON, I think you'll have to take my word for it).

In that mystical, opulent, and ultimately nonsensical way dreams have of being ABSOLUTELY FABULOUS while defying concrete description (and also, maybe I shouldn't have mixed cough syrup with Nyquil last night)--I was perfectly happy with the idea of living in these peoples' basement.

For one, the family seemed nice, if the maternal figure seemed a bit suspicious and haughty (What is this random Korean girl doing in our basement, and why are we letting her stay there?).

For another, I remember having a running commentary in my head about the wonderful strangeness of their basement, which was full of furniture crammed willy nilly together, all happily Bargain Basement Deluxe (they even had an absurd room stuffed with Christmas wreaths and trees and baubles--a permanent shine to jolly St. Nick, as it were).

But, I was happy, because they had a very comfortable fold-out couch bed, with one of those sea-foam green felt blankets with the satin edging you find in better hotel chains (not the ratty, dubiously damp kind in the scarier ones).

In any case, it sort of devolved from there, into a vaguely anxiety producing dream about work--no doubt spurred by the imminent test tomorrow, which without a single bit of geek-pride cockiness, I'm pretty sure I'm going to shame myself into professional misery over, partially because I've been sick this week and not a prime candidate for study (although I did an impressive stint of rote memorization last night, proving All Is Not Lost In Middle Earth, Frodo Baggins) and partially because I really haven't been paying much attention the last tw months or so of "class" which I shall loosely term, because even though I am afraid of performing crap-tacularly on The Exam And All, I also thought the classes were a bit of a joke.

That sounds ungrateful, even snotty (and I am being accused of these very personality traits by, oh let's say, Piper, because he is an innocuous enough figure, and also, can't communicate his distaste for this blatant scapegoating with words).

What I mean is, I found half of the classes completely redundant, and bored by endless reams of information (and, I'll just say it, a particularly annoying-to-me group of classmates who put me in mind of some of the worst in my divinity school cohort--which isn't saying a lot to those of you who weren't there, but will make Katy both cringe and chuckle AND be smugly in the know). Ergo, I did my usual insert-own-foot-in-ass bit of protest and missed the classes I probably should have gone to (had I checked the syllabus in advance).

Yes, yes yes. Arrogance and ennui are a very bad combination, and I am living to reap the fruits of my pathetic would-be labor.

On the other hand, not that this excuses any of it, but I have a healthy amount of disgust and despair for my profession that I feel trumps caring about pointless classes dedicated to making me want to strangle my classmates. Putting a decided misanthrope in a crowded, poorly constructed auditorium designed for Liliputians is not a way to inspire me to academic greatness. And clearly, I've been through so much school that my special learning needs should be catered to.

(Ah, yes, I'm being brazen this morning--I'm also being ironic and waging a silent, although not wordless--war against those who seem to think I'm incapable of good old fashioned hard work and so forth.)

snake oil charlatans alive and well, thank you very much.

2008-04-14T16:26:00.002-07:00

Modern Hospitalization, a mini-rant.

Working in a hospital, is, I feel, a lot like being part of not only the porn industry, but part of a porno itself, and not in a kicked back, fun, sleazy way, either.

I'm not talking about the body parts and various gadgetry going here, there and everywhere into said body parts, either.

I'm talking about the whole overdone, overblown, fakey drama of what we do, the whole friggin' kit and caboodle. It's exploitative to both the participant and the onlooker, and yet, as hokey and demoralizing and yet ghetto fabulous as it can get at its zenith of ridiculous gratuity, we just can't look away from it.

Take the dress-rehearsal-for-death which is our Stock Script For People With Really Bad Diseases And Shit. Basically, we tell sick people, in this vague, mealy mouthed, litigation-fearing way that seems to place responsibility in some ridiculously Enlightenment slavering, cosmic ethos of scientific progress to fuck off and leave us alone, we've got twenty other priorities on our shit-fest list du jour.

Cue ridiculous fake orgasms of concern and empathy, etc.

And inside, you know what I'm thinking while we natter on in fake sympathetic tones about this that and the other thing? (I mean aside from, "I'm tired, I haven't eaten or peed in 10 hours and I still got three hours of charting left. Will you please shut up so I can go away and drink toilet water to kill what's left of my sense of moral culpability for the crap care we're giving you?"

Well, this is the other part of that diatribe:

"Hey! Don't worry! You have plenty of time to die! You think you feel like shit now? Well buddy, don't start carping about your tanking blood pressure or clot-throwing arrhythmia just this second, because you've got hours, no... days, if not weeks or months of us basically fucking around with our thumbs up our butts, generating pointless numbers we may or may not treat, yet spout at will to make it seem like you're getting relatively better or, as more often the case, worse. Then we'll pat ourselves on the back when you finally do code, because we ran such a fine death show with all the bells and whistles. It's really not about you, dude. It's about us and our skilz, man.

Oh, and, just a friendly asses up, buddy, take my advice and hold onto yer ass in this place--because if we leave you in bed for as long as I think we're gonna, you may not have one when we discharge you."

Yes, indeedy. We are in the business (and what a business it is!) of keeping people alive to kill 'em later.

And what bugs me is instead of being transparent about the crap care we're able to give, we put on this vague, mealy mouthed, litigation-fearing, freaky puppet show that seems to place responsibility in some ridiculously Enlightenment slavering, cosmic ethos of scientific progress. I mean, I love the Enlightenment and all, but come on, those people lived what, several hundred years ago? Let's move on and acknowledge that paradigm often sucks/doesn't work for things like fixing broken people's organs and stuff.

I mean, in a way, I feel we're all completely condescending crackpots. Consumers of health care know they're getting ripped off and shit on, and that the only way to get adequately treated (or even over treated) is to be some obnoxious sonuvabitch with a Percocet-and-meth-habit death wish. (And I think I may have scored the day's most politically incorrect statement about a certain patient population we're no longer supposed to call "drug-seeking.")

The least we could do is own up to the fact that we're a bunch of fakey charlatans running around selling snake oil. I think people actually might be more sympathetic and understanding if we just came out and told them, "Yeah, all this medical intervention is bullshit. You wanna just go home and watch The Simpsons and eat cheesy puffs and beer until your heart swells to the size of a garantuan beach ball and die, or what?." End mini embedded rant.]

Pavlovian hubris.

2008-04-14T07:27:00.011-07:00

I often think, with bitter irony, that I would have done well emotionally in an ICU three years ago as a new nurse (god, has it been that long in this godforsaken job?!) due to being a much feistier soul who hadn't yet been beaten down not only by the insufferably cruel Way Of The Hospital, but the endless death-dance I like to call the Stepdown Shuffle: "Wait and See."

After playing "The Wait and See" game for three years, often with docs and coworkers too busy or burnt out to care, in a system set up to fail, I've gotten a good feel for well... my ass, because I'm always reaching around to make sure it's still firmly attached, and not about to be kicked into oblivion.

I've also gotten a sense of how much bad care a patient can tolerate, frankly, and in some cases, it's absolutely amazing how sick you can let a patient get before they code and die. I'm talking weeks of a slow shuffle to a miserable death.
So, experienced stepdown nurses--we don't get too fussed about crappy numbers sometimes because well, in the past, when we got fussed about them, guess who cared? Like one other person, maybe, who was a sympathetic coworker, but not anybody who could actually fix the problem.

I learned to "front" and manage the problem, and on the rare floors where I had good staffing and charge nurses to help me, it usually didn't become a crisis. On bad floors, with none-of-the-above, I just knew my patient and I were doomed to a crappy shift.

My point is not that I'm a bad, uncaring person or nurse, and that I should clearly try harder, it's that I have tried harder, I have cared. As nurses--we all have (except for those random, scary ones who seem to be leftover patients from electro-convulsive therapy of the 1960's gone badly wrong). It's just I've found, like so much Pavlovian hubris, that caring and trying to be a good nurse frequently doesn't matter.

So, I've adapted, maybe I've matured, maybe I've just become more realistic about the nature of health care.

So, maybe I don't get as excited when I see numbers drop incrementally, marginally, for a few seconds. I keep having to remind myself that ICU nursing is all about treating the numbers, and if I don't act like the sky is falling every twenty minutes (without, however, giving an impression of hysteria or mania, which would likewise signal I'm a crappy nurse) I'm going to be viewed as a Bad Nurse.

Three years ago, I would have been all over this kind of care, because new nurses are good at nothing if not freaking out about bad numbers.

I'm not saying I'm a lackadasical nurse or I purposely suck at my job because I'm too tired and burnt out to do it properly--I"m just saying the ICU Kultcha Klub can be difficult to wrap my head around at times, and it would have been nice when I was a little less jaded about What We're Actually Doing For People, to see action and response when I had concerns.

Now, after being conditioned into a slave-like mentality at work, my main goal now is to grind through a shift with minimum harm to my patient or self, without stepping on anybody's toes or pissing anybody off (not easy to do in a veritable mine field of hair trigger, bombastic egos and operatic tempers). Not that I care that much about pissing people off, but what I've found is pissing people off leads to me in spiritual meltdown-mode for the rest of the day. I used to sort of have this balls-to-the-wall approach to people who put me down, and now I just kind of take it, almost without carping comment, just to save my energy for the next fake nursing or medical crisis.

And so, in between all these battles and power plays, I sort of gave up on the Militia Woman Nurse model, and opted for the I'll Do Whatever You Say, Whenever You Say, As Long As It Doesn't Appear To Kill the Patient Faster model, otherwise known as Apathy Nursing.

If this sounds distasteful to you, it's probably because it is, and I can only argue self-preservation, not to mention point once again to the sinking, burning, death-trap of a Titanic which is American health care, and plead that it was like that before I ever got on board, honest to God.

Where does that leave me now, professionally and ethically?

I'm still trying to work that one out.

silver bullet

2008-04-13T14:24:00.002-07:00

Pardon my blog absence, which I'm sure has gone virtually unnoticed by those with actual lives whose existences don't revolve around the navel-gazing observations of a cranky ICU nurse-in-the-training.

Perhaps I'm making a broad generalization here, but since this blog is not bound my any strict scientific convention that I'm aware of, I'm going to make: April seems to be a traditionally crappy month for me.

As in: last year, I was fighting off demons at work, and this year, I'm in the midst of job training that on some days might give the Marine Corps a run for its money, dithering back and forth and back and forth and back and forth on some personal issues, and recently, whallopped by what I am calling "strep throat" and the medical community at large isn't calling anything else (okay, maybe "pharyngitis") due to their inability to provide all but the most nominal of primary care services (including answering services whose operators can't be bothered to even page a triage nurse properly).

After five days of suffering the wrath of a mighty plague that rendered even Miss Chatterbox herself grimly croaky (and cranky beyond belief to boot), I finally scored some blackmarket antibiotics (you know you're getting old when your drug dealer happens to be doling out Z-packs unused by family members in whom it caused anaphylatic shock) and have, I think, just turned the corner with this ugly disease.

Unfortunately, I'm still required to inform work of my whereabouts, deathbed ill or not, and I've spent most of the week not only wishing I were never born, but also having immense psychological trauma induced by trying to figure out how I will be perceived calling out so much with such short time "on the books" as it were, on my new unit.

I've even tried to gauge if I'll sound "sick enough" to warrant a dispensation from my boss (who happens to be an extremely nice, fair boss).

There's nothing that says, "You're a fucking weak-ass slacker!" like getting strep throat 2 months in to training and calling out sick for the better part of two weeks.

On the other hand, there's nothing quite like knowing you're going to be forced to work one of the most stressful jobs on the planet at a health capacity of say, 50-80% for the next month, and that on your days off, you're going to be shut inside, an invalid, prisoner not only of your body but conscience as well, shunning extracurricular activities that might actually be fun for you and replenish your flogged soul, would it not for the worry that you'll be causing yourself a flag in energy and thus limit optimal recovery time.

I don't know if I was this neurotic about sick time before, but having succumbed to all manner of illness since joining the wonderful workforce of indentured servitude nearly three years ago, I can't tell you how much headspace is devoted towards covetously accumulating, and then judiciously doling out one's own precious sick time.

I won't even go into the mental and bureaucratic gymnastics of how it's possible to be sick for four days in a row during a certain month and be "written up" for "abuse of sick time", as per my old staff job.

Any way, I was rather hoping to employ a strategy of not getting sick at all for orientation, when the pressure isn't as high stakes (imagine that) and I'm not truly counted in the staffing numbers, and in some ways, it's less of a burden not to have an all-thumbs, green newbie stumbling around pouring the contents of a patient's tube feed all down her front in a fit of complete nerves.

This strategy would have meant saving up sick time for when I really did fall sick, and am going to be counted in the numbers.

So much for that. I'm now legitimately ill, a few days before a written exam, which I ominously predict I shall gloriously fail, due to the inadequate ratio of time studying versus being a dull stupor this week.

And then people will sit around and shake their heads, and mumble darkly about that wayward Jamie person, who is showing early tell tale signs of being a Bad Employee.

SO MUCH STRESS.

No wonder I get sick so often!

Sigh.

A Few Rules For Surviving an ICU Orientation (Dignity Intact Optional)

2008-04-07T21:11:00.005-07:00

Rule #1: You're wrong. Everyone else is right.

Corollary: If you're not wrong, don't worry: you don't know enough yet to be right. About anything.

Even today's date.

(True life story! If someone says it's the 6th but it's really the 5th, don't argue with them. Just say, in the most deferential voice possible, "Really? I thought it was the fifth, but I could totally be wrong. Okay, it's the 6th." Even if you just looked at the friggin' calendar, and you know it's really the 5th--trust me, don't set yourself up for failure-to-communicate-with-your-superiors, here. It's the 6th if your coworker says it's the 6th, goddamn it. Trust me. Console yourself with the fact that it's probably the 6th somewhere across the international dateline, if you're having a hard time accepting your new reality of Always Being Wrong.)

In short, just make it easy on yourself and admit you're wrong even before any one else has submitted their opinion about the situation. Saves time and energy, and that's half the battle in an ICU setting.

Benefit: the quicker you admit you're wrong (even if you are in fact, wholly correct) the less apt your superiors and co-workers will be to beat you around the head with your supposed superiority complex. Less beating about the head saves precious neurons, and you're going to need them, even if it seems like you don't, because you're always wrong anyway.

Rule #2: You know nothing, capeche? NOTHING.

Corollary: We lied. You know nothing except for Rule #1: You're wrong.

Beyond that, you know nothing. Even if you think you might know something about something, you don't.

Repeat after me: YOU KNOW NOTHING.

You see, as far as I've worked it out, whereas it might seem counterintuitive to profess your lack of knowledge in a setting where people live or die by their health care providers' skills and professional acumen, it never fails: your coworkers will instantly distrust you if you seem to know more about something than they do.

As far as I can tell, your coworkers--the ones who are sheparding you through your ICU infancy, any way--are not primarily concerned with your IQ, your ability to use big impressive words, or the fact that you memorized the entire contents of your hemodynamic monitoring textbook and can recite them verbatim.

No, they're far more interested in how much of a clueless, panicked pain in the neck you're going to be when the shit starts hitting the fan. And they are not impressed with anything that might suggest in addition to clueless and panicked, you're gonna act like a know-it-all schmuck.

In other words, they might be able to protect you from your own stupidity, but you make their job a lot harder if they think you're an arrogant asshole, and they don't like when you make their already crappy job even crappier.

So, pretending you know nothing assures them you really are just a stupid backwater hick, and they figure they won't beat you about the head as often in order to keep you docile, since they want to protect the few God granted neurons you actually have in that thick skull of yours.

Rule #3: Beg for forgiveness and mercy. Frequently. Remind people of your stupidity early and often, and if all else fails.

I'm convinced generations of ICU nurses have made it through orientation based largely on their ability to submit docilely to humiliation on a daily basis.

You'll be allowed to display more of my own unique personality and attitude later on, when you're off orientation. Right now, however, it's just in your best interest to demonstrate your willingness to frequently profess your own boundless servility.

It's like magic. The minute you say something to the effect of, "Really? My nursing judgment totally sucks ass? I never really thought about it that way, but you know, now that I've thought about it, I totally agree with you! Thank you!" --it seems like everyone seems to relent a bit, and think you're not such a fuck-up after all.

Rule #4: Try not to drink too much or self-inflect head trauma (eg, repeatedly beating head against the wall) to dull the pain after a shift.

Because tomorrow someone in charge of you might decide you do two have synapses to rub together (or they're short two nurses) and let you off orientation--and you're gonna need all the brain matter you can get, even if you have to scoop it back up off the floor from your last work-related clubbing.

mulled whine

2008-04-01T22:58:00.002-07:00

I know you haven't heard from me in awhile, and that's partially because I've been vacillating between being pummeled at work and licking my wounds in a corner, and playing emotional dodge ball on the home front with various and sundry issues.

FUN TIMES.

So, this post could be all about how work sucks in new and different ways I never imagined possible, but then, I feel to adequately convey this point, I would need a 500 page dissertation and perhaps some Everclear to make the reading a bit more palatable.

And, this post could also be about how sometimes, despite the best of intentions, even the most insipid of domestic disputes can turn into some crazy-ass Tet Offensive that gives even the most benign of administrations a run for their "credibility gap."

But really, this post is gonna be about how I wish I had super magical powers, and could make everybody play nice and fair, and not make me wish I'd done everything in my life all completely different.

Or at least had the supermagical power of drinking lots and lots of alcohol without a hangover, because if I could do that, maybe I could get through like, this next week or so without having to watch all my ideals come crashing down around me.

fool's gold

2008-04-01T22:47:00.002-07:00

There is something deeply, chafingly ironic about today being April Fool's Day, and in the fullness of time, perhaps I can one day confide in you, gentle readers, what prompts me to mark it thusly.

However, for now, let me just say how thankful I am to have friends who don't care what I do for a living, and that sometimes, the best you can hope for in a day is a little bit of coffee talk, a little bit of knitting, and a few belly laughs at the expense of The Erectile Dysfunction Awareness Campaign.

for the discriminating cheapass

2008-03-18T08:03:00.004-07:00

And lo, they asked for a Costco wine.

And lo, they received it.

God bless Kirkland Signature products. For ye, though the middle class cannot live by bulk shopping alone, they're sure as hell gonna try their damnedest.

Hell is For Heroes

2008-03-13T08:42:00.002-07:00

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.

All your bedalarms are belong to us.

2008-03-04T22:36:00.008-08:00

In a brief statement last night, senior officials at Hospital of Lost Causes, nestled in its home town of Some Poor Shithole, America, revealed their "Every Patient Left Behind" campaign--a facet of their 5 Million Deaths and Counting JCAHO approved marketing scheme--to increase morbidity and mortality in their elderly patient population, and streamline what they call "door-to-morgue" time.

"Basically, what we were finding is that patients have a one thousand fold risk of death or disfigurement by complication if admitted under any number of our substandard services, but that that risk dramatically increased when patients underwent coronary angiogram under my care," said Dr. PoPo Schneiderfrast, one time winner of the Douchebag Dildo Award and hospital director of the newly established MOR-ICU. The MOR-ICU is modeled after the assumption that since patient decompensation and eventual expiration occurs so frequently and disturbingly quickly under Schneiderfrast's supervision, a lesson or two in patient mismanagement could be learned from what Hospital of Lost Causes employees jokingly refer to as their Angel of Death.

Schneiderfraust further explains the "MOR-ICU" concept: "We also found that we were really spending more resources on post-mortem care, and felt that since so much of our funding goes to keeping our patient-death lawsuits out of the press, we'd do just about anything to cover up our sloppy shit-for-care in any way possible before an error is even committed, much less discovered. Also, the MOR-ICU protocol streamlines the time, money and energy it takes to get a patient from the ambulance bay doors to the morgue (thus the moniker "M[orgue]-ICU) in just under 12 hours. I think it benefits everybody, from our overworked risk management team to the bedside nurse."

Will good nursing care be under-evaluated in this new plan? Fear not, says Director of Corpse Care Services, and co-manager of the TRY-CU and BUNK-U, Alesio Bitchtits. "It's so much easier to manipulate and punish nurses now that we have this new "Every patient left behind" campaign. I'm really delighted by the new and manifold ways it's now possible to implicate nursing in just about every patient death hospital wide, no matter who or what the real culprit. I'm just thrilled." Bitchtits further says that the program involves a "rigorous application of root-cause analysis, and due to the new, executive-approved algorithm, virtually every patient death now involves some component of nursing care, whereas under the older hospital policies, there was always a small margin of doubt as to whether or not the nurse named in the affadavit was really ever an employee of Hospital of Lost Causes at any time."

Boasts Bitchtits, "Our nurses are really, really good at writing death notes. We have some of the best post-mortem documentation in the country."

RN Clinical Nurse Specialist Theresa Lotsaspaghetti says she's working hard on a newly modified BRA [Breathe, Rest, Ambulate] protocol for recently deceased patients. Her new brain-child, LAZARUS (Let's Ambulate Zombies And Resucitate Ugly Saggies) is a novel way of approaching the challenges inherent in preventing hemodynamic stasis in patient's suffering from what she calls "a modified organic state." Says Lotsaspaghetti, "Of course it's challenging to get dead people to walk around, but if Jesus did it, so can we."

Risk management lawyers for Hospital of Lost Causes were not immediately reached by phone, and no one was answering the phones at any of the nursing stations hospital-wide.

Rabelais a day... keeps the lawsuits at bay.

2008-03-04T22:23:00.003-08:00

Bear with me while I share some of my off-the-cuff hospital humor in the form of wicked satire.

Promotional Flyer for the Newly opened BUNK-U floor at our favorite hospital: Hospital of Holy Terrors!

Come join the latest in our innovational new approach to substandard care!

We here at Hospital of Lost Causes truly believe that our commitment to the worst possible outcomes for our patients is of paramount concern. To that end, on the heels of our wildly unsuccessful venture in mismanaging and misappropriating resources and finances, namely, the TRY-CU, our team of incompetent and lazy motherfuckers in upper management have developed the BUNK-U.

Says Chief Head Giver Phoot Puut Evans, "We knew that our sentinel events and near misses was usurping that of hospitals in war torn areas like the Gaza Strip, and we decided to capitalize on that. Knowing our nurses are amongst the most beleaguered, down-trodden, and easily suspectible to brain-washing, we implemented a truly atrocious yet unique plan to set them up to fail in yet another egregious fashion. By creating the BUNK-U, we believe our hospital deaths related to falls and accidental strangulations will increase by at least 500%, a margin of error that would impress even Satan Himself."

The BUNK-U, Hospital of Lost Causes "new" unit ("And by "new," we mean we had to kick out a colony of resident rats in the basement kitchens to make room for it," quips Project Director Boscoe "Dirty Balls" Boballino, is a 91 or maybe 92 bed unit that features hospital beds stacked two or three high. The goal is to "economize on space, safety, and increase the amount of unnecessary work and patient deaths" according to a confidential memo.

Chief Executioner of Operations, Janky Cracka Fool, gave this canned and completely insincere statement about the new plan: "We here at Hospital of Lost Causes are really proud of our bizarre and notorious reputation for completely ridiculous and frankly, atrocious levels of hazardous, toxic, and unsafe practice and policy, and I think the BUNK-U epitomizes what we're all about."

Credited with the idea for BUNK-U, and five time winner of the Seymour Koffins Award (Hospital of Lost Causes' dubiously prestigious nursing award which replaced the Florence Award in 2005) is The Nurse Formerly Known as Soviet Reject Tech. In halting English, Ms. Soviet Reject states somewhat incomprehensibly, "For my RN III project, I take look at amount of surgilube and correlated that to fall risk angel sign. Then, I come up with BUNK-U idea, which work very well in my home town in Siberia. Everybody now send me death threat! I feel so lucky; it's just like being back in Victory Retraining Camp in my homeland."

One nurse, who spoke on the condition of anonymity and appeared to be in critical but stable condition herself, merely said cryptically, "We are Legion!" Other nurses around the unit wandered aimlessly about with a tell-tale " thorazine shuffle." Although they had patient assignments on multiple floors, these nurses, who appeared to be on suicide watch themselves and often were chained together in groups by the ankle,merely gave furtive looks of sheer terror when approached by our reporters, and refused to comment further than repeating, sycophantically, either the hospital's mission statement or the meaning of the R.A.C.E. acronym. Nurses seemed to have an obsessive compulsive tic, checking bed alarms every five minutes or so. In fact, one nurse was found to be totally preoccupied with her seventeen patients' bed alarms, and seemed only to be able to repeat the phrase, "All your bedalarms are belong to us."

Teressa Lotsaspaghetti, former neurological disease nurse and newly appointed Clinical Nurse Specialist for the BUNK-U explains that "I did a study that showed the more you ambulate and check bed alarms, the better and more productive a nurse you are. Even though these nurses have been working continuous shifts for weeks, we feel that the constant movement not only prevents thrombus formation, but also promotes a feeling of communist solidarity so important to good work ethic, and consequently, excellent care for our patients."

When asked where Hospital of Lost Causes saw their BUNK-U vision going in the future, Alesio Bitchtits, newly elected manager of the BUNK-U said, "We're not sure what the Final Solution to the Healthcare Problem is going to be, but I believe we're working hard on honing our skills of eternal damnation, and I think we have an exciting purgatorial future ahead of us."

Patients were not immediately available for comment on the new BUNK-U arrangement, officials said.

as seen on t.v.

2008-03-03T20:09:00.003-08:00

GSW victim:
[wheeled up on guerney; lying in blood soaked sheets]
So, have you been watching t.v.?

NURSE:
No, should I be?

GSW victim:
Can we turn on the t.v.?

NURSE:
[redressing chest tube incision, distracted by, you know, tending to the gun shot wound]
Why?

GSW victim:
I wanna see if I'm on the news yet.

NURSE:
[chuckling good naturedly]
No, sir, I don't think you've been on the news yet.

GSW victim:
[apparently extremely disappointed]
Damn. That sucks.

NURSE
[thinks to self]
As opposed to the bullet that pierced one of your major organs?

son of "as seen on t.v."

2008-02-27T21:21:00.005-08:00

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.

2008-02-27T20:56:00.005-08:00

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.

2008-02-27T20:47:00.004-08:00

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.

2008-02-26T19:18:00.002-08:00

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

2008-02-26T16:07:00.002-08:00

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

2008-02-26T15:32:00.003-08:00

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

2008-02-21T19:06:00.005-08:00

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

2008-02-17T20:23:00.003-08:00

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

2008-02-12T15:51:00.001-08:00

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

2008-02-07T19:40:00.000-08:00

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

2008-02-07T18:51:00.000-08:00

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.

2008-02-06T20:39:00.000-08:00

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.

2008-02-06T19:25:00.000-08:00

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

2008-02-06T17:33:00.000-08:00

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.

2008-02-03T21:55:00.000-08:00

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.

2008-02-03T14:26:00.000-08:00

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,

snow day and creature comforts

2008-01-30T15:44:00.000-08:00

This was the scene the greeted us a few days ago (out the front door):

Proving snow is an equal opportunity type of weather, the back patio and yard received a dusting as well:

And one mustn't forget The Koi Pond:

Meanwhile, inside, we had this cozy love fest, everyone all snug as bugs in/on rugs:

And now, several days later, we finally have the trappings of a living room (including an actual rug!):

Piper seems to be enjoying the creature comforts of this situation; here's a pic of him watching Law and Order (okay, so it was I that was watching LAO, and the dog was merely sitting in front of the t.v. Or was he?):

bunny of leisure

2008-01-26T15:22:00.000-08:00

As I toiled outside in freezing rain (yes! freezing rain!) with the thankless task of sweeping the patio, sidewalks, etc, with naught but a straw house broom, meanwhile, back at the lodge we had this very idyllic scene:

And this one:

And yet another:

All they need is a pipe, silk slippers, a tumbler of brandy, and a copy of the evening newspaper.

suburbia, ho!

2008-01-22T16:32:00.000-08:00

So, we've moved to the Little House On the Hill (pictures forthcoming, when it's not so bloody cold out, and I get off my arse and put batteries in my camera). We have a partial view of Lake Washington (a pretty cobalt color when the sun is shining; slate grey when--as if often the case--it rains) and, on a clear day, we can see the downtown skyline to the northwest, and the snow capped mighty Cascades to the northeast. Lurvely.

Piper now has a back and a front yard, which he surveys self-importantly--and rather less impressively with his diminutive stature--despite the inclement weather, and lately, the frosty chill in the air (the trade off is sunshine, the lack of which was driving me to Seasonal Affective Disorder Overdrive. I was seriously considering buying those light boxes for insane prices. Yes, really.)

Piper even has his own room (largely because we have very little in the way of furniture yet, and the den will probably last on the list of Rooms in Which To Put Stuff). So, what he really has is fleecy blankets piled strategically near a heat vent (donated generously by David, who has since graduated to Jamie's Handknit Crap.)

As for lack of substantive or interesting blog posts as of late--forgive me. I'm aware nothing I say on here has any universal meaning or indeed, even entertains the 2-3 devoted readers who do take the time to look up the site. Furthermore, the quality of said posts has sort of mimicked the Dow Jones/financial state of the market at present (stories of Germans cashing out worthless retirement savings to buy a loaf of bread in a post-War Weimar Republic now sound like chilling echoes of history beginning to repeat itself.)

I can't think of a reason why this should be (the brain melt/crappy posts that is, not the financial state of the world market). My brain is not so much frozen as much as I suspect it has melted into goo over months of subpar intellectual stimulation. I'm a bit worried as I'll have to recover some semblance of study skills for ICU consortium (I love they use a fancy Latin word for "lots of crappy classes in which we teach you stuff that's guaranteed to leak right out your ear the minute a real-life medical crisis asserts itself"; I love Latin in part because makes the mundane and trivial sound so official and regal.)

I'm also worried because New Job at New Hospital is starting soon, and I'm realizing, with rising panic my God, there's a 5:30a.m., and people actually get up at this hour! Seems like a cruel, however usual, punishment for the work-a-day world.

Must not think about New Job.

Must think about something interesting and noteworthy that is not boring. (This crap definitely isn't it).

Stay tuned.

damn it feels good to be a gangsta'

2008-01-14T20:17:00.000-08:00

I'm listening to some distinctly un-gangsta'ish American rock 'n roll right now, but I got all inspired by The Geto Boys earlier, who made some timeless remarks about the U.S. political system (you tube link here) in verse four of Damn It Feels Good To Be A Gangsta (1996)* (full lyrics here).

So voters of the world keep supportin' me
And I promise to take you very far
Other leaders better not upset me
Or I'll send a million troops to die at war
To all you Republicans, that helped me win
I sincerely like to thank you
Cuz now I got the world swingin' from my nuts
And damn it feels good to be a gangsta

If you still can't get enough of the 1990s rap scene nostalgia, try wasting a few brain cells on this site, which will christen you with your very own gansta name.

Fat Ugly Goat Smuggla out, suckas and thugs!

*Remember this gem from the Mike Judge's 1999 film, Office Space? Of course you do!

so easy, anybody can do it.

2008-01-05T19:24:00.000-08:00

One of the things that brings me marginal hope in a week that can best be described as absolutely shitty is the fact that a former stripper wrote the screenplay for the movie Juno, which is supposed to be whip-smart and funny.

This gives me hope precisely because it feeds my fantasy that one day, I too, will be a recognized writer, despite my current crap career as a beleaguered, war-weary nurse. (I think strippers probably have slightly better working conditions than most nurses, to tell you the truth. Definitely more respect from the general public.)

My contract was unceremoniously canceled without warning on Wednesday morning (a day which, note, I was supposed to work). Now I'm out of a job for four weeks, and facing another extended period of more-than-usual worry about finances and housing.

It feels weird to be suddenly unemployed, and wondering if dog food is a good source of protein.

On the other hand, probably watching t.v. shows about spouses murdering their other halves is probably not going to cheer me up, either.

christmas comes but once a year. (thank G-d).

2007-12-29T00:42:00.000-08:00

So as not to offend Ye People of Good Cheer and Good Will and all that crap, obligatory Christmas Dinner Party pictures (of my friend Nancy, and her people, plus me, Obligatory Oliver Twist):

First, Ye Obligatory Photo of Ye Olde-Fashioned Turkey Carvingl:

Next, we shall move on to Ye Obligatory Photo Of Ye Impossibly Cute Little Grannies Chatting It Up:

(Aren't they just so cute you could plotz? Or whatever kanji symbol represents the Japanese equivalent of plotz?)

Where there be turkey, fiat crustula: (Hey, dudes, don't diss my Latin, okay? I know if I were all sexy pimpin' Latin Goddess, I'd translate the whole sentence to flumox and bedazzle all--okay, some--but it's been like what, six long years since Latin I and II? I'm surprised I remembered the subjunctive, or that crustula = cookie, especially at 1 a.m. in the morning):

So, fine: Where there be turkey, let there be pie. (Cookie was as close to pie as I could remember from my Wheelock's vocabulary list).

So much for ironically dumb attempts at cleverness.

Moving along, then, to more Wholesome Family Time:

Can you stand a little more, folks? (Don't worry, we'll soon return to our regularly scheduled program of Jamie Bitching About Her Stupid Job next week!)

Phew! I've exhausted myself with all this posting of memories of happiness and good cooking.

Hope all enjoyed.

full. metal. jacket.

2007-12-19T23:50:00.000-08:00

I accepted a job at Big Scary Teaching Hospital's TICU/SICU.

In a brief psychotic fugue, I had the notion that I am not only in Stanley Kubrick's Full Metal Jacket, but I am, in fact, Vincent D'Onfrio's character, Leonard Lawrence.

I am Gomer Pyle.

And never mind the decidious trees in Kubrick's English countryside Vietnam, I am a stranger in a strange world.

But mostly, I'm Gomer Pyle, sitting in the head with my rifle, loading live bullets. maybe I'm even screaming F-U-C-K-E-D-A-G-A-I-N to the tune of the Mickey Mouse Club song.

Well, okay, so I don't actually have a rifle, and I call the bathroom a bathroom, not a head.

But I can envision myself sometime in the next few months, singing a rousing chorous of "Fucked Again" on my Nazi death march to the shuttle parking lot, at the end of a long, grueling shift, alternately screaming at my companions, "Raus! Raus!"

Or maybe, to shift movie metaphors, I'm in Apocalypse Now. I'm Charlie Sheen, dancing half naked across the room, muttering:

Everyone gets everything he wants. I wanted a mission, and for my sins, they gave me one. They brought it up to me like room service...It was a real choice mission - and when it was over, I never want another...

Or Chef:

Never get out of the boat. Absolutely goddamn right. Unless you were goin' all the way.

What I'm saying is, I don't exactly envision the next few months are going to be full of sunshine and lollipops.

bargain basement diet drinks!

2007-12-05T16:36:00.000-08:00

Call me crazy, but I am way, way suspicious of my gut.

I'm pretty sure it's plotting to do me in.

I came home Sunday, after a Fun In The Sun type holiday in Florida (with all kinds of solid foodstuffs crammed down my gullet by a mother who replied to my protestations of, "I've gained weight!" with a dubious sniff, "Well, you're not as emaciated as you were before.")

David came up to a very Meet the Parents type scenario, in which Mom Indefatigably Exhausted a Plethora of Boring And Slightly Embarrassing Childhood Stories, Dad Chuckled More Heartily Than Usual, and Jamie Was Rather Glad To See The End Of Said Debacle.

Fun for all, I expect.

D and I then went down to St. Augustine, for a baffling chilly afternoon of Touristy Goodness, of which I have pictures that I am too dizzy and lightheaded presently to bother with posting.

Off the next morning late to Orlando, and later on that day for me, a fun-filled evening transcontinental flight designated for Evevryone And Their Screaming Two Year Old. Pleasant.

The next morn, I awoke to an unwelcoming, depressingly soggy and soaked Seattle, in which it half-heartedly was attempting its best at frozen precipitate (aka snow).

In addition, it seems I also had borne along with me from O-town, a wonderfully nasty GI virus (which Loz believes I contracted from her via internet) and was laid low for two days with gut-wrenching stomach pain and nausea of the likes I have not had for quite some time.

Eh--hew.

Done with The Sickness Unto Death, for now at least, I feel a bit weak, and my stomach seems rather suspicious still of solid foods (which still bother my tummy) but I soldiered on bravely today to Target, where I bought all manner of cheap dry and canned goods.

May I also confess I bought Target Brand Diet Shakes (chocolate flavor, if you must know).

And while I may now be stocked and pilloried, internet-style, and have my ninety-five pound ass mocked for all eternity (or at least until the internet runs out of usuable space, which I am told Is Going To Happen Any Decade Now) may I feebly offer up a small bit of defense on my part for the purchasing of such ludicrous goods?

First of all, Target brand was cheaper by a buck or so than the Comparable National Brand. And I am all for the "penny wise, pound foolish" approach to savings. Second, I can't wait to hear my co-workers not only ridicule me for drinking diet shakes, but for drinking Target diet shakes at that. I mean, there's even the bullseye logo on the can, so I can't even be discreet about my cheapness.

Lastly, let it be known far and wide: I am not attempting to lose weight! But, my stomach dislikes, apparently, for me to eat too much solid food, and yet, I require caloric intake as much as the next person. Alas, eating can be difficult to do when you're running around a unit for eight to twelve hours at a time. Ergo, we arrive, at last, at the logical conclusion: Fake Slim Fast, Target Style.

It's a meal in a completely environmentally-unfriendly steel can, people!--how much more ludicrously, gratuitously American can you get? (Yes, I recycle. When I remember to. No, I don't know why it has to be a steel can. I suppose they had to figure out what to do with all those old steel-bodied cars from the 1950s lying in junk heaps around the nation).

Yes, instead of actually putting effort into feeding myself nourishing food, at thirty-one, I'm still seduced by the promise of fast food as solving my caloric and nutritional needs.

I fully realize I suck as a human being, okay? Just let me drink my cheap ass synthetic Target drinks over here, please, and you take your self-righteous I-cook-all-my-meals-from-home-grown-organic-preservative-and-artificial-flavor-
free-foodstuffs over there thank you.

In the meantime, Much Knitting has been completed, including Linen Kilt from Knit 2 Together and Mystery Gift for Loz's Bump-Which-Is-Soon-To-Be-Baby. Hopefully, Sea Horse Express will not drown on its way towards the fair continent of Australia/merry old land of Oz, and baby will have her baby things before she applies to university.

In other news: I have made up my mind to make up my mind by Monday (or, possibly, Tuesday) on Which Job To Take. The debate must end, before my head explodes, my family disowns me, my friends stop answering their phones when they see I'm calling, and David leaves me in lieu of less frustrating but slightly more interesting company, such as a Rubik's Cube or Jenga Tower.

breakfast of the champions

2007-12-02T00:02:00.000-08:00

holiday! celebrate!

2007-11-26T21:00:00.000-08:00

I'm on holiday from work for the next week, and headed to Florida.

I have a fun red-eye flight ahead of me, and am actually sitting here in the SeaTac Airport, typing this oh-so-interesting entry.

In work-related news: I have another job offer. When it rains, it pours, people.

This job offer is in a combined Burn and Pediatric ICU. Pros: I think wounds are interesting. (I can also talk, while eating, about digitally disimpacting feces and other people's vomitus without batting an eyelash or turning my own stomach. What I can't do is ride in a car without feeling nauseous and needing Dramamine. I am cursed, I tell you.) Cons: Burns are painful and disfiguring enough-- taking care of burned and traumatized children strikes me, on the whole, as much, much worse than taking care of burned and traumatized adults.

And while I think of intubated, sedated adults with complex medical and surgical problems as interesting nursing, I think of intubated, sedated children as completely sad and tragic.

No more work. Must think of sunshine and beaches and mostly no work.

worker bee, buzzing away!

2007-11-25T02:59:00.000-08:00

As any one who has been within 5 feet of me (or, e-mail recepient or telephoe capable) lately can attest, I have been Freaking Out About The Job.

I could outline the Freaking Out About The Job thing, but, I hated when they made us do outlines in school. Does any one remember that crap? I do. Because, like I said I hated it.

I think I hated it because I never really needed to outline my crappy ideas--they just flowed organically, like so much crap.

In any case, it's kind of like a showdown: TICU vs. CVICU.

Oh, did I tell you? Another friggin' two job offers. One on Beloved Stepdown Floor, With The Cool Peeps, and another one at Happy Hospital's CVICU.

For the record, the job version of NBA playoff proportions reads: TICU vs CICU vs CVICU vs Stepdown.

(Continuing the lame sports metaphor, this job debate would make for some great WWF wrestling match ups, too.)

Any way.

One of the sub debates I'm having involves my own work ethic, which is really kind of crappy, from an attendance point-of-view.

I'm usually a very good worker, when I show up. It's just the showing up part I have trouble with. I think I'd be fired more often, if the nursing shortage wasn't so bad, and my work was remotely shoddy, or I quarreled with my colleagues frequently, or smelled badly.

My work ethic actually puzzles me somewhat, because I was very diligent about showing up for school (well, until certain parts of undergrad, and grad school). I'm sure I won lame Attendance Awards--which I'd like to show to my current employers, to show them I wasn't this loser-ish all of my life.

In my defense, the high stress and the physical bullwork of the job has me succumbing to various minor illness (and the evil tummy issues, which are Largely Mysterious, not to mention very painful). I don't like to go to work feeling sub par, because I'm always afraid I'm going to get a very heavy, taxing assignment, and screw something up, and kill someone accidentally. I'm less worried about the latter than I was two years ago as a new grad, obviously, but, I still worry about it.

Any way, this nattering on about work ethic all dovetails into my current "Which job should I take?" because I realize ICU is gonna be hard. I'm basically going to be a new grad all over again, and the patients are going to be, by definition, more unstable and a lot sicker, and I'm really going to need to be in top physical and mental form to do the job properly.

Only, I don't feel top form at all. I feel sort of soft-around-the-middle, like I've lost my edge. Maybe I freak out less because I know my job better, but then sometimes I worry I've become some lazy ass second rater.

I also don't feel physically up to it, on a lot of levels. The part of me that deeply wishes not only to avoid hard work, but also preserve my joints and ligaments for a slothful old age of bitching about my nursing home amenities, feels a bit worn out. That part of me wants to be Part Time Jamie, with the cushy eight hour shifts, on evenings, a schedule with which my body can actually cope semi-decently.

I don't really want to do twelve hour shifts (because oh! The PAIN! IT BURNS! I say). I've never been a twelve hour shift kind of girl. Because anything over eight hours in a work day = slave labor, in my book.

I don't really want to do nights either, because I don't remember much about my life on night shift last year, except that I was constantly sleep deprived and very, very very cranky. Plus, I was continually disoriented. It was a bleary, post-hangover way to live, without the fun of imbibing or indeed, ever being drunk in the first place.

Unfortunately, I seem to have about 36 years left until I can retire and collect my Fake Social Security. Thanks, Baby Boomers, for consigning me to a few more years of pointless, soul crushing employment!

Any way, my biggest fear (other than learning a brand new job, and staying awake at night--oh, excuse me, I mean, during the day, when I'm supposed to be sleeping--wondering if I accidentally killed someone, even someone on tons of life support) is failing at a) showing up to work at all and b) staying awake on night shift long enough to learn anything about not killing my patients.

There are many, many more tedious sub-debates about this whole Job Debacle, which I subject my loved ones to in a constant, monotonous litany ("What if it sucks?!" and "No, seriously, what if it really, really sucks?!" being the top two favorite variants of the same damn thing). Maybe I'll treat my erstwhile readers to a few of them, in good time.

However, I'm trying not to alienate everyone with my boring prattle, and considering the same people who read this blog also probably are getting fifty e-mails a day debating the de/merits of each and every single facet of my oh-so-fascinating dilemma, I think I'll stop, and spare everyone the grief of recounting it again, in IMAX like proportions.

geeky geekiness

2007-11-16T20:34:00.001-08:00

A couple of nights ago, I dreamed I was in Latin class.

Duuuuuuuude.

I soooooooo need some better drugs.

I mean, come on Jamie, how geeky can you get?

Let us count the ways:

1) Dreams about Latin
2) Dreams about enjoying Latin class in a happy, blissful way most people associate with eating their favorite dessert, or watching the world unite in utter peaceful harmony (over Latin, of course).
3) While dreaming, criticizes the choice of textbook used and laments the absence of Wheelock, the One True Latin Textbook.

I think in many ways #3 is even geekier than my favorite Latin dream, which is the one where I'm winning University Honors in Latin.

Oh well. I suppose this beats the dreams I have where a patient is coding and I'm immobolized with fear and dread, whilst others about me beat me on the head to do something, stat.

trauma drama.

2007-11-16T17:06:00.000-08:00

I know this this is gonna come as a shock, but I am seriously considering a job offer in a Surgical Trauma ICU at a level one reigional trauma and burn teaching hospital.

I know, I know.

What happened to CVICU Bitch Goddess dreams, Jamie?

Well, you'll be happy to know that those dreams haven't really gone anywhere, they just might need to be delayed in favor of Mega-Awesome Hardcore Trauma ICU Job That Will Kick My Ass.

I really hadn't given serious thought to changing my specialty. Believe me, I was like, 'CVICU or Bust' last week.

The problem is, CVICU at Happy Hospital where I currently work (and despite the bitching, actually really like) was dragging their heels about an interview, and Lofty University Teaching Hospital 's CVICU isn't hiring.

So, I decided to go for what I thought was a second choice, and interview at a hospital I like to call 'Crack Ho's Evil Twin's Inn'--the facility best known for its sexy, hardcore ICUs on the one hand and "charity care," on the other."

Nota bene: "charity care" is hospital corporate speak for "We treat all the crack/meth heads in town." And "sexy, hardcore ICUs" is Jamie speak for "And then, all the crack/meth heads go directly to stepdown or MICU, so TICU doesn't have to take their crappy overflow.")

Suffice it to say I wasn't stoked about that patient population (we often get this hospital's overflow "fake chest pain for narcs" at Happy Hospital, and we begrudingly joke, "Why couldn't Heroin Addicted Bitch go have her totally fake chest pain in [Crack Ho Hospital's] ER?")

Not a place I ever thought I would consider in my ugliest nursing nightmares, in other words.

So, how did I get lured over to the Dark Side?

Well, it certainly wasn't the money (ugh, staff wages again!) nor was it the opportunity to become, once again Vampyre/Shift Work Disorder Bitch Jamie (night shift, alas).

It was, however, a pretty impressive interview and tour, and the unit manager talked up this unit, and every single nurse I've talked to thinks this is the sine qua non of ICU experiences in the metropolitan area.

Plus, the Mega Geek, Mega Type A Bitch in me got seduced by the elitism of it all. This is the floor for which the hospital built a brand new wing! This is the floor that typically has a waiting list of RNs! This is The Floor.

Any way, that was the schtick and schmooze I was sold on, and believe me, that manager must've had my number down when she looked at my application and saw what a dork I was, going to all that school.

I like sick hearts and open heart surgery better, but, I think I'd kick myself in the ass later on if I didn't take this job.

And, I knew, no matter how painful and sleep deprived next year is gonna be, that I was meant to be an ICU nurse when I saw intubated, vented sedated patients on a dozen drips, with more invasive lines than Jesus had disciples, and the first thought I had wasn't "My God! Run away! Run far, far away!" but rather, "RAWK! Patients who can't talk to you or get out of bed! No ambulating those poor bastards to a commode! Beautiful!"

Don't get me wrong. The sight of patients more complex and sicker than any other patients I've ever seen terrified the shit out of me.

But, sick bitch that I am, it was also kind of... well, my version of interesting nursing, where the focus of nursing care isn't a stroll around the nursing unit for a post CABG patient, it's the patient's illness and management of their comorbidities, period.

I feel I'm a better nurse when I don't have to talk to the patient, and can focus on things like memorizing their lab values. I'm not a good "talk and teach" nurse, who's into stepdown type activities like progressive ambulation and breathing exercises. I find I don't care that much about coordinating their discharges with social work to skilled nursing facilities, or any of that psychosocial crap.

On the other hand, give me the medical side of the nursing bullshit, especially on a patient who's about to go south, and I'm all over it.

Like, if I were a patient on stepdown, and I somehow had some version of me as a nurse--I'd think I was kind of bitchy and perhaps, even a bit clueless about stuff I wanted to know about, like whether or not I'm going to get my dinner tray on time, or if I can get up and go to the bathroom.

But, I'd want a nurse like me around if I was on a stepdown unit, getting acutely sicker. Sure, I'd probably remember to thank the sweeter, nicer nurse who arranged my pillows in exactly the geodesic dome shape I had taken the trouble to diagram prior to my hospital admission. On the other hand, I'd be around to thank her because Bitchatolla Jamie Nurse--who I only vaguely remember as The Bitchy Nurse who barely took the trouble to conceal a sigh of deep annoyance when I asked to be ambulated to the commode--was around to get me back to the unit before I respiratory arrested, or something like that.

I'm not saying ICU is gonna be bullshit free, because if anything, it's gonna be more bullshit. But, at least it's gonna be highstakes, hardcore bullshit, and not some lame drama over a patient who didn't like what the brand of yogurt that had been brought up on the dinner tray.

And, I'm going to probably suck at my job, and feel incompetent for at least a good year after orientation, and this is probably good for me, so I can remember those sweet, innocent days of stepdown nursing and all the complaining I did over largely stable patients.

Well, any way, all this is outloud talk. I reserve the right to tuck tail and pass on picking this particular professional poison, and stay at Happy Hospital, on Friendly Fun Unit, with my peeps, all hanging out and joking for at least part of the shift. After we ambulate our patients and tuck them into bed for the night, that is.

why work is a wanker.

2007-11-14T01:45:00.000-08:00

I've managed to figure out a major distinction in my Why I Currently Hate My Life's Work.

It's not really about the job. The job itself, at this particular hospital, on this particular floor, is fine. The people I work with are really nice and mostly sane, and most of the time, I can get a marginal amount of shit done during a shift (which is saying something, given the usual conditions of hospital nursing).

It's more about the profession itself, and the basic job description of a nurse.

For example, I think, baseline, I'm supposed to care about my patient. And I think I do care, in so far as I deliver mostly safe, medically sound nursing care.

But, lately, I care less and less about the patient, and more and more about how very, very bored and frustrated I am with a job that is starting to feel increasingly stultifying and pointless, and never really made me particularly happy in the first place.

I'm tired of the subservience and general all around lack of social status associated with nursing. Nursing, for all its aspirations to be taken seriously as an actual profession, still is and always has been a pink collar job.

I'm all for degrees and professional advancement, I just don't think it's necessary in bedside nursing, and there's a reason why there are multiple points of degree entry that all culminate in the same licensing process and boards: because baseline, being a bedside hospital nurse requires some common sense, an ability to multitask, and a deep enjoyment of being treated like a servile wench.

It doesn't require years of college, however, and I have always thought that my years of schooling are an impediment to tolerating my working conditions, which often require me to modify my vocabulary and communication skills to that of an average seven year old in order to "reach" a "challenging patient" (read: noncompliant asshole).

For indeed, I find half to three quarters of my job duties, while requiring excellent organizational skills, feel to me as if a moderately intelligent fifteen-year-old with a solid babysitting background could probably manage independently if given minimal direction.

Practically nothing that potentially interests or attracts me about the profession (treating and managing disease) is actually in my purview or scope of practice, and ambulating patients to the commode and warning them about sternal precautions and using their incentive spirometer, day after day, frankly, gets a little old.

In short, it's hard to be stuck in a job when frankly, you know your intellectual capacities far outstrip the job requirements. I imagine most nurses end up feeling this way, at some point or another.

I'm really kind of over the profession, to tell you the truth. Going to work feels more like some kind of crappy adult version of detention, complete with writing lines.

I thought, maybe, doing ICU would make me feel more of a bad ass, but, on the whole, I think after a year or two, I'll simply feel like a monkey who's been trained to pull a few more levers and push a few more buttons. And that monkey will probably be even more stressed out, bitter, and overworked. So, I'm not sure I should really do it, even though the annoyingly type A, bitchy competitive part of me wants to do it.

Sadly, I'm currently all out of ideas as to what I should do, or what new stupid job I should pursue. The bad thing about being in a profession you hate is that it kind of starts crushing your soul after awhile, and you end up in this anhedonic, borderline depressive state which pisses off and alienates all your loved ones and colleagues. Especially when the whole ICU application process seems like a never ending scene from a Tarkovsky film.

I suppose it wouldn't hurt to try ICU, though. I mean if it sucks, that's basically par for the course , and I can do something else.

There's always the annual post-end-to-Daylight-Saving-Time depressive funk to resort to, as well, in which Jamie loses interest in her life and takes to sleeping 16 hours a day when not at work.

But, that doesn't sound very healthy, either.

blanket statement

2007-11-11T12:27:00.002-08:00

It's been All Blankets, All the TIme Around here. Behold: Christmas Blanket 2007 (Christmas Blanket 2006 met an unfortunate fate in mom's washer, and has been demoted to the lowly status of Erstwhile, Would-Be Potholder 2007).

And, below, my take on a Gee's Bend Quilt.

This blanket was a birthday present for David, although Piper claimed it several times during its inception and completion:

David has brought up the suggestion that I knit a blanket for Piper, so he doesn't have to look all pathetic and sleep on the back of the couch, blanketless, in this pathetic manner:

I'm convinced PIper should be spokesdog for those charity commercials: Save the Endangered Couch Dwelling Dog. I mean, look at the pathos in that pose!

wolly bully.

2007-11-11T12:21:00.000-08:00

Piper, status post bath.

why, hello there, may I help you?

2007-11-11T11:49:00.000-08:00

it's like you never left. because you never did.

2007-11-04T07:44:00.000-08:00

Because the end of Daylight Saving Time came later, I worked a 17 hour shift, from 3p.m. until 7a.m.

Just saying that makes me think of some kind of bizarre preamble to Kiefer Sutherland's 24: The following takes place between 3p.m. and 7a.m.

Bonus: I warded off the scabies/MRSA/fungus admission. This poor person went to another floor, actually. Because the words "open heart surgery patients" should never be used in the same sentence as "scabies" and "fungus." (Really, MRSA should never be used in the same sentence, either, but we'll give ourselves credit for doling out that one all by ourselves!)

Not-so-bonus: I got, instead, a "drug-seeking" chest pain admission.

Amusing part of the shift:

ADMISSION NURSE:
So, what meds are you on at home?

CHEST PAIN GUY:
[in thick working class Worcester, MA accent]

I take Cah-di-zam.

ADMISSION NURSE:

Wha'?

CHEST PAIN GUY
[clearly annoyed by the need to repeat himself for these special needs, developmentally delayed West Coast bitches]:
Cah-di-zam.

JAMIE:
[quickly intervening/translating]
He means Cardizem.

ADMISSION NURSE:
[vaguely huffy]
Yeah, I know.

Not-so-amusing part of the shift:

CLOCK:
2 a.m.

CLOCK:
[one hour later, thanks to the End of Daylight Saving Time]
2 a.m.

what a gas.

2007-10-31T17:15:00.000-07:00

In what may well be My Exercise Quotient For The Winter, I went on a run with my friend Nancy at Gas Works Park, an unfortunately named, but pretty, park in northern Seattle. We ran to the Fremont Bridge. David and I know Fremont from our haphazard journey to Woodland Park Zoo a few weeks ago. The neighborhood boasts not only of being "the center of the universe" but even has a Latin motto: De Libertas Quirkas.

It has a Latin motto, so it's settled. I must live there.

My favorite part (other than spending time with Nancy, and getting gifts of Professional Running Clothes Such As I've Never Had Before) was the lunch buffet at Bengal Tiger Indian Restaurant in the U-district. We met up with her friend Donna, also a nurse, and her friend Erica (not a nurse, who looked politely interested as conversation turned, inevitably, to shop talk.)

Any hoo.

In other news, I threw my keys and wallet down the trash chute today.

We won't even get into how I managed to accomplish this feat of incredible ridiculousness, but due to some unnamed maintenance person at the apartment complex, I have them back, in non-compressed form.

Instead of discussing my retarded behavior, we will laugh at the even-lamer remark made by one of the front desk people, who misheard the word "keys" and said, "Wait, a tree? Is it your tree or someone else's tree that's stuck in the trash chute?"

Even more annoyingly, she said it in that flat tone of bureaucratic indifference that translates,"I-really-don't-give-a-fuck-and-hope-I'm-not-the-one-responsible-for-
doing-anything-about-your-dilemma-but-I'm-standing-here-so-I-suppose-I'll-
have-to-feign-interest-and-ask-you."

If I hadn't been more worried about my keys becoming one of those tidy cubes-o-crap you see in cartoons involving the joys of trash compactors, I would have told her to go back to looking unhelpful and dour silently, please.

I mean, seriously. Why bother to pretend you were listening if you're going to say something that asinine as your response?

bye, bye, blackie

2007-10-27T20:06:00.000-07:00

I woke up today and like a lazy ass, I didn't bother to get out of bed until about 11 a.m.

When I did, I went hopefully to the mouse cage. After a leisurely shower, which I now somewhat regret.

I was even thinking, as I washed my hair, that maybe I should call the vet, now that Blackie (my mouse) was seemingly getting better, and see if they could change the antibiotics from po (by mouth) to IM, or SQ, or whatever the heck it is they give to something that weighs slightly more than the supposed weight of a human soul (didn't you see "21 Grams"?)

Maybe I should have taken Blackie's refusal to take her meds these last few times for what it what: 'Dude, I know I'm dying, get over it, you big stupid human, and stop trying to feed me this pink gooey shit out of a dropper.' But she seemed to be eating more, and a little more active, and I was stupidly hopeful that she'd do one of those Miracle Mouse Recoveries.

Alas.

Blackie 'waited' long enough for me to amble over the cage, notice she was breathing in a close-to-death, horrible sort of way, and dragging her left side around in a panic. She was gasping, miserably, and looked at me.

I understood she was dying, and I knew it was probably too late to ask for proper help.

I picked her up, thinking crazy thoughts about mouse CPR and intubation, and how did secure the airways of rodents the size of chicken eggs, any way?

I called the vet.

Less than five minutes later, I knew she wasn't gonna make it to the vet. So, in vain desperation, I called to ask if I could bring her in now.

Just as the the receptionist said, 'Sure, bring her in, dear." I knew it was too late, and I told the receptionist so. The mouse died as I hung up the phone.

I don't know. It was pretty horrible, because she went the same route as my adopted rabbit Mookie did last year.

In fact, Mookie died on October 16.

Other Pets of Jamie, take head: October is turning out to be a historically crappy month in this household for Unfortunate Pet Expirations.

I didn't think I was gonna cry over a pet that cost less than a gallon of gas, even adjusted for inflation.

But, I did.

Then, I took Piper to the vet for his annual check up (I learned today they check a dog's prostate in the same way the check a human male's prostate. Eew).

I just about cried when I saw the bill for his vet exam, but those tears were (almost) shed for a different reasons, namely, my poor wallet.

a mouse, a mouse, a kingdom for my mouse.

2007-10-23T20:42:00.000-07:00

At the risk of shitting on Shakespeare, I just have to say...

My poor mouse.

I know it sounds nuts, but I really do have a pet mouse. Two, actually.

I didn't really name them, and refer to them even now as "the black one" and "the fat ass."

However, since "the black one" while descriptive, doesn't sound like much of a name, I decided to call her "Mousie" or "Blackie." Well, I kind of had to fake like that's been her name, when I drove to the clinic. (Drove to the clinic, got lost, was forced to drive back home again, and then drive back to the friggin' clinic. It took me an hour to drive 4.4 miles. For a mouse.)

(And, incidentally, since "the fat ass" sounds just plain rude, I call "the fat ass" mouse "Martha Stewart." Maybe "fat ass" is less rude than calling her Martha Stewart, I don't know, but she's fat, blonde, bitchy, and makes a mean mouse nest, so it works.)

Any way, the black one is My Favorite Mouse Child. She's friendly, inquisitive, enjoys climbing, and isn't shy at all.

However, the black one is also Very Sick. And I feel I have been a Very Bad Mouse Parent, watching her get more and more snuffily, and thinking "oh, she'll get better."

Any way, I think it was Hagrid of the Harry Potter books who said it best when he tells Ron to forgive what he thinks is Hermione's misguided love for her cat, saying, "Well, people can be a bit stupid about their pets."

And how.

Case in point: I took a little pestilential creature worth a few pennies to a specialty vet clinic today, and paid eighty bucks for a vet to look at her and tell me what I already knew: mousie is very ill, and is probably going to die from pneumonia any day now.

He gave me a a milliliter of antibiotics to assuage the Pet Owner Guilt, and declined to put her down, although he didn't think she was going to make it.

I call tell he was thinking this way, because he started giving me the same speech about the mouse that we give to family members of human patients when we think their people are super sick and won't make it.

It goes like this, "Well, we can hope for the best, but really, you need to prepare yourself..."

Translation: "You're loved one is a goner."

David, in all his dry humor, encapsulated the comi-tragic scope of the thing when he said: "I think he was thinking he'd save you the extra fifty bucks to put her to sleep, considering what you spent already on a vet visit for a pet that cost you less than a Happy Meal to purchase."

Yes, thank you, Nurse David, for that wonderfully heartwarming sentiment. I'm sure the hospice patients all love your warmth and sensitivity in times of crisis.

Clown.

Any way.

So, I'm doing the Fake Hope Thing, like when a stroke victim's wife says hopefully, "Oh, he's doing so much better today! See, he's practically talking!" and I'm looking at the patient, and he looks at me, and I'm thinking, at best, he has expressive aphagia, which is nowhere near talking coherently at all.

Meanwhile, back at the farm, I'm pretending the Fake Antibiotics (I guess they're real, but whatever) are making her feel better, even though I can practically hear the poor mouse's agonal breathing from across the room.

It's very silly (my sadness over my little mouse) because I've only had her as a pet for about a year and a half, and she's just a little mouse, and it's hardly like her suffering matters in the great big plan of God's Craptastic Universe.

But, I feel very guilty I can't give her more palliation, as opposed to stupid fakey doses of antibiotics. I think the vet is convinced I will feel better about her death if I go through the motions of allopathic cure, but I just feel like that time they made me tie down that demented patient so she could die this really crappy, prolonged death.

I do draw the line at mouse CPR or radiographic studies of her lungs for definitive diagonsis, though.

And, who knows. Maybe the abx will do the trick, and she'll be able to breathe better, and I'll feel less guilty about not putting her to sleep.

Although, based on my experiences in the hospital, I sort of doubt it.

represent.

2007-10-22T18:30:00.000-07:00

Work has been a mite better than say... oh, last time I blogged.

My assignments were pretty decent, in that my patients a) stayed in bed b) complied with treatment c) weren't on the call light every five minutes d) had appropriate family members, or none at all.

As horrible as it sounds for the patient, I sometimes wish they didn't allow family/friends to visit for hours at a time, because my God it's such a fucking inconvenience to have to talk to them.

I loathe talking to the family, who always want to know something mysterioso I can't possibly answer, but they think I should magically know. My least favorite question du jour is When The Doctor Is Going To See Their Dad/Mom/Brother/Sister/Pet Hermit Crab?

Dude, if I had a dollar for every time I was asked that question, I could quit nursing and do something marginally more useful with my time, like knit blankets for homeless pet hermit crabs.

Then, for some reason, they want to know How Dad/Mom/Brother/Sister/Pet Hermit Crab is doing.

Like, what the fuck do I look like, Font of Hospital Wisdom 2007? The Great and Powerful Oz? An internet search engine?

How the fuck am I supposed to know, exactly?!

Half the time, the doctor's don't even know precisely what the fuck is going on, and I'm magically supposed to know myself?

Fuck the Nurse Friendly crap. I wish it was possible to say, "I don't know how they're doing, but give me fifty bucks and I'll make up some half-baked story, like I'm doing now, so you maybe won't bother me for fifteen minutes, so I can go see my other patients and make sure they aren't dead."

In fact, I think I have a reputation around the unit as being a bit of a hard-core bitch when it comes to whiny family/patients. I make the unit nurses laugh with my blunt expressions of apathy and toneless, ironic wit, but I think I also scare them just a little bit.

I know.

Me. A bitch.

Who would have thunk it?

I'm actually kind of honored, though, that other bitches think I'm a bitch. It's kind of like getting jumped into a street gang.

That totally makes me like, Bitch Goddess of the Unit, or something.

I know that's not exactly something to be proud of, but it is kind of funny, because before I became a nurse, I thought of myself as a nice, mature person who didn't play petty power games with others, or have to suppress the urge to roll my eyes and look totally annoyed when families ask how old, craggy grandpa hermit crab is doing.

But, it turns out, I really am an impatient, half-crazy Bitchatolla with very little emotional self control when it comes to high stress situations that aren't life threatening.

Stunning revelation, that.

For example, this weekend, I happened to be totally bitching to my coworkers about some wacked out Uber-Weird, Uber-Bitchy interventional radiology nurse. This nurse was totally giving me the shit-end-of-the-guiac-stick, so, in retaliation, I decided to page him a few extra times, just to piss him off.

I knew it was totally immature, and that he wasn't gonna answer the pages, but I know how fucking annoyed I get when my pager goes off multiple times in a row over the same crap, and he'd been such a fucking asshole, and left me with about an hour's worth of extra work to do, that I decided, "Ha ha, bitch! You just fucked with the wrong bitch, bitch!"

It was a very Cartman moment. I get kind of teary-eyed thinking about it.

By now, the unit nurses have all gotten used to my style of The Sky Is Falling tantrums when I get stressed out over nothing. I think they sort of treat it like, "Oh, here goes The Jamie Show. Tune in next time, same Bat Station, same Bat Channel."

I seem to only have this reaction to minor, bullshit situations. When Real Shit Hits The Fan, I'm pretty reliable and get down to bid'nez, and that's why I think my colleagues overlook my unfortunate tendency to hyperbolize when I run into some small snafu.

But, when I was a new grad, on the floor where I was a new grad, guaranteed, this little crap incident would suddenly snowball into some multi-faceted situation that would totally suck ass for the rest of the shift. In Ghetto Nursing, you had to have your back up 24-7, or you totally got beaten down and taken out. So, I kick Freak Out Mode into high gear, totally over-compensating, because that's what we all did back in my Ghetto Nursing Days.

It's like East Coast meets West Coast, and West Coast is all, 'What the fuck is wrong with that East Coast bitch, all stressing over nothing? It's all good, man. Tell the bitch to chill out!"

(Telling my East Coast Ghetto Nursing stories to these West Coast Kayak-Granola Nurses, I notice there's a huge disconnect between my New Grad world full of thugs and hos, and their world of Duuuuude, Possession of Pot Is Just a Misdemeanor Here, Quit Freaking Out, It's All Good. )

Any way, one of my colleagues, who I consider to be a sharp nurse, but even more of an abrasive bitch than I am, laughed at me as I was muttering aloud like a psycho, planning my petty paging-fest revenge, and said, humorously, "Oh my God, Jamie! You're a such a fucking bitch!"

I know it sounds fucked-up, but this was her version of a compliment, and I took it as such.

"Yeah, well, bitch shoulda never given me his pager number, that dumb fuck idiot." I declared in a self satisfied way, as I imagined that Bitchy Interventional Nurse going all status epilecticus as his pager went off for the fourth time in a row, courtesy moi.

I'm glad I spent all that time in divinity school writing essays about compassion and forgiveness, because it certainly hasn't come in handy when dealing with boneheads on the job.

The Scutmonkey

Red Scarf Project

Top Ten Signs You Might Be Living in the Tri-State Area

screw that!

The Curious Incident of the Fake Wife In The Nighttime.

beginning, middle, end.

a day late and a loonie short

Big T's Resume and Cover Letter Service.

shit never dies.

This Is Your Brain: An Illustrated Guide For Trauma Patients and Their Family Members

Sartre Kiteboards

in which I labor under the delusion "everything is fine."

in defense of academia

Icarus be damned or "Back in the saddle again."

begin the begin.

possession

the bladder scanner as postmodern metaphor

plus ça change...

bullet proof bullet points

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

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

folsom prison blues (lego style)

i-pod

hiatus: a brief retrospective.

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

canto

perishable goods.

late night living

The Silence of the Worms

time in a bottle

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

double your fun

blue's clues

mostly martha

day is the new night

tired of being tired

crash course.

"seat belts save lives." discuss.

do androids dream of electric sleep?

g'night.

belltown

little black ache

why I heart hearts.

misery hates company

bright copper kettles and warm woolen mittens

sickness unto death

batteries not included.

most of what i know.

k.c. and the sunshine band

lost

shit never dies.

Random REM

snake oil charlatans alive and well, thank you very much.

Pavlovian hubris.

silver bullet

A Few Rules For Surviving an ICU Orientation (Dignity Intact Optional)

mulled whine

fool's gold

for the discriminating cheapass

Hell is For Heroes

All your bedalarms are belong to us.

Rabelais a day... keeps the lawsuits at bay.

as seen on t.v.

son of "as seen on t.v."

zen and the art of motorcycle maintenance.

ba da bing. ba da boom.

be on time. do not be drunk.

no news is good news

occupational hazards

top ten things never to say your first year in ICU

sedation vacation

dis-oriented

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

the early bird not-so-special

older, yes. wiser, no.

waking up is hard to do.

as good as a hole in the head

on the 3rd evening.

All American Girls.

snow day and creature comforts

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