shit never dies.

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

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.

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.

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

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)

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

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

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

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

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.

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.

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.

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."

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

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

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

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

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

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

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

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

zen and the art of motorcycle maintenance.

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

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

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

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

ba da bing. ba da boom.

Overheard in the ICU:

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

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

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

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

be on time. do not be drunk.

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

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

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

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

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

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

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

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

no news is good news

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

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

Honest, it was more fun than watching paint dry!

But just barely.

occupational hazards

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

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

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

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

Maybe they knit while they roller derby?

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

top ten things never to say your first year in ICU

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

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

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

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

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

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

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

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

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

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

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

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

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



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