"Because you don't suck."

Ok, this morning, I was walking towards my car with another ER nurse friend of mine, someone I really just love because she's a great nurse and actually genuinely kind.
And the subject of double time came up -
we get double time pay when we stay over past our 12 hour shift (rocks, seriously). And she made a comment, and I commented back that my pay was not that much.
And she said, "Why? That's BS!"
And I reminded her:
"Well, they started me at the lowest pay possible. I've only been a nurse for 17 months. I'm a baby."

And she stopped, and looked at me, and said, "You know, I forget that, because you don't suck. You're, like, really on top of your sh*t." (that word is obviously "shot" since I work in a trauma center). "You know how some new nurses just suck horribly? You actually are really smart, and everyone likes working with you. I forget that you're new. You're, like, not really new. You're quasi-new. Some people never get it, and you totally get it."

I blushed. I think I muttered something inane and ran towards my car, waving good-bye/good morning.

But I secretly really liked that compliment.
I am scared of being a sucky nurse. And I'm glad that at least some of my co-workers don't perceive me that way, because honestly, I really care.
So, that was kind of awesome.

No, really

Yeah, now it's really been a while. And why?
Because no matter what anyone tells you, it all comes down to the fact that night shift... TRULY SUCKS.
Yes, the camaraderie is amazing. Yes, you will learn more than you would on day shift. Yes, you have to troubleshoot for yourself, and doggone it, it's good for you when you talk to salty old nurses who can reminisce about how tough it was to have a night shift and be so stranded with few resources and new interns and new residents and oh my god we're gonna hurt these 8 patients I had to take care of in the snow uphill but....
it all comes down to:
Night shift sucks. Ass.
It creates good bonding, and to those who are naturally night people? Good on' ya. Please keep our world turning.
I remember being up before sunrise. Now I stay up until 11am sometimes. And it makes me feel weird.

But overall, it's good for me. Or so I keep telling myself. So, until the holidays are past, I am going to keep a positive attitude. I have my dream job. I am working in a level 1 UC trauma center that gives me tuition discount etc...
I see things that most people will never see (Rheumatic Fever? Really? Seriously?)
I see cutting edge treatment. I've run a gurney to the OR with a surgeon's hand in someone's heart, holding an Aorta together. I've seen dead people come back from a code. I've seen trauma unlike anything I could imagine. And I'm still here.

And my husband is by my side. So, that speaks for itself.

Been a while.

It's been a while. There have been so many life changes, I can't even begin to start writing about them. Apologies to those who have left comments- when I write, I really like to spend time focusing on writing, and given a new job for both of us, a billion life changes, and a wedding to plan, I'm stretched thin.

Ok, the short version:

Will is now the CTO (chief technical officer) of a 3-D television company.

I just got my dream job, that I've wanted since I decided I was going to nursing school:
I am now working at UC Davis medical center in the Emergency Dept. We're a Level 1 Trauma center, which means: teaching hospital, sicker patients, and total insanity. Add the fact that the ED is moving to a 50,000 square foot brand new building in about 1.5 months, and there is total utter chaos.

Keep in mind I'm following HIPAA when I discuss patient stuff:

In the past month on orientation at Davis I've done CPR on about 10 people.
None of them lived.

I'm in process of filling out a ton of competencies. Our orientation binder is about the same thickness as an entire quarter's class. There are 10 new nurses orienting together, and I think they just added 5 more. There will be another 10 coming in soon.

As far as CPR and codes/determining death go:
The really cool thing is that not only do we use two different leads, we actually use ultrasound on the heart to see if there's any activity at all. If there is, we take a next step (still learning what that is, depending on the person and the attending physician's preference).
For those of you who may not know, in order for a physician to pronounce death, the patient has to have asystole in two different leads/EKG perspectives on the heart, which ensures that the patient really is dead. It's a failsafe. Using ultrasound is even more accurate. It's really cool how far they'll go to work to save someone.

I've driven a gurney at Mach 3 to the OR with blood dripping behind it a-la-Hansel-and-Gretel-trail, with a surgeon's hand in someone's chest holding their dissected aorta together while three nurses were hanging blood as fast as they could to keep that person alive. At least you can really say we tried. No, that person didn't make it.
The twisted thing is that all I could think about was BBQ afterward. I attribute it to the rib spreaders. What? I mean, I know, it's twisted. I warned you. This blog isn't always pretty, and we EMS folks are a little... different. Thank goodness.

I've seen someone pronounced dead after being coded for an hour. Asystole on two leads on two different monitors, ultrasound of the heart showed no activity. Full on "Time of Death: blah blah blah."
Somehow, a few minutes later, this person was in NSR (normal sinus rhythm: ie, their heart was beating. Normally. This kind of thing ONLY happens in soap operas, folks).
Nobody has seen anything like that in their entire career.

I've seen all sorts of other stuff. Crepitus (Sub-cutaneous air) from a pneumothorax, some really sick people in general, lots of intubations... it's a mad, mad place.

I've seen imminent delivery. That's actually kind of happy and fun, but messy.

The nurses I work with, for the most part, are some of the most intelligent, welcoming folks I've met. We are expected to have a vast array of knowledge, and to be able to anticipate a lot of interventions. Many of them have advanced degrees. Half of them have over 15 years of experience. I am a baby in comparison.

Nobody could ever be on facebook here. There's no way in hell you could do anything but try to keep your patients alive. Especially when 4 people come in with CPR in progress, the Resuscitation Room nurses need help, and your patient's blood pressure is dropping and you need help, too. It's insane.
And I love it.

I start nights again this week, which I'm not looking forward to, but at least I know what to expect.

On my off days, I'm back in my Sacramento routine: outrigger canoe paddling, cycling long distances on the American River Bike Trail, and I have yet to visit my old Bikram Yoga studio.
Our new place is infinitely better than any of our old apartments. It's a 2.5/1.5 with tons of storage, a backyard, a garage, a basement, and a rose garden in front. Our landlady is super cool and likes to share a glass of wine with me on the back porch.
Life is pretty good.

Assaulted or A-peppered? Happy Nurses' Week.

I mean seriously, come on.

There are nights (actually, I guess mornings) when I leave the ER and I wonder if people show up just to fuck with the nurses.

Since starting work as an ER nurse, I've been kicked, grabbed, clawed at (I understood that one, though- 90 year old on whom I was inserting a Foley catheter), spit on, yelled at, called every name and *then* some, pushed, and had someone very nearly injure my thumb. And that's just from the patients.
That's not including patient's families.
Let's not forget the MDs who sometimes lose their cool, because even though we're part of the healthcare team, we're still "just a nurse" to some of them.

I've seen tricks, from fake seizures, to "I'm suicidal" right before discharge of a homeless person (because they have to stay on an 8 hour hold after that until the Psych team evaluates them, so they have a bed to sleep in), to "I can't walk" - until that person wants to smoke outside, to "I have 10/10 abdominal pain... can I get a meal tray please?"

And yet, most of the time we just take it all in stride and brush off the mean comments, the yelling, the snide remarks, and know in our hearts that we do our best to care for people who really, really need it.

And sometimes, people say "thank you." You have no idea how much I appreciate those words.
And sometimes we fuck up, like all humans. Hopefully they're small f'ups.

Last night, I had a *patient with advanced cancer (*NB reader, I will reiterate, all patient stories are changed to comply with HIPAA). He was grouchy because he had been there a while, had no white blood cells to speak of, and we had been promising him a room for hours. And then, of course, I missed his portacath when trying to access it. I've never missed before. I was about halfway in and the Huber needle bent, which I've never experienced, which honestly, just sucked. And when you have an already grouchy patient, who has a real reason to be grouchy, who is actually very sick, and you're trying your damndest to do something good for them and you fail? Well, you feel very much like you suck. I had another nurse re-try and he was successful, and fortunately we got that person upstairs to a more comfortable bed, but yowza, if looks were lasers- I felt like he mustered his last bit of energy to shine some anger on me. I understood, but I had been doing a lot behind-the-scenes to help him out, regarding pain management, paging physicians, and getting the antibiotics and blood going that he needed to help make him feel better. It wasn't so much the missing the portacath, mind you - it's probably the knowledge of impending death, pain, feeling like hell (Hemoglobin and Hematocrit of 7.2 and 21.5, respectively, which SUCKS), and having everyone tell him "soon, you'll get a bed" for four hours... and then me missing the portacath.
And I felt awful. I had worked on his inpatient orders while taking care of three other very very sick people- my least acute patient had an open compound fracture (splinted in place) and was going to surgery in a few hours - and understandably had pain control issues, which I was also having to manage every 20 minutes - and trying to get a doctor to increase an order for dilaudid ("no NOT 0.4mg, we gave him 4mg today. Yes. What?? You want to start with 0.4? Did you see his arm? Okay. I can guarantee you're going to be paged all night. Can you increase it to 1mg q 2 hours?"). My other two were 1) psychological issues with COPD (who went home after her breathing improved greatly) and 2) someone with a BP of 225/115 with blurry vision. Yeah.
And just when it was all almost under control, we get someone who overdosed in to my section- not my patient, but when that happens, we all help out because it's a heavy, heavy workup.

We had an assault patient show up as well. It was 4am, and he was a bit difficult to deal with, and the doc was getting frustrated. The doc asked, "So what did he tell you about being assaulted? Do you think he really was?"
I deadpanned, "No, he was actually a-peppered."
At 4am, that was really funny, and decompressed some of the insanity of the night.

Later that night (or early morning), my mentally ill COPD patient came back to scream at us and tell us that we're all incompetent, and then ask if she could watch TV. She started holding her breath to show us how short of breath she was (yes, after screaming). It was an incredible act, and I just shook my head. She pointed at me and the doctor to say that we sent her to the "Clinic hospital" and we were incompetent. Um, yep, I gave her info on a free clinic where she could follow up for managing COPD and her behavioral issues at her request, and made sure she had directions and a bus token. Apparently, she was angry that they weren't open at 5am on Sunday morning. Sigh.
It was almost as good as the girl in triage who I watched shove her finger down her throat to vomit, and then tell us she had nausea and vomiting. Classic.
I had no energy to say anything. At 6am after working all night and taking care of everything under the sun, I just have no patience for that kind of bullshit.

So, my point being: Happy Nurses' Week.
Someone, a friend of mine who is almost an RN and just finishing nursing school, said she thought that we have "very little power and great responsibility."
I absolutely disagree.
I think with great power comes great responsibility.
I know with absolute certainty that I do my very best every day for my patients, even if I shake my head sometimes.
We have the power to make people feel very comfortable in times of great distress, and sometimes in times of great embarrassment.
We have full on Jedi-mind power to decompress a lot of situations.
We have the ability to mostly let things roll - water off a duck's back, my friends.
We have the trust of both patients and physicians. And of our colleagues.

And we deal with a lot of shit. Figuratively and literally.
So, point being, next time you see a nurse, make his or her day.
Just say, "Thank you."

Spring Cleaning

Those crowbars are on the floor of Will's grandpa's kitchen. We were pulling out drywall and I put the bars down and *gasp* there it was, love in the middle of us pulling down the walls. Kind of awesome.

Between working night shift and planning a wedding, writing has taken a back burner to life lately. Some fun things have happened: I found my digital camera, although it's not charged, so I can share more fun photos of cool things, like the most awesomest pen light EVAR in the shape of a killer whale that my friend Katie sent me as a thank you- and my little kiddo patients love it. *Happy Dance!*

Wedding plans are deep underway: venue, bridesmaids all picked and dresses purchased, DJ, Photographer, on to cake tasting. The worst part is the list of invitations. We have been *agonizing* over the invites. Anyone who's been a bride knows this pain.
Sheesh.

I've also been weeding out sources of stress. This past month, I've gone 50 days without any alcohol (I know, can you believe it?), which was a real eye-opener as far as stress relief goes. Many of us use alcohol to de-stress, and I've had to use other venues, such as walks, yoga, stretching, meditation, tea, art, and of course, shoe shopping. I've had more massages in the past month than I have in the past year. There's been some balance restored. Much needed.
I have also done some work examining (with help) people who have used me in the past or who I have allowed to cross my boundaries - this list includes folks from college to people I work with occasionally, to even patients, and recognizing how much I tolerate without speaking up has lead me to be a lot healthier- and now I let people know immediately if something bugs me. I still have to say in some cases, "If you can't say something nice..." is a good rule, but for the most part, I'm not rolling over on my back anymore.

The smell in the air and the wind and rain has been reminding me of river season. I had a moment, driving up the central valley, where I just flashed back to the first time I drove into a river canyon, and that familiar feeling of love and excitement comes back to me. I can't wait to put my paddle in the water.

That's all for now. Working to get a per diem job, taking another year out from UCSF so I can really have the experience to help me as an expert in the future, and doing work on maintaining and constructing good boundaries.

And I'm also saving up for shoes. Oh my god, shoes.

Vampire Hours.

It's been a while since I've posted, which is partly due to the holidays, and partly due to the fact that I've been on night shift for the past month.

I feel like a vampire.

A couple of things have been developing. For one, I'm actually on my own as an RN next week, which I'm simultaneously excited and terrified for- on one hand, I won't have someone looking at everything I do; on the other hand I won't have someone checking up to make sure I did things right.

The night crew is so amazing at helping each other out with things in the ER, so I have to say I have seriously enjoyed working with everyone all night. The camaraderie is beyond anything I've seen.

The sleep deprivation has been difficult, but I'm lucky enough to be able to sleep between the hours of 8a-4p. Wild. This schedule all stops next week when I work a more normal 1200-0030, or noon to midnight in regular time.

Other wild things: We've had Tornadoes here in SoCal, snow, rain, thunder. I love it.
Today I also had my first experience at Disneyland as a SoCal resident. All I have to say is that "Yo-ho, Yo-ho A Pirate's Life for me" never gets old.

Oh and wedding preparations. More to come with that.