"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.

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.