1. every time i think i've seen one of the worst things that i've ever seen, i see something else awful.
last week i was taking care of a young guy with a bunch of kids and awful head and neck cancer that was literally rotting away at him. it was truly one of the worst things that i've ever seen (see above), and i can't imagine a more painful and scary way to die. all that i could do was try to make him comfortable and pray that he would decide to become a DNR before he coded. the cancer was dangerously close to his carotid artery, and one day i walked in and he was spraying blood out of the side of his neck. i grabbed him to put pressure on the wound, which was excruciatingly painful for him. i think he could tell that things were really bad, and at this point he was trached and couldn't talk. he grabbed his little white board and started to write. at first i thought he was trying to tell me something, but then i realized that he was actually writing a goodbye letter to his wife. i can't even describe the emotions that i felt in that moment. it was sacred and terrible, and i thought for sure that he was dying. but wouldn't you know, i lifted my hand and the bleeding had stopped. the patient got to spend 6 more days with his family before he finally died. he had me copy his letter to his wife, and on the day where he slowly slipped into unresponsiveness, i gave it to her.
i keep finding myself intertwined into the most important moments of people's stories. on one hand it's a privilege, on the other a burden.
2. make a power of attorney. have everyone you know make a power of attorney. after the first month in the ICU, i found myself telling all of my friends, coworkers, and families to never let me become a trached and PEGed TBI. seriously. you can intubate me, but no trach and no PEG. i would literally rather be dead.
this week i got my first emergent transfer from the floor, a 90+ year old in a halo in respiratory with periods of apnea lasting up to 30 seconds. a full code. what started out as a fairly stable situation quickly deteriorated into an emergency fiberoptic intubation with anesthesia, and me giving poor grandpa 1 chest compression before someone finally found a thready pulse (courtesy of his pacemaker).
DO NOT DO THIS TO THE ELDERLY PEOPLE IN YOUR LIFE.
and do not make nurses commit elder abuse in the form of CPR and other forms of life-saving assault. it's just barbaric.
3. teamwork is the only thing that allows people to survive in this hostile environment. every single person in the ICU has been kind to me. they've said encouraging things, they've answered my questions, and they've jumped in to help me when someone is trying to die. i gave up the best team in the world, and i think that i may have found one just as supportive.
4. you HAVE to find the humor wherever you can, or you will go completely crazy.
in the spirit of teamwork, when an admission comes in everyone jumps in to help. nasal swab, finger stick, temperature, bath...boom boom boom. we got a patient a few days ago who had broken into a restaurant and went about cooking himself up some food, namely a few steaks. the owner came in and caught him, a fight ensued, and the patient got stabbed in the chest. he walked himself to a local hospital and told them his chest hurt, however failed to mention the stabbing. he was immediately transferred to us, where he proceeded to refuse surgery. he rolled up to the ICU, where i decided to be helpful and catalog his belongings. i recorded a couple of bags of clothes, and then came to a heavy plastic bag full of brown goo. upon opening the bag, i realized it was a to-go box of food.
it was the steaks.
and it that moment, i had the once in a lifetime opportunity of recording "bag of meat" in the patient belongings list.
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this has not been easy for me, but there's something rewarding in challenging yourself and realizing that you're capable of hard things. 12 weeks down, 2 to go.
Friday, December 11, 2015
Saturday, October 17, 2015
goodbye
when i decided i was finally ready to transfer to the ICU, i knew that people would die more frequently. i've done a decent share of palliative care in the past, and it's something that i enjoy. but, once again, i was not prepared for the reality of dealing with that level of grief.
on orientation, my main goal needs to be to see as many things as i can. that means that when there's a challenge, i need to take it. it's the only way i'll get enough experience, and the only way i'll be able to survive on my own in a few months. so when i saw that there was a patient who we were going to be withdrawing cares on, i seized the learning opportunity.
my patient was a middle aged man who fell down the stairs. he was found by his teenaged son. neurosurgery had determined that he has a non-survivable brain injury, so the family made the decision to terminally extubate him.
terminal extubation- not a thing that i have ever experienced before. essentially, we remove the breathing tube that's keeping a person alive with the knowledge that they will die soon thereafter. depending on the level that the patient needs the ventilator, death can happen quickly or take days.
so after family meetings, hospice paperwork, and a whole lot of waiting, the respiratory therapist pulled the tube. i'm not sure what i expected to happen, but it was a bit anti-climactic. we suctioned the patient, and gave him a ton of morphine to manage his air hunger. his family stepped out during the extubation process, but i quickly called them to the bedside so they could be there. i felt that things would go pretty quickly, as the patient became tachycardic and his oxygen levels immediately dropped.
i felt the way that i've felt in these situations in the past: sad, but at peace. i knew this was the right thing to do. and i felt that way until the patient's son came to the bedside. and then i witnessed the most heartbreaking goodbye that i have ever experienced in my entire life.
a teenager shouldn't have to sit and hold the hand of his dying father. it just seemed so incredibly cruel to me, the fact that less than 24 hours before everything had been normal for this kid. i stood quietly in the corner and just watched this kid sob, apologize, and promise to be a good person who would make his dad proud.
after a half an hour, the patient died, and the family said their final goodbyes and left. and to be honest, the enormity of the moment didn't hit me right away. there was so much to be done...calling the donor network, getting paperwork together, preparing the body. my preceptor and i made ink handprints of the patient and sent them along with him for his son. we sent the patient down to the morgue, and i still had another patient to take care of along with a ton of charting that needs to be done perfectly before the body can be released.
so it wasn't until i was driving home, and couldn't stop thinking about this family, that i realized what a toll the day had taken on me. i was physically and emotionally exhausted. i couldn't stop thinking about the patients son, and about how he was feeling. about what would happen to him.
i wasn't all that surprised when all of the sudden there were flashing lights behind me, because i was in a daze and didn't remember most of the ride home. the officer came up to my car, and saw my scrubs and badge. he asked if i was coming home from work, and must have asked me something about my day, because the next thing i knew i was sobbing on the side of the road and pouring out the whole story to this stranger.
sometimes this job just hurts. i have seen things that i would rather forget, but will always remember. i have so many storied locked away inside that i would never tell my family or non-nursing friends because i don't want them to have to carry that weight. but i carry it. most days i don't even think about it, but on a day like this one, sometimes i get so tired that i don't think i can take another step. it's exhausting. it's a huge responsibility. and it scares me, because i just signed myself up as a witness to more grief and pain than i could previously imagine. what will that do to me? i am not a person who can just go about my life like these things never happened. i care. i care sometimes even when it's detrimental to myself.
how do you keep yourself separate from the pain of other people without being cold? how to you empathize with their grief without getting hurt? there must be a line somewhere, one that i'm going to have to learn to tip-toe up to without crossing. i think it must be a skill like any other, one that i'll learn with time. at least i hope so.
on orientation, my main goal needs to be to see as many things as i can. that means that when there's a challenge, i need to take it. it's the only way i'll get enough experience, and the only way i'll be able to survive on my own in a few months. so when i saw that there was a patient who we were going to be withdrawing cares on, i seized the learning opportunity.
my patient was a middle aged man who fell down the stairs. he was found by his teenaged son. neurosurgery had determined that he has a non-survivable brain injury, so the family made the decision to terminally extubate him.
terminal extubation- not a thing that i have ever experienced before. essentially, we remove the breathing tube that's keeping a person alive with the knowledge that they will die soon thereafter. depending on the level that the patient needs the ventilator, death can happen quickly or take days.
so after family meetings, hospice paperwork, and a whole lot of waiting, the respiratory therapist pulled the tube. i'm not sure what i expected to happen, but it was a bit anti-climactic. we suctioned the patient, and gave him a ton of morphine to manage his air hunger. his family stepped out during the extubation process, but i quickly called them to the bedside so they could be there. i felt that things would go pretty quickly, as the patient became tachycardic and his oxygen levels immediately dropped.
i felt the way that i've felt in these situations in the past: sad, but at peace. i knew this was the right thing to do. and i felt that way until the patient's son came to the bedside. and then i witnessed the most heartbreaking goodbye that i have ever experienced in my entire life.
a teenager shouldn't have to sit and hold the hand of his dying father. it just seemed so incredibly cruel to me, the fact that less than 24 hours before everything had been normal for this kid. i stood quietly in the corner and just watched this kid sob, apologize, and promise to be a good person who would make his dad proud.
after a half an hour, the patient died, and the family said their final goodbyes and left. and to be honest, the enormity of the moment didn't hit me right away. there was so much to be done...calling the donor network, getting paperwork together, preparing the body. my preceptor and i made ink handprints of the patient and sent them along with him for his son. we sent the patient down to the morgue, and i still had another patient to take care of along with a ton of charting that needs to be done perfectly before the body can be released.
so it wasn't until i was driving home, and couldn't stop thinking about this family, that i realized what a toll the day had taken on me. i was physically and emotionally exhausted. i couldn't stop thinking about the patients son, and about how he was feeling. about what would happen to him.
i wasn't all that surprised when all of the sudden there were flashing lights behind me, because i was in a daze and didn't remember most of the ride home. the officer came up to my car, and saw my scrubs and badge. he asked if i was coming home from work, and must have asked me something about my day, because the next thing i knew i was sobbing on the side of the road and pouring out the whole story to this stranger.
sometimes this job just hurts. i have seen things that i would rather forget, but will always remember. i have so many storied locked away inside that i would never tell my family or non-nursing friends because i don't want them to have to carry that weight. but i carry it. most days i don't even think about it, but on a day like this one, sometimes i get so tired that i don't think i can take another step. it's exhausting. it's a huge responsibility. and it scares me, because i just signed myself up as a witness to more grief and pain than i could previously imagine. what will that do to me? i am not a person who can just go about my life like these things never happened. i care. i care sometimes even when it's detrimental to myself.
how do you keep yourself separate from the pain of other people without being cold? how to you empathize with their grief without getting hurt? there must be a line somewhere, one that i'm going to have to learn to tip-toe up to without crossing. i think it must be a skill like any other, one that i'll learn with time. at least i hope so.
Saturday, October 10, 2015
growing pains
so it's official, i have a new job. that's right, after over seven years on the trauma unit, i finally decided to move on and am now a nurse in the surgical critical care area. it's definitely challenging, and i'm learning a lot. i'm trying to adjust to my orientation schedule, and to being brand new instead of being the resident expert. things are going well!!
...so that's pretty much what i say to people when they ask how things are going. i'm trying to be positive and tactful, and to avoid saying anything that will get back to the wrong people and get me in some kind of trouble with my new unit. but the truth?
THIS IS SO HARD.
i won't say that it's the hardest thing i've ever done, because it's still better than being fresh out of nursing school. but not by too terribly much. first of all, i hate change. hate it. HATE IT. i would much rather be warm and cozy in my familiar environment with people who love me and accept my neuroses. instead, i'm treading lightly so these people don't think that i'm actually insane and trying to keep a handle on all my feels because, as i've been told, "there's no crying in the ICU".
to my credit, i haven't come close to crying at work. yelling at people, maybe. quitting to become a librarian, yes. cursing the day that i thought i should do this, oh for sure. i have run through every possible emotion. and i know in my heart that this is the only way for me. as i said before, change is not my thing. this is how i react to it. this is basically what i knew would happen.
but knowing it and going through it are two different things. first of all, i'm exhausted all the time. when i can sleep, i sleep for like 12 hours. it's like being a newborn baby. i also have what fellow coworker (thank God I have one friend from the floor who's doing this with me!) and I have coined as "ICU brain". in short, the high volume of new knowledge leaves no room for anything else, including basic brain functions and motor skills. this leads you to completely forget entire conversations, to drop pretty much everything on the floor, and to throw your car keys into garbage bins instead of actual trash. it's debilitating.
also a delight is the 29387489723 hours of online education that i now get to enjoy. this ensures that when i actually do have a day off, i feel either stressed or guilty. it's a throwback to nursing school, minus large volumes of alcohol.
and of course the main issue: this people are terrifyingly sick. this week i had a lady on nine drips. Another patient's pressors ran out and his blood pressure tanked. one day i was half way though pushing a med and my patient when into an unstable rhythm, then into V-fib (read: bad. dying.), then back into an unstable rhythm, leading my preceptor to utter the terrifying words "we're going to have to code her". um, yeah, ok. we can do that after i finish PEEING MY PANTS. for all of those who think that i should have expected this, duh, i thank you in advance for keeping those (very true) thoughts to yourself.
also something i've noticed about the ICU: everybody dies. ok, not everybody. but people die at an alarming rate. i've been on the floor for three weeks and two of my patients are dead with one other not far behind. again, in my head this is something i knew that i'd have to deal with. but it's way different in practice than in theory.
so at this point you probably wonder if i'm going to
a. jump off a cliff
b. end up institutionalized or
c. quit
and the answer is...none of the above. i am in this for better or worse. i am doing this, i am not quitting, and i will get through it. these are growing pains, these feelings are normal, and it will get better. it HAS to get better.
because that thought is what is currently getting me through my days.
...so that's pretty much what i say to people when they ask how things are going. i'm trying to be positive and tactful, and to avoid saying anything that will get back to the wrong people and get me in some kind of trouble with my new unit. but the truth?
THIS IS SO HARD.
i won't say that it's the hardest thing i've ever done, because it's still better than being fresh out of nursing school. but not by too terribly much. first of all, i hate change. hate it. HATE IT. i would much rather be warm and cozy in my familiar environment with people who love me and accept my neuroses. instead, i'm treading lightly so these people don't think that i'm actually insane and trying to keep a handle on all my feels because, as i've been told, "there's no crying in the ICU".
to my credit, i haven't come close to crying at work. yelling at people, maybe. quitting to become a librarian, yes. cursing the day that i thought i should do this, oh for sure. i have run through every possible emotion. and i know in my heart that this is the only way for me. as i said before, change is not my thing. this is how i react to it. this is basically what i knew would happen.
but knowing it and going through it are two different things. first of all, i'm exhausted all the time. when i can sleep, i sleep for like 12 hours. it's like being a newborn baby. i also have what fellow coworker (thank God I have one friend from the floor who's doing this with me!) and I have coined as "ICU brain". in short, the high volume of new knowledge leaves no room for anything else, including basic brain functions and motor skills. this leads you to completely forget entire conversations, to drop pretty much everything on the floor, and to throw your car keys into garbage bins instead of actual trash. it's debilitating.
also a delight is the 29387489723 hours of online education that i now get to enjoy. this ensures that when i actually do have a day off, i feel either stressed or guilty. it's a throwback to nursing school, minus large volumes of alcohol.
and of course the main issue: this people are terrifyingly sick. this week i had a lady on nine drips. Another patient's pressors ran out and his blood pressure tanked. one day i was half way though pushing a med and my patient when into an unstable rhythm, then into V-fib (read: bad. dying.), then back into an unstable rhythm, leading my preceptor to utter the terrifying words "we're going to have to code her". um, yeah, ok. we can do that after i finish PEEING MY PANTS. for all of those who think that i should have expected this, duh, i thank you in advance for keeping those (very true) thoughts to yourself.
also something i've noticed about the ICU: everybody dies. ok, not everybody. but people die at an alarming rate. i've been on the floor for three weeks and two of my patients are dead with one other not far behind. again, in my head this is something i knew that i'd have to deal with. but it's way different in practice than in theory.
so at this point you probably wonder if i'm going to
a. jump off a cliff
b. end up institutionalized or
c. quit
and the answer is...none of the above. i am in this for better or worse. i am doing this, i am not quitting, and i will get through it. these are growing pains, these feelings are normal, and it will get better. it HAS to get better.
because that thought is what is currently getting me through my days.
Wednesday, June 17, 2015
too little, too late.
i just came from a meeting in which i was handed everything that i wanted.
terrible manager is leaving. nice CNS is now new interim manager. staffing is improving. we're taking the next six months to "focus on us".
and it sounds ungrateful and entitled, but my mind was screaming the entire meeting: IT'S NOT ENOUGH.
not enough to make up for the past 5 years in which we were constantly told to do better. not enough to undo the repeated threats of "consequences" and "corrective action". not enough to make me forget the agonizing meeting i had in the office where i was told that i'm negative, or the one where i tried to make them understand how bad things on the unit were getting only to be handed a mental health brochure.
i. am. so. angry. they made me feel like a failure. they made me believe that there was something wrong with me. i felt crazy, like it was all in my head and maybe i just couldn't cut it as a trauma nurse and that it was all my fault.
then, in one 2 hour meeting, all is supposed to be forgiven and forgotten? as if the "leadership team" didn't know exactly what was going on all that time? i feel like some bullied kid, picked apart for years and years and now the bully is gone and i'm just supposed to put a smile on my face like it never happened.
it happened. it hurt me. it made me a different person.
and you can give me more staff, a kinder/gentler manager and free prizes, but it doesn't make it go away.
i'm not sure how to deal with this. everyone is so happy, so relieved, and i'm just sitting here frustrated and uneasy, wondering exactly how i'm supposed to get over years of hurt and bitterness.
like how terrible manager chased away so many of my coworker friends. or how i would send emails about problems that were never addressed. and when i did bring issues to light, i felt as if i had a target on my back for mentioning something that wasn't positive. or how we had terrible staff satisfaction scores for years, and wasted so much time making action plans that never changed anything.
i resent all of that.
and, if i'm being honest, i think i resent that this change is happening when i'm finally ready to move on. here i am, more likely than not getting a new job in the next several weeks and NOW is when we're finally going to solve the problems? NOW is when we're going to start listening to the staff? NOW is when we've decided to say out loud what we've all been thinking for years? really??
well go figure.
i think that what i've realized above all else is that i'm doing the right thing. if i can't be happy about this, about the best possible scenario coming true, what would make me happy? nothing. so i'm trying to make a conscious effort to be glad for my coworkers left behind. to embrace these changes and not say the things that i'm thinking. to let this news make other people happier and more satisfied at work.
but for me?
it's just too little, too late.
terrible manager is leaving. nice CNS is now new interim manager. staffing is improving. we're taking the next six months to "focus on us".
and it sounds ungrateful and entitled, but my mind was screaming the entire meeting: IT'S NOT ENOUGH.
not enough to make up for the past 5 years in which we were constantly told to do better. not enough to undo the repeated threats of "consequences" and "corrective action". not enough to make me forget the agonizing meeting i had in the office where i was told that i'm negative, or the one where i tried to make them understand how bad things on the unit were getting only to be handed a mental health brochure.
i. am. so. angry. they made me feel like a failure. they made me believe that there was something wrong with me. i felt crazy, like it was all in my head and maybe i just couldn't cut it as a trauma nurse and that it was all my fault.
then, in one 2 hour meeting, all is supposed to be forgiven and forgotten? as if the "leadership team" didn't know exactly what was going on all that time? i feel like some bullied kid, picked apart for years and years and now the bully is gone and i'm just supposed to put a smile on my face like it never happened.
it happened. it hurt me. it made me a different person.
and you can give me more staff, a kinder/gentler manager and free prizes, but it doesn't make it go away.
i'm not sure how to deal with this. everyone is so happy, so relieved, and i'm just sitting here frustrated and uneasy, wondering exactly how i'm supposed to get over years of hurt and bitterness.
like how terrible manager chased away so many of my coworker friends. or how i would send emails about problems that were never addressed. and when i did bring issues to light, i felt as if i had a target on my back for mentioning something that wasn't positive. or how we had terrible staff satisfaction scores for years, and wasted so much time making action plans that never changed anything.
i resent all of that.
and, if i'm being honest, i think i resent that this change is happening when i'm finally ready to move on. here i am, more likely than not getting a new job in the next several weeks and NOW is when we're finally going to solve the problems? NOW is when we're going to start listening to the staff? NOW is when we've decided to say out loud what we've all been thinking for years? really??
well go figure.
i think that what i've realized above all else is that i'm doing the right thing. if i can't be happy about this, about the best possible scenario coming true, what would make me happy? nothing. so i'm trying to make a conscious effort to be glad for my coworkers left behind. to embrace these changes and not say the things that i'm thinking. to let this news make other people happier and more satisfied at work.
but for me?
it's just too little, too late.
Wednesday, June 3, 2015
seven years
i was thinking about nursing, and about what i've learned over the last year. there's always something...another crazy story, a new way to get doctors to do what you want, how to fly under management's radar. but when i really thought about it, i realized that this was the year that i finally learned how much of myself to give to other people.
that sounds silly, because nurses are supposed to be this bottomless pit of compassion and selflessness, but sometimes that's just not realistic. i've learned the hard way that i have to take care of myself, or i'll have nothing else to give to other people.
i've said it before, this job is HARD. you see and hear terrible, sad things that make you ache for people and wonder how the world could possibly be so cruel. and you're frustrated on a level that you never thought you could even get to, because you're literally fighting for peoples lives and yet still have to deal with trivial things like money and ego and resources. meanwhile, the people who are supposed to be supporting you are some of your biggest rivals, and you find yourself fighting for better staffing and more security and things that you really shouldn't have to ask for, much less beg repeatedly for.
and in the midst of all this, i let myself get worn down to the point where i could barely keep going. i kept hearing how much i was supposed to be giving to my patients...the hourly rounding, the mountain of charting, the folders upon folders of teaching, and i actually believed that i could do it. and when i fell short again and again, i started to believe that i was failing and that i was terrible and i started asking myself why i even wanted to be a nurse in the first place. so before i went completely crazy, i decided that something had to give.
hourly rounding? not going to kill myself over that. CHF teaching on people who have 23908457 folders at their house? nope. i started to delegate more tasks, because that's why our techs are there. and as bad as it sounds, i started to help my coworkers less, because they don't need me hovering over them all the time. i am not lab and dietary and PT and pharmacy and social work. i started to worry less about everybody else's jobs and think more about my little piece of the pie.
i'm a micromanager and i'm particular and i like things to be tidy and perfect. but that's not realistic, and i've finally realized that i can't kill myself over those things anymore. i'm getting better at prioritizing, and taking time to sit down and chart, and also at not giving everyone everything that they want right this minute.
it makes me happier, and it makes me feel like i'm doing a better job.
and then there are the days that i just say screw it and decide to do the things that people really need, efficiency be damned!! the last shift that i worked i gave 2 people afternoon baths, because it really needed to happen. then i wheeled my GSW to the chest over to postpartum to meet his twin sons for the first time. and as i stood over there for a half hour, i probably should have been initialing some rounding logs or filling out some duplicate paperwork somewhere, but i really didn't care. because i got to watch the patient hold his babies for the first time and just stare at them. it was a rare and magical glimpse of what nursing should be and what i thought i signed up for, and it was worth it.
in the past seven years i've learned a lot about caring for other people. its taken me a long time to realize that i need to be just as focused on taking care of myself.
that sounds silly, because nurses are supposed to be this bottomless pit of compassion and selflessness, but sometimes that's just not realistic. i've learned the hard way that i have to take care of myself, or i'll have nothing else to give to other people.
i've said it before, this job is HARD. you see and hear terrible, sad things that make you ache for people and wonder how the world could possibly be so cruel. and you're frustrated on a level that you never thought you could even get to, because you're literally fighting for peoples lives and yet still have to deal with trivial things like money and ego and resources. meanwhile, the people who are supposed to be supporting you are some of your biggest rivals, and you find yourself fighting for better staffing and more security and things that you really shouldn't have to ask for, much less beg repeatedly for.
and in the midst of all this, i let myself get worn down to the point where i could barely keep going. i kept hearing how much i was supposed to be giving to my patients...the hourly rounding, the mountain of charting, the folders upon folders of teaching, and i actually believed that i could do it. and when i fell short again and again, i started to believe that i was failing and that i was terrible and i started asking myself why i even wanted to be a nurse in the first place. so before i went completely crazy, i decided that something had to give.
hourly rounding? not going to kill myself over that. CHF teaching on people who have 23908457 folders at their house? nope. i started to delegate more tasks, because that's why our techs are there. and as bad as it sounds, i started to help my coworkers less, because they don't need me hovering over them all the time. i am not lab and dietary and PT and pharmacy and social work. i started to worry less about everybody else's jobs and think more about my little piece of the pie.
i'm a micromanager and i'm particular and i like things to be tidy and perfect. but that's not realistic, and i've finally realized that i can't kill myself over those things anymore. i'm getting better at prioritizing, and taking time to sit down and chart, and also at not giving everyone everything that they want right this minute.
it makes me happier, and it makes me feel like i'm doing a better job.
and then there are the days that i just say screw it and decide to do the things that people really need, efficiency be damned!! the last shift that i worked i gave 2 people afternoon baths, because it really needed to happen. then i wheeled my GSW to the chest over to postpartum to meet his twin sons for the first time. and as i stood over there for a half hour, i probably should have been initialing some rounding logs or filling out some duplicate paperwork somewhere, but i really didn't care. because i got to watch the patient hold his babies for the first time and just stare at them. it was a rare and magical glimpse of what nursing should be and what i thought i signed up for, and it was worth it.
in the past seven years i've learned a lot about caring for other people. its taken me a long time to realize that i need to be just as focused on taking care of myself.
Thursday, May 21, 2015
moving on.
first of all, i'm not dead.
that being said, back to the same old same old. i guess i just felt like i was whining about the same things over and over, because nothing really ever changes. it's the same old issues that cycle around. the floor is bad and the floor is terrible and then things get better and so on. maybe i've just learned to accept that this is the way things are.
but i don't like it. i don't like the way i feel about my job, and i don't like that i've grudgingly accepted the nonsense that occurs on a daily basis and that i've adopted the "it is what it is" mentality. i've noticed a change in myself, and i miss the person that i used to be. i feel like healthcare has been completely de-humanized in the time that i've been working as a nurse. every part of my nursing practice is now scripted. i see my patients at a set timeframe. i introduce myself using a specific script. I use alliterating buzzwords to see if they have any needs each time i'm in the room. i talk about the things that i'm told to talk about, and any sort of individual thought is completely left out of the equation.
i'm a nursing drone. i feel completely and utterly ordinary and like i'm totally replaceable. i get to make very few decisions independently, and there is pretty much no area of my practice in which i'm allowed to have choices.
my job is pretty unsatisfying, because i have fought the man for the past 7 years and they have slowly chipped away at my reserves. i woke up one day and realized that i've just started to do what's easiest, because i don't have any more to sacrifice for people.
i go into my patients' rooms and try to spend as little time there as possible. get in and get out. be efficient. need to make sure that i have plenty of time to chart or else i'll be sitting in front of a computer until 1 am.
the things that i'm supposed to care about, i just don't have time to care about. walking people? psssh, like i can find 15 whole consecutive minutes to spend on one person. we had a staff meeting today where they talked about how we need to be doing patient education, and i actually caught myself thinking about how that should be someone else's job because i have too many other things to do and don't have time for that.
or more accurately, i DO have time but it is time stolen from another patient or from myself.
i have basically nothing left to give.
and i know i've said this all before, but this time it's different.
i've realized in the past several months that there has GOT to be better than this. and as more and more of my coworkers leave for new jobs, jobs where they're appreciated and generally happier, i've finally see that it's not me. i'm not broken, i'm not a crappy nurse, i work in a toxic environment under an unsympathetic and ineffective manager and it's next to impossible to succeed in that kind of environment. so i'm done.
i've made the decision to leave, and even though i don't know where i'm going yet, it still feels official. this is the first time in the past 7 years that moving on truly feels right. it's bittersweet, because i love my coworkers and i still have so much nostalgia about how things used to be. but i can't do this job anymore. i won't put myself through it. and although i've tried to bring various problems to light over the years, i feel that actions speak louder than words. they never listened when i talked, maybe they'll listen when i walk.
but it's more than that. if i'm being honest, i think i'm still doing what i'm doing because it's comfortable. it's familiar. it's honestly all i know. and i still believe it's important, and underrated, and that i make a difference. but am i happy? am i being challenged? do i love this? is this the only thing i could ever imagine doing?
not anymore.
and so it's time for moving on.
that being said, back to the same old same old. i guess i just felt like i was whining about the same things over and over, because nothing really ever changes. it's the same old issues that cycle around. the floor is bad and the floor is terrible and then things get better and so on. maybe i've just learned to accept that this is the way things are.
but i don't like it. i don't like the way i feel about my job, and i don't like that i've grudgingly accepted the nonsense that occurs on a daily basis and that i've adopted the "it is what it is" mentality. i've noticed a change in myself, and i miss the person that i used to be. i feel like healthcare has been completely de-humanized in the time that i've been working as a nurse. every part of my nursing practice is now scripted. i see my patients at a set timeframe. i introduce myself using a specific script. I use alliterating buzzwords to see if they have any needs each time i'm in the room. i talk about the things that i'm told to talk about, and any sort of individual thought is completely left out of the equation.
i'm a nursing drone. i feel completely and utterly ordinary and like i'm totally replaceable. i get to make very few decisions independently, and there is pretty much no area of my practice in which i'm allowed to have choices.
my job is pretty unsatisfying, because i have fought the man for the past 7 years and they have slowly chipped away at my reserves. i woke up one day and realized that i've just started to do what's easiest, because i don't have any more to sacrifice for people.
i go into my patients' rooms and try to spend as little time there as possible. get in and get out. be efficient. need to make sure that i have plenty of time to chart or else i'll be sitting in front of a computer until 1 am.
the things that i'm supposed to care about, i just don't have time to care about. walking people? psssh, like i can find 15 whole consecutive minutes to spend on one person. we had a staff meeting today where they talked about how we need to be doing patient education, and i actually caught myself thinking about how that should be someone else's job because i have too many other things to do and don't have time for that.
or more accurately, i DO have time but it is time stolen from another patient or from myself.
i have basically nothing left to give.
and i know i've said this all before, but this time it's different.
i've realized in the past several months that there has GOT to be better than this. and as more and more of my coworkers leave for new jobs, jobs where they're appreciated and generally happier, i've finally see that it's not me. i'm not broken, i'm not a crappy nurse, i work in a toxic environment under an unsympathetic and ineffective manager and it's next to impossible to succeed in that kind of environment. so i'm done.
i've made the decision to leave, and even though i don't know where i'm going yet, it still feels official. this is the first time in the past 7 years that moving on truly feels right. it's bittersweet, because i love my coworkers and i still have so much nostalgia about how things used to be. but i can't do this job anymore. i won't put myself through it. and although i've tried to bring various problems to light over the years, i feel that actions speak louder than words. they never listened when i talked, maybe they'll listen when i walk.
but it's more than that. if i'm being honest, i think i'm still doing what i'm doing because it's comfortable. it's familiar. it's honestly all i know. and i still believe it's important, and underrated, and that i make a difference. but am i happy? am i being challenged? do i love this? is this the only thing i could ever imagine doing?
not anymore.
and so it's time for moving on.
Friday, January 30, 2015
humans and monsters
I've been thinking a lot lately about compassion, and justice, and how it's really scary that evil doesn't look like you think it would.
last week i took care of a murderer. now a lot of my patients aren't exactly saints. and i've definitely taken care of people whose poor choices meant that they killed someone. but there's a big difference between driving drunk and hitting someone with your car and stabbing four people, two to death.
i guess that i don't know what to think. once again, nursing school never prepared me for this. i'm a strong believer in being kind to people despite what they've done. in treating people the way that they treat you, even if they are a drug dealer or a pedophile or a manslaughterer. never before have i felt guilty for being nice to someone. but last week, i did.
the first time i met my patient, he looked like any other post-op patient. he was young. vulnerable. but he was also covered in the blood of the people he'd killed. and somehow, it was my job to wash that blood, the blood of his murdered baby, off of his hands.
it was surreal. disturbing. and it made me feel like somehow i shouldn't be taking care of him. like he should have to sit there and think about what he'd done, and i shouldn't be giving him blankets or offering him food or having him rate his pain. but that is not a thing. people don't get cared for based on whether or not they deserve help. i believe that everyone deserves to be treated well, and that what they've done has nothing to do with the care that i provide. don't i? i thought that i did.
so i treated this patient like any other. then i went home and couldn't sleep. i can ALWAYS sleep. i just can't help thinking that we got it wrong. society believes that evil has a face, some sort of tell. that you can see it in someone's eyes. and while i'm pretty savvy, i bought into it. to me, killers fell into a few categories: people who do stupid things without thought of consequences, mentally ill people who don't know what they're doing, cold calculated serial killers who actually like that kind of thing. reckless, crazy, or defective. but this patient was none of those things. he was basically a kid. he looked scared. he cried. i actually somehow felt bad for him. and it's still upsetting to me, because that's not what evil is supposed to look like. and try as i might to figure out how someone can be so human and still do something so horrific, i can't.
the day after, i got to work and everyone was in a panic. the surviving victims had ended up on the floor as well, and their families were out for blood. the news had informed them that my patient was at the hospital, and they wasted no time in scouring the doors looking for his name and knocking on windows trying to draw him out. my coworkers who were caring for those patients heard the plan loud and clear: they were going to find him and kill him.
sadly this is not the first time that i've felt like i could be in danger caring for someone. but to cut down on the risk of more violence, the decision was made to transfer the patient off the floor. unfortunately, we were literally backed into a corner, and the only way out was past the victims and their families. i ended up pushing my patient through a usually locked back door, wearing a surgical cap and mask, wrapped completely in blankets and accompanied by a 5 person police and hospital security detail. and once again, i somehow felt that i was doing something wrong. i was helping a murder escape vigilante justice!! but clearly, diffusing the situation and getting the patient off the floor was the right decision for everyone. so i no longer had to care for the patient, and i tried unsuccessfully to put him out of my mind.
the week after, he was formally charged and his face was all over the news and social media. as usual, everyone felt the need to throw their two cents in and post things like "fry him" and detailed descriptions of how they wanted him to get raped to death in prison. and somehow, i felt like i should DEFEND him. enter more guilty feelings. what this man did was horrible. unforgivable. he should receive whatever punishment he gets, and it still won't be enough to even things out. people are justified in their outrage, and i understand why they would say those things when they heard what he did.
but they didn't have to look into his face. they didn't see him cry. they have the luxury of looking at that man as pure evil, as less than human. but i know the haunting truth. that man is scarily "normal". and i can't stop thinking about how that could be possible. about what it takes to turn an average person into a monster.
last week i took care of a murderer. now a lot of my patients aren't exactly saints. and i've definitely taken care of people whose poor choices meant that they killed someone. but there's a big difference between driving drunk and hitting someone with your car and stabbing four people, two to death.
i guess that i don't know what to think. once again, nursing school never prepared me for this. i'm a strong believer in being kind to people despite what they've done. in treating people the way that they treat you, even if they are a drug dealer or a pedophile or a manslaughterer. never before have i felt guilty for being nice to someone. but last week, i did.
the first time i met my patient, he looked like any other post-op patient. he was young. vulnerable. but he was also covered in the blood of the people he'd killed. and somehow, it was my job to wash that blood, the blood of his murdered baby, off of his hands.
it was surreal. disturbing. and it made me feel like somehow i shouldn't be taking care of him. like he should have to sit there and think about what he'd done, and i shouldn't be giving him blankets or offering him food or having him rate his pain. but that is not a thing. people don't get cared for based on whether or not they deserve help. i believe that everyone deserves to be treated well, and that what they've done has nothing to do with the care that i provide. don't i? i thought that i did.
so i treated this patient like any other. then i went home and couldn't sleep. i can ALWAYS sleep. i just can't help thinking that we got it wrong. society believes that evil has a face, some sort of tell. that you can see it in someone's eyes. and while i'm pretty savvy, i bought into it. to me, killers fell into a few categories: people who do stupid things without thought of consequences, mentally ill people who don't know what they're doing, cold calculated serial killers who actually like that kind of thing. reckless, crazy, or defective. but this patient was none of those things. he was basically a kid. he looked scared. he cried. i actually somehow felt bad for him. and it's still upsetting to me, because that's not what evil is supposed to look like. and try as i might to figure out how someone can be so human and still do something so horrific, i can't.
the day after, i got to work and everyone was in a panic. the surviving victims had ended up on the floor as well, and their families were out for blood. the news had informed them that my patient was at the hospital, and they wasted no time in scouring the doors looking for his name and knocking on windows trying to draw him out. my coworkers who were caring for those patients heard the plan loud and clear: they were going to find him and kill him.
sadly this is not the first time that i've felt like i could be in danger caring for someone. but to cut down on the risk of more violence, the decision was made to transfer the patient off the floor. unfortunately, we were literally backed into a corner, and the only way out was past the victims and their families. i ended up pushing my patient through a usually locked back door, wearing a surgical cap and mask, wrapped completely in blankets and accompanied by a 5 person police and hospital security detail. and once again, i somehow felt that i was doing something wrong. i was helping a murder escape vigilante justice!! but clearly, diffusing the situation and getting the patient off the floor was the right decision for everyone. so i no longer had to care for the patient, and i tried unsuccessfully to put him out of my mind.
the week after, he was formally charged and his face was all over the news and social media. as usual, everyone felt the need to throw their two cents in and post things like "fry him" and detailed descriptions of how they wanted him to get raped to death in prison. and somehow, i felt like i should DEFEND him. enter more guilty feelings. what this man did was horrible. unforgivable. he should receive whatever punishment he gets, and it still won't be enough to even things out. people are justified in their outrage, and i understand why they would say those things when they heard what he did.
but they didn't have to look into his face. they didn't see him cry. they have the luxury of looking at that man as pure evil, as less than human. but i know the haunting truth. that man is scarily "normal". and i can't stop thinking about how that could be possible. about what it takes to turn an average person into a monster.
Thursday, January 22, 2015
working aboard the titanic
lately there's been another wave of people jumping ship, and i can't figure out why it's so upsetting to me. there's the fact that i spend more time with my coworkers than i do with my own family. the fact that we both laugh and cry together, that we bitch and vent and support each other. that we are a small, peaceful gang bound together by terrible shifts, mutual struggles, and 70+ hour weeks. so when someone decides to leave it's always hard. it changes the dynamic, and it's difficult not to feel abandoned.
yes, i realize that i cannot officially take it personally when people choose to change jobs. officially. but in the land of turnover, where i have lose 70 coworkers in the past 7 years, somehow all my angst feels justified.
but it's more than that. i feel like every time someone leaves the floor to go somewhere more glamorous or dramatic like the ED or the ICU, they have this air of superiority. they are going to DO SOMETHING THAT MATTERS. they are going to SAVE LIVES, all massively transfusing people and cracking chests at the beside while all i do is pass apple juices and push dilaudid.
and, yeah, i'm more than a little defensive about my job. floor nurses are hugely under-appreciated and taken advantage of. when the ICUs are short-staffed it's 'dangerous', when we're short it's 'busy'. they have a locked door and visitation policies, we have the whole damn fam. they collaborate with doctors, we go down fighting for our patients and are seen as an annoyance.
what i do matters too. being able to look at a patient and know how they're doing without a billion monitors is an unsung superpower. so is balancing the care of 5 different patients. and it's not as exciting as floating a swan ganz or running codes all the time, but it's still important.
but more than anything, the mass exodus from the floor has made me come face to face with my own insecurities. because is it really the people who are leaving who are making me feel inferior? or is it the fact that deep down, i know i should be doing more than what i am? i'm having a hard time figuring out if i'm happy or just comfortable. do i resent the people who are moving on because i'm just jealous?
in short, i know i'm being a hater but i'm tired of saying goodbye to people ALL THE TIME.
yes, i realize that i cannot officially take it personally when people choose to change jobs. officially. but in the land of turnover, where i have lose 70 coworkers in the past 7 years, somehow all my angst feels justified.
but it's more than that. i feel like every time someone leaves the floor to go somewhere more glamorous or dramatic like the ED or the ICU, they have this air of superiority. they are going to DO SOMETHING THAT MATTERS. they are going to SAVE LIVES, all massively transfusing people and cracking chests at the beside while all i do is pass apple juices and push dilaudid.
and, yeah, i'm more than a little defensive about my job. floor nurses are hugely under-appreciated and taken advantage of. when the ICUs are short-staffed it's 'dangerous', when we're short it's 'busy'. they have a locked door and visitation policies, we have the whole damn fam. they collaborate with doctors, we go down fighting for our patients and are seen as an annoyance.
what i do matters too. being able to look at a patient and know how they're doing without a billion monitors is an unsung superpower. so is balancing the care of 5 different patients. and it's not as exciting as floating a swan ganz or running codes all the time, but it's still important.
but more than anything, the mass exodus from the floor has made me come face to face with my own insecurities. because is it really the people who are leaving who are making me feel inferior? or is it the fact that deep down, i know i should be doing more than what i am? i'm having a hard time figuring out if i'm happy or just comfortable. do i resent the people who are moving on because i'm just jealous?
in short, i know i'm being a hater but i'm tired of saying goodbye to people ALL THE TIME.
Tuesday, July 8, 2014
kibbles
so i just had the kind of shift where i got completely slaughtered. people were having seizures, new admits came with terrible pain issues, ICU patients transferred out that had only been off the vent for a few hours...that kind of thing. completely. slaughtered.
i had already accepted the fact that the night couldn't be salvaged, so my orientee and i just had to hold it together for an hour until the night nurses took over. we walked into our total cares trached/PEGed patient's room and what did i spy upon the floor but a bowl of kibbles and a water dish.
sadly i didn't blink an eye.
so i asked the patient's daughter the first question that came to mind. "...is that cat food?"
and she nonchalantly replied, "no, it's dog food".
i suddenly noticed the zipped shut black duffle on the chair that was squirming suspiciously.
"ok", i said.
and then i finished my cares and left.
things i don't have time to deal with:
1. dogs in duffle bags.
and that, friends, is a prime example of choosing your battles.
i had already accepted the fact that the night couldn't be salvaged, so my orientee and i just had to hold it together for an hour until the night nurses took over. we walked into our total cares trached/PEGed patient's room and what did i spy upon the floor but a bowl of kibbles and a water dish.
sadly i didn't blink an eye.
so i asked the patient's daughter the first question that came to mind. "...is that cat food?"
and she nonchalantly replied, "no, it's dog food".
i suddenly noticed the zipped shut black duffle on the chair that was squirming suspiciously.
"ok", i said.
and then i finished my cares and left.
things i don't have time to deal with:
1. dogs in duffle bags.
and that, friends, is a prime example of choosing your battles.
Friday, June 20, 2014
six years
yes, it's true: i've been a nurse for SIX years now.
thoughts on this include:
1. i've survived (!!!)
2. i am old
3. it took this long to feel like i've kind of got it together
something magical has happened in the past year, something i can't really explain as i don't understand it myself. one day i just realized that all i have to give people is my best. i came to terms with the fact that people will do well or people will do poorly and that i don't get to control that. all i can do is be vigilant and competent and the best nurse i can be, but people will still get sick and code and even die and that is NOT MY FAULT.
so long i lived with the fear of feeling the terrible guilt and depression that i felt after my first code and death, and it crippled me. the weight of that has lifted this year and i finally have some perspective.
i'm only human. i give everything i have and some days that's enough for people, some days it's not. but that's all i have to offer. i care about my patients, i fight for them daily, and i try to be encouraging and kind and sympathetic. but my other patients have needs, and my coworkers require my help, and i've finally learned that giving everything thing i have until i'm empty and emotionally drained isn't good for me and ultimately doesn't help anyone.
some days patients aren't going to like me. doctors are going to think that i'm making a big deal out of nothing. management isn't going to want to hear my opinions on a new policy. my coworkers are going to think that i'm overreacting to something.
and that's ok.
a long time ago when i first started nursing and it was hard, we came up with a motto: "you know the truth". it still applies. i know that i'm doing the best i can to give my patients great care, to support my new coworkers, and to make my unit a better place to work.
that's all i have to offer
and it's taken me six years to realize it, but
that's enough.
thoughts on this include:
1. i've survived (!!!)
2. i am old
3. it took this long to feel like i've kind of got it together
something magical has happened in the past year, something i can't really explain as i don't understand it myself. one day i just realized that all i have to give people is my best. i came to terms with the fact that people will do well or people will do poorly and that i don't get to control that. all i can do is be vigilant and competent and the best nurse i can be, but people will still get sick and code and even die and that is NOT MY FAULT.
so long i lived with the fear of feeling the terrible guilt and depression that i felt after my first code and death, and it crippled me. the weight of that has lifted this year and i finally have some perspective.
i'm only human. i give everything i have and some days that's enough for people, some days it's not. but that's all i have to offer. i care about my patients, i fight for them daily, and i try to be encouraging and kind and sympathetic. but my other patients have needs, and my coworkers require my help, and i've finally learned that giving everything thing i have until i'm empty and emotionally drained isn't good for me and ultimately doesn't help anyone.
some days patients aren't going to like me. doctors are going to think that i'm making a big deal out of nothing. management isn't going to want to hear my opinions on a new policy. my coworkers are going to think that i'm overreacting to something.
and that's ok.
a long time ago when i first started nursing and it was hard, we came up with a motto: "you know the truth". it still applies. i know that i'm doing the best i can to give my patients great care, to support my new coworkers, and to make my unit a better place to work.
that's all i have to offer
and it's taken me six years to realize it, but
that's enough.
Sunday, June 1, 2014
how am i gonna be an optimist about this?
today i had my ass handed to me. twice.
the first time was by this pregnant patient with a bowel obstruction who refused to see reason and systematically tortured me all shift. halfway through receiving an MRI to determine what exactly is going on in her belly, she decided she had enough and demanded to go home. and she remained dead set on this terrible idea even though her entire family and all of the hospital staff told her it was a horrible idea. after literal hours of trying to bargain and reason and threaten the very real possibilities of sepsis and death, i just couldn't handle it anymore. she made her decision, i pulled out all of her lines and drains, and she left AMA.
and it really sucked, because i didn't agree with her decision, yet i was the one that had to take out the PICC line giving her the nutrition that is keeping her baby alive. and i had to get rid of the NG that is keeping her distended bowel from exploding. and i had to pull the foley that was showing us her terrible urine output and let us know just how sick she was. she made me do things that would ultimately harm her and her unborn child, and it made me feel kind of terrible.
so after this emotional abuse, i was treated to 10 rounds of fighting with an overprotective daughter who refused to let me put a catheter in her elderly father. the guy is super old with a bowel obstruction, and i couldn't tell how his urine output was because he's incontinent. i explained to the daughter that we need accurate I&Os to tell us how his fluid balance is, and that we don't want to give too much fluid because of his bad heart, but also that we need to perfuse the kidneys. i explained that catheters don't stay in as long as they used to, and how there are initiatives to DC foleys asap to avoid UTIs. and then she basically told me that if we put a foley in him we would never get it out again and "i'm not taking care of a 91 year old with a catheter".
and she went on and on about how we need to give him a bunch more fluid and she can tell when he needs it and he won't go into heart failure because she can tell and she knows and she watches him because the nurses are too busy, especially the last time he was in the hospital and did i tell you about 12 years ago one time after he had surgery and we had to stay for a few extra hours because he wouldn't pee and i had to have a catheter last year and i would never wish that on anyone because it was so painful and terrible and blah blah BLAH.
and i know she wanted me to agree with her, BUT I DON'T. and even after i told her like 12 times that i would have her discuss her concerns with the doctor, she JUST KEPT TALKING.
and then it was shift change, i was way behind with report, and guess who's getting readmitted?????
yes. so it turns out that when you have a bowel obstruction you will go home and vomit and then go directly to the nearest ED, who will do nothing but place an IV and send you back from whence you came a short 5 hours ago because YOU NEVER SHOULD HAVE LEFT IN THE FIRST DAMN PLACE AND YOU HAVE NOW WASTED ALL MY TIME AND EMOTIONAL ENERGY AND I AM SO FRUSTRATED.
and in sitting here trying to find some sort of moral to this story, i'm coming up empty.
may tomorrow be better. goodnight.
Saturday, May 3, 2014
if you don't want to hear me vent you should skip this one.
hey management and associates, why don't you GET OUT OF MY LIFE.
first of all, you are not even real nurses. you have no idea what i go through, and could not do my job if you tried. if you spent one day in my shoes, the tiny blackened piece of your soul that is left would shrivel up and die.
you don't know me. you don't know my life.
also, i could care less about your administrative BS, or some script you want me to read to introduce myself, or your opinions about how often i should be in my patient's rooms, or where i should give my report to the oncoming shift, or how i teach about medications, or your thoughts about how i should magically be able to infer how each of my patients would like to be treated.
i am tired of you looking over my shoulder. i am tired of you following me around to listen to me parrot exactly what you want me to say like a good little soldier. i am tired of forging my signature of one of your thousands of check off/audit sheets.
you. are. dead. to. me.
and here's looking at you, wanna-be floor nurse turned leadership team member!! you are terrible. how about you actually read the policies before you spread a bunch of misinformation about what they say? too much to ask? just so you know, i will not be following the ideas you pull from the air at a whim. and when i call you on your stupidity and you have the audacity to suggest that i don't take good care of my patients? you are lucky that the lord is working in my life and that i'm practicing controlling my tongue, because the wrath that i have for you is bottomless and when i sleep at night i dream about you getting hit by a bus. what ever happened to clinical assessment skills? to critical thinking? to professional nursing judgement? no, i'm just supposed to shut up and go along with your idiocy. no thanks.
and you, terrible manager. you bring nothing but pain and sadness and i am convinced that there is a small trap door in your office that you use to dump the bodies of the people who are "fired", aka disappear and are never seen or heard from again. you have single-handedly destroyed my will to go on and have made a piece of my soul die.
and you may think that you have won, but I WILL NEVER GIVE IN. because i have learned the secret, which is to stop caring about the opinions of people who don't understand you and whom you don't respect. and also:
i just don't care anymore. i will be fabulous at my job and i will take good care of my patients and i will do it on my own terms. and you may be able to make me fall in line for awhile, but know that i think you are cold, empty, terrible human beings, and that i kind of hate your guts. and what you think about me? :
RIP.
first of all, you are not even real nurses. you have no idea what i go through, and could not do my job if you tried. if you spent one day in my shoes, the tiny blackened piece of your soul that is left would shrivel up and die.
you don't know me. you don't know my life.
also, i could care less about your administrative BS, or some script you want me to read to introduce myself, or your opinions about how often i should be in my patient's rooms, or where i should give my report to the oncoming shift, or how i teach about medications, or your thoughts about how i should magically be able to infer how each of my patients would like to be treated.
i am tired of you looking over my shoulder. i am tired of you following me around to listen to me parrot exactly what you want me to say like a good little soldier. i am tired of forging my signature of one of your thousands of check off/audit sheets.
you. are. dead. to. me.
and here's looking at you, wanna-be floor nurse turned leadership team member!! you are terrible. how about you actually read the policies before you spread a bunch of misinformation about what they say? too much to ask? just so you know, i will not be following the ideas you pull from the air at a whim. and when i call you on your stupidity and you have the audacity to suggest that i don't take good care of my patients? you are lucky that the lord is working in my life and that i'm practicing controlling my tongue, because the wrath that i have for you is bottomless and when i sleep at night i dream about you getting hit by a bus. what ever happened to clinical assessment skills? to critical thinking? to professional nursing judgement? no, i'm just supposed to shut up and go along with your idiocy. no thanks.
and you, terrible manager. you bring nothing but pain and sadness and i am convinced that there is a small trap door in your office that you use to dump the bodies of the people who are "fired", aka disappear and are never seen or heard from again. you have single-handedly destroyed my will to go on and have made a piece of my soul die.
and you may think that you have won, but I WILL NEVER GIVE IN. because i have learned the secret, which is to stop caring about the opinions of people who don't understand you and whom you don't respect. and also:
i just don't care anymore. i will be fabulous at my job and i will take good care of my patients and i will do it on my own terms. and you may be able to make me fall in line for awhile, but know that i think you are cold, empty, terrible human beings, and that i kind of hate your guts. and what you think about me? :
RIP.
Monday, April 21, 2014
easter sunday
the first time i heard screaming during the shift i worked on easter turned out to be some sort of prayer revival. the second time was the pure hood antics that our unit is famous for.
we were all minding our own business at shift change when we heard the following: "YOU DISRESPECTING ME (n-word, string of swearing). THAT'S WHY YOU IN HERE, THAT'S WHY YOU GOT THOSE WOUNDS 'CAUSE YOU DISRESPECTING ME!!". assuming that someone is about to get the beat down, we promptly called security. we all gathered outside the door to hear what was going on, expecting this to be some sort of baby mama drama, etc. much to my surprise, it turns out that the very upset visitor screaming at the patient was actually his mother. apparently someone had a few too many drinkies at the easter barbecue and decided to come to the hospital for a nice visit totally sauced. lovely.
at this point she was crying hysterically and had to be removed from the room by security. she was so obviously impaired that the officers asked her if she was taking any drugs. she blamed the whole thing on being drunk, yelling "IT'S THE ALCOHOL!! THE ALCOHOL MAKE YOU DO THINGS...IT MAKE YOU SAY THINGS!!" and continuing to be hysterical. poor security took her outside to "get some air" and i thought she left. about 20 minutes later i get a phone call. apparently security had been sitting with this lady in the lobby the whole time, and was calling to ask when her daughter (her ride, who had so wisely driven her trashed mom to the hospital) was planning on leaving. i went to the room and tried to tactfully ask the daughter when she was planning on heading out as her mom was "upset" (aka completely wasted). after staring at me for a minute like i was stupid, she told me that she wasn't about to "waste her gas drivin all the way out here to be here 10 minute" and that her mom "gon have to wait". then she proceeding to sit in the room for another 25 minutes until the security officer came back to the room to get her.
1. don't bring your drunk mom to the hospital
2. seriously, you won't take her home? aren't you embarrassed at all that security has been babysitting her for the past 45 minutes?
3. and on a holy day? for shame.
so the moral of the story is...save the hard drinking for christmas. or something.
Monday, April 7, 2014
on passing
i knew that he was dying from the moment i met him. i was surprised because he didn't look bad on paper when i was getting report, but in person it was clear. he was an elderly man who had fallen and broken multiple bones in his face, neck, and back. i could see hear crackly lung sounds the second i stepped into the doorway. he fought the oxygen mask that was cranked up all the way, and the respiratory treatment he was getting did not appear to be helping. his color was terrible, his foley had no urine despite diuretics, and it was pretty obvious where this was going. my suspicions were confirmed when i got vitals and saw an oxygen level in the 70s maxed out on O2.
even in a world where it's somehow ok to try to keep brain-dead people alive, this man was not going to make it. the question at this point was how he was going to die. would it be in a few days intubated in the ICU, sedated and maxed out on pressers? or would it be under my care in a few hours?
the day shift RN and i went to the back room to talk to trauma. everyone knew that the patient had a terrible prognosis, but i don't think anyone realized how little time we had. "he is dying now" i told them. "we need to make sure the family knows what's going on".
the family had been at his bedside the entire time, watching him struggle. that's a terrible thing to see, but despite their own feelings they were doing the best they could to hold it together. a granddaughter was holding his hand so he wouldn't pull the oxygen mask off his face. i stood on his other side doing the same.
i held his hand for over an hour. my wonderful coworkers took control of the rest of my patients so i could see things through until the end. trauma came to see the patient, and in quiet panic went to call the palliative care team. i wasn't sure they would make it in time.
both teams made it to the bedside shortly thereafter. they were compassionate and clear about what was going on. the family talked amongst themselves and decided that he wouldn't want to live like this, and they would follow his wishes not to be intubated. the palliative care team ordered a small dose of IV pain meds and i gave them.
a half hour later, the restlessness stopped. he took a final breath surrounded by his family, and he died.
i had been about to give him some more meds because he was agitated, waving his arms up towards the ceiling when he hadn't been doing that before. now it seems to me that he saw something, and was reaching for it.
but of course we can't be sure of that.
his death was hard to watch, especially for the family. but overall i would say that it was a good way to go. suddenly and quickly, after almost 90 years of a good life. a few short months behind his sweet wife who, according to his family, was his reason for living. there are worse ways than this.
it's a sacred and sobering thing, to be involved in the dying process. how to guide a family through it is not something that they teach you in nursing school. it's another one of those things that you pick up as you go along. more so than anything else, you put aside professional boundaries and just be a human being...a person who has experienced loss personally, and who can empathize. you do everything you can to make the experience easier, and if you can't, you acknowledge the fact that you know it's really hard.
from the moment i met the patient to the moment he died was a short two hours. but i've learned that you don't forget important things, no matter how briefly they lasted.
even in a world where it's somehow ok to try to keep brain-dead people alive, this man was not going to make it. the question at this point was how he was going to die. would it be in a few days intubated in the ICU, sedated and maxed out on pressers? or would it be under my care in a few hours?
the day shift RN and i went to the back room to talk to trauma. everyone knew that the patient had a terrible prognosis, but i don't think anyone realized how little time we had. "he is dying now" i told them. "we need to make sure the family knows what's going on".
the family had been at his bedside the entire time, watching him struggle. that's a terrible thing to see, but despite their own feelings they were doing the best they could to hold it together. a granddaughter was holding his hand so he wouldn't pull the oxygen mask off his face. i stood on his other side doing the same.
i held his hand for over an hour. my wonderful coworkers took control of the rest of my patients so i could see things through until the end. trauma came to see the patient, and in quiet panic went to call the palliative care team. i wasn't sure they would make it in time.
both teams made it to the bedside shortly thereafter. they were compassionate and clear about what was going on. the family talked amongst themselves and decided that he wouldn't want to live like this, and they would follow his wishes not to be intubated. the palliative care team ordered a small dose of IV pain meds and i gave them.
a half hour later, the restlessness stopped. he took a final breath surrounded by his family, and he died.
i had been about to give him some more meds because he was agitated, waving his arms up towards the ceiling when he hadn't been doing that before. now it seems to me that he saw something, and was reaching for it.
but of course we can't be sure of that.
his death was hard to watch, especially for the family. but overall i would say that it was a good way to go. suddenly and quickly, after almost 90 years of a good life. a few short months behind his sweet wife who, according to his family, was his reason for living. there are worse ways than this.
it's a sacred and sobering thing, to be involved in the dying process. how to guide a family through it is not something that they teach you in nursing school. it's another one of those things that you pick up as you go along. more so than anything else, you put aside professional boundaries and just be a human being...a person who has experienced loss personally, and who can empathize. you do everything you can to make the experience easier, and if you can't, you acknowledge the fact that you know it's really hard.
from the moment i met the patient to the moment he died was a short two hours. but i've learned that you don't forget important things, no matter how briefly they lasted.
Monday, March 10, 2014
visitors
dear visitors,
this is not your house.
love, the help.
lord help me the visitors are going to make me lose it. i understand wanting to be there to support someone who's sick, but there are boundaries, people!! how do you know if you are the annoying visitor? i have compiled a list of problem visitors and their characteristics below.
the daycare:
you feel the need to bring 5 kids under 3 to the room, who cry and scream, run loose in the halls, and demand juice and graham crackers. extra points to you if you come up to the desk and ask for a pamper, then glare at me when i tell you we only have adult diapers.
the two-for-the-price-of-one patients:
you are the visitor who feels that your loved one's hospital stay is a good time to ask medical advice for your own health issues. chances are you were just discharged from the hospital or intend to go down to the ER while you're here to "get checked out". you have no problem asking staff to push you around in your wheelchair, take off your shoes for you, or to hook you up to the hospital oxygen. extra points if you ask me if i can help you go to the bathroom.
the move in and stay:
you don't leave. EVER. you bring a good portion of your personal belongings to leave around the room, use the patient's shower and bathroom for your beauty rituals, and take up all of the refrigerator space with your personal food. extra points to you if i have to ask who the patient is because you insist on wearing hospital gown and slippers.
the cuddler:
you are in the bed (ug, WHY do you need to be in the bed, seriously?). you make it hard for me to do my job because you are in my way. extra points to you if you are only partially clothed, and BONUS points if you are caught performing some sort of sex act on the patient by one of the staff members.
the whole damn family:
you are part of a 30 member group of aunts, cousins, and at least one elderly person with an assistive device parked right in front of the door. you spend your entire visit hunting down staff members to ask for extra chairs, even though you could not squeeze one more person or furniture item into the room. you make sure that each member of your group asks for a beverage, preferably at intervals so i have to run back and forth to the kitchen several times. extra points to you if you bring a bunch of fast food into the room that you leave sitting around for me to clean up when you go.
the homeless:
you make a habit of sleeping on different people's couches, usually because you are drunk or high most of the time and have no ambition. you like to latch on to a "friend" or distant relative you barely know and use their hospital room as your new home. you leave the room only to go get more drunk or high, and then like to come back and snore loudly enough in the recliner chair to wake half the floor. extra points if i need to wear a mask in the room because you decided to take your shoes off.
sadly i could go on. in fact just the other day we had to tell a family member that he couldn't sleep on the six foot long bench that he stole from another floor's waiting room and wheeled up to the room on a cart (which he also helped himself to). no. boundaries.
so don't be that visitor!! bring your own snacks! sit in the chair, don't sleep in the bed! and for the love of all that is good GO HOME once in awhile, you're driving me crazy.
this is not your house.
love, the help.
lord help me the visitors are going to make me lose it. i understand wanting to be there to support someone who's sick, but there are boundaries, people!! how do you know if you are the annoying visitor? i have compiled a list of problem visitors and their characteristics below.
the daycare:
you feel the need to bring 5 kids under 3 to the room, who cry and scream, run loose in the halls, and demand juice and graham crackers. extra points to you if you come up to the desk and ask for a pamper, then glare at me when i tell you we only have adult diapers.
the two-for-the-price-of-one patients:
you are the visitor who feels that your loved one's hospital stay is a good time to ask medical advice for your own health issues. chances are you were just discharged from the hospital or intend to go down to the ER while you're here to "get checked out". you have no problem asking staff to push you around in your wheelchair, take off your shoes for you, or to hook you up to the hospital oxygen. extra points if you ask me if i can help you go to the bathroom.
the move in and stay:
you don't leave. EVER. you bring a good portion of your personal belongings to leave around the room, use the patient's shower and bathroom for your beauty rituals, and take up all of the refrigerator space with your personal food. extra points to you if i have to ask who the patient is because you insist on wearing hospital gown and slippers.
the cuddler:
you are in the bed (ug, WHY do you need to be in the bed, seriously?). you make it hard for me to do my job because you are in my way. extra points to you if you are only partially clothed, and BONUS points if you are caught performing some sort of sex act on the patient by one of the staff members.
the whole damn family:
you are part of a 30 member group of aunts, cousins, and at least one elderly person with an assistive device parked right in front of the door. you spend your entire visit hunting down staff members to ask for extra chairs, even though you could not squeeze one more person or furniture item into the room. you make sure that each member of your group asks for a beverage, preferably at intervals so i have to run back and forth to the kitchen several times. extra points to you if you bring a bunch of fast food into the room that you leave sitting around for me to clean up when you go.
the homeless:
you make a habit of sleeping on different people's couches, usually because you are drunk or high most of the time and have no ambition. you like to latch on to a "friend" or distant relative you barely know and use their hospital room as your new home. you leave the room only to go get more drunk or high, and then like to come back and snore loudly enough in the recliner chair to wake half the floor. extra points if i need to wear a mask in the room because you decided to take your shoes off.
sadly i could go on. in fact just the other day we had to tell a family member that he couldn't sleep on the six foot long bench that he stole from another floor's waiting room and wheeled up to the room on a cart (which he also helped himself to). no. boundaries.
so don't be that visitor!! bring your own snacks! sit in the chair, don't sleep in the bed! and for the love of all that is good GO HOME once in awhile, you're driving me crazy.
Friday, February 14, 2014
the abyss
"He who fights with monsters should look to it that he himself does not become a monster. And when you gaze long into an abyss the abyss also gazes into you." -Friedrich Nietzsche
last week wore me down.
there is this dynamic in my patients' lives that i just can't understand. so much of my nursing practice involves working with this population, and it completely baffles me. we take care of this core group of 18-21 year old men who are trauma patients (usually shot or stabbed) with no jobs, criminal records, multiple children by multiple different women, and seemingly no desire to do anything worthwhile with their lives.
i just can't figure it out. it's not a race thing (although it's way more prevalent in certain groups), it's not a class thing it's a LIFESTYLE, and this lifestyle is being glorified all around us. somehow these guys have gotten the idea that certain things in life are the most important: money (the biggest problem, in my opinion), power, reputation, being desired by multiple women, having a lot of kids as a symbol of being "a man", certain clothes/shoes, a "hard" attitude, etc. i see the same signs of people trying to live this life all the time. it's in the tattoos covering my patients' bodies that say things like "money power respect" and "get rich or die tryna". it's the fact that these boys have the mentality and impulse control of children but the anger and ability to destroy things of adults. it's the way that these patients cry like little boys when they're in pain, and then an hour later are on the phone ranting about "doing their business" and how they're "grown". there is such a disconnect here that i have trouble putting it into adequate words for myself, much less explaining it to other people.
essentially, i often feel like my patients are doomed, and their children who are being born into this lifestyle are doomed, and that society in this city is destroying itself and there is nothing we can do about it.
working with this population has changed me, and probably not for the better.
i want to grab these boys and shake them. i want to talk some sense into them, to make them realize that this life they are aspiring to is beneath them, and that the things that they are living (or more accurately, dying) for are not as important as they think.
but i also realize that i have no idea how life is for these guys. i haven't grown up in their neighborhoods, i haven't been indoctrinated with the idea that selling drugs is normal, going to jail is no big deal, that getting shot is some bizarre rite of passage. i've had opportunities, and a safety net, and a chance.
so instead, i find myself without sympathy. i am SO SICK of this. i'm tired of watching people perpetuate the behaviors that are hurting them. it's like watching someone smoke 2 packs a day for 30 years and then get lung cancer. do they deserve it? no one deserves that. did they earn it? probably.
i sent a patient to jail last week for violating his parole by accidentally shooting himself with a weapon he wasn't supposed to have. he had no idea he was being discharged, and no idea the police were waiting for him. when they walked into his room to arrest him, he didn't bat an eye.
it was like he didn't even care.
it's things like this that have worn away at my optimism, made me doubt that i can ever make a dent in the problems in this world, made me so jaded and cynical that even i am shocked at the things that come out of my mouth sometimes.
i have looked into the abyss, and it has looked back into me. and now i need to figure out how not to become a monster because of it.
last week wore me down.
there is this dynamic in my patients' lives that i just can't understand. so much of my nursing practice involves working with this population, and it completely baffles me. we take care of this core group of 18-21 year old men who are trauma patients (usually shot or stabbed) with no jobs, criminal records, multiple children by multiple different women, and seemingly no desire to do anything worthwhile with their lives.
i just can't figure it out. it's not a race thing (although it's way more prevalent in certain groups), it's not a class thing it's a LIFESTYLE, and this lifestyle is being glorified all around us. somehow these guys have gotten the idea that certain things in life are the most important: money (the biggest problem, in my opinion), power, reputation, being desired by multiple women, having a lot of kids as a symbol of being "a man", certain clothes/shoes, a "hard" attitude, etc. i see the same signs of people trying to live this life all the time. it's in the tattoos covering my patients' bodies that say things like "money power respect" and "get rich or die tryna". it's the fact that these boys have the mentality and impulse control of children but the anger and ability to destroy things of adults. it's the way that these patients cry like little boys when they're in pain, and then an hour later are on the phone ranting about "doing their business" and how they're "grown". there is such a disconnect here that i have trouble putting it into adequate words for myself, much less explaining it to other people.
essentially, i often feel like my patients are doomed, and their children who are being born into this lifestyle are doomed, and that society in this city is destroying itself and there is nothing we can do about it.
working with this population has changed me, and probably not for the better.
i want to grab these boys and shake them. i want to talk some sense into them, to make them realize that this life they are aspiring to is beneath them, and that the things that they are living (or more accurately, dying) for are not as important as they think.
but i also realize that i have no idea how life is for these guys. i haven't grown up in their neighborhoods, i haven't been indoctrinated with the idea that selling drugs is normal, going to jail is no big deal, that getting shot is some bizarre rite of passage. i've had opportunities, and a safety net, and a chance.
so instead, i find myself without sympathy. i am SO SICK of this. i'm tired of watching people perpetuate the behaviors that are hurting them. it's like watching someone smoke 2 packs a day for 30 years and then get lung cancer. do they deserve it? no one deserves that. did they earn it? probably.
i sent a patient to jail last week for violating his parole by accidentally shooting himself with a weapon he wasn't supposed to have. he had no idea he was being discharged, and no idea the police were waiting for him. when they walked into his room to arrest him, he didn't bat an eye.
it was like he didn't even care.
it's things like this that have worn away at my optimism, made me doubt that i can ever make a dent in the problems in this world, made me so jaded and cynical that even i am shocked at the things that come out of my mouth sometimes.
i have looked into the abyss, and it has looked back into me. and now i need to figure out how not to become a monster because of it.
Thursday, January 30, 2014
wearing out our welcome
mark my words, we are going to get kicked off of our new floor.
it all started after our 'big move' d/t construction on the old unit. suddenly for the first time since i've been a nurse, we have neighbors!! this is nice in the way that it conveniences me when i need a green top or a vial of metoprolol, but strange in that i can't tell which patients belong to us and which are just passing through. and then there's the whole matter of our unit showing its true colors...
we are hood. and now everyone knows it.
it started innocently enough, in a baby momma fight that involved weave getting ripped out in the middle of our shared hallway and the screaming of the phrase "stupid ho" loud enough to make the nurses on the other unit come running. the sheriff showed up and hauled people off to jail, and that was that.
then a week later security showed up looking for some visitors. when trying to find teenagers who steal food from the cafeteria, apparently our unit is first on the list of places to look. and sure enough, there they were. after getting lectured by security and having someone pay for the food, the kids were of course very apologetic and saw the error of their ways. just kidding. they actually went back to the cafeteria and threatened the workers who turned them in, leading the sheriff to pay our unit another visit.
a few days later, we had a gentleman who thought it was acceptable to grope at the nursing assistants and call them "baby". a manager tried to talk to the patient and explain that this was inappropriate behavior, which didn't go over too well. things ended with the patient chasing our manager down the hallway in his wheelchair and calling him a homosexual. cue the sheriff.
and a few days after that, one of my coworkers was asked to put his patient's coat away. he opened the closet in the room only to find a samurai sword. yes, a samurai sword. when the sheriff showed up (for the fourth time in two weeks, but who's counting?), the patient was also found to have a hoard of oxycodone and his urine came back positive for cocaine.
these things happen in the land of trauma drama, but not usually so frequently and never so publicly. but now here we are, on display for the rest of the hospital to see. i'm half glad that other nurses can see what we're dealing with while they're taking care of normal looking people, and half embarrassed to be "that floor".
thankfully it will only be a few months until we move back to our own unit, tucked away in a corner by ourselves for reasons that i now see very clearly. and it's my hope that these few weeks of lawlessness will reinforce to 'the man' that we really do need the locked unit we've been begging for.
but until then, new neighbors, my apologies.
it all started after our 'big move' d/t construction on the old unit. suddenly for the first time since i've been a nurse, we have neighbors!! this is nice in the way that it conveniences me when i need a green top or a vial of metoprolol, but strange in that i can't tell which patients belong to us and which are just passing through. and then there's the whole matter of our unit showing its true colors...
we are hood. and now everyone knows it.
it started innocently enough, in a baby momma fight that involved weave getting ripped out in the middle of our shared hallway and the screaming of the phrase "stupid ho" loud enough to make the nurses on the other unit come running. the sheriff showed up and hauled people off to jail, and that was that.
then a week later security showed up looking for some visitors. when trying to find teenagers who steal food from the cafeteria, apparently our unit is first on the list of places to look. and sure enough, there they were. after getting lectured by security and having someone pay for the food, the kids were of course very apologetic and saw the error of their ways. just kidding. they actually went back to the cafeteria and threatened the workers who turned them in, leading the sheriff to pay our unit another visit.
a few days later, we had a gentleman who thought it was acceptable to grope at the nursing assistants and call them "baby". a manager tried to talk to the patient and explain that this was inappropriate behavior, which didn't go over too well. things ended with the patient chasing our manager down the hallway in his wheelchair and calling him a homosexual. cue the sheriff.
and a few days after that, one of my coworkers was asked to put his patient's coat away. he opened the closet in the room only to find a samurai sword. yes, a samurai sword. when the sheriff showed up (for the fourth time in two weeks, but who's counting?), the patient was also found to have a hoard of oxycodone and his urine came back positive for cocaine.
these things happen in the land of trauma drama, but not usually so frequently and never so publicly. but now here we are, on display for the rest of the hospital to see. i'm half glad that other nurses can see what we're dealing with while they're taking care of normal looking people, and half embarrassed to be "that floor".
thankfully it will only be a few months until we move back to our own unit, tucked away in a corner by ourselves for reasons that i now see very clearly. and it's my hope that these few weeks of lawlessness will reinforce to 'the man' that we really do need the locked unit we've been begging for.
but until then, new neighbors, my apologies.
Monday, January 20, 2014
presence
nursing is usually just a series of tasks. pass the meds, walk people, do some dressing changes, call the doctor to clarify orders, whatever. we run from patient to patient usually desperately behind and looking to spend as little time as possible in each place so we can catch back up. the whole idea of patient care, the actual caring about and spending time with people often gets lost in the shuffle. it's just the way things usually go.
last week i found myself in a unique situation. we were shuffling all of our patients from one unit to another because of construction. my job was to wait for my patients on the new unit and to settle them as they arrived. because of the hugeness of picking up and moving a whole unit in several hours, we were blissfully staffed with the never before (and never again, i'm sure) ratio that essentially left all of us with only 1 or 2 patients to move. my first "patient" to arrive was actually just her husband pushing a wheelchair of her belongings, as she was in the OR. the patient had advanced cancer and was getting a washout for an infection from a previous procedure. as i started to put her things away, the surgeon came to the room to let her husband know her surgery was over. i was on my hands and knees wiping up the entire bottle of the saline i'd just dropped on the floor when i heard him tell the husband that there was a tear in the bowel. this was followed by a very matter of fact "if she gets a fistula, i think it's time to pursue palliative care. if it were my wife i'd start thinking about how long you want to fight this thing". and then the surgeon left, and it was just me and my patient's husband whom i had met less than 5 minutes before.
what do you say in a moment like that? i've been there? i'm sorry? i'll do whatever i can to make this even the tiniest bit easier for you? all of the above? are there really any words that can blunt the pain of that kind of conversation?
no, there aren't.
in nursing school we aren't taught how to be helpful when someone's world is falling apart, probably because that's not something that can be learned. so i offered the husband what i had, what i NEVER have but for some reason on this day in this situation, i did. my time. no other patients to worry about, no other tasks to run to, no ringing phone to interrupt the moment.
i sat with him. i gave him the comforting words that came to mind, and when those sounded like not enough to my ears i was just there. it didn't change things, or make the truth any less difficult, but it was something.
i think that it's easy to lose sight of the fact that just being present when people are hurting is helpful. sitting with someone whose heart is breaking is sad and sometimes uncomfortable, and for me brought up memories that i'd rather not remember. but it was what the moment called for, and because of that i was happy to be there.
this is the thing that i so easily forget: taking care of people means actually caring. it's so easy for me to view the day as a giant checklist of meds and tasks that i put a line through when i finally finish. i power through 10 or 12 hours with a death-grip on 'my plan for the day', trying to be productive and efficient. but sometimes the day just calls for sitting in a chair and shedding a few tears for someone else's pain; for offering up my presence when i have nothing else to give.
Wednesday, January 1, 2014
2014
2013, i don't know what to say about you. it wasn't a bad year, but it certainly had it's moments. it was a year of growing pains, and i'm not quite sure why. i feel like this was the year that i became officially branded as 'trouble' and i resent that. i feel that the hospital's need to make money, cut costs, please patients to unrealistic levels, and essentially eat the lower half of the state reached an all time high. i feel that i'm being asked to do more things in less time taking care of higher acuity patients and all with a smile on my face.
but that, i suppose, is just healthcare now.
in 2013 i finally learned to stay in my own backyard; that i need to leave people to care for their patients in their own way and that i get to do the same. i don't find myself having as many run-ins with the residents, mostly because i don't really think that i have anything to prove anymore. i know that i'm good enough, and i think i'm figuring out more and more which battles to fight for my patients and which to just let lie. the longer i work at this job, the more that i see the shades of grey: the policies that don't apply in every situation, the rules that can be bent, the nontraditional ways to provide good care...just a more intuitive way of practicing.
i'm not a perfect nurse, not by a long shot. but i care about my patients, i want to give them my best and that is something.
so without further ado, in 2014 i would like to:
but that, i suppose, is just healthcare now.
in 2013 i finally learned to stay in my own backyard; that i need to leave people to care for their patients in their own way and that i get to do the same. i don't find myself having as many run-ins with the residents, mostly because i don't really think that i have anything to prove anymore. i know that i'm good enough, and i think i'm figuring out more and more which battles to fight for my patients and which to just let lie. the longer i work at this job, the more that i see the shades of grey: the policies that don't apply in every situation, the rules that can be bent, the nontraditional ways to provide good care...just a more intuitive way of practicing.
i'm not a perfect nurse, not by a long shot. but i care about my patients, i want to give them my best and that is something.
so without further ado, in 2014 i would like to:
- be less judgemental; of the doctors, of my patients, of my coworkers. we are all only human and doing the best we can. i need and expect grace when i fall short and i need to give it in return as well.
- try to be manageable. i have a rebel's heart, and i don't like being told what to do/how to do it. as a result, i have a big problem with authority. i realize that i'm to the point where i've got an axe to grind over just about everything that comes out of 'the man's' mouth. i need to be open to trying things a different way, and i need to give change a chance.
- not let 'comfortable' become 'stuck'. my job is like a little security blanket that i haul with me wherever i go. i know it, i'm good at it, and i'm more than a little afraid that i'll turn around one day and realize that i'm about to retire and i never left the floor because it was easier that way. i simultaneously want to be challenged and am terrified of the unknown. i need to keep my eye on the prize, which right now seems to be moving to the ICU.
- never be too busy to be compassionate. i easily turn selfish and focused on my own stuff, and it freaks me out how i forget to be grateful that i'm not the person in the bed. cardiac nurse bff once told me about a patient satisfaction survey where someone complained 'no one said sorry i'm sick'. entitled as that might be, it stuck with me, and now i try to remember to tell my patients that i'm sorry this happened to them.
i like the new year because i like definition and order and the belief that one particular day turning into the next somehow means that i have a clean slate. i guess that's what i want more than anything in 2014. i need a fresh start, and the chance to prove that i can be better than i am now. first i was a good person, then i was a good nurse, and now i want to be both.
here we go.
Thursday, December 26, 2013
christmas cray
...because it's not christmas until we're wrestling with a hallucinating amputee who's trying to run from the guy who's trying to kill him in his room.
restraints and haldol to all and to all a good night.
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