enough.

i've never been very good at accepting less than perfect.  five years of nursing has taught me that there is a limit to how much i can give, that sometimes doing 'the best i can' is all i've got.  but lately that hasn't been enough.  you'd think that i'd get used to being so frustrated, seeing as how i've spent the better part of my career feeling that way.  unfortunately not.

this week, which sadly has only been 3 days, has made me realize a lot of things.  i'm not happy in my job at all anymore.  the compassion that used to come so naturally to me just doesn't anymore.  i've started to view almost everyone that i come in contact with as an inconvenience to me and an obstacle to me making it through one more day at this miserable job.  i don't remember the last time i loved my work or the last time i thought something at work was fun or exciting or interesting, in fact i'm so unhappy that i can't even remember what made me want to do this in the first place.  i've lost all joy and wonder; the reality of nursing and working on a toxic, thankless floor has killed that for me.

because the truth is, nothing i do is enough.

i work in a place where all we hear is "good job with that, BUT...".  management nags us constantly.  now i realize that this is their job, but it's excessive.  we can't just be piloting one new project that no one wants to participate in, it has to be three.  there isn't one new required form of duplicate charting, there's two.  it doesn't matter if patient acuities are through the roof and nurses with 10 years of experience are literally crying, half the floor WILL go to a mandatory meeting to discuss what we can do to make the floor better...oh the irony.

but it's more that that, really.  it's the feeling that my patients deserve more than what i can offer them, not because i'm incapable but because i'm so stressed and spread so thin.  it's the feeling that i've never had to work so hard to be such a failure in all my life.  i'm tired of sucking at my job all the time.  i'm tired of trying my very hardest to barely keep up, and to fall short of the 'expectations' that i'm being held to.

every ounce of care that i used to have for this job and this floor has been sucked out of me.  i have become the 'things will never change' nurse, and i'm sure it shows.  you can only give more than you have to other people with nothing in return for so long.  after that you apparently become bitter and washed up and sad and old.  well who knew?

i feel like a caged animal.  i am desperate to escape, and i'm willing to claw anything that keeps me from my goal of making it through another day.

i used to be kind and now i'm calloused.  i used to be optimistic and now i'm a downer.  i don't have compassion and i don't have patience and i probably have no business working with people at all when i feel this way, but i have bills to pay and no other choice.  i've begun to desperately search for another job.  i've sent applications, i've emailed managers.  at this point i will do ANYTHING to escape...leave my friends, work nights, lose my seniority...ANYTHING.

i  can't work like this anymore.  i can't live like this anymore.  i've just had enough.

favorite things.

fav new RN on working with the 'laid back' nurse: "my back is killing me...from carrying the team"

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new work motto:

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awesome coworker on the elevator music we're forced to listen to: "seriously, this music sucks"
me: "um, that's your patient's chair check"
(awesome coworker sprints off)

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two new forms, new IV pumps, and mandatory triple charting on patient med teaching this week.  as favorite float pool nurse says "they should just tell me when to show up to get the chip put in my head".

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brain injured patient to my fab pregnant nursing assistant: "you know what you gonna name that little gangsta boy?"

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and this:

"i tried carrying the weight of the world, but i only had two hands".  yes, that exactly.

hood life.

i grew up in the hood.  not the mean streets of new york or anything, but still ghetto enough that when i say i'm from ___, people make comments.  we had the token airbrush store at the mall where you could get your tall-t "RIP" shirts made.  we had a police liaison office at school.  during lunch i would watch the hispanic girls fight each other (after taking off their giant hoop earrings first, of course) and little balls of yanked-out weave would roll around in the halls.  after school we had a paddy wagon that would pull into the school bus circle and people who were trying to start something would get thrown into the back.  maybe that's not normal...to me it is.  i'm not saying that i was ever a gansta myself, but that kind of life is pretty familiar to me.  i think that's part of the reason why i took to the trauma unit right away.  it feels like home, in all of its dysfunctional glory.  the ghetto made me (or at least that's the joke), and it's what i know.   and this week at work was par for the course.  

one day i was urgently called out of the nurse's station by a family member who said a patient (not mine) needed help (not true) and her call light wasn't working (also not true).  when i got to the room the multiple grilled/weaved/false-eyelashed visitors argued for awhile if i could even help them or if they needed a doctor (good luck with that one).  after i encouraged them to go ahead and try me, they asked me if "yo blood in yo body be blue".  this is apparently why i went to nursing school.

a few days later i got this patient who was in for his second evading the police car accident.  turns out someone has 5 kids (in his mid-20s) and hasn't been paying his child support.  apparently this guy has also been shot a couple times...so classy.  the "trust no bitch" and "only god can judge me" tattoos were a nice ironic touch.

for better or worse, these are my people.  and now that trauma season is drawing to a close, these are the people that i'll miss for the next 6 months where all i see is slid-on-the-ice MVCs and old people falls.  until the summer, my friends from the hood...i'll be waiting for you. 

taking pills

this week's important lesson: don't buy random unmarked pills from people in bars.  

so i get this patient out of the ICU s/p MVC with multiple rib fractures.  the guy is 70 years old and was driving his car when he suddenly lost control of the vehicle/passed out/basically has no idea what happened.  

fortunately, this is why social work notes were created.

turns out that grandpa likes some percocet for his arthritis (don't even get me started on primaries overprescribing pain meds), and ran out.  so he did what most people would do (NOT) and bought a bunch of pills off "some guy" in a bar.  

so after the crashing is done and the patient is in the ED, the unmarked bottle of pills comes out.  pharmacy looks them up and turns out that grandpa got himself 4mg Dilaudid tabs.  WHY DO 4MG DILAUDID TABS EVEN EXIST??  to be abused, that's why.  

he ended up taking "some" (aka ODing on narcs) and then getting behind the wheel.  

on the plus side, he probably didn't feel a thing when he slammed himself into a tree.  

on the minus side, he now has 10 broken ribs and his dilaudid was confiscated.  

on the plus plus side, he now gets to take oxycodone AND oxycontin. 

STOP BUYING PILLS OFF STRANGERS IN BARS.  

that will be all for today. 

 

lies

there is something about being lied to on a daily basis that has made me stop trusting a thing that people say.

case in point.  i had this patient awhile ago....8 months pregnant, accidentally stuck her hand through a window and severed an artery.  almost bled to death on her front porch.  upon arrival to the ED, they almost did a C-section in the trauma room, which is NOT DONE (i know, i know, the TV show ER lied to us all).  they finally got a blood pressure on mom in the 40s systolic, so they ran her to the OR and did the C-section there.  after a ridiculous amount of blood...like 16 units PRBCs and 9 of FFP, everybody was still alive.  baby ended up doing pretty well in the NICU, and the patient came to me in less than 24 hours from when she was almost dead.

she had some problems, to say the least.  drug and alcohol issues, didn't have custody of some other kids...that kind of stuff.  but when she told me that her issues were in the past, something made me believe her.  and when she teared up every time she talked about her baby, she was genuine.  she didn't even want to go home on narcotics, such was the dedication to the idea of changing her life.  i don't usually drink the kool aid about that kind of stuff, but with her i did.  i was convinced that she was going to change her life, and when she got discharged i was hopeful for her.

a few days later one of my pregnant coworkers saw her in the OB clinic waiting room.  she was falling out of her chair, dropping things, eyes half closed...obviously on something stronger than percocet.

i guess i shouldn't be surprised.  it still makes me sad, though.  i wanted better for her.  i wanted for her to prove everybody wrong, for her to prove to the state that she can be a good mom.  for her to be able to keep her baby, to fight her addictions.  but i guess she just doesn't have it in her.

now that i think about it, i don't think that she was lying to me as much as she was lying to herself.

it's an age old question: how do you give your best on a daily basis to people who most likely will never change the behaviors that brought them to your door in the first place?  or do you just do your job and stop caring about the rest?

i want to believe that people can wake up one day and say 'enough is a enough', stop living out destructive behaviors and making poor choices, and completely turn their lives around.

i WANT to believe it.  i'm just not sure i actually do anymore.  

run and tell that.

a while ago we had a visit from some governmental friends.  while they who will not be named were in the house, we had an unauthorized dog running around the floor, a patient trying to bathe themselves with cavi wipes, and a patient elope to mcdonalds playland for 3 hours because "nobody told me that i couldn't!!".  cue widespread panic and cover ups to ensure that we didn't look like morons and get dinged 234098234 times for violating like all the policies we have.

and while our visit with 'the man' went fine, it always ticks me off when they're around.  mainly because we have to spend more time worrying about timely charting than about actual patient care.  and because i have to hide my coffee.  but now they're gone...let the use of unauthorized hand lotion begin!!

in which i am traumatized by camp nursing.

so i do this thing every year where i work a 70 hour week and then head straight to kids camp and be their nurse for a few days.  every year i dread it, and every year i leave happy and feeling like i did something good.  for the past few years, i have soothed the hypochondria of children and put on some band aids.  this year, i expected more of the same.

that was, until, the very first night of camp.  when a mere 5 hours after the kids arrived, i heard the horrific screaming that only comes when someone is very very hurt.  my suspicions were confirmed when people started yelling for me, so i followed the noise to the kid writhing in pain on the ground with a very obviously broken arm.

now i'm a trauma nurse.  but i don't work peds, and i'm not a first responder.  the fractures that i see are all splinted or ex-fixed or at the very least, covered in some way by the paramedics.  i'm definitely not used to seeing such a little hand just hanging there, especially when it's attached to a terrified little kid.  i would like to say that i launched into nurse mode, but i actually think that it was more like mom mode.  i grabbed the crying child, pulled him into my lap, and held on for dear life.  the arm was bleeding, and even when i was asking him if he remembered falling on anything, i was pretty sure we were dealing with an open fracture.  and instead of my nice shiny sterile hospital setting with all of my supplies, i'm sitting in dirt at the bottom of a hill with a first aid kit that somehow doesn't have gloves.  and this is my fault, because i was the one who "restocked" the first aid kit....just not very well, apparently.

i honestly think gloves wouldn't have mattered anyway, because the kid wouldn't let me do anything to his arm.  i had nothing to splint it with.  the open area was all the way underneath the arm, where i would have had to twist it to look, and he was having none of that.

so there we sat.  in the dirt.  at the bottom of a huge hill.  him in my lap, his broken and bleeding arm laying on top of my intact one as i acted like a human splint.  i held his hand on the broken side, and we waited.

i have never been so relieved to hear sirens in all my life.  we packed him up in the back of the ambulance and went to the hospital, where the xray showed a both-bone open fracture that needed to go to the OR right away.  i stayed until his mom got there, then went back to camp.

i talk about being this mighty trauma nurse who's seen everything and is not phased by anything, and that night it just wasn't true.  sitting on the side of a big hill, in the dirt, with a crying and terrified child in my lap...it was SCARY.  none of my supplies, no resources, no higher authority than myself...everyone looking to me to decide what we were going to do.  you would think that someone who loves to be in control would be thrilled with such power, but i wasn't.  i was out of my depth.

so once it was finally over, i called my nurse bff and cried.  and then i felt better, and went on to nurse another day.  a day in which i had to deal with this:

it turns out that it's a bad idea to wrap a t-shirt doused in lighter fluid around a piece of wood to make an "olympic torch" and then run with it through camp, as one of the counselors learned the hard way.

such.  big.  blisters.

i hear both 'patients' are recovering well, and after a week i finally have too.

hats off to those who make a living listening to the panicked screaming of people who are healthy one minute and broken the next.  i have officially learned that is not for me.