nursing in an urban war zone.

as i walked into work yesterday i noticed a police car heading pretty fast towards my side of the hospital.  then another as i got closer.  and another.  and another.  by the time i walked into the building, there was a gathering of dozens of squads outside.  there were employees huddled in the doorway murmuring something about bomb threats, and i got the general sense that i did not want to be walking in to whatever this was.  but as with most things, when normal people are running away, nurses are going in.  so i went about my day, only to get on the unit and learn of a man with a gun in a neighboring building.  and it felt a lot like this day.  the news was rabid outside the window of the unit, and on tv they were airing whatever "tips" that random people were calling in from inside the building, almost all of which weren't true.  the police ran crime scene tape around the trees outside our charting room window, and we watched from the inside as people gathered for a press conference.

it made me angry.

you shouldn't have to feel unsafe at work.  you shouldn't have to wonder if an angry family member with a gun is coming for you.  you shouldn't have to feel obligated to put your own personal safety at risk like some sort of martyr's sacrifice to take care of other people.  i signed up to be a nurse.  in the midwest, not some sort of combat zone.  and yet in the past 6 years i have watched the police push up ceiling tiles in a patient's room on the hunt for a weapon.  i've been handed a grainy picture of an attempted murderer who tried to kill one of my patients and have been told to "be on the lookout".  a little over a year ago i hid in a room with a patient, listening to news broadcasts saying there was a mass shooter with a gun in the hospital cafeteria, and waiting for him to come up to my unit looking to finish the job.  i've had veteran trauma nurses tell me the story of when US marshals came to arrest a patient's most-wanted family member with guns drawn and made all the nurses lay down on the nurse's station floor.

these are the things that are happening, and these things are not ok.  i NEVER thought that i would have to deal with anything like this when i became a nurse, and i still don't think that i should have to.  i care about my patients, and i want to keep them safe.  but at what cost?  and am i obligated to put myself in harm's way to protect people i barely know?

the man with a gun was shot by police.  then he ended up in the trauma bay, and we all were afraid that he would get admitted to the floor and we'd be forced to take care of this man who no one could muster up much compassion for.  but he didn't, and then it was done.  the news went away, and the helicopter stopped hovering overhead.  the crime scene tape came down and the squad cars left one by one.  and we were just supposed to go on with our day, like it didn't matter that we had another example of just how easy it is to waltz into a hospital with a gun down your pants.

it matters.  and it is NOT OK.  

fatigue & compassion

there is a thing called compassion fatigue, and that basically means that you are tired of caring for other people.

yes.  that.  

i am exhausted.  i have nothing left to give.  i sat down after my shift today not having charted anything.  ANYTHING AT ALL.  i felt like i gave my patients everything that i had to offer, and didn't even come close to meeting their needs.  

my brain injured patient has an ever-growing left arm that no one will address.  he won't eat and hasn't gotten out of bed.  he barely gets turned because he's a huge guy and just doesn't roll.  he sleeps all day, except for when he's screaming out in pain.  and i know he's brain injured, but it still makes me feel like a horrible person when he's yelling at me all the time that i don't understand his pain.  

my admit has a room full of nurses and is herself "medical".  she looked at me with accusatory eyes from the first moment i stepped foot in her room and right away i felt the need to prove my competence and live up to unrealistic expectations.  when she said "that medicine isn't doing anything for my pain", it was obvious that she meant that it was ME who wasn't doing anything for her pain.  and despite my ice packs and moving pillows all about and switching around pain meds and adding muscle relaxers and splinting her fracture, the pain got no better and i achieved nothing.

my sweet GSW to the chest has a necrotic liver, and just feels like crap all the time.  there is basically nothing that i can do for her, and that feels like failing too.

so i sat down at a computer to do 10 hours worth of charting, and started to cry.  the exhausted, frustrated, i'm crying about one thing but it has become everything kind of tears that don't stop.  and as i sat charting and sobbing and blowing my nose and creating a mountain of used kleenex next to me, the door to the charting room opened and one of the oral surgeons walked in.  and he sat with me and awesome coworker for almost an hour as i continued to cry and chart and try to cover my feelings with cheese bread and vent all my nursing guilt and inadequacies.  he told me that it's ok to care, and that i am making a difference, and that i'm not a failure.

a surgeon.  who has feelings.  who is not scared by my ugly crying, but as i found out later heard that i was having a rough day and sought me out just to talk.  there are no words for that.

when you live the kind life where you pour everything you have into other people and typically go home having been given nothing in return, receiving compassion and kindness for yourself is a shocking and wonderful thing.

my coworkers know and love me, and they are incredibly supportive.  we take care of each other, and they are the only things keeping me at this incredibly challenging and frustrating job.  but this doctor doesn't know me particularly well, and he doesn't owe me anything.  yet for some reason he took it upon himself to offer me support and reassurance when i needed it.

and because of that, i have lived to nurse another day.

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.