Pieces of Eight

Right, almost forgot this one. Thanks for the tag, Markie.

Eight things about myself…hmm…

1) I like coffee. Specifically, I like to go to Starbuck’s and get a tall white chocolate mocha cappuccino, breve, with whipped cream. My budget can no longer afford it, though, so it’s in my dreams at night.

2) I’ve lost six pounds since Thanksgiving. No lie. Too much stress, yo. This is on a 5’7″, 125 lbs frame, folks. CanNOT lose any more weight.

3) My second son had a non-displaced fracture of his right frontal bone, on the suture line. Wish I could  share the CT with you. It was hugely obvious, even to a little US/MT like me. But no worries. It’s all good now.

4) My love ignores me. Seriously, it’s what they say–you fall in love with a man-whore, you shouldn’t be surprised when he dumps you like leftover fries. Bastard.

5) I’m addicted to blogs. Not writing, necessarily, but reading? Yeah. Like, I should be reading about cardiac stimulants and depressives right now, but I’m blogging.

6) I love Firefly. That and BattleStar Galactica are my favorite shows on television today.
7) I had my clinical final. My prof looked at me and said, “You are an OCD control freak. Chill out, or you’ll be a really good nurse for about five years, then turn to a crisp and go back to English…oh, and I think you are going to be a wonderful nurse once you learn that you aren’t perfect.” *sniff. I cried. Of course, she said a lot more than that, but I can’t share it yet. Needs a new post.

8) Rat bastard. ICU nurses suck, guys. For real.

She’s gone

ThoroughDoc is gone.

Damn, I didn’t even get a chance to say goodbye, or blog about her, or anything.

Here’s the deal. ThoroughDoc is thorough. CNAs hate her–she asks specific questions about patients that they could only know if they’ve actually, you know, seen the patient. If she writes “strict I/Os”, she expects them to be charted every hour…not when you feel like it, not once per shift, but every hour, and damn if she will not be checking on you!

Expected we monitor techs (oh, yeah, that’s happened, too. I work in the ICU as a monitor tech now, yeah!) to be able to tell her, in great detail, exactly what the patient had been doing…how frequent are the PVCs, what do you mean by “occasional”? Thought a unit secretary should know basic things about the patient’s color, day, diet, etc.

I miss her. She was so good, didn’t miss a thing, wasn’t afraid to chafe the ass of the rad.tech to get a scan read on a weekend, and then chafe the ass of his superior to, ahem, motivate the nighthawk to get it done. Nurses think they advocate for their patients–could learn something from her, let me tell you.

She was so small, mousy, could’ve been a smokin’ hottie if she’d wanted, but she had other things on her mind–caring for patients as her first priority.

Dammit.

She’s gone, and this little sandy corner of the world got a lot less safe.

A good story

This is awesome, y’all.

I’m in preclinical, assessing my patient. He’s s/p explap that led to a colon resection. I ask him about his pain, you know: “How are you feeling?” and all that crap and he says, “Well, my leg hurts.” Okay. Which leg? “This one.” Can he wiggle his toes? Nice in the left leg, not in the right. Color looks fine, a little pale…pedal pulses? CanNOT feel them. Plus, the foot is friggin’ cold, and they were covered up the same with the blanket. Ask a few history questions, yadda yadda ya, can’t find a reason for the chill. So I go tell his primary nurse. You know what he says?

“It’s because he’s old.”

“…What? I’m sorry–did you just say it’s because he’s old?”

“Yeah. Old people do funny things.”

Wha–I mean, WHAT THE FUCK? He just had surgery. I cannot palpate his pedal pulses. I can feel his popliteal pulse, but it’s weak. He can barely wiggle his toes…in the one foot. He’s complaining of pain. I’ve assessed and documented areas of numbness in his lower leg. Um, guys?

“Well, he probably came in that way.”  And how would you know that, since you HAVEN’T DONE HIS ADMISSION H&P, AND ASSESSMENT, IN SPITE OF THE FACT HE WAS BACK FROM SURGERY 5 HOURS AGO, YOU SCUTMONKEY?!

Bastard. Then later, I overheard one of the LPNs on the other side of the floor talking about “that student. They always think they’ve found something funny.”

Well, hell. So, the next day I get there…it’s worse. No popliteal pulse, can barely feel the femoral pulse, foot is white, leg is pale. Can’t wiggle toes, unless you count foot shudders as wiggles. I tell my clinical supervisor the whole thing. She sighs deeply, says: “Student nurses. You people always overreact.”

Bitch. You could’ve at least looked at the damn thing.

Now…we SNs aren’t supposed to go to the patient’s primary nurse unless a) it’s an emergency and b) our CS says it’s okay. Screw that, bitches, I’m getting this guy some help. Frakkin’ looks emergent to me, now, so I go to the guy’s primary nurse.

Hell if it isn’t my good friend Mary, thank the gods! She knows me, she believes me, she goes in, listens to what I say and what the patient says, calls the doc, gets interventions online, and I’m happy to say that by the end of the next week–because he was in there a lot longer than he should have been–he was all better.

Moral? Don’t discount SNs just because we’re baby nurses. Babies know enough to cry when something’s wrong.

I’m BAAAck

Damn. Been forever.

Okay, so everyone is wondering what I’ve been up to. Well. Let me tell you. I’ve been up to…

my elbows in shit. No lie. See, here’s the thing. When I hear a call light go off, I look to see who it is. No big thing, right? Apparently SO, for certain people who think that the definition of nurse is “someone who is never around when you need them, especially if you are a blind diabetic with COPD and a GI bleed, in the bathroom”. Frak. Dammit, I spent more time cleaning up bloody poop in the room next door than I spent with my own total care patient.

This went on for four weeks of clinicals, yo. Somehow, I and SlackerNurse were always paired. They tried to do that to help us out, right, so we were together for four weeks. Holy shit, that’s all I did, answer her frakkin’ call light! The first two weeks weren’t like that, but on the second week her patient went south, called a fast team. Hell, I don’t know what she thought it was going to be like when the anesthesiologist said, “Now, SN, you’ll have to monitor his BP every five minutes once I give this bolus.” She smiled and said, “Okay!” and got busy setting the auto-BP. Then when his second pressure was iffy, she got worried…his third was total crap. She lost it. We almost had to escort her from the floor, no lie. She needs to be in a little clinic or something.

So anyway, from that moment on she was like, “If I’m not in there, they can’t blame me,” or “If I don’t see it, it’s like it doesn’t happen,” or some such shit. So who took care of her patient, and my own, and helped everyone else, and ran interference so we lowly SNs could actually chart? Me, of course. “Miranda, could you…” “Miranda, Slacker needs help with…” hell, everything. Ambulating her patient. Checking their pulse. Getting a bedpan. Charting safety rounds. God.

Because it’s all about the patient…right?

Good news!

I think I fixed my comment moderation difficulties. See, it’s hard to get things working properly when YOU DON’T SCROLL DOWN ALL THE WAY.

Ahem. I believe I’ve mentioned before that I am an idiot. Yes, this is one of those idiot moments I’m famous for.

Another word about surgeons

or rather, surgery.

Here’s the bitty part (make sure you read the comments).

Our bodies dance. We move, groan, weep, exhale. A thousand tiny deaths each time your heart beats, a thousand births–more. Our cells grow, divide, do their duties, die and are consumed constantly throughout our lives.

Surgery is an imposer upon this dance.  Interrupting the flow, like a outcropping in the path of a waterfall, firm hands overtake our bodies, and move our inner beings. To do that, to move us like that, requires confidence on a grand scale. From my (lesser) experience, confidence is not something surgeons lack.

For that matter, neither do family practice doctors.

Find someone, anyone, who has spent upwards of twenty years practicing their craft, and is good at it. Do they lack confidence? Do they say, “Aw, shucks, you know it weren’t me,” and mean it? If such a person exists, I haven’t met them yet.

Dirty jokes

It seems that I am an innocent because I blush.

I can’t help it. I am fairly thin-skinned (or thinly fair-skinned), and I blush. One of the more interesting people I work with (congrats on passing the NCLEX, by the way!) said, “You can’t lie, can you?”

Me: *assuming deer-in-headlights look* “What? Of course I can.”

Him, laughing: “No, you can’t. You’re blushing right now.”

“I am not. It’s hot up here!”

He’s right. I can’t. Or, I can, but everyone knows. I am unable to lie, cheat, stretch the truth, whatever, without it being written across my face. This quality of mine, this hangover from my virgin youth, is a source of great fun in the unit. That is to say, I am the ear of many dirty jokes. No matter how many times it happens, no one is tired of seeing me blush.

“Hey, Miranda–do you smoke?”

“No.”

“Do you know why I like women who smoke?”

“…oh, God,” I groan.

“Almost,” he says, then gasps in rhythm. I blush. Then all the docs laugh. “Hey, good one!” High fives all around.

“Hey, Miranda, did you like that fruit salad?”

“Yeah, I’m done, you can have it.”

“Seriously?” *wink, wink “Right now?”

Blushing, I’m blushing.

“Miranda, this paper doesn’t go here.” He hands me a chart. “It goes, like this.”

“Oh, on top.”

*snickering. “Yeah, just like that.”

Only these people can make putting a chart together dirty.

To be fair, it isn’t everyone. It’s a select few. And some of the nurses, who have been here since this place was a clinic (seems like) are able to give it right back. I only have one snap to my name…but it’s a good one.

Critic leans over to watch cute student swish out of the doors. “God, she’s a fine lookin’ girl,” he whispers in my ear. I turned to him and said, “Yeah, she really is.” And then licked my lips. And HE blushed. Only, it backfired. Now he won’t leave me alone.

Could I turn them in? Of course. But it’s no different than what has happened at every OTHER job I’ve had. Maybe I over secrete pheromones, or something. Or maybe I’m just irresistible when I blush. I don’t know. I guess I’m a sensitive soul, an innocent in a sea of jades, cynics, critics, and jerks.

Perhaps a little innocence isn’t such a bad thing.

Perspectives

is the name of the new three-part series by a cop, a paramedic, and a nurse–three views of the same tragedy.

This hurt me more than I can say, to read the words and follow the story to the end. We nearly lost my brother, and then my sister a few months later, because of the same thing….read it. You won’t regret it.

Dear floor staff,

Hi, this is your temporary secretary. I know you don’t recognize me–I’ve been working here as a floater from the ICU for merely a week now, and have yet to be introduced.

I’m sorry that I don’t know all your names. There are so many of you, you see, so many chatting together around the center station while I’m trying to answer the phone. I apologize that I told you to be quiet–the woman was calling from her cellphone about her dying husband, and through the static and the tears and your rather stimulating account of last weekend she couldn’t understand my directions.

Yes, I understand that stat orders must be done now. I would love to enter them into the computer in a timely fashion, if you would give me the chart instead of taking it with you to the breakroom. Of course I should have reminded you–perhaps if you had not been so busy explaining how the breakroom is off-limits to me and how stupid I am before you slammed the door in my face I would have done so.

I’ll be happy to call Dr. God to explain why the orders were not entered, taking full responsibility–I am the secretary, after all. That’s why I get paid the big bucks. While I’m at it, I will redo all these charts. Of course I should have checked to ensure that you noted the orders I entered. Please excuse my ignorance–I had assumed that flagging the chart and placing it on your “to note” shelf was sufficient.

I understand that I have made you look bad in front of the doctors. In the future I will try to remind you more than once that when an order says “call me with results”, you call the doctor with those results. Yes, I will page him for you. I will also apologize to the doctor for you when he calls back from the OR and you have left the floor. I’m sorry I told him the patient’s complete metabolic panel results–it was your job, after all, but he asked me to read them to him since you were unavailable and he was on a tight schedule.

Yes, I did make fresh coffee. I’m sorry the aroma is unpleasing–the doctors are rounding, and I thought they could use a fresh pot. I apologize for pouring out the pot you made. It had been sitting there since noon, and I didn’t realize you prefer your coffee burnt. Of course I will clear your desk immediately. I really should have done it sooner, but the orders seemed to be more important. I won’t make that mistake again.

Now that the doctors are gone, I will be happy to hold all calls while you sit in the breakroom. You have a hard job, after all, and you do deserve these small moments to yourself. I know you’re getting ready for report so I will happily admit three new patients without bothering you. I didn’t mean to assign them to the wrong rooms–we only had four empty beds, so I assumed I couldn’t go wrong. Yes, I will change all their charts, print new forms and labels, and instruct the CNAs to transfer these patients.

I realize that an hour before report you don’t like to get new patients–the ER was full, you see, and I figured that since we have the staff and space…You’re right. I should have told them to wait until after report. Three hours isn’t very long, after all, and the ER nurses are bitches anyway. I should probably mention that I need to go to the pharmacy to pick up some meds–they are understaffed at the moment and can’t spare anyone to bring them up.

Is that right? Oh, I didn’t realize I should have done that before I admitted new patients. I thought I would wait since the new patients need meds, too, and some of those orders are stat orders. I’m sorry I didn’t remind you of that–I did knock, but you responded by locking the breakroom door.

Thank you for your instructions. I’ll do better next time.

–Miranda

ETA: This is me being sarcastic. If you read this, and think I’m talking about you, well, I wasn’t. But in that case, you might want to change your management style. Just sayin’. Also, to be perfectly clear, I don’t think ER nurses are bitches. Except for the ones who are, should they exist.

ETA2: Sorry about the comment moderation–I can’t take it off. It says it isn’t on, yet it still asks me to moderate messages. I have no idea.

A word about surgeons

I hear a lot about the egotism, the posturing, the arrogance of surgeons.

We have this one–I’ll call him, say, God. Dr. God. That’s about right. He’s a fab surgeon. If I was on the table, I’d want him scrubbing.

He is, however, an asshat.

There are other surgeons here, some good, some better, but (fortunately) the rigors of medical school, internship, etc. being what they are, usually the bad ones are eliminated before reaching the final round. All of them are competent surgeons (at least, that’s the word from the surgical aides), except for Dr. God, who is incredible.

His arrogance isn’t misplaced–I imagine operating to be essentially an act of ego, kind of like sex. I mean, if you’re good at it, you’d be stupid not to notice. You might as well admit it and use the fire to keep you going.

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