O Brave New World

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.

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.

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.

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.

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.

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.

you were an asshat.

Really. I thought it said MD on your lapel–oops.

My first day, first surgeon at rounds:

Mentor: “And this is Miranda, our new orientee. She’s training to be a unit secretary, and this is her first day.”

Doc: “Hm.” Walks over to charge nurse. “Let’s get started.” They robe up, whatever, it’s time to do a tri-lumen.

Mentor leaves the floor. Tri-lumen placement proceeding nicely. I ask one of the nurses: “How do I know if an order has already been made?” as I stare at a chart with no marks but the surgeon’s orders.

“Oh, you’ll know.”

“…okay.” You know what happened next. Of course, the chest xray to check the placement of the trilumen wasn’t ordered, and the doc yelled at me to know my job. He slammed drawers, looking for a pen, and I gave him mine which he stole. He then asked me detailed questions about a patient–did I mention I’m not a nurse? good–and ripped me up one side and down the other. Complete with spittle and finger-pointing, slamming a chart on the desk, and STEALING MY PEN.

Dammit. It’s my favorite pen. Was.

Asshat.

I asked one of the interns later what I should have said, if I should have known the answers to all those questions. She just grinned and said, “What does your badge say?”

“Unit secretary.”

“Okay, then. No.”

“Oh. Well, how are they doing, anyway?”

“I don’t know, that’s not my patient.”

“Ooooh.”

“Don’t worry. He’s always like that–he’s an asshat.”

I did it.

I used the keyboard. It was hard, but I proved I was capable of using the system without the mouse. My mentor was so proud–I have completed (almost) my competency.

I even participated in a Code Blue.

Okay, so all I did was hand the chart to one of the team responders, but still. My first code!

Also, now I know that two baby squiggles on either side of a vertical line means either nasal cannula, normal saline, every shift, milligrams, metric equivalents, cubic centimeters per hour, consult, every four hours, for pain as needed, follow-up in the morning, midnight, or bedrest, depending on the doc and the context. Oh, or it could mean Xanax. Or treatment. Or ambulatory as tolerated. Just depends.

Yay for dictation, boo at verbal orders and refusal to sign!

Also, FYI–it creeps me out when you put your arm around me and ask for fruit salad and to guaiac all stools. In the same coffee breath. In the future, you shall be known as Dr. Creepy.

Heh. I know you missed me. I finished my third test in Human Physiology (got a 91, yay!)–I got a new job at the hospital, working in the ICU–I’m dead tired. I added the hours up, and last week I spent nearly 92 hours at class, tutoring, and ICU orientation. Sorry. If I had internet privileges, I would have blogged. My, how the time does lag during orientation.

I’ve used a computer almost my entire life. I don’t need step-by-step, hand-holding modules, and it’s a waste of my time and your money to pay me and a mentor to sit at a computer learning how to use a mouse. For thirty minutes. Yeah, I’ve got that already.

The system is new–they’ve only had it hospital-wide for a few months. My mentor, an elderly woman, has only worked in the ICU for five weeks. She worries. “No, don’t–no, don’t do that don’t do that…” when I use the mouse instead of the arrow keys. I was filing orders Tuesday. I couldn’t read everything–I think the doc was on his 150th order of the day, or something like that, so you can imagine–so I did what I could read, filed and verified. My mentor comes back from the supply room and says, “Have you read over it?”

“Yes, but I didn’t understand this one and this one. When he says…”

“Okay, but we have to go in order, so open the order screen and do this one.”

“I already did that one.”

“No you did not.”

“Um, yes I did. It’s right here.”

“YOU MEAN YOU ALREADY FILED IT??!”

“…Yeah. Is that a problem?”

“Well, NOT REALLY, but now we have to start a whole new order!!”

I’m thinking–so I have to make three whole keystrokes and open the sucker back up. Big whoop. But to my mentor, it is a very big thing to have to go through the agony of pressing two keys and Enter. Also, because I use the mouse instead of the keyboard, she refuses to sign my computer orientation paperwork. I have not yet demonstrated proper competency, apparently. “Don’t worry about it, dear,” she says. “When you are more familiar with the system, you’ll be able to use the keyboard just like I do.”

I-I-I…don’t know what to say. I mean, I don’t know. I can do this. I worked my way through high school and my first college, as a receptionist and later as a secretary. I can do this job. I’m working as a chemistry tutor right now at the college. I was an English major. I can handle a little system like this. But silly me, I do shortcuts, and those scare my mentor. She’s constantly worried that I’m going to crash the system, so I can’t complete orientation.

I mentioned it to my supervisor–she said, “Well, I’m sure she’ll pass you when she feels you are ready, oh and by the way, you know that job you applied for? The one I said you could have? Well, one of my RNs has a future daughter-in-law who needs a job, so I guess you’re going to have to wait.”

No, she didn’t say that. Not really. But that is what happened. Which means I don’t get to work during the hours I told her I needed. Which means I have to pay for childcare. Which means more money out of my pocket, on top of which the job I don’t get is the one with the pay she told me I could have, which means I am making forty cents less an hour. I make more tutoring…but tutoring doesn’t further my medical career.

On the plus side, the RN who got her FDIL a job? She’s leaving without notice when she gets back from vacation next week.

Also, more bad news. My mentor has been sick this week, and the two days she hasn’t been sick have been “low census”, which means I can’t work. I can’t work when my mentor is sick, I can’t work when it’s low census…are they trying to tell me something?

FDIL put it forty hours this week. I put in…less than four.

The worst part? FDIL is my friend. I got her a tutoring job when she couldn’t find a job anywhere else. I told her about this job I applied for…asked her to ask her FMIL to put in a good word for me. She promised she would. Three days later I found out I’m not getting the job–she is.

This is after I gave her all my notes on the digestive system, which she missed due to an interview.

I didn’t know she was interviewing for my job.

*sniff.