I’m an RN.
Yesterday was a busy day. I was pretty tired when I got home. My back hurt. I probably fell asleep thirty seconds after my head hit the pillow. In my previous career I was a software engineer. I thought I had busy days back then. Yes, I had some long days but mostly it was staying late to figure something out or catching up on emails. I’d be tired when I got home and declare, “whew, we need a vacation. It’s time to decompress”. Looking back, I was tired because I’d sat in a chair without moving for eight hours. I’d eat crap food and drink gallons of coffee. By the end of the day I’d have a headache from staring at the screen. I was tired, but not from “work”. I really had no idea what it felt like to be truly tired.
Yesterday I got to the hospital at 6:30 AM. Found out they were floating me to another floor. This makes everything exponentially more difficult. You don’t know who the doctors are, what their expectations are for wound care, etc… You can’t find the supplies you need. You don’t know what the access codes are to the various secure areas you need to get to. Basically, you need to ask someone for help for simple things all day long.
I transfused blood. Started IV’s. Removed IV’s. Changed dressings. I discharged three patients and admitted three more. I infused IVIG. Each of the transfusions requires staying in the patient’s room and monitoring vital signs every five minutes for 20 minutes, then every 30 minutes for the multiple hours it takes to finish. I did at least ten physical assessments. I lifted old people onto bedside commodes. I rolled, pulled, wiped, cleaned, changed sheets, and generally manhandled a 300-pound bed-bound patient who shit the bed. I argued on the phone with the pharmacy about medication timing. I struggled to coordinate how to admit a direct-admit patient with the doctor, the admitting office, and a unit clerk. I got yelled at by a drunk patient who was tired of waiting for his x-ray. When he got back from x-ray, he promptly shit all over the floor from the oral barium they gave him. I was told by a nasty old man that I was pretty useless and clearly didn’t know what I was doing. He had a critical hematocrit level and I had to sit in the room and convince him that yes, taking his blood pressure every five minutes was actually important. I sprinted down the hall every time a confused old lady set off her bed alarm to go look for her cat. I ran from one end of the hospital to the other to catch an Uber driver who was waiting for a patient and pleaded with him to just wait fifteen more minutes while we got the patient dressed. I had to sneak a patient’s anti-seizure medication into pudding and convince him to take it. Phone calls. And more phone calls. Charting. Paperwork. More charting. More paperwork because I forgot to add the year to a date on a form I sent to the blood bank. Written hand-off reports. Verbal hand-off reports to four different nurses.
After my shift was over, I spent another thirty minutes to finish charting things that I didn’t have time for during the day. I did not take a lunch. I left the hospital at 8:20 PM. In my previous life I thought I worked hard. I thought I was tired after a workday. I had no idea.
I’m an RN.
- People in the hospital are rarely happy (ok, maybe in the maternity ward). I’m generally not seeing people when they’re at their best. I accept that and knew it going in. I understand if someone gets a little snippy, or forgets to say thank you if you go above and beyond to do something for them when they’re in significant pain. This week however, was a special low point when it comes to patient and family behavior. It started with a schizoaffective patient constantly screaming at me to stop playing mind tricks on them, and then having to be brought back by security after running amuck through the hospital hallways. That’s a mental illness, so I don’t take it personally. Then there was a family member accusing me and anyone who came in the room of not caring about the patient and ignoring them and their needs. Constant very passive aggressive loud muttering about everyone having their heads up their asses and waiting 30 minutes after pressing the call light (it was 5, our system shows us exactly how long it’s been). Sigh… deep breath, their family member doesn’t look to have a good outcome. I’ll cut them some slack.
- But then there was the real humdinger. A patient and family member who were both serious meth-heads, combined with a rainbow of other illicit substances, with no money, resources, or insurance, who were there for a trauma. For two days straight the patient yelled, screamed, cried, manipulated, and generally behaved like a flaming asshole to anyone unlucky enough to go in the room. The patient was getting enough pain medication to tranquilize a horse, yet screamed and cried that we were inflicting intentional torture. The family member would show up, hear this, and begin the litany of demands to see everyone from the charge nurse, floor supervisor, hospital president, and city mayor. The family member would then announce they couldn’t take their level of anger and had to leave before ripping someone’s head off. They’d return an hour or so later and it would begin again. This pattern repeated all day long. Any attempts to engage, refute, or otherwise point out they were being unreasonable only resulted in additional yelling, just at a louder volume.
- Twelve hours a day, for two days is a lot to take of that sort of behavior. I was pretty angry and frustrated each night when I got home. Upon reflecting on those days, I think I’m most angry at myself for putting up with it. At the time it seemed easier to mostly ignore it. All three scenarios were verbal battles that I wouldn’t win. These were not people who’s minds were going to be changed. It’s often less stressful to simply nod and say mmm-hmm and get out of the room as fast as possible so you can get on with the thousand other tasks you have to get done. But I didn’t realize how much the cumulative impact of continually taking the verbal abuse would affect me. On the drive home after day two I briefly thought what the hell am I doing? At my age I don’t need to put up with this crap. But I still like the job. It’s rewarding in many ways that working as an engineer for mega-corp never was. But it seems like the hospital population is more and more the mentally ill, the indigent, and drug users who are not capable of dealing with life in general. The bad behavior has become so common that when receiving report on the rare, “nice”, patient a nurse will make a point of letting you know, “you’re lucky, he/she looks like a normal person”.
- I’m not sure what the answer is. I could move to a clinic of some sort, but just taking blood pressures all day would be like watching paint dry. Besides, I’m in a spot where I have the perfect schedule. It would be hard to replicate it working on a different floor. I think I’m going to try an experiment. For the next few weeks I’m going to be a semi-jerk. There will be no shit taken from anyone. You want to be an asshole? I’m going to be one right back. Of course, in a professional manner. This may make my day more difficult (and certainly the charge nurses – people LOVE to escalate any perceived wrong at the drop of a hat), but I’ll be curious if my mental health will improve? Will I have an overall better outlook if I go home knowing that I didn’t accept any crap from people? Nursing is such a hard balance. How do you continually be compassionate for people in a bad situation, yet not let yourself become a doormat? If you know the secret, please let me know!
Song of the day: Twisted Sister – We’re Not Gonna Take it (Extended Version)
- Everyone has a chore they hate doing. Dusting, mowing the lawn, cleaning the inside of the microwave, organizing the Tupperware, everyone has something they dread. For me it’s getting a haircut. Don’t ask why, I just do. Maybe in part it’s because in my head I’m convinced I’ll soon look like Brad Pitt in Legends of the Fall. The reality is closer to greasy Appalachian trailer park resident. The same with facial hair. Any day now I’m going to have a Jack Murphy beard. Reality is… well not that. So my cycle is let it go until it’s embarrassingly long and I’m coating it in major amounts of hair goop to keep it out of my face (or wear a hat every day), then shave it all off. And every time I cut it I swear I’ll schedule a haircut every five to six weeks like clockwork. At my age I guess I should just be grateful I still have a full head of hair to worry about. Anyway, today’s the shearing day.
- Speaking of hats, an update on the surgical cap. I don’t particularly like it, but it’s doing the job and saving the tops of my ears from the surgical mask ear loops. It’s clear that even though they say “unisex”, they were designed for women. I ordered something that’s more like a doo-rag to see if that works better. Stay tuned, part two.
- The injury update – I have a bruise that goes from my hip almost to my knee. It looks gruesome, but doesn’t really hurt. When I landed on the key fob it created a tennis ball size hematoma. All that blood has to go somewhere. It looks like I got hit by a truck.
- So Project Veritas manages to secretly record CNN editorial calls for months. It shouldn’t surprise anyone that CNN is nothing more than a propaganda machine for the left. I’m sure secret Fox news meetings would be similar. Never air anything that hurts your political agenda. These are not news organizations. I’m not sure we even have just straight news anymore? For me the most humorous part is CNN “referring this to law enforcement” when they have no qualms about doing the exact same thing.
- I was going to make a joke about the woman who “lured” a 14 year old boy to her home and had sex with him. I suspect my sarcasm wouldn’t be appreciated by the outrage crowd, so never mind.
- I had a patient go AMA last night. For those who don’t know, AMA stands for “against medical advice”. The patient had a fall a week ago, finally came in and had an unstable vertebral fracture. The neurosurgeon ordered bedrest until a rigid clamshell brace could be fitted. The patient completely ignored the bedrest orders and spent the day walking around the room (complaining of pain) despite everyone’s attempts to describe the potential for further injury. At the very end of the shift the brace arrived and the patient took one look at it and said hell no I’m not wearing that, I’m leaving. After spending the better part of an hour (and ignoring all my other patients) trying to convince this person to stay and wear the brace, printing paperwork, explaining the consequences of leaving AMA (the massive bill insurance won’t pay), etc… the patient packed up to leave. Several minutes later he hit the call light so he could ask where his pain pill prescriptions were? I informed him that if you leave AMA there are no more scripts. Cue the lengthy, expletive filled rant on how we don’t care about people and do we not understand he’s in pain? Oh, and can I help him get his shoes on because he can’t bend over that far. Is it any surprise that I’m becoming very cynical about the human population?
Song of the day: Nena “99 Luftballons (Live 1983)”
A random list of things and shower thoughts that an old Gen X dude finds cool or worth pondering.
- It’s hard not to laugh a little after the Mueller report release. But, as I said before – if you find yourself disappointed, or was hoping this was going to “take down” this president… you are part of the problem. Are you really more interested in allegiance to your tribe than the overall interest of the country? In two years we have another popularity contest and you can vote for the sock puppet of your choice. Until then, let’s try to keep our economy moving forward. Deal?
- Speaking of sock puppets, if the democrats 2020 entire message is going to be the Green New Deal, Medicare for all, and Trump is evil… they’re going to lose.
- This is an interesting look at an issue with the Tesla autopilot. I’m a big believer in autonomous vehicles… but we’re still in the beginning stages. It shouldn’t be shocking that there’s problems. As a former software test guy, I’m fascinated at what must be an unbelievably complex test environment for the Tesla software.
- Yesterday we struggled to get a urine sample from a patient. When we had success I sent it down to the lab. Who then called me to tell me they threw it away. Why? Because I wrote “UA” (for urinalysis) on the label instead of “UCC” (for urine clean catch). Bureaucracy and mindless process drives me insane.
- I listened to a podcast that had two really smart people with a bunch of letters behind their names debate the cause of obesity. Is it hormone driven metabolism and storage triggered by sugar or is it genetic driven by the brain? The discussion went way into the weeds and devolved into name calling and utter dismissal of the research papers the other guy cited. The entire time I had two thoughts. First, this is what science is – have an idea, do an experiment to prove it, and let your peers try to disprove it. Second, it’s interesting and not surprising that two very smart guys have widely differing opinions on an extremely complex subject – both backed by oodles of research. This almost sounds like… oh, I don’t know… climate research?
- Cloud kitchens partnered with some sort of Uber model are going to be a huge deal.
- It’s time to start playing golf again. I spent most of last summer vowing to quit this evil game. I really wish I didn’t enjoy golf, because I hate it so often. I’m generally pretty good at every sport I’ve done – except golf. For the life of me I cannot hit that goddam little white ball. Maybe this will be the season…
Song of the day: Morgan Heritage “Nothing To Smile About”