Friday, January 16, 2009

a good egg

A co-worker used an expression the other day that I haven't heard in a long time. She called someone "a good egg", and then, because it was the end of the shift and we were all punchy, she went around and told us all exactly what kind of egg we were. Some were hard boiled, some were cracked, a few were scrambled. When she came to me she said, "You're all gooey in the middle." Then she paused for a second and added, "But you're getting harder all the time."

This is someone I adore, someone who played (and still plays) a huge part in my ER education, one of the people who trained me, and a person whom I totally depend on to tell it like it is. My initial thought was WTF?, but I realized instantly that she was not only very perceptive, but dead right. I am getting harder. And while on one hand this makes me kind of sad, on the other hand I understand that it is absolutely inevitable.

One day at my old job in the trauma ICU, I got floated down to the ER for a shift. There was a patient who came in for some reason I've totally forgotten, and the triage nurse said (rolling her eyes), "This one's going to need a little TLC". The charge nurse made an awful face, looked at me and said "You're up, kid. We don't do compassion down here. That's for you ICU nurses." I was horrified and angry all at the same time. You don't do compassion? Are you not a nurse? Is that not a major job requirement? I didn't say any of this, because the charge nurse scared the living daylights out of me, but I thought it. There was another thought in there too. The day I don't want to comfort my patients will be the day I should find another line of work.

I get it now. I absolutely and totally get it. But here's the thing. It has nothing to do with compassion. It's not easy to nail down what it does have to do with, since it's such a loaded subject. Some things though are easy to identify.

It has to do with respect. I would say a good quarter of our patients have no respect for what we do unless there's a narcotic involved somewhere. I'm really tired of playing Drug Seeker Monopoly where we go around and around an imaginary board pretending to buy property when I know all along that every word out of their mouth is manipulative. Sometimes I think I would almost respect a person who came in and said, "I'm not in any pain at all, but I want 10 milligrams of morphine IV. I'll even show you the veins I have that you can still use, but you need to be careful because I'm Hepatitis C positive and oh, by the way, I stopped on the way in and drank a pint of (fill in the blank) because I'm going to go into withdrawal seizures in the next ten minutes. As soon as you give me the drugs, I'm going to throw a hissy fit about an imaginary issue and insist on leaving against medical advice, because I don't need your stinkin' advice. I only want your narcs." We could bypass the whole writhing on the floor screaming business until I leave the room and then they pull out a bag of chips and reach for the TV remote. We could eliminate the whole drama where they rip out their own IV, leaving a trail of blood behind them as they stagger down the hall toward the exit, because I didn't do it fast enough for them, refusing to screw with blood without gloving up. We could, simply put, cut to the chase. How refreshing would that be?

It has to do with resources. If it's noon and you woke up at 11:30 with a minor sore throat...this is not an emergency. Not in any universe. This is why god invented the salt water gargle. And Tylenol. Or cough lozenges. Or, to be really wild and wacky, the primary care physician. This little ER trip for a sore throat? Is going to run you a thousand bucks. Oh, wait. You're not planning on paying for any of this, are you? Never mind. The nurse is just a little slow. You're the third sore throat she's triaged this morning.

I guess it has to do with feeling used and abused. In my experience, really sick people don't often use and abuse. They tend to be a little more appreciative for what they get. But if you have someone who isn't truly sick, and then you stick them in a waiting room and then poke them with needles and then, on top of all that, start them off with non-narcotic pain meds,'re going to have a problem.

Give me someone who is really sick and I'm fine. Someone legitimately in pain and I'm all over it. I can't push the narcs fast enough. Show me a freaked out family member who needs someone to vent to, and I'm there. This is why I love what I do. This is how I feel like I'm doing something productive and good. Give me a task, a medical puzzle, a complicated procedure and I'm a relatively content human being. Give me a code - especially a code where we get them back - and I'm heading straight toward happy.

I always thought that it would be the pain and suffering and death that would wipe me out. But I've built a much better protective wall than I'd realized, and I'm able to stay more objective about those things than I ever would have thought. But the other stuff - what I call "the stupids"- doesn't roll off of me that well. I'm trying, but I seem to have less patience for it by the day. There are the stupids in every profession, I'm well aware. How does a journalist write a straight faced story about a burglar who gets stuck in the Taco Bell drive-through window? What about the bartender who watches the same guy with the same tired pick-up line night after night? Seriously. At what point can you not keep a straight face?

I'm just as compassionate with my real patients as I ever was. The problem is that I see fewer and fewer of them all the time.


Rudee said...

I get it completely. It happens in my line of work too and it can be hard to be compassionate when replacing an IV or subcutaneous line -for the third time in one week- because the caregiver was careless disconnecting to get a little for themselves. I want to bitch them out when I hear the explanations of how the catastrophe happened and why so much drug is missing. I usually don't even ask anymore. I'm not getting into it with an addict in their own home.

You haven't lost anything except tolerance for bullshit. Don't give it a second thought.

ped crossing said...

A few too many stupids today? And they are in every occupation in some form or another. I hope tomorrow is stupid free.

Maggie May said...

It must get you down when so many take advantage of you.
Never lose your compassion for the real casualties, though!

softinthehead said...

I cannot imagine going to ER for a sore throat. My family members have to be in dire need for us to even contemplate the thought of hours waiting etc. Last time we were in emergency my son had dislocated his shoulder and was in severe pain, before that I was bleeding profusely from a 3" cut in my calf (don't ask!) - if I could have fixed these things at home - be sure I would have done. I'm sure you must just want to slap some people - I admire your patience:) We are all grateful that people like you are there when we really do need you.

Iota said...

I don't think it's fair that you seem to do so much more triage than the other nurses (or is that just my perception?) Can't you ask to do more of the "real" nursing?

-Ann said...

Fantastic post. I hope the next time I'm unfortunate enough to end up the the ER that I get a nurse like you.

Akelamalu said...

I can understand your frustration if only you could just kick the malingers out the door!

distracted by shiny objects said...

I hear you. Now I hear that Medicare/Medicaid is going to base payment on Patient Satisfaction surveys. Let's just call it a day a hand me a tray, some roller skates, and a cute little apron.

Wisewebwoman said...

I've nearly always been on death's door when entering ER, one time with a ruptured appendix. I wish there had been a nurse like you around, only for my partner screaming a lot did I get pushed ahead of the queue with the condition that my personal physician come to ER and assist with the surgery (she did) and it literally saved my life. it was one of those horrific nights, bad accidents, drug users, broken limbs. I was lost in the mad shuffle. I don't know why sore throats show up in ER or bleeding fingers.
And I prefer to see you as a soft-centred chocolate.

Rositta said...

I have never gone to ER for a sore throat, ever. I did have occasion to spend a few hours in ER on Sunday and found the nurses to be incredibly good to me. My husband spoke to a few people who had been waiting hours and were still waiting when we left. I guess they pick and choose who needs attention first. Does it have something to do with how you look or dress?...ciao

Devon said...

A few more rounds of Narcotic Monopoly and your soft gooey center will be gone!

I started with ambulance work, then ER, on to SICU. There came a time when I realized that I was changing to survive and I didn't like the changes in myself. It works for some, but didn't for me.

I went on to hospice/homecare and love it! Everyone gets real, doesn't play games and really only cares about the things that truly matter!

Good luck RC! Only make the changes you want to see!

Anonymous said...

In Australia we call then NUMPTIES and my god they breed...Hang in there sister they ensure our job security.