RC/RN 2

Basically speaking, I picked the hospital I wanted over the exact job I wanted. I applied for the Surgical ICU position, and then spent three weeks jumping through one hoop after another to try to land it. As badly as I had wanted ER before, I now wanted this with an intensity that kind of scared me. I looked at it as invaluable experience, particularly in trauma, and if at some point down the road I could request a transfer to some other (ahem) unit...this was one hell of a stepping stone.


Three interviews, four references and a hotseat Q&A later ("Take a look at all these lab values. Which three are critical and what exactly should you do about them? And in what order? And why?"), I had pretty much figured the one position available had gone to someone else. On Christmas Eve day I got the phone call proving me wrong. It may have been the best Christmas of my life up to that point. To make it even sweeter they let me pick my start date, so I had the prospect of the whole month of January off. After the hell that was nursing school, I was looking forward to a month of normal life.


Now let me make perfectly clear that I've had moments of nervousness in my life. I've had times where I was almost paralyzed with fright. But I've never (in a non-health related instance) felt the fear I felt walking on to that unit for the first time as a graduate nurse. It was head between your knees, waves of nausea, spots in front of your eyes panic. I made a mental bet with myself that I could get through an entire twelve hour shift without killing someone. There was a part of me that was detached enough to be amused by this, figuring it was all beginner's jitters. Luckily, that amused and detached part didn't realize that this particular fear had just become a permanent fixture on my psyche.



And to add to the fun, I still had to take my State Boards a month down the road. No pressure with those, though. No pass, no job. No prob. Boards deserve their very own post in their arbitrary hellishness, but I'll just hit the highlights. Our nursing program was what they call a bi-level program, which meant that at the end of our first year we took LPN boards. You had to pass those to stay in the nursing program. Then, after you graduated you took your RN boards for your license. I thought the pressure of the LPN year was bad enough but it was nothing compared to this. The way the test is given doesn't help. It's a computer generated interactive test. You have to answer enough questions right to get to a high enough level, then you have to answer enough questions right to stay at that level. If you answer a question wrong it bumps you back down a level and then you have to be right a certain number of times in a row to get back to where you had just been. To say it sucks the big one is to damn it with faint praise.


The minimum number of questions you could take was 75. The maximum was 225. It gave you as many questions as you needed to prove competency, but if you hadn't proved it by 225 you failed. I took the test with three friends from my class and we all took 75 questions. We were hoping this would happen, so before I hit submit on question 75 I held my breath and prayed to the patron saint of people who should have stayed in television production. The screen went dark and told me to have a nice day. Fat chance. It was five minutes before my knees stopped shaking enough to walk out of the room. And despite all of my predictions of how I had been so inept that they had failed me with the minimum number of questions, I passed. We all did. Life was good.


My experience on SI was going well, also. I did a twelve week orientation and then took on my own patients. That was another scary day, but the support from the other nurses was phenomenal. My preceptor looked me in the eye, told me I could do it and kicked me out of the nest. And, to my amazement, I flew. Zig-zaggy and shell-shocked, but airborne.


To give an idea of our patient population, here's something one of the hospital administrators told us sometime during my second year there. Our unit had the highest acuity patients in the entire hospital. Our hospital had the highest acuity patients in the entire two state area it was in. This helped explain why I had discovered that adrenaline really does have a taste (metallic, like blood) and why the top of my head permanently felt like it was going to pop off.


We took care of patients immediately after coronary bypass surgery. We handled the liver transplants. We had patients from every surgical specialty in the hospital, including the neurological unit overflow. And then, of course, there were the traumas. Motorcyclists who hit concrete pylons at a hundred miles an hour. People who tried to commit suicide by jumping in front of buses. Point blank gunshot wounds to the head. People who had jumped three floors out of a burning building. Any variation on a vehicular accident you can imagine. If you define "life support" as being on a ventilator (and most people do), at least half of our patients at any given time were on life support.















The patients were a story unto themselves. Murderers. Gangbangers. Child molesters. Wife beaters. I learned more about human nature in that job than I want to think about. The Film Geek still remembers how I would watch the 11 pm news after a day at work to find out exactly why my patient was in the hospital. More than once my skin crawled when I found out what had happened immediately before they came to our fine establishment. And to think that I had been in a small enclosed space with them alone. A lot of those people were seriously jacked up.



Take your garden variety gangbanger, for example. Used to be if they wanted to kill someone they'd shoot them in the head. Several times if necessary. Well, it seems that that isn't good enough anymore. Too fast. Relatively painless. The current thinking is to shoot them point blank in the abdomen. Why, you ask? I'm going to tell you. Consider yourselves warned. Because, gentle readers, if you shoot someone in the gut you're going to involve their intestines. It's a given. And what that means is that they will then have fecal matter scattered all through their abdomen. Which means that, in spite of the best medical care possible, and at ungodly expense, they will probably develop a horrendous infection and, after a colostomy and months in the hospital on a vent will die from sepsis. Slowly and horribly rotting from the inside out. As one fine upstanding citizen explained to me, "It's funny, bitch. He's got shit all on his insides and a bag on his stomach. Don't you think that's some funny shit?" and then cackled at his own wordplay. Shit. Get it? Right.


The best illustration of the unit I can give is this ICU monitor. All of our patients were on the monitor 24/7. One of the first things I always did was to familiarize the family with the monitor, since it seems to be second nature to watch it constantly and it makes more sense when you know what you're looking at. I told them what everything meant and what normal limits were. This way when it alarmed (which was often) they wouldn't panic every time.


Let's take a stroll through the monitor.

The first green number (78) is the heart rate. The pattern is the heart rhythm. This comes from the electrodes on the patients chest.


The red line (129/58) is (obviously) the blood pressure. But...the red color indicates it's an arterial blood pressure, not a cuff pressure. Arterial lines are basically like IV's, just in an artery instead of a vein and you don't put anything in these lines. If someone is on a vent you need frequent arterial blood gasses which hurt like a son of a bitch, so they put these lines in for monitoring. Other than the fact that you can bleed to death in about three minutes if one gets dislodged, they're pretty handy.


The yellow number (9) is a Central Venous Pressure, which is an invasive monitoring of the pressure in the right atrium of the heart. Basically, there's a probe physically in the heart.


The light blue ICP line (19) is Intracranial pressure. Basically, there's a probe physically in the brain.


The purple 100 is the percentage of oxygen the patient is getting throughout their body.


And the dark blue 12 is how many times a minute they're breathing.


We always had two patients at a time. We charted vital signs every hour and did a full body assessment every four hours. Most of our patients had at least one triple IV line and quite a few had two. Each patient was receiving a minimum of three kinds of IV meds, not counting fluids. It was not uncommon to have a patient getting fifteen IV meds, with half of them being incompatible with the others and having to be spaced perfectly. If a patient was on a vent there was a whole other set of vitals to chart and the vent itself to monitor. Patients on vents were always restrained to keep them from pulling out their airway and sedated to within an inch of their lives. These both had to be charted and scrupulously monitored. We drew all of our own blood for labs. We did almost all of the surgical dressings. We were given perimeters on a lot of the drugs we gave and we decided the dosage. The worst thing was when you had to "travel", which meant taking your patient (and their vent and their drips and the crash suitcase) to CT or MRI. And, because most of our patients were unconscious, we had to physically reposition them every two hours around the clock. We didn't sit a lot. I wore a pedometer to work one day out of curiosity to see if I reached the 10,000 steps a day that the Heart Association recommends. At the end of the day (which had been uncharacteristically slow) I was at 17,000 steps. I never wore it again.


The medical teams rounded every morning and wrote orders. We spent the day carrying out these orders. By the time we were thinking of being caught up they rounded again and wrote different orders. There was real animosity between the day and night shifts, so if you left even the tiniest thing undone you'd hear about it. The days flew by. It was not unusual to look at the clock in horror at all the things you still had to do in the half hour left of your shift and realize that you had neither eaten nor peed in twelve hours.


But I wouldn't trade the experience for anything. I saw some of the most incredible things imaginable. We were cutting edge and it was electrifying. Our unit had a little bit of an ego issue, frankly. We weren't allowed to call a code, since we were one of the units responding to codes on other floors, and it would look bad. But our little "code" for a code was to call Anesthesia (usually for an emergent intubation). If you heard "Anesthesia Stat SICU" overhead, you knew that all hell was breaking loose. And between us, hell breaking loose was a daily happening.


In an unexpected way I got a lot of ER experience, too. ER would basically plug up as much of the bleeding as they could and race them up to us as fast as possible, leaving a current of blood behind them. Not only did the helicopters land there, but often we ourselves took the people off of them and straight to our unit.


It was the most intense experience of my entire life, but I was burning out big time toward my two year anniversary. I had gotten all the adrenaline inducing adventures I could have ever wanted - and then some. I had literally been up to my ankles in blood and brains. I had seen so many people die that I was almost immune to it. I'd seen one too many grieving parents for my taste. Three twelve hour shifts a week were slowly turning me into someone I didn't know anymore. I had basically come to the conclusion that you could sum up every shift this way: for twelve hours a patient would actively try to die on me and I would do my best to prevent it. The final kicker was that my boss wouldn't let any of us transfer to other units, but by that point I didn't think I wanted to anyway. I had hit trauma overload.


And all it was going to take was one more thing to push me completely over the edge.


To Be Continued...
(and good lord am I sorry this is so long)

nancy clue

I'm still a day out on the next thrilling installment of how I came to earn my paycheck, but since I've led people to expect a nursing story I feel I have to deliver. Sit tight, people, this is not your ordinary nursing story.


I collect old Nancy Drew mysteries. It's a guilty obsession that I've had most of my life and I have a fabulous collection to prove it. I also love Cherry Ames, the World War ll era nurse who only took care of patients who provided mysteries for her to solve as well. I guess in the 1940's and 50's they figured every little girl wanted to grow up to be a detective.


Last week a friend of mine gave me a Nancy Drew she had found in a thrift store. She didn't look at it closely, but, being a sweetheart of the first degree, always keeps an eye out for what her friends collect. We were at Bunco and the wine was flowing freely when she handed it to me. I looked carefully. I blinked. I looked again. This is what I saw -


The Case of the Not-So-Nice Nurse
A Gay Adventure!

When nurse Cherry Aimless lands in San Francisco in search of Nancy Clue and a flock of missing nuns, the earnestly whitegirl 50s meet the oh-so-queer 90s in a delightful parody of both girl detective novels and lesbian romantic fiction.


Or, as they put it, For everyone who knew all along that Nancy and her girlfriends had secrets all their own.


Here's the back cover -


The night air cut right through her silk dress. She pulled her wrap closer. "Don't do that," her companion whispered. "I like looking at you." The girl surveyed Cherry, looking her up and down. She whistled, a long, low appreciative whistle. Cherry dropped her coat. "It's a full moon," the girl said. "You never know what will happen." A shiver went down Cherry's back, for she was having that very same thought. Cherry began to wish she had worn panties. She had decided against them to preserve the line of her dress, but they would be a big help right now.

Okay, it's me again. The hilarious thing is that this book is designed exactly the same as a Nancy Drew. Same colors, same format, same line drawings - everything. You oughta see the drawing opposite the title page. Yowzah.


And the kicker? (Not that there aren't twenty kickers already). My buddy bought this at a church auxiliary store. Imagine how that book got there...


I see a doting aunt who buys a gift for the young girl in her life, thinking it's a beloved detective icon. Can you imagine the phone call from the kid's mom the next day?

Would you love to be a fly on that wall?

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Surfer Dude got a speaking part! Yay!

Fun Monday #11

Ann at For the Long Run is hosting Fun Monday this week and she wants to hear about a website that's changed our life. A website we can't live without. A website whose inventor we'd like to see win a McArthur Genius Grant. I've got one (kind of) word for you.


If you're a thrifty, yard sale loving, odd thing collecting fool like I am, this is about as good as it gets. As a matter of fact there are days I'm convinced I started blogging to keep me off eBay. After all, I can't really obsess on two sites at once, can I?

If you want it, it's there. If you need it, it's there. And because it's there...I'm there.

Cinnamon incense. Check.

Enough garden seeds to plant an arboretum. Check.

Brand new hardback books that you're too cheap to buy at Borders, but someone will put up to recoup a small part of their outlay. Check.

Stila lip glaze that may be my favorite piece of make-up - period, but that I would have to drive forty five minutes to buy. Check.

Slipcovers. Check.

My favorite book from elementary school that I could never find anywhere else. Check. (and under a dollar, by the way).

You get the thrill of the hunt, the adrenaline of the auction and the convenience of at home delivery. It's like a yard sale on steroids.

I have to go now. I have an auction closing.

the acting bug

A couple of weeks ago Surfer Dude's class put on a play about the Jamestown settlement as part of a history lesson. Somehow he and one of his best friends ended up with two of the larger parts, and we were on pins and needles leading up to the performance. We ran through lines until he had them down cold. He emoted from one room of the house to the next. Then in front of a school day audience of parents and lower grade children, their class brought Jamestown to life. Beautifully.


And he's had the acting bug ever since. Like there isn't enough drama in this house already.


His friend may have even been bitten harder, although that's difficult to imagine. The friend's dad (who is a good friend) and I tried to steer them into the same drama class that Gumby is going to be taking this spring, but they were too young. But...there is a play being staged in March that was holding open auditions - and they wanted to go. They were casting adults and children, and from the sounds there were not a lot of parts available, but the kids were determined. They would also be casting some extras and understudies. If you survived the first cut call backs would be Sunday. I privately said to the Film Geek that for $40 a kid to be in the play the producers would find as many parts as kids who showed up. I'm cynical that way. I can't help it. (I also made a point of taking Surfer Dude to this thing myself, since the FG and this director have worked together many times and I didn't think that should be a factor in his decision. On the subject of cynical).


So Saturday afternoon we showed up for the auditions. Self esteem not being one of his issues, he was convinced that he had a lead part in the bag. I tried to insert a little reality into his fantasy, as I knew they were expecting a full house of applicants and that he had no real experience besides school stuff. I pointed out that he had several friends trying out and they all wanted the same parts. I told him it was all about the experience and if he didn't get a part it wouldn't be the end of the world. I said to get out there and do the best job he could and not worry about the rest of it. Most of all, I said, have fun.


The theater was full of parents and kids. There were a bunch of people I knew, including a lot of the kids trying out. It was social hour for the adults as their kids went up on the stage. The director ran them through their paces and then broke them into groups. For three hours he had them run through lines in various formations. I was so nervous I had to take the stitches out of the hat I was knitting two times. I should have given myself a pep talk while I was at it.


When it was over the friend's dad and I privately agreed that, though they had done well, they probably didn't have a realistic chance at a part. There were a lot of kids there with experience. And, most importantly, the big audition scene our guys did was with adults who chewed the scenery and spit it out. Our kids could barely get a word in edgewise. But they had had fun and gained some experience, and that was a good enough thing.


Two hours after we got home we got the call back notification for today. So did the friend. As we were dancing around the kitchen singing at the top of our lungs (and dodging butt biting dogs who get all weird when we dance) I didn't really feel cynical about the reasons. The joy on this kid's face was priceless. I'd love to think it was because he knocked their socks off.


But if every single person who showed up gets a part, I can totally handle that.

RC/RN

There have been some questions lately about my nursing career and I thought now would be just as good a time as any to answer them. How did I start? How long have I been in the ER? And, maybe most provocatively, what is it that I like about nursing and that keeps me in it? I'm going to try to explain the whole tangled mess. Bear with me. This is going to take a while.





The whole time I was in nursing school I knew two things - I wanted to work in the ER and I wanted to be where the helicopters landed.


This is the story of how I got both, just not at the same time.


When you grow up in an urban area you take it for granted that there are hospitals everywhere. World class hospitals. If you get hurt or sick you go to one of them. Simple. In the Midwest it's not that simple. So much of the area is rural and the hospitals, while not exactly hard to come by, are not usually going to be where you find a neurosurgeon or a burn unit. If you get hurt or sick in most of these places they fly you out to where those specialists are.



And that's a Level One Trauma Center. Simply put, this means that there is 24 hour medical coverage from a wide variety of specialists, including a comprehensive trauma team. Not coincidentally, these also tend to be teaching hospitals, almost always associated with major universities. There are various trauma designations. Level One is the gold standard. It's the end of the road, so to speak. It's where nothing is too critical, too catastrophic, too unusual to be treated. It's where the helicopters land.


I knew exactly the hospital I wanted to be at. It was the hospital I had fantasized about since the day I had gotten up the nerve to apply to nursing school. The problem was getting the in the door.


Toward the end of my last semester of school I "shadowed" for a day in the ER at this hospital. Shadowing is a really good idea. You get to follow a nurse around and really see what the unit is like, without the pressure of providing any medical care. You are only there to observe, nothing else. I had a great experience, other than the fact that I felt like Naive Nelly barely ten minutes in. I lost count of how many times I thought (or said) "Oh, my god. Is this for real?" over the course of the six hours I was there. And like a good adrenaline junkie rising to the lure of a caffeinated piece of bait - I was hooked.


This hospital had a program designed to train new grads in different areas of critical care nursing - ER, and Burn, Peds ("peeds"), Neonatal, Medical, Surgical, Neuro and Cardiac Intensive Care Units. The idea was that you would go to the unit that you were the most interested in and commit to a two year contract. In return the hospital would pay a (very) generous sign-on bonus and, for the next twenty four months, train you to within an inch of your life. You would receive every certification you could possibly want or need - all on the hospital's dime. Competition for spots in this program was tight, and they absolutely used that to their advantage .


But here was the problem. My nursing program had a December graduation. And someone had slipped up and all of the ER new grad spots for the year had been filled with the May graduating class. Every other area was, of course, still open. I met with a very nice HR woman who asked me a bunch of questions about what interested me and then suggested I apply for a spot in the Surgical ICU. She explained that this was not only a trauma ICU, but also took care of patients from every surgical specialty, so was quite varied in the patient population. I said I wanted ER. She said I should think about SI (as they called it). She even persuaded me to tour the unit with her, and even though I thought it looked fascinating, I left the interview disgruntled and completely unconvinced.


My best friend in Nursing School, who was a major reason I survived a program designed to stomp the life right out of you, had always wanted to be an ICU nurse. I, of course, wanted to be an ER nurse. We spent hours, in the blissful ignorance that is so prevalent in students, debating the pros and cons of each. We tried in vain, wanting badly to work together when we graduated, to sway the other to our point of view. It never worked. I had badgered her relentlessly to get her to apply at "my" hospital, as I thought of it, but it would have been an unmanageable commute for her. Against my will I was in this alone. And to make it worse they were trying to talk me into trying out for an ICU job - a compulsive, no excitement, anal, chart keeping, med passing, boring ICU job.


I felt a little sick to my stomach walking to the parking lot, the feeling you get when you have built something up so big and realize that it simply isn't going to happen. My brain was bouncing around like a tennis ball - whup whup whup - as I mentally fumbled with a Plan B. As I reached my car I realized that my tennis ball whup whup whup was getting louder, and I looked up to see a helicopter lazily landing on the roof of the building I had just walked out of.


And as the engine cut out and the blades slowed down, I realized exactly what my Plan B was going to be.


To Be Continued...

The Friday Four(got)

I worry myself sometimes, I really do. For example, as long as I've lived Thursday has come after Wednesday and before Friday. No real rocket science there, and yet it just slid on by.


But to prove that it is indeed possible to learn something from your kids, I offer up four reasons why it's not my fault. If a kid with scissors in one hand and my brand new (shredded) kitchen towel in the other can look me in the eye and say they didn't do it... well, so can I. And with as much conviction.


#1. It's been a little stressful around here. The report card came and was just as bad as anticipated. Some dear, dear friends of ours are having serious marital issues that threaten to completely upset our little world. One of my closest friends was (out of nowhere) diagnosed with a potentially life-threatening condition. The Film Geek has just leapt into a nice little mid-life crisis. The week has been filled with intense discussions in all the roles of mother, wife, friend and nurse.And I'm sick again. (Still?)


#2. The weather is nasty. Too warm to snow, too cold to get comfortable. Grey, gloomy, sleet spitting, lip chapping, dark around lunch time weather. Ugh.


#3. Some weeks were just made to make you feel overwhelmed and this is one of them. It was a Bunco week (which means a night out) and I've picked up extra hours at work. I'm volunteering in Surfer Dude's classroom for a project. It's been a struggle to stay up to date on my blog reading, and for that I apologize. I'm about caught up, but it's taken a while. For all of you out there who have left me such wonderful comments and not heard back from me - I'm getting there. Honest. I'm nothing if not compulsive.


#4. Isn't three enough?

the library card

For a lot of reasons, this has been a very off balance week around here. Solid ground shifts, tectonic plates stabilize...and life goes on. It's so easy to get so caught up in your own drama that you can become oblivious to the world around you. Until...


I was standing at the counter of the mega-library in the next city over, filling out an application for a library card. Liberal Collegeville is a great place, but our library leaves a lot to be desired. The Big City-ville library is amazing - huge, well-stocked and gorgeous. For years I'd not listened to people who told me this was the library I needed to use. The tide was about to turn.


As the counter clerk was putting my info into the computer, a grey haired man stepped up to the clerk at the next window. She looked up at him, smiled in a personable way, and asked how she could help him.


The man paused, opened his mouth and quickly closed it again. The clerk's smile didn't falter. She allowed him to take his time. He tried again. As if on the edge of a precipice he teetered, took a deep breath...and jumped.


"I was wondering what you do with library cards that won't be used anymore," he said.


She looked at him quizzically, but didn't have time to answer.


"My wife just died," he said in a rush. "And I want to know if you need her library card back."


The clerk was at a loss. She asked the woman who was helping me, and was told that they wouldn't need to get the card back from him.


"So I can keep it?" he asked carefully.


They told him he could and he picked it up gingerly off the counter. He turned the card over in his hands and placed it in his breast pocket. For the briefest moment his fingers lingered on his chest. He smiled, thanked them and was gone.


I was still watching him walk away when the clerk handed me my new card to sign. As he closed the door behind him, I scrawled my name.

Life goes on.

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Aargh!! I just realized it's Thursday. Aargh!! No Thursday Three. Aargh!!
I may have to improvise something tomorrow. Aargh!!