Bus Stop

Stress

I thought I knew stress.

A first date?  Stressful.

A job interview for a position I desperately wanted?  Yep, stress.

Stress, the kind that makes you sweat, keeps you up at night, and generally stands there in your mind, gently prodding your vital bits and pieces, sending them into a frenzy, was something I thought I knew how to deal with.

Frakking hell I was wrong.

Year one of nursing school is over.  One down, one to go.

—

Last year I thought I was hot shit.  I thought I knew stuff.  My experience actually working in hospitals led me to believe I’d be able to cope with life, school, and work, taking very few bumps along the way.

Notsomuch.

In the last month, a friend received a terminal diagnosis, a family member became critically ill, a friend of the family had a stroke, many Very Bad Things happened at work with patients, I had to choose a lottery number and register for my Fall classes, and took not one, but two final exams; both summaries of my first year as a Student Nurse, each taught from a completely different set of textbooks.  With different “most correct” answers.

The new grey hairs in my beard are worn with pride.  But excuse me if I never want to go through that emotional roller coaster ever again.

Something tells me that isn’t an option.

—

In the fall I begin my fast and furious rotations.  Five weeks each of Psych, OB, and Med Surg.  Two of the rotations will be in a hospital I know well, but on units I’ve never seen.  The little bit of familiarity is comforting, as my schedule will ramp up from a 7 hour semester to a 12 hour one.

Full time baby.  Gah.

Aside from the mysteries of the mind, the uterus, and more advanced procedures, I’m going to be rotating through six different instructors in a short span of time.  Selfishly I had the same clinical and classroom teacher for the last two semesters.  No more of that.  Time to meet a slew of new personalities.

The biggest upshot, by far grander than even a familiar hospital, is the circle of friends I’ll have in clinical and classroom.  Some good people will be joining me on the ride, people I study with and trust explicitly.  We’ve navigated the waters this far, and have another year to get through.

At least we’ll do it together.

—

All I want right now is a vacation.  That’s so far from anything I can actually do at the moment, it’s a bit depressing.  Instead, with Oberon on my lap, I’ll be playing Bioshock 2 during my little pockets of downtime.

Now excuse me while I return to Rapture.

Wabash

Randolph & Michigan

Old Bio Lab

The Old Neighborhood

Uptown Mural

Him

I just knew he'd respond the moment the phlebotomist stuck him with the butterfly needle. There were track marks up and down his hands, like some evil roadmap, marking out where his veins lie below the skin.

He didn't even flinch.

He is a zombie. Occasionally he blinks his eyes in response to pain.

In and out, she sawed the needle back and forth under the skin to find a vein. It'd flash, then stop, then flash again, then stop. A normal person would be crying.

But he just lay there, gazing off toward nothing, unresponsive.

I keep asking myself, when it is okay to let someone die?

End Stage Renal Disease. Congestive Heart Failure. Diabetes Mellitus. Previous Deep Vein Thrombosis. Chronic Obstructive Pulmonary Disorder. Lethargy. Acute Respiratory Failure.

The list goes on and on. He had it all. And laying there, in a hospital bed for the last month, he was only getting sicker as time passed.

First MRSA. Then C. diff. Now a pneumonia, possibly aspiration from his G-tube feeds. He hasn't made urine in months. Dialysis three times a week pulls off the fluids.

Lungs; crackly. Skin; damp. Color; awful.

If there is a hell, you get there when your code status is Full for no good reason.

When I get home from a clinical, I usually rush to the shower to wash off the hospital. Today, as I stood in the steaming hot water, I was trying to wash away my feelings.

I felt guilty for caring for this zombie. I felt ashamed all I could do was look at him with pity. I felt angry that his decision makers were selfishly keeping him around to assuage their own guilt. I felt embarrassed that we have this technology and yet we use it in senseless ways.

He won't just appear in my nightmares. He'll haunt my dreams.

Maybe A Prayer

I never really found out what the plan for him was.  Ninety years old, barely able to open his eyes in response to voices, good BP, a little tachycardic, no fever, lungs clear, bowel sounds hyperactive, but he hadn’t eaten in 48 hours.  He had a new hip two weeks back.  Recently at his rehabilitation facility, he stopped responding.  According to the H&P he was feisty and had great cognition before the episode.  Not so much right now.

Scanned his head, all clear.  Scanned his lungs, nothing.  Lytes were out of whack, but according to his docs, not so out of whack to cause his altered status.  A bit of dehydration.  Culture reports clean.  It was a creepy picture to be honest.  And I had no clue what to do with him.  No clue at all.

So I defaulted to doing the only thing I know how to do well.  Got a stack of linens and went to work washing him from head to toe.  His skin was pristine before I washed him, but I washed him anyway.  This was obviously a relatively healthy person who suddenly took a turn for the worse.

I left my clinical that day feeling like I did very little.  Sitting here, staring at my post-clinical paperwork, I’m clueless what to say.

Maybe a prayer is the best thing. 

—

I’m less than eight weeks away from finishing semester two of four.  The breakneck pace hurts, but I’m very clear that this is nothing compared to next semester.  I dislike being this tired all the time, but I’m making my way through the fog as best as I can.

Work is draining, mostly due to the f-ups I work alongside calling in on a regular basis.  There are high points of course.  The baby-holding and the toddler-coloring sessions I love so much.  But clerking for twelve hours all alone just plain sucks.  My RNs are great, and my charges are too.  But sometimes I want a break, and that’s tricky lately.

Our numbers have been off the charts.  It blows my mind to see the unit full at 4am.  I’m not sure why an hour of fever is an emergency at that hour, but the broken system is the broken system.  Everyone who comes in gets seen, no matter how small the issue.

I never thought I’d wish for the slow nights we had last summer, but I’m beginning to think it’d be a relief if we had a few here and there.

Maybe a prayer is the best thing.

sometimes we cry, sometimes we laugh

Sometimes we cry.

—

They said a bird was landing for us.  Translation: the helicopter is bringing someone in extremely poor condition to the ED.

An argument with a family member tipped the scales.  She went to her room and tied a bag over her head.

The same family member she argued with found her.

She was twelve.

She landed in the bird’s nest at an unusually early hour that evening.  When I caught the gaze of my staff as they rolled her off the elevator and toward the trauma bay I could see pain in the eyes of friends.

Intubated in the field, pH of 6.84.  GCS of three.  I heard it clearly announced.  Then repeated and confirmed.

Everyone knew all the meds and interventions in the world wouldn’t bring her back.  The fight was to save her organs.

The angels came way too early for her.

Her body, now several days later, failing, is still in the ICU.  Each day the organs are less viable.

No one wants to lose a child.  But when they are medically gone, I constantly question how long it takes families to let them go.

It isn’t my place to judge, but often I find it very hard not to.

—

Sometimes we laugh.

—

Pediatric sedations are fascinating to me.  We do them frequently in the ED to set bones, stitch up various bits and pieces, and occasionally to calm down an anxious little one during a scan.

Most kids slip out of consciousness and come back to us when we bring them out.  Sometimes, however, a paradoxical reaction sets in.

Often to the amusement of the staff.

There have been very young teens who have shrieked out more curse words per minute than all the foulest comedians combined.  A particularly lexicographically talented young lady commented on how large our attending MDs lips were, and how she must enjoy orally pleasing her husband’s wildly large  member frequently.

She didn’t use those words.

Another jaunty young gent was so enamored with Harry Potterisms that everyone around him became a character from the stories.  Most impressive were how freakishly spot on his descriptors were.  Calling one of our larger, bearded CT/Xray techs Hagrid is still a story that is frequently passed around.  Even the day shifters have heard it and passed it along.

We shouldn’t laugh, but hearing a little kid swear is something of a novelty act.  It’s incredibly hard to maintain composure when a six year old is yelling, at the top of their lungs, during a scrotal repair, quote “Motherf#$kers!  What the f$%k are you f@#$*ng doing to my balls you sonsabitches!”

Adults should use the term “sonsabitches” more I think.  Why only let the kids have fun?

—

It’s why I love the ED.  Laughter and tears.  The whole roller coaster.