—

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.

The focus this semester is much deeper.  We are moving into “the nursing process” as defined by our nursing model, the Roy Adaptation Model formed by Sister Callista Roy.  Her Nursing Process is a six-step model consisting of assessment of behavior, assessment of stimuli, a nursing diagnosis, goal setting, interventions, and evaluation.

It was all so amazingly confusing last semester.

This go ‘round things are starting to click into place.  I’m no expert on the Roy Model, but our teacher clearly follows the model and teaches around and within all of the parts regularly.  The consistency has brought things into focus during the first few weeks as we’ve reviewed concepts of last semester and built on them.

At first I was apprehensive to choose the same teacher for two semesters in a row, but thus far I’m glad I did.  I’m already hearing horror stories from cohorts who have switched classes.

—

I just celebrated my thirty-fifth birthday.

Let us ponder that for a moment.

Okay, too much pondering and I may end up hurting something.  Seriously, after thirty things begin to hurt.  Not big things.  Little nuisance things.  Walking in inappropriate shoes is no longer a good idea.  Dancing all night, and the usual drink that accompanies, can take you out for a good eighteen hours.

That pepperoni pizza with hot sauce?  It may make you feel a little something in your belly that you didn’t feel in your twenties.  And speaking of bellies, mine threatens to grow further unless I chain myself to the treadmill and force a good, long, fast-walk.

I’m in nursing school, thus I eat for comfort.

Mostly healthy because I cook a lot.  Occasionally I stray to the large vat of ice cream with all the trimmin’s.  And then I attempt to walk it all off on the treadmill.  She’s a tricky mistress that treadmill.  I love to hate her.  But with iPad in tow and a good film or television show on the screen, I walk without really noticing the time pass by.  Or so I tell myself.

Another thing about being in your mid thirties?  Making plans with other adults takes forever.  Gone are the days of ringing up a friend “hey girl, hey, let’s go out” and meeting somewhere in less than thirty.

Everything is a strategically orchestrated dance that not only takes days to plan, it all happens via text message/Facebook.  Sometimes I feel I’ve typed a three-thousand word essay to coördinate a drink at a local bar.

Not to complain, really.  Thirty-five has brought a career goal into focus, the wisdom NOT to have that shot of Jägermeister for the road, and an utterly honest candor when it comes to relationships of any sort.

I know what I want.  When you aren’t it, I’m gonna tell you.

If we become friendly and you aren’t acting like a friend, you won’t see me.

If you are a coworker, we can try to hang outside of work.  If it doesn’t work, let’s be gracious about it.

And gentlemen, when you aren’t completely out to your family, and I mean all the way out, we will never be more than friends.  That’s a Liz Lemon deal-breaker.

My three-in-a-row shifts are the only real commitments I have.  That’s not necessarily a bad thing, but I’m ready to get back into the swing of things.  Anything that brings me closer to NCLEX will make me happy right now.

I know right.  Who’s a nerd?

-

Pardon the rant that I’m about to go on.  Actually, don’t pardon it.  Read it and learn.

-

The ED has been filling the hospital with very sick kiddos lately.  With acuity through the roof, the shifts tend to speed by.  Some nights I blink and it’s midnight.  However, some of the useless slugs I work next to really need to fall into a puddle of something strong and be gone.

I’m not talking about RNs.  Not even residents.  I’m talking about useless I’m-going-to-call-off-again clerks.

Here’s the deal with my job;  I’m really good at it.  Call me conceited but my work speaks for itself.  Within thirty-ish minutes in the ED, I know most of the kiddos and their cases.  I know which OSH transfers are incoming and where they are going.  The highest acuity kids are on my close radar, their consulting services tucked in the back of my brain because they WILL call in and look for random resident X.  I regularly round to check our fast-moving equipment (pumps, IV poles, etc.) and if you need the tiniest foley, a wacky surgical instrument, or a random g-tube, I can get it here in minutes because I know the Central and Sterile folks well.  I bring them cookies.

Cookies can get you almost anything in a hospital in under five minutes.

Got a Medical Records issue?  They’re my girls.  The omnipresent Lab vs. ED battle usually subsides when I call down to check on something because I know them face to face.  And I say please and thank you.  CT/XR/Resp, whenever we have extra potluck food, I call them first.  And housekeeping?  Baby, those folks are my good friends.  Your “vomick” will get dealt with in a timely manner when *I* ask for their help.

To repeat, I’m good at what I do.  I Get. Shit. Done.

And then there are some of the other folks that are called clerks.  They complain about the schedule non-stop.  They call in when the day they requested off doesn’t go through.  How they think they’ll get away with it amazes me.  When someone asks them for a 6FR cath kit, they draw a blank and bark the number for central at them.  Questions like “Who was the crouper in bed six that went up?” get yelled at the charge for an answer, like there was an angry echo on the unit. 

Their uselessness does not amuse me.  I’d rather work a 12h shift alone then alongside an energy vampire.  Which, if you think about it, when they call in, I do anyway.

Some people should just call in sick permanently.

-

End rant.

-

I want a kitten.  A Sphynx kitten.  A companion for Oberon, my Sphynx.  I *think* I’m in the market at the moment.  I just haven’t officially told myself that indeed, I’m looking for another cat.

So for just a little bit of gleeful squee, I’ll leave you with Obi’s baby picture and his picture today.

And please.  Do not mock my hairless puss.

The first of four semesters of Nursing School officially came to a close ten days ago.  I sat for my 75 question final, worked my way through the exam, and left with a smile on my face and a spring in my step.  Having shaved my head early that morning, I was feeling good about life yet generally terrified about the next eighteen months ahead of me.

Sweet cheese’n’rice the semester F L E W by.  To quote Sondheim and Lapine from “Into The Woods”:

And I know things now, many valuable things, that I hadn't known before.
Do not put your faith in a cape and a hood, they will not protect you the way that they should.
And take extra care with strangers, even flowers have their dangers.
And though scary is exciting, nice is different than good.

C'mon Summer of 2013.  NCLEX, I'mma getchu!

—

Registration for the next semester of classes came and went.  This semester my classroom work was Mon/Wed day with a 7a-1p Tue clinical. Next go ‘round I’m in class Mon/Wed day with a 7a-1p Thu clinical.  Which means I spend six hours at one hospital, shower, nap, eat, and head to my hospital, Big Hospital for Kids, to work the first of three overnights.  I’m still working 7p-7a Thu/Fri/Sat. 

The weekly shift-flip remains, but I’ll gain a full Tuesday off.  Definitely a luxury I’m looking forward to.

—

So what did I learn in semester one of four?  Assess, assess, assess, and if you fail to spell ‘assess’ correctly in a nursing note, you’ve just written the word ‘asses’ in a patient chart.  Twice in my case.  As you cannot scribble out mistakes, somewhere there is a medical record with something close to the following entry:

“…with the assistance of Petit Filipina, R.N. (obviously not her real name…) and four other team members, rolled patient to the left side to asses asses ASSESS skin breakdown on the back, sacral and perineal area…” -Nosokomaniac S.N.

Joking aside, the goal of our program was to learn assessment and safety skills when caring for patients.  That covers a surprisingly large area of nursing, but overall I feel pretty confident about the things I’ve learned.  My psychomotor skills (to use their parlance) are absolutely lacking, but practice and repetition will hone them over time.

My CNA coursework and clinicals in early 2010 taught me good stuff.  There were ten students in my clinical section, three of us CNAs.  The contrast between us and the other students was remarkable.  I can’t fault my cohorts for their lack of experience, but you can guess who I asked for help when I needed it.

My Nursing School does not require incoming students to have their CNA, but I cannot recommend it enough for anyone considering nursing school.  We were miles ahead of everyone in both the clinical and classroom setting.  The language, the familiarity with equipment, body positioning, ADL care, isolation precautions, you name it, we surveyed in CNA class and it made a huge difference in Nursing 101.

—

It could be the case that in every vocational training there are people who bemoan the educational staff constantly, I’m not entirely sure.  What I do know is that there are some folks in my program who are so inconceivably rude and ignorant, I find myself doing kegels every time they speak. 

Let me sidetrack for a moment.

Back in my former life in Investment Banking, I had the good fortune to attend many classes on communication and management.  One of the teachers was lecturing us on how to deal with difficult people in several different scenarios.  He taught the text to the letter for a bit, then closed the book, sat on the table at the front of the class, and proceeded to blow our minds.

“Unless your life depends on it, whenever you encounter a difficult person, instead of spitting negativity back at them, do ten kegel exercises.  I guarantee when you consider what to say to them, it’ll come out a lot more effective that if you were simply reactionary.”

Trust me when I say it works.  In the face of negativity, tensing and relaxing the muscles in your pelvic floor will diffuse any snap judgements you might make.  Of course there are situations where it’s inappropriate.  Say for instance a person is threatening you with a knife with the intent to slice you to shreds.  I would NOT recommend pausing to tense your pubococcygeus muscle ten times.  However, when one of your cohorts is shit-talking like there is no tomorrow, ten quick squeezes down there isn’t gonna hurt the situation.  In fact, it’ll help keep you from perpetuating the negativity.

So.  Back on topic.  The naysayers who feel it necessary to belittle staff and many of their other cohorts are few in number, but they seem to be spreading misinformation like rot through the program.  I’m definitely not gullible enough to drink their poison koolaid, but a few people are.  And it’s worrying.

In the interim, my pelvic floor is getting stronger.

Today I was a nurse.  A full fledged, steth-and-sphyg toting, head-to-toe assessing, comfort-giving, oh-shit-this-is-super-real, nurse.

It was amazing.

—

A few months back I was sitting at the ED desk chatting with my coworkers.  Many of them were describing their past medical missions to other places around the world.  Somehow we moved from that conversation to volunteering at the Chicago Marathon.  My ears perked up.

“Do they let student nurses participate?”

“Absolutely!  Let’s go to the website to see where you sign up…”

And so I did.

—

This morning I woke up at 3am.  Maybe I shouldn’t even call it waking up.  I got up out of bed at 3am, having had a restless set of naps.  I was way too excited.  Today was marathon day.

At 4am I was standing in front of a local 24-hour restaurant in the gayborhood.  Two of my RN friends were on their way to meet me to inhale a big breakfast before we’d spend the day as medical volunteers at the marathon.  I’d been to this place countless times, but usually at the end of a night of drinking.  It was in full swing, packed with folks fresh out of the clubs, dressed for the night out, their breath sweet with booze, temperaments slightly skewed to drunk.

I was wearing a pair of grey REI convertible cargos, my dusty worn-in New Balance, and a white Duo-dry tee with a stethoscope on my neck.  One of those nicer metal disposable ones.

Needless to say I stuck out.

A fay little lad sauntered up to me.  He asked me a few polite questions, told me I was cute, and asked if I’d like to join him for breakfast.  On any other night the answer would have been yes.  But this wasn’t my night.  It was the start of my day.  The cutie asked for a hug and I obliged.  He told me he’d like to see me around and maybe we could play doctor.

Note to self: wear a stethoscope out more often.

My RNs showed up.  We ate and caffienated, hopping on the train afterward to descend into the check-in chaos.  By the time the dust settled we were in a van heading back to our med tent at Mile 8.  Which just so happened to be right in the heart of the gayborhood again.

I swear that wasn’t planned.

Five MDs, six RNs, a couple medical students, and a PT made up our little group.  Four chairs, two cots, a table with various supplies and a kiddie pool of ice packs surrounded us.  We were ready.

During the check-in chaos earlier, since we were relatively close to the start of the race, we had to get through the line quickly.  Some folks corralled us up front and quickly checked us in.  Instead of a white medical student hat, I got a red one.  Red was for all med pros.  And as we were running to catch our van, someone handed me a blue RN bib.

Suddenly I was a nurse.

—

We saw the wheelchair marathoners first.  They sped by with their cyclist escorts.  So much power in their torsos, arms rippling with muscles, thick necks pitched forward in determination.  Some hand cycled their chairs forward, some directly drove their wheels.

It was the beginning of a very humbling day.

—

We had vaseline blobs on long pieces of outstretched cardboard for the marathoners to grab as they went by.  Apparently they slather it on whatever bits are chafing.  At first, everyone was out there offering it up to the masses as they ran by.  

Then we had our first patient.  Then two.  Then a steady stream began to trickle into our tent.  A cramped calf here, a seriously chafed pair of thighs there.  Tape this, ice that, mostly we saw ortho stuff.  Our PT was busy stretching, helping to knead, and manipulating parts.

We had clipboards with a pretty simple head to toe assessment sheet.  Get their flag number, name if possible, presenting complaint, any treatment, dispo, and they’re off.

Then I heard the magic words “we need vitals over here.”

I grabbed her wrist while someone was getting her oral temp.  Shouted the pulse and respirations to the recorder. I cuffed her arm and did my first BP in the field despite the racket around me.  Temp was good, pulse high, bp a bit high for her, breathing fast.  Suddenly there was another body on the cot behind me.  “Need vitals!” said one of the docs.  I looked down at that first patient, looked her straight in the eye, and told her we were here to help and she was in good hands but I needed to work on the other person next to her.  She squeezed my wrist and thanked me.

And so it began.

—

Sometimes I took vitals.  Sometimes I started and finished the H to T, sometimes I passed it along to the MDs who recorded.  I tried to chat with all the patients, offer Gatorade, a bag of ice, an Ace wrap, whatever they wanted.  About an hour or so in, I could tell what they needed just by the way they walked over to the tent.  For the most part, we fixed them up in ten to fifteen minutes.

The saddest cases were the people who had to drop out and leave via EMS.  The hollow look in their eyes broke my heart.  I held quite a few hands.

Three hours later we started to pack up.  We headed back to the main medical tent.  Little did I know it was about to get more intense.

—

When we arrived in main medical it was pretty slow.  Our doc said we should relax, have a bite to eat, and stick around. The four hour mark is where things would start to heat up.

In the interim, we walked over to the finish line.

I’ve written this paragraph three times now, trying to describe what it felt like to see them cross.  Since I cannot seem to put it into words, I’ll just say I teared up a bunch of times and tell you what I saw.

There was an older gentleman who ran the final with his family hand in hand.  The way they all embraced in a big pile on the other side of the finish hit me hard.

Scores of people with shirts in memoriam of someone they lost.

Two older women in pink, crying as they crossed.  I’m not sure they were tears of joy.

The looks of exhaustion and exhilaration on faces as they raised both arms up to cross.

Two RNs on either side of a limping runner, his face contorted in pain, helped him across the finish.  He collapsed as they went through the gate.

So many tears.

—

By the time we returned to main medical, it was much more serious.  We were by the ambulance entrance.  If they didn’t need the ICU tent and we had a free bed, they stopped at us.

The massage therapists and PTs hovered close for the scores of extreme cramping.  Transporters from the finish were bringing people in who needed attention.  MDs were all consulting the RNs and each other.  The lab techs were busy in front of their machines.  

A lot of our patients needed IV access.  My RNs rocked the angiocaths.  There were iStat draws for lytes and gasses.  Frequent vitals and assessments.  I saw many liters boluses run wide-open, pouring into the dehydrated marathoners.  Didn’t realize how fast an 18ga can pump it in to a person.

I watched people go from very confused, shivering, pale, and diaphoretic to warm, pink, and smiling.  I also saw some people on monitors not getting better, whisked off to the nearest ER.

Intense.

—

As I was on the train heading home, I realized I helped bring people back to health today.  It didn’t happen in a vacuum either.

It wasn’t just spiking bags and priming tubing.  Not just vitals and hand-holding.  Not simply chatting in Spanish or offering more Gatorade.

It was working as a part of a team to bring patients back to health.  It was nursing.

And damn it, I was doing it.

She has no hair and the biggest blue eyes you’ll ever see.  Their intensity is magnified by the yellow mask that I always see her wearing when she’s in the ED.  She’s been to see us far too often.

The visits seems to be getting more frequent.

There are a string of baseball-stitch type scars across her little head.

She just turned seven years old and has been recovering from the excision of an anaplastic astrocytoma.  On a scale of one to bad, that kind of tumor is nearly the worst kind.

Everyone looks tired.  She looks tired.  Her parents look tired.  The family that joins them, usually about twenty minutes after they arrive in triage, looks tired.

The angels are near.  They may take her soon.

The attendings spoke the words ‘palliative care’ the last time I saw her.  Immediately I told charge I needed to step out of the unit for a bit.

There is a bathroom near the unit that is a great place to cry.

Is it wrong to want to see a child pass away?

I bring eyedrops to work. None of the other parents need to see that you’ve been crying.

—

Social Services tried in vain to find a place that would accept her.  Four hours later, there were no institutions in the city and surrounding suburbs that would accept.  The family had given up years ago.  They were disengaged in the care of their child.  She wasn’t even their child anymore.  She was a ward of the state.

How do you give up your child?  It must be an awful feeling.

Behavioral problems are often the most tragic things I see.

The devils of the mind are indeed wicked.

—

Aside from the occasional meal outside my apartment and work, I’m eating, drinking, breathing, and excreting Nursing School.

Once a dream, now a reality.

Where are those eyedrops…