Nursing and waitressing

I waited tables and bartended to pay my way through nursing school. I remember thinking, during particularly busy dinner shifts with customers who were high maintenance or angry or demanding or just determined to be unsatisfied, that things would become SO much better when I graduated from nursing school and became a real nurse. NOBODY would order me around, treat me like a servant, talk down to me, attempt to make me feel inferior or repeatedly send me back to the supply area for extra condiments. NOBODY! I would be the EXPERT! I would have POWER! (that I would wield responsibly of course…)

Surprise! Ten years later…I get ordered around, treated like a servant, talked down to, attempted to be made to feel inferior, and repeatedly sent back to the supply room for extra condiments. Except the condiments are drugs. Lots of ’em.

This field…

This field of work makes me, amongst other things, have no boundaries when it comes to all things gross.  When people throw around the acronym “TMI”… I’m like… “What’s that?”  Because, really, nothing is TMI for me.  I’m in the business of inquiring about that much information.  When was your last bowel movement? What was its consistency? What color is that discharge? Does it smell bad?  Do you practice protected sex?

So it is no big surprise that this also applies to my personal life.  Things that I’m quite certain should gross me out…don’t.  (with the exception of bathtub drain hairballs…I’d rather rip out my fingernails one by one with a rusty pair of pliers and then dip my hands in lemon juice and battery acid than snake the drain after a month of my showers)

Case in point this morning.  We feed our cat twice a day.  And he acts like we’re starving him.  There’s no real need for an alarm clock, as he is already tromping all over the bed demanding to be fed by 0530am.  And I have yet to hear him chew any of his kibble.  I’m certain that if I dissected him soon after a meal that I’d be able to package up his stomach contents and sell it at the farmer’s market as organic soft kibble.  And make a fortune.

So this morning as I’m feeding him I realize we’re running low on cat food.  Which means a trip to Costo on Sunday which I hate.  I’d rather… well, you get the point.  So he inhales it in a very ungentlemanly pace and manner.  And then as I’m getting dressed I hear the sound that every cat owner knows.  I don’t even know how to spell it.  “Whomp, whomp, whomp ….eeeccchhhh”  I just hope he’s not on the area rug.  A whole house full of wood floors and he manages to get it on the area rugs about 96% of the time.

So there it is, right next to his feed dish.  A little pile of freshly regurgitated cat kibble.  Right next to his feed dish.  And we’re running low on cat food.  Waste not want not, right?  So I scoop it up in a paper towel and empty it right back into his dish and go on about my morning.  And he ate it.  And he’s been sitting on the easy chair grooming himself ever since.  Maybe its better the second time around. And he almost could have enjoyed my husband’s breakfast the second time around too. From now on I’ll make sure he’s not in the room when I recycle the contents of the cat’s stomach.

The Devil Wears…Danskos?

The devil doesn’t wear Prada on my unit….he wears old worn out brown Danskos.  Danskos that I wish he would replace, STAT.  He’s our bigwig surgeon.  Dr. X.  He’s arrogant, he’s charming with the lady patients, he’s published like a gazillion papers in peer reviewed journals, he has impeccable outcome statistics and he has expectations of perfection that only Mother Theresa could meet.  But his Danskos? He’s had to have had those things since residency, which must have been ages ago.  They probably smell horrid, like a combination of dog anal glands and epoisses on a hot day.   A lot of surgeons have their “thing”.  A little superstition.  A certain surgical cap, a Mont Blanc fountain pen they’ve used for every paper order and progress note since the 70’s, their alma mater pin etc.

This guy? His ratty brown Danskos.  Now, don’t get me wrong.  I have a love/hate relationship with my Danskos.  I fought the good fight to avoid buying a pair until my aching feet protested after a year of 12 hour shifts.  I caved.  I bought.  I hate.  They’re so ugly!  But they’re SO comfortable.  And the 1 3/4″ heel comes in mighty handy when you have to walk to work in the rain.

When Dr. X breezes onto the floor for rounds, you can see him coming down the hall with his entourage of 4-5 residents, a few interns and perhaps a terrified medical student trailing 4 feet behind.  They flank him like a flock of geese migrating south in  V formation.  And every time I find myself humming “My Posse’s on Broadway” when they walk by.  Usually we’ve had about 23 seconds of lead time before he arrives to round on his patients because his Danskos have a certain recognizable squeak.

You know the scene from The Devil Wears Prada where Meryl Streep’s character is making her way into the building for work?  Scenes of her getting out of her town car, entering the building, getting in the elevators and opening the big glass doors to the fashion magazine headquarters are interspersed with scenes of frantic fashion magazine employees racing around making sure everything is perfect in the office before she arrives.  Cleaning up clutter, touching up their makeup, changing out of comfortable shoes into high stilettos, hiding carbs, taking off functional clothes and putting on haute couture, setting her coffee in its exact proper location on her desk.

That’s what its like when Dr. X comes on the floor.  We race around making sure all his patients are awake, out of bed (“get up now! get in the chair!”), medicated, working on their pulmonary hygiene (“If anyone asks you’ve been doing this incentive spirometry all morning!”)* or…jackpot…just happen to be walking in the hall when he arrives (which he loves).  If they’re asleep and shaking them awake wouldn’t be appropriate, we just shove the incentive spirometer into their limp hands. **

And he buys it every time.

* We normally do all these important post operative nursing interventions anyway.  Many times a day. We’re good nurses.  He just rounds so early in the morning before we’ve had a chance to get everyone going.

** I’ve totally done that before

The surgeon seamstress

The day after Halloween, while my Facebook feed was being flooded by parents posting pictures of their children in costume, I was at work discussing with my friend various tactics for deterring trick or treaters from my front door.  I obviously don’t have children.  And the doorbell scares my cat.  And I don’t appreciate begging, extortion and gluttony, which is basically what trick or treating is.  But I do love a good costume.

So our discussion turned to costumes and the various guises we had inhabited on Halloween throughout our childhoods.  Many of mine had dark and morbid undertones with lots of fake blood and fangs and black fabric.  One year I had a momentary lapse when my mother sewed a sparkly “good witch” costume.  My friend (who is 6’1″ and about 250lbs) was an Oompa Loompa every year.  Our discussion peaked the interest of one of our plastic/reconstructive surgeons who was dictating nearby.  He said his daughter had wanted to be Voldemort that year.  Not Hermoine, but Voldemort.  I liked her immediately.

Now, I like to entertain the notion that I am impervious to gender stereotypes, but when he proceeded to described in great detail the elaborate robe which he sewed for his daughter’s costume, I was at first skeptical.  Yeah right…you sewed your daughter’s entire costume.  Snort.  But then he showed us pictures on his phone.  And it was gorgeous.

And then I realized…he sews skin better than Buffalo Bill.  So naturally he can sew an elaborate wizard costume.  Naturally.

Dirty floors

It kills me when little kids visit a family member in the hospital and their parents let them run amok on the unit. Especially if they’re running amok sans shoes. In my head I’m seeing the little old man who just ambulated down the hallway leaving a nice little chocolate trail behind him as his anal sphincter failed him. A nice chocolate trail that we hastily mopped up with towels while waiting for housekeeping to come and give a proper clean to. But not before little Tommy runs over it in his bare feet as he’s screaming and running around the halls! Yay! C.diff for everybody!!

I hate that word.

Sometimes I hate the word “nurse”.  Usually because its a patient yelling the word from down the hall because they’ve forgotten how to use their call light.  Or using it instead of my name.  Like at the end of my shift yesterday.  I’m doing my rounds, making sure everything is ship shape for the next shift & everyone is alive etc., and my patient says, “oh nurse, the ice melted in my water”.

[blank stare]. By me.  I mean, technically I don’t have to answer that.  It’s not a question.  But…

Three things.

First: Is it necessary to use the word “oh” in front of nurse?  Are we speaking in sonnets? Or iambic pentameter?

Second: It won’t kill you to polish off that water sans ice.  Or perhaps you would like a lemon slice when I bring the ice?  A lemon slice which I will desperately resist squirting on your surgical wound.  But lets not get carried away.

And third….you really don’t remember my name after 12+ hours? I mean…I remember your name, and I memorized pretty much every important detail about your body & your health.  And of my four other patients as well.

Guess I’m just not that memorable.  *sniff*

Family

I always find it quite sad when I get handoff on a patient and the off going says, “There’s been no family here.”  It happened yesterday.  On a patient who had been in the hospital for two months.  She had four sons, one of whom had power of attorney and refused to give his contact information to our social worker who had tried for days to contact him and finally got through via her medicaid application.  So here she sits, all tubes and drains and lines and artificial airway.  Lonely.  Probably scared.  Totally disengaged and in no way willing or able to participate in her care.

Family.  It can be my worst enemy or my best ally while I’m caring for one of its own.  I place families in three rough categories.  Up My Ass, Pleasantly Present and Nowhere To Be Found.  On any given day I may have a smattering of all three, the worst being multiple UMAs or NTBFs at the same time.  The woman above was a clear case of NTBF.

PPs are the best.  They don’t need much explaining.  They just need Nobel Peace Prizes.  They’re present, helpful, observant, stand back when they need to and step in when its appropriate.  I love PPs.  I like to think that I’d be a PP if any family of mine was hospitalized.  They get a disproportionately small paragraph in this post, but have disproportionately more respect from me.

NTBFs have a spectrum of their own.  Sometimes Dad just needs a lap chole and nobody can get the time off work to come sit and chat while he sips his broth and munches jell-o.  They show up on discharge day and Dad’s no worse for the wear.  The other end of the spectrum is like the woman above.  Often they’re incredibly complex cases with many co-morbidities and complications.  I’ll never forget a patient who was on my unit dying.  He’d been there for several days and had had no visitors or family at the bedside.  He was obtunded and unresponsive and we were withdrawing life support based on a phone call from a son who had legal DPOA.  The son lived a plane flight away and there were two local children who provided no contact.  The patient indeed needed to be allowed to pass.    As the time neared, I found myself sitting in his room while I did my charting, thinking about different family relationships and dynamics.  I realize some families must just suck.  Physical and emotional abuse, estrangement, fighting, substance abuse and mental illness would all be very difficult to deal with in a family.  I get that.   I have no idea what kind of father, brother, son, uncle or grandfather he was.  Maybe he was one of those I just described.  But as I sat watching this man take his last breaths I couldn’t help but be sad for him.  I felt strongly that he shouldn’t have to die alone.  So I held his hand and wished him peace wherever he went.  Even more sad was the phone call I had to make to that son after he passed.  We needed to know what he wanted to do with the body.  “I don’t care what you do with it” was his reply.  So the remains were sent to the county medical examiner’s office to be mass cremated with the other unclaimed, perhaps unloved bodies.

UMAs are, in my opinion, the worst.  They think of themselves as PPs, but they most definitely are not.  Quite often, the patient is very complex much like the NTBFs patients.  A typical UMA has been in the hospital for some time, is very ill, may have had some unfortunate complications and if there is an error to be made (diagnosis, medication or otherwise) it inevitably will happen on these patients.  Murphy’s Law.  This leads to distrust of all staff (somewhat understandable) and further travel UMA.  They do shifts, just like the nurses.  They have their own shift handoff too.  An update, a warning and a phone call 10 minutes after leaving the unit for an update.  I take particular offense to UMAs.  I know I shouldn’t; I’m learning not to.  But I still do a little.  It’s the trust thing.  I take pride in my excellent care.  I’m type A at work, I’m smart, I think critically, I’m personable, I’m organized, I’m observant and I get what I need from doctors and surgeons.  And when someone doesn’t have the trust in me or my staff enough to leave their family member alone in the room under our care for one single minute, I take issue with that.  And then I take that issue and I stuff it way down next to my ego.  Because experience has taught me to just go with the flow with these folks.  They micromanage, they perseverate on the things they think they understand, they control the things they can.  Like refusing to use the call light and waiting until it is answered, instead opting to trawl up and down the halls until they spot me in another patient’s room and stand waiting outside the door until I have to come out like a trapped and cornered raccoon.  UMAs usually have a rudimentary knowledge of basic medical sciences from their family member’s experience with illness.  They always want to know lab results.  “What was his blood sugar this morning? Oh, it was 205? Well you must not be giving him enough insulin because at home it’s always under 150.  I’d like to talk to the doctor right now please”  or “what was his white blood cell count? It was up? Well the doctors don’t have him on the right antibiotic then.  Call the surgeon right now because there must be some infection inside.”

Gah! It’s making my blood pressure rise just typing this!  I believe medicine and nursing are as much art as they are science.  And UMAs take some artistry.  I look at them as a challenge though, and this helps me stay neutral and calm.  Because I love a challenge.  And I think I’ll always be working to perfect my own art of nursing.  I’m sure it will never be perfect, but that’s the challenge right?

So if you find a family member in the hospital, be a PP.  It’s your duty as family to be present (author’s opinion).  Bury the hatchet if you find yourself being a NTBF, find closure or resolution, forgiveness and grace.  You’ll feel better.  Bitterness rots the bones (its actually envy, but I like to insert any negative emotion into the quote).  And don’t be an UMA.  You’ll turn everyone off, create tension and counter-productivity, and make some nurse’s day more difficult than it already is.  We want the best outcome for your loved one, and you won’t find that outcome up my ass, you’ll find it in being pleasantly present!

So here’s to family, good and bad (raising an imaginary champagne glass, beer stein, wine glass, ice water etc.)  May you never be hospitalized, and pass peacefully in your sleep at 98 years of age.

And for your viewing pleasure, here’s the third member of my family.  Don’t be jealous, but I trained him to poop and pee in the toilet.  True story.