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.

thirty-five

Our first exam of the semester came and went.  A bit of excitement for the students that had never taken my instructor.  For me it was formulaic.  Expand the study guide, work on HESI/NCLEX questions related to the subject matter, and memorize several dozen facts.  I wouldn’t call any of it easy, but the preparation and first exam are behind me and I feel good about things.

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.