June 24th, 2009 by Emergiblog in Better Health Network, True Stories
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Well, somebody likes their job, I must say.
Although I can’t figure out why she is smiling.
Her cap looks like conjoined coffee filters!
Conjoined coffee filters that somebody sat on!
Maybe she doesn’t realize it’s squished, and would die of embarrassment if she knew!
********************
The emergency department “regular”.
Every emergency department has them.
A patient can become a “regular” for many reasons. Maybe they are a recurrent cardiac patient. Perhaps they suffer from chronic pain. Sometimes, they become a “regular” because they utilize the ER as a clinic and bring the whole family in over the course of a month. Some regulars are drug seekers. Others are homeless and know they can find respite in the department for at least a couple of hours and maybe get something to eat.
If you work in an emergency department long enough, you will know who they are.
And you will get to know them.
*****
Recently, it dawned on me just how well you get to know them.
I work in a community hospital. It’s one of those hospitals that patients actually request to go to from all over the county. We have our shifts from hell, but it is far from the county-trauma-eight-hour-wait-time environment of the huge medical centers. There is time to talk to the patients, find out more about them than what hurts, what is swollen or what prescription they have lost.
Over time, the conversation stops being scripted and “starts getting real”, as they say.
*****
This particular shift was steady, but not crazy. And almost all the patients I cared for were “regulars”. Easily 90%. For some, it was their usual health issue. For others, something different.
I found out a lot that night over the course of that shift
Someone’s youngest would be starting kindergarten in September; someone’s oldest had just graduated from high school. Someone had gotten into a recovery program and had been clean for a month. Someone had just welcomed their first grandchild, another was mourning the loss of their mom the week before. Someone had lost their job earlier in the week. Someone had gotten married since their last visit. A baby sister was on the way for one of my patients. Another patient had enrolled in the local junior college.
We saw them, treated them and sent them on their way with a wave and a prescription.
Hopefully they left in better shape then they arrived, even if all they needed was reassurance.
All I know is that I thoroughly enjoyed that shift.
*****
I had done all the usual things. Saline locks, blood draws. Medications and re-evaluations. IVs and education.
But I had also congratulated success, commiserated over frustrations and offered consolation over losses. We covered birth and death, struggles and successes, dropping old lifestyles and starting new beginnings.
That shift, I saw my patients in a different light.
*****
The best part of nursing has nothing to do with disease or diagnoses or procedures or prescriptions.
The best part of nursing is the patients themselves.
I thoroughly enjoyed catching up with my “regulars”.
I hope I was therapeutic for them.
They were most certainly therapeutic for me.
*This blog post was originally published at Emergiblog*
June 8th, 2009 by Emergiblog in Better Health Network
2 Comments »
You walk into the unit, put down your backpack, fill your pocket with pen, scissors, and tape, sling the stethoscope over your neck, swipe your namebadge into the infernal timeclock and enter stage right.
It’s showtime!
Get the triage, hook up the monitor, grab the EKG, slam in the saline lock – grab the bloods in the process, hang a liter of normal saline, put up the side rails, hook the call bell to the side rail, throw on a warm blanket, medicate for fever and slam the chart in the “to-be-seen” rack.
Repeat x 30 over the next eight hours.
Feel like burnt toast, look like burnt toast, act like burnt toast.
*****
Where’s the patient?
You know, the person you just triaged, hooked, slammed, hydrated, side-railed, blanketed, medicated and lined up for evaluation?
Oh.
Did it ever occur to you that the reason you feel like burnt toast is because you are so focused on what you are doing you have lost sight of the “who” you are doing it to?
*****
Well, it occurred to me.
Because that is exactly what had happened.
Oh, my physical care was fine.
But I had stopped looking patients in the eye. I was spitting out standard responses instead of listening to what my patients were saying. I was expending the bare minimum of energy required to complete tasks.
I was doing; I wasn’t caring.
And I was burnt.
*****
But I discovered something.
And this is huge.
I was not focusing on tasks because I had burned out, I burned out because I had started focusing on tasks.
Let’s face it. The ER, while seemingly exciting to those outside the ambulance doors, can actually feel redundant to those of us who deal with the same issues every day. The same complaints. The same symptoms. Over and over and over.
So, what makes each case interesting? What makes each case unique?
The patient behind the story. The person under the symptoms.
Lose sight of the person and you lose sight of the profession. Lose sight of their humanity and you lose sight of your own. Lose sight of your own and you become a burnt shell.
*****
You would think that after three decades of this, I’d have figured this out by now.
I guess you never stop learning.
This time, my teachers were an elderly man with a DVT who talked to me about his time on the LAPD, back in the day.
And the young woman who described, quite vividly, how it felt to go from the pinnacle of health to the devastation of a cancer diagnosis, overnight.
Or the 18-month old who tucked their head under my chin and fell asleep as Mom described the terror of witnessing a first-time febrile seizure.
*****
Who would have guessed that sometimes patients are the cure for burn out and not the cause of burn out.
The patients didn’t change, they were always willing to talk.
All I had to do was stop and listen.
That simple.
Go figure.
*This blog post was originally published at Emergiblog*
June 3rd, 2009 by Emergiblog in Better Health Network
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FROM THE “BEST OF EMERGIBLOG” FILES, ORIGINALLY POSTED AUGUST 16, 2005, THIS WAS ONE OF THE VERY FIRST POSTS OF THE THEN BRAND-NEW EXPERIMENT KNOWN AS “EMERGIBLOG”
I never knew this game existed until I did a web search for the character! There are actually pristine, unopened Cherry Ames games on eBay.
No, I didn’t buy one. Seventy-five dollars is a wee bit too much to pay, although I did spend that much on a vintage Barbie outfit about ten years ago.
Hey, it came with the original shoes and Barbie fans know it’s all about the shoes!
(UPDATE 5/09: My co-worker gave me all of her Cherry Ames books – a complete set – and a copy of the game, in perfect condition!)
***********
Those who study human behavior should spend a shift in the emergency department.
The games played in the ER make the Olympics look like a tetherball tournament. Some of the participants are patients and some are staff. Some are gold-medalists in their specialty and some arrive a few feet short of a full balance beam.
Let’s take a look at “The Emergency Olympic Games”:
“The Suck-Up”
Usually the player is suffering from an acute lack of an opiate prescription for chronic pain symptoms with a nebulous origin for which they have not been evaluated by a doctor but they have an appointment with a specialist next week but they ran out of their Vicodin and they just cannot bear it.
Said patient is overwhelmingly complimentary to Team Nursing . The targeted nurse is SO much nicer than any other nurse anywhere in the whole world and gee, that other nurse was so rude they wish ALL nurses were just like you! These compliments are dispensed within 3.5 seconds of spotting the nurse, often making said RN feel an acute need for a shower.
The player realizes she is out of medal contention when the targeted nurse responds with, “Gee, thanks, but I just came in to get a Betadine swab….”
”Mean Medical Matchup”
This game is closely related to the Suck-Up, utilizing the same team.
Player has been evaluated by the ER doctor, who, having the audacity to disbelieve their story, has gone for the gold and verbalized his lack of belief to the patient. Bottom line: no prescription. The patient prepares for this event with the “Which Doctor is On Tonight?” drill, using a telephone to assess the playing field before engaging the opponent.
“Peek-a-Boo Bypass”
This event requires a large team that converges on the patient’s playing field soon after the patient’s arrival. Anyone can make the Peek-a-Boo team, although it is usually composed of family members and friends of many generations.
Upon arrival, Team Nursing announces the event rule: only two members of the Peek-a-Boo team on the field at a time. This is met with a courteous response and extraneous members go to the bench in the waiting room, where the goal is getting back onto the playing field without Team Nursing noticing. This is accomplished by one Peek-a-Boo team member returning to the patient at a time until the bedside number has quadrupled. Stealth and dexterity are assets to this goal. Occasionally Team Security will act as referee.
“The Two Guy Offense”
The preliminaries for this event take place off the Emergency Stadium grounds.
The player reports a spontaneous assault by Team Two Guys. The members of this team are always unknown to the patient and the initiation of contact always unprovoked.
The goal of Team Patient is to obtain care from Team Medical with minimal disclosure of the playbook. The involvement of Team Police is always declined as so as not to incur a penalty. Team Two Guys apparently has many expansion franchises.
“The Two Beer Defense”
Team Patient enters the arena via Team Paramedic, having received a report of “player down” on the sidelines of a local Team Seven-Eleven. Team Patient arrives supine on a movable gamepiece.
Upon arrival in ER Stadium, body fluids are released for assessment by Team Nursing who immediately take defensive positions. Performance-enhancing ETOH is suspected as the characterisic Odor Offense is noted. Team Medical waits for the Designated Cleaners and takes the field.
Minimal interaction takes place between the teams for many hours at which point Team Patient verbalizes that he only had “two beers”. Team Medical knows to multiply this number by 58. Team Patient is taken out of the medals race on a credibility technicality.
“The Decibel Debate”
Team Patient attempts to propel themselves off the bench and onto the playing field by increasing their verbal intensity. Team Nursing counters with internal auditory blocking mechanisms. The goal: Team Patient enters playing field at appropriate interval. Team Patient rarely medals in this event.
“The Titanic Panic”
Team Patient arrives, usually via Team Paramedic, complaining of numbness, chest pain, shortness of breath and near-syncope occurring at the preliminary event at Home Arena which involved a “Decibel Debate” with another member of Team Family.
The Peek-a-Boo team arrives to act as cheerleaders for the event. No medal is awarded, as the full cardiac work-up that ensues turns out to be negative. An Academy Award nomination, however, would be appropriate.
These are just some of the Emergency Olympic events to which I have a front row seat and perpetual season tickets!
*This blog post was originally published at Emergiblog*
May 12th, 2009 by Emergiblog in Better Health Network, True Stories
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I love this ad.
I was about this age when I decided to become a nurse.
Maybe a little older.
I was holding a book instead of a teddy bear.
I wouldn’t have been caught dead in that cap, though. Even in those days I knew how to make a totally cool nursing cap out of paper.
That looks like a pillowcase.
Sometimes it’s hard to remember why nursing sounded like a good idea.
********************
You don’t realize it’s happening.
You set a goal and you do what you have to do to get there.
For awhile, you manage to do it all.
Nine semester units.
Working 24 hours a week.
No sweat.
Been there, done that.
Lived through it.
*****
But things start piling up.
Work needs you to pick up some hours. Coworkers on leave, folks needing time off.
You say yes, because when you need time off, they will make sure you get it.
Only your body isn’t cooperating.
You are in bed for the night at 1600.
And up at 0530.
Then you can’t fall asleep before you go in at 1900.
So you’re up for 28 hours. Straight.
Twice in one week.
That worked when you were eighteen.
It kills you at fifty-one.
*****
So you work, and work is uncharacteristically busy.
You start getting depressed four hours before you go in.
Then you start getting depressed because you have to work the next day.
Your coworkers are getting on your nerves.
You are really getting on their nerves.
You hit the ground and twelve hours later you sit for the first time. In the car. For the ride home.
To sleep for ten hours so you can go back and do it again.
Before your one day off.
That you sleep through.
*****
You fall behind in class; the professors are cool and allow you extra time for the assignments.
Which you need because you are so exhausted you cannot think.
But you won’t give less than an “A” effort so you stress and research and study and fine-tune and finally turn in the missive 48 hours after it is due.
Only to discover your classmates managed the assignment in two paragraphs.
How the hell did they do that?
*****
You start to lose it.
You don’t leave the house on your time off.
You stay in sweats all day and don’t bother to fix your hair.
Your husband thinks you are having a breakdown because he hears you laughing hysterically one minute and bursting into tears the next.
Except it’s not a breakdown, you are just watching “Scrubs”.
(Why the hell did they kill off LaVerne? Idiots.)
You start scanning the ads for a desk job. Part-time. Days. No weekends.
No blood. No pain.
No death.
*****
I’ve been here before.
The demon is back.
I’m in full blown burn-out.
But no major life changes.
Not this time.
I know what to do.
No more extra shifts.
The money is nice. Sanity is nicer.
No more twelve-hour shifts. Kudos to those who can do them.
I can’t.
No summer school.
I’m 12 units away from a BSN. I can graduate in the Spring of 2010. I gain nothing by sacrificing my mental health to do it by December.
*****
I’m scaling back, I’m taking a break.
For the next few months, it’s all about me.
More visits to Starbucks to read blogs.
More visits to Starbucks to read novels.
More concerts.
More mini-vacations. Son’s graduation. Nascar race in Sonoma. BlogHer in Chicago.
*****
I wish I could do it all and be it all and have it all.
It’s hard to face the fact that I have limitations.
But, I know,
I’m no Superman.
And that is a major bummer.
I’m No Superman
*This blog post was originally published at Emergiblog*
May 4th, 2009 by Emergiblog in Better Health Network
2 Comments »
That’s Edie Falco.
You remember. She played Carmella Soprano.
Great actress; I love her.
Too bad I won’t be watching her new character on Showtime.
*****
“Nurse Jackie” is a new series.
I received an email from Showtime asking me if I would curate a selection of nursing experiences for an upcoming “Nurse Stories” web site that would coincide with the debut of Nurse Week and “Nurse Jackie”.
Whoa.
I don’t get email from Showtime every day, so this sounded pretty interesting.
I went to the website to check out the show before responding.
I made it through one video.
*****
Nurse Jackie is a competent, hard-as-nails, take-no-prisoners ER nurse.
With a heart, of course.
One minute she’s telling a doctor he’s full of it, the next minute she tells a patient to get out of her ER (classic!).
Edie Falco is perfect as the title character.
You’ve all worked with her.
Hell, you might even be her!
*****
My first reaction?
Oh..my..god, they did it!
They made a show with a strong nurse protagonist, and damn! if they didn’t get the ER environment down!
I had goosebumps, literally.
I was ready to (a) start getting Showtime, (b) spread the word far and wide and (c) take the job.
But then…
*****
They started grabbing her chest.
I think in a the short video I watched (five minutes?) Nurse Jackie had her breasts fondled by three men.
Oh great.
My first thought?
Here we go again with the nurse-as-sex-object stereotype.
(Actually, my first thought is that I must be working in the wrong hospitals.)
But it got worse.
*****
Nurse Jackie is a drug addict.
Has back pain.
Snorts crushed up Percocets.
Oh no they didn’t………
*****
Oh yes.
They did.
Now, would somebody please tell me why, why? they had to portray this nurse as a drug addict?
Did they not see that they had the potential for one hell of a nurse character here?
Did they not see that they could break the mold of media stereotypes in nursing and pave new ground?
Did they not see that there is enough material to build a nurse character out of what happens in the ER alone without adding the oh-so-subtle touch of drug addiction?
*****
If you’re an nurse who spends a lot of time with other people fondling you, you might like this show.
If you’re an RN and addicted to drugs, you might like this show.
In fact, why don’t you go check out the website for yourself.
Watch the video, get a feel for the character.
Tell me what you think.
Tell Showtime what you think.
And if you are really pissed, write to The Truth About Nursing.
I already did.
*****
As for me?
I (a) am not subscribing to Showtime, (b) will not promote the show to anyone outside this blog post and (c) did not take the job.
I am so sick, and so tired, of stupid media portrayals of nurses.
Didn’t watch “ER”. No “Grey’s Anatomy”. Won’t watch “House”.
Here goes trying to explain to my patients, again, that “no, I don’t watch that show because of the portrayal of nursing.”
*****
You blew it, Showtime.
Of course, it’s not too late to rectify the issues, the show has not debuted yet.
But know this:
No matter how funny, how dramatic or how well written “Nurse Jackie” is, you are doing nothing to advance or promote the nursing profession. But then I guess the goal is ratings and nothing defines a “hit” like sex and drugs.
*****
“Nurse Jackie” is described as “Saint! Sinner!”.
Saint.
Sinner.
Sound familiar?
Yeah.
Sigh.
