Thursday, September 11, 2008

The Filth and the Fury

So I've been working as a R.N. in the ICU. Finally. Spent a lot of time contemplating what was fucked about nursing and the medical field. Spent a a few brief moments contemplating what was cool about nursing and the medical field. It revealed some truths about myself and it revealed an uncomfortable amount of truth regarding our culture, race, class status, identity. It has been a lot of painful discovery. I have been misunderstood every step of the way, accused of being a monster, a racist, a dude working in the wrong field. I am working in the right field for this stage in my life, for who I am as a person and the fact I have the integrity and stubborn mule-ishness to stand up for the good ol black and white. Learning to slowly accommodate for some of the grays, too.

So far, all my patients have been intubated and either comatose or completely sedated. Frankly, I prefer my patients sedated. At this stage in my level of expertise, I need them to be quiet so I can focus on getting organized and delivering pharmaceuticals in a safe and effective manner as well as the stack of paperworks the depth of the 9/11 commission report on a nightly basis.
On my first clinical night, I might as well call it "Krystal Nacht" from here on out for the brutality of it. The poor tiny 100 lb female Nepalese nurse across the way from me had a 4 BILL (that's a 400 pounder) RETARDED HUNGRY AS FUCK MASTURBATING BEAR NPO of a patient. The kid was S/P left AKA with the biggest, nastiest dehiscence I've ever fucking seen. As far as I could tell that amputation had never even been sutured together. It had that bright red meat grinder look to it. And you know how scared, mentally retarded compulsively masturbating opiate resistant patients are when they are confined to a bed and are missing a limb that they were partial to. Fuckin' crazy.
I felt bad for her, the nurse. She kept screaming, "Stop touchin' your stoof" in a cute accent. At first it was funy. But then he would scream so wretched a response in gutteral grunt language, desperate. Communication was completely impossible. I was kind of cracking up at first, listening to the nurse telling him over and over, knowing his behavior was a matter of self preservation and not anything that could be reasoned with.
And then I saw Baby Huey WAS frantically touching his stuff and it was just sad. I mean it was like a statement about man. When man is confined, lonely, missing his Mom who feeds him multiple chickens daily, when man gets down to it, he beats off his Foley'd tiny penis, buried somewhere in the mounds and mounds of flesh with a brutal vigor.
Finally, after a shitload of fentanyl, ativan, and fucking haldol the attending decided it was time to put in a central line via his left subclavian. The poor giant retarded kid. The attending turned the patient into a goddamn pin cushion and he must've hit the clavicle on one of his stabbing expeditions because at one point because he withdrew the needle (I swear to god it had to be a 16 guage) and it was completely bent in the middle. So then the attending chuckled in the same way one chuckles when accidentally throwing a gutterball at the bowling alley, I grabbed another triple lumen kit and he started over, gunning for the left femoral. And the attending made it. That's right, he put a delicate, highly invasive line INTO THE KID'S RANK CROTCH. Perhaps the attending is used to lots of male masturbation. One word comes to mind with this type of line placement with this type of patient: Inevitable.
An hour later the masturbating bear, in a furious attempt to satisfy his ungodly minotaur urges ripped of the soft restraints, yanked out the femoral line and furiously stroked himself into a brief five minute slumber. The interesting thing about this was that he didn't bleed. The mounds and mounds of fat applied pressure to the torn sutures and open vessels. Lord knows what was now floating around in the kids blood stream but at least it wasn't a bloody mess.

Then it was time to pack up, monitors, ACLS drug pack, more R.N.'s and off to CT to figure out why this retarded kid had been acting retarded. You read me right. Head Ct time. One of the residents decided that this kid's behavior was unusual. His mother said he doesn't act this way at home when he gets hamburger helper intravenously. So naturally the first thing that comes to everyone's mind is: "Yeah, lets take this completely fucked up man/child down into the basement for a CT scan where he could hurt himself/or any number of staff members on the trip down to see if his brain is bleeding. There is no reason why his brain would be bleeding but he is screaming very loudly." Never mind the fact his former left knee looks like a raw, marinated porterhouse steak. That's secondary to whatever else they can bill somebody for.
I mean, there's no way the isolation, the drugs, the no mama to grossly over feed him, the missing limb and loss of ability to walk, the tube in his penis might have anything to do with his bizarre behavior. The resident thought it might be a brain bleed because he had fallen two weeks ago after surgery trying to get up at night. This is the same resident who was the first to bail when it came time to get Gigantor downstairs to CT.
I made him stay. I don't care if I'm a new grad or not. I don't care if he found it aggressive or pushy or rude. His little pager went off, the resident attempted a lame performance of having to run so I blocked his exit. I stood right in front of him and I said, "You ordered the CT. You will help us get him down to CT and make sure he doesn't get hurt on the way. You push from the head, I'll guide the front." And he obeyed. Easily, just like all doctor's do when you are assertive and don't apologize all over yourself like a fucking ninny.
Once we got him in front of the CT suite we couldn't fit him in because the bed didn't fit through the doors. Ultimately, this patient and the word "suite " should never be used in the same sentence. The effects were exhausting. (What's the deal with hospital's building doorways that beds and people can't fit through, is this just me or do you know what I'm talking about?) This kid was in the biggest Hill/ROM ortho giant bed they make, with big steel bars forming a rectangle on top, for a pull up triangle. We pushed, we pulled, we kicked. Couldn't get the fucker through the doorway. Looking back, I don't even know how we got the bed in the elevator. Tran, the CT tech got so pissed off he kicked on metal frame that was above the bed, above my 6"1 head as hard as he could, a beautiful crescent kick, reminiscent of something Bruce Lee may have done except that Tran was Vietnamese. The metal frame shot out of its damning socket and freed itself of the main bed frame. And in we went to take an expensive pointless picture.

Once we got the kid onto the table I went to the linen cabinet to get a new sheet and when I turned back around the resident had split but that was fine. Because there was no way this dude was going to stop beating off for the CT to work anyway with sedating him to a goddamn inch of his life and maybe then young Master Resident would understand the comedy of futile useless back breaking labor. Nurse Nepalese nailed the Big Kid with another round of Haldol. And if Nepalese Nurse played her cards right, and filled the incident report out properly, Young Master Resident might have to answer for the destruction of his Master's handiwork. (central line). Post Haldol blow dart, he stopped jacking off for like, 15 seconds. Just enough time for a brand new 64 slice Catholic CT scanner to do its thing.
We got the kid upstairs, two tiny female nurses, and me: appallingly out of shape male nurse (me) grunted gutterally ourselves, sweating, earning our bucks. What other job do you need to know the intricacies of the science behind the machine that works you to the bone and only get credit for this boggling dichotomy in your head? Sweet nursing.

It feels great to be back in the game everybody. I had a good, soulful time getting the kid to CT. To me it was funny and bizarre, and one of those situations where I'm just like, "what the fuck am I doing here at 3 A.M.?" Making money. Practicing my knowledge of how things work, inside and out. Applying past experiences of knowing how and what medically related people are thinking, mostly either 1) how my co-workers can avoid breaking their backs and 2)how patients can get a sense of how suddenly any sense of control has left their lives.
And looking forward to learning so much more.
I left at 7 in the AM, utterly exhausted, kind of pissed, kind of euphoric. Critical care nursing is going to be great once I figure out what the hell I'm doing.
Oh, babies, I am home.