Monday, February 16, 2009

Electrified and Numb

Occasionally, my coworkers are serpent-esque. Dealing with them is as challenging as handling this intubated snake.

I’ve been busy. Bizzzee. Dizzy. Running around. Puttin’ out fires. Starting fires. Paying my dues. Because in nursing you think you pay your dues in nursing school but this most certainly isn’t true. You pay your entrance to the show dues in nursing school so you can pay your real membership dues, dues to the V.I.P. lounge once the fun begins. And then you pay your dues for at least the first three years of being on the job in all sorts of painful, alienating ways. Cuz every step you take, every move you make, some bitter nurse with more years of experience then you is there to tell you how completely stupid you are to do what you did. I can’t help but identify with Shaolin Kung Fu monks or Jedi Knights. When it gets bad or heavy, I think of Luke Skywalker as a R.N. being reamed becuase he didn't turn off the occlusion alarm fast enough for the older, more irritable Jedi's who perpetually have Jedi migraines from using the force all the time. Someone is always more experienced than you and not nice about it. Even your good moves show weakness.
“Didn’t you do this with your preceptor?” My first admit from the E.R.
Yeah. In September. But my preceptor didn’t really let me do it because she thought I wasn’t up to it, i.e. it’s such a tedious mindless procedure with pages of redundant paperwork that my preceptor didn’t even want to bother. And none of my 10 preceptors ever did. I was going to do an admit last week but the charge nurse said loudly, “He’s new. Brand new. No way.” Except I’m not brand new. I’m off orientation for about a month. I’m past brand new. Perhaps you could call my current stage: I’m really new but still held accountable for everything goddamn thing that happens regardless phase.
Last week the charge nurse thought I was too new to admit a patient. This weeks charge nurse feels I’m not so new to admit a patient, who happens to be the fucking E.R. doc’s father V.I.P. patient, so I’m pretty much shit out of luck. So yeah, I did it with my preceptor but I didn’t do it. Impossible to explain to the current charge nurse without sounding like I’m throwing out excuses. So I asked for a quick rundown of the necessary admitting paperwork. She makes a face like I asked her if we could try and resuscitate Adolfe Hitler. Her face says: How stupid!

Two shifts ago I had a patient on a ventilator. He coughed so hard while I was repositioning him that he popped the oxygen tube right off the connection point at the ventilator. I couldn’t figure out how to get the thing back on because the respiratory therapist put a “tester hose” right in front of “the real hose” which didn't fit the oxygen tube. So my patient now has no oxygen source and I’m trying to connect a fake hose to a real one and it’s not working. And my patient, without an oxygen source is desaturating to the low 80’s. Meaning he's not breathing.
Uh-oh time. My supervisor, Murphy’s fucking Law, happens to be walking by as this is happening. My supervisor has already told me she thinks I’m “weird” and “will make life real hard” on me. I’m not sure if she despises me in particular, possibly just any other living human being. My supervisor smiles when they pronounce someone dead. She giggles during CPR. She admires the pain on a patients face when a NG tube is being placed. And she loves pussy. She huffs and curses at you under her breath when you don’t know the location of the bacteria that has gotten your patient into isolation.
“Why is your patient in isolation?” she asks everybody at the beginning of the shift, because you know, fifteen minutes into the shift R.N.’s have time to go through the chart in a leisurely manner and find out facts that are only useful to her. (funny because now I make time to find these facts out cuz I’m sick of her cursing me beneath her breath.)
“Because he has MRSA.”
“Where?” She asks impatiently.
“I don’t know.”
“Son of a mother huf gab dubda…”
And that face. Oh, that hateful frown. That look like You utter piece of shit, now I have to do my job. Personally, I don’t give a shit where my patient has MRSA. I’m wearing gloves, gown and a mask no matter what this mother fucker has. Who gives a shit if my patient has MRSA in the nares. I’m not going to be picking his nose anytime soon. I won’t be licking his nostrils for pleasure in the immediate future. What the fuck lady? What…the…fuck?
So the ventilator alarm is screaming. The monitor alarm is shitting itself. Hell is starting to break a little loose.
Enter: The know it all nursing assistant. He walks in and cops what I call the “observationist attitude.” And attitude, I must say, I have been guilty of plenty of times. The observationist attitude is where you are watching a stressful situation unfold and you feel free to predict the outcome of the situation before there could even possibly be an outcome. CNA’s are especially guilt of second guessing nurses. Nurses are especially guilty of second guessing doctors. Doctors are especially guilty of second guessing specialist MD’s. The observationist has several qualities that make him/her an observationist. They are:
1) The Observationist has no actual responsibility in the situation.
2) Feels comfortable enough to openly judge the performance of those around her/him, though he is “below” their position.
3) Thinks the solution is easy to fix, having never fixed it.
4) Everybody is stupid because the solution is easy to fix.
5) Resents the fact that she/he is making one fourth of what the stupid people around him are making because he knows how to fix the problem.
6) Is pissed cuz he knows if she/he keeps talking he will be told to shut the hell up.

So I gots this little situation on my hand. I got a mildly retarded CNA who I swear comes to work for the free coffee and to give out tax advice though he makes 10 bucks an hour. I have a positively hateful short haired, dyke supervisor (she prefers to be called a dyke) who openly hates my ass. I’ve got an explosively coughing intubated desaturating patient, and oh yeah, there is a volunteer in the room who looks up to the CNA for some unknown reason (I think she loves free coffee) and is adding to the clutter and general chaos in the room. Could things get worse? Of course they can silly! They can get absolutely fucking horrible.
Supervisor tells me to get the hell out of the way. She yells, “Start baggin’ him.” I concur. Except we can’t find a BVM. It’s buried somewhere behind the ventilator. The nursing assistant dives in front of me, in an effort to impress the supervisor, “I’ve got it.” But he doesn’t have it, because he is the observationist, and observationists have nothing. I ask him is there a BVM?
“No!” he says. I stupidly trust the CNA. As I’m sprinting out of the room to my other patients room to grab a BVM my supervisor shouts, it’s right here, it’s right here! The observationist is already back tracking, trying to explain in the middle of this situation why he couldn’t see the BVM. Nobody cares. He tries to hand the BVM off to the volunteer who is jumping up and down like the last kid picked for a kickball game. “Here! Me!” A fleeting thought runs through my mind, You are about to get showed up by two unlicensed coffee drinkers and THIS IS MY PATIENT! I am responsible for the outcome of this situation!

“BOTH OF YOU GET OUT OF THE WAY!” They scrambled out of the way. In fact the volunteer ran outside of the room and never came back. I haven’t seen her in the I.C.U. since. My supervisor looked at me for the briefest millisecond ever recorded in humanity with a look of like, Well maybe this guys not so bad cuz he just was really rude to these two lesser human beings. Supervisor hooks up the BVM to oxygen. Now I’m shouting where is the mask? The CNA, with his observationist ego badly wounded shouts back, “He doesn’t need one!” Damn. Duh. I was an E.M.T. in the ER waaay to long. The CNA, now with his mojo back, tries to tell me how to connect the E.T.T. tube onto the BVM but I’ve already done it realizing my mistake.

So this is the part of the story where the dues are paid. I start bagging the patient. Trying to get that O2 sat back up from 70’s land, where it’s been for about 10 seconds. I’m just thinking, Fuck it, I’m gonna fill this fucker full of O2. The sats start to rise. 82% 86%. I was pumping that bag like Arnold pumped iron. My supervisor barks, “He was on 12 respirations a minute, how fast are you bagging? You’re gonna fill him with air.” I start to argue, look I just want to get these numbers up but then I realize I’ve already fucked up enough today so I slow down. I slow down bagging. BUt each squeeze is hard, people. I make those 12 resps. a goddamn wind tunnel. And I shut up. The O2 will go up anyway, just slower. IN WALKS THE DYKE SUPERVISOR’S ARCH RIVAL: THE OTHER NURSE THERE WITH MORE THAN 25 YEARS EXPERIENCE: The charge nurse. SHE HAS COME TO COLLECT HER DUES FROM ME AS WELL.
“Why the hell are you bagging so slow, The R.N. Formerly Known As Angry Male Nurse?” Carol, the arch rival, bellows at me.
I start stuttering, I’m thinking cuz super dyke told me to but then I don’t want to have that fight right now, I just want everyone out of my fucking room, so I sidestep the confrontation and just say the sats are going up.
My supervisor decides to engage the bogey. “You don’t want a belly full of air do you?”
Carol switches to guns and fires her canon, “Who cares? Get the oxygen up.”
I manage to sputter out, “Oh look 90%, good, back in business. Where’s that RT?”
The arch rival’s stare each other down. Then they look at me. I’m standing there like, “Garsh, ladies.” Pretty fucking stupid. Afterwards they both took me aside to tell me that they were right and the other one was wrong. Supervisor says bag slowly (which is stupid) but she was actually nice about it because technically I took her side during the engagement-Arch Rival Carol says do whatever you have to do to get the O’s back up (right thing to do).
Hark, I am at everybodies mercy. And when the mistake is a blunder, whoa baby! Everybody has their two cents to put in.
2 minutes later everybody left my module to go talk shit about me. Everybody left. The supervisor left, Carol the arch rival left, the CNA left, fuck even the secretary we have once a week scrambled out of there. Paying my dues. No bizness like show bizness. When I finally got to lunch I attempted to retell the story but when I started recanting the tale, I noticed that everybody looked away and the fellow new grad I was telling the story to just looked down. Then I realized the CNA was sitting right next to him. Oops. I forgot. My story had already been told at least five different times in five different ways by people who couldn't wait to tell of the failure of this new R.N. What is he doing here if he can't even figure out how to reconnect the patient to the BVM? It takes years among people who feel bad about themselves to give their esteem and respect to others. It takes 6 seconds of confusion to get labeled a doofus for life. I'm glad my supervisor was confused, too. Otherwise, I probably would have been written up.
Turns out the hose that stumped me and my supervisor was a “tester” hose to check the quality of the connection. Why it was taped directly in front of the port connector I’ll never know, cuz the RT sure as fuck didn’t. But then again, RT’s don’t know much of fucking anything. (Sorry guys- I still can’t figure out what you guys do exactly. I guess wearing white lab coats has gone to your head. But I'm more or less an observationist to your skills.)
What a bonehead beginner mistake to make. And of course I received the obligatory lecture on always knowing where your BVM is from my supervisor. Which I deserved. The whole thing was my fuck up. Because I am new, and prone to stupid yet deadly mistakes, I have to pay my dues. Even the CNA’s get a piece. Fuck even the volunteer got a little slice of my pride.

I still love my job. I love getting better at it. I love knowing I will never make the same mistake again. I also like knowing that I am one of the few nurses who checks to make sure that the BVM is hanging inside of its bag and where exactly it is on the bed of every single one of my patients from here on out.
Right now I have to go. I’m meeting up with that Observationist CNA. He said he’d do my taxes for $50 bucks.

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