Soft Shelled Soul

My life is good. My son (now almost 2!) is more like a little boy than a baby. He's my buddy. I often think about his innocence, and the sincere love of my wife for me and him during the drek of some of my more challenging, heart stopping, tedious, or humiliating shifts. I endure the ebbs and flows of an often scary, dysfunctional career choice for them, and through my family, I get stronger when the tide ebbs and flows.

Nursing is fucked. At least in the beginning. New nurses in my unit are treated like sub humans. Everything we say or do is mocked and considered stupid. And in all honesty, a lot of the things that we new nurses do is pretty darn mockable and stupid. But more often than not our treatment is excessive and has no purpose other than to amuse bitter, older nurses who feel resentfull that the profession has moved ahead and sky's the limit. It is no longer a career choice for those who seem to have chronic, deep self esteem issues and hide behind "a calling".  I hear abot the chaos of their personal lives: divorce, or other wise never married, twelve cats, vacation money spent on taking the dog to the vet.. Nurses are smart people, not particularly intellectual, observing some rigid hierarchy that takes at least 5 years to climb on and carve a niche of protection for oneself. I don't get to work with the other 12 new grads they hired into the ICU. It seems I am on the opposite weekend schedule as almost all of  them. I work except for two or three almost exclusively with senior nurses. I've spent a lot of time wondering if I am still paying dues, or if I  am the young being eaten (frustrating at 32-ooh they hate that. Second career er's).  Perhaps they are just foul tempered in general-and this seems to be the case. But an especially vicious, degrading venom is saved for new comers to the field. I would take this venom with no complaint if it came with information on how to do my job better but the majority of the time I am sighed at, snapped at, loudly gossiped about, IGNORED COMPLETELY I am not privy on how to do my job better. The worst part is that all of the experienced nurses do the same task differently and if they do bless you with advice, solicited or not and you choose to not take it, shit-you're fucked and MAN they resent that.

I have come to find that the constant stream of disrespect is not about me personally, though often the intent is to make it personal, only to make the sting worse. But I work with a group of people who have been together, most for at least five years some as much as 30 and have come to see new hires as management's way of reminding them that there is cheaper, happier, labor out there. To make matters worse, they are forced to "baby sit" us, to teach us, to guide us. They don't want to. Unless precepting they don't get paid any more for it. They are coiled snakes, Iam the urban backpacker, blindly smiling at the scenery, carousing through the grass after dipping my feet in the pool at the bottom of a waterfall when OWWW! I stepped on a snake. 

I got my first 1 to 1 patient assignment two nights ago. She was my patient again last night.

During shift assignment I asked if I could have the admit, I told them ,"I need the experience, with paperwork and otherwise." I'm tired of my admits being confusing disastrous affairs. Endless paperwork I never see unless I'm admitting, trying to still balance my other patient. I am here to learn. Practice. I was not cavalier or loud. I stated a plain fact as none of them showing any pretense of liking me, a reasonable request. They got a hearty laugh out of that.  The oldest one, Rhonda, shook her head and said, "You'll never want an admit again." More evil laughing. Fuck them. I'm here to learn. I practice the number one rule, applicably to any situation in career, love, life: Do you job well, be the best, no as much as possible- and then you have a foundation.

My admit was a direct admit t from the OR, preceded from a frantic call by the OR nurse, with little to no information other than, "I don't know what's taking them so long to close her up." I asked how much blood had been lost. "They said only 300cc's but I counted 20 completely soaked towels." The patient's arrival was preceded by the general/trauma surgeon covered in sweat, writing orders. Telling me to anticipate an anxious family. This struck me as odd because the surgeon doesn't normally bring the family talk to the ICU.  "Just get the FFP in her as fast as possible, use whatever vent settings keeps her alive. She's not a full code, no compressions or defib. Other stuff. In the paperwork somewhere."  Then he split. RT got ready with a vent. The only other white male nurse on my schedule, Roger (sorry p/c world but you notice these things when you are a minority) with just over three years experience, one foot inside the circle the other foot still dangling out did his best to prep me for battle. "I'll do compressions, you just get drugs." 

He more or less gave me a pep talk which was nice. The patients arrival reminded me of a trauma arrival in the E.R. Everybody happily pumped at first, then within five minutes everyone is sick of waiting, all jokes had been told, just ready to get to work. 

My dyke supervisor hadn't shown her close cropped head yet during the shift, which was unusual. I thanked god. She is a barrage of insults, veiled threats, dirty looks, intentionally confusing verbal directions. She adds the cluster to the fuck. Gross. She just makes life miserable and nasty.

My admit was a bowel resection gone on too long, patient too old (past 75 years) to be so morbidly obese at 155kg+, her  hernia not dealt 

with for like 40 years. AMS for 5 days, apparently her bowels had been recieving no blood flow for this long-her hernia cut off blood supply. 1500/cc's of dark brown fecal matter suctioned from her NG tube prior to surgery.  50% of her gut had to be removed. She had no neuro reflexes. Levo at an outstanding 20mcg/min to start.  5 liters LR already in. She came to me with a A-line BP of 75/30. HR good. Order for 4 units of FFP waiting.  

I hooked up the A-line to the monitor while Roger got the bed situated, RT started hooking up. The OR nurse looked freaked but I ignored her. She looked to rattled to even figure out how to disconnect the portable monitor. She's always jittery so I tried to pay it no attention. The anesthesiologist starting apologizing to me for the

 chaos and the fact that the patients right IJ line  wasn't sutured in place and then I got a little freaked. Looking back, I realize- the OR nurse and the anesthesiologist  were trying to give me an updated report from the phone, also going over info I already know-but they didn't really help get her on our monitor or set her up. They both asked, "any questions?" at the same time. How do I know? I'm trying to get the patient at least hooked up- the levo was so high that her extremities were mottled, we couldn't even get a pulse ox reading. Any questions? Yeah. One. What the fuck? What about that category status?

Then walks in the supervisor. Fucking EVERYTHING up. Barking orders, pouring on the confusion. Asking for the patient's property sheet. It was so frustrating. I was 50% set up. Getting ready to take  a step back and evaluate the patient. Roger had got a little ahead of himself and had put the IV pole on the left side, even though I had told him the IV lines were on the right IJ. I had already set the room up. As the patient came in I didn't notice Roger moving the pole. By the time I did the supervisor had already started her fucking harassment. "The R.N. formerly Known as Angry Male Nurse, why did you put the pole on the left side?" First off, in this stress full situation, why ask me why? Do we really have time to explain? I continued to set up the A-line, I wanted to say, "Roger did it" so she'd get off my back but then I would be ratting Roger out, who while not being the most impressive or experienced nurse around is the only one offering help. So I say, "I didn't move it over there. " Roger finally mans up and says, "I did, I didn't see the line." Supervisor's tone TOTALLY CHANGES.  

"Oh, yeah too many people to see. No problem. Well lets move it back over." WHAT THE FUCK?

Then she barks her first direct command at me, "T.R.N.F.K.A.A.M.N. (me) start your assessment we'll move the pole." Fine except 1) my physical assessment doesn't mean shit if I don't know if the patient is alive or not and I'm 20 seconds from having the A-line running 2) Dr. Drugs didn't suture in the Right I.J. and Roger is  so fucking scared of the supervisor he's literally YANKING OUT THE LINE. I pull the lines with my right hand to get some slack and I compress the IJ insertion sight with my left. In my head I was thinking - I should explain what I'm doing to the supervisor- but then another part of my head said- isn't it abundantly obvious what I'm doing, focus on keeping the line in, yell at Roger to stop moving- I yell at Roger, "Line!' and my supervisor, I swear to god tries to pipe in "NE!" Like she's got it under control. She tells me to get out of the way again but Roger is too far away to give slack. I don't say anything. I'm literally stretched out over the bed, one hand on the jugular one hand holding the line."

She literally screams, "Fine! You don't want my help than do this yourself!"

She storms out of the room, no doubt to run from module to module telling any nurses with 10+ years how horrible I am. That's how I know how irritable she is. The more annoyed she is the less years of exeprience it takes her to slander me. I 've had her at the 5+ years before. That's not paranoia, people. Some of the ancillary staff, R.T.'s, the one tech we have until midnight, have told me verbatim the bullshit she tells people about me. I can never win.

Roger brings the line around. 

"Man she makes things difficult", I say.

"She can be a bit of a drama queen," Roger replies. But drama queen doesn't cut it. First off, she looks like an old dude. She has the worst case of penis envy ever had, I know she's wearing a fake dick.  She slanders, she lies. She cannot have a single interaction with me without making a joke at my expense, rolling her eyes, glaring at me, cutting me off.  She's thinking "How come this weird, wrongly confident guy gets to have a dick and I DON'T? I wish I could sit down with her and say," It's just a dick, boss. It's what's on the inside that counts." In her head she thinks life is easier for me because I'm a guy. A white guy. Just like the ones that treated her  former Iowan redneck ass  like total shit. I can totally picture her figuring out around the twelfth grade that the reason why no guy ever asked her to prom is because she's freakishly boyish, likes to kick football player's ass, and finds the smell of vagina somehow alluring...vowing to hate. Her last ditch attempt at femininity was to become a nurse but she quickly realized that for those with the right moves it was a way to burn to memory her unspoken desires. To this day she lives alone, childless, doesn't have an old lady, loves the 49'ers. So I suffer.

But this time, like many other times, I have my patient to retreat into, to focus on, to nurse.  I get working. It's Roger and me for about an hour and a half. He's grabbing the UA, pulls an ABG for me, relays some lab values, he grabs the four packs of FFP for me. We double check them off together. Team work until 11:00 p.m. when the supervisor comes back into the module. I see her walk in. I hear the older nurses laughing. I hear one of them say, "He'll never want another admit again." Then Roger is gone. Sadly, for the next two shifts he cops an attitude with me. Just like that. I know what happened. The supervisor made it clear. Him or me. Roger has a family, too.  Supervisor leaves and the charge nurse says, "They should of just let her go." It's a fucking hernia you jaded psychopath! Being old doesn't mean you should die. The charge nurse is like 65 years old herself. What the fuck happened to these nurses to make them hate so goddamn hard?

As they are laughing at my fading vital signs 65/30, still no fucking O2 sat because she has no peripheral blood flow. I ask the RT to get one that adheres to the head. "Nope. Can't do it. We are only supposed to use those as a last resort in the case that we can't get a pulse ox reading from the hand and we've tried repeatedly."

"I can't get a pulse ox reading and I've tried repeatedly,". I'm getting the vibe she's been Supervised if you know what I'm saying. The intern walks in. "Still no pulse ox? Can you get one of those ones that goes around the head?" The RT sighs and says, "I'm really busy, but I 'll see what I can do." Like it's a personal goddamn favor or something. You'd think the Respiratory Therapist would want to know the saturation of the patient she's setting the ventilator to minute by minute but hey, an ABG once every 4 hours is good enough I guess.

She comes back with the head band. "TRNFKAAMN, this is it. Alright. I did you a big favor here."

Is she going against the will of the Supervisor, does she have a limited stash? Or was she just to lazy to go get one? No doubt she's busy, we all are but fuck, we need a goddamn pulse ox reading. Either way, I thank her profusely, I act as if a great personal favor has been performed.

Intern wants a C.V.P. Got to set that up. Haven't set up an A-line and CVP simultaneously from scratch before. It takes me about 10 minutes longer than it should have. I see  the Supervisor an

the old Burnouts watching the monitors from outside. "Wait-there it goes, nope!HA-Ha!" It is sport. I plug it in wrong like 5 times but eventually I realized I had the CVP in the right ports, I just needed to zero the monitor out before it would start reading. Low and behold- got 'em both. Now that knowledge is mine. CVP=5. That's low. The written order is to continue bolusing until CVP is above 15. We gots along way to go.

My patient B.P. sank then rose as we brought the levophed up to 40mcg/min. The resident walks in. He sees the patient start to move her right arm. The k-hole (ketamine) Dr. Drugs had put the patient in to paralyze her is starting to wear off. I'm relieved. She's got neuro reflexes slowly coming back. So what's the first order form the rez? Fentanyl and Versed. Fucking drip. I literally said, "My BP!" The rez went on some diatribe about how much pain she must be in, I was thinking yeah, but think about how much pain she WON'T have when she's dead. He insists. An hour later, with the smallest rate of Fentanyl and Versed possible, she takes a dive like a bomb over London in 42'. which also happens to be her systolic blood pressure again. 

And then my friends, the light shone upon me. The gift of experience, the undeniable truth of going-thu-it came to visit me that eve, and left me as excited as a waking seven year old who has left  a molar underneath the pillow. The intern and I concluded: She's not dying tonight. We went to town. Dobutamine. Max it the fuck out, to start. Pound a bolus down. Family comes in. Intern and I tag team to stay functioning. I listen to their fears, he gives them the surgical realities. Intern manages to sink a one and a million shot at 4 am with a new triple lumen in right groin. Now I got accesss baby. 2 bags of albumin down the hatch. Next up: Fuck it 25% Albumin.As I'm running by  Charge Nurse says, "You asked for it." I tell her do you hear one iota of complaint from my mouth. "No. Nope," she says. Good. Shut the fuck up.No one would help me if I asked. Certainly no one offers. Snickers and asshole comments as I run. I'm sprinting to other modules to grab pumps, bags of saline since I had used all of ours. At 4:30Am the intern says, "This is a lot of work for you isn't it?" 

"Yeah,"I replied, "But great experience". CHECK THIS OUT: ALL THE WHILE I'M STILL TAKING CARE OF MY OTHER FUCKING VENTED PATIENT.

Fortunately he was over sedated by the day shift nurse who is approaching an increased age and mentation  where I wonder if she knows where she is during work, I can't believe she's a nurse in the I.C.U. let alone taking care of people. She means well and is generally nice. Fuck it- that counts. I know the reason why the sedation was up so high because 1) she can't figure out how to operate the ancient "computerized" pumps and 2) she had the observationist tech do it (SEE:LAST ENTRY-dude got me $4K back on my federal tax returns)  I pull back on his sedation, tighten his celestial reins and it buys me time. He doesn't have too many meds, he's certainly not shitting after the opiate load he got today, I just duck in and reposition him q2 hours. 

Supervisor tells me I have to take lunch.  My turd of a charge nurse takes over which means she parks her fat ass in front of the monitor and calls the other modules to tell them how funny it is I'm running my ass off. "Yeah. One of the new ones."

While I'm having lunch one of the most vicious of the old guard strolls in on his third lunch break, his assignments are a fucking joke, a facetiously asks me how tonight is going. This fucker never asks me that. I tell him, "Going well. You?" He doesn't makes eye contact. 

Day break comes. I hear the morning traffic start to blare out from television in the conscious patients' room. At 5:30 AM my experienced co-workers were forced to take over my other patient. I had so many pumps and drips going that according to union rule, or maybe it's in the old testament, not sure which, my patient became a 1 to 1. But never missing the opportunity to insult and degrade I hear my supervisor tell the day shift  supervisor, "Well, she's a soft 1 to 1."

Her tone insinuating, we have to, but we don't want to. Listen friends: I know it, you know it, she didn't want to give me credit, her insult was an admission of truth, there was no sarcasm to decipher no questions without self incriminating answers to stumble through: her dislike of me was a gift of credit. For if she had said "Wow this patient was a fuckin train wreck and you need some good staff on this one"-well that would have done me justice. That would have put my rank higher and I honestly would have thought that she was goofing on me. Her answer was a begrudging admittance of truth: a soft one to one, for a soft new nurse whose shell hasn't hardened yet from years of overwork, abuse from superiors, no breaks, distended bladder so-called friends hating/loving you from  one minute from the next. A soft 1 to to 1.

The patient was mine again the next night. During the day the Attending M.D. had come in, broke some rules and stabilized her with techniques unavailable to the night shift. I can't elaborate but he did what Attendings usually do and ignore patient wishes in the place of his ego's demand. No matter. She didn't die that night either. 

Three people, it's true! No less than three people told me I did a great job of keeping that lady alive.  Somebody noticed. And even though the Supervisor apparently heard that one of the people who had told me I was doing well was too valuable to her to have a compliment like that stand. Even though he too stopped mysteriously talking to me 3 hours after his compliment, the compliment had been spoken, like a wish thought out during a birthday, or a coin thrown in a fountain, or victory in snapping the majorous side of a wishbone. 

     The RN that complimented me, Chuck, normally works float during the day but was filling in as house supervisor for the vacationing real one. People generally thought it funny that Chuck was House Supe as he normally just does lunch  breaks. I needed a compressor for leg squeezers and two of the senior nurses told me to call him to bring one up. My supervisor found out and did her fake drop the jaw thing, parade around the base desk, smacking her fore head, accused me of violating the chain of command by calling the house supe who happened Chuck that night. I detected a faint smile underneath her rant. Happy, he fucked up. Of course the older nurses who told me to do it didn't speak up. When Chuck delivered the compressor he said he was glad he could help out  but in the morning when I thanked him again for the compressor he just said "whatever", scowled, and literally turned around and walked away.This is my Supervisor's way. I have experienced this with other older nurses as well when they turn someone against you. "I can't believe he did that to you, who does he think he is?" The person who previously wasn't aware thatthey had been insulted now feels SUPREMELY insulted.)

The vicory was still mine. And while I do not believe I could ever function in this high acquity without the support of my co-workers, it's too exhausting and inevitably a fuck up will slip that will put yur career's fate in the hand of the Supervisor on duty, well that's it.  However, tonight I got one step closer to independence and got just a little bit closer to not being at the whim of those who are so "experienced" as they recipricate the abuse they no doubt at some point endured or continue to endure.

I never was a bully in school. I moved a lot as a kid, some years I was popular, other years I was shit. But I never broke down an teased others to make myself look better. Now, I talked shit about every more popular, better off, better looking kid under the sun to my friends out of jealousy but this was out of general disgust of human behavior and a deeply disturbing underlying antisocial outlook on circumstances at the time but I never attacked the vulnerable. It's not in me. It wasn't then, isn't now, never shall be. 

The only thing is, is it obvious? or hidden like I like to tell myself that it is. Wanting to consume the biggers power, experience, knoweldge, standing.

I think of what the only new hire with experience in the group said to me as a friend during orientation, "I may have been a nurse for only six months but these bitches are going to hate you forever, for life. You do just the right things to piss off the older nurses.  They hate you because you are right and that's why you don't realize you are doing it."

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.

The Hard Way Pt. 2

Taking me a while to update my posts. Apologies. The learning curve is keeping me busy. Collecting excellent stories to share. Give me more time...

Me:“That’s right. I did nothing all day. I fake added up my I/O’s. These numbers you see here, they’re fake.” I was adding up the last hour of I/O’s after report had been given to night shift. They come on at 1830, I leave at 1900, that leaves a half hour gap for me to take care of.

Preceptor: “Ha. Ha. Okay I see. Because if you hadn’t added up your I/O’s I would be VERY angry at you.”

Friends, my nerve got hit. Hard. I'm learning. I make mistakes. I make a lot of mistakes. Dumb ones. I don't profess not to. BUt I'm here to learn, not get verbally or brow beaten. Unlike some nurses, I throw back verbal punches. Maybe bad for the career in the long run, but my fists land. And they leave marks. And sometimes they land hard enough where I don't have to go home hating myself.

Me: “I DON’T GIVE A SHIT if you get mad or not. If I had neglected to add my numbers up until the last minute then I would be disappointed in myself for not using my time properly which, apparently you haven’t noticed, I did.”

Preceptor: (Not really sure that he had just got told off): “Uh…ha-ha.”

Sorry friends. Preceptors can be jerks, micromanage, hell they can even be disrespectful. But getting angry over not adding up I/O’s as a threat of some sort, sorry. Needed to put him back into line. The blowback? I’m sure he told anybody who would listen how terrible I am but I’m not really too worried about it. For the last few days other nurses have been coming up to me and saying, “How’s M------ abuse treating you today?”

Repercussion for my words? I don’t know. I don’t care. His preceptor, 3 years ago, was a notoriously abusive bitch, it’s too bad he hasn’t figured out he doesn’t need to act that way anymore. My preceptor is a good ICU nurse. Obsessive, detail oriented, gives a shit about the patients. He is somebody I have learned a lot from, and he has helped be focus on areas where I need work. Certainly I can be a stubborn fucking mule. Dangerous qualities as a new grad in the ICU. I am aware. But I don’t believe in fear based nursing. I see how my preceptor is afraid of management. He doesn’t understand that kissing their ass has brought him no respect, just more responsibilities that he doesn’t get paid for taking on. The ICU day shift supervisor told my preceptor to “drill instruct me” and have me ready to be solo in 2 months. Well, I’m ready to be solo. Scared shitless about it but ready. But I aint in the military. Call it pride, ego, vanity, stupidity, whatever. I got boundaries and they will not be crossed, as a matter of self preservation. So much disrespect and dehumanization burned me out as an E.M.T. the first time around. I’m not going to let it happen again.
As my best friend, who is a S.I.C.U. nurse told me, “Dude, just make it off probation.”

Has to be on my terms. This is why I write about my one confrontation as a new grad. Because it has to be done to change nursing. I write to remind myself and other nurses that being disrespected, patronized, condescended to, yelled at, or humiliated in any way is unacceptable by any medical personnel. That HORIZONTAL VIOLENCE is behavior that is truly unbecoming of a nurse. Not having a fucking opinion that differs from the general consensus should not be the impetus for school yard behavior.

The Hard Way Pt. 1

This is a long ass post, my apologies. I know shorter posts are easier and more fun to read. But I don't have much time these days, so I crank it out when I can. I seperated it into two parts so you can take a break, go to the bathroom, make some pop-corn, grab a beer, make love to your signifigant other, WHATEVER YOU NEED TO DO, so you can read the whole thing. Tally Ho!


Hard thing, to be a new graduate in an I.C.U. Trying to acclimate to steady stream of new information, theories, styles of practices, sometimes mellow- sometimes brutal clash of personality. It’s a hard thing. I’ve grown a lot these last few months. It’s been a wholly healthy experience, trusting a hospital unit to mold me into a functional nurse that can be trusted to take care of a very sick human being. So many defenses pop into my head when I trust my unit. I work for a corporation, it’s image or brand is that of Catholicism. I am precepted by various instructors, of all nationalities, sexual preferences, mentalities, experiences, I am open to their criticism, their warnings that something I may be doing is not working or will lead to more trouble down the road. I am even open to the ever stinging and painful attitude adjustment. I put trust into my I.C.U. that it’s interests are getting me up and running, not degrading my worth as a nurse and person.

I don’t know why nurses feel it is so important to remind newer nurses that they are new. I know only a tiny fraction of the over all incredible tidal wave of information required to run an I.C.U. I mean, I know this. This realization occurred to me my first week: In my career I will never learn every condition and procedure in great depth of detail enough to be masterful in all workings in the unit. This truth was stunning and provoked fear in me. That in itself as humbling as hell. More experienced nurses, however, are so threatened by the fleeting moment of recognition that every new grad has, when training comes together, when that smile comes on our face, “Hey, I learned this. I know this. I know why it happened, I have enough background knowledge and theory to manipulate this situation to favorable outcome because I’ve seen the outcome of this situation before.”

My preceptor with 3 years experience says to me, “Yeah, well, I think you just got lucky here.”


Then I go into my patient’s room and the noise by the charge’s desk drops. It gets eerily quiet. Cuz they are talking shit. That is the attitude adjustment. Not that I have done anything wrong but the attitude adjustment lies in the fact that the words that come out of my mouth reverberate around the unit and can leave a favorable or unfavorable impact, depending on the disposition of the nurse gossiping. I can control some of this, I must retain the attitude that I know so little and am awed by the skills of those more experienced. Sadly, my true feelings are threatening and infuriating to the more experienced. By claiming some victory over a situation I have hit a nerve with any nurse with more than 3 years of experience. Some of my preceptors let me have opinions let me make the mistakes that change those opinions wisen me up while most are too insecure to let me do so. To the insecure nurses, my attitude has changed. For the sake of peace, and career longevity, I swallow it and oblige their weakness. My attitude has changed.

Well sometimes. Mostly, I’ve been good, kept my mouth shut. I know better than to point out the 5000 contradictions that preceptors have amongst each other. I did try to point this out one time out to a preceptor that while I had no problem doing the task they asked of me or the way they asked me to do it, my previous preceptor the night before felt just as strongly about doing it completely different. That never chills ‘em out though. They just feel more threatened and insecure. Secure preceptors don’t give a shit about minute differences. Insecure ones cannot fathom that one single task can be done safely and appropriately 20 different ways. Especially when it comes to charting. That night’s preceptor kept saying, “But do you understand why I do it this way?” I was like- fuck, I understand you rationale is perfectly understandable but DO YOU UNDERSTAND THAT IT CAN BE DONE THIS WAY?
Preceptor: “What’s this?! You haven’t tallied up any of your I/O’s? You’ve already gave report. You’re behind.”

The following is my response after 2 months of my 27 year old preceptor acting like a cocky ass, making nothing but negative comments, criticizing my questions as repeats and therefore-stupid, not making any attempt to communicate, looking only for inane mistakes in my paperwork ( I put the MD’s name after the telephone order as opposed to putting the MD’s name UNDERNEATH the telephone order), all around being pretty worthless. Acting as if my dumb mistakes are somehow a reminder of my total failure as a new nurse. Each “Tssk" and deep sigh pushing me closer to the edge. Each day he’s got closer and closer to being out of line.

END OF PART ONE. YOU GOT 5 MINUTES. HURRY UP. OTHERWISE I'LL START WITHOUT YOU.

Cold Cold Ground

I could write for days. Days, I tell you! Funny stories, aggravating instances, tales of monotony and terror, personal reflection and the ultimate sad but true truth. Highlights like a hot lady with dark hair and that kind of naughty, kind of cute, light brown streak, the highlight, running across the lateral side of her head. Lateral. Hot chicks with high lights. New grad dude nurse feels overwhelmed for 12 hours can't seem to get it right. When is this shit gonna get easier?
Still love the ICU. I'm happy and grateful to be there. My supervisor wants me to be more humble and ask questions more nicely. Reasonable request. Cuz don't forget, experienced nurses can shit all over you but the second you bite back they're moved to tears and outrage and cookies and WILL NOT BE SPOKEN TO LIKE THAT BY A NEW GRADUATE. Sorry. Just don't make up hospital protocol (if a doc writes an order for ANY drug you as nurse have the autonomy, the discretion, to give the dosage you see fit as long as it doesn't exceed the order) and get pissed when I point out that legally, that's asking to get sued. If a doc writes an order for 3mg morphine and you think it might kill your patient, call the bastard up and get a new order for 1mg of morphine, even better, have it written as a sliding scale PRN. That's legit. That's communicating with a doc who probably appreciates the foresight. Now, who wants to be the motherfucker to call at 0300 for that bullshit? Not me. That's when you give a nursing dose. But regardless, we may give the drugs, but we don't write the fucking orders. And don't male up rules on how "it really works". I didn't call you sloppy. I don't even care. I just don't roll that way. So now all 30+ ICU nurses know of my argument and have taken away about 20% of the warmth they initially extended to me. Ahhh, good looks can only get you so far when you come across as an arrogant dickhead.

I keep telling them, the experienced ones, till I'm blue in the face, "I understand your rationale, you don't want to overdose your patient but you need to get a new order if you are going to change the dosage and a sliding scale or dosage parameters have not been set." Not that abrasive right? Opinionated, fuck yeah. But I'm not like, " ALL NURSES OLDER THAN 35 WITH MORE THAN 5 YEARS OF EXPERIENCE SUCK AND ARE STUPID COMPARED TO MY NURSING SCHOOL ASS. I WAS CLASS PRESIDENT BITCHES, AND DON'T FORGET IT." My god, I politely didn't agree with your practice and had, what I stupidly thought, was a healthy argument.

And with that, my friends, I earned the label "Cocky". It is pretty ridiculous, I mean I'm a new grad, a student with a license, telling them how to do something they've been doing for 10, 15, 25 years. It IS outrageous. What can I do? I'm gracious when they share knowledge with me, my questions come across as a challenge and that's my bad- they aren't challenges-I thoroughly enjoy debates and spirited arguments, I love tumultuous, vigorous conversation. I do not raise my voice, I do not call names, I preface my statements with, "I don't mean any disrespect" or "I'm confused about this order do you have a second to explain it to me?" Even, "What do you think if I was to do it this way?"
And then I argue until I understand what they are saying. That's just me. A stubborn weirdo who respects the people who can thoroughly explain their rationale before I implement it into my own practice, so I know why I'm doing what I'm doing, rather than just doing it. My preceptor tells me I don't ask enough questions. God, I must be a prick.
In nursing, its just not okay to debate. Nurses are fragile with their truly impressive knowledge. I'm not being sarcastic. I love nursing knowledge. But all it takes is some first year intern to tell them they are wrong and toss out what the nurse considered to be a rule of biblical proportions (give Desmopressin to a polyuric pisser who basically has no electrolytes and is in DI). Intern says no, "Lets keep supplementing with IV electrolytes." Resident backs it up. Attending likes the way it sounds. They all read some study on desmopressin that R.N.'s don't even have access to. She's pissed and humiliated.

Nurse: your knowledge is hereby rendered dated and you just lost a little more of your repetoire.
I guess I realized this week that new grads aren't allowed to bring new nursing science to the table. It's seen as insanely arrogant and mildly suicidal.
Kind of sucks. I wouldn't argue with experienced nurses unless I respected them. But I don't think too many of them respect themselves so they don't really get that.
My ICU preceptor and subsequent staff are aware of my argumentative hard headed nature. I tried to hide it. But its been 90 days, I'm still on precepting. I still make stooopid mistakes. I forget to sign off the morphine I gave two hours ago, again. I feel stupid. I forget to transcribe the lab results onto the flow sheet because I've got the hard copy in my hand and I've already shown the critical values to the resident. My preceptors says, "You know, I'm tired of babying you with these lab results, you need to record these on the flow sheet as soon as you get them and intepret them."
I ask, "Even before I notify the doc that my patients K+ is 2.5? He says, "Yeah".
I don't argue. And I make mistakes. Some preceptors are cool. Some are hard asses. Can't say for sure I 'm making the grade. I think I am. I mean, I ask for the heaviest patients the ICU has, I make 5 million little mistakes throughout the day but I always leave on time. I just woulda thought that if a new grad, a preceptee, asks for the heavy patients then the powers that be, that general hum that runs through a unit, like a positive ion gossip charge pulsating through a rumor bed, I thought they would have cut me a teeny bit o' slack. Guess not. I asked. I received. duh.
Yep, there is a lot I could write.
But I'm tired and tomorrow I have to be able to tell my preceptor where an MI is likely to occur in someone with right coronary artery failure. Inferior, posterior left ventricle, I think. Got me. They're not gonna let me get near a heart patient for like, 15 years anyway. And understandably so.

Cloud Nine

I AM OVERJOYED!!

CYNICISM, BITTERNESS FADE AWAY.


THE 8 YEAR PRISON TERM IS OVER.


FREEDOM BREAKS THROUGH LIKE CRACKS OF LIGHT IN A CRUMBLING BRICK WALL BUILT ON THE BACKS OF THE WORKING CLASS SLOGGING THROUGH LURKING POVERTY.

Appetite for Deconstruction

Better than your brightest lights
Because they still can’t penetrate the darkness
Of the heart with their song of
The ballad of the buried woman

Dazed and confused up for nights
Soaring in fingertip reminiscence
Of larger bore needles bored to tears
Once again, you can't imagine the depths

Every night, every shift
We wade through people who feel like human debris
Rendered bed-ridden by too much grease, not enough time
And hard earned paychecks that as slim as their chances
Of getting out of here alive, this time anyway.

You know me, and I know you
We both know we are better than that
But empathy is in short supply for the perceived
The poorly recepted. The gravely misunderstood patient

Whose bad judgment has left her on my unit
Confined to a giant bed, that rotates her adipose years
From side to side, to keep her skin from obliterating
And showing us that the color of her soul is a milky yellow

She wears a mask during sleep that I would have thought cool as a child
But it only prolongs her suffocation, from yearly daily routines
That provided sustenance, but coated her vasculature a bulbous insulation
And now this mass, my patient, this woman, teeters on the brink
Of becoming an empty vessel that five of us can barely move

And she suffocates when sleeps on her right side
Her lungs squeeze themselves masochistically when we roll her on her right
I watch her face turn from turbid fleshy pink, to turpid red, to ending purple
She is a human so huge she can't live anymore

And she’s a dime a dozen. Well, at least that’s the deal she got every morning she told me with a smile on her face.
“In between litigation, and depositions I found time for Chinese. In between discovery and cross examination I had a two meatball grinders with a chicken on the side. And during bathroom breaks during trials I ate boxes of krispy kreme donuts and chased it down with 1/2 gallon of chocolate milk. I don’t think I’ve gone without a soda during my waking hours since I was a 15 year old fat girl. I drank diet coke for twenty years, but that’s like switching form Marlboro Reds to lights, really what does it matter?
But I never did drugs, never smoked, never had sex. I stayed disciplined, dedicated, I listened so well. I am an excellent attorney. I just can’t breathe anymore.” Her Trio cell phone rings. She answers it. I see the custom made three piece suit still on the chair in her room. I see the diamond studded feminine Rolex awaiting security to come and lock it up. Her engorged fingers have many rings with precious bright stones, some colored the same as the incredible amount of fluid I will see leave her cracked open chest later on that night. Like a fortune cookie. What did the fortune say? It said:

“We are all here. We are all here.”

I think dignity and control are fleeting in any situation.

But I have paperwork to learn how to do properly. Blood to draw, progress notes to read, sugar to check, insulin to give. IV’s to titrate, dressings to change, wounds to pack, pictures of wounds to take, charting to chart, labs to ponder, family to let in, sheets to change, a body to clean. And these are the “eassy” patients. The painfully ironic “lighter load” patients. I have to explain that we can breathe for you but the bacteria that traveled from your vagina to your kidneys to your intra stellar galaxy will get you first and I must remark that I never seen anybody with such a rapidly dropping BP answer so many seemingly important phone calls. Never has sepsis had such a soft punch.
Later on, something popped in that chest, and the megalomaniac brilliant cocksucker cardiothoracic degenerate surgeon did surgery in her temporary office, the air support bed. And just before she became a live dissection a passerby would have heard one of us say from her room:

“So you want to know the life of a mind?”