One good thing about Bush

One good thing about that fucking heartless criminal George Bush:


RECORD, and I mean RECORD voter turn out for a primary. After these last 8 miserable years, you bet your ass people are going to start voting again.


History will haunt Bush Co. like a fart in a car. A car with the windows rolled up and the heater on. It will linger way too long.

The Roughest Nursing School West of the Mississippi

The beat goes on. Or maybe I should say the beating goes on. Semester 4. Holy Moly! Glad to be here. Glad to be almost done.
This semester instructors did their usual show-of-force routine as previous instructors before them: not acknowledging the presence of any individual students, no smiles, no jokes. Eyeballing us secretly from the back of the room where they quietly congregated,looking at us, turning away and chatting, then looking back at us as if to say, "Look at that one there. What a chump. I'm gonna break him!" It had a real WWF wrestling vibe to it. I envisioned my 5'10,rather husky Nigerian born instructor, picking me up and spinning me above her head like apiece of pizza dough and then throwing me against a pile of chairs. After I hit the ground she bellows at me, "What labs should you check to see if you're okay after this traumatic injury? RBC's? No! Who cares how many red blood cells you have? BUN/Creatinine? I don't care about your kidneys. No! Check your CKMM, YAARGGH!"

The 4th semester chair had this to say, "I guarantee you by the end of this semester you will be burned out, so use your sick days wisely."

WTF!? Is that what nursing is about? A fucking marathon of busy work and a battle of wills? Maybe it is. What I can never separate, what I continually struggle to understand, is my instructors desire for us to be very competent novice nurses or are we reveling in their dark sticky bully side where they get off on fucking with us. I guess all this ball-breaking is for a good cause, and I, no doubt, will look back when after graduation and be thankful for the lessons I learned while still in school as a student as opposed to being on the floor with a license to defend...but at what cost? I can not BELIEVE how tired I was a month ago. It was scary. I was so tired, I didn't EVEN KNOW how tired I was.

I finally decompressed on the last week, the 4th week, of break. The first two weeks of vacation I was an anxious, irritable ball of nerves. The third week I slept, the fourth week I rejoiced.

Now I'm back in it with more soon to be fulfilled promises of extreme exhaustion and cramming. These fuckers even want us to come in on Saturdays to go to healthfairs and recruitment sessions (and I know like you know you can't recruit to a captive audience). Including clinical which is 17 hrs a week, I'm in class another 8 hrs over two days. Plus fucking 6 more for Saturdays. Isn't there some like nursing student sweatshop law? With all the massive write ups, projects, and arbitrarily graded care plans (fucking 3 our last semester- grand total of 9 throughout the program) and hellish exams I'm already in a straight jacket.

Whine, whine, whine. Fuck it, just get through it, I'm almost done. Keep on'. I'll do whatever it takes to have a job I feel truly passionate about and be able to adequately support my family. I should be so lucky.

Thanks for everyone's support with the previous post. It really helped.

Stacked and not so Angry anymore

Aaahh my people. My fellow nurses, healers, friends, nemesis's, those I adore and admire, those I can't stand.

One more semester to go. So much to tell. So many thoughts have furrowed my brow, like a crashing thunder storm on a hot summer afternoon, passing as quickly as it obscures the sun.

I got real depressed this semester. Every afternoon, around 1530, after school and on the way to pick my son up from day care. I felt so empty. Tired and empty. I have never felt depression like that before. It was like, physically painful in my gut. I felt no joy. And let me tell you, picking up your child, and feeling depressed, joyless, really makes one feel ashamed or guilty. It can be a very destructive cycle.

So AMN, what was bothering you? Why so blue?

The critically busy 7 days a week schedule, the lack of sleep, the monotony of obligatory rotations that have questionable value, the constant degradation and mind games at the hands of perpetually insecure instructors. Friends, I was bummed the fuck out.

You know what I realized? I'm not Angry Male Nurse anymore. I realized I had become:

THE MOST SHIT TIRED BURNED OUT NURSING STUDENT IN THE HISTORY OF FUCKING NURSING.

But I'm cool now. I rested. I contemplated my sadness. I contemplated my anger. I wandered the hallways of my mind, pondering the meaning of a nursing career, directions to take, units to work in, mistakes NOT to be made. My friends, I pondered!
My wife and baby (he's doing great by the way) are visiting family out of town. Last night was the first night that I had slept alone since June 26th. It was the first time I did not wake up two or three times during the night in a very long time. And I realized: "Dude, your depression was secondary to your incredible exhaustion. Who the fuck wouldn't be depressed?"
I think Everybody, I think I was just really really tired.


I'll keep this relatively short:
I was working in the ER a month ago as a Student Nurse Worker. Basically an overworked NA. Two Samoan- American kids came in from a popular local rave. Roller #1 was a small guy, about 20, shaved head. Roller #2, was a pretty buff young dude, maybe 19, looked like a rugby player. They were under arrest for possession. They were handcuffed to their gurneys. And they were ROLLING THEIR SAMOAN BALLZ OFF! Dilated pupils, chewing their jaws like they were made of gum, rubbing their heads on the pillows of the gurney in ecstasy. Looking back, they probably had just ingested several pills prior to arrest to avoid more prosecution. Probably a good thing they got arrested because, frankly, I have never met guys their age with such warm, open, and funny dispositions. Such vulnerability. (It was also abundantly clear that neither of these guys should be behind the wheel) Maybe it was the E. Proably it was the E. Maybe they were just nice dudes. They got cleared after my shift was over, I worry about what happened to them in County lockup. But ecstasy only lasts a couple of hours, so by the time they got cleared they were probably more hungover than anything and got their sense back. (VS stable, both had fevers probably related to pharmacodynamics, no immediate cardiac or respiratory distress- though they both were hypertensive and diaphoretic.)

The following is a rough transcript of the conversation that made my soul feel better:

Roller #1: Hey man. Where is your wife? Your baby?
(I don't know how he knew that I had a wife and baby)

AMN: Home.

Roller #1: But you are here.

AMN: That's right. I'm working.

Roller #2: You can do it. Man. Keep on with yourself.

AMN: Gotta pay the bills. I'll see you guys in a couple of minutes.
( I came back fifteen minutes later. They watched me while I worked with other patients.)

Roller#1: I know you're tired. I can FEEL how tired you are. Keep on though. Keep on.

Roller #2: I'm not embarrassed to say it. Right now,I think I love both of you, dearly.

(His eyeballs kind of rolledback into his head, his eyelids nearly close-then his eyes popped back open. He satisfyingly grinded for a few moments.)

Roller #2: This is true.

Roller#1: Hey nurse guy, we believe in you. It's okay to be tired. You look really tired.

AMN: You guys alright?

This is no joke everybody:

Roller #1 and Roller #2: We're more worried about you, man. How are you doing?

AMN: Well, I guess I'm a bit tired.

Roller #1: I'm open to talking.

Roller #2: That's what we're here for.


I guess I looked as bad as I felt. Tired and blue! But what can you do when the only official protocol, the only mandate available is to Keep on'.

So I kept on. And we talked. Not advocating drug use, but their empathy was wonderful. I know, boundaries, bad idea to burden the patient with my problems, but in this instance, it just worked. I didn't give them intimate details but I summarized. I'm pretty much a closed book to coworkers and patients alike, I guess my soul was cold, and I needed their warmth.

Those young dudes completely shocked me. I realized, nobody had asked me recently how I WAS DOING. And yet another reminder to never EVER judge a book by its cover.


More to come friends!

Stay up Late

Fatherhood continues and evolves. For this first month, my wife and I have had a pretty moody little dude on our hands. Gas, poop, and hunger. Limited amounts of sleep. Something to work through. I couldn't hold him without him kicking and screaming, waving his tiny balled fists, trying to swat away whatever it was that was agitating his pain. My little dude was not having a lot of fun with this new life and frankly, I wasn't having a lot of fun, either. The wife did great though, kept her spirits up and worked with what she had. Mother in law came to stay with us for a month and that was immensely helpful. Mother in law left, and we still had the Moody Dude on our hands.

But!

For the last two days, miraculously, for who knows whatever reason, perhaps on of the thousands of tricks we employed to fight colic and fussiness paid off. The last two days have been awesome! Little crying, just a lot of looking around and even a few smiles. A vessel ready to explore the world. A baby that listens to and watches his mobile, as opposed to hysterically shrieking at it, he sometimes smiles at the hanging mobile that to me, is strangely reminiscent of a Pink Floyd concert I went to in high school. The change has been so dramatic, we noticed it immediately. And best of all, we pulled five hours of sleep. I probably shouldn't us "we" because my wife has to get up far more frequently than I do to give him the bizoobs but the change is duly noticed. And it feels great!

SO... to get to the meat, to get to my thoughts...today at work a 29 year old man ran into the ER carrying his crushed 1 1/2 year old child in his hands. When the father was leaving home, the boy ran out and the father backed over him with the massive family SUV. As bad as you've seen it in your experience, it was. I (thankfully) didn't see anything gnarly, I came into the situation as a big crowd of people moved into trauma. Staff came out of the trauma, talking in that glazed sort of way, when the adrenaline is high, the experience is burning into your psyche like a liver fluke into your gut. When your still not sure if what you saw was medically inspiring and challenging or you just voyeured into a devastating personal moment for someone. My co-workers came out of the trauma and I heard grim remarks, saw heads sadly shaking, "blood everywhere" "brain matter" " seriously not looking good". I only saw the father briefly, standing up, his head shielded by his arms as he leaned against a wall and cried, large numbers of family circling him, giving him support that must be baffling and terrifying at that moment. What do you do? What do you think? Are you angry at the father, do you feel sorry for him, do you forgive, do you dare to visualize what his life will be like after the so sudden and immediate death of his child? I was working in triage most of the night so I directed the upset and anxious family members as they poured in, asking how to get to the pediatric ER. I tried my best poker face, almost pretending that I didn't know what nightmare I was about to direct them into, "The pediatric ER is just to the left." Afterwards everyone in triage would also shake their head, what a nightmare.
And of course the Sheriff department tore apart the SUV, police lining it off where the dad had driven up to the ambulance bay doors. Furiously burrowing into the vehicle, under seats, in doors, looking, looking, for some proof that this father was a murderer and needed to be charged with a crime as horrendous as the accident. So weird, this tought looking family vehicle became a crime scene and I don't know the outcome of their investigation nor do I want to. What a shitty job...

I never felt like this before, I couldn't stop visualizing myself in his shoes, I kept imagining picking up my injured child off the ground with catastrophic injuries that I inadvertently inflicted. I couldn't imagine killing my own child. How do you live after that? How do you go to work, how do you be with family, what does your wife do? Does she hate you with the venom that mothers reserve for those who hurt their babies? Does life become a rollercoaster of self destruction, do you give up?
Do you try to die?
I'm so thankful that I wasn't even involved directly with the medical care. I've prided myself on my non-squeamishness around blood, around eagerly encountering the human wasted, the trauma's, the human drama, but I tell you what- tonight, just hearing the details, I thought to myself, "I don't have the stomach for this anymore." One of the most upsetting experiences of my medical career and I wasn't even involved.
Sadly, this validated my fatherhood more than anything else that has happened to me, more than any other joyous or challenging experience I have had with my boy, thus far, in this beginning first month. The thought of the sweetness, the innocence, the innate struggle to survive I see in my boy, for that to be taken away by my own hand is utterly upsetting.

Licensed to Ill

Sorry I've been gone for awhile. It's not good blogger etiquette to only write sporadically, it doesn’t bode well with my legions of fans and fanatics. But what can I say? Personal life has kept me busy and I needed a certain amount of time to decompress, because Angry Male Nurse was becoming Burned Out Angry Male Nurse as does happen from people who invest everything they’ve got into their career form time to time. I’m okay with that, I just need to make sure I have the tools, the support, and the time to chill when I need to. Which I do.

Finished off 2nd semester. Did okay. Made it through with virtually no personal drama, until the end when the students who failed the most absolutely ridiculous and unreasonable final written in the history of Med-Surge got pissed and started manipulating student and staff to get their way. I really felt bad for the students who didn’t get through, I felt that some of the blame did not lie on their shoulders, that teachers who couldn’t even write questions with 8th grade English skills should be held to count for it. But then I saw how the failed students played games and threatened and eventually turned on each other, and I saw that perhaps that the reason for their failings their failure lay more with their lack of professionalism and maturity than anything else. So I backed off, let the chips fall where they may and began to recoup.

My wife and I had a baby on Tuesday. He is the most enigmatic, beautiful, and poopy little dude I have ever met. I’d like to tell you his name but there are some haters out there so I can’t. But it is a fitting name for such a cool dude.
Labor was 30 fucking hours long. The epidural was too strong for my wife so at about 20 hours in her contractions basically stopped, which relieved her so she could rest but scared the shit out of me because the thought of C-section after my wife’s valiant efforts would have broken my heart. I have no problem with C-section, just that my wife wanted to go natural and her spirit was into it. 2 1/2 hours of pushing and the use of Pitocin and suction and my little baby boy came out. I cried when he came out, a good cry, tears that contained my fears, my stress, my anxiety. Also with it came utter joy and amazement, love for my wife and relief that we were all safe. The nursing profession, nursing school, became small dots in my mind, like light coming into the opening of the end of a distant tunnel. Put things into perspective.

I love politics. That’s who I am. But a game is a game is a game and even though it involves human lives I am not responsible for the millions of unbelievable outcomes, for all the incredible personal tragedies I see and some that I am involved in. When I am working I am in a state I call, “In the Mix”, meaning I float from one living to dying crisis from the next, I hear all the other nurses working alongside me performing in the mix, applying their knowledge and intangible personal skills, putting out fires, fucking starting them, dealing with it, I exist in all the noise and I can apply myself one situation at a time. Brains here, not breathing in the ambulance bay there, relieved discharge here, comforted by morphine here, change the patients diapers there. I am in the mix, talking to my mind, listening to the noise but being part of it, too.

I love becoming a nurse. I feel like I am becoming something useful and functional. Skills develop and flourish, unique skills that I am very proud to possess. Some nurses wield them with confidence, other dish the skills out in utterly small insecure amounts.

Sometimes I think about the Beastie Boys from “Licensed to Ill”. Their ZaZen in the mix of 1980’s partying, music industry, cultural racial significance wrapped around them like a blanket


Let it flow let yourself go
Slow and low that is the tempo
Let it flow let yourself go
Slow and low that is the tempo

Have you ever felt water pour on your head from a small waterfall? Not that I get to that often, truly I live in an urban jungle, but I have been in nature a few times. The waterfall is surprisingly loud, and forceful, all that water pushing down on your head and neck, feels like your skull might cave in. But it doesn’t, and after a few moments you realize that the tension in your shoulders is being worked out and you are bending to the will of the water and sort of being with it. That is how I feel in the ER. Stretched out but adjustable. And when the bull shit politics starts to overstretch me, when the patients bullshit becomes a bit too odious, when the doc decides that he or she will revert to pissy 14 year old nerd mode, I put my clasped hands over my head, like a shelter, and shunt off some of that cold water pouring onto my head from the waterfall, and I look around, catch my breath, and let the beating begin again.



Let it flow let yourself go
Slow and low that is the tempo
Let it flow let yourself go
Slow and low that is the tempo



Rainbows, waterfalls, and unicorns, bitches.

Bring it!

They sue doctors, they send nurses to jail

I just saw this in the LA times. Even though its like 2:30 AM and I'm study the umbilical placement of the fundus, this got my goat.

http://www.latimes.com/news/local/la-me-king20may20,0,6057993.story?coll=la-home-center

Attached is my letter. Dig it!

Subject: you idiot tool
Date: May 20, 2007 2:38:09 AM PDT
To: charles.ornstein@latimes.com

This is off the record...
Good job moron. By focusing your blame on a callous nurse and by publishing her name, you have now not only endangered her personally but you have done the bidding of various county supervisors who make unaccountability an art form. Your story is so full of holes and misinformation, all the details you forgot to include while you made a case against the nurse and police.

Incidents like this happen from time to time in the ER world. Somebody cries wolf and when it really is their turn nobody believes them. ER nurses know this better (and should know better) than anybody. So what can a nurse do in a situation like this, repeated discharges and the patient is still returning? Had they performed a full workup, or did they just send her off with Vicoden? All the triage nurse can do is check the patient in, monitor vital signs every 4 hours, as is county protocol, and let the patient do whatever the hell the want in the lobby (scream, cry, threaten, use drugs, fight). Which she did, followed county protocol. Doctor's decide when to intake the patient.

So there were no doctors involved in this situation at all? What about the too busy to be bothered doctor who couldn't figure out that she had choleolithiasis or a bowel obstruction. How is it that YOU PUT THE BLAME ON A NURSE WHO IS ONLY ALLOWED BY STATE LAW TO CHECK IN, MONITOR VITAL SIGNS, AND TRIAGE ACCORDING TO SEVERITY OF ILLNESS.
A nurse cannot order ultrasounds or pull lipase blood panels . A nurse cannot order laproscopic surgery. All she can do is check the patient in and inform a doctor of the situation. Do you think her getting a workup for the third time that day was on the top of the physicians list? Should it have been?
Obese lady is yelling that her gall stones have exploded and is carrying on. Number 30 for the day. Abdominal pain is the number one complaint in the ER. It is also the most difficult to treat and diagnose. It takes time, because all those people ahead of you with heart attacks, gunshot wounds, and diabetic ketoacidosis are in more danger than your vague (but vocal) complaint.
Junior Blogger: there was nothing the nurse or any medical professional could do for her. You know why? Because LA County DHS is run by a crew of egomaniac rich politicians. As an emergency professional, I can tell you, County Emergency medical care is fucking scary. Its called a lack of reasonable resources. That's not the nurse's fault. But guess whose it is?

You are a tool because the nurse is the most expendable member of the health care team, and as you may now be noticing, DHS is going into general quarters, taking their doctors with them into a protective PR wagon circle. You chump. And just so you know, other than increased pulse, decreased blood pressure (if the perforation was bleeding), and a temperature greater than 101, a complaint of severe abdominal pain means nothing. Ms. Rodgriguez was nothing special in the ER because half the people in the ER were waiting with the same exact complaint. Unless you are involved in a trauma or have an identifiable life threatening situation,you have to wait in the waiting room, just like everybody else at county, you wait your turn. HEY CHUMP! PAIN IS NOT AN INDICATOR OF LIFE THREATENING EMERGENCY. SCREAMING DOES NOT GET YOU BACK ANY FASTER, BECAUSE THEN EVERYONE WOULD SCREAM TO GET BACK. HEY YELLOW JOURNALIST, EVEN HER OWN BOYFRIEND LEFT TWICE TO GO "RUN ERRANDS." AFTER MIDNIGHT NO LESS! She must have been really bad then right?

She was seen by two doctors for full consultations and yet you blame the nurse who evaluated her at triage. Now some media horny DA is ruminating over filing criminal charges, we're not sure who yet, but we do already know that because of your brilliant piece of heart felt investigative journalism it'll probably be the nurse. But that's good for you, right? This ridiculous story goes on and on. Hey, maybe you'll win a Pulitzer.

Mr Ornstein, let me tell you what you are now the cathartic enema for. Nurses will be afraid to properly assess people, patients who like to scream will get moved ahead of people who are really dying (idiot, Ms. Rodriguez was the exception, most people are dying quietly in the waiting room because they are too sick to scream and carry on). When nurses become the flavor of the month for stalled out DA's, any shot of recovering the American healthcare system will be permanently destroyed. You think doctors are afraid of getting sued? Imagine a nurses fear of being sent to jail, for having the strength to do her job, to not crumble under the mountain of LA's worst stories. If a nurse is afraid to do his or her job you won't even get in the door.
That's right chump, people are dying in the waiting room everyday because there aren't enough beds, hallways, tables, to put the bodies on. If someone has the energy to scream at me, I tend to think they aren't dying. Ethical Journalism Reject, you have enabled LA county DHS supervisors to shirk off some glaring reminders of their managerial incompetence, yet again. A morbidly obese Latino woman (Hypertension + Diabetes endemic) sadly crashes after a life time of giving her shoes to people and basically being kindest, sweetest greatest person on earth, well aside from those warrants, and you want to hang the nurse whose job is to categorize and put the patient in line and attend to any life threatening situations that might arise.
I wonder why the whole night shift ignored her, lying there, screaming in pain, and no doubt in real agony. Why would they do that, I wonder...

"I am completely dumbfounded," said county Supervisor Zev Yaroslavsky. Ya think?

Good job.

Positive Role Model Found!

A breakthrough! My OB instructor is great! Honest, sense of humor, argues with doctors during C-sections, is open about the problems with the hospital she works at, lets us make mistakes without humiliating us, and seems to take a genuine interest in my performance. Best of all, she believes in the absolute competence of the nursing profession, and pointing out the bad habits of uninvolved nurses.

I feel like Michael Banks in "Mary Poppins" when the two kids write a letter requesting a new nanny, and FUCKING MARY POPPINS SHOWS UP. Before you know it she starts giving them hard core drugs laced with spoonfulls of sugar and making rooms fucking clean themselves. What a relief! I just needed someone to give me some guiding light: a nursing instructor that acts like a normal person!

I'd like to write more but I've got a serious PEDS/OB test manana.

Cheers