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?”

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.