War of Attrition

When I first started my externship this past January, there were two GNs starting their internships on our unit. They were both externs during nursing school-- one on our unit, the other on a generic med-surg unit.

The GN that had externed on our unit made it out of her internship, but only a few weeks past that. It was quickly evident she wasn't ICU material, although she claimed it was because nobody would help her, and we all let her drown. Of course when you stand around flapping your jaws, people tend to assume you're caught up, and don't need help. But whatever. Whatever it takes to soothe that keen edge of personal responsibility.

The other GN did much, much better. She is turning into a solid nurse, especially for having as little experience as she does. She's 8 months in--always comes to work when she's on the schedule, and shows up swinging with both arms. She's doing really well.

Or so we thought.

Yesterday I found out she changed her status to PRN. When I asked where her new job was, she just gave me a blank look. Confused, I asked why she was going PRN if not for a new job. She just about broke down when she told me.

Since she started working she's been having major anxiety attacks at home. She's gaining weight, her hair is falling out. She's been having crazy dreams about patients and about work. One night she dreamed she'd left a patient in her car, and even though she knew better, she went downstairs to check her car, just to settle her mind. She'd been able to hold it together at work, but her personal life was a wreck, and she was a shell of a human at home.

I'd had no idea. None of us did. Didn't ask for help, didn't confide in anyone. She was trying to soldier on, on her own.

Now have no doubt, our ICU is relatively small. We're only 16 beds, and we get bypassed for most major traumas. But we are pretty busy and we do see our fair share of critically ill patients, and the pace can be pretty heavy.

I feel bad for her, I really do. I think she's selling herself short thinking she's not ICU material. This hits home for another reason too.

These days I sit and contemplate: Do I stay where I am or move to a major hospital in the area?

I like the unit I'm on. It's a brand new hospital built only 4 years ago. I know the people both on the unit and around the hospital. I know how things are done. I will get some solid experience, especially DKA's, post-cath, post CABG, STEMIs, strokes, renal failure, COPD. Pretty well rounded actually. It's only 7 minutes from my house by car. The down side, it's not a hugely impressive name on my resume. I won't see major traumas, and I may not see as *much* cool stuff.

The big-name hospitals are all at least 30 minute commutes, but they are all awesome organizations. I will no doubt get an amazing amount of experience. But with current job markets, I may not even get onto a dream unit.

And now, given my co-worker's plight, the self doubt starts to creep in. Could I really hack it on a truly busy unit? Am I up to the truly critical nature of the patients at a teaching hospital?

My current unit is safe. The big hospitals are the great unknown.

I'm scared to death regardless. Maybe like a patient extubated too soon, I just won't fly...

I don't know if I can take another graduation and then colossal failure.

Applying for Graduation

Today I applied for graduation.

It was a simple online form on the registrar's website with little fuss. There was no trumpet fanfare or chorus of angels breaking into song. At least not that I heard. Most of the form was auto-populated from my records, but there was one question that made me pause.

"Are there any special circumstances we should consider in evaluating your application for graduation?"

Innocent enough question I suppose. Probably it was meant for those who had some major event that interrupted their schooling or challenging substandard grades.

Why do I deserve to graduate? What special circumstances do I ask to be considered for that special honor?

Is it because I went to class, listened to lectures, regurgitated the information in some sort of highly concentrated factually dense exam vomit? Because I paid my exorbitant tuition, wore my geeky uniform complete with iron on shoulder patches?

No.

It's the people, the patients. Aside from education, no other course of study is so deeply entwined in the lives of outside people. Psychology makes a valiant effort, but falls short. Do I dare say even medicine is found wanting?

But I do know this: there is no way I can condense my experiences into a 300 character text box on a stupid administrative form. How could mere keystrokes do justice to the anguish and despair on a father's face while he watches his 17 year old son slipping away. What spell-checked phrases could relay the gratitude of the Pakistani man. All I did was protect his dignity while getting him cleaned up, and take a few moments to talk with him. He'd only moved from the old country a few short years ago, and yet he had the words to say, "May God bless you. May God bless your children." No special font could adequately describe the moments when the last flicker of life fades from the eyes of someone starting their next great adventure.

So why do I deserve to graduate?

Because I've earned it.

Not in a "check the boxes" kind of way, but in a visceral, poignant, and experiential way.

So, apply for graduation?

Oh you can bet your ass I did.

Orbs of Normalcy

Just spent my textbook money on a doctors visit and an SSRI prescription. Despite my holistic beliefs, I join the millions of medicated Americans.

Are our lives really that bad?

Hoping it makes a difference. I'm so very tired of the daily colossal battle to just be functional. Is it too much to dare hope to not have to struggle merely to exist?

Meanwhile I help make the makers of Lexapro rich. And in the process give up my love for well-crafted wine, beers, and Scotch.

Exhibit A

I give you Exhibit A--the reason I haven't posted lately. My dear laptop got knocked off the arm of the couch, and though it fought a valiant battle with the floor, in the end even with the upgraded carpet pad, the concrete slab was just too much and the laptop succumbed. While we're careful not to unjustly accuse or falsely lay blame, two exuberant children were seen in the immediate vicinity of the scene of the crime when the incident allegedly took place.

All I have to say is they're lucky they're stinking cute.

We have a desktop also, but it's in our bedroom, and I typically have blogged when my wife is asleep during the days on the weekends, so that just doesn't work.

The budget is pretty tight this summer, so I just don't know when I'll be getting another laptop. I don't dare come within 100 yards of my blog at work, and I'm pretty leery of the same on school computers. I guess what I'm hinting at here is that my posts may be a little spotty for a bit.

Hmmm, where to start--I have so much to tell.

• Running is still going well. I had a week where I only got 2 workouts in, 5 days apart due to family in town and not feeling well, and that really set me back. My previous best had been 25 minutes straight, and I was struggling to make it 20 again. But on Monday I pushed through and ran for 30. That's exciting.

• My wife and kids are out of town with her mom and two of her sisters visiting extended family. They've been gone since Sunday, but they're coming home today! My wife's grandmother hadn't yet met our youngest, and I'm happy to report he passed granny-inspection.

• Work has been difficult because of the type of patients we've had come in, but I'll post more of that later.

• Remember me talking about this hospital? Well, I got an email a couple days ago advertising a "Nursing Open House", so I left work early and attended. Open House in the work world doesn't mean the same thing as Open House in the elementary school world. This wasn't a "Meet the Teacher" night, it was a straight up job fair. I was of course completely out of place in my scrubs, and no I didn't have copies of my resume with me. Not that it mattered anyway, I was still "too early" to start applying for new grad positions. I did however get to meet the woman in charge of the ICU Internship, and got her email address. They post those positions the 2nd week of September, so don't think I'm not checking their website 3 times day. Yes....I know it's still August.

• Umm yeah, August. 18 days in a row over 100* and forecast another 4 this week before any relief. This is why every summer I vow it will be my absolute last this far south!!

Eh, that's enough to chew on for a bit. Assuming I still have readers of any kind. I'm going to try really hard to post more, promise! And read, and comment on other blogs!

Epiphany

Last week I helped take care of a patient who had come in through the ED for a drug overdose/suicide attempt. 47 years old, his wife of 17 years had divorced him, and the legal proceedings were final. To celebrate he broke his 8 years of sobriety, got very, very drunk, and started downing pills. He took everything from Lexapro to Ativan. He quite nearly succeeded in killing himself. He had called his ex-wife to tell her his final goodbyes and she could tell he was slurring his words, became concerned and went to check on him. She found him unresponsive and called 911.

He'd been down for bit--his pH was 7.18, his pCO2 was in the 70s. By the time we got him, he was pumped full of charcoal, vented and restrained. I try hard not to be judgmental, but this guy was a character. He had an obvious metro-salon haircut, an elaborate nipple piercing, and his toenails were professionally painted. With daisies on his big toes, and zebra stripes on the others. People are only human, and we humans are some strange birds sometimes. When I inserted a foley on him it was obvious he had some kind of penile discharge--and not the kind you get from a monogamous relationship. So who knows the rest of the story regarding his marriage.

There were other qualities about him too; qualities I'd be envious of. He's a good looking guy--that body type that allows one to wear all the trendy fashions. Think J Crew or A&F. Based on his hygiene and personal effects, he was pretty affluent. He's clearly a guy that people gravitate towards, judging by the crowd that came to visit him. Probably the life of the party.

And in the quiet moments when we kicked his visitors out to suction him or clean the charcoal impregnated shit (one would think that charcoal shit would be odorless since charcoal is used to filter odors, but sadly, it's not) out of his bedding, I had a very harsh epiphany.

**If I'm not careful, I could very well be him in a few short years.**

I've alluded to wanting out of my marriage--that I've felt it's so stagnant that I feel I'll smother if I am required to bear any more hurt and insult. But the sad truth is, if my wife left me, I'd be devastated. And I don't know that I'd have any reason to keep on. I don't want to go so far as to say I'd be suicidal, but I can certainly foresee getting to the place where that might seem a viable option.

And what a horrible, horrible option it would be.

It seems the only truly viable option is to love her now. To love her the way she wants to be loved, not the way I think she wants to be loved. Even if I have to give the whole of myself away, isn't that a better option than splattering myself across the wall or ending up a shit burrito in some LTF somewhere? And maybe somewhere in the process, my love for her will set us free enough to allow that love to be returned.

I think there's a better chance of that in the here and now than if I were laying in a puddle of charcoal impregnated shit with a nasty green penile discharge 10 years from now.

I can change Ebenezer, I can change!