Where Has All The Goodness Gone?

Alone.

At home in the living room.

Kids in bed. Wife at work.

And I'm searching for the good. The TV is on--an episode of HouseHunters International. A woman is moving to Paris after battling Stage 3 breast cancer and losing her husband over the last year.

She's looking for the good.

When the show is over, she's happy in her new apartment in a beautiful, romantic city.

My eyes scan the shelves of movies we own, and come to rest on "The Sound of Music". It doesn't get much more good than that. My mind examines why this is? It was a time when there was a definite line in the sand. On this side was the bad. On this, the good. One was the enemy, or not.

70 years later it looks pretty black and white.

But what if the enemy is within?

Where has all the goodness gone?

I live in a comfortable home--a dream completely out of reach for many. Yet I want to move. I long to live in another place. Anywhere but here, really.

I have a job--the deepest desire of many. It used to afford me moments of joy. Delight in saving lives. But now I struggle to tiptoe through each shift worried more that I will do something that will get my hand slapped, or worse.

I am married--and so many are so alone. But I struggle to maintain even the simplest lines of communication. The specter of my insecurities and past hurts and grievances shadows over all.

I have kids--while so many are desperate to bear children of their own. One child that no longer wants to live with me. And my bearish tendencies and low patience threshold send the other two to my wife's welcoming arms.

I feel so very grey.

Where, oh where, has all the goodness gone?

Alone

"We're born alone, we live alone, we die alone. Only through our love and friendship can we create the illusion for the moment that we're not alone."

--Orson Welles

Perspective

Sunday I worked--another insane shift, and another insane assignment. But that's another post.

I was assigned to our reverse isolation pod where we put our heart and lung transplants. I was assigned two very sick transplants with complications, but across the pod was a fresh lung transplant from Friday. When I came on shift he was doing pressure support trials in preparation for extubation. He was pretty anxious--as most people intubated without sedation are--but even more so because he was a lung patient.

He passed his trials with flying colors and was quickly extubated. His family came in afterwards, thrilled to be able to talk to him. The family was bubbling over with happiness and enthusiasm, which is pretty typical of post transplant patients and families. They are just so thankful that their loved one has been granted a second chance afforded them by their new organs.

The patient was doing his best to match his family's mood, but it was pretty clear to me that he wasn't doing as well as he was making out. His wife kept asking him if he felt better, and he would agree that he did, managing a tentative smile for her.

He was a little more forthcoming with his nurse when the family wasn't present. He admitted to some pain and feeling somewhat short of breath. He also was pretty fatigued. Most of all he was just tired of being in a hospital bed with all the ridiculous lines and tubes we insist on attaching. And rightly so I think--we do tend to take things a little far with what we expect our patients to tolerate. He had come to our hospital from 750 miles away for the transplant consult, and it had taken 10 months to get where he was because of some other complications that needed to be resolved before he was a true candidate. Imagine being away from home temporarily...but for 10 months. Did I mention we don't have TV's in our open pods? In short, he was just cranky.

A couple hours later I overheard him ask his nurse how much of the surgery he would be awake for. I stopped what I was doing to look across the pod and listen in.

The nurse gave him a blank look and asked, "What surgery?"

A little annoyed, he shot back, "The one I've only been waiting 10 months for!?"

"Uh, you had your surgery on Friday, today is Sunday."

His turn to give a blank look.

She repeated, "You got your lungs on Friday, you've had your transplant already."

"No shit??" A slow smile spread across his face.

Thanks to the anesthesia the last thing he remembered was changing into a gown...

It's amazing to see the shift in his perspective and his mood based on that one small piece of information. Suddenly he was pleasant, jovial even. He was happy to see his family, even when they stayed to long, or asked him for the 50th time, "How do you feel? Are you better??"

So let me ask you, when you woke up this morning, did you face the day like it was gift? Like you had been blessed with a new set of lungs?

Or are you still waiting (for 10 months now!) for something good to happen?

If I may draw from the wisdom of Frog on the kids show Little Bear, (a favorite in my house), "A day is just a day. It isn't good or bad." We decide if it's good or bad.

What will you do with your new lungs today?

You Might Be...

You might be a nurse if:

You start a vitals/medication flowsheet at home when a family member is ill...

Pay Day

My wife and had a financial meeting this morning, as we often do on the morning after our paychecks get direct deposited into the checking account. Usually it's a quick assessment of what little we have to show for our hard work after the dust clears from the bills feeding frenzy.

Today was no different.

However, we did a quick check of our gross income to make sure that we were on track with our tithe amount for church. And that's when it hit me.

My gross pay for the year (with numerous extra shifts and overtime) was just over half of my wife's gross pay to date. Right at 55%. My wife doesn't often work extra shifts (although she has occasionally.)

Let me qualify this observation:

a.) She has been at her job for 9 years, I for less than 1 year.

b.) She works a contracted weekend plan that pays her an extra differential for working every weekend.

Ok, so she's had a significant head start, and she gets compensated for forking over our social life essentially.

But twice as much? Really??

She works for a nationally recognized non-profit children's hospital. It is a large hospital--over 300 beds, and expanding even as we speak. It is a designated trauma center. She works on a critical care unit at the highest level of care provided by the hospital to its patients.

I work for a nationally recognized non-profit hospital. It is a large hospital--over 1000 beds, and expanding even as we speak. We are designated a Level 1 trauma center. I work on a critical care unit at the highest level of care provided by the hospital to its patients.

New grad nurses at her hospital make on average at least $10,000 more per year than new grads at my hospital.

My wife gets paid extra for working in critical care. I get paid the same as any other nurse in the hospital--day surgery to med-surg to L&D. We all get paid the same.

I recently remember working a weekend (extra diff), night (extra diff), holiday (time & a half), overtime (time & a half) shift. After adding up all my diffs and overtime, my hourly pay was only slightly more than my wife's base pay.

I don't mind that my wife makes more than me, at least not consciously. In fact I'm quite thankful as her job is the only way we've survived financially through my job failures and extra degrees. But when I think about how hard I work and the razor edge I routinely walk with my patient's lives and my license, it is a little disheartening to see the disparity. I don't think my wife works any less hard than I do, but I don't think she works any harder either.

Because of my past degrees, I have a crippling amount of student loan debt. Two of my three loan payments were more than this 2 weeks paycheck, and the third loan payment will be another 1/3 of my next paycheck. Lucky for me, the end of those payments is in sight--only 29 1/2 years from now.

I guess like many, I'm lucky to have a spouse willing to lump her paychecks into the joint checking account to provide for her family.

So sweetie, "Thank you," for paying my car payment this month, and my insurance, groceries, and fuel. Oh and "Thanks" for providing me a place to live.

I'll do my best to repay you when I get my earning potential soul back from the student loan companies.

Either that or when my life insurance comes through.

If It Isn't Charted...It Never...

...happened.

I generally regale you, my faithful readers, with stories of my wild successes. Usually I play the distinguished (if not a little crusty) hero with some great over-arching theme to impart upon the nursing masses.

Not today.

Today I was called into the office for a closed door conference with the unit educator and the unit manager. The door closing behind you is pretty much a fateful sign. You're not escaping without some pound of flesh taken in payment.

All this over a shift that was an ass-kicking from the start. Two very sick patients--one in severe septic shock, and the other most likely in the same situation. One was on hemodialysis, the other on CVVHD. A handful in and of itself, but across the pod lay a 180 kg woman who was to be taken for a CABG. Only the night shift nurse had pulled the PCI sheath, held pressure for 4 minutes flat, determined the patient wasn't bleeding externally from the site, and called it a day. It wasn't much later that the patient developed a football sized hematoma. That grew to be basketball sized while her pressures cratered from the shock of it all. Not hard to do when your ejection fraction is <15%.

Meanwhile that patient's nurse was chasing herself silly trying to get her other patient transferred to the floor because the first case of the day needed to go into that bed for staffing reasons. As in, we didn't have staff to take that case. When she left to transfer her patient, I was tasked with watching her other patient's hematoma grow.

I was left to doppler distal pulses and set up a C-clamp to hold pressure on the femoral artery to prevent the hematoma from growing any bigger. All the while maintaining some semblance of hemodynamic stability. I had just turned the patient's levophed up to our unit's max dose to maintain a pressure in the 60s (nothing like squeezing a dry tank, right!?!) when my patient on hemodialysis bottomed her pressures in response to the fluid draw. So away I went to titrate some pressors to maintain a MAP above the renal injury threshold. Just as I was about to get her settled, my CVVHD patient clotted her filter. And it was while I was attempting to rinse back the 200+ mls of blood in the machine that the anesthesiologist and anesthesia tech appeared to take hematoma lady to the OR.

It was a dangerous situation. Did I mention my charge nurse was off the floor kissing Joint Commission ass with the manager--we were being recertified for LVADs you see.

I had no help.

I spent the rest of the shift trying to catch up on my charting while taking care of two still very sick patients. Towards the end of the shift one of my patients began breathing at a rate greater than 50. She was intubated, but not sedated, and pressure support CPAP-ing. (Recipe for disaster really since we were not about to extubate her...)

My calls to physician essentially fell on deaf ears. I received orders to increase the pressure support, but nothing else. I complied, and at shift change the patient wasn't doing much better.

In my rush to get home to take over care of my children from the babysitter, I neglected to chart my communications with the physician. (And somehow went an entire shift without charting vent settings!? Facepalm! WTF??)

And the night shift nurse took exception to the hot mess I handed her and promptly tossed me under the bus.

Fade to employee conference. I sat in my seat while my manager and educator talked down to me, asked me loaded questions in the most condescending tone they could muster, and basically held my nuts to fire...

Because I screwed up and didn't document.

So in the meantime, I've been banished to "the garden" to take care of chronic patients.

There are so many things wrong with the way I was treated that even now I get tears of frustration thinking about it.

BUT.

Kids, remember this.

If it isn't charted.

It. Never. Happened.