somniare.

sometimes, my head explodes

Purpose (epically long entry) February 5, 2008

Filed under: about me,my evolution,on work — somniare @ 1:15 am

I don’t usually write at night. Typically, I sit down so drained by my day that the idea of trying to translate my mental chaos into a well streamed monologue to the public… well that is beyond my realm of capability.

It has been one of those bizarre days where everyone asks whether it is a full moon outside or if we’ve been transported into an alternate dimension where insanity rules the minds of even the most level-headed. Even the weather has lost it’s mind, as I can’t remember a time where I saw lightning in February!

My thoughts today remain on the topic I mentioned in my previous entry: patience. Since then, I’ve been on the brink of just giving up that unique quality I have. But today was a perfect example of exactly why I honestly believe I could never be any other way.

The shift started out in a bizarre way. One of the patients I had during my shift Sunday evening was furious with the events of the entire day. Her husband ran into me on the way to the lobby level and asked me why I wasn’t assigned to his wife. I told him that they moved me because the person who had her all day was on a 12 hour shift and they didn’t want to give the girl a whole new assignment after having the same one for the first 8 hours. He told me he was going into the manager’s office to discuss the terrible way his wife had been treated. Did he ever! I walked past the office about a half hour later to see him standing in there, bright red with rage and yelling at the top of his lungs. Afterward, my manager (who just started last week) came to the nurse’s station to tell us about the situation. The girl who had the patient during the day was banned from the room. They also said that everyone should be like me since I obviously cared about my patients and had gone above and beyond to be compassionate and helpful. These people were far from being rational mind you. Of course I care about my patients… but having them on my assignment was an experience. They had been traumatized by the impersonal nature of the nursing staff and physicians on the intensive care unit where she had spent two days previous to coming to our floor. They wanted to get to know everyone who came into the room and wanted everyone to take the time to know as much about their lives as they could get out. They wanted each and every person who saw her walking in the hall to greet her and ask how she was doing. While that would be absolutely lovely, we all have multiple patients on our assignments and can’t always take a lot of time for chit-chat. Being that I am one bearing the curse of inhuman patience combined with my inability to end a conversation, I nearly got out late Sunday evening because I spent 45 minutes in there listening to them talk. Every time I went in there, I felt like I was being interviewed, “Where did you go to school? How old are your kids? Who watches your kids while you’re here? What did you do before this job? How many pets do you have? Here, let me tell you about all of ours and every story we know about them.” The list is absolutely ENDLESS and I wanted to scream. In fact, I was so frustrated by the fact that I stood there so long that my legs were cramping that I wished something, ANYTHING would just burst into flames or violently explode. Did they know that? Nope. And it paid off as I received glowing reviews as the only one who really seemed to care. My new manager is wonderful though, I didn’t get used as an example to publicly humiliate my coworkers as my last boss would have done and caused me to spend the rest of the night getting childish scowls hurled at me from around every corner. Instead it was simply suggested that a couple pages from my book of patience be applied and some extra TLC be given to a very needy patient.

About half way through my shift, one of the patients on a coworker’s assignment decided to go insane. HE started climbing out of bed, tearing at his tubes and IV, and attempting to bludgeon anyone who tried to stop him. That coworker was told to remain with the patient on 1:1 (one to one) observation for the remainder of the shift because that is what we do with patients that pose a danger to themselves. About a half hour after being in the room, my coworker had reached the end of his rope after being assailed by one of the patient’s family members for the level of force he had to use to keep the patient in his bed. He announced he was going home and not coming back, signed out, dropped off his pager and left the floor short. The situation could have been easily diffused by putting someone else in to sit with the patient and then he could pick up that person’s assignment. We’ve all been at a point where the job was just too much and wasn’t worth the misery… in my eyes, it wasn’t one of those nights. Because of that, someone else had to be pulled from the floor to sit in that room and the rest of the unit was left stranded in a state of desperation due to severe understaffing.

My patience was straining as I ran from one end of the hall to another, trying to satisfy the needs of my, now 14 patient assignment as well as do the standard and scheduled duties of my job. As I’m running, I hear all sorts of yelling and banging around. I rushed down the hall to the origin of the ruckus and found two of my coworkers wrestling the insane patient who had finally managed to get himself out of bed. One was holding him from behind with her arms around his chest and the other was being pummeled in the face by his flailing hands as she tried to get to his legs. They both were just holding him yelling, “Where’s the doctor??!!” Neither of them making a solid attempt to get him back in bed or acknowledge that his IV and foley catheter (the tube draining the urine from his bladder) were still firmly attached to the bed and would have caused a lot of pain and bloodshed if they remained in that position. Seeing as I appeared to be the only one left with a shred of sanity, I ducked like a boxer underneath his swinging fists, grabbed him under his knees and flung him back into the bed with the powers of pure adrenaline. He then proceeded to walk around on top of his bed, stomping on his catheter (how in god’s name that didn’t rip out and tear him in half, or cause enough pain to make him lay back down, I have no idea) and my coworkers just stood there staring like robots waiting for a command. I did just that, commanding them to reach behind him and guide his back, I gripped a hold of his ankles and pulled his feet out from under him while holding all of his tubes and wires out of the way at the same time. By this point, I’m wondering what would have happened if this patient had managed to seriously injure himself… would I have been the only one capable of thinking fast enough to attempt resuscitation?! My patience could have saved this man’s life, and I’m not being dramatic.

As the night wore on, the patients all seemed to reach an interconnected state of mania. Every staff member looked on the brink of complete implosion. The staffing for nights was in a state of desperation and the bed coordinator called to continuously book beds when we already didn’t have enough people to care adequately for the patients already on the unit. As I watched the chaos, I felt like I left my mind and entered a state of complete silent observation. Everything around me turned to slow motion as I moved fluidly like cement filling the cracks of a crumbling building. At a speed unable to be clocked, I finished my work and moved to the task of getting 16 sets of blood pressures and temperatures to help the night shift. I moved over to the other side and helped the other person who was left with an equally obscene patient load. I finished up her work, moving in and out of the rooms like I had wings. All with a smile on my face. One woman even commented to me how soothing my voice was to be woken to!

When the night shift came in, one of the other veteran nurses came up to me and asked why I never worked at the desk any more. I have bounced back and forth between patient care and transcription so much over the years, people have a hard time remembering exactly what job it is that I do. I used to alternate back and forth and I loved that because I knew that when I found myself having a terrible day, I knew that the next one may be equally stressful but the fact that it was a different job altogether made it seem like the easiest thing in the world. They hired too many new people for that job though and there were no more shifts left for me to cover there. This nurse told me how much she missed having me there because everything was always flawless, she never had to double check the doctor’s orders and everything was always done to perfection. This particular nurse doesn’t compliment ANYONE. Just hearing a thank you is like watching hell freeze over before your eyes. Working behind the desk for me is tedious work and it tries my patience like no other as I spend all of my time picking up after everyone else and preventing the incompetent residents and other lazy physicians from killing the patients. It pays off though as I was revered for my obsessive compulsive attention to detail and the fact that above anyone else, I can always be counted on to do my job right.

At a time when everyone else cracked, I stood strong. A chorus of thank yous at my back as I walked off of the floor and ended my shift on time and not a second late. I needed this night to remind me why I am the way I am. I sit here now with a renewed sense of purpose… the very same one that made me take on a job taking care of the people I go out of my way to avoid in my personal life. My patience is an integral part of me and for as long as I can remember the only time I ever felt like I was worth anything was when I was helping someone else. Without that fortitude, I can’t be any good to anyone and I certainly can’t dedicate the time it takes to truly be there for another person in need.

My desire to help people, not only in my job but even the random person who sees potential in me, represents the only goal I have ever achieved: to make a difference. If I go so much as a day without feeling like my existence affected another in a positive and beneficial way, my mood is affected drastically. I learned that today. Powerlessness is something I have to deal with in most matters of my own life but one thing I have control of is how I reach out to other people and be something more than just another stagnant human being living life for themselves alone. I truly, without any exaggeration, feel nothing but complete and utter elation when I hear that I made an impact. Days like this make me feel satisfied with my life and who I am, in spite of the fact that I am still lacking most of the things I want for my life. The pain of other unfulfilled desires fades away when my true purpose seems reaffirmed. I have not failed in everything, I can be something more.

 

Christmas: defiled December 26, 2007

Filed under: about me,on work — somniare @ 1:49 pm

T’was the night before Christmas and I found myself forced to recall the traditions I’ve cherished for so long. My son Richard, having no part in the whole ordeal, sat downstairs playing his video games as if telling me, “You think I’m moody and self-absorbed NOW?! Just wait, as it’s only just begun!” My daughter Brooke, full of Christmas spirit insisted on reminding me each detail I had forgotten along the way.

“But Mommy! Remember last year we took the stockings down so Santa doesn’t have to jump to reach them!”

“But Mommy! We forgot to make cookies this year! Good thing Santa reeeeaaaallly likes peanut butter, we can give him the pretzels with the peanut butter in them!”

“But Mommy! What if the milk gets weak?!” I’m sure she was meaning to say “warm” but the phrasing made me think of some sort of bizarre spiked milk that would become less potent if left to sit too long. Santa could have used some spiked milk, that’s for sure.

She reminded me that we just HAD to write a letter. This year, she wanted to write a novel since her pride at being able to write it herself surpassed the desire to hurry to sleep to speed up the process. We bargained over sentences since she was going to make it sound very business-like in her gramatically correct style. “We hope you like the pretzels with peanut butter. We also hope you like the milk. We hope you bring us lots of presents…” There was just way too much hoping going on there, I was forced to conjoin sentences such as “We hope you like the pretzels with peanut butter and the milk…” Richard made a brief appearance to draw some scribbles at the end and let me hold his hand to write his name. Brooke then wanted to draw a picture for Santa. She made a family of three stick figures and all on her own wrote “THE END” over their heads. The end indeed, just the three of us.

We placed the note next to the plate of pretzel sandwiches, went downstairs to pull Richard away so that we could have our annual reading of “T’was the Night Before Christmas”. Of course, Richard wanted no part in it because it didn’t involve a video game of any sort and always meant going to bed afterward. He scurried off and I read the story to Brooke alone. A 10 minute battle of who got to sleep in what bed ensued afterward as both of them wanted to sleep in the other’s room. I put them in their proper places, gave them hugs and kisses and last glasses of water and then trudged back down the stairs to sit in silence.

Opening a beer, I found myself sitting in front of my computer… just like any other night. Hearing Richard put his winter boots over his footie pajamas and stomp to the door to sneak out, I yelled at him to get back in bed. After about 3 repetitions of this, I finally hear, “GRRRRRRR!!!!!!” Followed by the sound of his angrily flicking the light switch off and flinging himself back into bed kicking at the foot board for another 10 minutes. After this episode, all was quiet.

I traded joking text messages with my ex-husband about the antics of the evening which only succeeded in making me feel more lonely. I sat on the phone and drank beer, putting my wrapping off until about midnight. When the distraction was gone, I just cried. I cried for everything I had and lost. Years of traditions and happiness all gone. Yes, I still had my children… but no one to carefully wrap meticulously chosen gifts for in my handmade paper or fill a stocking full of completely ridiculous things I had found throughout the year. No one to lay exhausted with me on the living room floor and stare at the tree upside down in the dark. No amount of wishing could help. Nothing could fill the gaping chasm where my christmas spirit used to lay. Christmas is about family and togetherness… and all I had in that moment was myself.

Christmas morning came. Richard opened one present in his stocking, a video game which he hoarded away into the play room and refused to participate further in opening presents. Brooke raced through the opening of her gifts with super speed. Squealing with delight at how Santa knew JUST what she wanted and spraying thank you’s like a fountain between gasps of joy. It was over quickly as I couldn’t afford mountains of gifts but the elation I saw on her face made up for how quick the moment had passed. I had to wait for my ex-husband to come pick Richard up so that he could help me coerce him into opening his presents. The last thing I wanted was to battle a crying child to receive gifts! So “togetherness” even in the moment of Christmas morning was shattered. No opportunity to sit under the tree and pass presents around, opening in unison.

Dave had brought me a couple of small, yet thoughtful presents which was more painful than nice. We sat outside and had a cigarette as Richard stomped the ice in the driveway with his boots and coat over his footie pajamas. I said my goodbyes and went back inside to bide my time waiting for Ryan to come pick Brooke up. We discovered that the bulb for the TV had broken so we made hot cocoa, brought our mugs to the bedroom and cuddled in my bed to watch one of the DVDs she had gotten. Ryan arrived to pick her up, and we exchanged small presents for each other. Unlike Dave, my relationship with Ryan is a very close one and I didn’t find myself sad during this time. His gifts for me were completely random and perfectly suited for me as usual and he adored the zombie inspired meditation book I had found that just screamed for me to get for him. We said our goodbyes and I went back into the house to get ready for work.

I knew better than to deliberately switch shifts to work on the holiday. I should have known I’d find the same disenchantment there as I had at home. No one had brought food and cameras as we had in previous years. The decorations were sparse and very sad. Everyone had worn their typical scowls due to the abundance of miserable patients. Of course, I found myself with the assignment full of whiny medical patients who shouldn’t have been there in the first place and patients from the intensive care unit who never should have been transferred. I was a glorified waitress, catering to the various excessive “needs” of my medical patients and their families, “I need 3 waters, 2 jellos, and a partridge in a pear tree, thanks!” I can’t forget the guy who’s girlfriend was a bigger headcase than HE was and he had mild retardation! His girlfriend insisted on getting free food by convincing everyone that she was hypoglycemic and if she took the time to go downstairs and purchase food (or god forbid, go HOME to eat for free) she would deliberately fall over on the floor. She demanded a constant supply of ginger ale and crackers throughout her stay, threatening that she would vomit without them. I deducted she was one of those people who invents illness while around people who are ACTUALLY sick. Forget the fact that she was morbidly obese and would have probably resorted to eating the patient if we didn’t bring her food… it was the low blood sugar driving her to consume everything in sight. Yeah, that’s it.

As I’m getting ready to take my dinner, one of the nurses calls out from one of my patient’s rooms (an ICU transfer from earlier), “I need your help! He’s unresponsive!!” Let the games begin. The world’s most incompetent resident arrived to order a barrage of tests, asking me the same questions a million times because apparently memory becomes unimportant when you’re a doctor. I’m trying to do an EKG, get a blood pressure, and tell him for the millionth time the dosage of a drug that was administered. I could go on and on describing the idiocy but I’m going to spare myself from reliving that particular frustration. It was decided to move him back up to the ICU since his lungs were full of fluid and he was barely able to breathe.

After the whole ordeal was finished. I went to dinner 2 hours behind schedule and came back to request that I switch places with the person sitting with a patient on one to one observation. The patient was going through alcohol withdrawal but spent pretty much the whole time sleeping. He did wake up briefly to say, “Isn’t there anything else on besides Christmas shows?” I informed him that he’d be hard pressed to find anything else with it being Christmas and all. He then proceeded to subject me to Deal or No Deal. Horrible show. In fact anything resembling a game show is horrible. Right up there with reality TV and the women’s station dubbed “Lifetime”. Outside of that, he did also have a habit of missing the urinal and instead just pissing all over his bed then sleeping through my struggle to clean him up and change the bed underneath him. I also wonder if dental hygeine had EVER been a concern for this man since with every exhale a rank cloud was expelled from his mouth and swallowed the entire room with it’s horrid stench. From across the room, I was forced to breathe by pulling my arm halfway into my sleeve like a turtle and put my nose into the hole. If he would have fallen into a bit deeper sleep, I would have brushed his teeth while he was out cold. All in all though, it was a perfect way to conclude my Christmas day.

I stopped at the gas station on my way home, purchased a pack of cigarettes with quarters since I am just that poor, then drove the rest of the way home sullenly. I picked up the explosion of wrapping paper from the morning and put it in the garbage bin. I changed into my pajamas and laid in bed, falling asleep to a movie as usual. Just another day come and gone. Honestly, it’s hard to tell if it even happened at all.

 

the usual chaos October 26, 2007

Filed under: on work — somniare @ 7:45 am

What I see day in and day out is typically enough to turn the stomachs of the strongest individuals.

Last night, once again the floor was hideously understaffed. I was split between working at the desk for the first 4 hours, going to a conference regarding the development of the hospital, then the remainder of my shift picking up a patient assignment on the floor. This was how things were supposed to work.

We had already had a deranged veteran on the floor who needed one to one supervision. This means that the hospital was supposed to designate someone from the nursing office to come and sit with the patient due to them having needs that were beyond the nursing staff on the floor to be able to accommodate on top of being able to take care of the rest of those on their assignment. This usually pertains to patients who are at risk for climbing out of bed, confused, ripping out their IVs or other medical devices, etc. and require someone to sit with them 24 hours a day to make sure they don’t hurt themselves in their mania. In the first hour of the shift, we received another patient in a state of dementia. Because the nursing office had already decided to leave the unit stranded without any help, someone had already been pulled from the floor to sit with the crazy veteran who screamed at everyone in military terms and then had to find someone else to sit with the new woman. That lucky person… me.

So I’m walking in (following the screams to find the correct room) and am greeted by 5 pairs of exasperated eyes as they were struggling to turn her to change the linens underneath her. She’s howling on and on, “This is TERRIBLE, I feel AWFUL!!!” But her favorite phrase was, “This is just ROTTEN, I feel ROTTEN.” This poor little woman in a state of complete degradation… she had to be the oldest person alive. Shame on me… all I could think about was, “Oh lord, if I ever get to this point where I don’t even realize that I have lost my dignity, please just remove me from the planet with swiftness.” I will spare you the gory details as to WHY this poor woman was brought to the hospital as the visual I’d create for you is one that would cause sleeplessness for years to come… well as an inability to every eat a grapefruit… yeah, you don’t want to know.

When the commotion was finished, I sat on the windowsill next to her bed as there was no chair for me and no one would take the time to bring me one. I sat and talked to her. She glanced at me with looks of disdain every now and then but refused to be baited into conversation. As she sat there looking away from me, I decided a different tactic was in order. I looked at her hunched shoulders as she struggled to get comfortable in thought with her head bent at such a crooked angle. Her arms were covered in goosebumps from having been recently stripped and exposed to the cold, dry air. She wouldn’t drink the lovely concoction otherwise known as a bowel prep that I was lucky enough to have to give her. So I walked up to the side of the bed, lowered the head a bit, pulled the pillow to the side so that her head would stop rolling off of it and put an extra blanket around her shoulders. I stepped back and she looked up at me with the clearest blue eyes, lucid and aware she said, “You are lovely. That is so much better. God bless you.” From there on out, she would listen to no one BUT me, she wouldn’t so much as look at anyone else. When the nursing office finally sent someone to relieve me, I said goodbye.

Later in the evening, I had to head off to the ridiculous conference regarding all of the new plans for the hospital. “Crucial Conversations” they call them. I had been to the first round of these talks and dreaded walking into this one. I am not shy about speaking up in these. I am no public speaker but for some reason, I feel the need to speak up for myself and those that have suffered with me for years on my struggling unit. I brought up a few points that got the entire room riled up and the conference ended up lasting nearly two hours throwing me way back in my work by the time I got back to the floor.

I walk back up to the unit and was met with what could be described only as pure chaos. They had blocked off multiple sections of the floor due to having to wax the floor so the halls were absolutely crammed with stretchers, equipment, linen and supply carts and employees weaving in and out like pedestrians during rush hour in NYC. The call lights above the patient’s rooms were lit up and down the halls like seizure inducing beacons. I was immediately assaulted by 3 or 4 people telling me about various things that needed my attention, “Go help them with the patient that was dropped off in 67… they didn’t even call report and the room wasn’t even clean yet, they are just sitting in the hall and no one knew they were coming!!” “The only aide scheduled to come in on the night shift called in! There’s no one to do midnight vital signs!” “There’s a stat blood draw in 58! Go get the bucket!” “I need a pre-op EKG in 76!” The list went on and on and my head just spun as I stood in the middle of this apocalypse. The last bit of news was the icing on the cake. The one to one from the nursing office had to leave at 9, you have to go sit with 54. Well, alright then… at least that saved me from all of the needy bastards that had the balls to launch a million things at me within seconds of returning to the floor.

I walked back in to the little old woman’s room. Sit back up on the window sill and look at her. She’d reverted to her epic pouting, sitting with her arms crossed, picking at her blanket in misery and wouldn’t so much as look at me. I sat quietly on the sill for about an hour. I decided to risk speaking with her again. She looks over at me, not quite lucid any longer but her emotions were sparked. She goes off on a barely coherent tangent about being degraded and how everyone is out for themselves. She was waving her arms in disgust at how the doctors and nurses are all out for themselves to merely get ahead in the world. Her treatment wasn’t about here any more, it was about a mission to boost egos and look better on paper. For some reason, I understood. I asked her if she had any children in an effort to steer the talk a different direction. It worked. She had one son whom she seemed to think the world of. “He’s a good boy… such a good boy.” She repeated this sentiment in various forms for a good half hour before she tired herself out. She spent the next 15 minutes contentedly staring at me when she thought I wasn’t looking. When the time came for me to leave as the relief for the night shift, I reported off to the nurse and stepped back up to the bedside. She reached out and took my hand and a smile lit her face in a way I would never thought imaginable. Youth and vitality just radiated. As I held her hand she says to me, completely coherent, “I have had my day and I want to enjoy the rest of my days. I will live through this as I have lived through everything else. You have been absolutely wonderful. Thank you so much for taking such good care of me when everyone else just left.” I would be lying if I said I wasn’t touched. I made a difference to someone. Whether she remembers me is not important, I will remember her.

I walked out and proceeded to help out with the midnight vitals for the next shift. I did my patient assignment (whom I never actually got to see over the course of the evening) and then helped out a bit extra. I got out 15 minutes late and my head and chest were killing me from breathing the fumes from the floor wax. I was untouched by it all though. I looked around at all of the miserable faces and felt a small little burning of hope for them all and the future of this unit 2800. I haven’t felt anything in months working there. Nights like this… well, they put life in perspective. Put my purpose into plain view. I am here, on this world, in this job, doing what I do for a reason. I slept like a baby that night.

I love my job.

 

reconnect October 24, 2007

Filed under: on work — somniare @ 1:56 pm

It’s cold outside. I adore the fall. I wish I could be outside taking a walk and there wouldn’t be houses and cars booming with teeth-vibrating bass. Or people who don’t move at all as you approach and instead demand that you circumvent them because drifting to the side a bit is below them.

I will be dragging myself back into work today while mentally clawing at the walls for escape from all of the dramatics and sadness that reflects the bleak weather on the outside of that building. Yesterday was terrible. I went in with high spirits that were slowly chipped and broken throughout the course of the day. Even when negativity isn’t directed toward me, I absorb it like a masochistic sponge. I sit and watch as my coworkers are degraded into tears and just feel like I’m going to drown in my own bitterness. I’ve put up with this for years and have managed to retain myself through it all. Hardest is watching many wonderful people who used to be pillars of support in the field, digress into the dynamics of highschool. Their personalities have shattered . They bring it home, carry it around with them, their anger is so obvious.

The patients suffer the brunt of this. Scattered in their rooms like tantrum-flung toys. They are the truly broken bodies that demand attention. The nurturing touch of those that can step out of their own lives and the traumas of existence on unit 2800… and instead, well… they are victims. It pains me to hear some of the things they tell me. Nurses running off to get an aide to help them to the bathroom because they couldn’t take the time to get them out of bed themselves, aides not taking the time to so much as offer to shampoo their hair during their morning baths because it would be too time consuming, the same cup of water sitting at room temperature that hasn’t been replaced for 3 shifts. The simple things.

Everyone forgets the simple things. So absorbed by the severities, attention to detail is lost. The medical field should be an art… a complex and beautiful symphony of people working together for one sole purpose. As it is, all I can hear is the clamoring of a junior high band. Out of sync and not really wanting to be there… thinking more of where they are going after school and passing notes in study hall. Without focus, there is no hope.

When did it become such a rarity for people to step outside of themselves and redirect. When did it become a million people all talking about how to improve the circumstances but not one single person stepping up as the catalyst. What does it take? Apparently the pain and suffering of the innocent people laying at the mercy of cruel fate is not enough to inspire true action.

I speak of this from the inside, not an outsider looking in.  I lack the power to be the mentioned “catalyst” but I sleep well at night in the security that I can pick up some of the pieces… repair some of the damage. Be someone better than what surrounds me. I don’t bring my home life to work and I don’t bring my work life home. Ultimate detachment whilst attempting connection within the individual sections of my life.