There are very few patients who push my buttons. In fact, I'm the one that the nurses come to when they have a patient they don't want to deal with. So when one of my favorite nurses (she refers to me and herself as "the alpha bitches," which from her is a compliment) snagged my arm at the nurses' station and started telling me about the patient she'd just brought back, I kinda rolled my eyes.
"firefighter girl, she's 17, diabetic, states she's had high sugars for a week and a half and is now convinced she's DKA. She refuses to put on a gown, has a leopard print blanket and a red heart teddy bear, and claims she's a hard stick. p.s., the woman with her is her mother, but don't expect her to say a damn word."
Alpha Bitch leans close and grips my arms hard enough to leave bruises. "good luck."
Piece of cake.
I grab the IV tray, and if I coulda set it twirling on top of my index finger, I would have- my game was that good, baby. I love patients who are "tough sticks." Especially the ones who think they know my job better than I do.
I walked in to see the princess sitting criss-cross applesauce (we used to call it Indian style) on her gynie bed throne in a private room. Mom stood anxiously at the foot of the bed. Amazingly, as soon as I entered the room, the princess started Kussmauling. I leaned in a little closer and sniffed for that sweetish ketone scent a true DKAer would have, but all I could smell was the pungent odor of bullshit. I looked at her, sat down on my rolling stool, and started preparing the IV goods.
"Just so you know, I'm a tough stick. You're only going to get me from here up, and even then you'll have a hard time," she says, gesturing to her antecubitals. "It always takes them four or five times to get me. At least." She glared at me triumphantly, then resumed her Kussmauling.
I recommended that she calm her breathing down before her hands got all numb and tingly and stuff. Her eyes narrowed. I started asking my standard questions, things that I ask every diabetic patient: how high have your sugars been, for how long, what are they normally, have you been sick, do you take your insulin regularly, etc etc etc, blah blah blah. Princess stops her hyperventilating long enough to take a deep breath in order to deliver a speech she's hoping will scorch my eyebrows off.
"I. Am. A. Brittle. Diabetic. When I am sick or stressed my sugars go way up. We'd all do a lot better if you'd just shut up and quit judging me and start paying attention to what I'm saying. Understand?"
It makes me blink a little. I try to cover up my guffaw with a cough. I explain to her that these are questions I ask every diabetic, I've never met her before, I haven't read her chart, I'm here to start an IV and draw some blood. I am being very, very nice and oh-so-polite. And as patient as god, I might add; my mother would be so proud. She sighs and flips her hair. I ask for her arm, and wrap the tourniquet. I dutifully check her ACs- nothing doing- and then, lo and behold. . .
a beautiful vein goes POP in her right hand. And another one springs to attention in her wrist. And so I reach for the swab. . .and she yanks her hand away.
"Excuse me. We just went over this. You're not getting any vein down there; they roll. And while you screw around with that and miss, you're wasting precious time that you could be using to start an IV where I tell you so I can get the medication I need."
I'm afraid I may have started losing my patience. I give her the standard "I will take your suggestions into consideration, but I do this all the time and I will start an IV in the place I feel is best. Please allow me to do my job" speech. I reach for her hand, swab at that gorgeous, bouncy blue vein, and she yanks her hand away again.
"If you aren't going to listen to me, you aren't going to start my IV. Go get somebody else."
I unwrapped the tourniquet and said, "fine, honey. I'll go see if I can find somebody to help you. We're awfully busy, though, so it may be awhile." and I smiled at her, left the room, and went into the store room to kick some boxes. It was that, or pull her hair and scratch her face with my nonexistent fingernails.
I decided to ask the one male nurse on shift if he could fit in the IV. I had a feeling the princess would prefer a guy, anyway. And I told my young, buff medic student to hang around and soften her up a bit, too. Male nurse said his rooms were all full, but he'd get to the princess when he could. I thanked him, asked if there was anything I could help him with, offered to wipe his patients' butts because that would be far preferable to dealing with the brat. . .er, princess. . .again. He laughed. I warned him I would be getting the better end of things. Pun intended.
As I walked by the room, I noticed the brat's mom hovering outside her door. I mentioned that I had someone coming in, but it would be a while before he could get there. She said, "you know, she's such a hard stick, it would probably be best to get the IV team in here to do it."
I smiled at her. "Ma'am? I am the IV team."
Medic pay in the ER? not much to write home about
The incredibly self-satisfied feeling I got, watching her jaw drop and her mouth open and close like a fishy while she attempted to stammer an apology for her spoiled rotten daughter? priceless.
fyi: if my daughter ever, ever treats anyone like that, she will be flogged and bound and forced to watch reruns of . . . of. . . Barney until she gets control of her lip. I cannot imagine treating anyone as poorly as that 17 year old girl treated every single person entering her room with the sole intention of helping her. And I wasn't the only one kicking boxes in the stock room last night.
Monday, April 28, 2008
Friday, April 25, 2008
how to pay karmically out the ass for your next 15 lives
be an arsonist, and decide to light the lovingly rebuilt, restored, revamped Lincoln Continental of a tattooed paramedic/firefighter nicknamed. . .well, nicknamed the name of a guy you probably wouldn't want to mess with, who happens to be good friends with most of the cops in Meth Central. Oh, and pay no attention to the Maltese Cross on the back window, the one that says "american association of firefighters." Yeah. Good luck. Have a nice life.
mini update
1) we picked the implant we liked, and MixMan's surgery date is June 25th.
2) BSUYAM told me the position is mine and approved the schedule we made. (can i get a whoa! and a hell yeah!)
3) The hair pet problem seems to be under control. Although the stench of rosemary and tea tree oils with a light note of neem rolls out of our house in waves when you open the front door.
2) BSUYAM told me the position is mine and approved the schedule we made. (can i get a whoa! and a hell yeah!)
3) The hair pet problem seems to be under control. Although the stench of rosemary and tea tree oils with a light note of neem rolls out of our house in waves when you open the front door.
Thursday, April 24, 2008
a few of my favorite things
working night shift does crappy things to your brain. It messes with your emotions and your mental health, especially if you aren't getting any sleep for three of the several days you work because you happen to be a mom, too, and kids don't understand night shift. But that is neither here nor there, it just is what it is. I used to be such a cheerful, happy person, fairly compassionate, and then I got pneumonia at the end of october, and was in bed for two weeks, and by the time I got back to work- still sick, mind you- I realized that most of the people in the emergency room as patients were less ill than I was. And that made me a little bit pissy.
Anyway, I decided this morning that I need an attitude adjustment, and the best way I know how to do that is to make a list of all the things I love, and all the things I'm thankful for. So here it is. . .my freaking joy list:
my bed, with its cushy top and down comforter; the color combination of pink and green, tulips and daffodils, ranunculus and windflowers; my son's toothy grin, lying in bed with movies, books, and a notebook, poetry penned on napkins and restaurant coasters, found poetry, colors so gorgeous and vivid I want to pop out my eyeballs and soak them in it, rainbows after a violent storm, the warmth of my lover next to me in winter, lying naked in front of a fireplace, pears and cheese with wine, the perfect pair of jeans, or failing that, the near-perfect pair of jeans, Jembosaults, my daughter's uncensored laughter, the way an iv feels going into a vein just right, coffee so strong and thick a spoon stands up in it, realizing that you can live without a certain someone but you'd really rather not, sitting under a tree on a blanket in the summertime, sundresses and sunhats in the garden, flip flops, toe rings, chokers, piercings, tattoos, LuLu Guinness glasses, grippy toes, bare feet, hot tubs, hiking, camping, snowboarding, views that take my breath away, my mama's hugs, spending time with my family, how loose and lovely my body gets after 15 hard minutes on the treadmill, dancing away all my give-a-shit, strong bass I can feel in my bones, listening to my deaf son sing, any music with real soul, books I can get lost in, home- not necessarily the place you live, but a place that feels so right you don't want to leave, wet kitty noses, the smell of old books in leather bindings, art almost as old and grand as god- the Sistine Chapel, the statue of David, you know what I mean-, mud between my toes, my children's safety, good friends who love me unconditionally, recovering from a Sylvia Plath moment, redheaded sisters, geminis, astrology, handwritten letters, love letters, getting flowers, gifts that show somebody's listening, affection, public displays of affection, mail slots, running my hands over the Rock Star's shaved head, the crinkles at the corners of his eyes, lips so soft I want to suck them off, holding babies (and then giving them back!), hot showers, lavender plants, rose oil, necklaces, clothes I can change with my mood, secrets, massages, interior design, getting down to the nitty gritty in a relationship and really knowing the soul of someone else, fuzzy socks, text messaging, all the Lou Whos, fingerpainting, love and being loved, trust, and last but not least, R E S P E C T.
Anyway, I decided this morning that I need an attitude adjustment, and the best way I know how to do that is to make a list of all the things I love, and all the things I'm thankful for. So here it is. . .my freaking joy list:
my bed, with its cushy top and down comforter; the color combination of pink and green, tulips and daffodils, ranunculus and windflowers; my son's toothy grin, lying in bed with movies, books, and a notebook, poetry penned on napkins and restaurant coasters, found poetry, colors so gorgeous and vivid I want to pop out my eyeballs and soak them in it, rainbows after a violent storm, the warmth of my lover next to me in winter, lying naked in front of a fireplace, pears and cheese with wine, the perfect pair of jeans, or failing that, the near-perfect pair of jeans, Jembosaults, my daughter's uncensored laughter, the way an iv feels going into a vein just right, coffee so strong and thick a spoon stands up in it, realizing that you can live without a certain someone but you'd really rather not, sitting under a tree on a blanket in the summertime, sundresses and sunhats in the garden, flip flops, toe rings, chokers, piercings, tattoos, LuLu Guinness glasses, grippy toes, bare feet, hot tubs, hiking, camping, snowboarding, views that take my breath away, my mama's hugs, spending time with my family, how loose and lovely my body gets after 15 hard minutes on the treadmill, dancing away all my give-a-shit, strong bass I can feel in my bones, listening to my deaf son sing, any music with real soul, books I can get lost in, home- not necessarily the place you live, but a place that feels so right you don't want to leave, wet kitty noses, the smell of old books in leather bindings, art almost as old and grand as god- the Sistine Chapel, the statue of David, you know what I mean-, mud between my toes, my children's safety, good friends who love me unconditionally, recovering from a Sylvia Plath moment, redheaded sisters, geminis, astrology, handwritten letters, love letters, getting flowers, gifts that show somebody's listening, affection, public displays of affection, mail slots, running my hands over the Rock Star's shaved head, the crinkles at the corners of his eyes, lips so soft I want to suck them off, holding babies (and then giving them back!), hot showers, lavender plants, rose oil, necklaces, clothes I can change with my mood, secrets, massages, interior design, getting down to the nitty gritty in a relationship and really knowing the soul of someone else, fuzzy socks, text messaging, all the Lou Whos, fingerpainting, love and being loved, trust, and last but not least, R E S P E C T.
Tuesday, April 22, 2008
it was a really close shave
patient comes via ambulance with vague abdominal complaints. Doc goes to do a quick stool occult. Suddenly, from behind the curtain, we hear this:
"well, son, you've got somethin' shoved up there!"
I hastily cleared a private room.
a gentle reminder: never do anything you can't explain to the paramedics. or the ER staff.
Monday, April 21, 2008
Saturday, April 19, 2008
this is a thing called hope, and it's on the horizon
MixMan and Miss Diva woke me up this morning at 0730. They'd been up for an hour already (why is it that during the week I have to drag them out of bed at 0700, but on the weekends they're raring to go all bright and shiny? I need my blasted beauty sleep.) They're downstairs, watching Saturday morning cartoons in their pajamas, MixMan with his cochlear implant brochures tucked under his arm. I'm upstairs in the work room, studying a couple of canvases, some emails, and contemplating another pot of coffee.
A friend of mine and I were discussing some rather personal things last night. I may have mentioned in a previous post or two that night shift has made me a little crazy, and I'm finding my Bell Jar moments are becoming more frequent; so much so that at least one of my friends is starting to refer to me as Miss Sylvia. But I was trying to figure out how it was that I became so impenetrable to emotion. And it's not that I don't feel it, I do. And I honestly feel like I show it a lot, too. . . but that's apparently not the case. During ACLS classes, a couple of the veteran night shift nurses were talking about how tough the testing used to be, how they'd throw up before "mega-codes." And I said, "me, too! I hate testing, I get so nervous I can't breathe." And one of them looked at me, and said, "yeah, right, FFG. Whatever. Nothing gets to you." And I've had ex-boyfriends tell me that they get so petrified of doing anything wrong because if they do, they get "the look" that makes them feel like they just killed someone's puppy. And yes, that's a quote.
When did that happen? What jacked up bull crap kind of coping mechanism is this, that pushes everyone away when I need them the most? Sheesh. Night shift and lack of sleep certainly haven't helped. In this profession, too, it's necessary to maintain a very delicate balance of compassion and cynicism, and frankly, the compassion index is usually a little low. But (Blow-Sunshine-Up-Your-Ass)istant Manager posted two new medic positions for noon to 2200, and when I mentioned that I was interested, he told me to go ahead and make my schedule. So I handed it over to Rock Star, because he's better at these things than I am. And he came up with a schedule that gives us lots of time together, and time with the kids, and time for sleep and real life. (isn't he amazing? I think so.) Now to pass it by BSUYAM. . . keep your fingers crossed for me. And that light you see at the end of the tunnel? I'm running as fast as I can toward it.
A friend of mine and I were discussing some rather personal things last night. I may have mentioned in a previous post or two that night shift has made me a little crazy, and I'm finding my Bell Jar moments are becoming more frequent; so much so that at least one of my friends is starting to refer to me as Miss Sylvia. But I was trying to figure out how it was that I became so impenetrable to emotion. And it's not that I don't feel it, I do. And I honestly feel like I show it a lot, too. . . but that's apparently not the case. During ACLS classes, a couple of the veteran night shift nurses were talking about how tough the testing used to be, how they'd throw up before "mega-codes." And I said, "me, too! I hate testing, I get so nervous I can't breathe." And one of them looked at me, and said, "yeah, right, FFG. Whatever. Nothing gets to you." And I've had ex-boyfriends tell me that they get so petrified of doing anything wrong because if they do, they get "the look" that makes them feel like they just killed someone's puppy. And yes, that's a quote.
When did that happen? What jacked up bull crap kind of coping mechanism is this, that pushes everyone away when I need them the most? Sheesh. Night shift and lack of sleep certainly haven't helped. In this profession, too, it's necessary to maintain a very delicate balance of compassion and cynicism, and frankly, the compassion index is usually a little low. But (Blow-Sunshine-Up-Your-Ass)istant Manager posted two new medic positions for noon to 2200, and when I mentioned that I was interested, he told me to go ahead and make my schedule. So I handed it over to Rock Star, because he's better at these things than I am. And he came up with a schedule that gives us lots of time together, and time with the kids, and time for sleep and real life. (isn't he amazing? I think so.) Now to pass it by BSUYAM. . . keep your fingers crossed for me. And that light you see at the end of the tunnel? I'm running as fast as I can toward it.
Thursday, April 17, 2008
overheard. . .
from the front seat, while driving children home from school
my five year old, dainty, blonde-haired pink-clad Miss Diva: "MixMan!! Pull my finger!!" with the usual result and great belly laughs ensuing.
in the break room at work
the blow-sunshine-up-your-ass new assistant manager of our ED, speaking to one of the docs:
"hell, no, I'm not having any more children. I just inherited 37 of them when I got this job."
my five year old, dainty, blonde-haired pink-clad Miss Diva: "MixMan!! Pull my finger!!" with the usual result and great belly laughs ensuing.
in the break room at work
the blow-sunshine-up-your-ass new assistant manager of our ED, speaking to one of the docs:
"hell, no, I'm not having any more children. I just inherited 37 of them when I got this job."
sometimes, dreams come true
three months ago, MixMan was telling me about his dreams, which he likes to do. Usually, they involve a great deal of running and shooting and 'splosions and magic power jewels and all things Sonic the Hedgehog. But this particular time, he looked at me and said, "Mama, in my dreams, I can hear, and I don't have to sign."
the next day, I started gathering up referrals and getting everything in order to determine his eligibility for a cochlear implant.
so on Tuesday, we went up to Big City Hospital. Before we were even out of town, MixMan's daddy started complaining about my car and my music and my driving. He said I drive like a grandma.
whatever.
Anyway, I told him to shut up or he could walk. He shut up.
Once we got up there, MixMan went through a battery of audiological tests. He stayed focused and worked so hard, and it turns out that his hearing loss is in the profound range (which I knew, but he's so sneaky and smart and hated the hearing tests so much that we never could confirm it). In any case, he's definitely eligible for the cochlear implant, and we spoke with the surgeon, and picked out the model that we like, and we'll be scheduling the surgery for some time this summer. The audiologists and the surgeon are all very very hopeful and optimistic about MixMan's potential with this-- he's had such dedicated speech therapy since he was 10 months old that in addition to being able to hear normally at 20db with the ci (instead of the 50db he hears at a whisper with hearing aids, and to put that in context, a normal conversation takes place at 35-40db- which means MixMan is very good at lip reading), his voice tone will also most likely improve. They did say that because of the profound hearing loss, he is eligible for bilateral implants, but most people we've spoken with recommend unilateral with the hearing aid in the other ear, at least for a while. The ci also comes with little attachments for an ipod or mp3 player, so MixMan can listen to music instead of just the thump of the bass.
MixMan is so excited. and so am I.
the next day, I started gathering up referrals and getting everything in order to determine his eligibility for a cochlear implant.
so on Tuesday, we went up to Big City Hospital. Before we were even out of town, MixMan's daddy started complaining about my car and my music and my driving. He said I drive like a grandma.
whatever.
Anyway, I told him to shut up or he could walk. He shut up.
Once we got up there, MixMan went through a battery of audiological tests. He stayed focused and worked so hard, and it turns out that his hearing loss is in the profound range (which I knew, but he's so sneaky and smart and hated the hearing tests so much that we never could confirm it). In any case, he's definitely eligible for the cochlear implant, and we spoke with the surgeon, and picked out the model that we like, and we'll be scheduling the surgery for some time this summer. The audiologists and the surgeon are all very very hopeful and optimistic about MixMan's potential with this-- he's had such dedicated speech therapy since he was 10 months old that in addition to being able to hear normally at 20db with the ci (instead of the 50db he hears at a whisper with hearing aids, and to put that in context, a normal conversation takes place at 35-40db- which means MixMan is very good at lip reading), his voice tone will also most likely improve. They did say that because of the profound hearing loss, he is eligible for bilateral implants, but most people we've spoken with recommend unilateral with the hearing aid in the other ear, at least for a while. The ci also comes with little attachments for an ipod or mp3 player, so MixMan can listen to music instead of just the thump of the bass.
MixMan is so excited. and so am I.
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