Getting in my own way...

"Never let yourself get in your own way"

Wait...what does that even mean? *Sigh* Quick tongue, quick temper, quickly in trouble. If I can just figure out when to bite my tongue and let things go and when I need to speak up and hold my ground I feel I'll be a lot better off. So many personalities, opinions, patients, situations in the ER. To explain a little further, we had a registration gal tell us they wanted to bring a patient back, skipping four patients that had been waiting longer, because "this patient never comes in". Uhh, that's technically discriminating, and we can't do that. Another registration gal makes a little mistake and brings back a patient who hasn't been waiting as long as someone else. Not really the end of the world, but I know these patients are watching who is going back first, and keeping mental tabs on who has been waiting longest. I got to hear all about it last week when a patient flipped his lid that I saw someone else before him (he was brought back out of order, and  I tend to look at the situation first, then the triage time, so yeah, he came back first, but the other patient was waiting longer). But the second gal wants to make a big deal about this, in front of everyone, and it's awkward, and I'm wishing I had just not said anything to feed into this dispute. I have six patients to take care of, and I really don't want to piss off the charge nurse.

Demons & Denial

Whiskey eyes/It's not him looking down at me/He's mad, and a small bolt of fear hits my heart/I don't know this man/There's no reasoning with him/He's mad, and I don't know what to say, or do/I keep quiet, refusing to argue with him/Crashing and anger/This isn't real...

He's gone and back again/This time he's hellbent/Threats and anger seeping out of every pore/I'm still half asleep/What is going on???/There's a gun now/And I'm calling 911/This isn't my life/His whiskey eyes are angrier, filled with fire and hate/I don't know what exactly he's capable of/But I don't want to find out...

There's so many cop cars parked in front/This isn't my life/That isn't my husband/I'm so upset; so angry/This is my home/My peace and serenity/I second guess every decision I've ever made/Do I stay or do I go???/My little guy is wide eyed, looking around/Trying to figure out what is going on/Why are Grandma & Grandpa here so late?

Somehow, someway, everything turns out okay/No felonies, no harm/My heart is broken/My mind is reeling/I'm so upset/do I stay or do I go???/I look down at my little guy, sleeping in my arms/I made a promise once/He deserves the life I never had/So I reach out to his dad/He's beside himself/Hating himself and blaming himself/He knows now he can't drink/He knows now how close he came to losing everything/Somehow we'll try again and try to make it work/For him...

Inadvertent Skirmishes

Time: 9 days ago
Setting: All by myself, no second nurse, no ER Tech, no breaks. My bladder is about to explode, my stomach has stopped rumbling a long time ago. The ER is getting pounded with ambulances, every room is full with ten people in the waiting room. The queue keeps getting longer. I'm helping out as much as I can, taking people back to fast tract to "get them going" until a bed opens up front. Never mind the acuity, never mind the lack of monitors. Never mind there are six of them and one of me. There's a gentleman who will need moderate sedation to pop a dislocated ankle back into place. Labs & IV started, x-rays done, pain meds given. No problemo. The usual drug seeking behaviors, lots of time-consuming IV abx. My charting gets more and more behind. The ER medical director asks me if I'll stay late; kind of a moot question since I'm already late getting off. No problem, I agree to stay until the 4's are gone. The last one finally leaves, at around 145 AM, and I look at my mountain of charts that still need to be documented. Wait, my NP provider says. There's a "soft 3" in the waiting room, we should see him too. She says something about IV fluids, and I know I've hit my limit. I set the clipboard down with a little more force than necessary, and tell her I'm already behind...I'm due back tomorrow, on a shift I've picked up on top of my regular schedule, my little guy will be getting up in 5 hours, regardless of how much sleep I've gotten, and I am done. I just don't have it in me. The ER Gods smile down on me as I learn that the S3 has eloped, or has left before being seen due to the wait times.

Time: 8 days ago
I'm back for the shift I've picked up, and I'm getting pummeled again. I have a sepsis work-up, two infants (one 12 days old) that need IV hydration, and an admit. At least Siv is my ER Tech; he's good and a hard worker. I'm so grateful to have someone to help out a little. I talk to the NP about my outburst later on that shift, and apologize. She says she understands, and I tell her I'll work harder on controlling my emotions. I didn't realize I upset her so much, but I feel better after talking to her. 0100 rolls around, and my crazy string of shifts comes to an end. I walk out, looking forward to six glorious days off.

Time: Yesterday
I email my manager to relay my concerns about the acuity and being so understaffed. She apologizes, states she didn't realize the ER Techs were being pulled from me to do random things up front. She's hired another nurse to start the beginning of July. And by the way, what was up with me throwing a chart last week? I'm shell shocked. What? I didn't throw a chart. I had no idea Deb was so upset about this. Why would she go to Kendra? She never said anything about this when I talked to her. I apologize to my supervisor, try to explain what happened, but I get the sinking feeling it isn't doing any good.

Time: Today
My first day working with Deb. I am still a little upset and hurt, but I've decided to suck it up and just be professional. Subconsciously I think I'm deliberately being extra cheerful because I don't want her to think I have a bad attitude. The shift goes well, and we're on the last patient of the day. Slammed her hand in a car door...looks pretty painful. No obvious fracture on the x-ray, so Deb gives us an order to ACE wrap and her discharge papers. I go in to let her go, and place the ACE wrap on her hand. I'm wrapping it a lot more loosely than I normally would; she's cringing and appears to be in pain. She looks up at me and says, "I think I'm going to pass out". Her skin is super pale, especially against the contrast of her raven black hair. I tell her to put her head between her knees, ask the ER Tech to get her a cold washcloth, and check her vitals. Her blood pressure is 80 something over 37. Shit. That's not good. I'm asking her questions, and taking her blood pressure again. I try to find Deb, but she's gone. I have a sinking feeling in my stomach...technically the provider isn't supposed to leave until the patient is gone. I ask the charge nurse, Mike, if he's seen Deb. He says she's done for the night. I explain to him what's going on, and he comes back with me. I check a blood sugar, another blood pressure reading, and so on. Mike talks to the ER medical director about bringing her up front. Crap. This is Deb's boss. I can't help thinking, I really hope Deb doesn't think I'm just trying to get her in trouble. The patient feels better and is insisting on going home. As I finish up my charting, say my good-byes and walk out the ambulance bay doors, my stomach is churning and Nate's saying is running through my head...ducks and kangaroos and orangutans with healthy doses of rhyming profanities to go with each.

I'll never make it out....alive

Twisted dark thoughts Fighting to remain in control Feeling of overwhelmingness An overwhelmingness that has no rhyme or reason I'm not sure what I'm doing here But I'm swimming against the tide The water gets darker Not unlike my thoughts My dreams continue to haunt me Each night gets darker than the one before And I fight to sleep for a moment Undisturbed, at peace. Fighting for a deep breath but there's something inside Taking up space and so I gulp on these bits of air Trying to get enough To calm this panic The tide is rising and I'm fighting as hard as I can But how long can I go before it's too much?

What is wrong with me? Why do I think this way...First world problems I have nothing to be upset about. I have nothing to feel this way about.

Thousand Yard Stare

Slipping out the door after my fourth 13+ hour shift, without a real break in between, scarfing down a piece of pizza here, my Starbucks caramel machiatto and Rockstar, a few walnuts and candies there. So ready for some time off, to rejuvenate and recuperate after this particularly stressful stretch. The patients are a blur, the rooms they occupied a revolving door. At one point I stand in one spot and survey the emergency room, and I notice after a particular rush of patients has ebbed away, almost everyone has that thousand yard stare; going through the motions; their personalities, energy, and sometimes compassion sucked dry by the demands of doctors, patients, coworkers, themselves, their hidden worries about their families at home. The call lights continue, the orders keep coming, and the waiting room queue only gets longer. The panicky feeling rises higher and higher, the feeling that I'm losing control, that I'm getting further and further behind. I haven't peed since this morning, but there are so many things that need to be done, he needs pain medications, this person needs labs drawn, the 1 year old baby is crying in room 1, and my provider wants to know what the status is on the patient in the other room, and family members are asking for water, and it continues, as one minute clicks into the next, and I just do my best to keep up with the chaos. I try to be in the moment, this patient has been waiting an hour and a half to be seen; my mind flashes to the time I had to wait that long to be seen, the anxiety and frustration, the impatience. What are they doing in there? Why is it taking them so long to come see me? I look them in the eye, introduce myself, and thank them for their patience. They are my focus now, and I sit and listen, and try to my best to make them feel better. It's rewarding, so rewarding and so utterly draining. Lying here in bed, wondering what time my 2 year old will wake up in the morning, and wondering if I'll have the energy to focus on him, to give him the attention he demands and deserves.

Yet on my days off, I can't help but wonder what's going on at the hospital, what I'm missing out on...

The Hardest Part

The family. We were a strange little band of characters trudging through life sharing diseases and toothpaste, coveting one another's desserts, hiding shampoo, borrowing money, locking each other out of our rooms, inflicting pain and kissing to heal it in the same instant, loving, laughing, defending, and trying to figure out the common thread that bound us all together. ~Erma Bombeck

“Parents can only give good advice or put them on the right paths, but the final forming of a person's character lies in their own hands.” ~Anne Frank

I knew couples who’d been married almost forever – forty, fifty, sixty years.
Seventy-two, in one case. They’d be tending each other’s illnesses, filling
in each other’s faulty memories, dealing with the money troubles or the
daughter’s suicide, or the grandson’s drug addiction. And I was beginning
to suspect that it made no difference whether they’d married the right person.
Finally, you’re just with who you’re with. You’ve signed on with her, put in a half
century with her, grown to know her as well as you know yourself or even better,
and she’s become the right person. Or the only person, might be more to the point.
I wish someone had told me that earlier. I’d have hung on then; I swear I would.”
Anne Tyler, "A Patchwork Planet"

"A successful marriage requires falling in love many times, always
with the same person."
Mignon McLaughlin

I'm not advocating for loveless marriages. But it's also the case that marriage
doesn't make us happy every day. No marriage does, but your marriage serves
as so much more than just a vehicle for immediate individual adult needs. It makes
one world for your child, and children will tell you that means everything to them.
Elizabeth Marquardt, Between Two Worlds

A baby is God's opinion that the world should go on.
Carl Sandburg

Making the decision to have a child - it's momentous. It is to decide forever to have your heart go walking outside your body.
Elizabeth Stone

They're the ones dying...

Recording a trauma...motorcycle accident, no helmet. His injuries severe, prognosis bleak. Recording blood transfusions, medications, injuries. Hardware sticking out of his arm from previous surgeries, swollen left eye, the doctors looking at him, shaking their heads. Just another patient.

Until I hear he is related to so-and-so, and with a sinking heart I hear he's related to people I know, and my dad even knows him, and so on, and he's not another patient; he raised so and so, and these broken arms cradled her, and those eyes looked down on her as he gave her away, and suddenly it's so much harder to leave him behind as I walk out the ambulance doors. He stays with me, days later, as I watch her Facebook updates, and my heart is heavy with sorrow and prayers.

I don't want to know relationships. I don't like knowing the details of who they know. Montana is way too small. It's so much easier when there is no relationships, when they are an unknown person.

My heart aches, and my prayers go out to him. God knows what is best for him; the x-rays stick with me. If he makes it, he has a hard, long road ahead of him. Part of me wants him to go in peace, but then I think of her, and God, what would I do if that was my dad? I would want him to fight with everything he has, because I can't picture life without him.

I hate that life is so fragile. I hate that it changes in a split second. I hate that we can't control it.