Insomnia

So it's currently 05:22, and I can't sleep. I've been laying wide awake in bed since 02:00. I do love night shift, but I do not love the havoc it wreaks on my off-time snooze schedule.

Probably another reason why I can't sleep is that I had another one of those bad nights at work this week. Not where I did anything grossly wrong, but I just felt stupid all night. I even said something really, really stupid, which I will not share with you because I'm still mortified by it. I knew what I was thinking in my head and it was a coherent and correct thought; It just came out wrong and made me sound like someone who has never ever been through a single nursing class before. Ugh, just embarrassing.

But besides that, I spent the whole night feeling dumb. Bladder irrigation? Sure, I know the process in theory. Setting it up in the middle of a critical situation, however, is a different story when you've never done it before. Also worked with some critical med drips that I haven't handled before. Not so scary, except that when you have to print off the infusion chart from the computer and then track down a more experienced nurse to make sure you've mixed it right and then hang it and wait for a central line access and then try not to get in the way of the doc, trauma surgeon, six RTs, eight RNs, and three techs rotating CPR can be a little overwhelming.

Running a heart attack protocol? Easy in theory. Not easy when this is the first one I've ever run and the cardiologist is not sympathetic to my new nurse-ness. And especially not easy when there is a whole other set of symptoms not related to an MI that we're trying to figure out. I sort of wished for one of those cases where you think the guy looks funny, hook him to an EKG, and watch the machine print out the "ohh...uh oh...oh shit! those are tombstones" paper, and BOOM it's a STEMI, jam some aspirin and nitro down his maw and zoom off to the cath lab. No, I couldn't get a straightforward one like that to start with.

I guess the reason I'm feeling so down on myself is because it's been almost six months since I've been off orientation and I still sometimes wonder what I'm doing here. While I've become competent in the small things, the big things still make me think, "there's no way I'm allowed to do this!"

There is something called the Impostor Phenomenon, which is when students and newly graduated medical field professionals go through a length of time in which they feel as if there is no way they're smart enough to actually be successful; instead, they think the success is due to being in the right place at the right time, a lucky break, or convincing others that they're smarter than they appear.

I most definitely am going through this right now. I sort of feel that whenever I successfully not kill someone, it's due to the help of the charge nurse, or more experienced nurse looking out for me, or just the fact that no one realizes yet how dumb I really am inside. Eh, it's just sort of depressing to know that you're the least intelligent, least experienced, lowest on the totem pole, most useless person in the room at any given time.

One of these days, I'd like to be the nurse the people can look at and think, "excellent, Shrtstormtrooper is here, so maybe this won't be such a giant cluster."

I definitely do love my job with all my heart...I'm just wondering when I'm going to be a good nurse and not just a dumb new graduate posing as a good one.

***
Well - this turned out to be more of a downer than I planned!

So to end on a light note, I just checked my stat counter and saw that someone reached this blog by Google searching "Idiot reading a book."

Love it!

Ready to go

I recently had a patient come in for belly pain. He was elderly and very sweet. I'm asking him all the routine belly pain assessment questions, asking if he has any sort of medical history that could help me out - do you still have your gallbladder, history of ulcers, GERD, diverticulitis, does your pain radiate to your back? Anything? He thinks for a minute, and then says, "well, I do have an aneurysm." I ask him to show me where, and he points right to his chest. And then to his belly. "I've got two of 'em," he says. In my head I'm thinking that this is it, his aneurysm is seconds from exploding and he'll be dead before the end of my shift. On the bright side, everything is stable. No pulsations, normal BP, good color. Nothing but the persistent pain.

I move him to a room closer to the nursing station, and we quickly order a CT. When it comes back, the doc and I huddle around the monitor to look.

It turns out that his aneurysm had expanded since his last CT, but was stable. His AAA was, I kid you not, more than TEN centimeters in diameter. And the aortic arch wasn't much smaller. The doctor went in to speak with him to explain that the pain he was experiencing was most likely related to his aneurysms, but that due to multiple factors surgery was not an option. He was okayed for discharge with the knowledge that his aorta is a ticking bomb, but that today wasn't his day to die.

He took the information remarkably well, but I couldn't quite figure out why. As I was getting him into his wheelchair to leave the department, he started talking with me about his life.

"You know, I've tried to be a good person both inside and out. I took care of myself, I tried to give back to other people. I tried to be a good person, and my wife was much better than I am. She and I were married for over six decades. My wife died earlier this year. She was the better half of me, and when this artery goes, I hope she is the first one I see."

He knows his aneurysm is going to rupture one day. He knows he will feel fine one moment, then feel ripping pain for a few. He knows that within a minute or two he'll be dead. And he's not only ready to go; he's looking forward to his reunion with open arms and open heart.

No one expects the Spanish Inquisition!

One of the reasons I enjoy night shift so much is because night staff likes Monty Python way more than day shift does. Thus we have many things to endlessly quote. And which I must now share with you, dear reader.

First, you force him to drop the banana. Next, you EAT the banana!


Our chief weapon is surprise, surprise and fear, our two weapons are surprise and fear and ruthless bigotry...



Well sir, I have a silly walk, and I'd like to obtain a government grant to help me develop it.


It never gets old!

The key to understanding sports

My mom always made it to all my high school sports games. She traveled with me for softball in middle school. She tolerates me yelling at the TV for NFL games. We've occasionally gone to NCAA basketball games. She's had a lot of exposure to sports throughout the years. However, she never really got into some sports like I did or grasped the rules as easily as I did, and I didn't know that she thought about this as often as she does.

What I did know is how funny my mom is, especially when ruminating about said lack of sports knowledge:

Now those days a long gone and I'm finding myself trying to watch and learn about sports again. Clearly it's easier these days. The Skins stink, so I'm learning from the comments made by other as to how they should be doing it. This is the missing link in the chain that would have made me knowledgeable. The team has to be a loser! I learned so much from my family and friends this season as we struggle to watch a failing team's efforts. I'm learning what you are supposed to be doing, what they aren't doing correctly, stats from their past and present and stats from other teams too. I even learned when a loyal fan switches teams.

Love you, Mom. And at the rate the Skins are going this season...you'll be an expert on them by the end!

***
I also just saw this trailer on tv: The Men Who Stare at Goats. I was mildly intrigued, and then Ewan McGregor asked Clooney, "so what you're saying is that you were a psychic spy?" Not so interesting. Until Clooney responded "A Jedi Warrior." If that's not using casting to a maximum effect, I don't know what is.

Anyway, I'm hooked. Multiple Star Wars references? Ewan McGregor? A goat? Boston music playing during the trailer? Count me in.



Srsly.

Things I can't handle

I have learned many things since starting my job as a nurse. Most importantly, I've somewhat learned how to be a nurse, although I have a long ways to go.

I've also learned that there are some things that just make me queasy. And they're not the normal quease-inducing things that might normally affect other people. For example, I've had a patient roll over in bed and vomit directly onto my shoes. I've held fingers that are only hanging on to the rest of the hand by a few strings of skin. I've become closely acquainted with the nether regions of patients, whether it's placing a foley or enema or suppository. I've eaten a meal whilst discussing the variations in smells of blood, poo, vomit, and gangrene. I've made (very realistic) fake poo as a prank.

I've put my finger into the depressed skull fracture of a dead person. I've taken the rectal temperature of a dead person. I've taken a dead person to the morgue. I've wiped up pus after the doc lances a butt abscess. I've cleaned up raging diarrhea from a morbidly obese patient while that patient lays in bed - and still continues to spew forth more and more c.diff even while I'm wiping. I've unwrapped "a little cut" and with some quick probing realize it's a 10 inch long scalp laceration so deep I can see the skull. I've unwrapped "a little cut" and had a spurt of arterial blood land six feet away on the floor. I've unwrapped "I think this is a bad cut" and realized parts of flesh are missing completely. I've seen both little and bad cuts get stapled, steri-stripped, and stitched back into place.

I've seen, smelled and touched things that no normal person should ever come in contact with - and yet not only do I not get grossed out by these things, I actually have no negative thoughts towards them whatsoever. Some things, like blood spurting and limbs falling off and cracking a chest are actually really cool.

But lest you think I am impervious to all things gross, I have discovered that there are two things that gross me out, and one thing that threatens to make me pass out.

Two things that gross me out:
1. Anything that deals with eyeballs. Like touching them or having to deal with potential eyeball trauma. I saw a patient recently who had a traumatic eyeball injury, and it was gross. Heebie jeebie.

2. Loogies. There's a reason I'm not a respiratory therapist. Sputum is just, yeegh. I watched a trached patient cough a loogie halfway across the room, and I threw up a little in my mouth.

But for the one thing that threatens me with an ungraceful syncopal episode? Bones. Ortho stuff. Crunchy out of place bones. Dislocated joints thunking back into place. Ugh. The weird thing is that a badly mangled bone just minding it's own business doesn't bother me at all. Only when we start to manipulate it does it bother me. The power drilling, reducing, splinting, traction applying, and crunching really just makes me...whew...

I'm queasy just thinking about all the examples I could write about.

Let's just hope I have already reached my quease-inducing maximum number of things. I don't really want to discover any more.

Whew

Man, it's feast or famine in the ER, seriously. I'll go a month without a super serious trauma, and then get slammed with two back-to-back in a night. It's like the EMS crews just ride around and look for accidents to bring us! I don't know how it happens!

What I do know is that sleep is so much sweeter after an awful night!

Drivel

Sorry it's been so long since I've posted! I had a busy week at work, then went camping all weekend. Good times, especially since no one was eaten by a bear.


And a few random tidbits:

Lucky win for the Skins today...will Zorn and Campbell have a job next week? We shall see...

Whilst browsing the interwebs, I found this wonder. Is it too much to hope for as a Christmas gift?

I burned grilled cheese today. New low for my cooking skills? I think so.


I promise I'll have some actual content this week...I just need to stop being so lazy!