Futility

I can't figure it out.

Most major building projects leave some evidence (besides the new building, of course) around. In the apartment complex where I reside the evidence is a large grassy knoll in the corner of the property where all the extra dirt went. That large grassy knoll, which is really just a pile of dirt covered with scrubby weeds, started out as just a huge deformed pile of dirt. Last year a single bulldozer came and smoothed out the pile into a nicer pile and covered it with grass seed and hay, which promptly scattered itself across the next 100 square miles as it was a very windy day. I thought all was done.

Then, about 6 months later, another bulldozer showed up and spent a morning smoothing the dirt again. It left after a few hours of smoothing, and nothing ever came of that activity nor was there any noticeable difference in the grassy knoll's appearance.

Until today.

At 0745, I was awakened by another bulldozer. Smoothing the pile. For the third time. I can't figure it out. What the fuck are they doing?!



And after all of this, I cannot for the life of me understand why they are taking this much care over the appearance of the grassy knoll while at the same time leaving this little piss-ant pile of sad dirt a mere 100 feet away.

And also,

No one can resist my Schweddy Balls.

teeheehee.

Dilemma

So I've been a nurse for 2.5 years. A real, off orientation nurse for about 2 years. I'm not great at nursing. I like to think I'm a good nurse, and on my way to eventually becoming a great one, but I'm nowhere close. As in there is a megagram of shit I don't know. And I know that I know this, which sometimes makes it a little awkward when a coworker is all like damn girl, you rocked that code, well done. Because knowing how much I don't know, I sometimes feel like I'm just a mediocre nurse who got lucky that day and really has everyone fooled.

Here is where the situation gets a bit sticky. On night shift we're essentially being bent over and told to hold our ankles, because management has run out not one - not two - not three - four fantastic nurses to neighboring ERs because of how crappy we are treated in many respects. These nurses were all career ER people - people who if I ever wreck my car or accidentally fall into a wood chipper, I pray that they are working. Now they are being driven out in mass numbers. This is where the dilemma lays: the fourth nurse is a Charge Nurse. So since we will be down to only two FT charges, there is a need for some people to be trained as relief charge*.

And here is why I'm in a bit of a pickle**.

The manager has asked me to train as relief charge.

Right?!

I told him I'd think about it, but really all I can hear in my head is someone screaming INEXPERIENCE! NEWBIE! YOU'LL ACCIDENTALLY IMPLODE THE DEPARTMENT! I truly am flattered by the offer, and the teeny part of me who wants to advance in my career is like oh hell yeah I'll do this, but the much more rational part absolutely knows that I really am too inexperienced to do charge. I'm know I'm not viewed as a complete moron by the current charges, because some of them have mentioned this before. Really though, I feel like I need more years of experience before I can competently keep the department from burning down.

The pickle is that I don't want to piss off management by just saying no since they can and have made life hell for these other nurses, but I also am not willing to take something I am nowhere near ready for.

Help. Advice?
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* Part of the fuckery that happened to the nurses is this: A (recently)current relief charge nurse noticed one of the new nurses engaging in some very stupid decision making, with the actual life of a patient at risk. Relief charge went to the nurse and mentioned her concerns, and stated that the new nurse maybe needed to change her ways. New nurse, instead of being like "this is embarrassing but oh yeah I almost just killed someone, maybe I should listen," instead went to the manager and wrote up the relief charge. Manager went to relief charge and chewed her out, and then took away the position of relief charge because she "needs to learn to be nicer." Srsly.

** I was kinda scared to google search the term "pickle." Maybe I'm just a paranoid with the sense of humor of a fifth grader, because all that showed up on the first page was...you guessed it...pickles.

Fair enough

There is a standard set of questions for ailments that I use to drag more information out of a patient, until I can tailor the questions more specifically. What were you doing when the chest pain started? How long has it been going on? Is it constant or intermittent? It is sharp or burning or pressure? Stuff like that.

Lots of patients experience their complaint for hours/days/weeks/years. One question I find particularly useful for them is "what changed about your complaint today to make you come in right now?" Usually it's because they're coming in at 0300 on a Tuesday for finger pain x8 months and just need a work note, but sometimes that question evokes a surprisingly legit response.

The best I've ever heard:
Me: So you've been having this diarrhea for almost a week now, what changed about today to make you come to the ER?
Leaky Patient: Well, I accidentally shit myself today. I figured it was an okay reason to be seen.

Touche, sir.

So you're telling me there's a chance

Yes, it's moderately flattering to have you, my 25 year old male patient, ask me out for a beer right after I'm done giving you your discharge papers. Even though the odds of me saying yes are slightly worse than the 3720:1 of navigating an asteroid field, you've still got a small chance.

That small chance, however, immediately goes to zero if you ask me out for a beer in between massive dry heaves since you're in the ER after nearly killing yourself in a drunken stupid decision.

Dr. Death

Democrats silent, vague on Weiner photo.

heehee. I'm five years old.

In other news, Dr. Jack Kevorkian died today. I was old enough to know what was happening but young and dumb enough to not understand a bit of it back in the height of his assisting of suicides. Now that I'm older, somewhat less dumb, and working in a field which allows me to truly understand the suffering of terminally ill patients, I've got a lot more respect for the whole situation.

I guess it's sad to see him go - if only because he was a figurehead for the debate in the End of Life issue and "dying with dignity" and the politics of it all. I don't necessarily agree with his methods; Kevorkian was theatrical and inflammatory against the media. I do, however, agree with his view: those who are terminally ill, of sound mind and wishing to end their life have every right to do so. It's their life, let it be their death.

I've watched so many patients die in my short ER career. There is one that stands out in my memory: a woman who I took care of for a mild complaint, in which she ended up being diagnosed with cancer in a weird place. Months later the same patient comes to the ER after seizing, aspirating, and nearly coding. I didn't even recognize her; the cancer had destroyed her in a very short time. But she died quickly, and relatively peacefully. Her family understood what was happening and didn't try to drag her back with CPR and drugs and futile treatment. They let her die with dignity, which she herself told me she wanted way back during that initial diagnosis. But there are many who aren't so lucky.

If someone's future only holds death and pneumonia, bedsores and tube feedings, being bedridden and in an ICU, renal failure and dialysis, and mental status changes until you don't recognize your family...I think I can understand why these people would want to choose their own manner of dying.

Imma get off my soapbox now. Put the pitchfork down, please.