Science

In the ER world, gravity + beer is a very bad thing. It inevitably starts with the famous "here, hold my beer" statement and is quickly followed by a brutal demolition of both ego and intact anatomy. I'm pretty sure Newton even started formulating his equations after witnessing some drunk guy holding an apple while on a horse go, "Hey guys! Watch this!"

These unfortunate people are most always surrounded by a group of people who either gasp in horror or point fingers and laugh. Sometimes, the act of Spectacular Fail is even recorded on video for posterity. Which helps me out in the ER, when my patient comes in with a broken arm and has a perfect rebuttal for the question of "Oh my God! HOW did you DO that?!"

Fortunately, there is no shortage of beer in this world and no shortage of stupid people willing to hand over said beer to try something dumb.

Take, for example, this girl:

Close analysis of the picture reveals a few things: a hill in the background, a bike, a bike wheel at an odd angle against a piling, and a bike rider with a face accelerating towards the dock at 9.8m/s^2. Fortunately, she's wearing an alcohol helmet and flip flops. Because safety first, you guys.

I can only imagine the shame that was felt by this girl after this accident. Wait. I don't have to imagine it...

Because I'm that girl.

Science. Helping drunk people make a fool of themselves since the Neolithic Era.

I'm done on this topic, for real. Until next time.

You see? YOU SEE?! I've posted many, many times about this. So have all the researchers. I'll post it again though.

VACCINES DON'T CAUSE AUTISM.

(Link: I Fucking Love Science: Huge Meta-Study of Vaccines Reveals No Link to Autism)

Night shift

I swear...night shift gets no love. Last week I worked a shift where we were severely understaffed - I'm talking there were TWO nurses from 3a-7a. This ER has been getting busier and busier, so of course this was a slamming night. Want to know about unsafe patient ratios? Try sixteen patients for two nurses. 8:1 ratio. That translates to 7.5 minutes of care time per patient per hour. Which is awful. Pretty much I went from triage to triage, threw in an occasional IV, and did a couple of EKGs in that time. And charted. Sort of. And because this place has no triage nurse, we can't leave people in the waiting room like a normal ER.

By the time 7a rolled around, we were drowning. I was sitting at the desk charting the three new triages and one EKG I had done in the last 10 minutes, and the dayshift charge grabbed the staffing clipboard to fill out the assignments for the day. "Oh man," she sighed, "we're so shortstaffed today! There isn't a float to cover lunches, this sucks!"

The other night nurse and I just looked at each other. Or we would have, except she was taking up her own tele admit since we didn't have any techs.

I would be pissed, but it won't do me any good. We'll continue to be dangerously short staffed on nights, because administration needs to cut costs and nights are where it comes from. We'll continue to get burnt out on nights because we do the same amount of work with a fraction of the staff. I'll continue to blog about it because I'm just a traveler who gets pulled aside to ask why I took an hour to discharge a fast-track patient instead of congratulated for making the five minute EKG time even though I did an entire nSTEMI workup myself.

On the plus side, free pizza almost every night. And free diabeetus...

Burnout

I love ER nursing. I really do. I love the rush I get from successfully managing really sick patients. I love the ridiculous things overheard from patients. I love being able to help someone not by giving all the meds or hanging blood or placing an IV, but by holding their hand because it's 6am and they're sad to be missing Easter dinner later today. I love the camaraderie of all the staff placing guesses on the BAL of the local college student who just came in. I love when the ER doctor I've only just met a month ago asks if I'd be willing to housesit for her, because she thinks I'm a competent and responsible person and "would trust me with the house, since I definitely trust you with patients."

There is a lot to love in the ER.

But when someone asked me the other day how I was enjoying travel nursing, I found myself not talking about all the things listed above, but how much I hated the politics of medicine and how awful satisfaction-based care reimbursement is and how resentful I am of the people who come in and get everything they want because they're entitled and know how to work the system.

I found myself saying, "I love the ER, but I kinda hate people now." And that makes me sad. I started this career as a nice person, one who loves people and helping them and was full of naivete and compassion. In return, the direction medicine has taken is slowly overtaking the compassion in me. It's still there, but it's buried beneath cynicism and bitterness.

When I get a patient who says to me, "I hurt and the only thing which works for me is dilaudid," instead of thinking she probably hurts really bad and has been through this before I immediately jump to how much of a drug seeker she must be and how it's bullshit to even be in the ER right now. When a 22 year old comes in on the ambulance for a mild asthma exacerbation, texting and wearing a brand new hat, then asks for a cab voucher home, I don't think that perhaps he is homeless and wearing the only things of value he has in the world; instead I think that he's just a typical arrogant entitled drain on society who will get that voucher because the hospital can't say no without getting a bad review. When a patient lashes out at me and calls me horrible names, instead of thinking that he is in the most stressful time of his life and have reached the crisis point where he can't cope with the stress anymore, I immediately write him off as a horrible person and provide appropriate nursing care but extend only the bare minimum of servility to him. The things about these patients may be true, but the fact that I immediately jump to them instead of giving the patients the benefit of the doubt, if only for a moment, says a lot about me.

I never wanted to be that cynical nurse from the nursing school horror stories. But here I am, waving that flag like it's going out of style. I'm sad to have found myself in this position, because I truly do love nursing and the ER. I'm hoping the system will someway somehow start to be fixed, because seriously. This can't continue.

Friends

The best part about travel nursing is the number of new friends I've made across the country. The hardest part about travel nursing? Making new friends.

You see, I went to a smallish rural high school where the people I graduated with are the same ones who pushed me down on the playground in kindergarten or who I puked on in gym class in third grade (just kidding - I actually puked in a potted plant, not gym class). All the friends I had in high school were people I had known my whole life. It was easy to be friends with them, and there were enough of them around that if you didn't like someone you just didn't hang out. When I got to college I was placed in a dorm with three hundred other people - a couple of us found ourselves living together the next year, and friendships were born. It's not hard to be friends with people when you have TV marathons at 4am and create hard copy calendars for pooping schedules and hold prank wars involving firecrackers in an underwear drawer or a Harry Potter doll set into jello. It's also not hard to make enemies when you have to fight a roommate over burnt out light bulbs or who forgot to wash a fork, but that's besides the point...

My actual point, which I've gotten kinda far from, is that in high school and college it's pretty easy to make friends. If one is super introverted it's a bit harder, but the opportunities are still there - in both schools there is a built-in group of people who one might have things in common with. Travel nursing removes that built-in group and forces me to step outside that comfort zone.

There is always the risk of rejection when meeting new people, because one doesn't have the benefit of being in a situation where you'll see them again and again for months or years and can mutually take the time to decide if a friendship should happen. Many times they don't want to invest in someone who they know will only be around for a short time. Sometimes you even hang out and discover that no, you actually don't like that person or vice versa. But you just have to put yourself out there on day one and hope that others will respond in kind.

I did just that in Austin - at one of my first post shift breakfasts I wrote my phone number on a bunch of pieces of the receipt and handed it out, saying "Guys. I don't have any friends here. I want to have friends. Call me if you're doing anything fun, okay? Here's my business card..." And it took a few weeks, but they did. And I made life long friends. So when I got to Denver and was seated in orientation next to a girl who works in a different department, we exchanged phone numbers after discovering that we didn't know anyone around. Tonight we met up for dinner, and have plans to grab drinks in another week or two. And there you have it. My first friend in Denver.

Calendar

I had a real post all set to go. But then the interwebz happened. And when you wake up,

You're welcome.

PS, actual post to follow in a day or so, after I've stopped laughing at this.

PSS - Yes, I know the size is off on the header picture up top there. Blogger has defeated me, and I give up for the night. In other news, I'm technologically illiterate. I've become one of those old farts that I always laughed at - like when your sweet uncle fumbles with the iPhone because it only has ONE BUTTON OMGZ but it's not funny anymore because now I'm that person. Le sigh.