January 12

A half-naked lady is brought in by EMS after being picked up from outside a gas station. She's loud and twitchy and disheveled but also surprisingly re-directable and coherent. I'm trying to figure out if she needs to go to a room immediately or if she's stable to park on the wall for a bit since we're super busy. The EMS crew is reading off her vitals and mention a blood sugar of >400. I ask her if she has a history of diabetes, and she nods in between wild arm flails. "Have you been taking any diabetic medicines?" I ask.

"I've been blazing and stargazing, baby! No time for meds, only time for meth!"

Gotta respect the honestly, seriously.

December 9

I can't believe it's been six months since the last post...although I keep saying that every time I go months without posting, so maybe I should stop being surprised at this point.

The past few months have been tough. Very, very tough. I took the full-time charge position back in April, and now I understand why every full time charge nurse I've met seems to be beaten down and crusty all the time. I'd like to think that I am a good nurse, and a decent charge - I genuinely love nursing and the ER, and I love taking care of the wildness that we see. I love seeing new grads grow up into great nurses and being a resource for them. I love managing the chaos of a busy department. But man. The past six months have been brutal for so many reasons. In one of my most recent posts, I mentioned an email I wrote railing about unsafe staffing levels and the general safety issues of the department, and how we would be in danger of losing all our staff if we stayed that course. Well, it happened.

The last two months or so have seen approximately 20 nurses quit. Most from night shift, some from midshift. We made our unhappiness known with the unsafe conditions of the waiting room setup, the lack of medics and PCTs due to extremely high psych volume requiring 1:1 sitters, multiple assaults on staff with little to no repercussions, and increasing expectations without the needed resources to support them. A real bricks without straw situation, honestly, and finally the staff decided they didn't need this shit and went elsewhere.

We are now desperate. In the previous posts I mentioned a Saturday night with skeleton staffing and how horribly unsafe it was. That staffing level is now our best case scenario. We often run the department with 12 beds plus a fast track area of 10 chairs. That's 22 beds for a wildly busy department, and it's on a good night. Being charge in a situation like that is more stressful than I could have imagined. I'm responsible for every walk in and EMS that comes thorough the doors, and scrutinized when I have to make patients wait. But what can I do? When I have six ambulances at once and no open beds, and every nurse is already in a 5:1 ratio, how can I give them more patients? How can I make everyone happy? How can I safely take care of patients when placed in a no-win situation?

It's untenable. I am unhappier than I've ever been in this job - which is so sad, because I absolutely love my career. But I have reached the point where I am actively looking to get out of this position. Healthcare in America is collapsing in general, and our hospital is no different from any other in the city. I could ditch for a different ER, but that will be just a same shit different place scenario. So I'm looking outside of ER nursing. I honestly never thought I'd get to this point. When I first started, I saw myself retiring as an old ER nurse, maybe picking up a different specialty every now and then but ultimately coming back to the first love. But now? I can't see myself in this job a year from now, let alone twenty. 

So I'll keep everyone updated on where I end up, but know that this is the reason this blog has mostly ground to a halt. I'm just trying to stay afloat here until the right moment of escape presents itself. 

July 1

A staff bathroom in the ER - placed head-scratchingly close to the ambulance queue spot in the hall and also the charge desk - broke the other day. Something with the pipes, or sink, or whatever, it's irrelevant. Anyway, it was broken. 

So I put this up. 

April 7

I promised y'all a followup post to the spicy email saga, so here we are. And yet the fall out was much, much different than I expected. 

Let me preface this by saying that I generally frown upon all forms administration, in that the C Suite people are so far removed from patient care that they've forgotten the one thing a hospital is actually supposed to do. There are still great administrators out there, it's the fallacy of the entire system that is bad. Our ER director is one of those great administrators, stuck in that broken system.

When I had my post-email meeting with her, there was an explosion of frustrations from me. I genuinely let loose, to be honest. I sort of apologized for the unprofessional tone of the email, but not what it contained. I also told her that I stood behind everything said, and would read it again to the president of the hospital if given the chance. There were also lots of good points made by her, and a lot of the frustrations I had were things she is aware of and actively working to fix, as much as is possible. There's a lot of transparency issues with major hospitals, and ours is no different - she promised to make our staff more aware of what they're working from the top, and I very much appreciated that. Staffing is our other big problem, in that we're constantly working short. I told her this was unacceptable, and that there is no other way around it and that the department will lose the rest of their employees if they don't address it. Within a week, we had a slightly better staffing grid.

So there were lots of positive outcomes from this. The one I was least expecting, though, was to be offered the position of full-time charge. In their words, "we appreciate your spiciness and willingness to say the difficult things while still being open to learn why things are the way they are." So there's that.

March 22

One of the reasons I'll never be in administration is that I am completely incapable of keeping the spiciness at bay enough to be a Real Professional Adult (tm). I know this about myself and it's never been a problem before, mostly because I know exactly what I want out of my nursing career and it doesn't include being admin.

I turn in a summary report at the end of each of my charge shifts. Nothing super complicated, just an email with any weird happenings, broken or missing equipment, and a list of any activations or transfers. Well, I came off quite possibly the worst shift of my career a few nights ago. I'm pretty sure I said this about another shift recently, but whatever that shift was like was completely demolished by this disaster. It was a perfect shitstorm of critically low staffing, trauma activations, and incredibly acute and complex patients. The most terrible part of the shift was the low staffing part - for a well known trauma hospital, we had fewer than fifteen beds open on a Saturday night, plus missing staff for the rapid track/triage portion of the unit that normally sees about 50% of our volume. 

Anyway, I got in to work knowing it was going to be terrible, but we all said a word to the trauma gods hoping for a smooth night. Alas it was not to be. At 1906, our first trauma activation rolled through the doors. At 1945, the second. The third, may an hour or two later. Lots of trauma transfers in. A fun little medical intubation or two. Around bar closing time, our fourth, fifth, sixth, and seventh traumas came in within an hour or so. Our rapid track was at a 15:1 ratio for the single nurse out there for most of the night. And just for that little extra razzle dazzle, another massive trauma in the wee hours of the morning. It was relentless. 

So at 0730 I fired off quite possibly the spiciest shift report ever, railing against the unsafe staffing levels, the lack of planning ahead for getting traumas when we're a trauma center, and problem of all of our medics having to sit on psych patients instead of being actual medics. It was a brutal email. And it goes to not just our ER administration, but the hospital administration too. I knew that. I'm not sorry about it. But BOY HOWDY does a very spicy email highlighting horribly unsafe nights really light a fire under some people.

The next day saw multiple follow up emails, and today I had a meeting with our director about it. It was...interesting.

Next post will be the fallout from the spicy email saga and why exactly I'm not cut out for admin. It's a wild ride!

---

But in the meantime, please enjoy this picture of my now planted garden...which is currently under frost cloth because spring somehow still isn't fully here yet in North Texas and it's too cold out for the plants these next couple of nights. Come on, spring!

March 10

It's no secret that one of the worst parts of the ER is dealing with the awful, terrible people that come in. Not the "I'm having an awful day and so I snapped at you guys" kind of people, or even the "I have money and therefore think I'm entitled to the world" kind of people. Those people are tiring, but not what I'm referring to. I'm talking about the ones who are, truly, a piece of shit.

Like our patient the other day. He came in handcuffed with the local police to be seen for an arm injury, and as soon as he stepped foot into the ER he sucked in a deep breath and launched into a nonstop verbal tirade. Racial slurs, sexually explicit threats, spitting at staff and on the floor, insults about staff's physical looks...if you can think of it and it's awful, he said it. And since this is the ER and we don't do anything about it, instead of throwing the guy out he got to stay in our department all night long. Once he started spitting at staff he got medicated with some haldol and ativan, so we were blessed with a few hours of quiet at that point. 

When the patient first came in he had a backpack full of stuff. We emptied it out to check for weapons, and sure did confiscate like three knives and a meth pipe. Also found were multiple CLEARLY stolen items - watches, credit cards with different names, money, earrings, plus a couple of lottery scratchers. Why he didn't go to jail instead of the ER is still something I'm fuming over. BUT - I got my revenge. Oh boy, did I ever.

I can't take his money because that's stealing. I can't throw his stuff away because it's "his" stuff even though clearly stolen and the police didn't want it back because they don't give a shit. I couldn't throw him out of the ER or refuse to treat him.

So you know what I did? While he was sleepy from the medications, I scratched his lottery scratcher tickets. Every single one of them. None of them won anything, but that's not the point. The point is that I LEFT THEM WITH HIS STUFF. I scratched his lottery tickets, they lost, and I put them back into his stuff so he knows someone did it and wanted him to know they did.

Maybe it was wrong and I shouldn't have done that. But you know what? The medic who was the target of most of the racial slurs thought it was brilliant, so I'm okay with my choices here.

TWOSDAY! 2/22/22

We had a terrible, horrible trauma the other day - think Kill Bill style knife injuries and attempted murder. The staff working was incredible though. We genuinely saved a person's life, and while it's an immensely sad situation I can't even emphasize how proud I was to be a part of that care. With the general way things have been the past couple years we definitely needed that win. I found out today that the patient will make a full recovery - physically at least. It will be a long road to mental recovery, but I am thankful they get the chance to try. 

***

My seedlings aren't even really seedlings anymore - they're full blown plants in desperate need of better weather so I can get them in the ground. I've been hardening off the tomatoes and peppers outdoors, but the weather is about to get extra gross this week. We'll have 3 days of sleet, rain, and freezing temperatures. By this weekend it should be better though so hopefully by next week they can move permanently outside and then be planted by March 7 or so. I'll likely have to pot up some of the plants as they're rapidly outgrowing their 3" containers. I bought some gallon containers a few months ago and am feeling very good about that foresight. I'll definitely be keeping a close eye on the forecast going forward and I think in about two weeks I'll be able to post real garden pictures again.

***

Is it a good thing or bad thing to achieve your New Years resolution in February? I managed to learn the whistle! It's not consistent yet so I do still have a long ways to go, but I was practicing it the other day and managed to get a really good one. My husband was like "quick, do it again!" AND I DID! On command! A very satisfying feeling. I'll be continuing to get better and more consistent at it. If everyone could send some thoughts and prayers for the eardrums of my husband and cats, I'm sure they would be much appreciated.

***

Look! Plants!

January 27, 2022

I think six months is the longest I've ever gone without posting since this blog was started. It's been a rough, tough two years of pandemic and honestly that's just taken the wind out of my posting sails. I can't promise I'll get any better at it, but I don't consider this blog officially deceased just yet so it shall straggle onwards until further notice.

Honestly there's been a lot going on at work. We've lost four ER supervisors in the past two years, all of whom were excellent, to either retirement or other jobs. In the interim, we've gained four new supervisors. Two are absolute hot garbage, the kind who took the job because it's the next step up to administration and who genuinely don't give a shit about day to day ER life - you know, the very thing you're supervising. One struggled to get his footing for a bit but ended up being a great advocate for us and then had to suddenly move for family reasons. The last one is a brand new hire that we're all incredibly excited for as she's one of us - a bedside staff RN turned charge nurse from our department who absolutely wants the best for the ER.

I mention this because there were a few months of weird indecision where, when all this supervisor turnover was happening, I thought maybe I should apply for the job. There were a bunch of people in the department who thought I'd be good for the role, and at the time we had only two other supervisors who are both terrible. I applied, informally interviewed, and had a long talk with our ER director - who is great, by the way. She encouraged me to only take the position if it was something I truly wanted, not because our department deserved someone who gave a shit. After more thought, I ended up withdrawing my application. I'm content with that decision, because while I think I'd actually be good at it and good for the department, I don't think I would be happy. Admin isn't my dream, and I still enjoy being charge and bedside.

The rest of the department life is going as well as can be during COVID times. Our core staff of people is a solid group, and nightshift has some real winners. A few of our new grads are absolutely incredible, and I'm super excited to get to watch them flourish. Funny moments still happen on the regular, and I always have good stories to tell about the weird dumb shit that happens.

I'm in a good spot in my personal life too. My husband and I are both healthy and doing well. We've managed to find a balance between COVID precautions and normal life, and the anxiety over the unknown is at a minimum currently. Our core group of friends and family are all vaccinated which has helped immensely - especially since many of us have gotten sick in past months though all fortunately escaped serious illness. I've been running and doing yoga, and have progressed well. I'm signed up for a half marathon (at Yosemite NP!) in May and yoga has become both a challenging workout and intensely soothing mental exercise. My gardening has taken off as well. I started an absolutely ridiculous number of tomato and pepper seeds last week, so will have a ton of them plus many more to give away. I've got big plans for the yard with more vegetables, more flowers, more perennials, and also blackberries for the first time. I find gardening so incredibly relaxing, even when it's a lot of work. As for home improvement projects, we still have work to do but it is progressing.

Overall, I'm in a good place. That could change in a minute with the way things are going in the world, so I've really tried to be more thankful and mindful of all the positives I do experience. I didn't set any specific new years resolutions as I wanted to focus on something to work towards, not a goal to pass or fail. So, mindfulness and thankfulness it is for the year and on.

Hopefully the few of you that still check this blog are also doing well, and y'all stay safe and happy out there.

---

*okay I lied. I did set one New Years resolution - I am going to learn how to do that piercing two finger whistle that you see old ranchers and southern mamas and NYC taxi cab-hailers do. I'm GONNA learn. This is the year!

July 25

This past 4th of July holiday was awful. Not to celebrate, mind you, but if you were sadly at work like I was then it was just the worst. We had more traumas and CPRs and critically ill people than I've seen in a long time. Our trauma surgeon on call was fortunately one of our favorites - a generally nice woman, extremely competent, and not prone to getting flustered or yelling at staff. She, however, also had a terrible night.

We had multiple severe traumas all at once, and the surgery department nearly activated a mass casualty incident because of it - a super serious call that wakes up all the hospital administrators, OR backup teams, supervisors, and whatnot. She decided not to activate because fortunately (unfortunately?) two of the traumas were declared deceased fairly quickly. Had they continued to draw large amounts of resources, the MCI would have been activated. Anyway, it was still a terrible night and exhausting and just so bloody and tiring.

As you all may know, I'm a very well known shit magnet at work. So around 4 am (3 hours after my shift ended) I go to leave, and waved goodbye to the rest of the trauma nurses and staff. The trauma doc looks up at me from her computer and goes "OH SHIT. This was YOUR fault! I didn't even put it together until now..." Apparently my black cloud reputation has filtered down to the surgery staff.

RUDE.

So anyway, I'm at work the other day and right around 7pm we activated an incoming trauma. We're all standing in the room waiting for the patient when the trauma doc arrives and she immediately notices me, looks at the clock, and goes "you're leaving right? Please, for the love of god, tell me you're leaving. I'm still traumatized from you being here over the holiday." When I shook my head no, she sighed and goes "Shall I just call time of death now? Or we gonna do this?"

What can I say, y'all. I don't know whether to be offended or take pride in my disastrous little personal black cloud.

July 21

YOU GUYS. My plant life and ER life collided in the very best way this week. A patient came in, and she recognized a few of us that took care of her a while back. She happened to work at the nursery down the street and when she was discharged she asked if any of us wanted a free plant. Obviously I said yes. 

So she comes back an hour or so later with a little tray of plants, and now I have my very own philodendron micans and I love it so much. Look at this adorable little plant in it's adorable little planter!

June 26

We recently had a very drunk middle aged dude come in for an MVC, because of course he was shithoused, high, and driving extra fast. As people do. Anyway, he dislocated a hip out of socket and it was decided that we needed to do a conscious sedation after his CT scans to a) reduce his hip and b)shut him the fuck up because he was literally nonstop screaming at the top of his lungs. 

His belly was distended when he first came in to us so obviously we were concerned about internal bleeding, traumatic injuries, etc. After reviewing the CT though it turns out he was just gassy. Like, ALL the gas in his entire body was concentrated in his stomach. How that man wasn't constantly burping up stale beer air is beyond me. The trauma doc went from being super concerned about internal bleeding to very concerned about gastric rupture, in addition to his actual traumatic injuries. 

A belly full of gas + intoxication + sedative medication is just a beautiful recipe for aspiration, so before the conscious sedation could take place we needed to decompress his stomach. I was somehow the lucky one who got to drop the NG tube on a 250 lb screaming drunk idiot. There's no easy way to do these on a cooperative patient let alone a flailing one and also I hate doing them. But it was me, the patient, and about ten other people in the room waiting for me to place the tube so sneaking out wasn't an option.

I managed to easily get the NG tube down with holding help and a fair bit of luck, and OH MY GOD YOU GUYS. Normally we have to inject a bit of air and listen via stethoscope to confirm placement, but not this time. Oh, not this time. As soon as the tip of the tube got into his stomach, it was like one of those whoopie cushion cartoon farts. Air started rushing out of the tube so fast it was causing turbulence in the room. I started laughing. The trauma doc started laughing. The other nurses started laughing. The patient was not laughing, but you can't win 'em all.

The cartoon farty noise went on for at least thirty seconds. I was laughing so hard by the end of it that I had to leave the room to go wipe my eyes. I'm not lying when I say this is literally the funniest work moment of 2021. It's up there with the legendary pinkeye situation. Which also contained comedic flatus, so I think the moral of this story is that I'm a teenaged boy and farts are the funniest thing on the planet.

June 23

Hello! I've been away from blogging these past couple of months because it seems like there's no time! I've been wildly busy with work, gardening, sitting outside in this Texas heat in order to socialize with people, and also spent a very wonderful TWO WHOLE WEEKS with my family in May. 

After nearly a year of not seeing my folks, it was so incredible to just spend time with them. We had no agenda, just family hanging out. We are all vaccinated, and it was just wonderful.

My garden is also doing so well. It's a little less fun to go poke around in it now that the Texas heat has reached a million degrees daily, but such is life here.

I've got a couple of nursing related posts cooking too, so keep an eye out for them in the next week or so. Since this is ostensibly a nursing blog. Right? Anyway, here's some fun pictures of all the stuff. 

(non-garden pictures are from my trip to Maryland/Virginia to see the folks. I'm debating getting a little less anonymous and letting my face show on this blog, but maybe that's a bad idea. I dunno. We'll see!)

May 13

I've had more foot-in-mouth moments over my decade+ of nursing than I can count. Somehow for all my momentary embarrassment I've never been truly shamed by them because damn if they don't make hilarious stories. 

So I was at the charge desk last night when I hear an old pepaw going "nurse? Nurse!? Hello?" I looked over to find two of the new grads just sitting there ignoring him, so I got up and walked in there myself. I called them out on it but that's not what this particular story is about so let's move on. 

"I heard you calling, sir, is there something I can do for you?" I asked. The room was dark, so after he wanted to be repositioned I asked if I could turn the lights on. He responded with "well, you can leave them on for all it matters...I'm blind!"

Oh man. Oh, buddy. At least he laughed about it.

April 21

Good lord y'all, springtime got away from me there. It's been a busy few weeks since the last post. 

Work is...work. We're pretty firmly out of the winter COVID surge and back to our normal baseline, although the number of positive tests has been creeping back up the past week or so. I'm not sure whether or not I need to feel crushing panic and anxiety again like I did in the winter, but I'm cautious and hesitant to let myself feel too optimistic OR terrible. I've been feeling like things are better with vaccinations, but there's so many people out there who are just refusing to get one that I fear we'll never actually move past COVID.

I've been going to therapy which has been immensely helpful for me. I think part of the ability to not get paralyzed with anxiety and depression has been directly related to this, and the other part is the fact that springtime is fully upon us. The better weather, being outdoors in sunshine, and digging in my garden has done so much good. I honestly feel like a better person than I was six months ago, at least when it comes to dealing with all the shit going on.

We've had a couple of awful deaths in the ER recently, and normally that would send me into an ever-increasing cycle of anxiety but this time around it's been more manageable. Here's hoping I can continue to improve on my coping skills!

In other news, I get to see my family again in ONE week! I haven't seen them for nine months, and that's the longest I've ever gone in my life without them. But next Thursday I get to see them, finally. Both of my parents will be fully vaccinated by then, my brother and his fiancee are both vaccinated (one with both shots, the other with his first - although he had COVID late last year so hopefully still has some protection from it), and the couple of people I'll see have also been vaccinated. It's encouraging. We're still obviously going to be safe, and socially distance from the general public, but it will be amazing to just be in my parent's house again after so long.

Someone has to keep my plants alive while I'm gone though, so I'm gonna have to write up a watering schedule for my husband. Here's some pictures of my garden!

*more to come later today after I've taken some updated pictures

Updated: here's the full garden pictures!

March 18

 Y'all, I did a charge dayshift on Tuesday. DAYSHIFT. I'm honestly trying to remember the last time I worked a real, honest to god dayshift from 7a-7p. I can't think of it in the past 5 years, so question mark if it ever even happened? Maybe a partial dayshift when I used to pick up at home hospital, but that was 7 years ago so...

Anyway, DAYSHIFT. One of the new dayshift charge nurses got hired into the position, trained for it, completed orientation, signed up for her shifts on the next schedule, said schedule got finalized and released, and then she resigned two days later having accepted a job elsewhere. This nurse is a dumpster person in general, so while I'm not sad to see her go I am annoyed that she screwed all the other charges over. Like, why even bother signing up if you literally know you're leaving? Ugh.

But anyway, that's why they needed coverage help. So me, being the poor sucker that I am, agreed to a dayshift. BOY HOWDY is it different from nightshift. For starters I had to be there during the daytime. Shocking, I know. But I am a permanently midshift type of person. My brain becomes functional around 9-10 am, and firing on all cylinders around 11a. Which makes me perfect for mids, and capable of nightshift. But when my alarm went off at 0515...not my best moment, and many regerts. 

I also have the reputation of being a true shit magnet, and all the nightshift people thought it was hilarious when I showed up for report at 0645. They laughed their way out the door with warnings to dayshift about me. It was a beautiful two hours of nothing happening, and then promptly at 0900 it was like someone threw a grenade made of critical patients into the department. I shit you not, there was a STEMI and two Code Strokes AT THE SAME TIME. I activated two of them at once with the emergency page system, and they had me on hold for a second because they were already activating the first one from triage. Then we had a trauma come in, and then there was rumors of a CPR arriving, and at that moment the triage nurse called me and kindly asked me to fuck off back to nightshift.

But the crowning moment of terrible day was when I sent a very, very sick looking lady to one of our trauma rooms because I thought she might die any second and it turns out that BONUS FUN she was also covered in bedbugs. Like, crawling over her. I thought the primary nurse was going to kill me.

Then 7 pm rolled around and honestly it wasn't so bad because the day flew by but I don't know if I'm cut out for that early life. Consistently being awake at 0515 sounds just terrible. But it was very nice to get out of work and have a couple of hours at home to wind down. Who knows, maybe I'll do it again sometime?

***

Look at my garden! I got most everything put in, and we're building a third bed which will get the cucumbers, more tomatoes, and more squash/zucchini. Plus I impulse purchased a couple of strawberry plants yesterday, so we'll see how those go.