"When you get those rare moments of clarity, those flashes when the universe makes sense, you try desperately to hold on to them. They are the life boats for the darker times, when the vastness of it all, the incomprehensible nature of life is completely illusive. So the question becomes, or should have been all a long... What would you do if you knew you only had one day, or one week, or one month to live. What life boat would you grab on to? What secret would you tell? What band would you see? What person would you declare your love to? What wish would you fulfill? What exotic locale would you fly to for coffee? What book would you write?"
Sunday, April 29, 2012
Last night I come on to the floor, and its already a slow night. I'm already finished with my charting at 8pm, which means that I can sit at the nurses station at 8pm- And this is almost unheard of. This means that *sometimes* doctors are still lingering at the station, finishing up the days work for them. This was such the case last night.
Said doctor was already frustrated that he was still doing work at 8pm on a Saturday. He is a specialist and was seeing a patient for that specific specialty, obviously. However the patients family was very upset about a lot of other issues going on with the patient, and Mr.NiceDoctor was attempting to consult other specialties for this patient and even get some therapy started that night to speed up the healing process.
In order to do that, he had to page other doctors to speak with them for advice on what to order. So he pages Doctor #1. Waits 15 minutes. No answer. Pages him again. No answer. Pages another doctor. Doctor #2 answers, He's not on call this weekend- Click! Hang up. Mr.NiceDoctor dials operator in a rage to find out WHO is officially on call for the specialty he needs. Operator says....Oh...Its Doctor #3. Mr. NiceDoctor pages Doctor #3- That doctor says, "No- you must mean the OTHER DoctorWithTheSameLastNameAsMe. I'm not with that specialty."
This is precisely when Mr.NiceDoctor hangs up the phone and says (rather loudly) to anyone thats within earshot- "IS IT ALWAYS THIS DIFFICULT!?" ( I think he even stomped his foot, too.)
My answer, very softly- "Every day." And then I smiled.
He then proceeded to ramble on, "Is it always this hard to get in touch with people around here?!"
And I held back....because I love my job, so so so...so, much-And I said nothing except a little shrug. But me and my telepathic coworker said in our minds, "Just doctors!"
In case you like happy endings, Mr.NiceDoctor DID eventually get in contact with the specialty he needed and the patient was started on 3 antibiotics. Happy Ending.
Tuesday, April 24, 2012
Sometimes...the person we've idolized and created in our heads, the vision of the perfect mate for us....we meet that person and turns out they're not perfect. They are everything you asked for and yet it doesn't work. Sometimes the very attributable qualities you asked for in a mate turn out to be the very qualities that drive you crazy.
And sometimes...we fall in love completely blindsided. With someone we never would have seen coming or envisioned for ourselves. They arent right for you on paper but somehow, you fit perfectly into their arms and you connect on a level not known to other humans.
And that's the way the cookie crumbles. :-)
Monday, April 16, 2012
So, this is the first day in..........22 days, that I have to myself. No-plans-whatsoever. Not only do I not have plans, but its my first free space day in a long time. The past 3 weeks or so have been booked to the very last second. In order from spent most time doing to least time doing, let me attempt:
- Running silly errands
- driving people places
- visiting people in far away places (driving)
- Holiday (easter was in there somewhere)
- spending valuable time with friends, dating occasionally
My point here is that sleep came last on the list. Being on night shift is great...when you don't have any thing to do the next day and you can sleep to your hearts content. But night shift is not great when you hit your 32nd hour awake and you really begin to reconsider your job choice.
So, needless to say I have learned a lot about the effects of sleep deprivation over the last month or so, and thats not from doing any research whatsoever. Just personal living.
Then one of my lovely followers/readers/passerbys sent me an infographic about sleep deprivation (how ever did he know?). I read it and it all made sense, not just with what I learned in nursing school but with what I was feeling. He kindly asked if I could share it, and I will do so at the end of the post so look for it.
But I wanted to be scholarly and document the sleep deprivations I was experiencing of my own. You know, in case the world ends but the internet survives (could that happen?) and the next alien/humanspecies to live can look back on our internet and when they get really tired they can google (if they have google) sleep deprivation and then realize that they are totally-not-alone. Phew! Anyway, moving on.... o_0
From my experience , I have noticed that there are phases of fatigue, that I go through at least. One day I would be fascinatingly interested to be a part of a bigger study to see if this applies to everyone.
- Lets say I wake up at 4 pm, I slept all day in preparation to go to work. (For non-night shifters, pretend I'm asking you to wake up at 4am, got it?)
- I work a 7pm- 7am shift. sometimes I have to stay at work as late as 9am. (For non-night shifters, pretend you woke up at 4am and then worked 7am-7pm, til as late as maybe even 9pm)
- At this stage in fatigue (stage 1) I get very hyper. Especially around people. I could probably pass for being on crack because I giggle a lot and run around in circles (not all the time, just sometimes- lol). I know a lot of people do this when approaching fatigue. Especially kids.
- Normally, I would go to sleep after I get home and then sleep for 7-8 hours and there is no problem. However, once in a blue moon there are times where something either planned or not planned requires your attention more so than sleep. Okay. No problem. (for non-night shifters, 9pm might be a little late to go out and do something, but its do-able, right? Right. No problem).
-But then, that thing you have to do? It either goes really late unexpectedly or it was planned that way and you were stupid enough to do it. This is where dangerous things happen because you start hitting your second wind, adrenaline gets used up trying to carry you through. You think- "Pshh I stayed up all night but I'm still awake so I can stay awake ALL DAY YAY!!!!!!" -_ - So lets say that thing goes until 3pm. (For non-night shifters, this is your 3am. remember you stayed awake all day working. YOu're pretty tired and cranky, right?)
-This is when I would say I enter Stage 2. This is when I notice the effects taking place in my brain/body but they might not be as noticeable to other people.
These effects include (Stage 2):
- You notice yourself start to space out. Sometimes at inopportune times. Like, driving. Or, cooking. You are doing whatever you are doing, and realize 7 minutes later that you've been off on some other planet for a while and you have to snap yourself back into place.
- You suddenly find it really hard to pay attention to people. Especially in conversations that you wouldn't particularly find interesting if you were wide awake, but you would be polite and listen anyway. But now- you still have enough energy to stare at the person and nod and smile and throw in the occasional "Yeah" or "oh, really?" but you realize that you literally have no clue what the person has said within the past 8 minutes and really, you don't care. Your attention span decreases. In order to get your attention, the house should be burning down or someone should have an expresso shot in their hands, for you. There have been times where I said to myself, "hey, this is kind of important, I should listen to what this person is saying." And I start to...but then I find that I have been on Venus and didn't catch anything in the last couple minutes and she's still talking. At THAT point, its like- why bother paying attention now? And you go back to Venus.
- It starts becoming really easy to lose your patience. Suddenly stupid people are the arch-enemy and they deserve to see your ultimate wrath and you have to use your last bit of energy to do your best to not blow up at all of them. Suddenly petty, silly matters that awake people are concerned about seem really, really, really stupid to you and you're not even sure why Earth exists anymore.
-At this point, you're wondering why you're still alive. But there is light at the end of the tunnel. Its like 4pm now, its almost time where you can leave whatever you are doing, and go to sleep without being a total outcast. (Non night shifters, this is your 4 am).
-Now you are entering stage 3. I call Stage 3 when you've hit 24 hours awake. The rest after is all stage 3 until you can make it into a bed. This is the scary stage and the stage I hate making it too, because I hate the person I become.
Stage 3 Effects that I have noticed:
- decreased appetite. You don't even have enough energy to eat. Literally, all you can realistically do is sit there. Nod. Smile. Stare into space. Wait. Think about sleep.
- You have heard me talk about emotional shutdown in a prior blog, but here you go into what I call "Physical shutdown". And this is the part I hate. Someone is asking you a question, or trying to talk to you, maybe even someone you love dearly (a family member or significant other), and you find that you can't even respond. You want to. You do. You have a response thought of in your head, but the energy that it takes to open your mouth and actually respond and have a conversation, that energy is too valuable. That last bit is focused solely on things like walking, safety. Survival mode kicks in and your body is exerting all its thinking power to actually save energy. I hate this because people that are awake and haven't been awake for 30 hours don't understand why you are quiet. They think maybe you are mad at them or something is wrong, with them. They get mad at you for not taking part in the social activity going on or conversation. And even so, you really, really don't care.
- You start dreaming when you are awake. Literally I didn't know this could happen but it is one hell of a phenomenon. There was one or two times I hit around 7pm (non night shift 7 am-27 hours awake) that I had a "space out" moment- but when I snapped out of it- I realized I actually just had a complete dream in my head. Plot, setting, new characters, the whole thing. But I was still awake, my eyes were open. The whole time.
- Being that you haven't eaten and you're in stage 3 (more than 24 hours) you start getting really dizzy, so beware of that.
- Simple things start to not make sense anymore. You start to have memory impairment, short term mostly affected. You feel like you have dementia because you approach a red light and you don't immediately understand that red light means stop. Someone hands you a fork and you think to yourself, what am I supposed to do with this? Scary. On that note- don't drive in stage 3 unless your or someones life depends on it.
- You know that feeling where you walk into a room and can't remember what you did that for? That happens all-the-time.
- Your thinking time slows dramatically. Normally when someone asks you, "What is 2 +2?" Your answer is almost instinct, its practically memorized- it requires no thinking whatsoever. You spit out "4" before they finish the question. But in stage 3, you have to actually think about the question and your response might not verbally surface until 10 seconds.
I have made it to 32 hours. I went to bed at 11 pm once in this said scenario. (Remember that's like asking you to get up at 4am, work until 9 am, stay awake all night and then go to bed at 11am.) But that was a dire circumstance and If you are in stage 3, I say get to bed as soon as possible. If you are waiting for it to be socially acceptable (if you still care about social norms) OR if you are concerned about sleeping through the entire night, I say after 8pm you are good to go. Its socially acceptable and you will sleep through the night and even sleep in.
I do think that it is possible to stay up past 40, with adrenaline. Meaning, in dire circumstances. Like you're in the army, or other militia and its been one attack after another, or maybe you stay awake 40 hours when your child is born. Or you are a survivor or a health care worker of a catastrophe, you just keep on going and going. I believe that when I'm in stage 3, I think I could snap out of it all and go do CPR on someone if I had to. I could still bring myself back to full capacity if I wanted to. But that's all adrenaline and I wouldn't do that for just anything, obviously. It would be a dire circumstance.
I have noticed a little bit of a questionable stage 4- but this is when you are sleeping. Stage 4 only hits when I have repeatedly been exhausted- I have lets say hit stage 3 one day and then didn't sleep enough to recover, or did it again the next day, or even no stage 3's but a lot of stage 2s. Regardless, you're not getting enough sleep. Stage 4 involves the main effect of being so tired, so friggen exhausted- that you aren't getting restful sleep. Its tricky though to explain because it doesn't always happen. And sometimes I get very restful sleep in terms of staying asleep, but I realize my dreamscape has been full of nightmares and a lot of them, or even just a lot of annoying dreams. So Stage 4 I guess is more long term. Suddenly when you're awake you can't recall if blips of memory that are coming to you happened in your dreamscape, or real life and its pretty confusing. The more tired you are during sleep, the more your dreams have the ability to trick you into they are reality.
So those are my personal effects I've noticed. Those effects are all short term and can be fixed with a healthy dose of Vitamin C, Calcium, probiotic, protein, electrolytes, and 16 hours of sleep. But long term? I don't know. I don't want to know. But the infographic touches on that. Pretty scary stuff. I think night shift screws a lot of things up, but you can stay healthy if you just make sure you get sound sleep during the day and make sure you plan for recovery time.
If you are wondering what my opinion is on substances to pick you back up (i.e. coffee, caffeine, 5 hour energy) I say BE CAREFUL. I use 5 hr energy myself, but only during stage 0 (during my work shift) and only sometimes. Be extremelyyyyyy careful with using it in stage 2 and I say not to use it in stage 3. Caffeine can only carry you so far and the effects can have dangerous symptoms on your already vulnerable body. Also, if consumed in stage 3, you might appreciate the short term benefits but the benefit will disappear shortly and the caffeine will still be in your system, meaning when you do finally get to sleep you might even have trouble sleeping. Be careful!
Phew, long post! Thanks for reading, I hope you found it interesting and helpful to all..I know all fellow night shifters out there know exactly what I'm talking about!
Here is the infographic I received :
Wednesday, April 11, 2012
My educated answer? "google it"
So we googled it and unfortunately google didn't offer any insight.
At that time one of the nice(r) doctors strolled up to the unit. I whispered to my co-nurse that we should ask doctor, right?
Nurse: "Dr.YouShouldKnowThis, what would be the correct anatomical term to describe this area of the foot?" * you can't get it wrong, as said nurse even took off her shoe and really made sure to point at the right spot*
Dr.YouShouldKnowThis: ummm.....the ball of the foot?
Nurse: I know, but what's the fancy name?
Dr. YouShouldKnowThis: I don't know. I'd google it.
Now keep in mind, Dr.YouShouldKnowThis does have a Medical Degree, however she is a hospitalist. They treat patients that come into the hospital, they have no primary practice. They are usually younger doctors. They get paid pretty crappy for doing a lot of work. So I didn't even blame her for not being up to par on her anatomy.
So alas, being that this is important and we have to chart it in legal documentation, we had not finished our quest for enduring everlasting foot wound knowledge. So Dr.YouShouldKnowThis leaves, and a couple minutes later another doctor arrives.
Now this doctor is a lot older and more experienced. He's a family primary practice and he's seen a lot in his day.
Nurse: "Dr.YouShouldDefiniteKnowThis, what is this area known as on the foot?" is it...metatarsal? Plantar? *she takes off shoe again*
Dr.YouShouldDefinitelyKnowThis: ummm...I would definitely just google that.
Google solves all problems.
PS_ We ended up charting it as the ball of the foot.
Me: Do you know the name of it?
Patient: Oh, Its "Over the counter".
Me: Yes.....RIght- but do you know the name of it?
Patient: Oh....Rite Aid. . . or sometimes walgreens if Rite Aid is closed.
Tuesday, April 10, 2012
So that's the universal unwritten rule in nursing. But why is that? Doesn't that just add to our job dissatisfaction? Are we not allowed to bask in the joy of having a slow moment when not all of your patients are going ballistic? Why are we one of the few professions where we are not allowed to say "its so quiet. I'm going to enjoy this moment." Nurses believe in karmic balance, we believe in jinxes, we believe in full moons. At least on my unit. We all know that if that word is said, we can expect things to start picking up. In a bad way.
We believe in jinxes. Way too heavily. A couple of weeks ago, I was bragging profusely to a coworker that despite working on this job for nearly 6 years, I had never been assaulted. Kicked, punched, hit, bitten, scratched. Nothing. What happens 4 hours later? I got punched. Big time. By a patient. If that's not enough to make you think twice about the jinx phenomenon- Get this: We had a quiet night last night- not much going on. We were all walking on ice- afraid to say that word, but were finally happy to be able to take a little bit of a deep breath. Then- Out of the blue- 2am- we get a code blue. One of our patients stopped breathing. We of course call out all the stops and whatnot, run the code. The patient ended up not making it. After the code, during the time I was sitting down with the resident having him sign the papers, he told me- "I think this is my fault." I asked him, what do you mean? He said back, "Earlier this shift I was bragging to the other residents I've never had to pronounce any of my patients dead yet."
After he said that, I wanted to punch him in the face. Why would someone ever bring that karmic invite on?...
Lately the unit has been......insane. I have never particularly enjoyed psychiatric patients, and in the past two weeks I've been punched by a psych patient, and taken 4 knives away from another. Both under my direct supervision. And besides those incidents, its just been a run for our money in every way. A true test of patience, strength, passion and endurance.
I've discovered something about myself in all of this though, a new defense mechanism I didn't even really know I had in me. On the unit, there have been moments where everything is coming at you at once, you are having the worst possible night, no one can help you because everyone else is having a bad night too (in addition to your hospital being severely understaffed), and you face a decision: You lose it and throw a complete temper tantrum on the floor/ run out of the hospital screaming, or you find SOME way to keep yourself together. Not just together, but you have to be able to put on a smile and keep calm entirely in front of your patients and not let them see you're having a bad night in any way. Its definitely not easy.
So my new defense mechanism is something new. In order to prevent my inner psyche from going completely nuts, I went into what I see as an emotional shutdown. I went through the motions. I did what I had to do. I said only what needed to be said. I remained calm. I thought things through. I did my job. But I wasn't emotionally there...I couldn't be. Its like my brain and body were still working but my mind and soul weren't.
On my particular unit, we can't really take breaks. There are only two nurses on staff at all times and leaving the floor is not allowed. So my break consists of eating a sandwich at the nurses station. Also, being that there are times we are severely understaffed and have no aide, if a call light or problem arises while you are sitting and eating your sandwich- you must go attend to this. So really, you don't get a "true break". There have been night shifts where I couldn't even find the 4 minutes it took to pee until about 5 am. That's why nurses have extraordinary bladders. They expand :-)
But all this has definitely made me re-think whether or not I chose the right career. Its gotten me pretty low in the dumps, and its brought on a lot of thought. Lets start with the good- I am incredibly thankful for where I have gone in life. Meaning- I love having the medical knowledge database in my head. I love figuring out the mysteries, I love diagnosing people, I love applying medical knowledge, I love explaining things to laypeople, I love knowing more than the residents (hehe). I love the fact that when I have kids, I will know how to help them medically. I love that If I'm first responder to any accident as a drivebyer- I can apply basic medical attention. I can respond to emergencies on airplanes. I want to learn more and more and more about the medical field and apply it all. Its like a giant equation, a giant puzzle- and I want to collect all the pieces.
I keep revolving back to the fact that I should have just followed my heart. My true heart. I just, once again, didn't have enough confidence in myself to believe I could succeed. I should have gotten a job that allowed me to exercise my creative artistic side at work. With Pixar. Or with a graphic design company. As a Writer. As a music-video design artist. As a movie-maker. ANY other job on this planet that could let me make art every day......that....would be my ultimate key to happiness. Sure I can make art on the side now. But in my time off- when I'm exhausted. When my mind is absolutely reeling from the shift I just had.
I think I'm mad at myself for just feeling this jaded after only five months of nursing. I wouldn't say that I am burned out, but the fire is lit and it shouldn't be. Not this early. I have to fix things. I'm tired of holding it all together. I'm tired of pretending to be strong.