late pass

So, the medic unit continues to put trucks out of service. BLS continues to drag the stretcher to the second floor. Might makes right is the vision statement of our national leadership. Thailand has swooned into the arms of a military dictatorship. And Jonathan Metsch isn't in jail yet, and probably never will be.

And, in the universe of things I have a little more control over, there are uniforms to be ironed. ATM receipts flutter across my desk, waiting to be validated against my online statement. The bed is unmade. The cat grows impatient; he expects a ticker tape parade in his honor, perhaps with the shredded ATM receipts. It's not much to ask.

But the sun is shining, and I have a late pass, at least until on-call starts at five. I got the late pass yesterday, from a somewhat flustered school nurse, who had called us because the eight year old in her office was having a grand mal temper tantrum. I needed it, because I had arrived at work an hour late, having slept straight through my alarm. (Sometimes my brain stem is smarter than I am, and it was letting me know upfront that it wasn't buying a second week of this pious work ethic crap.)

I didn't miss anything important. Our first job was the lady in New Milford that I intubated a couple of months ago; she was in very early failure yesterday, nowhere near as sick as the first time. She's had a few admissions since then, but she always comes home and enjoys her house and her family. It doesn't sound like much, but most 89 year olds don't do so well after requiring field intubation. She has remained an intact person. I rode to the hospital with her, and she patted my face and called me a sweet girl.

My partner and I sneaked into Hackensack and saw my friend, who was in town for chemo. MICCOM had been running us from pillar to post all morning, but the board cleared up miraculously just as we were pulling up in front of the hospital, so we were able to visit for a bit with another person who continues to humble me with his stubborn insistence on remaining intact.

I made a lot of progress lining up resources for the HAPE physical. The folks at Employee Health say it's fine for me to use one of their exam rooms during off-hours, and I've lined up a patient and videographer. I'm optimistic that I'll be able to get this done with a minimum of fuss.

So I'm drinking my coffee slowly, and I'm limiting the agenda items to things like, "breathe" and "enjoy sunshine".

on being forced to play well with others

The easiest way for me to get myself to +3 anxiety these days is to think about my upcoming performance exams that require videotape. As much as I didn't have any fun this past week hammering out my papers at the last minute, it really wasn't that terrible, because I was the only person whose schedule was affected. If something needed to happen, I could juggle priorities, pull an all-nighter, spin straw into gold, whatever. Totally self-contained. Having to involve other people in a mess like my academic endeavors is just aggravating.

So, I need to recruit one stunt patient, to be examined on tape, by me. It's tough to find someone who's willing to do this, but who also will be able to keep in character, and who won't be cracking me up in ninety seconds. In addition, I need to find someone to operate the camera, who also won't be laughing audibly while tape is rolling.

Wait, I just remembered that my little brother has a bunch of buddies who are into filmmaking. They'd probably be amenable to being hired for a project like this. . . and, of course, my cousin who lives in the city is in the film industry as well. That might work too.

PSPR goes in the mail tomorrow, FedEX

My muse is a sick bitch.
She only comes around
when I have dark circles under my eyes
dark circles on the draft show where the cold coffee was
She's not one for small talk.
She won't hold your hand,
but she'll smile when you apologize for getting in the way.

PSPR home stretch

The deadline for the report is 9/22; given the fact that the report currently does not exist, I have a pretty good idea of what my weekend activities will be. It's going to be a bit of a neat trick, since I already have plans for most of the weekend.

I'm writing this as I get ready for a shift at the ER. They just called me wondering where I was; I called last night to confirm a start time of 0900, but at some point between 1900 yesterday and now, they managed to change it to 0700, making me an hour "late" right now. I'm not surprised, and I'm certainly not going to go and get myself into a big hurry over it. These people have such a genius for fucking up a one car funeral.

from the top

(Just started Health Assessment and Promotion with Excelsior. Our first order of business was to introduce ourselves.)



Hello everyone, my name is Nurse Cha. I hope to finish up my BSN with Excelsior in the spring. My professional goal for the degree is commission in the Air Force as a nurse officer. I also expect to continue my education beyond the BSN, but for now, I am not certain what direction that will take.

I work as an ER nurse in a midsize community hospital in the inner city, and as a paramedic in a densely populated suburb. Additionally, I provide critical care transport nursing for a professional ambulance service.

I have developed my assessment skills in practice areas that require a rapid exam focused on stabilizing life-threatening conditions. I have learned a lot in that environment, but it does not lend itself to an in-depth, holistic assessment of the patient and family. I’m looking forward to expanding the breadth of that knowledge base in this class.

I graduated from University of Delaware in 1997, where I studied political science and geography. I became an EMT in 1998, a paramedic in 2001, and a registered nurse (through Excelsior!) in 2004. I hold certifications in emergency, critical care and transport nursing.

I usually have to make a conscious effort to unplug from school and work, but when I do, I love to travel. Sometimes time and money constraints keep me from boarding a plane, but I can usually find an opportunity to explore wherever I am.

non-therapeutic hyperventilation

I had the intubation class today. It was a pretty exclusive group -- only one nurse bothered to show up. That's okay. She got to be the test subject for the program. And she did very well. We were discussing rescheduling for the rest of the nurses, and my idea is just to do the program with them one or two at a time on Tuesday nights, when I'm on call anyway. My hope is that keeping the classes super small will reduce the problem of any nursey groupthink about not being able to intubate or manage an airway alone. I doubt it's a coincidence that the one nurse who did make time to show up for the class is a former EMT who, after 13 years inside, is sick of it and wants to become a paramedic. We discussed the relative merits of several education programs. She is the rare bird who already has her RN license, and is motivated enough -- and has enough respect for the separate knowledge base of EMS -- to go slog through a two year medic program. I'll be thrilled if she does go through with it. We need her, and about a hundred more like her in this state.


Dr Y. was also there, with a decent PowerPoint presentation on RSI (that's rapid sequence INDUCTION, people, not INTUBATION. . . although the error has become common enough to be the accepted truth). He was medical control back when I was just a little bitty paramedic in JC. What a relief to not have some random ER doc as medical control. It would really slow things down if I had to take the time to sell someone on the purpose, training and scope of practice for paramedics before we could get anything done.

He liked the troubleshooting list I'd prepared for intubation in the SCTU environment, and said he'd be taking it back to his ER for use there, as many of the potential complications overlap. That felt pretty good.

My preceptor also seemed really happy with the class, although he was rolling his eyes a bit at the poor turnout and the regrets emailed in at 10 pm last night from a few of the other nurses. We had all of the material we needed for a successful class, although the brand-new intubation mannequin head is so stiff that we could barely displace the jaw enough to see the cords. (Rich, our EMT who can just about bench the bus, was our most successful laryngoscopist.)

So now, all that's left is to write it up and do the online discussion with the other PSPR students. I was able to score some more journal articles at the hospital library this afternoon. The librarian was very helpful in accessing some articles that I was unable to get online -- once she determined I deserved her help.

I'm certain that a good deal of the anxiety I've experienced in preparing this project has been at the threat of success, not failure. The thought of failure in this program is dismal, and unappetizing, and I have no plans to fail. Some days, though, my plans for success scare the hell out of me.