Sunday, March 12, 2006

thoughts: random, disorganized

When I was in training we had to experience different areas of medicine. We would be thrust into the hospital for six week rotations. The standard was geriatrics first, then medicine,surgery,labour,delivery and postnatal care, pediatrics and psychiatry.

I hated psychiatry. Because I was raised by a woman who was seriously mentally ill I hated to be exposed to these people. I had no sympathy,no patience except for those suffering with schizophrenia. To me at that time schizophrenia was the only true mental illness. It had science behind it. Eventually I added bipolar because it reacted so dramatically and positively to medication.
As I got older and reconciled my own feelings about my mother I allowed myself to understand that depression is in fact a real disease. It is not something chosen, it is not a bratty selfish thing like I thought when I was thirteen and feeling lost in puberty.
I had my own transient twenty four hour run in with drug induced depression and my relief, my joy when that black cloud finally lifted truly opened my eyes.
Looking back I missed an important learning experience because I refused to let go of being absolutely pissed at my crazy mother.

My pediatric rotation was heartbreaking, confirming for me that I could never be rational when caring for a sick child..that option was out.
I loved labour and delivery. I loved being a part of such a momentous thing, being a hand to hold, a voice that guided a mother through labour. I couldn't do it for a living though. The threat of a lawsuit for my entire life was too great a burden for my family to endure. Any mother can sue you up to the eighteenth birthday of the child you helped deliver. Some nurses got sued because some kid didn't get into the college of their choice. The mother said she was sure the nurses had done something to make their kid dumb..the dumbness seemed to appear only at college application time and only for Ivy League..the kid got a place at the state college. They settled out of court.I can't live with that over my head.

I was on a medical floor caring for a very kind gentleman who had fainted at home. In his embarrassment he refused to tell his children what was wrong so they called an ambulance. When he arrived he told the doctor he had been bleeding quite profusely from the rectum for weeks.. He explained that he had always had trouble with hemorrhoids so he thought it would just go away on it's own like it had so many times before. I came in that morning, got report and went into see this man. He seemed very sad and humiliated. I asked him what was wrong and he began to cry and said he thought he had soiled himself and that he was very,very sorry.
I held his hand and told him he had nothing to be sorry for , that he was sick and weak and that thesethings happen and that is why I was there to care for him.
I got some clean linen and a basin and asked him to turn over...I couldn't breath when I saw the blood. It was everywhere, thick and red. I quickly washed him and placed new linens. . All I wanted to do was run from the room screaming but something steely inside held me back. I had a job I promised I would do. I did it.
I walked out of that room and straight to the nurse in charge and told her I believed that he was bleeding out through his rectum.
The first time you see a staff gear up for an emergency is awesome. Monitors come sliding in and are hooked up, blood bank is called and runners make mad dashes to the lab and for blood. I got my chance to insert a nasogastric tube. A tube that enters through the nose and is fed carefully down the throat into the stomach and then hooked to suction. Blood came flashing through the tube. This poor man was assaulted by technicians, nurses and surgeons and I never left his side. I cleaned him over and over as he continued to bleed faster than we could pump it back in. Finally the operating room called and said they were ready. I went with him into the OR and held his hand as he drifted under the anesthesia. I watched as the surgeon removed a massive amount of colon but happily said it doesn't look like cancer. I waited with everyone else for the labs decision and we all cheered when it came back no cancer.
I went to the intensive care unit with my patient.
I was so completely overwhelmed. All the IV's , the pumps, monitors and ventilators.
I ended my day knowing that I thrived on crisis. The ICU was my home.
I spent more time with that man who taught me what my vocation was. I was as happy as he was the day of his discharge I think. To see someone at the brink of death pulled back by sheer teamwork, that awesome engine at work.
A six week rotation seems very short in theory but in practice it is more than enough time to teach you what you will love and what you will never,ever want to do.

I had a good laugh reading the New York Times today:
Hospitals short on Ventilators if Bird Flu hits by Donald G McNeil Jr.

Gosh didn't I just write about that a few weeks ago?
There is no way we will have enough ventilators for a quarter of the patients. We don't have enough vents for the patients we already have. I agree with using CPAP and temporary vents. They are cheap and do the job. I really wish the media could stop the panic crap. How about figuring out ways to be ready for when the shit hits instead of whining about what we don't have?
I wish we had more ways to force action instead of so much talking and meeting and holding hearings and blah blah.

We were bored at work the other day and we were talking about how the media and the public hold two completely contrary views of nurses. In movies and television we are usually whores. We sleep with every doctor in the hospital happily passing on gonorrhea or worse mental angst and inability to commit. Please, if Goran wants to marry you and have little Goran babies you would have to be a nutcase to refuse. Then the next exnurse/new doc walks up to bat and gets knocked up. Movies always describe the nurse as hot and visitors ask patients if the nurse" gave them a bath yet" and did they get off. It's bizarre because in the next breath nurses are described as saints full of endless care and compassion. We are given shiny halos.
We were laughing because some of the descriptions are true. Just like in any profession we have nurses who have sex with doctors..lot's of obvious, irritating sex and we have nurses that would not be amiss in a nuns outfit.
The other irritation is nurses all want to be doctors. No we don't. Most nurses love the fact that when their shift is done they can go home. No one calls you at home at three am either. Nurses love the fact that they get to have a real relationship with their patient. Doctors have so many patients it's a wonder they can remember any of them.

Nurses are just like the rest of the world..kinda slutty sometimes, kinda saintly other times.

There is a weird thing that happens in hospitals sometimes that I have never quite figured out how to deal with. Sometimes you will walk in and a patient will be masturbating or their wife or girlfriend will be offering" aid". I understand that people don't lose their sexuality just because they become patients but part of me always says "holy shit" and I am embarrassed. I become all weirdly conservative and pissy. I wish I could just stop being so priggish and leave them be instead of going all nurse and behaving like my patient is being assaulted by a stranger. When they are masturbating alone I feel creeped out.. I know they are as embarrassed as I am but I feel judgmental like Dear Abby " all there is a time and a place for that" but what better time and place? You feel sick, you have pain wouldn't an orgasm be a good thing? Endorphins release and you feel happier painfree..maybe we should encourage masturbation..give a prescription....

Why are we such prudes about the whole thing?

As nurses we have seen a million penises, peni? vaginas, we understand all about sex and needs and how beneficial a healthy sexual relationship can be..I need to stop being so weird and think about how happy it makes my patients and happy patients are easy to care for..that makes my job easier..right?


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