intrinsic

one of the greatest moments in ER history:

an EMS call comes in from our local fire/rescue guys. they ask for a doctor to take the report (usually, nurses take them) because they want to divert to our nearest psychiatric hospital instead of having to medically clear someone in our ER first (and potentially tie up a bed all night). those guys had our best interests at heart, the dears.

so this gentleman, with a history of psychiatric disorders, has been off his meds for awhile and was found talking to himself and scratching the wall outside of a mcdonald’s. no medical complaints, no signs of any injuries and no risk to self or others (not wanting to harm himself or anyone else).

doctor’s reply? “get that man a big mac, fries, a coke and divert to Psych”
paramedic replay? “that’s funny actually, we got him a big mac, fries and some milk, is that ok?”

i haven’t laughed so hard in ages.

i think chris put it better than i could’ve when he wrote about how much he loved Sadie. but i loved Sadie too.

we met when i was 17, she was probably 12. it was always the same with Sadie; everytime i pulled into the driveway she trotted up to my car, complaining in that broken meow that she did NOT have enough food. i always picked her up, hugged her and smiled when she began purring instantly. chris calls Stripey a gratifying cat- so was Sadie. they’re a lot alike, i think. but, she hated other cats, frightening Stripe every time he dared go near the front door. she was protective of her food dish. other cats better not go near it while she stood watch.

but she was always so sweet to us. crotchety and territorial maybe, but always so happy when i pulled up to the house. chris and i debated taking her with us when we moved out- but it wouldn’t have been fair to her. she loved rolling around in the front yard, oblivious to the dirt she was collecting in her beautiful tortoiseshell coat. she loved roaming the yard- always careful to stay close to home. she wouldn’t have liked living inside. she certainly couldn’t have tolerated Mannie and Stripey either.

i’m sad to let her go- sad i won’t see her trot up to me next time we visit his mom, but i know Sadie was loved and died loved, after a long, happy life. i’ll always remember her. i’ll always remember that voice and i’ll always remember laughing while she rolled around on the ground, purring and so happy.

we’re embarking into some unknown territory right now.

home buying.

we’ve found one we’re really interested in and are in the process of seeing how our offer goes, but i’m pretty encouraged we can find something at a reasonable price. we’re in no real rush, we can just qualify for a nice sized loan and might be able to score that $8000 tax credit- so we’re taking a shot at it.  it’s weird place- real estate- full of strange language and games that i don’t fully understand. i’m learning a great deal, but it’s still so confusing. periods of a deep lull followed by periods of rapid change and action. but mostly the boring lull part where you don’t hear anything and wait around hoping.

there is a lot of high anxiety going on regardless. i’m hoping, hoping, hoping this house thing pulls together- but i’m trying to be realistic about it. we’ll see…

Listening to people on a favorite radio show talk about atheism today makes me think that most people just miss the point. They were discussing how atheists were just Anti-Christian, just “didn’t believe in anything” and basically painting them in the same light as the fundamentalists of many religions.

That’s not really a fair depiction. Sure, any group of people has their fundamentalists and the tendency for some people is to be anti-religion, but i think that true atheism is just to be areligious. I’m really just speaking for myself and the people I know, I wouldn’t say I’m an expert on the topic in anyway. Atheists don’t need religion. I don’t believe in any God or higher power and I don’t need them to explain the world around me. I’m comfortable with everything being random and based on scientific explanations rather than mystical ones. I’m comfortable with the idea that this life on Earth is all there is and that when I die, I’m worm food. I’m down with that. I’m not Anti-Christian or Islam or anything. If people are part of those belief systems, I (and most atheists I know) have no problem with it; we don’t find those people weak or stupid or faulty in anyway. Are there atheists who do? Sure. But, just as there are Christians (for example) that find atheists evil, there are atheists who find Christians moronic. I don’t know any religious people like that. And it doesn’t matter to me one way or another.

That said, in some ways, I admire people who have a strong religious belief. I can’t believe in a God. I just can’t wrap my head around it and it doesn’t make sense to me. People who can and do, who have a totally different way of thinking and can give themselves up to something they can’t see or feel or prove are amazing to me. I need proof. I can see the devastation in Haiti, for example, and explain it with politics, earth science and medical information. I can’t see it as the plan of some higher power. People who can be that optimistic are really amazing to me.

So clearly, I’m not antireligion. I’m just areligious. I admire those who are, but I don’t need it to get by in life. I don’t need a set of morality rules to not run out and kill or rape the first person I see. I think I lead a pretty good life, being the best, if not ultimately flawed, person possible. I find it unfortunate that atheists are often depicted as amoral or hateful, instead of admired for the conviction that many religious people are credited with.

i have a lot to think about this week.

it’s the 10th anniversary of a high school classmate’s death by a drunk driver. she was killed right outside where my ER would eventually be placed; i actually think of her quite often as her memorial still stands just outside our parking lot. i wasn’t close to her at the time, but i attended her memorial with many of our classmates. i went with the idiot i was interested in the time and my best friend at the time. my friend was crushing on this guy named Chris who was closer to our classmate than we were, and whom she thought was pretty upset that day. so, when we got back to her place that afternoon we called him up to (according to her) check on him. i ended up talking to this Chris fellow too and we started chatting on IM over the next few months. over the summer, we lost contact as happened so often in pre-cell phone days. i was online chatting with my CURRENT man of interest just before school started again in the fall when Chris reappeared. we started hanging out at school and quickly became close friends. and i quickly broke up with the guy i was previously interested in. and that was the last time i really cared about any other boys.

so it’s fitting that at this time, Chris and i are starting on another adventure together- home buying.  we’ve been fortunate to hook up with a realtor friend to help us out and have already talked to a mortgage broker to get a rough estimate of what price range we can afford. there are a few homes we’re anxious to check out and we’ll see from there where things go… i’m excited, to say the least. owning a home is so important to me, and i’m glad Chris is finally aligned with me in that regard. i’ll be updating about those adventures as we create them.

this atheist is really getting into the Christmas spirit! seriously though, it’s probably my favorite time of the year, despite my a-religious standing. i’ve been gearing up with some of my favorite carols and movies, baking, decorating and gifting. i just wish it’d snow a little bit and then we’d be in business!

here are some of my favorite songs and movies:

carols:
“Carol of the Bells”
“Good King Wenceslas”
“We Three Kings”
“Here We Come A-Wassailing”
“I Saw Three Ships”
“White Christmas”
“O Holy Night”
“Baby, It’s Cold Outside”

Movies:
“A Christmas Carol” (the George C Scott version)
“It’s a Wonderful Life”
“Christmas Vacation”
“Love Actually”
“Little Women” (not really Christmas per say, but a bunch of does take place in the winter at the start of the movie…)
“A Nightmare Before Christmas”

i’m so pumped for the 25th!

i came across some amazing albums this year- but not necessarily all of them were released in 2009.
here are my top ten favorite albums from this year:

1. minus the bear- menos el oso (2005)
2. giant squid- the ichthyologist
3. katatonia-  night is the new day
4. the dear hunter- act 3
5. alice in chains- black gives way to blue
6. regina spektor- far
7. minus the bear- ice planet (2007)
8. as tall as lions- self titled (2006)
9. rachael yamagata- elephants… teeth sinking into heart
10. callisto- providence

i read an article last week in the Alibi (a local, independent newspaper) about some dude’s trip to the ER for h1n1 (OMG! THE SWINE FLU) and about the terribleness of the Downtown ER. from his account of the trip, my nursing diagnosis is:  he’s an idiot. complaining about wait times, about his hospital bill, about the lack of magazines in the lobby, etc.

look, waiting in the ER sucks. especially if you feel bad or are injured.  ERs are overcrowded, understaffed and insane. this is nothing new. “hire another doctor”, “hire more nurses”, “make it faster”. i’d love to, trust me. you’re preachin’ to the choir here. the facts are though: hospitals are strapped for cash all over the country. treating your ass is expensive on our end too. nurses and doctors are in short supply and hot demand and take awhile to train before they’re ready to step out on the floor. this can’t be fixed during an ER trip; it’s a moot point.

what annoys me about my job is that my clientèle don’t understand it.  when i triage them, they think i’m just asking a bunch of stupid questions and taking their temperature. when i pass them over for another patient who has been waiting less time, they think i’m just being a bitch. when i’m not in the room every five minutes, they think i’m ignoring them. when i don’t make them pass out from narcotic euphoria immediately, they think i’m withholding. and a bitch. when they wait three, four, five, six hours in the lobby, they think i’m just sitting on my ass doing nothing. and being a bitch. (it always comes back to me being a bitch…). the reality of the situation is: i’m working. i’m not ignoring them, i’m not sitting on my ass with my feet up eating cheetos.

here is triage in a nutshell: patient walks in, comes to the window and wants to check in. the first step is called an “across the room assessment”. basically, are you stable or unstable? gonna die this minute or can you wait a few? it takes awhile working in the ER to develop this gut instinct. this, along with the “chief complaint” helps me prioritize who i bring back first to fully triage. (i.e. a stable ankle sprain gets bumped for someone who is “short of breath” and can barely get three words out at a time while we’re talking at the window). once  i bring someone back,  i ask what is going on, they give me a basic complaint. my job  from there is to combine their vital signs with what they tell me about symptoms/past medical history/medications, etc, with how they look and decide where they fall in line. i have a set of protocols at my disposal that allow me to start lab work, x-rays, medications and  treatments while patients are still in the waiting room. this not only lets me prioritize people with serious illness or injury, but saves the docs some work once the patient gets back to a room. so i’m not sitting on my ass while people are out in the lobby.

at the same time, we’re holding patients in the main ER waiting on beds once they are admitted to the hospital. this can take anywhere from an hour to a day- and the rooms are essentially out of commission for this unpredictable time frame. then we have to prioritize the ambulances coming in the back, that the people in the lobby can’t see. patients crash and that sucks up a lot of resources, bringing the joint to a halt. if we have a handful of really sick people in the back, time and personnel eat up even more time. the ER is so variable and fluid- one moment is never the same as the next. while i love this part of it and don’t mind not being able to plan my 12 hours with any degree of certainty- today’s society haaaates it. i get that. people want to be able to take care of whatever injury or ailment they have  and not waste a bunch of time doing it. but if i can’t even plan when i’m going to be able to take a pee break, i seriously doubt you can plan an ER trip. i don’t understand why people don’t get that yet…

we live in such an instant gratification society where too many people have such a sense of entitlement and an overblown sense of importance. it makes everyone else’s illness or injury is worse than the guy next to him. waiting any length of time is unacceptable anymore. not being in control makes people insane. yes, your hand lac hurts. no, it’s not going to kill you. yes, i know what i’m talking about. yes, you can wait (and YES i know the guidelines for how long you can go before closing a wound and YES i’m worried about infection too). people, like the writer of the Alibi article, need to a) utilize emergency services appropriately, b) not be pissed off when they have to wait and c) not question my intelligence or competency.

i get really frustrated by my job.  i love what i do, but it pisses me off when people criticize my job without knowing or understanding a fucking thing about it.   i can sympathize with the frustration of anyone who has waited in an emergency room for any length of time. but take five seconds and try to sympathize with your nurse, ok?

i really enjoy this time of year. the weather is cooling down, the days are growing shorter. the mad rush of the holiday season starts piling on.

i’ve started knitting like a fiend again, making things for friends and family. i love the feeling of yarn sliding along my fingers, the clack of my well used needles tapping each other, the feel of the fabric i am building with each new row. i love seeing how patterns turn out, even though i know what i’m making. i hardly make anything for myself. a scarf or a hat every year; what i really enjoy is knitting for everyone else in my life. i find it much more enjoyable. since october i’ve made…. 3 hats, 2 child hats, two scarves and two headscarves. prolific cadie!

i am so excited for the month and a half to come. we’re visiting chris’ family in NC at the end of december and in the first part of january i am taking a short trip with some work friends to phoenix for the purpose of SHOPPING. i have thanksgiving off this year, which is way better than christmas in my opinion. this means of course, it is my turn to work christmas eve and day. after a stretch of 6-in-a-row at work, we fly out to NC. i will have never slept so much on a plane…

flu season in the ER seems to have been much  ado about nothing. we had 2ish weeks of a bajillion people a day whining about their cough and fever, and now… we’re back to having our shifts cut. how come summer time is proving to be busier than the winter again? summer is supposed to be the slow time in the ER and cold/flu season is supposed to make us want to drink? oh well. we’ll see how it all pans out. the hospital is still strictly budget cutting and some departments are having to lay people off. i won’t complain about my job cause i HAVE a job.

i’m always astonished at how quickly the year flies. it seems such a short time ago that kira was here and i was making christmas dinner. another year is nearly gone now- but i am excited for the next to come. each year seems to get better and better.

An ashen, critically ill patient tilted head down in an effort to force blood to the brain. The mad rush of paramedics, setting IV pumps and nurses yelling instructions to each other over the beeping monitor alarms. Trying to remember which button to push and how much Heparin seems acceptable for a drip.

The doctor standing completely fucking clueless while another takes charge of a deteriorating situation.

The sweat pouring down your back in the packed room, fit for several and not meant for a coding patient, but packed with two gurneys and a dozen staff members.

The anxious, calm husband standing outside the room, peering  around the doorway, in between personnel.

The realization that three minutes have passed, but you’re sure it’s been hours.

The sigh of relief that the patient is finally in the hallway on her way to the ambulance bay.

And then the heartbreak when her husband leans over, says something inaudible to her and kisses her forehead. And this is the last time he sees her alive and he walks out of the ER smiling at us.

The chill up your spine when you hear the radio call to Downtown ER a mere ten minutes later (usually a forty minute drive). “The patient went into V Fib 8 times” “She was shocked 8 times, we have a pulse of 122 but can’t get a blood pressure”. The looks on their faces when the medics return IV pumps a bit later and let you know the patient didn’t make it.

The conflict and frustration in your heart when you wonder if there had been a different physician? Maybe if you didn’t waver for that split second up in triage about taking her back to a room immediately or running an EKG in triage first? None of it mattered, but all of it runs through your head all night long.

That was about the span of an hour last night.