the crying phase of a paper

The writing process:
Gather information on the assignment/audience
Brainstorm
Research
Outline
Draft
Wail and Cry (repeating as needed)
Revise
Complete assignment.



At lunch yesterday, I asked for advice on the level of overwhelming-ness I'm experiencing right now. One option is to ditch the Honors project - and I teared up just asking the registrar how I would go about doing that because I'm so attached to the idea of completing it. One option is to stop checking out Nevada Barr books from the library and staying up until 3am reading. Another option is to resume my preescribed dose of wellbutrin bid, rather than continuing the sub-therapeutic one pill per day.

Still another option is to fashion a yurt from all the cloth grocery bags I've accumulated, insulate it with shredded notecards and move into my mother's back yard, where she would raise my son in the warm, dry house and toss hunks of casserole out to me each evening.

I described what I had done so far on the paper. I wailed that I had at least another 40 hours of work yet to go and how could I ever possibly fit that in, with ANS and NSNA and Honors and papers and 96 hours of clinical, blah blah blah!

My friends blinked, and said, no, actually, you don't HAVE to put in 40 hours of work on this. Write what you have and turn it in.

Blink, blink. What I have, I repeated incredulously. But. What if my advisor isn't impressed? What if she doesn't say that I could just turn this right into a master's thesis and do the graduate coursework later?

Oh. I see. Not realistic, you say. Hmmph.

This re-thinking of priorities and scaling back expectations to realistic levels is some sort of a life lesson, isn't it? I'm slowly catching on.




In other news, the beta fish has a wart on his (it?) (hir?) nose. I asked my fish friend if she thought I should kill it. She was a bit shocked, I think.

Not because it's ugly, I quickly assured her, but just because it might be suffering.

You have been spending too much time in the medical ICU, she said.

it's a cruel, cruel summer

tears for the first two weeks of the externship - because I was lost, because I didn't feel I could trust the folks I was supposed to be learning from, because I was not convinced that the patients were safe, nor that any of us were able to provide good nursing care.

But dammit, if I didn't learn a hell of a lot.

pow. zing. right on the kisser.

PT: You have to do those ankle pumps, so that your right foot won't continue to drop.

amazing patient: I DON'T HAVE TO DO ANYTHING. I'M THE PATIENT.

PT: Oh. Goodbye, then.

me (turning J.D. style to the camera in my mind): Yes! That's it! That's what I've been pissed at you about! And you don't, you don't have a do a flippin thing. You and your fistula and your ostomy and your graft sites and your dropfoot and your helpless ass.

Dad (off camera): Just lay here and die already!

me (still in the fantasy): Dad. Seriously. That's not cool. Knock it off.

me (returning to the room and speaking aloud): Mr. Patient, what's the overall plan here? I mean, what's your goal?

a.p.: Well, to go home of course. I have to get this surgery.

me: (feeling the Zen start to flow) Yeah. I remember hearing that you need to get your strength up for the surgery.

a.p.: well (snort) I heard that I need to get my protein up before I can have surgery.

me (with an infinite expanse of pleasantly interested detachment): Mmm. Having a higher protein will make you feel much stronger. I'm wondering about these four protein shakes on your bedside table. They deliver one with each meal, don't they? I can't remember seeing you drink one.

a.p.: WELL THEN HAND ME ONE, I'LL DRINK IT RIGHT NOW.

me: (moving the table closer) Here you go.

a.p.: YOU HAVE TO OPEN IT FOR ME, THE TOPS HURT MY FINGERS.

me: okay. (still in the zone) sure thing.


This was a hug yourself moment. I was so excited. I bounced through the rest of the shift.

I also had a horrible dream about this guy last night. The kid came in and got into bed with me at some point, and I almost booted him right out on the floor, because in my dream, he had a leaky ostomy bag and I was so mad that he was leaking shit into my bed.
And then I was so mad that my sweet baby child was this guy, this horrible guy.

This is awesome on so many levels - bringing the "shit" from the unit home into my bed, into my dreams has been really bugging me lately. I wake up feeling like I'm still running, still not getting enough people bathed or vital-signed or accu-checked or spent enough time with the preceptor or emptied enough foley bags or remembered to chart that output on the flow sheet or gotten enough ice water for other nurses' patients.
And the anger - well, isn't it all in me if my son is a sweet baby and this man is horrible? Aren't there times that I feel my son is horrible? I am the common denominator. I am able to detach from the knee-jerk and see the habitual thinking and examine it, if I choose. And then the bottomless pool of sweet Zen nothingness opens up in front of me, and I dive on in.

I wonder how I can let my brain know that I'd rather not dream about the unit anymore? I hope that I won't have to keep dreaming about it until I'm okay with everything that happens there, because that seems impossible. uh-oh, is that one of those things that you should do the thing that seems the most impossible? hmmph. Maybe venting crosses over into non-therapeutic, keeping my mind at work when I'm at home. Maybe a ritual, like a bell or something, to remind myself to leave the unit when I actually leave the unit.

I believe that it is no surprise that bedtime reading for the past couple of weeks has been first Eat, Pray, Love by Elizabeth Gilbert (this is the real thing, it's no poppy krappy imitation) and Thich Nhat Hahn's Peace is Every Step. ah... good night.

vented.

friend: no assholes = good day

makes sense to me

me: well, as unpleasant as emptying an ostomy bag can be, wiping an adult's anus is worse.

friend: I can't believe you've actually done that.

me: Dude. Get ready for a I've had the shittiest (literally!) day ever story. Settled in?

friend: uh oh

me: I have had this one patient for six days straight now. He is,hands down, the neediest, whiniest, and most - likely to be an abrupt asshole while you're holding his shit bag in your hand- adult I've ever met.

He has skin graft sites on his legs that are all crusted and oozing blood, and a abdominal wound on his belly about 4 inches across that leaks gastric contents onto his flesh several times a day.

So - he has a THOUSAND reasons that perfectly justify whining and crying.

friend: HOLY!

me: But everytime he screws his face up and whines, I feel like I have to physically hold my father back from getting down in his face and cussing him down the ground.

It's like dad's behind me, saying all manner of nasty shit, and I'm all, No, Dad, we're not going to say that to him right now. We're going to be matter-of-fact AND compassionate, and we're going to remember that he feels trapped in this room and scared of this pain.

And dad's all - Fuck that! Your kid can himself better than this little worm! Tell him to shut the fuck up and get his own goddamn toothbrush. Why isn't he emptying his own ostomy? Is someone going to do it for him at home? No, they are not!

friend: Hahahah, damn!

me: Jesus! I know! (this is the last thing!)
AND he's extremely hard of hearing, and he yells everything he says. Everything! So when he demands his toothbrush, or for me to rearrange his bag in his bed, or accuses me of taking away his important documents when I changed the bed, it's all at top fucking volume.

and in my head, I'm also yelling.
SHUT IT UP, BITCH.

whew.

I actually feel a little better.

friend: Ewwwww!

me:venting via chat can be therapeutic as well.

friend: You should have a journal devoted solely to venting about these things.

wait, that's an excellent idea!

Why Were You There?

This video is totally unrelated to nursing.


Except.


New nurses are getting plunged into the most challenging settings, just like first year teachers are.

Duh.


The units that regularly have 6 patients per nurse, routinely at least 3 of them on tubefeeds, with trachs or on oxygen, incontinent of stool and urine, and with some sort of fluctuating critical lab value* - those are the inner city schools of the medical world. And the experienced nurses are running in droves from those units. Because the experienced nurses have... experience. They know that is is a shitty situation. They also know that there is zero indication that it will change soon.

So that unit is staffed from the float pool. Or is on the list of getting new recruits.

What is the likelihood that those patients are receiving consistent quality care? Small.

What are the chances that those new nurses will stay on that floor? Slim.

What are the chances they will stay in the profession? Hmmm. Why should they? Will it be different anywhere else?

I'm 6 shifts out of orientation for my student externship, and I am already pissed off. Sobbing in the parking garage. Scurrying and sweating. Forgetting to pee for 7.5 hours. Wondering where the nurse manager is, and if this is just an 'off' day.

No. This is everyday.

And the response that I have gotten when I've tried to discuss this with professors in the past is so similar to what this woman says, it's eerie. They want to know why I'm not being more carefully precepted. I want to know why no one is freaking out.


* These are not ICUs. These are patients on the floor. I know (well, I don't know personally because I haven't done my ICU rotation yet) that the patients in the ICU are so much sicker than this. But the patients on the floor need care at a much lower ratio than 6:1.