play nice

into the woods, this is how I feel facing each work week, except the woods are much more foreboding

I have been so mad and upset for most of the week, still kicking around the hurt from work this past weekend. The odd thing is nothing absoltuely horrible happened. Friday the 13th sucked, I got an admission with change of shift which is always a huge pain in the ass. It's not difficult so much as I hate leaving my patient just sitting there wondering why it's taking me forever and a day to get around to them. But, this patient and his wife were understanding. Things went smoothly with them, the patient got a central line placed, foley put in (for continuous bladder irrigation because some chemos can cause hemorrhagic cystitis) and the chemo was up by 4:00. I got through it all without a problem. I had to deal with the rude IV nurse whose lack of industry and rudeness is such a slap in the face when the other two IV nurses are so friendly and helpful, seriously I sometimes wish I could find out this shrew's schedule just so I could make sure to schedule myself when she isn't working. But so I paged her about a patient and she did the absolute minimum, just slapped a dressing over the existing leaking one and didn't bother to change it, it's lazy and stupid but not entirely unexpected given who it was. 

Saturday I had four patients. I was busy busy and one of my patients handles fear of the unknown by being terribly mean-spirited, making comments about basically everything I do. Saying 'overkill. overkill' when I'm examining their feet, palpating for the pedal pulse. Talking about how golfing is for fools that don't know how to fish and then saying 'Do you golf Kim?'  I just try to deal with it and not let it take too much out of me, but I find behavior like that, well it's sort of like having a dementor for a patient, it can be wearing. My central line guy's dressing was leaking. Again. No surprise given the half assed way the dressing was taken care of yesterday. The IV nurse was on the floor and asked if anyone needed help before she left, behavior that was noteworthy for it's rareness coming from her. I said, yes my patient in room #- needs his dressing changed. To which she replied, what's the problem. Well it's starting to leak again and the dressing is coming up near the biopatch (an antibacterial foam disk near the insertion site to decrease the risk of infection). Her reply, if the biopatch is exposed it's your responsibility to change the dressing. I say but the line was placed less than 24 hours ago it was my understanding that only IV team can change dressings within that time. She makes some other comment about how she can't do this and how it's something I should take care of and then I say 'Didn't you just ask if anyone on the floor had anything you could take care of?' That silenced her and she asked what room number and said she'd look at it on her way out. Fifteen minutes later I saw her walking off the unit and I went in my patient's room to ask if she had checked in on him. No she hadn't. 

I gave her another hour but she didn't come back and by that time I figured 'fuck it' I might not do these changes as often as IV team but I'm anal to a fault when it comes to them so I just got the supplies and did it myself, and as nervous as I get about doing the dressing changes I do really good work, lines that seem to have an issue with leaking stop when I change the dressing. It's like glorified cleaning but using sterile technique and being on a person. I'm good when it's very important to make something clean and neat. The IV nurse showed up five hours later to change my patient's dressing at which point he said 'no it's already been changed.' This nurse then tried to remove the dressing I had done saying I shouldn't have put gauze where his steri-strips were, that I just should have put the dressing directly on top, that it would heal better that way. His skin at that site was a bit boggy (soft and moist) and I figured that it would be make more sense to put the gauze there to get the moisture and feel much better and if that area was moist how good a seal could you make with the dressing without gauze and why are flipping showing up hours after the fact and then acting all righteous and indignant at the fact that I changed the dressing. The patient got annoyed with her and told her to just leave it, he was fine. This patient, my admit from Friday, got discharged early Saturday evening, he gave me a hug on leaving. He was such a nice man and so delightful to take care of. He was a much harder patient than my walkie talkie dementor but I will take a challenging complete care patient any day if they're friendly. I don't mind working I have a harder time with emotional vampires.

Sunday my patients were easy, no blood, platelets or replacements. I only had three after my discharge yesterday evening. I couldn't beleive my luck. Then I saw it was at the expense of another nurse who had an assignment from Hell. I told her I would help her as much as I could and I tried to do my best, to help her out. I was getting pain medicine for one of her patients when my day took a nosedive. I went in the room and the patient was bleeding from the mouth. I knew he needed blood and platelets so I became concerned about a spontaneous bleed and hollered for the nurse. My old preceptor, who I love, came in to help me out and she called for the doctors. The resident came in first and then the fellow, I was trying to draw up the patient's morphine into a syringe. Now the problem was the morphine wasn't in a regular glass vial (short and squat that you place an equal amount of air as what you want to draw up ) but in one of the long slender vials that's supposed to be used with a carpuject but no one does that they just draw it up with a syringe (my first night working during orientation I accidentally put air in this vial and the bottom exploded off, along with my morphine, leaving me panicked that they'd think I'd taken the medication. fortunately others have made this stupid mistake). So I'm trying to draw up this med and I hated doing it from these slender vials and the fellow is looking at me like I've got three heads and I don't do well performing tasks in front of watchful eyes. The fellow suddenly says 'How long have you worked here?' And tone is everything. It wasn't friendly, or conversational or even humorous, it was a wafer thin veil of contempt. He might as well have said 'what the fuck are you doing?' I said, 'I'm new here, I started in February. Why?' All the time I've got this fucking syringe in one hand and vial in the other still trying to draw up the med under his black eyed scrutiny, sweating in the gloves and yellow gown. His response was because I've worked here over three years. 

perhaps I would have gotten a better response if I just looked at him like this? would go over much better if I was as cute as my daughter.

That was it and for the life of me I started thinking. What did I do wrong? Did I accidentally touch the needle hub with my gloved finger (due to the patient being on contact precautions). Was he mad that I had emptied the emesis basin three times rather than save the bloody water the patient had spit out. What had I done that could justify incurring such invalidating behavior. And it wasn't even my fucking patient. I was helping out. Emptying C difficile bedside commodes (diarrhea heavy and a smell that can make even veteran nurses gag). What did I do? I felt unnerved the rest of the day. And when I went up to the resident, I avoided the fellow, about another patient, very tearful, very depressed, due to be discharged the next day but talking about just wanting to be dead. I'm like this patient needs help. We need to get a psych consult. The resident nodded and the fellow just looked at me with this smile like I was an imbecile unleashed on the floor and the attending, to his credit, nodded and agreed that the patient seemed much more depressed but I felt my wee bit of confidence in my work eroding with this fellow's reactions to anything I did. At the end of the day I steeled myself and asked him about a medication for another patient, and it became this cat and mouse game. I don't think the patient needs this med, perhaps colace but not miralax, he's had three bowel movements today and two yesterday. He told me he had no bowel movements yesterday. Yes, well he had two, he mentioned blood on the toilet paper when he wiped the second time while he was getting  platelets yesterday, I talked to him about not straining. He had told me he hadn't gone. Yeah, well he did go, twice. We don't need the medicine. Which he hadn't ordered, I'd seen it in the progress notes but no order in the computer. I don't know it sounds so inconsequential but his tone, so dismissive and the way he would look at me, like I was an idiot or else he would avoid looking at me. But then the next second he's all friendly and chummy with the registry nurse sitting right next to me. It was awful, honestly I came home and cried. Why can't people be nicer. I so miss Aaron and Jason, two of the fellows from last year. Who were so easy to talk to and Jason went out of his way to tell me I was doing a good job. Now I get to deal with this guy until next July. Delightful. I hate that I get so unnerved by dismissive doctors. Please pray that next Friday through Sunday goes better.