epic fail

So this week I had a full day of chemotherapy class, in addition to my three twelve hour shifts, which means I qualify for overtime. And I will get overtime for the next three weeks because I have class every Monday morning from 7 to 4. Although I'm happy for the overtime that I'll get paid I don't know that it's worth it given how tired I am all the time. And I'm going to have a test on the many cancer drugs after these four classes and all this learning is making me really really dumb, it could be the exhaustion too. I think my IQ has been halved. I survived my two night shifts this week, thankful for that, I'm working the AM shift this weekend and then class on Monday and then back to an overnight shift on Tuesday, that circadian yo-yo is going to put me over the edge.

The nights this week weren't too bad though and it was my first time working since completing orientation. I'm now officially on my own, which is stressful but I've just accepted this whole first year is going to be super stressful and I'll probably need a facelift by the end of it. Being exhausted on so many levels is a great ager. BUT, all caps means is my blogspeak for tangent, I had people staying with me this week, I didn't even see them until last night due to my hours working. I haven't seen the one fellow in over a decade and the other, who I wasn't as close to, in who knows, maybe seventeen years or so? How can I put this delicately, the one I haven't seen in seventeen years, he looks bad. He looks easily ten years older than he actually is, he's missing teeth, he looks like an alcoholic, which I strongly suspect that he is. He crashed in my son's bed, which meant that last night my kids both slept in bed with me and I got next to no sleep. But as soon as they left this morning I put everything from Owen's bed in the wash and burned an oakmoss candle in his room because it reeked so heavily of smoke. The room reeked of smoke even though he had been smoking outside on my porch. Oh my, I really don't mean to sound judgmental or bitchy with this but it's sort of stunning how greatly your paths can veer with those you knew in your twenties. I feel like I have nothing in common with them anymore. I'm compulsively neat, cannot tolerate the smell of smoke at all (I hold my breath passing smokers), drink maybe a dozen times a year, have few friends and rarely go out, I'm fucking boring as all hell. I mean these guys are living a booze heavy lifestyle and when I see that now it just makes me sad (did I find this romantic in my twenties, was I really that stupid?) because I know where that goes, having seen how, for all my father's intelligence he amounted to nothing but a half million dollar mountain of debt with his death. Although, my father did have many friends, which is more than I can say and that always makes me think of the quote from It's a Wonderful Life 'remember no man is a failure who has friends.'  This man that looks like he's been on a bender since I saw him last seventeen odd years ago, he was very polite and thankful to me for my hospitality. And the thing that struck me the most, aside from his appearance, is that he drove from upstate NY to Pittsburgh, his face swollen from an abscessed tooth (I can only imagine how brutally painful that must have been) to help his friend cope with his father's death. I mean from a medical perspective I assess him and think, this guy's days are numbered given his lifestyle, but I don't know it's sort of touching he'd go to such lengths to help an old friend.  My friend whose father died came by train with his wife, who's pregnant and would have plenty of totally justifiable reasons to bitch or complain but she struck me as calm, cool, collected and infinitely patient. I was only on the periphery of their even staying here, having only saw them from like 9:30 to 11:30 last night and then briefly this morning but although I know I don't fit that lifestyle, have no desire to fit that lifestyle, I would like to have people I could count on being there for me to the extent his friend was.

The nights I worked this week I had the same patients both nights, one being a person who was recently diagnosed with HIV and then received a diagnosis of a certain blood cancer, I can't really think of two worse diagnoses to receive. Of course, when I first learned I would have this patient I got nervous and was thinking I'm gonna contract HIV. I know this is very silly and as long as I'm safe withdrawing blood samples for labs, which I always am, and avoid an accidental fingerstick, I'll be fine. And I was. Fine. But I feel like I have to be honest that when I initially learn a patient I'm caring for is Hep C positive or HIV positive I do a little freak inside. Until I meet the patient and then I exhale and realize I can handle this. Especially this patient, who was sweet and unbelievably appreciative and the patient's parents, completely adorable. There's certain specifics I'd love to note but I don't want to violate HIPPA. But I think when you see a person in this state and hear their parents mentioning things never said, I just see so much guilt and pain and lost opportunities that could have been avoided. Everybody means well but no one wants to hurt the other so years of stuff goes unsaid. I totally get that having been raised with repressed WASPs but I hope to God that I foster an environment of honesty and transparency with my children, if they feel they can come to me and discuss anything then I think that would be one of the biggest rewards and give me a feeling that I've done my job in being a good parent.

This job truly sucks the marrow out of me physically and emotionally but it is unbelievably rewarding in ways no other job I've had even comes close to. The only thing that drives me crazy is I want to know more. I read the patient's charts (like this patient) and I have so many questions why is the patient considered to be HIV positive and not have AIDS, the CD4 counts puts them in HIV positive territory but the lymphoma diagnosis could swing them to AIDS and how do you treat the lymphoma and not kill them by completely immunocompromising someone already immunocompromised? I'm confused. This is where I get antsy to be a nurse practitioner, to be able to talk and learn from the doctors more, because the hospital nursing, there's no time to really do that, you're so inundated with tasks, at least I feel that way. And I just have so many questions that go unanswered. But I'll look things up on my own and try to talk to residents or fellows when it seems like they're receptive  to questions and the cool thing is that some of the stuff I try to deduce on my own, through researching online, well it winds up being the right answer, which is cool. I want to learn more I just wish healthcare wasn't so maddeningly hierarchical. Okay I've got to go to bed now. Hope whomever reads this enjoys their weekend, please enjoy it on my behalf, the nurse who will run herself ragged this weekend. Have a drink or six for me.