This post has been interrupted a lot tonight. It's been one of those nights... people in the township keep finding the "9" and "1" buttons on the phone and putting them in that magical order.
I tend to be a black cloud when I work, attracting calls for all four corners; life-threats, bullshit and everything in between. But recently in the last few weeks, I've gone shift for shift with next to nothing. I'm not complaining, I just find the timing for the re-surfacing of the storm to be interesting.
I found out yesterday that the NCLEX gods conferred and deemed me worthy of placing the two letters "R" and "N" following my signature. It was surprising, but no less exciting. However, it appears I will definitely be unable to avoid trading in my four wheels for the four walls of a hospital unit. Or, more accurately, the 4 pods, intermediate unit, observation area, trauma bay and triage/waiting room of the Level 2 trauma center I've sold my soul to for $22 an hour and health insurance (which no one appreciates how much it sucks not to have until you don't).
It's not like I haven't thought about being on the other side of all this. I imagine everyone does, even if they they never actually end up there. Whether it's appreciating being relieved of 82 year old Spitting Sam and his unfortunate "Code Brown" situation or being disappointed you can't follow your 25 year old MVA trauma code resuscitation save to CT and beyond, it's pretty standard to wonder what it's like to be stuck with the patients you leave behind.
I wonder about the nurses too. I have several friends who are, and I always enjoy interacting and working with them when I see them. I enjoy it because they respect me, listen to my report and value my opinions and assessment. What I don't enjoy is when nurses speak condescendingly to me before I even have a word out, talk over me to the patient instead of listening to my report, or call me an "Ambulance Driver." I'm not allowed to drive. I crash things. I wonder about those nurses - the terminally crabby and bitter ones. I mean, everyone has their days (I sure do) but come on, if you hate everyone who walks through the door already, what are you doing here? But then I think, that could be me. I hope that if it ever is, I know to find something else to do before I hurt someone physically or emotionally. Before I miss something important because I'm too busy dismissing everything as "been there, seen that, everyone's wasting my time."
When I first started running as an EMT, I was so silly. I didn't know the up end of a backboard or the leads from the BP cuff. I was a disaster on calls and the absolute definition of "Whacker." I had goals though. Oh yes, and my main goal? My main goal was to be that cool EMT who walks into the ER and knows everybody. Who can walk around the ER like they own the place and make jokes with the Registration ladies, high five the nurses, suavely answer the doc's questions and trade stories with the cop on the way out. It's silly and funny but you know what? I guess I am. I mean, that is how I am (more or less) when I drop off in the ER. It's cute to look back on how I was and where I am, but that... that is not what I'm most proud of, not how I define who I am and what I've accomplished. (Thank god, right?).
Who am I? What have I accomplished, what have I learned? Well... This is what I know. Any idiot can learn when, where, and how to collar & board, give oral glucose, or hold pressure on a spurting wound. Being an EMT is mostly common sense; it actually is pretty hard to screw up as long as you act in the best interest of the patient. We can give hardly any medications, we don't start IVs, we don't secure advanced airways. Being a nurse is a whole different ballgame. There's a lot more too it. But my knowledge hasn't changed. I haven't added to my skills repertoire. Yet, yesterday I was just an EMT and today I am a Registered Nurse. I haven't changed. The difference between my being an EMT and my being a nurse, right now, is literally being allowed to hold the syringe (hence the blog title). That's it. And that's scary.
But, I digress slightly (impending full circle circa 2 paragraphs). The point was, the things I am most proud of and the things I believe define me have nothing to do with protocols and mechanics. I just can't do the job "cold". I can detach and "do what I have to do," but in the end, I'm the EMT that's going to hold your hand when you're scared. I'm the EMT who will answer your questions honestly and accurately and will find you the answer when I don't know. I am the EMT who will make sure you have a warmed blanket before my unit clears the ER. I am the EMT who will wash the sticky blood and dirt off your face and hands when you're strapped to a backboard and we have extra time on the way to the trauma center. I am the EMT who will lie on the rainy and wet highway next to your upside down car, holding your head in alignment through the window and talking about whatever keeps you calm and happy while the firefighters cut you out. I am the EMT who remembers to take your medications with you to the hospital. I'm the EMT who gives up my Saturday night out to hold your hair back while you drunkenly vomit and curse at me. I am the EMT who makes sure your family in the waiting room knows where to find you, who stays with your wife after the ED code team takes over, and who makes sure your kids aren't in the room when we defibrillate you.
It makes no difference to me if you appreciate it or not, that is how I am going to do my job regardless because those things are what make me happy and the job worthwhile. These are the things I have learned. These are the things that make me good at what I do.
Today my station had a fatal MVC. Guy went off his bike, hit two curbs and a hill. He basically made his helmet a brain bucket... broke every bone in his body, went into traumatic arrest and was pronounced locally... didn't even make it to the trauma center. My station is fairly busy (about 2500 ambulance calls a year), but things like this don't come along every day so I made sure to ask my buddy who rode it in if he was alright with what he saw, etc (read: do we need to go drink?). He said absolutely, when it came to those calls he's "pretty cold."
I agreed. At least while on the call, I find it easy to shut down and "do what I have to do", on autopilot if necessary. I have learned how to not be a mess. I have learned how to do what I do, and do it well, in any setting (rain, snow, angry dogs, 4AM, angry bystanders, even when treating someone I know). I know I can translate that part of my job, that much that I've learned to the Four Walls setting. It's the rest I'm not sure about. It took me a long time to not be a mess and then to be more than just adequate, to how I am today. I don't want to regress, so to speak. I don't want any patients to receive anything less than stellar, compassionate, accurate care from me while I'm busy figuring it all out again. I know it's inevitable and I have to try not to be so hard on myself, but these things are the things that mean the most to me, what I pride myself and my standards of care most on. These are the things I make sure to pass on to those I teach. The "little things" really are everything. I don't know how to take them with me AND be an excellent care-giver in this new job, when I just don't know enough. When I have other things I have to focus on and learn. I don't know how to be the one who stays with you and holds your hand or watches over your wife and kids when I have 8 meds to look up and give, a foley to place, a shoulder dislocation to assist with re-setting, a patient to go to CT and 3 IVs to start. I just don't know how, and I'm terrified.
All I know is what I know, you know? And I don't feel like it's enough. I literally feel like I'm going to be standing in the middle of a crowd of patients, doctors, experienced nurses and everybody else all looking at me and expecting me to act like and have the knowledge of a great nurse and I just feel like an EMT with a syringe.
Good writing. This one could have been written by any of us out there. You really put it into words well.
Ray
Posted by: Ray Mickol | August 05, 2008 at 12:46
Thanks Ray! :)
Posted by: Syringe | August 05, 2008 at 14:39