And We're Off!

School's started back up and we're already in 6th gear.  I read 250 pages of patho, pharmo & Bates' before the first day of lectures which seems to be about par for reading assignments for the rest of the term.  Yay.  Today is the second day and I'm already behind. 

Last year, our doctoring course was a fou fou easy-pass write off. Not so this time around.  I'm nervous about it.  We have our first OSCE- neuro in less than two weeks.

Yesterday during our third class, the lecturer started off with several slides of a Canadian study not related to the material but demonstrating the 'time saved' by 'traditional' clinicians who put their stethoscopes in pockets as opposed to around the neck (the 'cool' clinicians).

Slide 1:  decreased TB transmission
Slide 2: breakdown of Canadian workers (Drs, RNs etc) who wear it around neck and, with an average 0.32sec slower retrieval, totally Canadian economic loss = some 5 million dollars/year.
Slide 3: BIG LETTERS: women 2x more likely to fall into the 'cool' (as opposed to 'traditional') category.
Slide 4: If this lecturer sees anyone wearing their stethoscope around their neck during his rotation: automatic fail.

I was so pissed off by the unabashedly sexist 'mini' lecture, I couldn't pay attention to the real material.  What a jerk- what a way to perpetuate the impression of women doctors (in 3 slides no less!) being less capable, less efficient, more dangerous to their patients, more concerned with image than being a good doc and less deserving of respect! 

1. Ties (that men ubiquitously wear) are much more likely to transmit infections. Stethoscopes can be wiped down after leaving infected rooms. I have yet to see any man change his tie.
2. The 'unisex' lab coats are really mens' coats that women wear. Many of us larger hipped folks have to deal with a tighter fit around the waist making it much easier for things to fall out of pockets. And having big bulky metal things banging against hips is much less comfortable.
3. We tend to be smaller- certainly smaller than this lecturer's 6ft+ height. Smaller coat = smaller, shallower pockets= increased likelihood of things falling out.
4. Nurses, at least at the hospitals that I've worked, don't typically wear coats so the data is completely skewed.
5. There was no cross study of folks switching to the other method to determine if the 'savings' of 0.32 secs/use is accurate. 

Oooh, writing this, my level of 'pissed-offedness' has just skyrocketed.

Here are some photos of the Fields Museum  and the little sushi place where I had dinner in Chicago:

Dinner Party and Etiquette Question? Living Room West View

These "evolution" posts are fun.  I'm always fiddling my apartment decor but it wasn't until a photo organizing session last week that it became apparent how significant the change of all the combined little tweaks was.  So y'all are at the mercy of at least 2 more evolution posts: North/South views of living room.

My dinner party went well. I need to start taking photographs of the food.  Last night, in homage to the heat (I really did not want to use the oven), I went with a chilled finger food theme: 2 kinds of pinwheels (roast beef/provolone & ham/brie) on long skewers arranged as bouquets (I don't have many serving dishes- so I tried to get creative),  chicken salad (cranberries, pecans, celery, onion, mayo) bites (scooped on celery cuts), Greek salad (feta, kalamata, sundried tomatoes) on cucumber slices, Caprese skewers (ciliegine mozz, grape tomatoes, fresh basil & balsamic redux).

One of my friends brought an unchilled bottle of wine wine so I set it in the fridge and opened a bottle of sparkly and made bellinis.  After everyone had left, I noticed during my clean up that they had taken the bottle back when they left.  This has happened with this group before.  It struck me as weird before and last night it bothered me a little.

We're all poor college kids and even a $10 purchase can be a hit so I know that I shouldn't be sensitive to it but it strikes me as being really rude. 

What do you all think in blog land? What is the contemporary etiquette in this situation? Is it appropriate to take back a dinner offering if it's unused?

Onward to The West View:

 I wish that I had taken a pic before I put in the mantel (Craigslist: $45).  It was such a weird spot before. My neighbor who has the mirror of my apartment layout is using it as a closet space.

The white rug (now in the bedroom) is actually 2 ($9/each @ Kmart) that I sewed together.  The mirror under the mantel was a splurge ($40 @ Bedbathbeyond).

I went wild with the white paint: gathered twigs, rocks and the wooden box under the candles. The curtain behind the mantel was on clearance (Bedbathbeyond $12.99). It's actually a really pretty green in real life. I haven't been able to capture the true color yet (sea foam). I think the satin reflects the filtered light weirdly- it's shown as much yellower in the photograph. See here for the real color. I made the hanging lights from materials from HD (about $10/each).

 
 The green rug was in the Ikea as-is clearance ( I think it was a display piece, $24). The pillows on the couch ($12/each), the hanging lamp to the left ($9), and the sheepskin ($9) were bought on the same trip. 


All in all, my goals in this room were to add strong color without painting the walls (powers-that-be forbid it).  It's amazing the difference that adding the green rug made. I'm really happy with the result.  :D

EDIT: I've since lowered the paintings & added shelves.... More New Photos

Homestretch with a Limp

I hate anatomy and I hate how my instructors are teaching it.  Their personalities are fun and their talks can be really entertaining but they're incredibly sexist: 64 slides on the male lower abdomen and sexual organs, ONE slide on the female anatomy, not a single female specific anatomy part on our 'to find' list but 18 male specific anatomy parts and yes we do have female cadavers.  I could go on and on with other examples***. I worry that it's not preparing us enough for the boards and clinical but more so I worry that this sort of sexism is pervasive throughout medicine and the course teaches for that.

This block has been tortuous. I've struggled to keep my motivation and bombed my first two exams. I need an 85% on our final to pass the course. I've been gunning the last couple of weeks because the idea of having to repeat this is about the worst nightmare I can think of right now. Besides, if I fail, I lose my scholarship thus costing me 60K. How's that for a perspective?

Last Friday, we had our 1st year radiology final. It was an independent study course that paralleled topics that we covered in our other classes.  The game of identifying different structures on different films was awesome.  I did well on it and it gave me some much needed confidence and motivation. Anatomy isn't medicine... Anatomy isn't medicine...

I have 4 more exams, including anatomy, in the next two weeks. Then, absolute, no guilt for not studying freedom.


*** Ok, one more example: 'fun' slides demonstrating aging included before/after photographs. For the male examples, we were given various faculty members and politicians. As women, we're expected to age like Sophia Loren and Madonna. ARGGHHHH! Seriously?????

Invisible

I've noticed a number of constants over the last few weeks of this course.  It took me a little while because our lecturers are fun. They joke with each other, poke fun at their favorite students and make a hard (boring) subject entertaining.

They also don't see the 40% of the class that carry two Xs.

None of the students pimped are women. Not ONCE have I heard a female name called out.  There's no negativity towards us; we're just ignored.

No examples in any of the pathological examples in lecture are female bodies.

And today during an embryology lecture on the face, the composite photo of variability examples consisted of:

Men                                                       Women
1. Harry Truman                                        1. Jennifer Lopez
2. Michael Jordan                                       2. little Pakistani girl
3.  A 40 something Asian Violinist               3. a perfectly symmetrical Asian teen model
4. Dwight Eisenhower                                4. A very young Sharon Stone
5.  A Caucasian Marine                              5. Tyra Banks
6.  Morgan Freeman
7. Geraldo Rivera

Seriously, am I reading too much into this? That the examples of 'variability' for us women are 4 western-world-idealized women and a child?

Celebration

So... to celebrate that I scored precisely 5 out of 58 on the practice anatomy practical tonight.. (EEK!)
I've compiled two top 5 lists.

Things that I misplace daily (which is really annoying)

1.  The lens cloth for my glasses.  My glasses are chronically smudged and I've an unhealthy dependence on wiping them, an act I perform several times an hour.  You can call my microfiber lens cloth my security blanket. I refuse to use anything else (besides kimwipes swiped from the lab in desperation) because a) glasses scratch really easily and b) they're insanely expensive.  Last night, I emerged from my apartment after 11:00 for the 24 drug store because I direly needed a new cloth. They're like those single socks in the dryer; they up and disappear. This morning, the cloth was gone. Seriously. I set it on my counter and it walked away while I was sleeping.

2. My Ipod nano. It disappears from the gym bag pocket that's its home on a weekly basis only to return (after tearing apartment apart in search) to that same pocket. It's like the traveling garden gnome; at times I half expect postcards of 1.98x10^14 fathoms per fortnight (my nano's moniker because I really am that dorky) posed on the Great Wall.

3. Any important mail. I have the horrible horrible habit of sticking it in the book that I'm currently reading. When I go to retrieve it, I have to try to remember which volume du jour it had been. Books spore you know. You think that you have only a few hundred but then.. you blink... a week passes.. and suddenly you're tearing through thousands looking for the stupid electric bill.

4. My Ipad stylus. Despite the fact that it has an established home, like fathoms- it has pathological wanderlust. I put it in the same pocket of my bag after every class but when I return to put it to work, it's gone! I swear the Bermuda Triangle is legitimate, effective and exists in my bag.

5. My cell phone.  I actually don't have a problem with its disappearance days on end. I don't use my phone very often and my family has learned that email is a much more reliable way to get a hold of me. It usually will turn up randomly like when I'm putting groceries away or running a load of laundry.

List II : things my cat eats that she shouldn't

1. My houseplants. EVERY. SINGLE. ONE. HAS. BEEN. DESTROYED.

2. My remaining windowsill herb.  Apparently, cats love basil.

3. My Ipad charger.  ARGGHH!

4.  Used Qtips. She unlatched the bathroom door, opened the cupboard and dug out the Qtips. She was on a mission!

5.  My favorite pre-school splurge:

Sigh.... I really liked those shoes.

Dangling Threads

So far the greatest challenge of medical school for me has been keeping track of all the random ridiculous things that I'm responsible for.

Coming in, I had feared most that I wouldn't be able to manage the actual academics. The coursework though, has been really manageable. In contrast to undergrad, all the professors want us to succeed and work to make things clear and graspable. It's been pretty effortless to do well on the exams.

The overall BCMS organization is really confusing though. There's a daily class calender on our homepage but there are three other websites with pertinent info that we need to be constantly up on.

For example, a couple of months ago, we had a meeting listed on our daily calendar about a mandatory project.  The group of us went and during the meeting discovered that we had been required to watch a video beforehand. I had looked around the lecture hall and saw the same WTF faces on everyone else.  Afterwards, I spent 45 MINUTES hunting for any clue about the prereq or the video itself. Finally, after discovering, thru a link on a link, I found the assignment. Crap.

During that same hunt, I had stumbled on a service requirement that's due this coming week. Fortunately I made a note then and there and have been assiduously keeping at it. The assignment suggested going to two school departments for assistance but when I went, the folks there had no clue what was required. It seems the project is brand new to our particular class. But there has been no other mention anywhere else. Yesterday, I posted on our class facebook page reminding people about it and immediately received dozens of responses. It seemed that no one else had even known it existed.

It's been a reoccurring nightmare that I overlook something and fall into serious trouble with the school.

Well, this morning, I received THE EMAIL. For every completed course, every individual student is required to complete evaluations. The powers-that-be even send out email reminders.  There's even a tab on our homepage leading to the evaluation forms. Believe me, remembering all 20 lecturers for a particular course in order to evaluate them individually is a chore but I pushed through it. Well, it turns out that we're also responsible for evaluating the course in its entirety, link found on a different previously unknown website. Oops.

It burns me that I first hear about this requirement through an email telling me that I didn't complete them and my permanent record has been tagged with a 'concern for professionalism'. I can't help but wonder how many BCMS graduates have been 'tagged for unprofessionalism' because of the insane, confusing way the school HIDES the requirements we are supposed to fulfill. I hope if most of us get a tag here or there, it doesn't make a difference overall. It almost makes me regret letting my classmates know about the service assignment. I could have had lots of company in my unprofessional behavior.

I guess it's an augury for what my future as a physician will be: lot's of weaving unnecessary dangling threads (insurance, paperwork, bureaucracy etc) into a blanket while trying to improve patients' health.

ARGHH!  I want to SCREAM!!

Hometown Blues

The greater metropolitan population of my hometown is about 200,000.

There are over 90 bars, all of which serve the same house wine, domestic tap beer and have the same smoky dingy interior. There is one bookstore: Barnes and Noble- also the only free wifi location in town.

The male-female ratio is about 76:100.  Median income is 18,000 and 25% of the population lives in poverty.

The political tone is strongly republican and no one that I've talked to cares that the best gym at the local Y is men only.  After all, I'm such a feminist.

The average driver's age is 59.

There is a local racetrack and 2 movie theaters.  There are no art galleries.

A nurse on U8, one of the few who was interested in more than getting married and having babies, was after me for weeks to get together. Finally, we had a common day off and made plans.

I was thrilled to finally share conversation. She didn't show up. She sent me a text message the next morning telling me how sorry she was but a friend showed up in town unexpectedly.

Now, a week later, she acts as though we are best buddies, girl-flirting with me at work and constantly playing with my hair. I ignore it.  My resentment towards her is minor. Rather I resent that this stifling, backwaters town has so lowered my standards for friendship.  I miss my wonderful, interesting, reliable Seattlite friends.

She asked me if I was going to be sad on my last day next week and I laughed at her.

I hate this town and, now that my family is mostly gone, can hardly wait til I'm gone.

Oh Brother

Sometimes, my oldest brother has a way of making me feel as small as a flea. I love him desperately; he was even more excited about my first acceptance to school than I was. I can remember the look of thrilled shock on his face when I told him. Everyone should have someone to be so genuinely, unselfishly happy for them. I’m fortunate.

That said, he’s a freakin’ type A, control freak, micromanager with so-not-his-business. Argh. I called him today to chat. We take turns calling and so usually talk several times a week. I mentioned meeting an aunt for coffee and visiting our maternal grandmother in the afternoon.

Gram took great pleasure in reliving some of my “stubborn little pip” anecdotes. She and my aunt laughed at memories of me, a naked 4 year old interrupted from a fight with her brother, claiming that “Just because little girls are staying with their grandma, doesn’t mean that the grandma OWNS them.” Apparently, I was aware of my civil rights even at age four. I blame my mother.

I gave him quick updates on several of our cousins then mentioned finding sprigs of pussy willows on a walk. I have bouquets of willow shoots, winterberry and dried hydrangeas, pretty, easy to maintain and much much cheaper than fresh flowers. He’d always admired my displays when visiting.

Anyhoo, I also mentioned that when I went to the market I noticed that sashimi grade tuna was on sale for 7.99/lb and splurged on a filet ($5.28). I was excited to indulge myself on this weekend off.

His temper exploded and he ranted. How I can’t expect to pay for school, our shared mortgage etc, if I can’t budget my income… blah blah blah.

Now. I. Am. A. Freakin’. Penny. Pincher. I can satisfyingly squeeze a week’s worth of meals on a $30 budget with some creative use of spices and inexpensive staples (quinoa, eggplant, cauliflower etc.). I am also a master of the free/cheap entertainment: volunteering with the zoomobile for a free season pass to the zoo, free city wifi and no cable TV, forgoing downhill skiing for cross-country in open parks. I haven’t seen a movie in the theatre in years. Other than a few pairs of (clearance-no grey’s anatomy for me) scrubs and my interviewing suit, the only clothing I’ve purchased in the last 2 years has been socks and underwear.
I don’t mind. I’ve always been pretty low maintenance, but hell if, at 31, I’m going to be explaining every little purchase to anyone. I told him so. It escalated. Dammit. He’s just like our father; careful, loving and thoughtful but rigid, old-fashioned and by-the-book.

I remember being a teenager and chafing against my father’s restrictions. It was the primary motivation for my moving thousands of miles at eighteen to work for national parks. Every time that I jumped out of a plane, hitchhiked to the rodeo, climbed a difficult mountain or pushed myself past things that scared me, I thought “so there!” to my father.

Right now, I’m garnishing my tuna in a lemon wasabi remoulade (less than $1.50 to make- even with locally raised free range and hormone free eggs) sipping a glass of prosecco ($2.25) and thinking “so there!” at my brother.

Addendum: My brother, bless his soul, sent me an apologetic message a few minutes ago. He and my (favorite) sister-in-law have been under unrelated stresses and he didn’t mean to take it out on me. * sigh * How can I maintain my rebellious angst (damn you! Camus and Morrissey) when my family is so bleeping awesome?

Outrage

It was a busy crazy day at work. I’m usually the only one on the desk on evening shifts; the charge nurse takes a group of patients. This week, the patient who will not be named was here again so I worked with Charge in that room and managed the desk.

We’re implementing a new rounding system next month and so I was also responsible for logging all patient call bell requests in preparation for the new protocol.

There was a water line rupture in the unit next to ours and the shut-off affected some of our patient rooms, public bathrooms and other facilities. I needed to contact Engineering, itemize the affected plumbing, and make other arrangements for patients and staff.

We also had a stroke response on one of our post-ops. I had to monitor the call, STAT orders, arrange for CT, and, afterwards, restock the crash cart. The house staff was going to send the patient to telemetry and I arranged the transfer between the units.

In the meantime, we received 2 contact precaution admissions from the ED and, with no available isolation rooms, I had to rearrange the already admitted patients, inform the nursing staff, direct the aides, contact housekeeping to clean the rooms and then admissions to confirm the computer transfers.

While the stroke response was occurring, the nursing supervisor arranged for a transfer of someone already downgraded to medical from telemetry to make room for our unfortunate patient.

It soon became apparent that our patient belonged in intensive care and not tele. I began those arrangements.

Despite the alleviation of urgency, the other unit decided to send up the transfer, walking! before we were ready. I scrambled to find somewhere for her while her room was prepared. Argh! Her meds hadn’t been hung and she was due for pain medicine so she complained the entire time while I tried to juggle everything. Her new nurse was still dealing with the stroke situation.

Finally things settled a bit and, ten minutes before shift change, the supervisor called about a non-urgent transfer from intensive care. “ICU only has two patients, can this wait until morning?” “No, this patient needs to start PT first thing in the am.” “Sigh, alright.” I HATE moving patients around at 11 pm. I think it’s hard enough for them to get sleep without the jostling and noise from rolling squeaking beds and housekeeping carts. But I took down the details, another iso-room needed! and began rearranging our patients.
The aides grumbled but they moved the patients. The call bell system erupted from all the newly awake patients. “I have to use the bathroom.” “Am I due for pain medicine?” “Will you call my family to let them know about the change?” etc..

11:10 One of the nurses from ICU called to give report. I told her that we weren’t ready yet. Our nurses were just starting report themselves.
“NO! I need to give report NOW.”
“Um. No you don’t. It’s a non-urgent transfer and I know that your shift isn’t over until 0700”
“We’re just starting an in-service. I want to give report before it starts. I won’t send the patient up for a while.” Sigh.
“Jackie would you mind taking report now? She’s insisting.” I rolled my eyes and handed the phone to an incredibly patient nurse. Jackie gets report and says that the patient’ll be up between 12 and 12:30.

11:15pm. I track down the housekeeper just before he finishes his shift and beg him to clean the room for our transfer.

11:17 ICU nurse calls with update on the transfer patient. I tell her that the nurses are in report and that Jackie will call back when she’s ready.

11:19 Housekeeping is still in the room cleaning. The elevator door opens and our patient steps off, white knuckles grasping his walker and the aide carrying his belongings. !!!!

“The room’s not ready! Why are you here!”
“Oh. I just came on. They told me to bring him up.”
“You have to go back down. We’re not ready.”
“I can’t go back down; They already stripped his bed, we don’t have anywhere to put him”

Seriously? I lead them down to the room and pull a chair out into the hall for the patient.

Following the aide back, I laid into her.
“We told you folks several times that we weren’t ready! This is inexcusable. You didn’t even bring him up in a wheelchair!”
“I’m sorry, I just came on. I’m just doing what they told me to.”
Sigh.
“I know that it’s not your fault but this is ridiculous!” Grumble Grumble.

The aide leaves and I go back to the room to get the patient settled in. When I come out, the nurse from ICU is yelling at Jackie.

“How dare you yell at my aide! Blah blah blah, miscommunication that’s all your fault.. blah blah blah..”
I could feel the hackles grow across my shoulders like the hump of a grizzly bear. I’m outraged and start to jump in but a nurse grabs my arm and I pause. Jackie diffuses the confrontation by apologizing and the ICU nurse righteously storms off.

I’m told that the ICU nurse is something of a barracuda, is always right and never lets things go. After she leaves, the nurses gather and complain about her unjustified behavior and how awful she is.

It’s now five days later and I’m still stewing over the situation. It makes me so mad when people like that ICU nurse get away with laziness, superiority, inconsideration and recklessness because people are afraid to call them on their crap.

In hindsight, I know that if I had gotten involved, the confrontation would have escalated. It wouldn’t have been fair to the night crew to spark it and then leave when my shift was over.

But I HATE that someone else gave an apology for my behavior. If my behavior calls for an apology, I want, I NEED, to be the one to offer it.

In this situation, though I cognitively recognize Jackie’s motivation to diffuse the situation, her apology stabs me viscerally. I know that I should just let it go but I’m so outraged.

Wallet Blues

I lost my wallet last night. I spent the entire day looking for it.. under my bed, between books on the shelves, in the fridge, in the car; I tore my apartment apart searching. I drove to work hoping desperately that it would turn up in my locker or the unit lost and found.

Nope.

Sigh.

I immediately checked my balances online and.. whew.. everything was fine. So I called my banks and cancelled my cards. I drove to the DMV and applied for a new license. Then I stopped by the bank and withdrew enough money to last the next week.

Now, I'm at home and going through a bag of cards and letters that were sent to my mom during her hospital stay, a chore that I've procrastinated on for the last year. It makes me sad.

Between a letter from my grandmother and a card from an old neighbor is... baddam bam... my wallet.

ARGHHHHH!!

(I have NO IDEA how it ended up in this bag of letters which had been stowed deep into the recesses of my closet-- I'm blaming the cat.)

Sigh.

Oh and I just got rejected from Brown University SOM.

Rent

I received a phone call from my landlord today complaining that I hadn't paid November's rent which was due on the 10th.

I insisted that I had and that she had cashed the check a full week before the rent was due. We argued over it for a few minutes before I told her that I would send her confirmation today.

So my morning had been spent going to the bank, retrieving a copy of the cashed (and stamped) check, then scanning and emailing it to my landlord.

She hasn't responded yet to my message.

I've always taken pride in paying my bills early and am really irritated with this affair.

Impatience.

There's a nurse on our unit who come in nightly to regale us with tales of how awful her husband is. She dyes her hair only because he prefers blondes. She can't eat this or that because he thinks she's fat. He won't help her at all. He expects her to support them with her night shift and then take care of everything like chores, shopping, all aspects of child care while he sits on his duff and watches television during the day. She's always so tired blah blah blah.

Tonight's tale was about how he controls all of the money including her wages using direct deposit into in accounts that she has no access to. If he's feeling generous, he allots her a $5 weekly allowance. If she ¡misbehaves!, he'll take the money back.

First, I think she's totally full of crap. I don't doubt that the husband is a total jackass, but I'm pretty sure she stretches the truth unrecognizably.

She comes in with her stories and everyone fawns over her.. "oh he's awful!" "He should be shot for or " "You should kick his ass to the curb" and she preens under the attention.

I usually try to avoid engaging with the more manipulative staff but she put me on the spot and directly asked me what I thought in front of the rest of the crew. I tried to prevaricate but she was a bloodhound, asking me over and over.

I finally turned and told her that I thought she was spineless, that if she had such an issue with his money control to deposit her paycheck into her own damn account. He didn't hold a gun to her head when she signed up for direct deposit.

After that, she answered every phone call with "U8, Spineless speaking." Seriously, how old is she?

I would love to be a fly on the wall when she goes home and regales her husband to all of the stretched stories of how awful everyone is toward her at work.

On a more positive note, tonight was hellishly busy but I was working with my two all time favorite nurses and we totally rocked it. I love how efficient, sensitive and cool they are with the patients. Over the last year, I've learned so much from them about how to work with even the craziest, most difficult patients calmly and effectively.

Around 0300, "Dr. Armstrong" was paged to U7, one of the more dangerous pysch floors. We then heard thumping and shouts in the south stairwell. Unperturbed, Jackie, not taking her eyes off the IV line she was priming, strolls over and flips the lock on the door knob. A "Dr. Armstrong" is the hospital code for a combative patient. Moments after she locked the door, we heard a thud and more yelling.

Later, we discovered from the nursing supervisor, that one of the patients actually kicked in the door of the secured ward and escaped into the stairwell. I only caught some of the details in passing. Apparently, the patient had enough time to defecate on the stairs before pushing past the security guards to escape downtown. He assaulted one of the police officers chasing him and is now in jail. It capped the already crazy night.

My Month of Scramble

I sold my mom's house last week; the buyers paid cash and are forgoing an inspection which means a fast closing. EEK. and Yay.

I'm scrambling to find new housing, storage for my parents' things that we're keeping, and all the little errands that one doesn't realize until that time of moving is upon them.


I received my second med school rejection, ironically from my #2 dream school. Bah.

Work is interesting. Last week, one of the patients developed a really weird icky crush on me. He followed me around and asked me every day to join him in a new activity. Play Scrabble? Go to the zoo? In all honesty, it was creepy because he was not mentally impaired in the slightest. Somehow it's easier to understand/think cute/tolerate a patient's romantic interest if they're elderly and demented or young and MR. I don't understand how a middle aged man could rationally think it a good idea to ask out the nurses/aides.

We had a mandatory aide meeting yesterday, a punitive grousefest. Apparently, the aides aren't doing their jobs properly, have bad attitudes and things need to change. This was all based on our recent Press Ganey scores. The nursing aides are the front line to patient care after all. Later, my manager pulled me aside, basically told me that he didn't have any problems with my work and asked me to 'keep an eye on the moods of my coworkers'. I don't really know what he meant by that but I felt manipulated nonetheless.

I love autumn. I drove to work today and noticed the trees preening at their reflection in the river. I can't remember seeing the leaves change last year. It's astonishing how grief and sadness can blind one to such beauty.

Changes (and cleaning)

I know that I've been subtle about my frustrations with the folks at work. (tongue in cheek) A UA on the third shift has given her notice and I volunteered to step in. My manager is very thankful that I'm helping out and I'm really thankful that I get to work permanently with a stronger team.

I'm going to miss the greater opportunity to talk with patients during 2nd shift. I've found, though, the last few months I've been scrambling so much to do both the secretary's and aide's work I didn't have time to spend with patients anyway. I'll be glad to wear just one hat on this new shift.


On the cleaning note, I was out of town this weekend. I spent Saturday and Sunday up at my family's cabin. Coming home, I found my cat sitting on the window sill behind the kitchen sink watching the squirrels on the deck. Like she did all last winter...



As I turned to make a cup of tea, a mouse, A MOUSE!, ran across the stove and down into one of the burners. UGH! What's the point in having a pain-in-the-ass-she's-lucky-she's-so-cute cat if she doesn't mind roommates of the rodent extraction? I HATE rodents. Always have. I barely tolerate chipmunks and squirrels outside and the thought of them in my house makes my skin crawl. Their sharp pointy teeth that never stop growing are creepy. Besides, all of my work in Yellowstone has made me uber-aware of awful diseases (hantavirus, LCM etc) spread by little pointy toothed vermin.

I immediately pulled the stove out from the wall and, using a bottle of bleach, began scrubbing every surface I could reach. In my entire kitchen. For 3 hours. Then I went down to the 24hour drug store and bought a couple of traps. So far, I've only caught one and let it go across the street in the woods. My uncle mocks me for not killing them. He says that they'll just come back. But I can't rationalize killing something just because I hate them. Otherwise, all old drivers who go half the speed limit and don't use their turn signals...

Crying at Work

In Floating, I alluded to the reality that staff on my floor don't always do their jobs thoroughly. It's a major frustration; the onus of work usually falls on the shoulders of only a handful of people.

I get particularly fed up when our manager seems to coddle the biggest transgressors. He does have his favorites. Usually leaving before our shift starts, he's not much of a presence and I've always attributed his lack of enforcing job responsibility to his ignorance of what really happens during the evening.

When I first started, I really liked my manager. He was welcoming and warm and seemed to really try to create a happy work environment. As the first months past, he seemed really receptive to all of my little ideas for the unit, posting bed phone numbers over the information board in each room, changing the location of the linen carts to be more generally accessible etc. I reorganized the way that the medical teams, patients and nurses were listed on our charge board, color coding them to make the information much easier to read. You should have seen the way they did it before, it would take minutes to figure out who the doctor and lead nurse was for each patient! I was allowed to join the unit council (their first aide!) and I thought, despite my lowly status as a grunt, my thoughts, ideas and concerns were being heard. I took on all the training of new PCAs and attended workshops to improve my clinical mentoring skills.

Last month, another aide, ignoring an imminently dangerous situation for the patient, neglected to do something important. I stepped in and performed the required task, then followed the her to the nurses station. I confronted the aide and told her that she could not disregard those types of situations.

Well, she started to cry and complained that she was having a really bad day. Her brother was having oral surgery to have his wisdom teeth removed and she was so anxious about it. She became hysterical,(seriously!) and needed a twenty minute smoke break to regain her composure. Of course, I was rolling my mental eyes the entire time.

The next day, I was called into the NM's office and scolded. He informed me that it was not my place to police my coworkers(!) and that, and I quote, "not everyone has your work ethic". I told him that I was indeed having trouble adjusting to lack of my* work ethic in my coworkers and that my actions stemmed purely from my concern for the patient. He nodded sympathetically and asked me to work on my tolerance.

Of course, I've thought that maybe I was out of line or too harsh with the other aide. I talked it over with one of the nurses who had been present though. She reassured me that it happened as I remembered: 10 seconds of me getting the aide's attention, telling her to do her job and her becoming histrionic. She confessed that she too has been scolded for scolding someone else.

I'm currently looking for a new job** but I'm saddened and frustrated by the entire scenario. I absolutely love the work that my job entails (but not the poop part) and I hate that I'm leaving with such sourness. All that I've read about the evolution of healthcare shows that the culture is one of increasing openness to policing each other in the effort to generate fewer mistakes. To be slapped in the face with the very antithesis was shocking.


*my work ethic being that I actually do my job!
**I did call the 'anonymous' hotline two weeks later for an incident that I wasn't directly involved in. I haven't seen nor heard any outcomes but I hope that someone is looking into the mess that is my unit.

Floating

I'm glad to be off my unit today. Lately, I've had a hard time tolerating the young and, well, just young, attitudes/behaviors of my co-workers. The nurses are, for the most part, friendly but they can be callous and selfish in a way that only reflects their immaturity.

With more experience, most of them will probably develop into compassionate and wonderful caregivers but for now it's frustrating. With the patients, they can be dismissive of pain and fears, only noticing that the patient is inconveniencing them with 'petty stuff'.

Their own lives oscillate between two points: either everything is wonderful or it's awful. Calling in sick because their best friend's grandma had a heart attack, their parents' cat died or there's a power outage in their neighborhood is routine. In the last month, we've only had two shifts proceed without a call-in.

Today, I'm working on a telemetry floor. The staff is older and the shift is virtually tranquil despite the higher acuity. People are doing their jobs without histrionics or (much) complaining.

I can't help but wonder if the hospitalists realize how the differences in unit culture can impact the patient experiences and subsequently the HCAHPS and Press Ganey scores. Because of the future changes in insurance reimbursement policies, it's something that could really impact their livelihood.

*sigh*