Saturday, January 30, 2016

Why Doesn't This Happen As A Policy? Everywhere?

(I mean, besides the fact that none of the suit-and-tie wearers or lab-coated clipboard commandos of "higher" practice thought of it.)

The sitch is that E.D. is frequently slammed. (I know, who knew, right?) Like, multiple ambulance gurneys in a conga line out the door and down the ramp to the street. No, for real, not just in blog-perbole. We literally have fire engines blocking the street because they can't get in to park when I get to work.

So one night I'm coming in to sign in, knowing it's going to be a special slice of heaven already, and Staffing is telling a perfectly good ICU nurse "Hey sorry, we tried to call you off before you came, we don't need you." So I jumped over the counter and started pummeling him with a fire extinguisher because we were already four nurses short on a ten-nurse shift suggested to him that they send the "extra" ICU nurse to the critically overloaded and understaffed E.D. for the night, instead of telling him to go home, make no money, and leaving us (and 100 patients) hanging. Because mothereffing DUH. We don't expect him to chart, or fully take over care, with zero departmental indoc, but for cripesakes he gets the same patients we send upstairs all friggin' night, so it's not like working the E.D. would kick his ass. (And I'm the outsider here, not a staffer. I just work there more days and hours than the full-time staff do.) And lo and behold, Staffing does it! So we made him the extra float nurse for the whole department.

And this dude kicked ASS! He was a friggin' rockstar for twelve solid hours!

The nurse I was paired with, who was also a float from our step-down Tele floor, who we'd love to steal permanently from them if he wasn't too smart to do it, takes Awesome ICU nurse under his wing, gives him the ten-cent tour, and then we turn him loose for the entire shift.
He passes meds when any given nurse is busy with other patients, and he starts, by actual count, 23 IVs that night. He transports 75% of the tele-monitored patients upstairs, which leaves the regular E.D. nurses free to stay and get sh*t done in the E.D., and we can drag in an empty gurney and turn over a room in 60 seconds instead of 15 minutes, and the nurse doesn't walk into a crapstorm with an unstable patient who's been sitting there untouched while he/she was gone. Which cleans out triage and ambulance overflow in a few hours, instead of the hospital lingering on ambulance diversion all night long.

So now Rockstar has a blast, only charts the care he renders (starting IVs, giving meds, etc.), and if he gets a chance, he wants to come back. And he has a whole new perspective on what E.D. is like, and why, when someone says "I need to give you report on this patient now" they really mean "I'm up to my ass in alligators here and someone tied pork chops around my neck! Hook a brother up and take this patient NOW!" without him being beaten over the head about it.

And he'll pass that perspective on to his co-workers who've never set foot down here.

If you're keeping score at home, I think that's win-win-win-win-win-win-win-win.

So all I want to know is why, in the name of heaven, they can't make a policy for full-time staff that EVERY RN in the hospital will pull a blazing one whole shift in a department that they either get patients from, or send them to, each calendar year. And every year has to be someplace they haven't been before, until they've been everywhere. Where they'll then gain a little 'walk a mile in my shoes" appreciation, insight, and empathy for the people they barely interact with from other floors and departments. Maybe even get to know a few of them a little.

It wouldn't break the bank, it wouldn't cause mass chaos, no patients would be harmed, and people from the back door to the top floor would probably start to feel like they were kind of all on the same team. (What a concept, right?)

We'll forget about the fact that people who move up to management would have multi-department skillz and contacts built in, and everybody would get a free taste of other departments and practice areas, and thus maybe transfer within the hospital, rather than just bail, and leave the clueless monkeys in HR wondering where to find another round peg for the newly empty hole, at a per-hire search cost of $50K, on average. (It's scary, almost like I've thought about this or something, as if it made sense on multiple levels.)

And when I note the specific experience on one shift, the management I tell about it are all smiles. When I suggest they do it as an annual experiment staff-wide, apparently it's like my Invisibility Cloak has descended, and they suddenly have an urge to go to the bathroom, do a bedpan inventory, or something equally urgent.

So now, as I drag myself off to more education, remind me why management with BSNs and advanced degrees means a better-run hospital. Because I need some ibuprofen, or a softer wall to bang my head against.

Friday, January 15, 2016

Refugees, Take Two

Apparently, according to one response, because I'm not culturally suicidal, I'm nasty and embittered (Moi? Mai non!) towards "Syrian refugees". And fail to recognize that some of them are really nice people.

I'll happily stipulate that some of them are.
And note that much like the guy who turned into the car in front of me last month, he missed most of the oncoming traffic. Care to speculate how that turned out for him and his passengers?
Or the people in the other car(s)?

We could cast about no further than these two happy folks, one a State-Department-vetted legal immigrant, and the other the son of same; not refugees at all, in fact being both well-paid professionals:

Or we could ask the relatives of these fourteen folks:


I said relatives, rather than direct questioning, because the first two happy additions to the American melting pot killed the other bunch of actual Americans (and shot another two dozen who luckily didn't die). Because Diversity!
(And just between you and me, I wouldn't trade an ocean liner full of the first two for any one of the other fourteen. But then, I'm nasty and embittered.)
.
Or we could just note, as I replied,
It isn’t the “nice ones” that concern me.
Sorry, I couldn’t hear the rest of your argument over the gunfire from San Bernardino, just down the road from here.
Our own director of the FBI – an Obama appointee – has flat-out stated that we have no way to ever adequately or properly vet such refugees, and that any claims to the contrary are simply outright fabulism. So this isn’t a D/R thing, it’s a wise/foolish thing 
If you feel inclined to send them aid over there, then yes, by all means do. Even with my tax dollars. I’ll even kick in extra on top of what I already send, just for that.
But failing to strain out the problem children, as we certainly will, with the guarantee that incidents like the San Bernardino Christmas bloodbath will become a regular occurrence here, is a lose-lose deal. If those refugees want to get in line behind the 93 million unemployed Americans already here, who need no such importing, and us with a government debt increasing by trillions and trillions, we can talk about how many more outsiders we can afford to carry piggyback. 
And nota bene in the pic above [in the original post -A.], the strange preponderance of fit, healthy, well-fed military-age males in that picture, and the utter dearth of starving women and children. Perhaps the latter wasted away entirely before the photographer could get a snap of them?
If all they wanted was regular meals and a roof over their heads, there are a dozen or more countries between here and Syria where they share a common culture, language, and religion. Not to mention identical culinary preferences. 
So I find it breathtakingly disingenuous to pretend that this is anything Maslowian in action, rather than acknowledging the obvious facts that it’s driven simply and entirely by a desire to feed at the deepest trough to which they can make their way, aided and abetted by quisling leaders who would gladly throw their daughters to rape mobs to curry the favor of people who would happily cheer the throat-slittings of Westerners to come afterwards, as they already do now. 
If room can’t be made for them in Jordan, Iraq, Turkey, or Lebanon, let alone anywhere from Morocco to Pakistan, they have no special claim on our favor to re-locate here, and if they have the means to move 10,000 miles away from home in the first place, they’re hardly incapable of finding someplace two continents closer to their ancestral home than this country, where we have all this annoying freedom. Our women get to freely express their views on the Internet, run around without sacks on from head to toe, and without being molested en masse every New Years’, nor be mutilated by their patriarchs, or slaughtered in family honor killings. 
I’m kind of a fan of importing people with a higher quotient of freedom toleration from the get-go, rather than bringing folks here whose traditional cultural method of settling differences starts and ends with bloodshed.  
If they have that much time and energy, they might more profitably occupy themselves with overthrowing Assad, and setting their own nation’s house in order, rather than clamoring that the Great Satan of Nations welcome them with open arms and clutch them to our national breast as long-lost cousins. 
In fact, when last I looked, there was nothing in the US Constitution forbidding other countries from adopting it wholesale and reaping its benefits, if that’s all they have in mind in the first place. We could certainly use some more like-minded friends over there. 
Nurses meet people in need every day.
We don’t bring them home with us.
If things are so slow where anyone works that they don’t have enough people right in front of them that could use further efforts and assistance, I suggest what’s needed isn’t a refugee visa program, but rather perhaps a closer look around – within driving distance. 
But if, despite all that, you still want to buy the world a Coke, please do it with your nickel, and invite them to live in your house at your expense first, before you kindly sign the rest of us up for the privilege.
The problem with socialism is that eventually you run out of other peoples’ money.
Sorry, but that's not nasty or embittered at all.
And I don't despise Syrian refugees (or the other 98% that make up the hordes descending on the rest of the Western world pretending to be refugees, or Syrian, and/or both.)
I just have an extremely low threshold tolerance for simplistic bullshit.
And when you walk into metaphorical thorns up to your neck, on the Internet, the best thing to do is probably to back out quietly, with a minimum of whinging, rather than doubling down on it.

I anyone wants to talk about what we "owe" the rest of the world, have at it.
I'm not isolationist by any stretch, but it seems to me there are about a metric fuckton of American graves filled with our sons sacrificed on behalf of the rest of the world, in contrast with two statues of foreigners here who ever did anything notable for us.
(I'm not discounting any of the individual sacrifices on our nation's behalf by literal hordes of foreign people - who were, in the truest sense, simply Americans in their souls who were born somewhere else - just noting the dearth of any official response by other nations as such since Lafayette & Co. landed here in the thirteen colonies.)

Y'all give a holler when Syria, or any other twenty nations combined, hits the shores here to save us from tyranny. Let alone sends us so much as a fruitcake at Christmas, because they like us.

That'll be the day.

Thursday, December 31, 2015

Gift Wrapped

You had a heart attack a couple of years back.
Undeterred, you're still smoking every day.

But you had chest pain the other night.
So you came to the ED.
No, not by paramedic ambulance called to your house, with all the latest technology and pharmaceutical wonders at their fingertips right there in your in your living room.
(Too easy, right?)
Instead, you waited a few hours - to make sure this was really something - then had your wife run a few red lights driving you in to see us.
Then you came in, went to the bathroom, and then waited to register to be seen.
Without telling anyone why you were here.

Of course, your full arrest in the waiting room a minute later kind of let the cat out of the bag.
Lucky for you it was late at night, during the slow time, and we all came running.
And somebody jumped on chest compressions for you in about 10 seconds.
And kept on doing it until we got you onto a gurney and into the code room.

And you were in V-fib, of course.
So we zapped you a couple of times, cranked on your rib cage for a few cycles in between, and pumped you full of code drugs, sunk an ET tube on the first try, and got a pulse back.
(Did it sting? Do you remember any of this now? Just wondering...)

And then we shipped you off to the cath lab, and then they sent you to the ICU.
Who fixed you, and sent you home again.

As much fun as we had, we hope next time you'll call 9-1-1. First.
And not risk your wife plowing into a vanload of innocents when she's running red lights on the way to the ED.
Or you arresting in the passenger seat 10 minutes away.
Or dropping somewhere between the cars in the farthest reaches of the parking lot, and us playing hide-and-seek in the dark after your wife runs inside and tells us about it.

So maybe it's time to lose 50 pounds and ditch the Marlboros for good, eh?
Because you did nearly everything wrong, and evidently God's not done with you. Yet.
Congrats, man.

Happy New Year.
Enjoy it.
Oh, and you're welcome.

Thursday, December 3, 2015

Refugees, Politics, and an instructive fable


In reference to the most recent post at Florence Is Dead, regarding the thought that 2,290 Syrian refugees here since 2011 is not enough, the following:

We currently accept around 1,000,000 immigrants per year to the U.S., and that's just the ones who come here legally. (We can ignore the other 10-20 million here illegally we're currently supporting every day for another discussion another time.)
That's more than the sum total of legal immigration for all other countries combined, on the entire planet, and has been so for decades, year in and year out.

So given that the "refugees" in question are some 5,000-10,000 miles away (depending on where in the US we're talking about), and have to pass over any two of three continents, or over two complete oceans between them, to arrive here in this hemisphere, skipping past any 40-50 other countries en route, the correct number of Syrian refugees we ought to be accommodating here is therefore right around zero.

If you can find any of them who relish individual liberty, representative government by democratic republic, long for the benefits of our Constitution and Bill of Rights, the blessings of (mostly) free market capitalism, and eschew enforcing religious tyranny on all others at the point of a sword, and they have a working knowledge of English and our American history, by all means, send them - to get in line behind everyone else seeking a better life.
Just because 8 billion people want to move here (or to Europe) as part of the Free Sh*t Army doesn't nor should it grant them any claim to American citizenship, nor even to legal immigration status. Which is precisely the reason most of Europe is calling up troops and building fences to keep their hordes out, and why the governments there who ignore that are about to find themselves ousted. Or worse.
(That's the best event, assuming another couple of Paris-style incidents don't push the entire continent to the cattle trains and barbed-wire camps stage, which is hardly a new or surprising thing over there, historically speaking.)

But importing hordes of people to this nation from Third World poverty, without any marketable skills, and saddled with an allegiance to a repressive theocracy which authors the most brutal forms of repression, torture, and slaughter against women, gays, and every other religious faith is right up their with someone wondering what would happen if a person shoved a grenade up their tailpipe with the pin pulled out.

The two clearest examples of what that looks like for real need be gathered from no further back in history than Beirut in the 1980s, and Sarajevo in the 1990s. Anyone in any doubt should vacation there, and report back to the group on the experience.

And the enclaves of precisely the second generation economic refugees in Europe already admitted in better times (from Syria, Lebanon, Algeria, etc. - all former French colonial leftovers), and now without prospects, plus bearing no love for the country that sustains them, were the precise breeding grounds for those who conducted the Paris attacks. The correct term for those who kill their hosts isn't "refugees", it's "parasites". So let's be scientifically and pathologically accurate, shall we?

If someone is feeling the call to help Syrian refugees (who comprise some single-digit fractional percentage of the hordes now descending on Europe - the rest are from anywhere and everywhere other than Syria), then by all means, send as much of your personal resources as you'd like: to help them survive and make their way on their own continent, ideally in some safe enclave in their own country, or at worst nearby and geographically much closer. They belong in a place where they have some reasonable hope of someday returning to their own native homes, and staying alive in the meantime without resorting to trying to float to Europe on a raft made of floating debris, or walking on foot to the countries with the best welfare payments.

Better for them, better for us.

Anything else is tongue-kissing syphilitic lepers, and doing mouth-to-mouth on drug resistant TB patients, because compassion without cogitation.

Nursing is about using our heads along with our hearts to help people.
My namesake's fable about The Scorpion and The Frog comes to mind.
 
Bonus points for bravery/stupidity: putting this question to nurses at Loma Linda UMC in San Bernardino, today.

Monday, November 9, 2015

Keeper

Subject: New (to me) nursing blog

Title: Florence Is Dead

Instructions:
Go.
Read.
Repeat.

Florence kicks @$$.
Made my day. Added to the Bloglist--->.
MOAR please!

(h/t to Shrtstormtrooper, and her bloglist )

Tuesday, October 27, 2015

Financial Education For The Learning Impaired

Way too many shots of booze downtown on Saturday night:                       $167
Facial adjustment by Rocco and his 3 friends after lipping off:                  FREE
Ambulance ride to the E.D.:                                                                              $500
E.D. CT scan and lac repairs:                                                                         $4000
Admission to the ICU for subdural hematoma:                                         $12,000
Price for signing out of ICU AMA, going home, and waking up dead: LIFELESS

Scientific proof #3,467,882 that brain impulses cannot swim upstream against the current of alcohol.

Oh, and your Darwin Award nomination is in the mail.

I can tell people the truth, but no matter how hard I try, I can't make them smarter...

Monday, August 31, 2015

Take A Bow, Douchecanoe @$$hole Mouthy Visitors


It never ceases to baffle me how people who would never lip off at the DMV, or when getting dinner at a restaurant, or while standing in line at Starbucks, or anywhere else, think that when they show up at the hospital, the rules of civility and decency have suddenly magically disappeared - for them.

Dear fuckweasels: Thought For The Rest Of Your Life
Didja ever lip off at a restaurant, and show that dumb waiter who's the boss?
Didja ever notice afterwards that your food all tasted like spit??!!!
WORD!

Take a lesson: some of us won't be badgered by your rude assholerry, and will not only give you worse than you send, and that right in front of your friends and family, we're big enough to make it stick, including sideways up your ass in the parking lot if you think you can go there.

And nota bene: your friend/relative in the bed is the patient. They have an actual reason for being here. Your presence is a mere courtesy, and a revocable one at that. The minute, no, the second dealing with a knobjob like you interferes in the slightest way with patient care in my room, I don't care if you're the Pope's uncle, your ass is out, for good, permanently. I will make you persona non grata, with no visiting privileges, and I'll happily swear out the restraining order in the morning to make that a permanent situation. Test me, I triple dog dare you.

If you shut down your mouth long enough to engage your eyes and ears, you might also notice that your friend is
1) Getting damned good care
2) Not very happy when you're being an obnoxious litter box nugget
3) Eager to forget he/she knows you when you bring your Inner Jackass, and let him/her out to play in front of God and everybody.

So instead of "advocating for your friend"*, realize that you're just another pain in my ass, because all you're really doing is demonstrating your impotence to do anything more helpful than dropping a hand grenade into the outhouse just to watch the shit fly.

My cure for your problem is sending you to Siberia, forever, and if you want to go double or nothing, you can find out what the bail is on Monday morning for disturbing the peace, trespassing, and/or assault and making terroristic threats. See if the judge thinks it's as funny then as you do now. Especially if you blow a point-anything on the jail breathalyzer.
BTW, I document the antics of lunatics for a living; good luck with "your side" of things after I file my totally accurate notes of the encounter in a legal document, for the permanent record, right after it all happens, while you're still hitching up your trousers and looking for that missing piece of your hindquarters, sobering up in a holding cell, or trying to get someone to go good for your bond.

Or just cowboy up, and realize that if we're taking care of a friend or family member who's having a heart attack, a stroke, or bleeding out, fucking with us while we're doing our jobs probably isn't in their best interests either.

So do yourself and your buddy a great big favor: sit your ignorant ass down, or go get yourself a nice steaming hot cup of STFU, while people smarter than you do the job they're being paid to do, instead of dealing with dumbasses like you interfering with other peoples' care.

Momma may have pinned your diapers up on the family refrigerator and told you they were art since you were two years old, but now that you're only acting like a two year old, the rest of us can see your handiwork for exactly what it is, and reality is about to slap you real hard right in the back of the head. With a sock full of quarters.


*(After 20 years of this BS, it's no longer anecdotal evidence: 99.98% of these Special Snowflake Wannabe Patient Advocate douchenozzles are the visitors, not the patients. If you like watching Wheel Of Fortune for hours, and reading old dental hygiene magazines, keep bucking for Permanent Waiting Room Flourescent Light Therapy, proud soldiers of the Dumbass Army.)

Thursday, August 27, 2015

Trauma Is Never Pretty

I've been working trauma cases professionally since the early 1990s. (Before that was simply happenstance.) And while all trauma is the same after the first 500 times, no two are ever exactly alike.

Something you have to know, in a way most of you hopefully will never learn from bitter experience, is that some wounds are non-fixable. Whether you're working with a victim of a car accident or someone attacked by a mob, or simply one dedicated assailant, you have to know going in that you will not fix certain things, and that in many cases, no one can.
Not even if the injury in question happened inside a trauma surgical suite, with the doctors and team prepped and ready to go, even if you had 20 units of O-negative blood hanging ready to transfuse.

HIPPA and concern for a certain family prevent me from getting detailed at this point.
But suffice it to say that sometimes, a gunshot or blade will create more damage than can be fixed, and that person is simply going to die, rapidly.

There's a scene at the beginning of the plane crash in The Grey, when Liam Neeson's character is surveying the injured and dead, and he finds a guy with traumatic abdominal bleeding, and he tells the man, in his final moments, that yes, he is indeed going to die, right there, and rather quickly, which he then proceeds to do on screen.

That was truth: it works just like that in the real world too. When someone pumps out all their lifeblood in ten or twenty pumps, like they will, that's it. Getting an IV won't work, you aren't going to cut them open and crossclamp their aorta, and an IV or five isn't going to save them, because there's no hemoglobin in normal saline.

That means you can start IVs, even IO lines (that's an IV in your bones for the laymen in the audience), and pump in liter after liter of fluid, even with whole blood, and it ain't gonna do anything but come out the hole(s) you can't fix. And run all over the place outside. They'll still get no oxygen in their vital organs, and they'll simply be warm and dead and white as a ghost when you're finished, and that truth is ordained before you ever lay hands on your patient.

That's going to be true in a disaster, or even a trauma unit. In the latter, you do every damned thing you can, especially on a young healthy victim, because they have the best chance. Best being relative when the absolute odds are close to absolutely zero.

In a disaster or worse scenario, you aren't going to - and probably shouldn't - do all that. At that point, you're simply wasting precious supplies to feel better about someone dying that you couldn't save. Which is both wasteful and unwise.

God help you and your conscience if you haven't wrapped your head around that reality long before the day you get there. Even knowing the truth, the moments will hang around in your head for a good long time.

If you're going to do this, yeah, you save the ones you can.
But you have to know in your bones that there will be plenty you can't save, and you have to let them go. Physically, mentally, and emotionally.

And I can't even begin to tell someone how to do that when it's someone you know, or care for deeply.

Thursday, July 2, 2015

Dewey Defeats Truman






From the fishwrap of record:

MONROVIA, Liberia — More than a month after Liberia was declared free of Ebola, at least two new cases have emerged, the first discovered when the body of a 17-year-old boy tested positive for the virus, officials said Tuesday. 
The World Health Organization declared Liberia Ebola-free on May 9, a landmark moment in the country, which has suffered more deaths from the epidemic than any other.
But on Tuesday, Tolbert Nyenswah, Liberia’s deputy minister for health, announced at a news conference here in the capital that a new case had emerged.
It occurred in a small town just outside Monrovia. The family of Abraham Memaigar, 17, who died over the weekend, called a burial team that took swabs of the body and sent them to a laboratory. It confirmed that the boy had been infected by the virus.
On Tuesday, an Ebola response team exhumed the body and had blood drawn for a more precise swab test. That test also came back positive.
Dr. Moses Massaquoi, the case manager for the response team, said the blood test was necessary because investigators could not find the source of the infection and were trying to determine whether it was an “isolated outbreak or new strain of the virus.”

Late Tuesday, a person connected to Abraham tested positive for Ebola, and tests of two other people were inconclusive, Dr. Massaquoi said.
Thirty-three people who had contact with the teenager were isolated in their homes and were being monitored, he said. Three people will be sent to a treatment unit here Wednesday, he said.
“The Ebola fight is not over, but we must not lose hope,” said Dr. Bernice Dahn, Liberia’s newly appointed minister of health. She contended that the quick response to Abraham’s case, including the rapid testing and confirmation that the boy had the virus, demonstrated Liberia’s preparedness to deal with another outbreak.
Liberia has recorded close to 5,000 lives lost to the virus.
The country reactivated an Ebola treatment unit at a time when the facilities, built with the help of the United States military, had stood empty and Liberia was beginning to close them.
Mr. Nyenswah said it was not yet known whether the infection came from Guinea or Sierra Leone, West African neighbors that still have small numbers of new Ebola cases.
Abraham, who sold used clothes at a local market, fell ill at his mother’s house a week before his death, experiencing fever, diarrhea and vomiting.
Abraham’s father, James S. Memaigar, 49, a shoe salesman, said a local clinic had told him just three days before his son’s death that Abraham had malaria. The clinic had sent him home with a handful of tablets, Mr. Memaigar said.
Abraham died Sunday in his father’s home in a community known as Smell No Taste, a few miles from his mother’s home and a short distance from Liberia’s international airport and the Firestone rubber plantation.
Mr. Memaigar had contacted the burial team and dragged his son’s body out of his room on a mattress. Abraham was buried the same day by an Ebola burial team in an overgrown cemetery a short distance from the house.
Dr. Dahn said investigators were trying to determine how the boy had become infected.

Points of note:
1) In a country ravaged by Ebola, and desperate to convince everyone they're free of it, with purportedly only one case to deal with, the crack Liberia medical care system missed the initial diagnosis. Until it had doubled. Perhaps multiple times. Stop me if you've heard this one...
2) The virus, certainly not a new strain, but the same one that's been rampant since December 2013 in West Africa, has done its main thing: it has already spread to at least one other person, and perhaps a dozen symptomatic ones and/or a hundred asymptomatic soon-to-be diagnosed ones. A month later. Stop me if you've heard this one...
3) Liberia has proven competent to confirm two cases, now that they don't have people dying by the hundreds this year. Yet. But as far as stamping out the disease at such a low level, they are about as competent as the Iraqi Army against ISIS.
4) We have no idea how many other cases they've missed/mis-diagnosed since outside attention has waned.
5) With the uninterrupted media blackout of most all Ebola-related news, we never will, either there, nor here. It's frankly almost a miracle that the NYT even chose to publish this piece.

Don't worry, though.
Ebola will never ever get here from there, so there's no need for flight quarantines, and our superior health care system and dedicated medical practitioners would stop it in its tracks if it ever...oh, wait, nevermind.

Wednesday, June 24, 2015

The Real Thing

One interesting bit of apocrypha, is that the way they teach (or used to teach) bank tellers to distinguish counterfeit bills is by giving them the real bills to handle. After handling actual currency, the failings of counterfeit bills are immediately evident. Why this is germane may become evident as you read on.

For a wee decade or so, I took my prior job at Callous Bastard Hospital for granted. I was staff, I aced the interview, and I was senior in time served to most of the people there except the doctors I worked with. I also knew my job, both generally, and specifically with regard to that facility, and I was damned good at it.

But as my shifts were pre-ordained by scheduling fiat, I could guarantee several weeks in advance when and how much I'd work, and by dint of seniority had carved out a schedule that was about as sacred as it's possible to get. I could pick up extra days, but Uncle's confiscatory withholding made that option a fool's errand.

I also didn't notice, being the frog in the frying pan, how The Powers That Be had consciously and unconsciously (mostly the former) made the place progressively more of a hellhole to work in, by short-staffing, under-equipping, micromanaging, nannying, neutering, hamstringing, and generally undercutting everyone trying to do excellent work, mainly because Managerial Head Up The Ass Syndrome On Crack (times) Who Gives A Fuck About Actual Results As Long As We Meet Our Overlords' Asinine Goals.

The end result was that when I was set adrift with about as much concern as scraping mushrooms off the lawn, I was both depressed, because I felt like I'd failed to do something, and unaccountably relieved at not having to go to work there.

Flash forward to working a registry gig: I can't tell you how many days' work I'll get next week, next month or next year. I've been in quite a number of local E.D.s, all new to me before. I've been universally asked to return/stay/apply for a permanent position at most of them. I know I can work 9 days a week forever if I choose to. As it is, I've been pulling 5- and 6-day weeks with 12 hour shifts, pretty much non-stop since I started this in January. And I've noticed a few things.

1. You can tell a bad hospital in about one shift, after you've worked in a couple of good ones.*
2. I look forward to going to work now pretty much every day.
3. I've been told more times by patients and their families in the last 10 weeks (something like 50x) that "You really love your job, don't you?", than the total number of times I heard that in the prior 10+ years.
4. I'm smiling at work, even when it sucks whale turds, most of the time.
5. Measuring myself against the yardstick at a dozen other hospitals, I'm damned good at what I do, and I always was.
6. I really do like my job. A lot. And it isn't about the paycheck.
7. And oh, by the way, my paychecks have doubled.

So thanks for canning me, Callous Bastard Hospital. I got rid of everything I didn't like, I've maxxed out my income, and I've increased my personal job satisfaction tenfold, simply by not working for you. And now your staff is leaving in droves, and you're begging for people to replace them. Funny old world, i'n'it?

Among the few things you can change frequently in your life are your underwear, your location, and your attitude. If something in life isn't right, it's probably because you've skipped one or more of those three for too long.

And when life give you lemons, freeze them.
Because when you throw them back, they'll hurt more.





* I learned this lesson with film and television productions. But I expected most of them to suck. Realizing the principle applies universally To Everything was a real "Doh!" moment.