sunday evolves

friday i got blasted; nurses calling my name every other minute, doc's coming by and demanding my undivided attention, and me sitting amongst the chaos wondering if i'm missing something that will ultimately kill someone.

this morning there is calm (for now), and i find myself slowly, methodically sifting through the information on each patient, with the occasional low key interruption from sleepy sunday morning voices of doctors covering, only 2 or 3 of us at the nurses station. there is no shouting, no cursing, no air of frustration or urgency and it feels good for once. it feels like there's room to pay attention and really focus.

i can feel the events of my life over the last week and week to come rolling around in my brain and my emotions are unfolding inside me like some origami piece that wasn't folded quite right.

my compadre is cranky and has been consistently agitated by this job, while i quietly struggle to understand basic concepts; our frustration comes from the same place though we deal in very different ways; me always internally processing, processing, trying to pay attention and make small important changes. she's trying to discharge a patient, but there are no formal orders from the doc; lazy and lame. so she's frustratingly trying to decide what to give, how much and doesn't really know how to figure it out. i don't know the answer any better than she does, so i tell her to call the hospitalist, he can advise, but she refuses with the complaint that it should have been done. maybe. but it wasn't. isn't the point to do it right, rather than be frustrated and vent at me? this is how things get neglected, left undone or done poorly.

i feel her growing frustration like a noose around my neck, tightening with every additional question. why keep asking me, if my answer is always "call the hospitalist"? my own frustration is growing like a slow burn on an otherwise mellow sunday.

tick, tick, tick

a few hours later wingnut asks me if i want to take a walk. i called it this morning. still, all quiet on the cardiac home front. i predict the whole day like this. it's ballsy, but what have i got to lose. i tell her no, i'm trying to sort through a patients chart and let her wander on her own. maybe she will take stock, find a some peace, find some perspective... and as for me, i can take the time to myself. the chattering of the philipino nurses in their native tongue is the white noise of the cardiac unit. i'm feeling calm and centered, and am enjoying my job this morning.

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five hours out of twelve. stepping onto the unit is like stepping into a time warp, and the outside world doesn't exist. i have no idea if it's sunny, cloudy, snowing, day or night. the overhead lights glow the same all hours and very little changes in the beeping, patients calling out in frustration, boredom or pain. it's some netheregion that seems like a dream when i'm here. i feel like my own doppleganger with the hint of recollection that time is passing and i don't only exist here. i'm unconvinced.

mr t is having chest pain. he's not my patient. but house staff isn't answering the call. i watch everyone pass the buck in trying to track down blue team doc. after listening to 4 different people discuss who's job it is, while mr T's nurse becomes more flustered about his chest pain and possible weird EKG changes - i pick up the phone and page blue team. suddenly none of the nurses want to get upstaged and they start paging blue team. when the doc finally calls back, the stupid effin nurse starts telling her how they've been paging her for 20 minutes and where has she been, blah, blah, wasting precious time on mr T's possible heart attack - and i am grateful i'm not mr T.

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"leads off room 852a, leads off"...i hear this voice every so often and i think to myself, "hmm, god is a woman, yeah, i knew it"

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"he's gone" says the nurses aid laughing
"who?" says the nurse
"mr d" says the nurses aid "he yelled at me and just walk down the back stairs"
"call security" says the nurse, followed by jocular conversation about mr d, who has been medically cleared (and the doc told him) but is homeless, so he has nowhere to go. he doesn't want to stay anymore, but he hasn't been discharged. security calls up and says they have him. someone is calling the doc.
"no he's not confused" says his nurse. the conversation continues. here comes the patient with security, calm but confused looking.
"I thought i was discharged?" says the patient, he wanders back into his room, and order is restored. ha.

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wingnut is looking over her patients charts. she's been pretty chill since her mid-morning walk break. yeahbuddy. she calls me over to show me the I/O's (ins and outs, what goes in and what comes out, literally - food, fluids, you get the idea). Listed on her "in" list is 300 mL for her 87 y/o lady. not so wierd, except it's listed as 'breast feeds'...oh yeah. i wanna know the genius who pushed 300 mL of ANY fluid into that womans breasts. lol.

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her arms were swollen with fluid her vessels could no longer hold. he head was cocked at a painful angle. her lips longed to meet, but the stale hospital air kept them apart as she inhaled, exhaled, inhaled almost imperceptibly. every organ system played tricks, marco, polo; who was responsible for the ailing, failing of this woman. one, who had lifetimes ago, survived a concentration camp, the ink on her left forearm, clearly etched 5 numbers balanced on a triangle, palpable beneath my tender fingertips.
i cradled that arm as my colleague attempted to draw blood from veins that hid deep below the surface. the two pinpricks were likely insignificant in the scheme of her history - necessary in the elucidation of her complex picture of poor health - and still, we focused with the intensity reserved for heart surgery or some such feat. i held her arm as if it were the most precious thing i had ever touched; the cure to hate, the beginning of time. When she failed twice, I pushed fear and shame aside, and did what should have been my job to begin with - my patient.
One gloved hand on the needle, the other never letting her arm use it's own strength, her head ever so slightly turned to glance at me. Reposition, with the vision of sense in my fingertip, the flash and I was in. Watching the lifeblood of this woman, stronger than i could ever, ever know - one of too many - I nearly wept on her, at her bedside. All tenderness, calm and gentle voice, I humbly offered my thanks; hoping for an answer in this bottle.