Back in nursing school I had a teacher who, during a lecture on respiratory care revealed to us that she couldn’t stand phlegm.   “Phlegm is my thing”, she said.  She took a little tangential off-shoot, spontaneously (I think) to tell us that the thing that grosses her out is phlegm.  That is the one thing in the realm of the nurses job that makes her cringe, makes her skin crawl, makes her want to gag and leave the room.  She went on that, in her view every nurse has a “Thing” and hers was phlegm.  I could tell she was telling the truth, because she became jittery and and her body language said at least as much as her words about the way it physically affected her, even just thinking and talking about it.  These side tracks Margaret took and the physicality of her delivery made her lectures more memorable.  Interesting that it was not the material itself , but the personal divergence from the straight lecture that made it stick in my head, even to this day.

Every nurse has a Thing?  Probably true.  Could there be that one tank of an individual though that can keep on rolling through the worst of it unfazed?  Could be, but not likely when considering the broad spectrum of grossness we encounter.   So what’s my “Thing”?  It’s gotta be eyes.  If you could see me right now as I’m writing this, you would see it’s true too, because my posture has just changed and my face has gone sour.  I’m as transparent as glass.  More transparent.

Think about the eye for a moment.  What is it?  It’s kind of like a jellyfish… in the shape of a marble.  It’s just a bunch of flimsy, wet, filmy layers of material in a gelatinous glob all contained within some kind of membrane.  It’s not very strong but we lead our way through the world with our eyes right out front.  They’re pretty vulnerable when you think about it.  And what protects them?  Just a little row of hairs above and below?  Come on!  That and a bit of skin that closes over them?  Please!   It doesn’t seem like enough!  Not when you consider how heavily dependent we are on our eyes.

From time to time we get someone with an eye injury in the ER.  Most of the time it’s not too bad.  Something in the eye, or the sensation of something in the eye, that kind of thing.  But rarely we will get something more serious: Penetrating foreign body, ruptured globe, chemical or thermal burn, detached retina.  Most of my co-workers seem quite easily able to deal with these ocular emergencies.  Not me.

Before I was a nurse I was a bicycle mechanic for many years.  During that time there were several instances when I got fragments of metal in my eyes.  Two or three times I had to go to an eye doctor to get them taken out.  I still have a sharp memory of the pain.  There was no relief from it.  It was only bad and worse.  The unstoppable watering.  Blinking was torture.  Sleep was impossible.  Rubbing the eye, lifting the eyelid to try to get a fraction of improvement… there was no escape!  The eye doctor took out the metal that had gotten in my eye while I was cutting threads on a fork.  He showed me the offending material, the cause of my agony.  What a disappointment!  That tiny thing!  It was just the tiniest speck, almost imperceptible!  It was impressive the amount of suffering that could be produced by something so small.  My eyes are watering now.

Besides the foreign body I also had a corneal abrasion.  That eye doctor told me that that was why it hurt so much.  The surface of my eye had been scratched up by blinking and rubbing and had become swollen.  The good news was that although the cornea is exquisitely sensitive and painful, it is also one of the fastest healing parts of the body.  So after the crapola was dug out of my eye with a needle (He used a needle for chrissakes!) it did heal quickly.  In the range of possibilities, not a very significant injury, but enough to give me a heightened respect and strong aversion to eye injuries.

So when we get eye injuries I try to get someone better equipped to deal with them to take those patients.  I admit it.  But phlegm?  I’ll take phlegm all day long.  Blood, Barf, Melena, angulated long bone fractures… bring ’em on.  But please, no eyes.  That’s all I ask.  I’d have to say eyes are definitely my thing.

So, What’s your thing?

It’s 6:30 in the morning.  I’ve just gotten to work.  I haven’t even put my bag down yet.  The knit wool beanie my wife made for me 11 years ago still keeps my head warm when an ambulance rings us down on the radio with incoming traffic.   The medics are transporting a mid 50’s male with a report of heavy ETOH (That’s alcohol) and they inform us the pt is very familiar to us.  

Take a deep breath

No sign of injury, they continue.  No complaints from the patient.  But he is difficult to assess due to the ETOH.   He is slurring his words and has been incontinent of urine.  There was an empty vodka bottle on the ground next to him.  He is being verbally abusive, but not physically combative…

I should put my things down and get a room ready.

– – – – – – – – – – – – – – – – – 

Next patient: a baby with a fever presents in the lobby.  She has been up crying on and off the whole night.  She has a runny nose and is teething.  Her eyes are red and puffy.  Her young parents haven’t slept.  This is the first time she has been sick.  They are full of Love for her but have no idea what constitutes Big sick vs Little sick and have no clue what to do.  Not their fault.  No-one teaches this stuff.  Maybe I can take the opportunity to begin a little education while they’re here …

– – – – – – – – – – – – – – – – – –

“Michael, your other patient is urinating on the floor and it looks like he’s going ot fall out of bed!”  It’s true.  The guy is kneeling, leaning against the bed rails and relieving himself onto the floor.  He does look likely to topple onto his head.

I swear because I care.

– – – – – – – – – – – – – – – – – – 

This exact scenario hasn’t played out word for word (Or maybe it has).   This is the kind of thing that can happen though.   This is a job that produces unavoidable interactions with other people.  Interactions I would never have under any other circumstances.  I don’t control who I will be interacting with.  Or When.  Or how they’ll treat me.  Or who else will be there enacting their own behavior at the same time.  I guess a lot of jobs have this in common.  I’m going to guess though that on the social, behavioral, functional continuum of individuals the difference between interactions one relishes and those one shuns stretches quite a bit wider in the ED than in most other workplaces.  That’s the premise I’m going with for this piece anyway.

It doesn’t take too much imagination to envision situations where a person in such a position will be in wildly different interactions at the same time, each with its own demands and challenges and requiring deployment of wide ranging, sometimes even opposite behaviors on my part in order to provide the appropriate” care” for each patient.  Each patient needs something different.  That brings me to the thing I do have control of.  That is how I will interact with each patient and family I come in contact with.  

Let me tell you it is not easy.   And after twenty years in the ER I still have a lot of room for improvement.  To that degree I have grown better at it, I owe thanks to my wife Cecile whose loving example has osmotically transferred some useful tools to me over time.  Through her steady and compassionate nature and her genuinely held belief that Love is why we are here I have been able to expand my capacity for compassion.  (A smidge)
Ideally I would be able to bring my same self to each interaction and have something of myself to give.  Doesn’t that sound awesome!  I would leave work every day feeling amazing if I could have meaningful engagement with each and every person I dealt with! 

But I can’t.

I have to know where to set the aperture for my heart and soul for each situation.  Sometimes a wide open setting is called for to provide the touch that will provide a spark and Healing will happen. When it does it’s sweet and the feeling can sustain you.   Maybe it’s just taking a little extra time listening when someone really needs that.  Maybe it’s just showing basic respect to a person who never sees it from others.  Maybe it’s sharing some of my own parenting journey with scared new first time parents and letting them know it will be alright in the end.   Opening up to the other person on a basic level can create a space where everyone walks away feeling good.

But

 Sometimes a total lockdown is required to protect myself from the damaging effects that could be inflicted on me if I let the wrong person too close in.  Usually it’s somewhere in between.  Make the wrong choice either direction and the things can get bad.  Fast.  I can, and have unintentionally hurt people’s feelings and angered them through slight misjudgment on my part.  Sometimes someone who really does need some help will abruptly bolt and I may not even know what triggered them.    I have been knocked out of my chair with a punch to the jaw I didn’t see coming when I let the wrong person get outside the field of my peripheral vision.  I have been yelled at, spit at, treated to sublime profanity and wretched propositions by men and women, young and old.  People have said they would kill me.  Over and over and over, but I think I’m still alive.  

 It doesn’t pay to be a perfectionist about this.  But I sometimes forget.  It is easy to fall into a trap of thinking I should have known how things would go.  It would be cool if I could just nail this!  If I could just snap judge it, Bam!  And get it just right.  Yeah.  That would make things a lot easier in the emotional dance we do with our patients.  I could be a better nurse.  I could be more balanced when I get home.

When I get home…  Oh my, I have 40 minutes of driving time to transform myself from the hardened gritty shit magnet or tattered soggy dishrag I have turned into emotionally, through the crucible of my 12 hour shift, into some semblance of an appropriate family man.  I use that drive as my phone booth to change, to shuck off the things my family never needs to know and deposit them somewhere.  I have to do this in order to be the person who is going to interact with a wife and three children who don’t inhabit the world of the ER.  If I don’t something will slip or bubble out in an awful way and everything will go silent and still and I will know.  Know that my costume change has not been complete and Nurse Michael is still not quite ready for listening and reacting to Kindergarten stories.  Nurse Michael is not quite equipped to help with high school homework or to show proper sensitivity when hearing about the difficulties of a Loved One’s day, which though valid, pale by comparison to what I have just slogged through.  Sometimes that 40 minute drive is not quite long enough to leave it all behind.

Sometimes though, on the drive I will try to remember each patient I interacted with during the day.  I want to be able to remember, so I can process things, or write about something funny, or reinforce the memory of something that went right so I can do it that way again.  But most daze it feels like trying to pull something whole out of a blender.  All the distinction of each individual interaction has been homogenized into a grey slurry and I can’t seem to access any of it. 

Usually though I can remember and continue to feel whether I had to be Open or Closed to do my job, and whether or not it had worked.

“Daddy, will you dance with me to go to sleep like you used to when I was a baby?”

Sure I will.   You know, just because you’re another year older now… just because you’re six doesn’t mean you’re not still my baby girl.  No matter how big or how old you get, you’ll always be my baby.

“I know that Daddy. ”

I have an important question for you now.  Are you ready, because this is serious?

“Oh Daddy!  You can ask me your question, but this better not be one of your silly ones.”

What I need to know is if you want your regular “Sleepy Time Playlist”, or if you want Norah Jones like we used to when you were a baby?  I don’t know if you remember, but we used to listen to “Feels Like Home” by Norah Jones.  That was how we started, before we added other music to make your regular “Sleepy Time Playlist”.

“I want Norah Jones.  That’s what makes me get sleepy with my head on your shoulder and you’re dancing, with just a little bit of light.  Is that how you’re going to do it?  Please Daddy.”

Oh yeah.  That’s the only way, if you want it like it was when you were a baby.  Do you remember I used to carry you all the way down the road to the mailboxes and turn around and come back to help you get to sleep?

“Well we should start dancing right now before I get too heavy.”

That wont be for a long time.

“How long?  When I’m nine or ten?  Because that’s coming too soon Daddy!”

It’s a long way away.  When you’re nine is still three years away and when you’re ten is four years.  That’s a long time.

“Well I’ve got a great big hug and a smooch for you Daddy, because you’ll still dance with me”
This is how the talking went as my youngest began to quiet down, needing extra closeness. and a little movement, gently swaying and the smoky vocals of Norah Jones easing her off into Dreamland with her head on Daddy’s shoulder.  And for me, I could feel her little muscles softening as her grip relaxed and I wrapped my arms slightly more securely around her.  Her breathing steadied into a rhythmic warmth in my ear.  That moment stretched out, elongating in a shimmer barely perceptible but holding in it all the memories we’ve made together and the cradlefull of possibilities unformed before us.

No one’s perfect.

We may go years in amongst the sick without  ever needing to ask for help.  We may feel as sturdy as tanks or as sprightly as pixies taking our imperviousness as a matter of course.  After all, who is going to have a more robust immune system than an ER Nurse?   Who is constantly exposed to everything that’s going around?  Who is coughed on, sneezed on, barfed on?  Who is dealing with urine, feces, blood and sores of a broad swath of humanity?   The idea of coming down with something just doesn’t enter my mind.  I don’t think it does my peers either.

This isn’t just swagger or machismo.  I am just a guy doing a job that among its benefits includes exercising my immunity daily.  So getting what everyone else has just doesn’t really concern me.  I do take reasonable precautions and use PPE (Personal Protective Equipment) to protect myself from imminent and likely exposures.  That said, there are times when we nurses break down, become susceptible and get injured or ill just like anyone else.  After all, we are anyone else.

I am overdue in terms of statistical probability.  By the age of two I had stitches in my forehead.  Three times.    At age ten I had a hernia that needed surgery.  I think it was brought on by the sit-up competition we had in my fourth grade class when I did 59 sit-ups in a minute.  (If I can do ten now I’ll be surprised).   I think I tore something.   I remember having surgery at the hospital where my grandmother, Ella Elizabeth Nelson Bateman Williams worked as a nurse.  I am the third generation nurse along that maternal lineage after my grandmother and my mother Bonnie Hudson.  Not until I was 26 did I break a bone, in a mountain bike crash.   It was an abrupt communion with an old Oak tree.  Another bike crash had me in the ER when I was 34.  Other than that I have been blessed with good health and freedom from injury.  This is probably when I should knock on wood or throw salt over my shoulder, but I don’t put stock in that.

One of my coworkers loves to travel.  Well, that’s inaccurate.  Many of my coworkers love to travel, but one of my coworkers has had the good fortune to have travelled all over the world.  On one of her trips she visited the Incan city of Machu Picchu.  That is a bucket list destination if ever there was one.  The journey to Machu Picchu is meant to be one of the salient memories in ones life travel log.  But for my friend Machu Picchu itself, although amazing, hasn’t turned out to be the biggest memory, or most interesting aspect of that trip.  Why?  Because when she was in that remote destination she noticed she was having abdominal pain.  No big deal.  Just walk it off, right?  Not this time.  I don’t know if she developed the Wretched Trinity of symptoms, Right Lower Quadrant Abdominal pain, Nausea and vomiting, Fever that are text book for the ailment, but if you guessed she had appendicitis, you are right.

Well Damn!  All the way up in the Andes!  Now what?  She had to find out where there was a medical facility she could trust to perform surgery to remove her appendix.  And she had to get there.  She took the train down to Cuzco.  The way she tells it, in her low key, good natured, laugh about things kind of way, it was no big deal.  She says she met the surgeon, he looked at her abdomen and commented, “Too much sushi”.   (Because of her fat stomach is how her friend translated it).   She is of Japanese descent.  Can you believe that?!  Then she says when he washed his hands in the OR he dried them on his haunches!  I’m not making this up.   Such casual behavior did nothing to inspire confidence or assuage her concerns about having invasive surgery in another part of the world more famous for it’s ancient roots than it’s modern medicine.   As it was, her choices were few.  She had an appendectomy in Cuzco, Peru.  She asked the surgeon if he would do the procedure Laparoscopically and was told, “Yes”, but the scar on her belly tells a different story.  And when my friend retells it, everyone enjoys a great big laugh.  I laughed so hard I cried.  She is a very good story teller and I thank her for permission to use her Andean misadventure here.

Sometimes, the idea that we could really be sick is so foreign to us that we’ll just keep on working, not wishing to be any bother to anyone, or feeling embarrassed to become vulnerable and in need of help, even from (or maybe especially from) our colleagues.  The prospect is rather unsavory to me and occasionally I have asked myself what I would do, where I would go if I needed medical attention.

Another of my world traveling friends from work returned from a trip and felt a little under the weather.  She knew what the problem was.  It’s common enough and we certainly see cases on a daily basis in the ER.  She had a UTI.  That’s a bladder infection.   Nothing major, but not anyone’s idea of a good time either.  She increased her intake of fluids orally to maximally flush the kidneys, ureters and bladder.  And she got a prescription for antibiotics.  Now the first agent often chosen is something called Keflex (Cephalexin).  It’s a broad spectrum antibiotic that’s effective against most of the common bacteria responsible for the majority of UTI’s.  The problem is she is allergic to Keflex.  Another antibiotic frequently used for bladder infections is something that is also generally effective and has the advantage of only needing a dose twice a day.  It is called Macrobid.  She started taking the Macrobid and had two days off work .  On the third day she was scheduled to return to work, but she started to feel short of breath and contemplated taking another day off work to rest, but being a trooper she decided to go in.  After all it’s just twelve hours in the ER.  Piece of cake!  That decision may have saved her life.  No really.

She started the day at work feeling run down and a little short of breath.  A short time into her shift she started to have pain in her chest.  Now that’s not so good.  She keeps herself in good shape, exercises, stays active.  She didn’t think she was having a heart attack, but after the recent travel the notion of a Pulmonary Embolism (Blood Clot that travels to and lodges in the lung) was not out of the question.  She thought maybe she could just sort of, you know, without being too much bother take a little break and get a quick look over by the doc and see what he thought.  But she was getting worse fast.  The people she was working with flipped her to the other side of the line in the nurse-patient relationship and it was found she was suffering a rare, but previously known and documented side effect of Macrobid, something called Flash Pulmonary Edema.  That means the lungs are suddenly and quickly swelling and secreting fluid as an inflammatory process.  If you guessed all that fluid in the lungs displaces the availability for O2:CO2 exchange in the lungs you can pat yourself on the back.

She was admitted to the hospital and spent a few days upstairs before going home to take some more time to recuperate.  This kind of experience changes the way you see yourself.  That nice image of invulnerability gets knocked out of its gilded frame and wrinkled up a bit.  Still she wasn’t ready to consign herself to the ranks of the merely mortal.

Six months later she was on another trip.  A SCUBA trip in the Channel Islands off the coast of Santa Barbara.  Her doctor had advised her against diving so soon after her Pulmonary Edema.  Her lungs were likely weakened and susceptible to problems related to the pressure stresses of SCUBA diving.  “Come On!”, thinks she.  I planned this trip and booked it a long time ago.  I’m not going to cancel now.  That’s ridiculous!  I’m experienced.  I know my limits.  I’m not going too deep.  I’ll just take it easy.

We got a call that she had been transported to a hyperbaric chamber.   She had gotten the bends while diving not too deep, or taking chances and while adhering to reasonable limits.  Well Shit!  That takes the fun out of things.  That was all last year, in 2017.

One of the ER Docs we work with carries on a tradition started many years ago by his parents.  He has a New Year’s party and at midnight everyone goes down to Cowell’s Beach and plunges into the ocean.  This year the plunge was significant for this nurse who had suffered these health crises. She had a lot to cleanse away from a year she viewed as a real Crap year.  It wasn’t just the health problems.  She has a Caribbean paradise she has been tending and building up into her modest but beautiful retirement destination.  I can almost not move my fingers to the keys and type the words…  A hurricane ripped through the island and wiped out her property.  The structure.  The vehicle she had been keeping there.  The landscaping she had been doing…Gone.  Erased.  Back to square one.  Back to Nature.  Thankfully, as a sliver of Sunlight, a Ray of Hope, her friends, companions who are native to the island were safe and after a time she was able to go there and, well, Be there.  With them. That much she still has.  But come midnight on New Year she was in that ocean.  Not just a quick in and out but a complete submersion and purification.  She had a lot to wash away and I hope this year will be better for her.

Some of my coworkers are big into exercise and fitness.  One nurse I have worked with for about fifteen years does ultra-marathon races.  These are foot races of more than 26.2 miles, the length of a Marathon. Some are 50 miles or a hundred miles or more.  I could say she  is fit, but that hardly begins to tell the story.  See where I’m going?

One day at work she started to have abdominal pain that started in a nagging sort of way but got gradually worse.  She started telling me her pains were becoming more than just a bother and was looking for guidance what to do.  Should she just keep working and see what happened?  Should she go home?  Should she check in as a patient to really find out what was going on?  I remember her saying, “This is ridiculous!”.  She was trying by force of will to tell her body, “This is not going to happen”. “I am going to continue with my day and this little problem will go away”.

It didn’t.

I was her Triage Nurse.  The experience was interesting for me and I became acutely aware of the intrusive and highly personal questions we ask our patients.  I learned more about her in a few minutes than I had in fifteen years of working together. The abdomen is home to many internal organs.  Women’s abdomens even more so than men’s.  She was having some tests, ultrasound, pain medicine.  There was no answer yet by the time I had to go home.

Later I got a text informing me she had a hemorrhagic cyst on her right ovary and an inflamed appendix.  She had been transferred to Stanford because she has a blood clotting abnormality and they wanted to keep a close eye on her in case her appendix got worse or ruptured, because she would be high risk if surgery was needed.  She was up there a few days and was abel to come home, but had to take things easy for quite a while.

She didn’t end up requiring surgery.  She is back to her ultra-marathons.   She looks full of vitality.  She has a partner she trains with and now her two boys are running with her too.  It almost seems like none of it ever happened.

But it did.

She was on that unfamiliar side of the line and I was where I have been for twenty years.  I got to know her better because of it.  Better than I probably would have if she hadn’t found herself in her ridiculous situation.  I feel closer to her too.  Vulnerability and trust can open doors like that and change the shape of the world.

Note:  These stories were generously shared with my by my coworkers and by me with you through their kind permission.

a true story

Michael: “Did you get him to piss in a jar?”

Kat: “What?”

Michael: “Excuse me. I mean “whiz”.

Kat: “Urinate”.

Michael: “Thank you! I never thought I was more than a 7”.

Death is coming, is your constant companion, is holding your hand right now.  No one has more patience than death, but no one can be more greedy either.  Or as tender.  Or as cruel.

The way we live our lives is interesting.  Intellectually we know the deal:   We are born.  We live.  We die.   But here’s what we do.  We celebrate birth. We take Life for granted.  We fear Death and shun it.

When a new baby arrives, joins our family it renews our hope in the world.  We relish the gift of life knowing Nature is intact, operating according to a miraculous plan.  Each year we celebrate the birth again.  As I write this, for instance it is the birthday of my middle child, my second son, Oliver.  On the day he was born I received him with my own hands, in our home, welcoming him to this world.

This morning he was up before the Sun, yearning to seize the day.  He is fourteen.  He had agreed, last night, to go for a sunrise bike ride along the cliffs above the ocean with my wife, Cecile.  The view across Monterey Bay to the Santa Lucia Range is clear today with the water a slate grey, and bands of watermelon and papaya brightening the sky behind the shadowy purple ridge line.  It is a fine morning to be up celebrating the gift of life with the dawning of a new day.  And who better to share it with than the one who carried you and delivered you and nurtured you, who brought you across the mysterious threshold, risking her own life in the process.

It is thin and delicate membrane that separates the Before from Here, and Here from Hereafter.   Mothers occupy an ethereal guard post, straddling the portal into our earthly world.  I’ll bet most of them haven’t pondered the notion that the moment of their baby’s birth may be the closest they’ve ever been to death.  It is a moment out of our control, beyond the confines of manners and propriety and a time when Death can take you.  Usually it doesn’t.  I can’t say how grateful I am that our lives in my family haven’t been  touched that way.  I say this with the perspective of one who has been there when the gates have come unhinged and didn’t open or close the way they are meant to.

In such moments, as a nurse, I am a person in the presence of strangers who one minute are filled with the expectation of their greatest joy and are the next moment gaping down the abysmal maw of dark eternity.   It is hard not to feel out of place, like an intruder.  So many thoughts and feelings slam against the  shores of my being from inside and outside with a rapacious fury, yet I have to center myself and become a pillar of strength in that moment.  Though I feel their loss intensely, I am no good to them unless I can insulate myself at that moment from the strength of my own emotions and provide a solid grounding presence.  Sometimes I will just be with them.  Sometimes people will need physical touch to keep them here in this place, however tumultuous or lonely or damned it may feel, they need to stay here, on this side of the membrane.  Sometimes it is words, words that find their place and come from who knows where to keep a mother, or father from falling into a grief with no bottom.  It doesn’t seem real.   It is all wrong.  But nothing is more real or final.  

My first day of orientation on the job Death was already there when I got there, serving me notice, letting me know who’s the Boss.  Two girls walking to school had been hit by a car.  They were fifteen.  They were in the crosswalk.  The driver of the car had stopped at the intersesction, then proceeded making a turn toward the rising Sun, which for a brief moment blinded him.  That was all it took.  That brief moment became locked in a broken chronogram, which instead of passing without notice became etched into the memories of  people who were there.  One of the girls suffered a femur fracture and needed surgery, but the other had a head injury and was killed.  I remember the injured girl screaming angrily, asking why she and her friend were being kept separated, why she couldn’t see her friend.  Hers were just the first of the heartbroken, disbelieving chorus who came in waves, each joining and renewing the mournful keening that is still in my ears eighteen years later.

That day put a mark on me.  It made me look at each day differently than I had before.  Maybe most of the people who know me don’t know where my sudden dark and inappropriate “humor” comes from.  Well, it comes from experiences like this.  That girl screaming to see her dead friend.  The wailing of her parents, siblings, grandparents, aunts and uncles as they came in and learned she was gone.  The weight of helplessness and guilt for the destitute driver as the unthinkable reality of having killed an innocent girl on her way to school caught him and wouldn’t let go.  Wouldn’t ever let go.  He was there too,  in another room devastated by what he had done.  He was trying not to let the gravity of what had happened collapse his psyche in on itself, but being unable to do it.  We were trying to help with drugs, something to calm and slow his mind down and create a protective buffer against the immediacy and permanence of the moment.

I can’t even write this without weeping.  But I guess that is why I need to write it, to try to find a way of making peace with the terrible, unacceptable reality of being there, as a stranger in the presence of my fellow human beings as they are visited by Death. 
 

Let’s talk Lingo. Think about the work you do and the language you employ throughout the day.  Every workplace has its own language, the words and phrases understood by the users in their par…

Source: “Gimme a Nasal Trumpet”

After 18 years in the ER I’ve come to recognize something.  I’m sick.  Not ill mind you, just not quite conceptually concentric.  I never pondered the word  “Eccentric” before but I think I am described obliquely within its circumference.  I actually knew it long before now, but reflecting on my experiences and how I got to this moment I see it is a striking feature of the landscape.  Inescapable really.  That’s why I thought it would be appropriate, and honest, to give fair warning that the musings herein could be called “Astigmatic”.

My eye doctor once asked me how old I was when I first got glasses.  I was fifteen.  I had just recently gotten braces as well, but that’s a different story.  He said I probably needed glasses much younger than that based on my astigmatism.  He’s a charming man.  But to the point, my vision doesn’t work properly and needs a lot of help.  Optical Physics can correct physically for the visual (must I use the word?) defect. For those formative fifteen years though my mind was told by my eyes that the world was a certain way.  What did that do to the shape of my mind?

My eyes could not conform to a uniform shape to bend  light without distorting it.  Is it possible then that my mind had to bend to try to effect some sort of post production image manipulation?  Was I destined to have a warped view of the world?  I don’t know, but it’s interesting to  turn the idea over.  It is one of those physical fact versus perception philosophical questions like the tree falling in the forest: if there is no-one there to hear it does it make a sound?  Is the world the way I see it because my seeing it that way makes it so? Does my perception shape the world, or does the world shape my perception?

Just a few days ago a coworker and I were laughing about a situation she had gotten into.  She was in trouble with her adult daughter for a gift she had given her.  I don’t have permission to give specifics of the event, but the gift, given as a joke which was funny to my friend was received as distasteful and insensitive.  On hearing the story I thought it was a great gift. Very humorous. It had to do with a hard time this person’s daughter had gone through.  For sure it was inappropriate, but that’s where the fun lay…for some of us.  That’s the thing, every job has a personality type or range of personalities that suit a person to the work.  In the ER you have to be able to laugh at things that get pretty dark.  It’s either get chewed up and spat out or find a way to laugh in the face of some ugly situations.

I can’t even count the times I’ve heard, “That’s not funny Dad!”, or, “Miguel, can you please keep your work humor at work?”.  It’s hard to do.  In a sense, I live in two worlds that are very different from each other.  They require two different ways of being, of facing and responding to situations.  Sometimes I get home and haven’t yet shifted gears from gritty grunge, prickly shield Miguel to quiet listening, okay to be around little kids Miguel.  The Fight or Flight option hasn’t defaulted back to Harmonious Home life, softer quieter mode and I’ll easily say something inappropriate.  The same words coming out my mouth which would have been met with appreciation and gratitude an hour before will l and me in the dog house if I don’t reset in time.

Here’s a true story:  A young man in his early twenties, was brought in by ambulance having been saved from drowning by his girlfriend.  She had hauled him out of the water after he had fallen in head first off a rock jetty.  She really did save his life.  But here’s the (funny) part. The reason he fell into the water is because he fainted.  So why did he faint?  Well, you know those rock jetties, covered in barnacles and what not.  It can take a little scrambling on all fours to navigate the boulders.  In the course of this recreation the strapping buck got a scrape on his hand from a barnacle.  He felt it and looked and saw a tiny ribbon of blood, became light headed and fainted right into the water.   She rescued him, revived him a bit, called 911 and  little while later I was hearing this timeline of events.  While I’m hearing the report from the paramedics it pops into my head what a shame it was she didn’t just cut her losses right then and let him go.  I mean he was fine.  No head injury.  No serious wound.  No water in the lungs.  Fine.  Of course I wouldn’t literally advocate such a proposition, letting him drown to save a lifetime of dreary,  mollycoddling, but the inkling of the idea had popped itself into my head an struck me funny.  So much so that when I got home and the boys asked me what the funniest thing was at work that day, I just blurted out the story.  They were horrified and said so.  Damn kids.

Sick, inappropriate, funny?  Who is to say?  Where do you draw the line?  And how well do you see the spot where the line is to be drawn?

What does he mean , “Welcome to the Goat Rodeo”?

I have long intended to write about my experiences in the ER.  It’s an idea I’ve kept filed in the back of my mind waiting for a future date when I have an abundance of time and can sort through the mire.  Tomorrow I turn 55 and the lush landscape of leisure time I vaguely imagined isn’t anywhere on the horizon.  In fact time is only compressing and accelerating, so I figure now is as good a time as any to grab a hot torch and light up a bit of my particular vision.  But what is that vision and why do I call it astigmatic?

I am a RN in the ER at a community hospital on California’s Central Coast.  One great thing about the job is you just never know what is going to happen in the course of a day.  One very memorable day a few years ago will remain forever clear and bright in my mind.  It is from an event on this day that I have taken the name of my blog.

It was was during the time of year when influenza and similar respiratory viruses are laying people low right and left.  It was also a year when the CDC and mainstream media were trying (and to dramatic effect succeeding) at terrifying the general public about this, that or the other “Deadly” flu variant.  As you may be able to imagine the media hype led to oodles of mostly not very sick people thronging to the ER.  I know, I know… you’re thinking, “But if they’re not very sick why did they go to the ER?”  I encourage you to come in during flu season some time and conduct a poll about it in the lobby.  Maybe you can answer the question.  I, however will get crucified if I broach the subject with a patient or their family.

On the day I’m talking about I was assigned to triage.  This is the job where a nurse must sort the patients and determine who will see the doctor first.  Our ER has a capacity of 12 beds plus space in the hallways for 4 gurneys, that have next to no privacy for when things get hopping.   So when we get more than 16 patients someone isn’t going to get a bed.  Not right away anyway.  That’s just the math.  I take no joy in making people wait.  No-one likes it.  Patients certainly don’t.  People come to the ER, many of them thinking something along the lines of , “Isn’t this the Emergency Department?  I came to the Emergency Department because I need immediate medical attention”.  Something like that.  “So what do you mean I have to wait?  What if I was dying?  Would I just die here?”  We get a lot of that.  There are two other parts to the indignity of waiting and really they are just down to chance.

1.  People want to know how long they will be made to wait.  That’s natural.  But realistically it is a trap to try to answer with anything approaching an accurate estimate.  All the same we are supposed to try, and I do try.  The problem is I kind of suck at it.  The range of variables in play include: the acuity of patients already in the ER; will they get quickly in and out or will they require a lengthy battery of diagnostic tests?  Who is going to walk in the door next and how sick will they be?  Will we get Ambulance traffic between the time I venture an estimate and when the guy asking gets in.  I don’t want to over-estimate and depress people, but I don’t want to under-estimate either and have people coming up to the triage door tapping on their watches, interrupting the process and demanding an updated (yet equally unrealistic) estimate of the wait time every few minutes once their originally guessed at timeframe has come and gone.

2.  People who come in after you will go into the ER before you.  I know, I know!  “That’s not fair!  I have been waiting here and you just let that other guy go right in!”  Now this is the really hard part and the part that gets people really very, verging on homicidally,  ANGRY at me.  It is not hard to understand why people get mad: they come to the ER thinking they will get right in.  They are not feeling well.  A lot of the time they’re in pain.  Or they are accompanying someone they love and care about who is in pain, or is bleeding, or thinks they broke their ankle, or was in a car crash 2 days ago and feels worse now, or has had a cough for 2 weeks and got a fever this morning… all these people feel badly and have a right to receive medical attention in the ER.  But I have to rely on my training and experience to judge from an emergency medical point of view who is next.  If it’s not you and if you’ve been waiting a considerable length of time already… well you might be miffed.  I could go on and I will do another triage only post another time.

Anyway this was one of those kind of days, the department was full, it was flu season, people were feeling lousy and they were getting restless.  There was nowhere for me to put anyone.  A mom came in with her daughter who had minor flulike symptoms and registered to see the ER Doc.  I had more patients waiting than we could accommodate if the entire ER emptied that second.  We had been taking a beating all day.  After less than 5 minutes waiting that mom came up to my door and loudly announced, “I’m going to leave”.  I asked her if she would sign a form we have acknowledging that she was making the decision for her daughter to leave.  We were not refusing to see her, we just couldn’t see her right then.  She agreed to sign it.  I was actually a little surprised.  A lot of times people aren’t in a mood to sign such an acknowledgement.  When she handed it back to me she gave me an unexpected gift.  On her paper she had scrawled, “This place is a Goat Rodeo!”

That made my day right there.  I busted out laughing and went around and showed my work-mates.  Each and every one of us had a good belly laugh.  Not one of us had ever heard that expression before and the freshness of it and imagining the absurdity of a  rodeo of goats instead of bulls and horses, with clowns to distract the goats after they bucked off a hapless cowboy.  It was meant as an insult, I’m sure, but it had the exact opposite effect and it was an immediate pressure relief for us all.

The next day I wore a cowboy hat into work with a home made Rodeo champion’s belt buckle on my waist.  We all got another good laugh out of it and held onto that unexpected humor which had come out of such tension and it helped us through the day.  Thinking about it continues to make me laugh and helps me persevere when things are hard.

I have three children ( blessings each one of them) and the two older ones like to ask me when I get home from work,” What was the funniest thing that happened today?”.  When I told them about the Goat Rodeo lady they agreed that was a real top contender and suggested that whenever I get around to writing my book I should call it “Welcome to the Goat Rodeo”.

And so here we go.