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August 28, 2008

At The Swiss Cheese

I'd planned on calling the hospital of our current assignment the Cheese. Having arrived, I've decided to amend the name to the Swiss Cheese. That is because while this hospital has less than 500 beds (half the number of beds at either the Big D or the Y), the facility itself is enormous and very spread out. In fact, it's been called a honeycomb design during orientation, so given the cheesy nature of Wisconsin, I think Swiss is appropriate.

Currently I am sitting in a computer class for the computer charting system for the hospital. Naturally, it is fascinating, and I can barely tear myself away from it to write this entry. The thing about changing hospitals on a frequent basis is that you get to learn a whole new computer system nearly every time. Yea! Most systems seem like they seek to be counter-intuitive, as though they want to encourage the computer-illiterate nurses over the age of 45 to retire early. Here at the Swiss Cheese, technology is top priority. Everything is cutting edge here, from the monitors and pumps to little handheld scanners for meds. Seems like it could be handy, but on the other hand, sometimes simpler is better; replacing a single check on a paper with a complicated handheld device isn't necessarily the best thing to do.

This is actually my fourth and final day of orientation. Monday and Tuesday were hospital orientation, an experience that never fails to be painful and generally useless. Eight hours of sitting through non-applicable policies and boasting about the facility are eight hours that can never be redeemed nor retrieved. Yesterday was my single orientation shift on the unit, which I will talk about in a minute. Today, of course, is the computer training day, eight hours of following the tourist bike tour policy--that is, everyone goes the speed of the slowest user. There are plenty of older nurses in here who struggle each and every time they try to check their email. We won't be getting out early today.

Yesterday was an quite the day. It seems that each time a traveler starts on a new unit, the experience is different than the previous time. When I started at the Y, I only had an eight hour shift to get oriented to the unit. It turned out ok: I was shown all of the areas, given all the codes, given a general tour of the unit so that I could find my way around and could find supplies. That was pretty much what I expected from my orientation here. Tsk, tsk, perhaps not.

So, I was paired with a nurse who was taking a 1:1 assignment. The patient was a young man who was wheelchair bound. He had been crossing the street and was hit by a car, and ended up with all sorts of contusions and fractures. The assignment was supposed to settle out within an hour or so and then I would get the needed tours and information. By 9 am, it was apparent that there was not going to be any settling out with this patient. From his fractures, he developed a wicked case of ARDS (complete lung failure and multiple complications), with massive pulmonary edema. To make matters worse, he had internal bleeding from his pelvis fractures, requiring nearly continuous blood product infusion. We simply could not oxygenate the man; we had him on 100% O2, and his PEEP up to 20 (for those who don't know what that means, think of a bike tire that you keep inflating far beyond the safe recommendations--his lungs were the bike tire). I'm pretty sure that a PEEP of 20 is far out of the protocols, and in the end, we popped both of his lungs and had to emergently place bilateral chest tubes. There were several points during the shift that he came very close to death (e.g. when his O2 sats dropped to 40%, or when his PaO2 came back at 28 on 100% FiO2 or when he starting erupting pink froth from his endotracheal tube). We managed to pull him back from the brink, although it seems likely he suffered an anoxic brain injury from the long episodes of oxygen deprivation.

Needless to say, I didn't get a tour. At some point, during a lull in chaos, I was shown where they keep their supplies, where the meds are kept, and the men's locker--the important things. It wasn't very detailed, for sure, and there were vast parts of the introduction that I didn't get. For example, I have no idea what the unit's MAR (the medication administration record, one of the absolute essentials of nursing daily life) looks like, or how to do routine chores like order blood products. On the other hand, I did get to know my room very well, as in where all the various machinery and supplies can be found. I also got to see how they did certain procedures in this unit, such as place triple lumen IVs and chest tubes. We even put a Swan-Ganz catheter in this poor man, and practiced a little taking measurements.

I even got to play around with their technology a bit. Each room has a computer inside which has a screen that can be removed and carried around, and controlled by a touch screen. Labs and meds can be viewed this way. They have a setup to continuously watch cardiac output using the arterial line, which I hadn't seen before. All in all, it made the Big D look pretty old-fashioned, and the Y looks straight-up archaic in comparison. I think that when some hospitals like the Swiss Cheese upgrade to new equipment, they put their old equipment in storage for 5-10 years, then send it to the Y. Or ship the equipment off to Afghanistan for a couple of years before bringing it back to give to the Y.

At any rate, I won't know how effective my "orientation" to the unit was or how much more I need until my next shift. I have the weekend off, so I won't know until Monday. I don't think it will be a big issue; the staff on the unit is very friendly and open, and they are far too concerned for patient safety and well-being to let a nurse drown out of spite or disregard. That bodes well for me. I've been around nurses before who'd rather let the patient die than help you out. I didn't see any of those types yet at the Swiss Cheese. It's all about being willing to look a little dumb and have to ask questions whenever needed. That, and have a computer nearby to Google anything you don't know and don't feel comfortable asking. Which is a frequent thing, at least for me. Thank God for Google, if He didn't inspire it, he certainly owns stock in the company.

Finally, a strange event. As I stood waiting in the conference room for morning report to begin, I turned to find a familiar face looking at me. I didn't know if I was yet awake (I'm working all AM shifts), it was a bit surprising, but there before me was a nurse I worked with until late 2006 at the Big D. She has been traveling around the States, and actually is settling down after her assignment here at the Swiss Cheese. It was pretty remarkable meeting her, at this hospital of all places. We've also met travelers who know and have worked with traveler friends of mine in Colorado. A small world indeed.

Until next time, be safe.

Figuring Out Madison

It's been awhile since I've written an entry, and for good reason. Let's see, the last entry, I was in a hotel room having just finished our journey into Wisconsin. The plan at that point was to head north for a week of camping in the wilds of northern Wisconsin, maybe pick up a few more states by going through Minnesota and the Dakotas.

As it turned out, that wasn't to be. My grandfather was ailing, so the next morning, after being in Madison less than 24 hours, Jess and I loaded up and started the 15-hour drive down to Longmont, CO. We arrived by noon the next day. It perhaps wasn't the best circumstances to be in Colorado, but it was great to see my family, and we even managed to see a few friends one afternoon. Ultimately, my grandfather passed away, and we headed back to Madison Friday after the funeral. We pulled into Madison early Saturday afternoon, in time to arrive at the apartment complex and sign the papers for our new apartment. Our total mileage since leaving New Haven, CT: 3600 miles on the Rav4, which we drove to Colorado.

The apartment we had in New Haven was pretty nice, with a loft and two-story windows. It was pretty generic, though, with no real character. Our apartment here in Madison (called The Madison Apartments) really made that obvious; it is beautiful. For a one-bedroom apartment, it is huge, at 1500 square feet. It has a very large kitchen, with tons of counter space, which is a big plus for me. It is just a really nice place, quite easily the nicest place we've ever lived in. We even have a garage space right below us for one of our cars. This place would have cost a fortune in monthly rent in Connecticut, but according to The Madison's website, it only costs $1150 a month, which might actually be expensive for Wisconsin. Of course, we don't have to worry about that at all; we don't even pay utilities. Heck, with the stipend we receive as two travelers in the same place, we actually get paid to live here.

Since this is our second assignment, we already had a lot of the essentials of traveler household goods (pots & pans, dishes, etc.). That, of course, didn't stop us from blowing some serious cash at Target buying "essentials."  Jess has been using my shampoo, which actually bills itself as men's shampoo, for about six months now, which is not my fault in the least (she's just too lazy to buy her own). So, she splurged and bought herself not only shampoo but conditioner as well. As for myself, since I have had a hard time finding a barber that I trust since leaving NC in May (for which I haven't looked too hard), I haven't gotten a haircut for several months. I had to buy some pomade (think of George Clooney's character's use of Dapper Dan pomade in Oh, Brother, Where Art Thou?) to hold back my hair from my eyes. I've had marginal results; I look like a cross between a greaser and an old perv. I guess there is the ugly phase of growing one's hair out; that phase has lasted about a month so far for me.

We spent Sunday touring Madison. It's actually a nice college city. The university here is huge, with 41,000 students. The campus sits on the shore of one of Madison's three big lakes, which is really nice now, but probably sucks in mid-winter when the -40 degree winds blow in across the lake. Fortunately, school will be in session, so all the students will get to enjoy that. Bikes and mopeds are very popular in Madison (again, at least before the winter freeze comes); there are loads of bike paths, and I've seen more mopeds in the last week than ever before. Strangely, literally no one, whether on bike, moped, or motorcycle, wears a helmet. No one. On the main drag through town, the bike lane lies between the car lanes and the bus lane, so there is plenty of potential for MVA collisions. Sure enough, they have quite the active neuro ICU in town. Yet, the throngs of bikers in the morning all ride along with their hair blowing freely in the breeze, and there doesn't seem to be much encouragement to change that, from my limited time in Madison.

We walked all around the downtown area, which sits right next to the campus. There are a lot of the interesting little shops that sell things that college students find funny (I'm still young enough I usually see the humor as well). Apparently school was starting Monday, because that Sunday afternoon, all the students and their parents were coming into town. It's a little funny to watch parents drop off their kids, not just watching the mothers sobbing as they walk away from their kids, but also the looks of impending doom that cross the faces of most fathers. They've spent the better part of the last two decades trying to establish a sense of morality in their kids, only to drop them off in a gleefully decadent environment. In one store, I watched several dads looking over items that I can't even mention because I don't want my own mom knowing what I was looking at. Their looks of dawning horror is priceless. The glimmer in their children's eyes is also priceless. It's wonderful to watch.

There are also a lot of great restaurants in the area. It's nice to see a lot of ethnic food choices. We ended up eating at a Mediterranean restaurant, which was next to several ethnic restaurants, including one from East Africa, which sounded good. Even more exciting, Wisconsin seems to have caught some of Colorado's enthusiasm for microbreweries. There are lots of local brews to sample, and we've both added almost ten beers to our beer lists. There are even a couple of breweries right here in Madison, which makes a short trip for the necessary beer pilgrimages. One of our favorite brands up here is Leinenkugel's, which has several great beers.

So, we're warming up to Madison just fine. It's a different experience from New England, for sure, but that is the essence of travel nursing, to enjoy a multitude of different experiences in different environments. I think we'll like it just fine.

Until next time, be safe.

August 15, 2008

After A Long Trip...

We've arrived at our next assignment, albeit a week too early to move in. It's been quite a journey getting here.

Last weekend was pretty chill, we just relaxed and stayed in the area. Mostly we prepared for our trip. On Monday, we finally headed out from Connecticut. We had a rough start, we were supposed to be on the road by 11 in the morning, but the cards seemed stacked against us. We ran into obstacle after obstacle, the most annoying being my urine drug screen. I choked, I couldn't seem to perform, and couldn't produce enough urine to satisfy the requirements for the drug screen. Long story short, I ended up having to have new forms shipped to Wisconsin and only finished the test today. At any rate, we finally headed out of town mid-afternoon.

Our first objective was the Catskills, where we planned on camping a few nights. Again, the odds were against us, we arrived only to find rainstorms all throughout the area. After long consideration, we ended up at a campsite just outside of the Catskills, planning to head out the next morning if it was raining (the forecast was for a nearly constant rain the next day). We woke up to a brilliant morning, and despite occasional threatening clouds, the day was perfect. We toured around Woodstock, the town made famous for the '69 concert, and found that it has become a commercialized hippie town. We drove throughout the area, which is beautiful, looking at the lakes and the big hills, covered in forests. In the afternoon, we hiked a little in the park. It wasn't the most scenic place I've been, but it was quite relaxing.

We camped again Tuesday night, cooking our meal over our campfire, and roasting marshmellows. As nice as it was, we had to hit the road on Wednesday, heading down south through New York into Pennsylvania. We stayed that night in a little town called Somerset, after about a 420 mile drive. Thursday was our longest drive, more than 460 miles, over seven hours in all of driving. That day we crossed five states, three of which were new to me (lifers). We arrived tired but upbeat in Coldwater, MI, as the day had at least been as easy of driving as it had been long in length. We figured the worst was behind us. Today, though, that was proven wrong. We had a much shorter route, maybe 360 miles, but it swung us around Chicago. Even though we were in the outer suburbs, the traffic was atrocious, in particular the truck traffic. There were hundreds of trucks, as many trucks as other vehicles, it seemed. There was nearly constant construction, so the lanes were all very tight, and usually there were only two lanes. It was common to be completely boxed in by aggressive truckers, one on all sides except the side with the concrete barrier a foot to the left. This continued all the way to Madison, and it was almost too much after already having gone more than 1000 miles.

Incredibly, nearly all of the interstate roads that we took were tollroads. I am just not familiar nor comfortable with this concept. After all, a hefty portion of the $4 per gallon we spend on gas goes to our roadways; why do we need to pay additional tolls as we travel across the States? In Pennsylvania alone we each spent $10 on one road; altogether we probably paid $50 each in tolls. That's just too much. Besides, the condition of the toll roads was despicable for the most part, so what were we paying for? I have nothing good to say about it, it is simply highway robbery.

So, we were very happy to arrive here in Madison this afternoon. We found our storage spot, and dropped off the majority of our belongings. I went and finished my drug screen, drinking lots of Coke and water so that I was almost screaming for my little cup and a bathroom. We checked into a surprisingly ghetto Econo Lodge, I thought we'd left that all behind us in Connecticut.

We haven't seen much of Madison yet, we didn't even go downtown to check out the hospital. We just dropped into the hotel and haven't left yet, except to walk to a burrito place next door for dinner. Zuri, our dog, is simply mystified by all these changes. She is an adaptable dog, and was excellent in the car for the trip, but she is very nervous, she doesn't understand what is going on.

As I said, we are here a week early, as orientation doesn't happen until the 25th. That means we have a week to burn. Fortunately we were able to store most of our stuff and Jess's car, so the plan seems to be that we will be heading out of town again tomorrow, looking for fun places in Wisconsin (or Minnesota, or Canada) to camp out for a few days. We were too tired and frazzled today to really come up with a plan, I sort of doubt we'll have a plan by tomorrow when we have to check out at 11.

As for our trip, it was a long one for sure. From the time we left Connecticut, I put a little more than 1350 miles on the Rav4. That doesn't count the driving we did in the Catskills on Tuesday, which we did in Jess's Camry. Our Rav4, which we just purchased in the beginning of May, already has more than 7000 miles on it. Starting with Connecticut, we passed through nine states, four of which are lifers. That brings our state total since April to 25 states. There are only nine states that I have not been to yet.

We were talking over lunch the other day about it. We spend a lot more time fooling around as travel nurses than actually working. Compounded with the fact that our jobs, our assignments, are simply that and nothing more (no politics, no gossiping, no committees, no clinical ladders), it makes the time we spend fooling around even more significant. To quote Kurt Vonnegut, "I tell you, we are here on Earth to fart around, and don't let anybody tell you different."

Now, I think that's pretty sweet.

Until next time, be safe.

August 07, 2008

The Final Shift, & An Awkward Moment

Jess and I are both here tonight at the Y, working our last shift. It's a strange feeling. It's a little sad, but also a very satisfying feeling, as we have completed our first contract.

It has been quite difficult to really be motivated about doing too much tonight. After all, how are they going to tell me that they didn't like how I charted tonight or that they didn't like the fact that I didn't bath my patients since I won't be coming back after tonight (don't have a tiffy, I'm charting and bathing)? The act of actually coming to work tonight was almost too much for me.

People seem genuinely sad to see me leave. I've talked about my plans for the rest of the year with several people, and as the day crew headed out the door, they all wished me the best. I feel like they saw me as one of the staff here, as a part of their group. I have been given plenty of warm farewells this evening. On the other hand, I had a rather uncomfortable conversation with my bosses prior to leaving yesterday morning.

I stopped into their office to tell them that I've had a great experience here, that I was treated very well, and that I'm grateful. The dumbstruck look on their faces told me something was not right. There apparently had been no communication between my unit's management and the HR department here at the Y, which is technically the department that hired me. Back a month or so ago, when one of my bosses told me in another awkward setting that I had been re-signed, she took it that the arrangements would be made, and that I'd be staying. I wrote a entry about that.

Yet, we never received any sort of contract offer from the HR department. There was never any discussion or negotiations about trying to get us to stay. Of course, we were considering leaving anyhow; being renewed with the Y was a backup plan all along. Taking the job in Wisconsin was just another part of the process, and we assumed that the HR department would communicate back to our managers in our units that we wouldn't be staying.

At least Jess's manager heard that she was leaving, and had a conversation about it with her that mostly involved a half-hearted effort to get her to stay. My managers went as far as putting me up on the next schedule, which starts this approaching Sunday. They had no reasons to believe that I wouldn't be returning. I guess I could have been more forthright about my plans, but then I worked all nights here at the Y and never really spoke with them much except a nod in the mornings in passing.

Needless to say, it was a rather awkward moment. I could see that they were picturing the scrambling that they were doing in their heads about the new schedule issue. However, we moved on past it; I was a little excessive in my praise that I gave the unit, trying to erase the unease in the room with a little brown-nosing. They told me that they were very sorry to see me go, and that they wished that they would have been involved in the hiring process.

I didn't tell them, naturally, that they really, really would have had made it worth our whiles (i.e. a very big bonus) to convince us to stay. And they would have had to have done it a month ago, before we signed our names on contracts.

Other than that, my last moments here at the Y have been good. I have an easy patient load tonight, obvious from the fact that I am writing a long entry here. They didn't even give me a crazy patient or an alcoholic, which there are plenty of both on the unit right now. I guess they want me to go out of here with a last good memory.

It wasn't needed, though, as I have had a good experience here. It has been a very nice three months. So long, my friends at the Y.

Until next time, be safe.

August 04, 2008

A Hostel In NYC

I just wanted to put in a short entry about our experience this weekend. It truly was the icing on the figurative cake that has been our experience in New England.

Our plan for last weekend was to drive up to Montreal for a few days. We were to work Thursday night, though, and as the weekend approached, the idea of sleeping a few hours on Friday morning just to get up and drive 6-7 hours (depending on passport control at the border) for a two-night trip sounded less and less enjoyable. So, as of Monday we'd decided instead to spend a night in NYC, something we'd been talking about even before we left North Carolina to head up this way.

Something that we hadn't talked about was our accommodation in the city. Initially, we'd considered staying in a nice hotel, maybe checking out a show after eating at a fancy restaurant. Anybody who knows Jess and I, however, knows that we are really cheap (oh, yeah, she's cheap, at least as much as me). Considering that the HoJo (Howard Johnson, for those lucky enough to have avoided staying in such a hotel thus far) is more than $200 a night in NYC, there was little chance we'd be doing anything so fancy.

I've never been afraid of hostels, having seen some really bad dives in my day. I've been in places where the bedbugs put on full productions of Les Miserables, apparently including the cannonfire, on your back as you attempt to sleep. Jess, due to her association with me, has been exposed to such places; we both have fond memories of the hostel in Amsterdam that smelled something like a combination between a dirty gym bag and roadkill after they just cleaned it. Hey, backpackers stink, it's to be expected. Still, whenever I'd mention staying in a hostel in NYC to local folks up here, particularly those who were from NYC, I'd get a very skeptical look that progressed into a stunned, horrified expression when they realized I was serious.

I wasn't to be denied my cheap accommodations, though, so I searched the Net for the best possible place. Considering the reviews I found of nearly every place, even I almost changed my mind. In the end, I was steadfast in my frugality/stinginess, and eventually settled on a place called Jazz On The City. I decided on this place after exhaustive reading of the reviews of other hostels (most described some sort of insect infestation, and one was described as apparently being a homeless shelter from time to time, while another apparently is a homeless shelter). Reading all the reviews actually gave me a general sense of hostels in NYC, in that they are pretty scary, usually more of flophouse than a hostel. Still, I blazed on.

Good thing, too, because this hostel was really great. It smelled pretty good, considering the fact that stinky folks from all parts of the world were staying there. We were in a room with six beds, so we shared it with four other people. We had our own bathroom, though, a big bonus. The hostel itself was clean, had been recently repainted, and even had keycard locks on the door of our room. The complainers who left bad reviews on the Net obviously have not backpacked in Europe. You can't beat spending $45 a person after taxes, staying right in the middle of Manhattan, on a Friday night.

We didn't go to a show (whew), but we did have a great time. We arrived later in the afternoon, so we headed to Little Italy, and ended up eating at a great restaurant there. Afterward, we decided to walk up to the Empire State Building (it looked close on the map), and went to the top to see the city at night. That was a pretty touristy thing to do, but the view was worth the shame. We went back to the hostel afterward, for a few minutes, then headed back out into the surrounding neighborhood, even though it was almost 1 am by that point. We ended up staying out until after 4 am. There is nothing like NYC at 4 am, it is a great city. It truly never sleeps, and there is almost as much traffic (by foot and by car) as during the day.

We pretty much ate our way through the city on Saturday. After a delicious brunch, we cruised back through Little Italy, to pick up lattes and Italian deserts. Then we headed out to Chinatown. We didn't just stay on the touristy outskirts of Chinatown, either, where all the little shops selling miniature Statue of Liberties are. We delved right into the heart of Chinatown, where I'd gone during my last trip to NYC in July. Here they stop bothering to put English on their signs, they are mostly in Chinese. There are loads of little authentic shops selling foods and goods that only Chinese people understand the usage of, like dried fish, salted fruits, and many other items. It's like taking a quick trip to Hong Kong, there is that strong of a community and Chinese character there. It's my favorite part of NYC, which after seeing it with me, I think Jess might agree with as well.

Of course we ate our dinner in Chinatown, although it was at a Vietamese restaurant, oddly. Later in the evening, we slowly made our way back to Grand Central Station and on to Connecticut, and both of us felt a real sense of sadness as our train pulled out of Harlem and from the city, that this would be our last trip to NYC during this assignment. Jess loves the city, and I've grown fond of it over the summer as well. It is a fun, exciting city, and I'm glad that we were able to experience it even in its latest hours.

And I don't even have any bedbug bites.

Until next time, be safe.

Jess & I in Little Italy

August 03, 2008

End Of The Road

Three months is never a truly long time, but some three months last longer than others. These past three months, for me at least, have not been one of these prolonged periods. It has absolutely flown by.

Tomorrow night is the beginning of the end for our assignment at the Y. We will work three nights in a row, and then on Thursday morning, I will walk out of the lobby of the Y for the last time of this assignment, and likely ever. It will be quite the bittersweet experience.

There are reasons that I am happy, perhaps even relieved, to be leaving. Primarily, once I have made up my mind to do something, then the period before it happens feels like a waiting period. The papers have been signed, housing has been found, the job in Wisconsin is secure, and all that waits is for us to make the 1000 mile drive there. This is also our first travel assignment, so there is the relief, and satisfaction, of having completed what seemed like such a hurdle at first.

Along the same thought, I feel like we have really tapped this place out. The only trip that we haven't made is to Montreal through Vermont and New Hampshire (although we passed through a part of NH on our way to Maine). We have been all over New England, and enjoyed it immensely. Somehow, I feel that if we stayed here, we might start to get into a rut, to stagnate, because we have done everything we had planned on doing. Perhaps if we had signed another contract for the fall, we would have ended up less time exploring and more time sitting around. When we arrive in Wisconsin, on the other hand, being in an area of the US that I have very little time in (I'll be visiting five states I have never been to before), there will suddenly be a whole new area to explore. In comparison, for example, we just spent the night in a hostel in NYC, which was my fourth time in the city and Jess's fifth. We have crisscrossed this region several times. So, I don't feel like we're going to leave New England with any regrets about what we might not have done or places we might not have visited. Besides, it's not as though we can't come back to the area for future assignments (which we most likely will).

Also, I can't say that New Haven has been the most terrific place to live. Sure, it's a wonderfully central location, accessible to every point in New England we have wanted to visit. As for a city, it has the ocean access for fishing and so on. It has history and some interesting parts. But there are a lot of dodgy neighborhoods in this city, and there have been several incidents that have occurred in such neighborhoods that seem more likely to happen in Detroit or the Queens than in civilized Connecticut. And don't even get me started on Hartford, that giant ghetto of a city. Not to mention that people drive like maniacs in this state, and that gasoline is more expensive here than in all but seven states in the entire US. (It was the fourth most expensive at its peak average of $4.40 a gallon).

Nonetheless, our experience at the Y has been excellent. I don't think that we could have had much better experiences really. I think that we were very flexible--we both floated as necessary, put up with the assignments we were given without complaint, and so on. This is essential to the travel nurse experience, I think. Our units seemed to appreciate us for having a positive attitude, and that we were willing to fill the needs that they had. Some travel nurses are less inclined to do so, and that certainly causes friction with their relationships on the unit. It wasn't that we were constantly putting up with the worst experiences, either, they were generally kind to us. Jess ended up being floated a lot more than me (sometimes three times in a shift), but she found that actually doing so was to her benefit. After all, what all are you expected to accomplish in a four hour period, besides keeping a warm body next to the patient and of course keeping that patient alive? Certainly no baths or thorough charting.

Of course, our perspectives on nursing in general have seemed to change quite a lot since starting as well. We were much more inclined before traveling to be wrapped up in all the intricacies of the job--the politics, the need to take care of super-sick patients, the "climbing of the clinical ladder," as it was known at the Big D. I won't ever forget, coming back from Africa, despising the unappreciative patients and families that typify Americans, when I was trying to organize some sort of Big D nursing initiative for nurses to go abroad to perhaps Kenya (perhaps just so I could go back myself), and my efforts were being interpreted by the management as climbing that stupid clinical ladder. I didn't bother telling them I was planning on quitting within a year, so much for the ladder.

Since starting to travel, on the other hand, our lives have taken on a different focus. We still strive to be good nurses, no one wants to be a bad nurse who wipes out patients and gets fired, but we don't seem to have any desire to be the "best" nurse, by any stretch of the imagination. More now than even before, I am really interested in work only because it pays really well and it allows me four days a week (oh, believe me, no more overtime in my schedule book) to get out there, explore my world, and play. If I could get by without working, if the money came regardless if I showed up to work or not, I wouldn't be donning my scrubs and heading out to spend another 12-hour shift through the darkness of the night in the depressing company of yet another drunk who is being involuntarily dried out.

Even better is the detachment that we have come to cherish from the establishment of the hospital. No more are we obliged to have any particular emotion towards the management of our units, simply because it is the collective emotion of the unit. No more are we inclined to join committees and spend hours of our precious time off pouring energy into unit projects (ok, that was Jess, I never joined any committee, and I only went to one unit meeting in three years at the Big D, only to regret it later as being an infamously wasted hour of my life). Of course, I've already mocked the notion of working overtime; it's no longer necessary to choose between saving money and having a great time and lifestyle, as we make enough to do both.

In short, our focus has shifted from living to work, as we did at the Big D, to working to live, which we do now. Our focus is what we do on the four days spent outside the hospital, not the three days we spend inside.

That's not a bad way to live. To yet again paraphrase, this traveling gig is pretty sweet.

Until next time, be safe.

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