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September 30, 2008

Turning 30 On The 30th

I've been waiting three decades to be able to say that. Soon (tomorrow), I won't be able to say it. Anyhow, today is the big day, I'm turning 30!

I was pretty happy that they gave me some time off from work. Usually, when you are negotiating your contract, you request dates that you want to have off. It's in the contract then, they can't make you work those dates. Somehow, it didn't occur to me that I might want my 30th birthday off, or any time around it. I did email the scheduling person on the unit for an informal request, but there weren't any guarantees. Fortunately, she turned out to be a kind person and gave me five days off.

This will be something that Jess and I will have to work on more vigorously in the future. It's one of the things that you learn as a travel nurse, usually mid-assignment, and then you have to wait until the next assignment to take advantage of it. We didn't request any long weekends off together, so that will certainly have to be remedied next time, so that we have a better schedule.

I've been gradually getting more and more comfortable here at the Swiss Cheese. I've become familiar with the unit now, so it doesn't take me nearly as long as it did in the beginning. I did have an unfortunate experience, however, right after my first entry about this particular hospital.

Just to refresh, I had the worst orientation I've ever had. My one orientation day was before my computer training, and the entire day was spent either coding my one patient or trying to keep him from coding again. I had no idea where to even find the med cart for my next shift, much less how to find all the equipment and supplies. That's another thing to remember for the future--I will demand another orientation day (I should have gotten two anyhow) if my first day sucks.

So, the next shift just kicked my butt. I had two very busy patients, and I ran from room to room, trying to keep my head above water. I couldn't expect much help, it was a terrible day for everyone, they were running around themselves. I survived, however, and even managed to get all my work done. Tired but satisfied, I left, and didn't think much more about that day, considering it my true orientation day. That following weekend, I actually had a really good weekend, and was starting to feel good about the place, I was just starting to like it. Beware of such feelings.

I also worked that following Monday, a week after that frenetic day. This particular day was going well, I was helping people out, I got three nice IV placements, people were laughing and joking with me. I was feeling pretty good. Then, the manager of the floor comes and finds me, asking me for a moment to talk. No problem, I thought.

Once in her office, the needle that popped my bubble came out straight out. "Aaron, we've had a family complaint about you," she started right in.

Oh, yeah?

"Remember last week? Well, the wife of your patient said you made her feel uncomfortable."

Really? How?

"Oh, for nothing wrong. She came and told us that a traveler named Aaron had taken care of her husband, and he had seemed very disorganized. She said that you'd turned her husband by yourself, and that you didn't spend enough time in the room explaining to her what was going on with her husband. She's a nurse, too, and she said she just felt very uncomfortable about you."

Oh. Well, I'm sorry about that. (Note to self: never tell any family member, especially one who purportedly has experience in the medical world, that you're a traveler, until you really trust them. Which is never. There is no benefit to telling them, and they will use it against you if they want. Plus, would I have had this meeting if this lady had thought I was staff? )

"Oh, and since you're in here, we had one of our E-ICU nurses stop by with a complaint."

(In this unit, being the technologically advanced unit that it is, they have cameras that can watch you do all your work, and occasionally a voice comes on and asks questions and makes, um, suggestions. ICU nurses and doctors are the ones watching you. Talk about Big Brother. It's awesome.)

"Yes, apparently that day your patient's O2 sats were 89%, and you weren't doing anything about it. In fact, you appeared to be priming a tube feed bags. When she asked you (via the camera speaker) if you needed help, you simply said that he was doing fine. She thought that tube feeds must be more important to you than respiratory status."

(Apparently the wrong answer to give. I'm from the respiratory world, though, and for me, an O2 sat of 89% is just fine, especially with someone with chronic lung disease. True, I was aware of the sat reading, but I wasn't alarmed, and I was continuing to monitor it while I did other work

By this point, I was starting to see a pattern develop here. I wasn't going to get anywhere from trying to defend myself, so I simply puckered up and starting kissing. At the Big D, I always scorned those who sucked up to management, but I'm getting pretty good at it as a traveler. Two big lessons I've been practicing hard here: kissing butt and flying under the radar. The kissing butt part comes in when you don't succeed at flying under the radar, which is evidently not my strongpoint.

Anyhow, this meeting turned out to be one about how I had not done anything necessarily wrong, but by the exacting standards of this unit, I hadn't done things necessarily right either. I did point out that I had gotten a terrible orientation, that I really didn't get an orientation at all, which she admitted to be true. Then I told her that I had not gotten a lunch that day, it had been that busy, and that I couldn't find anyone to help me out when I needed it. I didn't point out that I'm not the type to sit in the room and hold the wife's hand and console her. Hey, your husband smoked his whole life, what did you think was going to happen? I'm a tough love kind of guy.

What I really got out of this meeting was that they have their eye on me here, much more than at the Y. This place is very confident in their superiority over any other place, that much is transmitted in most interactions with management I've had. That makes flying under the radar all the more important.

Either that, or getting better at brown nosing. I helped withdraw on a patient last week (we extubated the patient from the ventilator, which resulted in his death a half hour later). I made sure that I handed out a lot of hugs and condolences to the family. Normally I would have anyhow, I felt very bad for them, and they were very nice people. Given the recent meeting, this time I made sure to give out the hugs in the hallway.

Despite this less than pleasant interaction, I have been starting to enjoy my time here. I stay very busy, which isn't a bad thing. I have been able to listen to the doctors talk about some very interesting diseases and treatments. Also, since this is the major trauma unit of the hospital, I've personally taken care to two patients who I was able to read about or watch on the local news from incidences of the previous evening. That's pretty fun.

Besides, when I start to get comfortable with a place, I start to let my personality out a little, and a little of my humor. I've kept it on a tight rein here, but it's nice to be able to start to converse with people, to talk to the staff and have a little fun. Of course, my true humor will never make an appearance here, well maybe on my last day…

Until next time, be safe.

September 29, 2008

Trip To Door County

Jess and I had a couple of days off together last week, so we decided to head up to Door County in the northeastern part of Wisconsin. We'd heard a lot of people say that it is really a beautiful area. Of course, since it was a three hour trip, it would have been better to have had three days off, but we had to work with what we had.

It was also a good opportunity to try out my newest gadget, a GPS navigation system that my parents bought for my upcoming birthday. I've always enjoyed the logistical aspects of traveling--the mileage to the destination, the route, which road I'm on. I always buy several maps of the region I'm in, so that I can explore easier. So, I was pretty excited by the GPS unit, because provides all sorts of useful information.

Jess was a skeptic (and still is somewhat). She's not much into technology anyhow (I finally got her to upgrade last year to cell phone made in this century, and only when I bought it), so she's never a huge fan of more gadgets. She actually feels threatened somehow by my computer and camera; I never thought someone could be jealous of a machine until I met Jess. No matter, the GPS unit is for me, anyhow.

The trip itself is nothing, at least for us. When Jess was finding a place to stay, some of the people she talked to were very surprised that we'd drive up for a day. In August, we spent an entire week driving, putting in over 3000 miles. So, a three hour trip doesn't bother us much. Besides, we left early in the morning, and as the sun rose, it came up through some scattered fog for the first hour, which was really beautiful.

For people who may have never heard of Door County, it sits on a peninsula jutting out into Lake Michigan, north of Green Bay. I quickly gathered that there tends to be a lot of wealth there, with rich old fogeys keeping their summer homes there. It's also a big summer destination around here, and from what I've heard can be very crowded in the summer months. That would be unfortunate, because it's not really that big of a peninsula. There are quite a few charming little villages of 2000 people or so, many on one shoreline or the other. There's also a lot of history in the area, in particular with ships going in and out of Green Bay back in the 1800s. Best of all, it has a very nice rural feeling to it; the villages aren't large or superficial, and there are several beautiful state parks with hiking, camping, kayaking, and lots of other outdoorsy stuff.

We rolled into the area midmorning and found our hotel. We couldn't check in, but we wanted to use it to get our bearings. The hotel, a mom-and-pop hotel called Baileys Sunset Motel, is small and unassuming, just our kind of place. The owner suggested we head over to the Peninsula Sate Park for hiking, which we did. It didn't take long to get there, you are only at most 45 minutes or an hour from anywhere on the peninsula at any point. The park itself was quite nice; we went for a hike, then headed back to the town of Fish Creek, which is at its entrance, for lunch.

Actually, when the owner of the hotel was telling us where to visit, I thought she was telling me to go to "Fish Crack," that is what it sounded like she was saying. I kept looking for a Fish Crack on the map, and couldn't find it. Then I realized she was telling me to go to Fish Creek. Interesting accent.

After lunch, Jess wanted to go kayaking, so we went back into the park, and found a little business that rented kayaks. I rented our kayak for two hours, I'm not sure why, but it seemed like a good idea. Actually, it wasn't bad, we kayaked the entire time, and had a great time. At one point, there was a couple sitting on the beach watching us go by, so I had Jess in the front paddling hard while I sat back with my heels up on my paddle, just to see their necks craning in shock. There was a fairly stiff wind, so whenever we got away from the shore a certain distance, we would start hitting some fairly large waves. That made it more exciting.

After kayaking, we headed south to the village of Egg Harbor, where there is a little brewery called Shipwrecked. Not only did they have some excellent brew, they were also selling a wine called Hallowine, which is a spicy apple wine that is really delicious when served warm. Apparently, this particular brewery has been around for more than a century, although under different names and usuaully as restaurants. They claim that Al Capone spent a lot of time in Egg Harbor when hiding out, and even in Shipwrecked. Apparently, there is a system of tunnels under the place and the town for a quick getaway. Regardless of stories, they sold a good brew. We picked up a couple of bottles of that and a six-pack, then headed across the street to eat. We'd asked the bartender where he'd recommend that we eat, and he suggested that we eat at a very local place called John Henry's. It's so local that none of the brochures even note it. They had a half-rack of ribs on seasoned sauerkraut that completely changed my opinion about ribs. At that point, we finally headed back to check in at our hotel, since it was getting close to ten.

We had a busy day exploring the next morning. We first had breakfast in another local restaurant, then went to a little nonprofit park, The Ridges Sanctuary, which protects an area of natural ridges formed over thousands of years by the lake. In between the ridges are little micro-environments. It was very nice. We then went to the Cave Point County Park, which is a small park where huge waves from Lake Michigan crash against the cliffs that line that shoreline. With the size of the waves hitting the cliff, as well as the immensity of Lake Michigan (you can't see the far shore), it almost feels like being at an ocean beach.

Just south of the county park is the Whitefish Dunes State Park, with large white sand dunes that reinforced the idea of being at the ocean. Zuri wasn't allowed in that park, so while Jess walked along the beach I took Zuri to the rocky shoreline nearby and took pictures. The park is a little strange, in that it has dunes that look like the beach in North Carolina, but then they end as the evergreen forest meets them. It seems like someone did a little digital manipulation with two landscapes.

It was getting to be mid-afternoon, so we started south towards the largest town in the area, Sturgeon Bay. There is a really interesting lighthouse there, I wanted to take some pictures of it. We had a little adventure with the GPS unit trying to find the lighthouse, it left us on a little country road nowhere near even Lake Michigan. So, we had a little lunch in a quirky restaurant in Sturgeon Bay and looked up directions online. That simplified the process of finding the lighthouse.

As a side-note, we recently broke down and started paying for Internet, through Verizon. We have a little receiver that plugs into our computer and we can get the Net anywhere, even when we are driving or in the middle of nowhere. Pretty much anywhere that we have phone service, we have the Net. Granted, it's like $75 a month with all their fees and so on, which makes me yearn for the days of the free Internet we used to "borrow" from whichever neighbor didn't bother to protect with a password.

At any rate, we did find the lighthouse and I took many photos of it. In fact, I've taken many, many photos all during this trip, and hopefully they will be up on my webpage soon. We continued south towards the little town of Algoma, which is still in Door County although it is not on the peninsula. Jess wanted to visit a Door County winery, so we went to the von Stiehl Winery. We got there right near closing, but they still let us taste all the different wines we wanted to. We bought another case of wine there, even though we still have some bottles from the last vineyard we went to. Algoma bills itself as the "Sports Fishing Capital Of The Midwest." Indeed, it seems there is quite an industry of fishing boats and services there, even though it is a town of about 3400 people. I tossed out a line for a half hour or so just to see if being in such a fishing-centric town would help me out a little. It didn't.

It was dark by the time we got home, and we were tired. Still it was quite a great trip. I will try to have my photos up as soon as possible.

Until next time, be safe.

The Metropolis Of Madison

It's been a bit since I've put in an entry; that's partly because at first I didn't have too much to write about, and more recently, I've been keeping pretty busy here. The past three weeks, in brief.

At first, I was struggling trying to entertain myself here, as forms of entertainment are much more subtle than in New England. When we were in Connecticut, if I had a day off where I didn't have anything planned, then I could just jump on the train and head into NYC. Here it isn't that simple. For the first week or so, I was really having a hard time figuring out fun things to do.

Being in Madison itself has taken some time to get used to. Again, maybe that has a lot to do with the withdrawal symptoms I was feeling after leaving the very urban Connecticut. While Madison is quite a relaxed and interesting city, it just doesn't have that intense feel like we'd been experiencing all summer. There are a lot of nice parks, great neighborhoods for walking and people-watching, and great food and drinks here, but I have still had to get used to the area.

Actually, I have mostly focused on the surrounding areas so far. I always like to check out the surrounding areas of places I visit. I've done a fair amount of that in the last couple of weeks, both alone and with Jess. (We haven't had the most desirably aligned schedules here).

I've taken several photography field trips to visit the little towns that surround Madison. The farms here are really interesting. They have a very old-fashioned appearance, with big red barns and other structures surrounded by fields and fields of corn and other crops. This state is most certainly an agricultural based one, with its wide swaths of landscape covered by farm after farm. There are rolling hills and surrounding forests, and lots of lakes and ponds and rivers. I've taken a lot of rural landscape photos recently, the big red barns and accompanying silos a favorite subject out here. That's been fun.

Speaking of photography field trips, I made a day trip to Milwaukee, to walk around in the city center. That was surprisingly nice. I guess I had expected a city a little more rough around the edges. Perhaps the periphery of the city is a little rougher, since this is a big industrial city. Still, the center itself was very nice. The business district was more like a state capital than Madison's; in fact, for Coloradoans, a fair comparison of cities would be to say that Madison is like Fort Collins while Milwaukee is more like Denver. Around the business district, there were a lot of neighborhoods of older buildings, many with very interesting post-industrial bricked architecture. It seems like there were harder times for the city, but it has gone through extensive renovations, where the old factory-type buildings were reworked into quirky neighborhoods of shops and apartments. The Menomonee River runs through the center, and a long boardwalk follows much of its length through the center, and of course the city sits on Lake Michigan, so there is the lakefront as well. All in all, I rather enjoyed my day in Milwaukee, and it's only an hour and a half drive from Madison.

Besides getting out of town for photo shoots, I have also become more active in fishing, this area being quite a good place for that. Anybody who has fished with me knows that I suffer from a genetic malfunction that forces me to suffer from the chronic inability to actually catch anything from a body of water besides rocks, overhanging branches, and an occasional confused catfish. This is true no matter which body of water I am fishing in, or for what that I am fishing for, or which equipment I am using. Still, I keep on trying.

In Connecticut, I fished off the piers and docks regularly, at least once a week. The fact that I caught a single striper in the entire three months did nothing to persuade me to not fish. Here I have had a variety of fishing experience, all of which have one thing in common, the number of fish I ended up with. Which is zero. For example, I read that there are all these salmon running up the rivers from Lake Michigan, so naturally I immediately made plans to drive to the lake and try my luck. It was a humiliating experience, of course. I didn't get off as early as planned, and hit Milwaukee at 7 am, which is pretty much rush hour. A bit frazzled, but still excited, I arrived in a little town called Racine in between Chicago and Milwaukee, and hit the Root River, ready to bring home some salmon.

Within 45 minutes of first tossing a lure into the river, I had not only lost all eight of the spoons that I had brought along to the rocks, but I had snapped the end of my pole off succeeding in retrieving my last spoon so successfully that I hit the tree behind me. After raging in my car for a good ten minutes, I decided that the long drive demanded a second attempt, so I headed off to Dick's to buy more lure and a new tip. Upon resuming my fishing, I was able to avoid most of the rocks, but found myself watching these guys pulling enormous salmon all around me, and not even getting a nibble myself. A shady looking Russian nearby suddenly produced a huge twenty-pound salmon, but I still think that he had it frozen in his bag and just pulled it out when I wasn't looking, because it was as stiff as a board and I think I would have noticed him bringing something of that size to the shore. Still, he wanted me take a bunch of pictures, and he called a buddy to come and see the fish he'd caught. Then, with disdain that only a Russian can muster, he looked down his nose at me and my little pole and informed me that I'd never catch a fish like his with a pole like that.

Feeling sorry for myself, I went up above the dam where everyone was corralling their salmon and pulled out a sorry looking catfish. When I returned to my spot below the dam, a lady with two kids had arrived, and she told me that she was fishing with salmon eggs. So, I grabbed my gear and headed back to Dick's, to buy lots and lots of salmon eggs, as well as 16-lb fishing line for the expected boon of salmon I figured I would catch, now that I knew what others were using. Back at the river, though, I had the same results, and it was only later that I realized that everyone was fishing that particular day with flies, even guys with normal poles, who would just tie a fly onto the end of their line and flop them out. They literally stood in a line in the river, pulling one salmon after another, and no lure that I had nor the six varieties of salmon eggs that I'd purchased could convince the salmon to ignore the idiots standing in the river with flies tied to the ends of their lure poles. I literally stayed all day, up until 6 pm, and still I walked away with nothing but a bunch of new gear and bait.

I've tried a number of other lakes and ponds and rivers in the area, and invariably I've gotten the same results. I did catch a 21-inch walleye, but not knowing what it was or how tasty it apparently is, I threw it back. This morning I went off to a trout stream heralded as one of the top in the nation, since tomorrow is the last day of trout season this year. I did get two nice hits, where the fish jumped out of the water, but I couldn't bring them in, so I was reduced to stopping by a lake and throwing worms out to two-inch blue-gills. There's nothing particularly satisfying about those.

At any rate, I've spent a fair amount of time between photography and fishing. Of course Jess and I have gone on little day trips together. We went hiking in a very nice little state park called Devil's Lake. That day we also stopped by a little vineyard and winery called the Wollersheim Winery in Sauk City, which is in the general area. We ended up buying a case of wine there, after thoroughly enjoying their tasting. Last week, we drove up for an overnight trip to Door County, which is a terrific part of Wisconsin. I'm going to write a whole entry about that.

Well, it's a nice evening outside. Perhaps I will go fishing.

Until next time, be safe.

September 09, 2008

The Day Shift Quandary

It's been awhile since I've written, and for good reason. Working days has been a new experience for me.

I guess I figured that the difficult learning curve of my new unit was mostly related to the fact that I didn't know where things were found and how procedures were done in the unit. This is the first day/week (depending on the hospital) scourge of any new assignment. So, I expected to be at a loss the first couple of days, floundering around, trying to keep my head above water and perform some patient care at the same time. Then I realized something: it was less that I couldn't find anything, from saline syringes to triple lumen kits, and more that I haven't worked a day shift in a very long time. That made all the difference.

To put it bluntly, day shifts are difficult and ugly at best, and more commonly hellish. For someone like me, who prides myself in being as efficient (some might call it lazy) as possible, someone who tries very hard to get my work objectives accomplished with minimal to moderate exertion by cutting out the extraneous chores (e.g. climbing the notorious "clinical ladder"), working days is akin to slave labor. It's brutal.

Not only is there all the same work one would expect on night shifts, there is loads more of it. First, you get the pleasure of dealing with the packs of anonymous doctors parading around for the multiple rounds they make (every discipline, such as renal, cardiac, etc, does their own rounds on their patients, and any patient might belong to a large number of specialties). This means that every time you finally almost get caught up, another group of doctors comes up and asks a bunch of questions that you have no answers for, if you even were aware that your patient had a cardiac or renal issue, and that means you get to look a little stupid all over again. They all also write their own orders that may or may not be agreed upon with the unit team, which also rounds several times.

Next are families. I can understand the stress and frustration that runs in the veins of the families of the ill. That being said, families are the most irritating aspect of healthcare. Working night shifts, I had limited exposure to families, thanks to the 9 pm visiting hour limit. Now, they hound me, the mothers, the wives, all of them, like hens, clucking questions about their poor family member, telling me what one doctor on the weekend had told them (FYI doctors on the weekend will tell you anything, because come Monday, they won't be there to back it up), asking me, why oh why their husband who smoked 50 years has such difficulty being weaned off of the ventilator.

One such mother kept stopping me yesterday all throughout the afternoon with them same questions: why weren't we weaning? Why weren't we extubating? Why was he still under sedation? Finally, I needed to have her talk to a doctor, so I brought her to the fellow, who I didn't know but as a fellow, I expected some degree of intelligence. That turned out to be a dramatic mistake. She agreed with the mom to just turn off the sedation, in this case Propofol, which is a powerful, short acting drug but was running at a very high rate. I tried to explain to the doctor that this particular patient had failed a weaning test earlier in the day, perhaps she would want to talk to a respiratory therapist? Nah, she said, all patients need to be taken off sedation daily anyhow, and it looked like a good time for this patient (this is not true, but that's a whole different entry). By then, I was approaching the point of being hopelessly behind, so I decided fine, I'll show her what happens when you turn off the sedation on a patient not ready to be extubated. To make short a traumatically long story, it was a horrible experience for me, the patient, and hopefully the family, who all sheepishly hit the road right after the patient went completely crazy. The sedation came right back on, in addition to multiple doses of other meds to bring him under control and get his heart rate down from 165.

I really wanted to scorn that doctor, but as a traveler, I just had to smile and try not to look evil, as in better luck next time, fortunately the patient is still alive. Even when they are obviously incompetent, it is hard to say anything to them, because you don't want to step on any toes. Being a traveler means absolutely needing to fly under the radar. You also have to know which doctors you can never, ever ask a question or direct family inquiries to.

At any rate, these day shifts have been thrashing me like a dry field of corn (hey, it's everywhere up here). Even staying up all night working doesn't make me as tired as I am when I come home from working a day shift. Sometimes, I feel like I just finished 12 hours of Thai style caning, a beating that lasts all day. Days like yesterday, I work frenetically, I eat my lunch in ten minutes at 5 in the afternoon, I go from one chore to another constantly, and still I feel like I'm an hour or so behind. Mid-afternoon yesterday, I actually had a single hour where no meds were due for either of my patients; I must have celebrated too long, because the next thing I knew, I was an hour behind on meds for both of my patients. Days shifts are brutal, and now that I know my way around the unit pretty well, I can't even use that as an excuse anymore.

On the other hand, working day shifts does tend to be a very educational experience. It is interesting to listen to rounds, to hear what all of the patient's issues are (most of which are left out of the nurses reports), to hear a little education about treatment of all the conditions found in the ICU. It actually is very interesting, at least on the occasion that I can break from from the work to spend ten minutes listening to the rounds. I do like that aspect of days. Plus, it's nice to come home, go to bed, then wake up in the morning of a day off and not be completely exhausted. That is a nice change.

As it turns out, I have seen my tentative schedule through most of October, although the final version won't be out until next week. I'm working almost all days, except for a single four-shift stretch where I work nights. So, I guess I'll have to get used to the hustle and bustle.

Anyhow, there is something going on here in the Swiss Cheese that has not just been my observation. Again, perhaps it is a day shift phenomenon, perhaps not. There is a certain edge about this place. I'm not going to make a general statement about the hospital or even unit as a whole, but I have gotten the sense that some of the staff here have a certain sense of arrogance about their work and the way they do that work, which in turn is dangerous for travelers. These are the types who would think nothing of writing you up for anything, which at the very least creates bad juju with the management and could even lead to termination in a surprisingly short time. Thus, the art of flying under the radar is that much more important, especially in a place like this. Most of the travelers I have talked to have noticed the same thing; it's like we can sense it in the air: Danger!

Well, that might be a little dramatic, but it pays to watch yourself very carefully. Honestly, that tidbit is passed between all travelers here at this hospital.

Until next time, be safe.

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