Flexible Friday Random Ten

My day today required flexibility. I was scheduled to do dialysis on two people. I couldn't get the access (an arterio venous graft) to work on one patient, and left word with the doctor. I packed up and went to my next patient. At the end of treatment, I discovered that they are mother and son. At 72, the mother has lost both legs to uncontrolled diabetes. The second one must have been recent-- the staples from the amputation are still in. The son, who is 45, has lost one. Both are obese; he weighed over 500 pounds. It was really, really sad.

Since I did not do one of the treatments, I was sent to another hospital to do another patient I'd tried to treat on Wednesday. A doctor was supposed to put a new venous catheter in at 4 pm. I got to the hospital about 4:30 and it was not done. In fact, the doctor was not even at the hospital. I ate my lunch-- which was now really a dinner-- and discovered that the doctor was still not there. I was sent home at 5:30 with my boss' blessings.

My immediate boss, the one who is a nurse and not an accountant, was there, having met with the big chiefs of the hospital chain that is our main account. The other nurse who was waiting for the same doctor to put a new catheter in another patient and we got to chew the fat with our boss for about 45 minutes and get the skinny on what's going on. It put me at ease-- for now.

If there's anything I've discovered is that to be an acute care dialysis nurse, I have to be flexible. And that I am.

Tomorrow I'm working-- the first Saturday I've worked in a while. Tonight I'm meeting some classmates for a drink. I've got to take it easy since I'll be working 12 or 13 hours tomorrow. But tonight, it'll be good to catch up with my classmates, who have all got jobs now. I'm looking forward to hearing about their experiences, good and bad. And I suspect they've learned that they need to be flexible in their jobs as well.

1. Too Much Too Young- The Specials
2. Make Me Smile- Chicago
3. LIttle Bit O' Soul- The Music Explosion
4. Fallout- The Police
5. Tighten Up- The Black Keys
6. Only Women Bleed- Alice Cooper
7. I Say A Little Prayer- Aretha Franklin
8. Psycho Killer- The Talking Heads
9. Living For the City- Stevie Wonder
10. Autumn Leaves- Tony Bennett


Notes:
1. Love, love, love that first Specials record.
2. The great thing about being middle-aged is not having to make excuses for loving big old dumb pop songs.
3. Great mid-sixties one-hit wonder
4. A Police B-side
5. Love the video for this one
6. Alice Cooper's grown on me over the years. Didn't hurt that he had a great time lampooning himself in "Wayne's World."
7. Grew up listening to my dad's copy of "Aretha's Gold."
8. My kids love this song since doing it in "Rock Band."
9. This song is still powerful today.
10. Tony's still on my "Bucket List." Gotta fix that this year.

Groundhog's Day

I think I've mentioned this before-- the movie Groundhog's Day has a local connection-- it's only a few blocks from where I live. Most of it was filmed in the town of Woodstock, Illinois, a town that is about 50 miles north of Chicago. However, the scene in which he saves the life of the town's mayor, who is choking in a restaurant, was filmed at a German restaurant that is gone now, Hessberger's, at Lincoln and Cullom Avenues in Chicago. This is how it looked then.

I happened to pass by it today while running errands. It's now a popular restaurant/bar called The Bad Apple that has a great beer selection, and from what people have told me, good food. I've only been there a couple of times for drinks. When I was still in nursing school, and we were still in our old place, I used to walk or bicycle past it on the way to and from work 4 or 5 times a week.

It was recently the 20th anniversary of the release of the movie Groundhog Day. Though I like Harold Ramis, the director, and the actor Bill Murray, it's not one of my favorite movies, though I like the message-- that sometimes we have to keep doing it over and over again before we get it right. It has a personal ring for me lately-- although I'm not too happy with my current job, I do love my profession, nursing.

Tonight, I was texting with my buddy Brent and discovered that he had an interview offer in a telemetry unit. He was going to pass on the interview and I talked him into going to it-- and taking the job if it's offered. It's a step up-- it'll increase his skill set and get him ready to do anything-- being a regular floor nurse, ER, ICU, etc. It also reinforced my decision to start looking for another job.

More On the Job

I just had a text back and forth regarding work with the guy who's turned out to become a great friend at work-- a friendship that'll continue, I'm certain, after we both move on from the job. More on that later.

I ended up having a day off-- a badly needed and helpful day off. I've mentioned before that the scheduling snafu is one of the things I hate about the job. I understand that as acute care nurses, we need to be flexible. But this has gone beyond flexibility; the "schedule" is more like some abstract impression of a schedule. I've mentioned before that the unit had an ill-fated scheme to cut back on overtime in which some members of the unit would work 6 am to 2:30 pm in the "acute" room (where nurses and techs do two patients at a time) and be relieved by people working 2 pm to 10:30 pm; the people working the afternoon/evening shift would pick up a "solo" patient in the evening if needed. This scheme came unravelled immediately. I was one of the two people first scheduled for the 2pm to 10:30 pm shift, and worked it exactly twice. I came in at all hours-- noon, 2 pm, 4 pm, etc. and left at all hours-- including, one day, 7:15 am. And never once at 10:30 pm.

At the monthly staff meeting last month, they told us they were discontinuing that schedule. They did not. I worked, ostensibly, the 6 am to 2:30 pm shift-- with an actual schedule that was similar to last month's, except starting very early. And often ending very late.

At this month's staff meeting last week, they said they're discontinuing that schedule and going back to the old one-- 3 or 4 twelve/thirteen hour shifts a week plus a "call" shift every week to two weeks. It's rigorous, but works for me, and most of the other nurses and techs.

I have other beefs. They regularly schedule some of us for over 40 hours a week-- and then complain that we have lots of overtime. They are getting worse and worse about stocking. The fact that they've gone from having three drivers delivering to one-- they bragged at the last meeting that one of the drivers, who was, according to co-workers the best and most reliable-- was fired for "excessive overtime." Yeah, hilarious. So we all hoard supplies, knowing we may have trouble doing treatment if we don't have those supplies, or take longer to do them-- incurring more overtime-- if we don't have them. And we are constantly being criticized for hoarding supplies.

Communication is a constant problem. For starters, we are dispatched to our patients by an archaic paging system-- yes, pagers. That's how backward we are. And once in a while it doesn't work. Since our schedule is chaotic-- sometimes we have a day off when we're scheduled, and sometimes we're called in when we're off-- one would assume that if you're not paged, you're not working. But since the paging system is unreliable (sometimes not only do we not get a page that was sent, but when we call to confirm our assignment, sometimes that fails to go through too).

Another communication problem: there's a hospital chain that is our main account. We are all set up to sign in and chart at all the hospitals in that chain. A couple of months ago, word came down-- 2nd, 3rd and fourth-hand-- of a new way to chart the dialysis treatments. It was, we were told, mandatory. Here's the problem: five different people told me five different ways to do this mandatory way of charting.

But never fear! We finally got an email with an explanation of this way to chart. Problem is these instructions are hopelessly muddled. I'll do my best.

Today, I was relieved to be told that our patient census was low and I had the day off. It allowed me to do a bunch of errands-- groceries, laundry, cooking-- and to think about it all. I've decided to tough it out. I'll try to make it to August, when it'll be a year. That year is magic in the profession. Once you have that year, jobs open up.

In the meantime, I'm trying to make the best of it all. And remembering some of the fine people I work with.

My first day in "the field"-- my first day working in a hospital with another nurse/preceptor, I worked with Molly. She's literally about half my age-- 25 or 26. If you didn't know her, you'd think she was a sorority girl. But when you get to know her, she's anything but a sorority girl. She's smart and got a wicked sense of humor. When I'm working in the same hospital, she always checks up on me, and she's someone I can always call for advice and information.

Another person who's good for advice and information is Ben. I worked more with him than anybody else when I was training. He and I shared a love of music and being parents-- though, at 28, he's just starting the parenting game-- his kids are 3 and a newborn). I'm at the tail end of it, with kids who are 17 and 15. Ben, who is Filipino-American, grew up just a few blocks from where I grew up in Chicago's Albany Park neighborhood, but obviously decades apart. When I have larger nursing questions, I talk to Ben, who I think would be a great teacher.

In my training class, I became friends with two guys-- Neil and Brent. We're all close in age, and doing nursing later in life-- Neil and Brent are in their late forties (I'm 50). I always enjoy running into Neil. He's smart and sardonically funny. As we've gotten to be friends, he's opened up about his life a little more. He comes from a tight Irish family. He's been with the same guy for some time now; they're trying to decide whether or not to move in together. He worked as a nurse for a couple of years before this job, so he's also someone I ask for advice at times.

The guy I've become really tight with is Brent. At first, he annoyed the shit out of me; he was, at times, way too eager. He was one of the only ones who would wear his scrubs during the classroom part of training. He talked a lot. But pretty quickly, he and I became friends. In the end, we had a lot in common; we came from different fields than the medical field (he ran printing presses for one of the Chicago newspapers, and I was a teacher) and we both have kids (and ex's).

Once we got in the field, we not only became better and better friends, but came to depend on one another for help. Our cellphones were lifelines, texting back and forth, sharing experiences, observations and new information. And in one case, when we were training, commiserating about an unbelievably awful preceptor. As the job has turned more disappointing and frequently more stressful, it's been great to have a friend and ally to talk to. It's turned into a total Bromance. I know Brent's always got my back and I'll always have his.

Looking ahead, I know that I won't work at this job until I retire. At this point, I'm hoping to make it a year. I know that the next job will certainly have a its share of nonsense-- what job doesn't? But there will be a next job. Knowing that is helping me tolerate this job.

One More Haircut

This weekend, my kids and I were playing Monopoly and we started talking a little bit about the past and future. My son will be turning 18-- a legal adult-- in a few weeks.

A couple of years ago, my son said, in front of the whole family, that he remembered when I had blonde hair. I have a lot more grey than blonde these days. I found it pretty amusing. This weekend, as we played Monopoly, I realized that his hair, which was blonde when he was little, had turned a very dark brown, almost black, like my ex's. She is of 100% Chinese ancestry-- both parents were from China. I chuckled and pointed out that I remembered when we both had blonde hair. Both of my kids realized that I was alluding to his comment from a couple of years ago, and we all had a good chuckle.

My ex had asked me to take him to get a haircut this weekend. He doesn't like getting haircuts-- he likes to wear his hair longer, like I did when I was younger. But his high school, a Catholic high school, has hair off the collar as a part of the dress code, and he prefers the barber I take him to over the one my ex takes him to, and so we went to my barber.

As he got his hair cut, my mind drifted back to the first time I took him to get a real haircut, when he was about 2 or 3; up until that point, my ex's mother had given him haircuts. I let him watch me get a haircut, so he could see what to expect. When my barber, who I went to for years until he retired, pulled out a straight razor to finish up, my son's eyes became the size of pies, and he asked if he was going to have to do that (this was before he'd seen "Reservoir Dogs," even). I chuckled and said "No."

When I was finished, Jerry, my barber, put the booster they had in the old barbershops for the young kids that went across the arms of the chair so they could sit up high enough to get a haircut. As Jerry began cutting his hair, my son chatted with him like an old guy. There was a reason people always called him "The Little Man."

As he finished his haircut today, I realized that it was going to be the last haircut he got as a child. It was the last haircut my ex or I would have a say in.

Years ago-- fifteen years ago-- as I sat with my ex and a couple of lawyers and signed a custody agreement, March 7th of 2012 seemed like it was a million years away. Now it's only a few weeks away. Back then I thought I was going to be the happiest guy in the world on that day. To be sure, I'll be happy for a lot of things-- that I successfully navigated my son's childhood, that I'll have to deal with my ex a lot less, that when he finishes high school in May, I'll be done paying child support (though that'll soon be replaced with college tuition). But in the end, his eighteenth birthday in a little over a month will be a bittersweet affair.

The Transitional Friday Random Ten

No call for work today-- they're trying, once again, to cut back on overtime. Nice to have a day off today, but I'll miss the dough in two weeks. Still, it'll be nice to get some things done today. In the meantime, I'm adding "update my resume" to that list of things to do.

1. Ah Leah!- Donnie Iris
2. Samba Pa Ti- Santana
3. Only Good For Conversation- Rodriquez
4. What Is Truth?- Johnny Cash
5. Who Loves You Pretty Baby?- Frankie Valli and the Four Seasons
6. It's All Over Now- The Rolling Stones
7. The Oldest Story In the World- The Plimsouls
8. Don't Let Me Down- The Beatles
9. Wild Horses- The Rolling Stones
10. Life Is Hard- Timbuk3

Notes:
1. Donnie Iris was part of three "one-hit wonders:" this one, "The Rapper" by the Jaggerz and "Play That Funky Music White Boy," by Wild Cherry.
2. From the great "Abraxas" album
3. Rodriguez put the album this one's from, "Cold Fact," out in 1969, but it could have been recorded last year.
4. Johnny Cash played this one when he was invited to perform at the White House by Richard Nixon
5. Frankie Valli's token disco song.
6. The original of this was done by The Valentinos, which was Bobby Womack and his brothers
7. This one and "A Million Miles Away," also by the Plimsouls, were standouts in a movie with a great soundtrack, "Valley Girl."
8. From the stripped down version of "Let It Be"
9. The Stones in a reflective mood
10. Timbuk3's big hit was "The Future's So Bright, I Gotta Wear Shades," but this one's my favorite of theirs.

The Peeps

Okay, so today I ended up having a day off; I was scheduled in our shitty schedule, but since Tuesdays and Thursdays are "low census days" typically (most dialysis is scheduled Monday, Wednesday and Friday), I had those two days off.

So that tops my list of gripes-- their inept attempts to come up with a schedule that will cut back on the overtime. It made my schedule a living hell the last two months and burned off whatever goodwill I had. The asinine staff meeting just infuriated us even more. Among the other gripes I have:

-- Their training program sucked. As a former educator, I give it a D+. The classroom material was uninspired, one of the instructors was one of the worst teachers I've ever dealt with. Some of the nurse preceptors I worked with were great, but couldn't do nearly as good a job as they might have, because instead of working with one nurse through the whole training, we worked with one on one day and another and another... There was a lot of stuff we never went over because they had no way of knowing whether it had been covered or not
--Massive disorganization. I know that acute care dialysis is bound to have a little chaos because you don't know how many patients you'll have from day to day, but at least one of the coordinators, the people who actually tell us which patient to dialyze at which hospital, has no idea what she's doing
--The paperwork. The paperwork is disorganized, chaotic and in many cases completely redundant. We put the start and stop times of treatment on no fewer than four different sheets. The machine logs-- the logs of tests of the water, disinfection, etc. of the dialysis machines-- were apparently designed by a drunk person. There is no rhyme or reason to them. They also moved recently from a timesheet we turn in once a week to a hyperdetailed timesheet we turn in every day. And of course they issued this timesheet with no instructions on how to fill it out properly.
-- Too many chiefs, not enough Indians. I think there is about one administrator for every four nurses. And all of those administrators except the two who actually do some work, the coordinators, are standing around trying to figure out how to make us more productive. Here's how to make the unit profitable: fire the head of the unit, "Lumbergh" and the person who is on "light duty" from injuring herself doing something stupid, and is now charged with "auditing" the other nurses, trying to catch them doing something wrong. She's a tech-- not even an RN. She has no business auditing RN's.

But with the bad, comes the good. The peeps-- the people I work with. I'll tell a little about some of them.

One of my favorite co-workers is Patrick. He's young-- about 25. His family moved from the Phillipines when he was about 13, so he's grown up in two worlds. He's very quiet, but when he opens his mouth, he shows a wide breadth of knowledge. He's also been one of the people who has helped me a lot. It could be very humiliating having to ask a kid half my age about how to do my job, but he has always been respectful, never showing a bit of condescension.

Another favorite is Saint. He's lived up to his name a couple of times, including yesterday, when I had a patient accidentally pull a needle out. I had to keep pressure in order to keep the patient from bleeding, and asked another nurse to see if someone was available to help me. It turned out he was right around the corner; he quickly and quietly helped me with the patient and the machine, and calmed me down afterward. He's helped me out in a couple of other situations. He's also Filipino (there are a lot of Filipinos in the unit). He's another guy who's always ready to help without making me feel stupid.

Ramon is a guy I always get a kick out of working with. I thought he was latino when I first met him, but he's also Filipino. Picture a Filipino guy who looks latino, but acts like a combination of Warren Beatty and Bill Murray. He's got two families, one with the ex-wife and one with the current one. He's by all accounts a great dad. He's also my hero in that he's openly contemptuous of the managers.

Yesterday, he and Manny, another guy who is openly contemptuous of the management were scheduled in the "acute room" together. The reason became obvious; the unit manager who is a nurse, and pretty competent, and the woman who's on "light duty" spent the day in the acute room with them auditing them. It was farcical. Ramon and Manny weren't intimidated in the least.

A couple of weeks ago, I was working at one of my hospitals and I had to find Fernando, one of the veterans, to get a key. The hospital has only one key for the dialysis storage room, and so if a second (or third) nurse is called to that hospital, he or she has to find the other nurse. This is usually no problem-- we have a list with all of one another's cell numbers on it.

I went to the room Fernando was working in and had a chance, for the first time, to chat with him. It turns out that he's a tech-- not an RN. He told me that until pretty recently, the unit was a great one to work for-- until they brought in "Lumbergh." He has been doing dialysis for about 20 years, he told me. He added that he was stuck there; not being an RN, he can't go anywhere but the other big dialysis corporation. If he were an RN, like me, he told me, he'd be looking for another job.

I've taken his advice under strong advisement.

There are other folks I work with who, for the time being, are making a situation that is becoming increasingly uncomfortable and stressful tolerable. Between that and knowing I'm helping folks, I think I can tough this out for a while. I'll write more about my terrific co-workers soon.

The Job

Last night, my boss asked me if I would take on a third patient shift if needed (we do two patients or sets of patients a day, usually). Since I'm trying to get on top financially, I said yes. More on that later.

Today, we had a staff meeting. That meant I had to be in a suburb of Chicago that's about a 45 minute drive away at 7 a.m. Not a thrilling prospect. But since I have been bitching about a lot of things, I felt like I should go.

I'm glad I went, despite having worked a 17 hour day the day before (until midnight). Since the last meeting I've learned a little more about the unit I work for. I learned that it used to work a lot better than before-- until an accountant, rather than a nurse was put in charge of the unit.

That accountant, I've come to realize, is our Lumbergh. This was the boss in "Office Space" if you've forgotten, played to perfection by Gary Cole. He plays like he's a nice guy, but in the end is a corporate dick. He knows nothing about what we deal with day to day in our jobs. He announced today that we are trying yet another computerized system, with smart phones, that will start accounting, nearly to the minute, where we are and what we're doing.

One of the other nurses joked about using the GPS on the smart phones to track our movements. The accountant hesitated before answering, and we all realized that they had considered using the GPS on the phones.

This unit is about to become a lot less nice to work at-- and there are already problems. My plan is to try to work there a year-- the magic number for a first year nurse-- and then check out my options.

In the meantime, I'll be blogging about some of the people I work with, who are mostly wonderful. I'll be telling a little bit about my job-- as much as I can without compromising the privacy of my patients and my co-workers.

Which leads to my third shift last night. As I said, I jumped at the chance to work some extra hours-- not only for the extra dough, but because it was at a hospital I did two clinical rotations at, and know a lot of the staff at and am consequently quite fond of.

I was asked to call ahead to give an ETA. I called and was told to take my time-- the patient was having a central venous catheter installed at that moment, the catheter I was going to use to do the dialysis. Since I was close to home, I stopped there to have a quick dinner and then headed out to the hospital.

I got to the hospital and headed upstairs to assess my patient. My boss had gotten the machine ready for me already, saving me some time. When I got to the room in the ICU, I said hello to the patient's parent; my patient was only 23. She was suffering from a chronic disease that prevents the body from producing all kinds of blood cells.

As I looked at my patient, I could see my kids; my eldest is about five years younger than her. And as I looked at her mother, I could see myself. There is nothing more helpless feeling than having a sick kid. And having a kid who's got a cold, the flu, asthma, bronchitis-- is one thing. To have a kid in renal failure on top of a serious chronic condition-- I can't even imagine.

I set up and got my patient ready for treatment. As I did this, I explained to the patient's mother a little bit about how dialysis works. I could tell that it was allaying a lot of fear and anxiety. Later, she told me that she'd been hesitant to do treatment-- she knew little about dialysis. I told her that it's not surprising; I knew next to nothing about it until I was a dialysis nurse.

As I got treatment going, the mother, who lives in Virginia, fielded phone calls about her daughter from friends and relatives. The treatment was scheduled to be short-- only 2 hours. This is typical for someone new to dialysis, or someone who does not normally get dialysis treatment. Since there are frequently complications in early treatments, I asked the patient about those complications. She was fine. And so was the mother; I could tell that it comforted her to know that I knew at least a little bit about what I was doing.

About 40 minutes into treatment, my patient started looking better and became more responsive. As the toxins in her blood-- toxins that affected her level of lucidity-- were pulled from her blood, her condition rapidly improved. I could feel her mother's relief as she began answering questions, something she hadn't been able to do that morning.

My patient's mother asked my patient if she wanted some diet ginger ale. I checked with the primary nurse to make sure she wasn't on fluid restrictions, and her mother helped her sip it as she quietly chatted with her, telling her about her friends, her boyfriend and her relatives asking about her.

Toward the end of treatment, the mother thanked me for taking on the extra shift to treat her daughter. It was not a problem, I told her, and I meant it.

I worked hard to finish nursing school. I was lucky enough to get a job quickly, and am happy that after four years of sacrifice-- time given up with family, financial sacrifice-- that I've got a job that's paying me pretty good money. On the other hand, I've had this job long enough to hate aspects of it.

But last night, seeing my patient improve because of my treatment, and seeing the relief in a fellow parent's face as she saw her daughter's condition improve-- that is what it is all about. All the past sacrifice and current aggravation are worth it in spades.

RIP Anne Keegan, a Chicago Original

A few weeks ago, I stopped into the restaurant I worked my way through nursing school at to say hello to some of my old co-workers. I discovered, talking to them, that one of my favorite regulars, reporter and author Anne Keegan, passed away last May.

For a long time, I waited on Ms. Keegan not knowing who she was; I'd read her articles in the Chicago Tribune since I was a kid, but I had no idea what she looked like. In reading her obit, I discovered that there was a reason for this: she refused to create a "personna" for herself, much to the frustration of the Tribune.

I originally ended up waiting on Ms. Keegan for the simple fact that I was the only one who wasn't afraid of her. She intimidated the other servers. Having worked as a teacher on the tough West Side of Chicago, I wasn't easily intimidated. I suspect this may have endeared me to Ms. Keegan. Once she lowered her guard, she was a fascinating, warm and charming person.

Ms. Keegan spent her career writing about the regular Joes and Janes of the world. In a blog post, an old Tribune co-worker captures her duality-- a lady who was very charming, but the next minute could outswear a trucker.

She also authored two books. These also showed her dichotomy. Her first was "On the Street Doing Life," about a tough-as-nails Chicago cop. The other, published just a few years ago, was a children's book about a cat that she wrote for her granddaughter.

I remember my last couple of encounters with Ms. Keegan, at the restaurant. She liked sitting in front of the restaurant so that she could pop outside to smoke a cigarette. She had her usual drink-- she loved that I remembered it-- and usually something light to eat. The last couple of times I saw her, it was late, so the restaurant wasn't very busy and I got a chance to chat with her. She was, as always, interesting and gracious. She was a Chicago original, and I'm glad I got the opportunity to know her. She will be missed.