Juxtapose

Two people coded on my floor today, near-simultaneously. One was just getting stabilized when other started crashing. By coded I mean they went under... went into ventricular tachycardia... died.. sorta. One of them was my patient. I had this really bad feeling about that one patient from the very first thing in the morning when I saw his name on the assignment sheet. Nothing was emergently wrong, but when the techs called me over to the EKG monitors, I had this huge sinking feeling in my gut, and by the time I got a set of vitals on him and he was breathing a million times a minute and turning blue and clutching his chest, I knew that his blood pressure was lower than reasonable. I called the doc and after that I sorta had to step back. My hands were shaking and I was giving medications and I just couldn't make them do the things I wanted to. It was totally terrifying. I was happy, afterwards, that I knew what the warning signs were, that I didn't wait longer, that I didn't let my pride take over for once and asked for help when I desperately needed it.

Anyhow, now both people they are alive again, thanks to modern medicine, one for a little while, one for a longer while (I hope). My third patient is dying. I watched her dying all day and I couldn't do anything and the doctors were doing all sorts of things that didn't make much sense supposedly to "cure" her, though that cannot be done unless she goes for surgery, which she will most assuredly not survive. Damned if you do, damned if you don't. They were asking me to do lots of things that didn't help because she was already dying, they were saying that I should provide comfort measures. But I didn't think they were comforting, or the right kinds of comforting, but no arguing with the doctor could change their minds, so I did them. My patient, I am 97% sure, won't make it through the night and that really weirds me out. I found myself near tears and frustrated, my voice approaching a yell as I told my charge nurse about how upset I was that we were doing these things for the patient that were prolonging things that shouldn't be prolonged. I have never felt so ethically torn and so upset over the care of one patient as I have today. I know, I have been told, and I believe - it's okay that people die. Just some ways are better than others. The world weighs on my heart.

I'll be vacationing in the snow this weekend with my husband and a few good friends, and it couldn't have come at a more perfect time. Happy weekend, everyone.

Today marks the third consecutive work day in a row where I have been called a term that refers to a female dog by a third separate patient. All three times by patients who didn't belong on my floor, who weren't sick enough to be on my floor, who were bored enough and healthy enough that they had time and energy to have the aides order them three different lunch trays because each one wasn't good enough for them. All three thought they were saying it when I had left the room (but hadn't), and all three were patients who kept asking me to "sign their discharge papers" and didn't listen when I told them that they were there because they were being worked up and monitored for serious things such as metastatic lung cancer, GI bleeds, and diabetic ketoacidosis with blood sugars in the seven hundreds. Each time I got accused of pretending to be busy, and all three told me that I didn't understand, that they were starving from not eating in prep for their tests, though I didn't mention that, by the end of my shift at 4PM, I still hadn't eaten any breakfast, lunch, or dinner, either.

All in all, I have to say that I have a renewed respect for the people that work in the ER and on med surg who have these people all the time. My little diabetic patient was knocking on death's door last night when she came in, but by this morning, after all the work done to get her semi-stable, she was trying to sign herself out against medical advice because she didn't like the chicken soup just do she could come back another day and do it all over again. I'd rather have some patient who is crashing and hovering between kicking the bucket and surviving and be busy with that than being busy trying to keep people from walking off with IVs still hanging off their arms and having people yell at me because I am not able to get a hold of the doctor doing their colonoscopy. Give me a break. I don't get paid enough for this baloney.

I'm tired of being nice this week. I'm tired of being called a bitch. I have tomorrow off and then I'm back for another four days starting Tuesday. I am looking forward to March, with some spring weather and good company and good times.

I don't get a lot of drug-addicted patients on my unit at the hospital. More often, it's alcoholics who are in liver and congestive heart failure, scraping the bottom of the barrel of health to try and survive a few more years. Every once and a while, I get one or two, and each experience with drugs is more sobering to me than any anti-drug campaign. I'm stuck with the task of doling out narcotics that we're forced to prescribe as maintenance doses who they don't go into withdrawl, but even the massive amounts that the prescribers allow are usually not enough to tide people over.

My favorite addict was a chest pain patient on a nitro drip and 90 percent occluded coronary arteries who was awaiting bypass. He was a young guy, a sweet guy who talked to me the whole shift about his love for fly fishing and who, mid-assessment, yanked my stethoscope out of my ears to show me that on the television there was a little otter, belly-up in the water, cracking oysters with a rock so it could eat them. He never once pushed the button for the nurse except for every six hours when he would politely ask me if it was time for his pain pill yet, and every six hours I gave it to him, and every six hours my heart was a little bit sadder.

I've also had horrible experiences - people who are so tiny they barely look like they could stand, so wasted from drugs, alcohol, and smoking that they barely look alive. So, because we can't ever say we can't do something for someone, we give it a go once more. We take half a lung out this time, then another half a few weeks later, then biopsy the liver or try to coax their kidneys to work again after thirty or forty years of mistreatment. One eighty-eight pound patient in particular was a bit of an actress and in between screaming at me for her pills and calling me a bitch and other (more unmentionable) names because I couldn't give her more narcotics than she was prescribed, said, in a tiny, raspy voice, a crooked finger pointing straight down my nose, "You are making a med error. A MED ERROR. You need to get my meds straightened out or you will Lose. Your. License." Two minutes later she had taken her (prescribed) pills and grabbed my arm to pull me into a bony hug and started crying about how she was sorry and that she just couldn't understand why she would get lung cancer (40 years of smoking two packs a day) and why she was so thin (methamphetamines). Just.. so lost.

As if to remind me after reading Heidi's blog post about drug addicts in the hospital, yesterday I had a med-surg overflow admit who was a wearying cocktail of schizoaffective personality disorders, fibromyalgia, and "chronic pain" diagnoses. I ran myself ragged to try and nip his five bajillion absurd requests in the bud - "I'll need three cups of coffee, six sugars, three creams, an orange juice, and a prune juice.. my sugar gets low..." and "Get me a social worker right now! I need to make sure I get a voucher for my cab ride home tomorrow!" And as I brought him one of his three varieties of daily scheduled narcotics, he said the line that they all say, every time, every single time I have a "chronic pain" patient, "Thank you, honey! I didn't mean to yell at you for my pill, I'm not addicted! Been clean and sober for years! I'm just in a lot of pain, you understand..." And with that, he promptly gulped down his thirty milligrams and passed out, like the pain was gone already.

I'm a Big Girl.

I'm trying to decide what to do next - wash dishes, do laundry, read a book, eat ramen, lounge around, buy a pair of sneakers so I don't have to wear my MRSA-laden hospital sneakers around town, or clean out my entire closet of junk I haven't touched in an entire year of marriage.

Maybe ramen THEN closet.

I love my days off. Even taxes are fun when you do them sitting on your own couch with a cup of coffee and Radiohead playing in surround sound.

A husband who, every morning, kisses me goodbye on our way out the door with the same gentleness and love as our wedding day

Baby brothers who yell, "CASSIE'S HERE!" and run down the stairs from their bedroom to greet me when I show up at the house unexpectedly.

A sister who still lets me kiss her goodbye on the cheek every time I leave (even though she's well into her teens).

Two adult brothers who tease me and hug me and come over to my house to eat the food I cook and watch movies.

A mom who still sends me home with food every time I'm over for supper and calls me to let me know when she has something really good on the stove.

A dad who leaves Valentine's Day flowers on my doorstep for me to find when I come home from work.

I had originally written a very fiery post about the life and times of the Christian woman today. It got a little too personal on my end, so I am revisiting it now while I'm home for the day after a very long week. Today, I'm playing the young and hip and wired twenty-something neo-orthodox Christian wife who is blogging from Panera's free wifi and sipping tea. So very Web 2.0.

Some say that if you don't have a kid within nine months to the day of marriage, you're definitely slacking off in the Christianity department (a view that is both simultaneously nosy and presumptive that every woman is blessed with some incredible fertility). This camp often makes a big deal out of the wrongness of married women having jobs and generating income for their families, even before having children. I know a few of them. They are newly married, stranded at home with one or no children and very little to do, in actuality. They tout Proverbs 31 as their life verses, thinking that their Ultra Stay At Home Mom attitude means that they can't work from home or handle their family finances because that's a man's job. They think they're being Biblical but they're really just being Victorian, being June Cleaver. They've got one kid and a three-room apartment and a once a week young mothers Bible study to go to and that's it for the whole week and they STILL can't get the dishes done because they're too depressed. They wonder why the Proverbs 31 woman sounds so much cooler on paper.

They're bored, because, if they were really being all Proverbs 31'ed out, they'd be doing it like she did - working with her hands from early in the morning, going out into the city to sell her goods and bring home some eggs to go with the bacon. She's not some ultra-feminist powerhouse career chaser, but, you know, she doesn't lounge around at home playing pattycakes all day either. She takes care of her house, does her dishes, and still finds time to stretch out her hands to people who are needy. Women are fooled into believing in an idea of submission and godly housewifery that is nowhere near Biblical. True, there is no equivalent life these days for most people living in suburbia like I do - I have no yard to grow my flax and raise sheep so I can spin their wool into yarn. In that society type, you could have a lot to do and offer your husband by just staying home and taking care of animals and selling goods from home, but most of us don't have that luxury. I try to explain that the idea of women "keeping the home" as a primary occupation is a legitimate one, so long as there is something to actually keep up in the process.

This June Cleaveresque suburban sprawl of depression and lack of purpose spreads out into their marriages, too. Wife stays home all day with not much to do, eagerly awaiting the company of her husband all day, husband comes home after a long day of stress and exercising his brain and needs a few minutes to get in the door and decompress and unwind. Maybe he gives her a kiss at the door and then goes to his computer for half an hour by himself. Maybe he reads the paper for an hour on the couch and doesn't say much while the wife is all buzzing around making supper. Maybe he doesn't want to do anything for a while or doesn't want to immediately be all cuddly. So wife gets all stressed and doesn't get why he doesn't come flying to her like he's been sitting around all day doing nothing but thinking about when he gets home to his wife. But it's because he hasn't, he's been busy working, and he needs a few minutes to shake it off at the door so he can separate work from home. But the women don't get it. They are so drained from being alone all day they can't understand why he isn't the same way.

I am not perfect, and neither is my marriage or my relationship with God, but despite all that, and because of my understanding of the Proverbs 31 business, three to six days a week I get up at my 5:15AM alarm, stumble into the bathroom to put on my scrubs, pile my hair on top of my head, and pull on my winter coat the meet the chilly New England air. All of this just to kiss Mark and my warm bed goodbye for eight or twelve hours of work. I don't feel guilty about it, either. I am twenty-two years old, childless, and I live in a three room apartment that has no need of a 24/7 housekeeper. I am not a lazy person by nature and I feel proud to be working towards our future by saving money and giving money and caring for my little household in the only way I can at this point in my life. As much as I hate to peel off the covers and let my feet hit the floor, leaving behind my cozy home, I know that just as surely as God designed man to be the head of the home, I am doing as Proverbs 31 designed, by leaving behind an idleness justified only by modern traditions of "church culture." For as many books lining the walls of the Christian section of Barnes and Noble that are about "keeping the home," maybe there should be just one telling women to get off their rocking chairs and whiling away their precious time so that they can really serve, really love their husbands, really use their time wisely to serve their households and God. Not career women bent on advancement and leaving their families in the dust, just women not wasting their lives by following an ideal that is not Biblical in the least.

I can only say that I hope I'm some sort of Proverbs 31 woman for the 21st century, some adaptation of the same hard working spirit and dedication to God and family. Perhaps I'm a progressive, but I think it started more with my parents, who were not intent on only advancing the corporate ladder but who also were no slackers. Through the tough times when I was very young, my Mum worked many jobs that were far below her expertise and brains but that allowed her to both be a full-time mom and wife as well as make money during the droughts. She drove a special needs van from here to Boston for years as I sat strapped in my carseat in the front seat. She did construction and renovation with my Dad as I played in a playpen and stuck plastic hammers into my diaper so it would be like the toolbelts I saw her wear. As I got older and gained more brothers and a sister, she worked jobs from home and then somewhere along the way, became a full-time schoolteacher to us. My Mum is a Proverbs 31 woman. Housewife but never with a wasted moment, hand-in-hand with my Dad always. I loved walking into the kitchen and finding Mom stirring a pot of sauce and Dad poking her in the belly, teasing her about not putting oil in her pasta water. Being in bed in our little house before the addition and, through the walls, hearing the muffled sound of my parents talking and laughing about all the goofy things their gawky children did during the day. Being eight years old and waking up early on Saturday morning to sit on the hope chest in their room and be relentlessly teased by them, warmed by the greatness of being a kid and having parents who loved each other and who loved us. Such blessings I'm sure I do not in the least deserve. I have equal memories of a Mom who drove the special needs van early in the morning and knew how to tile a kitchen floor and a Mom who would dance to Second Chapter of Acts and the Grateful Dead records in the living room with me, Drew, and Chaz, back at a time when we were little and they were Andy and Chuckie still. That's the kind of Proverbs 31 I want to be. The version of Proverbs 31 adopted by married women these days is an imitation, a watered-down version of the sweetness that comes from two people working hard together to build a home and finances and love and grow together in Jesus. Thanks, Mum.