While I was in nursing school I worked as a tele-tech and a CNA in a small rural hospital. I was responsible for reading the tele monitor on all the patients who were on tele during the shift, as well as taking off orders.

If there were no patients on tele and no orders to take off, or the evening shift was in need of workers, I worked the floor as a CNA. I also worked extra when I could, especially during breaks from school. I made better than minimum wage but not much more. Therefore I picked up extra when I could.

One week in late December I was working as a CNA on the evening shift and we were unusually busy and all the rooms were full. In room 249 was a patient who no one wanted to take care of. He was mean and didn’t participate in the ADLs. When we were turning him in the bed he would reach out to pinch our rear ends. Twenty plus years later I realize that he had no control over anything, including his own bowels and that made him frustrated and mean and prone to strike outs.

Compounding his general demeanor he had had a radical neck dissection and a permanent trach, essentially making him nonverbal. He had a “pipe” that he used to communicate with. He would put the pipe up to his mouth and speak into it. It translated the air into sounds. The sounds weren’t very loud and he was difficult to understand.

He was terminally ill, though, and became sicker as he was under our care. This was due to the cancer disease process. He knew he was dying and he hated it. He hated it, hated us, hated the food, hated the nurses. He made sure we all knew it.

And then his pipe broke and he was without even that meager communication tool. And he was madder than ever. He was dropping weight rapidly and becoming diminished. Which also made him mad. Not much made him happy.

Remembering my classes I made him a communication board. So that he could communicate through pictures.

He went home to hospice not long after than. The last image I have of him is him gesticulating widely at the EMTs as they were transferring him to the gurney and shaking his communication board.

Why I remember him is that communication is key. Not only among the caregivers, but also from our patients to us. Patients may be in our hospital, but we have entered their lives at a time of no control. We have to use any means necessary to communicate with each other, even with unconventional means.

Want to hate on me for how I run the board?

Well step right up, CRNA! Step right up to dislike me.

That did not take long.

There is this other CRNA. No I don’t know how I collect these people.

As soon as he joined the call ranks he started to send every other CRNA home as soon as possible in the evenings, sometimes as early as 1600. And invariably a case would show up, which would have to go after the case we were already working on. Instead of running two rooms concurrently, which we are supposed to be able to do until 1900, the case had to follow after. Much to the delight of the surgeon who had to wait, and the evening folk who had to be in a room all night and not get their evening chores done, and the day shift who depend on those chores getting done.

I get it, man, I do. EVERYONE wants to go home early, and since the CRNAs get paid for the whole shift regardless of hours worked, they especially do.

But see above reasons for running concurrent rooms.

And no, I will not start a third room at 1815 because you asked Surgeon A if he was going to be done by 1900. Surgeon B absolutely would be done at 1830, but Surgeon A is lying to you. Or thinking only of his time, which doesn’t account for the waking up and going to PACU time. And no, I will not make my coworkers stay the extra 10 minutes. Just, no.

I will not start a third room at 1815.

I don’t care if you scowl at me. It really isn’t that impressive.

Don’t invoke how unhappy the patient is, or their dropping H&H. The surgeon should’ve taken the opportunity to bump when I offered it to her. But she didn’t and now that case is going to have to wait until Surgeon A and Surgeon B finish their cases.

I do this all night, every night. I think I know what I am talking about.

Stop pushing me to arrange the schedule for YOUR convenience.

Where do they find these people?

Oh, and Surgeon A didn’t finish until 1930.

Personal responsibility is a thing.

This is a hard taught thing but a thing none the less.

I’m a big fan of procastination, for example, see my life.

But not where it counts.

Not where it impacts my livelihood and job.

Because at the end, I’ve only got myself to blame.

So I keep a close eye on things that impact my ability to work, such as my nursing license expiration date, and when my CPR expires.

I don’t rely on others, including my boss, to remind me.

As always, I don’t understand those who don’t keep a close eye on what they need to work. And I’ve been called cruel for that, uncaring. Because what about life, parenting status, illness, work that get in the way of paying attention to the things that keep us employed?

We all have obstacles to our lives.

It is our part of personal responsibility to make sure that everything is done in a timely manner. So that we can continue to work to earn money to live.

Why don’t people get that?

Before I was a registered nurse, before I was an OR nurse, I was a CNA. And I worked in two places: a nursing home and a hospital. In the hospital I floated between two units: the medsurg floor and the skilled nursing floor.

All the while I was rehabbing my shoulder and looking to get back into nursing school.

Always one to look for the next opportunity I jumped at the chance when the medsurg floor was looking for an evening shift teletech. It would mean more structured days, it would mean more learning, it would mean also sometimes stepping into the CNA role.

So I applied and got it. This was in the nascent computer charting phrase. Yes, we had computer charts, but only for narrative nursing  notes. The orders and the MD notes were still done by hand, to be transcribed into the computer ordering system by the teletechs. The nurses validated our work, but we were the ones that inputted them.

Yes, that is one of the reasons I say I read scribble. No, the doctor’s handwriting thing is not a joke.

And while this was going on, the orders, and the CNA work, I monitored the tele machine. That means I watched all the different hearts on monitor and alerted the nurse when there was a problem.

There was one patient, who was still tele, with all the chest pain standing orders, with all the monitoring. However, this patient had a rare DNR order while on tele. Do Not Resuscitate does not mean do not treat. All of his needs were met, including the antibiotics for the pneumonia, but he didn’t want to be shocked, or CPR done to  him. This was his choice.

He was dying and he knew it.

And me, out at the desk, knew that he had a DNR but the nurses still treated his chest pain, and infection.

He had a pacemaker that had a low threshold of 60. That means that if his heart was beating above 60 it wouldn’t fire. But if his heart went below 60, the pacemaker took over.

One night, late, his tracing started to look different. Where before there hadn’t been any paced beats, now it was one out of ten. I alerted the nurse and she went in his room. By this time we all knew that his death was imminent. His family had come and said their last goodbye, his doctor was just waiting for the phone call.

His paced beats became more frequent.

And then the paced beats stopped capturing and all there was was the pacer trying to coax the heart back into beating. With no electrical response from the heart.

I couldn’t turn off just his line on the monitor. I had to get the nurse to disconnect the tele box.

But until she did it was sad, watching that pacer try to restart the man who had died’s heart.

What I learned from that is that technology, as magnificent as it is, doesn’t really hold anything over the body.

The winter rush seems to be dwindling.

Not that I don’t want to work.

Not that I want patients to suffer.

But the winter rush seems to hang on and on and on.

Our hospital is full to bursting.

Our ED may as well have revolving doors.

The flu is in full  bloom here.

But the thirty case days seem to be ebbing.

And like a calvary that got lost, there are to be two travelers for the department. The first showed up this week. I hope she can relieve some of the pressure on the staff.

You know, when the winter rush comes, well, rushing back.

Because right now is only an intermission. A remission of sorts.

The crazies will bounce back.

When I was a nursing student and a CNA on a skilled nursing unit in a hospital there was a patient who bonded with me. That is the only way I can think to say it. She would wait for me to come to work in the evenings and she would hug me and chatter at me when I entered her room.

She had esophageal cancer and had a radical neck dissection with a permanent trach.

She had very few visitors, her estranged brother lived in the area and would not come to visit.

She was lonely.

She and I struck up a friendship.

She was in her fifties but was on the skilled nursing floor to get strong enough to go home.

There was to be no cure for her.

She was essentially waiting to die.

She and I talked about all manner of things. Politics, which I’ve since learned to steer clear from, fashion, the deficit of cute doctors in our retirement community of a town.

She got stronger and was scheduled to go home.

I cheered her every step of the way.

The day she was to be discharged, I helped her shower and dress, brushed her thin hair.

She said that I was her friend and although she was glad to be going home, she would be sad to not see me every day.

I encouraged her to come visit.

She smiled and said she would. With one last hug and a good luck with nursing school she was gone from the unit. On her way home

Going onto the next stage is to be celebrated. Whether it is to home or to a place where there is no more pain. Celebrate it all.

My least favorite anesthetist left for … I don’t really care what.

The one who was never satisfied with my decisions, always wanting to move the schedule around to satisfy her need to get off the floor.

The one who would never take no for an answer, preferring instead to badger and cajole and talk shit about me behind my back to anyone who would listen.

The one if I said black, she said white.

My boss wouldn’t let me throw a thank God she’s gone party for the day after she left.

Me, publicly, subdued yay.

Me, in my head, YAY!!!

I might have had a party of one. I got lunch out from a grab and go place near work. I had my favorite cold caffeine. I deleted her number from my phone, I deleted her as a friend on Facebook (she friended me first before she knew I would not bend to her will).

My husband says don’t worry, someone will hate you soon.

I shrug.

Let them.

I’ve been doing this blog, on this platform for 18 months.

I have struggled with finding the time to write, with cementing the days I publish blog posts.

I have exposed new coworkers to the idea of a blog about the evening shift OR.

I have gone back to graduate school and struggled there as well.

I got my first C ever. EVER.

A dispatch is a communication to the front lines.

I have decided to make a dispatch from the front lines instead.

I am not Kate DeVine.

I write under a pseudonym.

I work in a suburban hospital but don’t identify my location or state.

I work evening shift.

I am the evening shift charge nurse.

I may write about patients but I do not write about specific details.

I may change the ages of patients, the diagnoses of patients, even the sex of patients.

I write about my coworkers, again no names although some have been recognized by people in the department.

I do not watch my tone, or my words, and am frequently very sweary.

I just wanted to reiterate that nothing in my posts can be identifiable regarding patients or the hospital. This is not just to protect them but to protect myself.

After licking my metaphorical wounds for four months I reached out to the graduate school.

I learned I was dropped after getting a C. Which I expected.

I learned I would have to reapply to the school. Which I did.

I learned that I would have to resubmit a bunch of paperwork, such as a new CPR card, another copy of my nursing license, my flu vaccination record. Which I did.

What I didn’t learn was if my scholarship that I had just received was terminated. If it had been, I will be reapplying.

What I didn’t learn, yet, is if I’ve been re-accepted into the program.

I hope it is as easy as I was led to believe.

Because I am not done yet.

I was explaining to my best, most supportive friend at work about the recent series I’ve been doing on Dispatches From the Evening shift. She began nodding when I said it was basically about those patients who don’t leave us, who we carry. She placed her hand over mine and said, “I understand.”

And in her saying that I knew that she understood about my patients. I also knew that she had patients of her own that she carried. My friend, the most compassionate nurse I know, the nurse who when one of our techs got devastating news about a newborn in her family was the one that I asked to speak to the tech. The nurse who had been caring for her in-laws for years, through health and sickness, even in death while making sure the family, who are not medical, understood what was happening with them. She’s the one who I look to to make sure what is coming out of my mouth isn’t too harsh.

Because I can be harsh, and crude, and expect people to be better than they are.

She and I have different ways of handling things and people.

But she makes me understand that I am not alone in what I feel about past patients.

I am not alone.

She is not alone.

We are not alone.