Running out of fucks to give

When I got into nursing I really, truly thought the vast majority of my time and effort would be spent on helping individuals that met with poor luck, poor health, or poor timing.  I had expected trauma, elderly, and the infirm.  What I get instead are abscesses, lots and lots of them.   A few are related to a rough cat or a pet rat or the neighborhood dog taking an inopportune nibble on someone, but most are related to injectable drugs.  And if it isnt an abscess related to drugs, it is a side effect from years of self abuse.  Wonder why your heart is failing at 50, lets look at your 30 year history of meth.  Why is it so hard to find a vein through your scar tissue and prison tats, oh yeah, the 20 years of heroin.  We have had people in their 60s and 70s that come in with drug related ailments now.

And far more often than one would think, people going through alcohol (ETOH in med speak) withdrawals.  Nothing like tending to someone going through delerium tremors and fighting their restraints.  Want to see people the color of the Simpsons, come on down and I will take you on a tour.

And even when you think it couldnt possibly be the case, it is.  That soon to be mom you just placed an IV in because they couldnt find anything to stick themselves, inevitably they are on Methadone.  If the baby is lucky, that is all they have been on during the pregnancy.

It is harder and harder to care when most of the people you see in a given day (mind you, we get called for any start that is difficult or not easily visible......so by percentage, we generally see only the worst) don't seem to care about themselves in the least.  Plus, we set up a consequence free environment for them.  If you shoot drugs into your central line, the doctor will pull it....and then shortly thereafter realize that the person still needs 3 more weeks of ABX and then order another line placed.  Want to go AMA (leave in spite of the recommendations from the doctor)?  Go ahead and feel free to come back whenever and we will do it again.  We have patients who go AMA and return later the VERY SAME DAY to the ER and then get readmitted and they order another line placement.  Its like you had a buddy who had no job and you let crash on your couch for a bit who then proceeded to eat all your food, drink all your beer, and then takes a shit on your rug before leaving.......only to then knock on your door later that evening looking for a place to crash.  And you fucking let them!

The good news is, these people are no longer uninsured.  No sir.  Now they ALL get signed up to OHP (in ORegon anyway).  So, we are monetarily contribute to this horrible little tax scam.

The ultimate fuck you in the whole situation is that we do nothing (ZIPPO) to help these people.  IF they came in homeless and drug addicted with a raging infection, they will leave without the infection but nothing else will have changed for them.  We have no plan.  Why would you repair the heart of someone who has been abusing amphetamines for 3 decades without any plan in place?  Are they going to suddenly stop?  Or are you just prolonging their ability to live a few more years within which to put more amphetamines in?

I don't claim to have a solution to this, other than cutting the drugs with antibiotics so they can stop the infection before it starts, but I am running out of empathy and growing so tired of feeling like what I do doesnt really matter.  I am doubtless far more competent in my skills because the patients are so very difficult because of what they have done to themselves.....now I just wish I could use those skills to treat people who I felt good about helping.

The university of Vantucky

I haven't posted in a LONG time.  I procrastinated it right out of existence.  Won't bother making amends.  Best to just sweep it under the rug and move forward of I will never get this out of idle.

We are now Vantuckians.  For those not in the know, here is the definition from the Urban Dictionary:

Vancouver, WA. Think Kentucky but in a different part of the county, and just a city. Just across from the river from Portland, OR the whole city seems to be a few years behind and mullets and 4x4 raised American made trucks are plentiful.

WE are close to the downtown area, which means we skew a lot more towards urbanites, but we are still rife with bleached hair, lifted trucks, and people who spend a week's pay for fireworks for any occasion they can justify.  Fourth of July was like Vietnam around here.  People do not mess around!  Its different here.  

On the plus side.....it is somewhat cheaper to live here and is still close to work.  We are currently in the throes of a seemingly endless parade of projects on our duplex (our nanny lives in the downstairs unit, which is awesome).  So, in the past 6 months I have learned to (with varying degrees of success), install a dishwasher, a new kitchen faucet, a garbage disposal, wired up some new lighting in both bathrooms as well as repainted, caulked, removed old shower doors, and refinished the cabinetry in the bathroom (that one I need to work on more), and, with the help of Diane and Tia, repainted pretty much every inch of the upstairs.  Next up will be re-doing the flooring (I would love to try my hand at it, but I think time and toddler constraints will have me shift that responsibility over to the pros) and then the yard (probably in inverted order).  

The messed up part is we havent the intention of staying here for more then a few years really.  But where to go if we left?  Tia would like nothing more than to return to Portland.  I am not opposed, but the reasons we left have not changed.  For a nice house, in a good school district that keeps us near our respective jobs, we would need to spend about $450K.  The same house in, say, Salmon Creek, might be nearer $300K.  Plus, you know, another $100-$200/mo in taxes on the PDX side with the price difference.  Ouch.  Suffice to say, the discussion rages on.  

In the interim, we are seeing lots of neighborhood flips, a slow revitalization of the downtown restaurants, and a new waterfront development in the works.  Could actually be a pretty trendy place to live in just a few short years.  

My back

Whoa!  I almost made it through the entire month of June without a post.  So far my plan to keep up with my blog is going about as well as my plan to start running again or floss ever.  Sigh.

At least presently I have an excuse for the lack of cardio, my back is effed up.  I am not even sure when it happened.  There was no moment that I thought, 'shit, that is really going to hurt later.'  Nope.  Just me and the whole getting older thing I guess.  Anyway, I came home on Sunday after my shift and felt fine (though tired.....it is hard to get used to doing 10s and pushing a cart all over the place as compared to working in the clinic where your brain is more taxed than your body is....hence the whole back thing).  Then I awoke at 3am with this horrible pain and didnt sleep thereafter.  Called out for my shift and made an apt for a massage thinking it was just a strain.

Massage was helpful, but the next day it felt like someone has spent the entire day punching up and down my spine.  I was hobbling around and it was painful to get up or down or to lift anything above my waist.  But, I thought there wasnt much I could really do and that the massage would ultimately help.

Come Thursday, I finally just went to the doc.  Pain was no radiating from the initial low back locale to my shoulder blades and my hips.  Thankfully, as I had guessed, it was just muscular and not bone related.  Also thankfully they gave me a muscle relaxer and some pain medication.  I had never been on a muscle relaxer before and I have to say they are FRIKKEN amazing!  Finally the pain abated and I could start feeling normalish again (the downside is they really do hammer you from an alertness perspective.  It felt like I was drunk).  So, hopefully this weekend shit starts to heal up.  I HATE using so much of my sick/vacation bank for actually being ill.

In other news, we are a week out from owning 2 properties.  Paperwork is signed and we take possession on the 25th.  Will be terrifying.  We dont move until the 3rd, so we will have a little time to clean, etc before jamming our stuff into the new place.  In the interim I thought/hoped to pull up the flooring and get new carpeting.  However, it turns out that new carpeting would be about 5K, so cleaning it is!  Then, once we are out of our current place, we need to get it staged and put on the market, hopefully around the middle of July.  After that it is just time to cross our fingers and hope we can sell it quickly (and full price or better would also be excellent!)  It is going to be a hell of a month for sure.

Quinn is almost 2 years old.  Crazy!  I cant believe it has been that long already.  He is really fun to be around now (well, 95% of the time anyway.........which is better than most people let alone toddler people) and is developing quite the sense of humor.  I am excited that the new place with allow us to have our super nanny, Gloria, downstairs and really hope that things work out well.

Back to packing.  Where did we get so much stuff from!

The Couv

It is looking more and more like our days in Portland might be numbered.  We appear to be very near to moving to yet another state.  All the way to Vancouver, Washington.

I think it might be an adjustment.  Legalized gay marriage, booze in the grocery store, and fireworks with no restrictions.  Oh yeah, and they are moving to legalize marijuana.  Plus they have no state income tax and they pick up your trash EVERY week. It is a libertarian utopia!   But, there is also the whole sale's tax thing.  Oh, and working in Portland does not allow you to escape the income tax thing.  Plus the state is adjacent to Canada......and you know how unstable and prone to warmongering they are!

We have an accepted offer and had our inspection today.  Also broached the subject of our nanny moving across the border with us (did I mention it is an upper lower duplex!).  Will have the report tomorrow, though nothing appeared to be significantly wrong.  Of course, they can also see what is visible.  Then we will need to go back to the owners and see what, if anything, they will fix for us (or cut the price).  But I really do hope it works out.  I am tired of the general choppiness of the neighborhoods (at least the ones we can afford) and the idea of being able to walk Quinn to a decent school is very very appealing (plus, they have WAY less shootings in their area!).

More to come.

Humans make mistakes, but humans in HR just make more

So, I just got off the phone with HR.  

TWICE!

First call (they left a message):

"This is (name redacted) with HR.  It appears that your Washington RN license is expired.  I dont know how you are supposed to work your new position if this is the case (frantic).  I hope you have not worked their recently.  Please submit for your WA renewal and get back to me as soon as you do."

I call back after verifying that, in fact, this is not true.  My license expires in 2015 on my birthday.

Me:  "Hi, I received a message that my license is expired and I am looking at the website and it appears to be active.  I just renewed it in March."

HR: "Oh, I am so sorry.  I was just told this by the business office.  I suppose that will teach me to check on these things myself before I call people.  So sorry to have alarmed you.  I will print it off and correct it."

Me: "No problem, thanks for fixing it."

2 minutes passes and phone rings again:

HR: Hi this is (name redacted) and I am sorry to bother you again, but I am looking at the page and on the one page is says it expires in 2016 and on the other page is says it expires in 2015 and (realizes it is 2014)..........oh, I see now.  Oh. I am so sorry for calling you again.  You must not think much of me and HR.  So sorry to have bothered you again with this."

Sigh.  It is any wonder why I don't trust our HR at all.  This is the same group that nearly lost me the job 3 years ago when I had to re-apply while working there because they neglected to check a box.  The same group who, when I called 5 years ago ran me around and around and basically treated my phone calls inquiring about the status of my application treated me like a telemarketer calling at dinner time.

I suppose I should be grateful though.  If a day ever comes when they opt to terminate my employment, what is the likelihood that they will be able to process that paperwork correctly?  

Does it count if I wrote it in April?

Well, this is my last week in the clinic.  Last Friday was really bittersweet as all three of my afternoon patients were visibly upset that I am moving back to the floor.  Two of the three also clearly weren’t fond of the less gentle method of IV placement that my replacement uses.  However, she finds the numbing agent to make the process less effective and, given the option of using it and potentially having to re-stick, most would prefer going without.  However, I don’t find it has any impact on most people’s veins…at least those that are healthy enough to come into the outpatient clinics.  That said, I think my (temporary) replacement will do very well.  She is very intelligent, has years of experience, and has the same jovial personality that I do.  She may not engage with the patients in the same manner that I do (part of it is my belief that the experience should be made more personal and personable and part of it, as my wife and her eardrums would attest, is my inability to shut up), but I have no doubts she will provide safe and effective care (at least until she goes on maternity leave in the summer). 

As far as who will be the one to take over the clinic ‘permanently’, there are still some questions.  Though, it appears, they will be opting to put a former employee in the position over the person that they had spoken of previously from out of state.  This is fine in some regards as I do not doubt the skill and ability the former employee brings to bear and she will be thoroughly familiar with the system and the clinic.  On the other side, she is not a very committed person…kind of a nursing vagabond really.  How long she will choose to tolerate the generally languid pacing and lack of internal support for the clinic will be interesting to see.  I have not been part of the process though, so I am unsure of what (or when) someone new will walk through the door.  All I know is that, come Friday, I will be little more than an occasional fill in.  Honestly, the whole thing bums me out. 

But, as there is no plan for the clinic going forward my choices were limited.  I could have ridden it out to its termination point of course, but that would have left me with precious few options when (and if) it occurred.  With one option still being closing the clinic, I could have found myself working on call at best.  Considering my utter lack of success in procuring a position outside of the department (a fact that still mystifies me as I have been a well-reviewed employee of the company for 5 years now), my confidence in moving to anything other than overnight butt-wiping shifts was low.  My other options would have put me on evenings, which would have put undue stress on Tia (M-F from 4p-1230a?  3 or 4 days a week from 5p-230a??) or me  (Pediatrics?).  So, in the game of work blackjack, I stayed on 17.  My hope at this point is that, down the line, a clinic gig will open up at the Creek.  Until then………well, the floor it is. 

Speaking of the floor, I am excited to have coworkers again.  Though, I must say, I would dearly like them to be more consistent in their attendance and perhaps fuller in their rolls of on-call employees.  How they ALWAYS manage to be understaffed by at least one if not 2 employees is beyond my understanding considering the abundance of unemployed RNs in the area and the higher pay and better benefits that working in a hospital affords.  But, it seems we have rarely been in any other position and this is truly the eye of the storm.  When there is a sick call at a peripheral site, they pull from here.  When there is a sick call here, they pull from the thin rolls of our on-calls (we had two reliable and hard working on-calls RNs, but both had to retire to start claiming their pensions or risk losing money by working, though both expressed the desire to continue doing so).  Sigh.  I just have to remember that some days will be tough and some days will be easy and in all cases to try to stay within myself and just do my job and not worry about how many rounds or starts are ahead of me as I can only control what I do.  I am sure it will be easier said than done. 

In Quinn’s latest Quinnism, we were at the grocery checking out and the clerk said hello to Quinn, who looked at her and said “I don’t want to talk right now.”  Quinn also got have a full on sugar Sunday when he had a belated Easter at grandma and gramps with his cousin that involved candy (of course) sweet rolls, and juice.  Then, following a nap, got to go to a birthday party for a neighbor’s kid and had cake and played in the bounce house (and took a whack at a piñata).  All in all, a pretty good day to be a toddler. 

Look with your eyes

Tia was telling me her parents, when she was out, would tell her to 'look with her eyes, not with her hands.'  I am sure we all heard that at some point in our respective childhoods.  Most of us basically understood that it was strictly hands off.  Quinn, however, is a little more clever.  He then leans over and puts his eye on the item in question (generally knocking it over that way).  Parents = 0.  Quinn = 1.  He has also now figured out the round door handles.  We are truly in trouble now.

We put in our second offer on a house that was, like the first one, outbid by others.  Also, like the first one, it was in the SW.  We have also briefly (VERY briefly) started looking around in some of the Vancouver school districts.  The market there is nearly the polar opposite of the market in Portland.  Largely, this is due to the commute being really awful and the fact that they have no growth boundaries.  Where Portland is dense, they are sprawling.  And where we are building condos and apartments, they are putting in homes.  Huge homes.  Like 2000-3500 sq feet and better homes.  The damnedest thing is you can get one of them for significantly less than here, with lower property taxes to boot.  Yet, houses linger on the market there for weeks and months.  Here we compete against 4 offers on the first day.  It is strange what a river and a bridge can mean.

Though it is somewhat dispiriting, the truth is there is no hurry and letting ourselves get swept up in the frenzy will not be to our benefit.  While we love our neighbors, the neighborhood is still not quite done clearing out the debris of years past.  To whit, there is still a rental property/grow house and a nice enough group of older meth heads both within spitting distance.  Plus, the schools are pretty damn near bottom feeding.  Yet, the area is 'hot' because it is so close to so many things.  The search continues.

It appears that the clinic may soon be in my rear view.  I start back on the floor in May.  I am not thrilled about it because I will lose a lot of what I love to do, but I am really trying to focus on the benefits of working in a team and not possibly/potentially being sold and/or closed at some point down the line.  It is a gamble I felt I had to make.  Plus, there always remains a chance that something opens up at our Washington location down the line.  Then a move to Vancouver would really make sense.

Had jury duty the other day.  More accurately I should say I spent the morning getting up early, driving to Gresham, waiting in lines, watching a video, and then being dismissed along with 50 or so other people.  Sigh.  If I am going to get called, it would be nice to be part of an actual proceeding.

The sun is finally back.  Hurrahs all around!  Can't wait to spend days at parks and nights at outdoor concerts again instead of shuttered indoors with the rest of my hibernating Portland bretheren.  

Offer number one

Trying to keep up with my blog is going about as well as trying to start running again…or flossing…or cleaning out the house.  But, given the chance to rectify one of those things, I am opting for the blog because I have a patient gap and am too exhausted to contemplate the running or cleaning and, lets face it, flossing just isn’t going to happen. 

I have, finally (sorta kinda), some job news.  I have been hired on to take over a floor position.  I currently work 4-8s.  I will be moving into 3-10s, along with what I hope will be the odd shift every week or two.  The upside, obviously, is one less day.  The downside is that I will be back to working every other weekend, some holidays (tbd), and the shifts will obviously be 25% longer.  The other news is that no one, not even my boss, knows when I will be starting this position as they have to now post, then interview, then hire and train a new person for my current job.  That is unless OHSU is still picking it up in June/July, in which case I will stay here until that happens.  No one knows that either.

Why change?  First off, it was not an easy decision.  While it can be frustrating at times and while I would dearly love at least a part time second nurse, I still do like what I do.  I will miss some of my patients a great deal.  However, the stories I have heard from the nurses who did go through the transition and have since left have been troubling at best and disheartening at worst.  Perhaps they will get the issues sorted out by the time they move on to this clinic, but I was not hopeful.  Additionally, though it is indeed a good skill to have and one I would not mind having as a piece of my practice, I really don’t want majority of my job to revolve around chemotherapy.  I have worked with chemo patients before, mainly doing blood transfusions, and it is just a terrible thing to watch the effects of the medications and the disease eat away at them.   Plus, the volumes they demand eliminates the true joy of getting to know the patients in the way that personalizes the experience.  So, ultimately, I worry about losing pretty much everything I enjoy about my job anyway…so why not go back to relearn the floor and placing PICC lines? 

Other than the job stuff and how it will possibly impact everything from childcare to Tia’s sanity, is that our nanny share looks to have a finite end point.  The gal we share with is pregnant with her second kiddo and due in October.   At that point they are going to look at putting their first born into daycare.  Plus, with my schedule shifting, we may well need to alter our care needs.  Oh yeah, and we are still looking to possibly move to a better school district which would blow up the share anyway.  Sigh.  You can never fully comprehend the sheer amount of things that change once you have a kid until you have one.  It really does touch on pretty much everything.

  

We also put in our first offer on a home since we started looking.  Shooting for a much upgraded school district.  It ended up being a microcosm of the housing market here as a whole.  It was on the market for 1 day.  We were one of 4 offers presented.  We were 1% above and non-contingent, which ended up being the lowest bid.  They ended up taking an all cash offer 2% above list.  This all in 24 hours.  You gotta move fast.  Oh yeah, and have hundreds of thousands in cash on hand.