Changing Tides

We have had an enormous change here in the Bitchypants household. Mr. Bitchypants, who has been unemployed for six years, went to work yesterday.

It’s been a long time. His unemployment started out by choice when the line he worked at in a hospital-equipment company moved to Mexico. Thanks, NAFTA. Anyhow, he was having a hard time finding a position to replace his earnings. Evan was in half-day kindergarten and we were paying full price for him to go half-days, and another $50 per week for the school bus to take him to school from the daycare in the small, rural community in which we lived. Instead of him just taking any job with a paycheck and paying $1000 per month for that arrangement, it made more sense for him to just stay home. Yes, I said it.

That is when it all started. Having him home was….different. First of all, while I am a feminist of sorts, my husband is the Man’s Man. USMC veteran. Country Boy. His wife supporting him while he stays home? Ummm, it didn’t sit well. Not with him, not with his family, not with society. Regardless of how progressive we think we have become, there are some deep-seated traditionalist views we all have. I had no problem with it, but the world in which we live had big problems, and I could see it everywhere we turned. I found myself defending our lifestyle. If the roles were reversed, and a man had an infinitely larger earning potential than his wife, and it cost the wife almost as much in childcare as she was earning by working out of the home, we would not bat an eye at her choice to stay home.

Make that woman a man. That wife a husband, That mother a father. Replace the vagina with a penis. Does the arrangement make any less sense?

Regardless of the rationality of our choices, we faced mud-slinging from everywhere. To my colleagues, my husband was constantly a “bum”. To our debtors, there was disbelief that he didn’t work. They wanted to put everything in his name, and he would tell them that his wife was the breadwinner, much to their shock. His parents would lecture him to get a job, that he would have no retirement when the time came. Of course, this was coming from his mother, who was living on her husband’s pension, with none of her own because she retired too soon. And the other objection: “What if Andrea leaves you, John?” Well, “Andrea” has been here for almost 12 years. Through homelessness, hunger, illness, poverty. And when the going got tough, I am the one who pulled myself up by the bootstraps, got a higher education and pulled my family out of that situation. And what of all of those stay-at-home moms? Does anybody ask them what they would do if the husband left them? So yeah, we heard it.

A couple of years ago, with the introduction of Zachary into our family, we really could use the extra income of John’s work. He began looking for work. The arrangement no longer made sense with diapers to buy and another mouth to feed. But with my establishment as the breadwinner for so many years, he couldn’t just take any job. We needed something that would A) not conflict with my odd schedule, or B) pay enough to compensate us for putting 2 children in childcare. And if one child was expensive in rural Indiana approximately 4 years earlier, the cost of 2 kids full-time in Cincinnati was damned near prohibitive. So John had trouble just finding positions for which to apply, let alone accept a position.

Enter the tension.

With two kids, we began bickering and fighting. I would come home from working God-awful hours to a house that was trashed. I would get ready to go somewhere and have no clean clothes. You see, John never was much of a housekeeper and I’m a little obsessive-compulsive. So we would fight. I would be upset that, while I was working my ass off to make ends meet, he was showing flagrant disregard by allowing our house to get trashed. I remember a particularly awful day where I found some of the boys’ expensive designer clothes molded because hey were under a wet towel in the basement laundry room for God knows how long. I began to try anything to get him to understand my point of view.  That is where I made my near-fatal mistake. Since he is a hard worker when he is getting a paycheck, I thought it would motivate him to do better by presenting it as if he was getting paid. With food and shelter and medical benefits, all provided by me.

How awful of me. I didn’t mean to hurt his self-image. I did not mean to completely emasculate him. I just wanted clean laundry and felt that I deserved it.

And with the pressure I was dishing, John issued his own counter-pressure. He wanted a job. Desperately. But he was still limited on the types of positions he could take. Then when he would find one that could work, he had to explain a years-long period of unemployment. Society still just could not handle that from a man. “You were a what? A stay-at-home-dad? What’s that?” So even if he made it through to an interview from the piles of applications, he never got an offer. In the meantime, I wanted him to find work. If I was going to clean the house anyway, at least he could bring home some money so I could maybe stop working all of the overtime. But nobody would give John a chance. And in John’s eyes, it was all my fault. I am the one who said, all those years ago, that he should just stay home. That it made more sense. And now, he couldn’t find work.

The man who served his country. The man who is such a hard worker. The man who, despite his own desires for his own life, put everything on hold to meet the needs of his family when the time came for it.

Well, yesterday, the phone rang. He was backing out of the driveway to go and put in yet another application, and I had to flag him down. It was a job offer, but the employer really needed someone. They wanted him to start then and there. So he left. The pay is only a quarter of what I make, but it is enough to compensate for childcare for Zachary one day a week. The only time we will need it is on Friday so I can sleep a little before going into work. Evan is old enough to play on the computer or watch a couple of movies while I nap, and he knows to wake me if he needs something. And we found a center that will do just one day a week without charging us for full-time care. In the fall, when I start my MBA program, they also allow flexible scheduling so I can pay by the hour while I am in class three afternoons a week. John’s schedule is 8-5, Monday through Friday, no weekends. In other words, perfect.

So the tides have shifted. Because while he may not have been a great housekeeper, I never had to worry about the kids destroying the house while I take a simple shower. If I mentioned that I wanted coffee, he would brew it for me before I even thought of moving. When I had to get ready for work, he would have my clean scrubs waiting for me. When we were hungry, he would cook…

I never realized just how much he did.

So while, with my career now and my future MBA, I will always be the breadwinner, John’s new job has done something monumental in our little family. I have a newfound appreciation for the partner I have had in John. I have taken him for granted. And with the first day of work, I have seen a change in him. He smiled all night last night. He was slower to lose patience with the boys last night. He seemed….fulfilled. And I had to realize that working is so much more than a paycheck. Being as into my career as I am, as motivated and driven as I am, I should have realized this all along.

Benefits to a job include medical, dental, vision, life insurance, vacation time, 401K. They also include self-esteem, self-worth, dignity. I feel like I have robbed John of that. I said it was all about the math, but I was so wrong. It’s more than math. It’s more than a Women’s Rights Statement and a big middle finger to the “establishment”. I’m still the breadwinner. I am stil the tough woman who will take the male-dominated world by storm one day. But this way, we all get what we need. Most of all, John.

I Shall Call This One “Someday”

Because…..

Someday, I will have time to make a dent in this 6-inch thick GMAT prep book.

Someday, I will have a day off of work.

Someday, Evan will go back to school.

Someday, Zach will start speaking and stop doing the whining/ grunting/ pointing thing.

Someday, this house will be clean. And neat. And organized.

And I will finish the 1000-page book I started reading out of a lapse in my sanity. Because for some reason, aside from GMAT prep, working like a dog, the questionably Aspergian high maintenance oldest child and the terrible-twos toddler, and all of the other shit I have to get done, I thought I would have time to read the damned thing.

Someday, I’ll relax.

Or maybe finish the apps for grad school.

Or maybe eat a dinner that is home cooked because we had time to cook.

Someday, there will not be sheer chaos in this house.

Someday, I will finish the 50 gazillion blog posts I have started about the different things I wanted to tell you all about but have not have the time to finish. On our Christmas. Or our anniversary. Or Evan’s progress and Zach’s delay.

But not now. Because right now, the tv is blaring, Zach is screaming because he doesn’t have the words or ability to tell John he wants apple juice. I am waiting for a phone call from the developmental interventionalist because I am finally worried about Zach’s speech delay to do something about it. And once I get the call, I have to go through the gu-wrenching possibility that my treatment during the pregnancy did something to him just when I thought it was all okay. And it is finally snowing outside, mixed with a bit of rain and freezing temps that are sure to make my commute a living hell.

And right now, I have to go to work. Again.

Fuck.

Role Transition

So what’s happenin’? Well, A lot and yet not so much.

The NICU stuff is winding down as we get closer to the day where we will start keeping the really sick babies. When you have a baby at my hospital, they warn you to not let anyone without a specially marked badge in to take care of your newborn. OB staff and NICU staff, as well as Peds staff all have these badges. The core NICU respiratory team is o be no different. So today, I had to go and get a new badge. The special marking? A bright pink stripe. Mine used to have a lime green stripe. How did they know pink is my favorite color? Actually, when I got it, I was appalled. my title is written all extra ginormously and the pink is glaring. Proof?

Pink means "Gimme yo' Baby!"

So not a big deal, I know. it’s the little things. I also renewed my NRP–Neonatal Resuscitation Program for those of you not in the know. It’s the fourth time I’ve taken it and it won’t be my last, as it expires every two years. The video for it cracked me up. They actually included RT’s in the scenarios with the rubber babies. As in, “Call Respiratory Therapy STAT.” And the guy who is supposed to be the therapist shows up and says, in utter robot fashion, “I…am..the…resp-ira-tory ther-a-pist. How…can…I…help?” Yeah, whatever, Dude. That is so not how it goes. I don’t wait to be told what to do. I know my role and get to work immediately. I’ll throw elbows if I have to. Same as wih the adults.

I’m sort of nervous about the change in roles. I’ll still be taking care of adults, too. But I will be on my own with the sick preemies and it worries me. I will see what could have been with both of my boys, and I will be crying a lot. Maybe this makes me less fit to care for this patient population. Maybe it makes me more fit. I guess it’s a matter of opinion. But someone saw me fit to be placed on the team. And so I shall do my best for the little ones while I see Zach’s and Evan’s faces the entire time.

Sometimes It’s the Little Things

We cannot fix everything. People have asked me what I thought was the most difficult aspect of my career in healthcare. It isn’t the 12-hour shifts anything else about my work hours. Yes, I work a lot, but my family understands that when I am not here, I am taking care of sick people, and that someone has to do the job. It isn’t that I have yet to find a good, comfortable pair of shoes that can hold up to what it is I do to them all night. It isn’t the blips on monitors or the screeching alarms of a ventilator.

It is simply this: We cannot fix everything. And sometimes, the things we cannot fix are the ones that will completely rip my heart out. I cannot cure cancer. I cannot take home an abused baby. I cannot expain why it is that a loved one has to die outside of the realm of the logistics of science and pathophysiology. And it sucks. And so, while not all of us do, most of us focus our working hours on what it is that we can do. Sometimes, that just isn’t much. It may mean I can hold a hand. Or tell you I understand. Or get you a warm blanket when you’re cold, or ice water when you are thirsty. I always ask when I leave a patient’s room if there is anything I can do to make them and their loved ones more comfortable. Most of the time there is nothing, and this just makes them smile to know someone cares enough to ask. Sometimes they come up with something frivolous. Sometimes I don’t get an answer and I make it my job to anticipate. Little things.

It was a standard night in the emergency room. I was at the more urban campus in a poor neighborhood instead of the large suburban campus where the median income in the area is well into the six figures. No. The majority of the patients that night were on Medicaid. And drugs. They were inmates arrested and awaiting jail clearance to be taken off in handcuffs. They were young girls in with STD’s or pregnancy tests. They were drunkards found in a parking lot, completely passed out. And you would think all of this would break my heart, but you really do grow cold to this stuff. You can tell the people who are having a rough time from the people who are in that situation by dumbass choices.

Here came this patient one night. He appeared to be no different than the others at first. We was downtrodden and dirt-caked. He was wheeling a grungy suitcase like he expected to be admitted. I heard a nurse ask what was up with the suitcase as he was escorted from the waiting room to his room in the back, to which he weakly smiled through grimy, decaying teeth and replied that he takes it everywhere. He was assigned to Craig, a tough-talking RN who really can be an asshole if the situation calls for it. In fact, Craig is the one we intentionally put with the assholes. The beligerent drunks who curse and yell at us. The idots who tried to get high and overdosed to a point that they have depleted their respiratory drive, then get angry at us for giving them a reversing agent because we ruined their high. Those are the ones for Craig simply because he will respond to their abuse by getting back in their faces and speaking to them in the same way they talk to us. And I heard this patient from my desk. He was out of his anxiety medication and wanted more. A refill on one of the most comonly abused drugs. Yeah. Like we haven’t seen that one before.

But the night wore on. The board went from being filled with drug seekers wanting prescriptions to get their weekend started right, to twenty-somethings who had sore throats and wouldn’t go to a family doctor like a normal person would, to the wee hours where the ones who come in are the drug overdoses, the arrests, the beligerent drunks with head lacerations from bar fights. And this man was still there. I heard a young guy yell and curse because he had been there a long time for his earache because we were treating true emergencies before we would get to his non-urgent complaint. I heard a drunk guy in one of the psych rooms yell at the doctor because he would give him narcotics. I heard laughter from a group of 14-year-old girls who all came  in for an STD check, as if this was a social function. I never heard a peep from this man. And Craig seldom had to go into the room.

Finally, at around 3 AM, the great asshole Craig had the papers to discharge the man. The man who looked like so many of the others, but behaved so differently. Polite, quiet, respectful, appreciative…Craig went into the room, discharge papers in hand. And I heard him ask the guy if he had somewhere to go for the rest of the night, to which the man replied that he did not. And Craig told him that, so long as he continued behaving the way he was, he could have the room for the night. The tough-talking nurse emerged from behind the curtain and promptly went to the fridge to take the man a boxed lunch. It wasn’t much: a ham sandwhich, chips, and an apple. But Craig showed his soft side. He gave the man a bed for the night and a meal to fill his belly. Without being asked, he sensed this from the patient. That he needed this, and Craig responded without request to do so. As the night faded to dawn, and the clock ticked closer to dayshift, the man had to go. Craig went in and woke him. Escorted him to the restroom with soap, a washcloth, toothbrush and toothpaste, deodorant, clean socks. Allowed him to clean himself up. Gave him numbers to local shelters and other social service organization in the area who may be able to provide more long-term assistance. And as the man left, he smiled and thanked us all with eyes glistened with tears.

It really is the little things we can do that matter. The tasks may be tiny to us, anyway. I go into a patient’s room in the ICU to withdraw care and allow the patient to die. I am no-nonsense. I perform the taks as if I am doing something menial like folding laundry. One would think, from my demeanor, that I do not care. It isn’t that. I do it because this keeps me from being sucked in. From crying. But if you watch closely, it is there. It’s there in the way I smooth the patient’s hair when I am finished. Or the way I tuck the blankets up around them in the bed as if I am home and tucking in my young child for his nightly slumber. Or the way I place a cool washcloth on thier face. Not much. Little things. Because that is all I can do. I can make them a teensy bit more comfortable as they slip from this world.

But sometimes, I think it can be the little things that mean the most to the patient. And just when I start to have my doubts in humanity after caring for some of the scourge of society in that urban ER, I see what it means to be human. Not in the patients, but in the staff. The people with whom I work day in and day out can do some things that touch me deep into my core. You don’t see it at first, because we have all been doing this long enough to allow ourselves to be encased by this hardened shell. The years add the layers onto this shell to where the softer side of us gets deeper and deeper down. But it is still there. And that night with the homeless man, Craig showed me that.

I love my coworkers. When the world shows me all that is wrong with it, the people with whom I spend my nights come through to show me the very best of humanity.

 

(Please note, as I have stated before, that I abide by all rules governing a patient’s right to privacy. I will NEVER reveal any characteristics that can identify any patient. NEVER! I extend the same courtesy to my coworkers, because, hey, I wouldn’t want stories about me to pop up randomly on the internet. Quite simply, if you are reading this and it sounds familiar, I can assure you it isn’t. You don’t know the patient. You are NOT the patient. Nor are you the nurse. ALL IDENTIFYING CHARACTERISTICS HAVE BEEN OMITTED OR CHANGED. For all you know, I may have just completely made this shit up. So…Peace Out, Homies.)

All Signs Point to YES

I work too fucking much. Sorry, but the f-bomb is the only word befitting that statement. Since I am a creature of science, by nature, I only believe that which can be proven, generally speaking. And so I have proof of this statement and all are completely true stories, I swear.

• I looked at my pay stub this morning, since payroll hits my account on Wednesday evenings. MMMMHMMMMM. Bastards. My net pay was only $52 more than the amount of my deductions, of which only about $250 was by choice because I like having insurance for the fam. They took fucking half. Enjoy the food stamps, people. You’re welcome.
• Just now, someone on a tv show yelled “OH MY GOD HE’S NOT BREATHING!” And for a split second I was just about to spring into action. Knee-jerk response.
• I tried to shop for new scrubs yesterday since mine are getting a little worn. And old. And I haven’t bought any new ones since I was 3-months-knocked-up with the Zachmeister. Damnit. I walked in and must have looked rather haggard, and the girl struck up a convo with me about where I work. And I told her. And she said this: “Where do you work there? Housekeeping?” (DISCLAIMER: Nothing wrong with housekeepers other than they are grossly underpaid. I’m just saying that I looked like shit and she assumed I was poor, underpaid, and overworked. She got the friggin’ overworked part right.)
• When I walked into the same store, I swear the sight of all of those scrubs–from white to neon-farking-green–made me nauseous for a minute or two.
• Yesterday, John and I tried to leave the house for some random errand. I had on a tee and denim capris with flip-flops. I knew in my head what we were doing. But nothing more than sheer habit made me reach into the little basket on my desk where I unload my work stuff every morning, and I actually put my damned stethoscope around my neck and grabbed my badge as I headed for the door. It took John cracking up with laughter to make me realize what I had done.
• John has ceased to ask me when I have days off. Instead, he looks at me and says, “What do you work tonight?” Because one just assumes I have to work something, whether that be a 4-, 8-, or 12-hour shift.
• I bought a perfectly good pair of gym shoes last month with the intention of wearing them to work. They look brand new, but feel like they are worn out because they are–on the inside.
• I have a stretch of 7 whole days off starting on the 14th. I was going to try to make plans to do something with them, like get away just for a bit. I know better. So instead, I am wondering how many of them I will actually get off. Surely someone will get sick or need a day off and I will be called at some point during that week.

So yeah, I work too much. It’s a combination of factors that make me do this, really. A sense of obligation to my coworkers. Money. The fact that I have worked too many nights where we are grossly understaffed and I know what it is like to work under those conditions, with a hospital full of really sick patients who have to have our care. I hate having my coworkers work under these conditions when I can help them avoid it by coming in on my day off. But it gets to you. You turn into the job. And it ends up that your whole life is wrapped up in your place of employment. And then it gets to be too much and there is a sort of breakdown where you know you simply must have some time off in order to avoid complete devastation in your life. So you take a couple of days before getting back to it.

I am at that point currently.

>How NOT to Get a Job

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Let me set the scene for you: It is 3 AM. I have been busy as all hell because A) people keep trying to die in the hospital and we have had more codes than I thought possible in one shift. And I have the main ICU. And B) I already have 10 ventilators going. 10 patients on life support, and they keep coming because you go to the ICU when you unsuccessfully try to die. Plus I am in charge, and I have one guy who is in a code and I am getting called for all of his patients he can’t get to because of that. And C) they are complete bullshit calls. (Example: I got called all the way to the psych unit for a patient “not breathing well at all” and I get there only to discover he has a stuffy nose. That’s it. Clear breath sounds, 99% on room air. But he has nasal congestion. Seriously? I have people who aren’t breathing without my help and I get called for that???) And so I have come back to the department for a brief second to wolf down a sandwich and a Diet Coke. And the phone rings.

Ringgggg, Ringggggg.

Me:”Respiratory, this is Andrea.”

Caller:”Andrea, are you an actual therapist there at that hospital?”

Me:”Yes, I am. How can I help you?”

Caller, to be known from this point on as MORON:”How many therapist do you have there with you?”

Me:”Ummmm, who is this?” I’m kind of creeped out by the question.

Moron:”My name doesn’t matter. But I saw you have a full-time night shift position opened. Will you hire a CRT? Because it says the position is for an RRT. “

Me:”Well, we hire therapists with their entry-level credential contingent upon them completeing their advanced practice credential within a year of their hire date…..”

Moron:”DOES THAT MEAN I HAVE TO TAKE THAT TEST?!?! I hate taking tests. Tests are boring. And that one is expensive!” (She’s sounded very agitated now.)

Me:”Well, there is quite a difference in pay between a CRT and RRT, so it pays for itself pretty quickly.” (I’m thinking that this girl is an idiot if she thinks this is the way to get a job. And obviously lazy if she doesn’t have the gumption to take the steps to get a credential that will further her career so much.)

Moron:”Okay, whatevs, how many patients do you have right now?”

Me:”Well, in the hospital we have about…..”

Moron:”No, not in the hospital. How many patients do you have? Right. now. How many units of the hospital are you covering? And how many therapists do you have there tonight?”

Me:”Well, we have 4, which is standard at night. I have the MICU, and I am covering all of the patients in that unit. There are 10 ventilators running up there right now and…..”

Moron:”OH MY GOD! Do they always work you like that??? I heard they did. I work at XXXXX now and I only have 2 treatments to give before 8 in the morning. That’s what I’m used to. I don’t like to work a lot. Or very hard. Ewwww. And a ventilator? I hate running vents. I haven’t run a vent in 10 years.”

Me:”Ummmm, we are usually pretty busy here. And since there are only 4 therapists in house at night, all of us may be asked to handle a vent or an intubation, even if we aren’t assigned to an ICU…” (Okay, now I think I may be being punk’d. Where’s Ashton?)

Moron:”Whatever, I guess I can try it. Where do I fill out an application?”

I had to give her the website where she can apply online. And I had to tell my boss this morning that if anyone calls who works at that hospital, to please not hire them. Who? Who really tries to get a job like that? Especially in our current day where even healthcare professionals are having difficulties finding jobs. I mean, when I applied for my current position, I called. But when I called, I spoke with the director of my department and simply asked, in a polite tone, if they had any available positions for a registered therapist. He asked me a few questions about my experience, and before I had even completed an application, HR had called me to schedule an interview. I actually completed the application and submitted my resume at my interview. But I was polite. And professional. And was eager to work. And motivated. Really.

So we really do have an open night position. And I swear I will die if this girl comes to work with me. Absolutely die. The last thing we need on night shift, where the staffing is bare bones, is someone who doesn’t want to do the job.

God help me. What is wrong with people????