Lament of the Non-Nurse

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Healthcare is all about nursing. I understand this. With 77% of non-physician roles in U.S. healthcare being those of the nursing variety, I can understand. They are the backbone of our hospitals. I am not a nurse. I had the option years ago, and I decided that, with poop being my Kryptonite and all, it would not be a wise career choice for me. I opted, instead, to help people breathe for a living. Thus I became the respiratory therapist. That choice has come back to haunt me in several ways.

The first of these started when I wanted somewhere to go from here. Nurses have so many avenues they can take to do this: become an instructor, a case manager, management at their facility, become an NP. What can the respiratory therapist do? Well, aside from becoming a Registered Respiratory Therapist from the entry-level Certified Respiratory Therapist, which I did the month after I graduated from respiratory school, there is nothing. Bachelors programs in respiratory are just starting to emerge, but a BS in respiratory gets us no more job perks, no more pay. You just get to say you have it. The majority of my bachelors-having coworkers got theirs in “health sciences”. Whatever that means. So instead, I opted to finish my BS in business administration with the added concentration of healthcare management. But then what? If there are only a handful of BS programs, there certainly are no masters programs. But my BS is in business anyway, so the MBA was a no-brainer.

So here I am. I am one of the more educated in my department, even in the hospital. My MBA is complete. I did well. I did it. So now what? Now I find a job.

I thought this part would be easy. Well, not really easy, but not this difficult, either. Let’s discuss my situation: I have spent the past eight years of my life working in the toughest in my field–adult critical care, and eventually NICU. To the layperson, let me explain further: I am a member of a critical care team who responds the emergencies in the hospital. We are called in when you or your loved one is at their sickest. We bring our skills, experience, and knowledge to you, make recommendations to the physician based on all of the above. We communicate with other members of the team, with family members, with patients. We assess and decide, then act. Repeat as often as necessary to the point that it is second nature to us.

So what does this tell you about me? Well, it tells you I can effectively communicate with anyone. I have non-English-speaking patients, when I am most certainly unilingual. I have deaf patients, blind patients, patients who are intubated and cannot talk, trached and cannot talk. My job is to find out what is going on with them rapidly enough to act. I have become, over the years, a master lip-reader. But that’s not all. The people with whom I interact each and every day have been anyone from a PhD-holding professor who was ill, down to a man whose education was limited to elementary school before he was put to work out in his family’s fields. On our professional team, we have everyone from housekeepers and registration clerks, who may only have a high school education, all the way up to senior management and physicians with advanced degrees. I. Can. Effectively. Communicate. With . Anyone.

Now for my work. It may involve looking at lab values that seem to others to have nothing to do with the lungs, but actually do. Watching vitals. Seeing how the patient breathes. Assessing vital signs. Looking at patient history to see what clues I can find. Listening to family members who may not speak the same lingo I speak. Look at x-rays, watch for clues. And I look at all of this, and since the physician is not there, I have to decide when we need to be concerned, when to call for more help, what I can do to help. So in a split-second, I have to take in this information from multiple sources–complex information at that, compare it to the knowledge stored in my brain, and formulate a plan on how best to proceed.

And under stress. The patient is either having trouble breathing, or even has stopped breathing, when I have to do all of this. Maybe their heart has stopped. Maybe their oxygen saturation is low. Regardless, I don’t often have the luxury of being able to take my time. I need to make a decision and act now, now, now. And while nurses have anywhere from 2 to 6 patients to care for, when I go into work, I have the respiratory histories of at least a few floors’ worth of patients in the back of my mind or in notes in the margins of my printed work assignment. If you figure the average respiratory rate is 10-20 breaths per minute, and there are usually 30 patients per unit, that it 36,000 breaths for which I am responsible in one hour of work on just one floor of the hospital. And I May have three or four floors. That’s a lot of responsibility and a lot of stress.

And I have done this for years of my life.

And then I got an MBA. So I understand finance and strategy, management and business law, marketing and accounting. I have been educated thoroughly in all of the above from a nationally-ranked program at a well-respected university. Add that to the ability to communicate with anyone, the ability to work under stress, the ability to extract complex information from multiple sources to formulate a plan….Nothing should stop me, right?

Wrong.

Because I am looking through these jobs, and seeing that many of the leadership opportunities are asking for someone with a nursing background. Why? No idea. We respiratory therapists go everywhere. A nurse may be hired to work in one specific unit. I can go anywhere in a single night, giving me intimate knowledge of the work flow of every patient care area of the facility, from behavioral health up to the ICUs. And I know healthcare. And I know business. At first, I noticed this trend, and I was a little discouraged, but I figured that I would find the right role  But today, I came across a posting for a pulmonary unit. They need a director. Perfect. Except, as I scrolled down reading the job posting, toward the end, it listed a RN as one of the qualifications. They want someone with my clinical experience, an MBA….and a RN.

It is what we all deal with everyday–we non-nursing patient care staff. We are skilled, we are experienced, we are valuable to patient outcomes, but this is the hand we are dealt, and frankly, it sucks. Part of me wants to just go to nursing school for a couple of years so I can say I did. But I shouldn’t have to do this. I have worked hard. I have done well, completing all three degrees with academic honors. I have the experience under my belt. This is just ridiculous.

Nursing is the backbone of healthcare, but I have yet to see a backbone accomplish anything without limbs, without muscle to hold it upright, support it and ensure it can move and flex in the ways needed. And it’s high time that the rest of the body gets some respect.

These are the Days

16 Days. Of course I type that while I am supposed to be awake putting together a 45-minute multimedia presentation on integrated marketing practices for class tomorrow. My final project for a marketing elective to round out my requirements for the almighty advanced degree. John, in his awesomeness, brewed the strong coffee for me before turning in for the night. And I can’t quit thinking. I can’t quit thinking, not of integrated marketing as I should be, but of the uncertainty of my life right now. Have you ever been in a place where the things you spend your days doing no longer feel like they are what you should be doing? Where you feel like maybe your real life awaits you, if only you can survive this short little interim? That is this place. These are those days.

My views may possibly be skewed. I realize this. There are people who have devoted their entire lives to do what I have done for the past eight years. They keep doing it, content with their contribution to the world. There is absolutely nothing wrong with that. It is honorable. I’m not selfless enough. I feel like I have spent the past eight years paying dues to the world, to my being in general. To the spirit of my mother, who died from lung disease. I’ve been a good girl, and I have been good at my job. There are, in all honesty, people who are breathing today because of the work I have done. I have been there to help babies who could not help themselves. I have been there when families have said goodbye to parts of themselves. I have wiped brows of the dying, delivered tough love when necessary, compassion when it was needed. I have put myself and my family last. And now, after all of these years of doing that, I want to do something different, and in my warped mind, I have earned that. Not because I will, in just 16 days, have a piece of paper with my name in beautiful calligraphy saying I have completed some requirement set forth from society, but because I have paid my dues in other ways.

People ask me what it is I want, and I always answer with a “we’ll see” kind of shrug. I love healthcare, am passionate about healthcare. And I want to leave some sort of mark on this industry that is on a higher level than the one I am currently leaving. And I want to do so in a way that allows time for me, time for my family.

Lately, I have been thinking a great deal about my path through higher education as a non-traditional student. Evan was about 2 when I put on a  backpack for the first time since my mom died, which was eight years before that. Evan is 12. I will finish this long road about 2 weeks before the ten-year anniversary of that first time back. And I have thought about it. I have allowed myself the luxury of pondering just sucking it up, reaching deep, and going straight into a Ph.D. program or a JD, even. And then I think of them. Of Evan and Zach, of John. And what I want is no longer about a higher degree or prestige. Now, when I think of what I want, it isn’t grandiose at all. It’s simple stuff. Little things that aren’t luxuries to most, but have been to me in these years where I have tried to do it all.

I want to come home and not have to rush off to class, be able to eat dinner with my family at a normal hour around a table with food we prepared at home. I want to watch a movie with John without worrying about homework I should be doing or, better yet, am actually trying to do with said movie playing in the background. I would love to take the boys to a movie or park on a weeknight for no reason at all. Maybe even go on a weekend hiking trip. Maybe John and I could have a real date once in a while. Or I could read a book that has not a damned thing to do with academics at all. I want to blog more. Maybe I could revamp this one a little bit with all I know about social media marketing and content creation these days. I want to join a gym and be able to go–and not some lame attempt a a resolution where I don’t have the follow-through because, hey, thinking I would even have the time for a workout each day was optimistic at best, even closer to being the world’s dumbest idea. No, I want to actually go. And work on myself a little bit, and not just on cramming my brain with as much knowledge as possible.

It’s so strange to me. When I started this, I thought, “MBA: the CEO’s degree. I’m want to be loaded.” It isn’t about that anymore. It’s about enjoying life and having the means to do so comfortably. There is only one material possession I even want, and it is going to sound worse than it is: that new Mercedes CLA 250. Sounds greedy and ridiculous, right? No, because in reality, it is only about 3K more than I paid for our current car and I bought it used. And the current car is too big for me to feel comfortable driving with my vision issues. So sounds crazy, but really isn’t. But anyway, here I am at the end, and the salary isn’t the thing anymore. The job is, the career is, the comfort is, but the money isn’t. And I am saying this about 2 days before I have an interview for a position that would pay more money than I have seen in my life–about 5 times my current salary. And now I suddenly don’t care. Well, I mean, I care in that there is a minimum I can take. I worked hard and paid a lot of money for my MBA. I can’t just give it away. But money isn’t the key determinant.

So here I am. Sixteen days from the big finish. And it feels like everything in my current life is winding down so I can start the new one. So these are the days. The days of excitement, of anticipation. Of anxiety and uncertainty. Of endings and new beginnings. Of wrapping up and starting anew. Of sheer panic mixed with resolution and calm.

These are the days I have to let go and hope it all works out, that it proves to have been worth it.

And if it does work out, these are the days I get to lean back, prop up my feet, and tell myself that after ten years, I earned every damned bit of it.

So Long, My Toxic Friend

458980Yes, I know I’m a respiratory therapist. I had a reply for people who would point that out to me: “Haven’t you ever heard the phrase, ‘Do as I say, not as I do?'” Or I would tell them that, unlike my patients, my lungs were healthy and I was not in a hospital bed.

I’m not stupid. Perhaps one of my coworkers summed it up the best: “Andrea, you aren’t stupid. Far, far from it. You’re a very smart girl. You just aren’t being very wise by continuing to smoke.” So the part of me with a brain knew that I was being a hypocrite, knew that I could use the defense that I wasn’t laying in a hospital bed.

Not yet.

You’re probably judging me right now. And that is fine. I have been a smoker since I was 21 years old. I put down the cigarettes when it was required to grow healthy babies. I banished the habit to outside when juvenile lungs took up residence in my home. As a healthcare professional, I can tell you that I never bought the idea that the odor of smoke on clothes was as bad as breathing second-hand smoke any more than the mere odor of marijuana makes you high. If you are allergic to smoke, I can imagine that the residue can be an irritant, but for the average person? I just could not believe it.I was content to just go outside. If I was outside when the kids were outside playing, I would move far, far away. Both my kids and those of others. I never smoked in restaurants because I don’t like to taste smoke with my food. If I was outside smoking somewhere and someone came up to sit next to me, I would ask them if it bothered them and then I would move away if they said it did. I was a conscientious smoker. I made great strides to ensure that the only person I was hurting was myself.

The problem with this is that I lost my mother to smoking-related lung disease. She probably only thought she was hurting herself, too. Now there are two little boys who will never meet their mom’s mom.

I have tried to quit more times than I can count. I can feel the changes in my body. I am a respiratory therapist, for shit’s sake. I know. I know that I am most likely to the point of irreversible disease. I knew all along that, while I could not change that, I could halt the damage in its tracks. And so I tried. Patches. Gum. Lozenges, Tapes. Wellbutrin. I even tried those Nicotrol inhalers, thinking that would be the miracle since it also replaced the physical act of smoking. I’ve tried support groups and keeping journals, all the while feeling stupid that I was having this much trouble with giving up cigarettes. Not crack. Not crystal meth. Cigarettes. A few years ago, I did have some luck with quitting. I was one month into treatment with Chantix, and in the middle of pre-med. I thought it was the medicine that was making me so queasy, so I would skip it, waiting until I had a solid meal to take it. Problem was tat I never got solid meals. My meals consisted of grabbing a granola bar between classes and grilled cheese sandwiches from the hospital cafeteria in the middle of the night on my lunch break. I stopped the medicine and picked smoking back up. And then discovered I was pregnant with Zachary.

With the exception of pregnancy-related quitting, I would always have the same reaction to lack of nicotine. I wouldn’t just get irritable. I would literally go crazy. I could be sitting with you, having a benign conversation about the weather and just burst into tears. My tolerance for anything would be so low that I would become completely dysfunctional. Once time, I got so upset that I had found a speck of missed food on a supposedly clean plate that I threw said plate at John’s head, leaving a massive knot. His response, instead of having me arrested, was to recognize what the true problem was and go and buy me a pack of cigarettes. He returned to the house with the pack and a new lighter and ordered me to smoke. For this reason, quitting scares me. I have a successful education going. I am good at my job. I have two children I love more than anything. I cannot allow myself to fall apart.

On the other hand, John’s heart cannot take exposure to any second-hand smoke at all. I need to be around for him. For the kids. I have to give it another go.

They tell you that in order to be successful, you have to want to quit for yourself. Maybe I am sick in the head, but I am more likely to quit for John and the boys than I am to quit for myself. I love them so much that I will do anything to give them what they need in life.

So nine days ago, I started Chantix again. I smoked my last cigarette almost 72 hours ago.  I have not killed anyone. I am not suicidal. I have only cried a few times, and it was soft, subdued tears instead of violent, crazy-bitch sobbing that would have taken place during other quit attempts. For the first time ever, I really feel like I can do this.

I want to document the process. I am hoping this will add some accountability, but I don’t want to turn the blog into a smoking cessation website, either. I rather like talking about whatever the hell I want on here without a real theme. Instead, I’m going to create a new tab. If you want to follow along, feel free. Maybe someone will be helped. Who knows?

But wish me luck, because I am taking this on at the same time I am taking on major lifestyle changes for John’s heart. Wish me luck.

NICU RT Confessions

So recently, I have been working the NICU more than I have been working with adults. It isn’t my favorite place to work, but I like it. Just so you know, my favorite will always be adult critical care because it is so…familiar. I have spent the brunt of my career (to date) taking care of the sickest of our adults. The NICU is interesting because it is a challenge. The critically ill newborn is not just a small version of a critically ill adult. There are new intricacies, new puzzles to solve. New. My inner geek loves the challenge–the part of me at my core that isn’t happy unless there is something interesting to do, a new challenge to tackle. Some of us went into the field because we wanted to cuddle little babies. I’ll be honest here: that just isn’t me. I like babies, but I like my own. I like kids if they are my own. I can look at your kid and think they are adorable, but I am just too no-nonsense for the goo-goo, gah-gah stuff. But I am a NICU respiratory therapist. Because someone told me I should be. Because I am good at my job.

So I have a whole new and different set of challenges, and oddly enough, several of these have nothing to do with the functioning of a neonate. I have personal challenges. Issues that reverberate to my very soul. And suddenly hardcore, no-nonsense Andi isn’t so tough. So here is my little list. My confessions.

1. That moment when I am called. There is a 30-weeker being delivered by crash c-section and I am needed in the OR, Stat. My heart still skips a beat and I still wonder if I am good enough. Will I know enough? Will I be able to help? What am I walking into?

2. That moment? You know the one, right? Where a new mom is born. And the room quiets except for one little cry. And my emotions are fricken traitors and my eyes get moist. Because to cry is to be healthy. And isn’t that what the parents wanted? And there is a new person in the room. It is absolutely awesome, whether that new person entered via guts and determination of the mother, or whether there was a surgical incision involved. It’s still the same to me. It should be to all of us. And I have just taught myself a lesson: to let go of the issues I have with the way my boys came into the world. They came into the world. That’s all I need.

3. If you name your child something stupid, I will make fun of you behind your back. Sorry, but you kind of deserve it. If we tell you your chosen name for your baby is “interesting”, that means we think it is the most ridiculous thing we have ever heard.

4. I got attached this past spring. I was there for 4 days straight. I was called to the OR for the delivery of a mom who almost died from blood loss. And she could’t see her baby for days. I resuscitated the baby. I kept him alive. I worked my ass off for four days straight. When he was crying because he was hungry, but he couldn’t eat. When he just wanted to be held, but any disruption made his heart rate plummet too low and his oxygen saturation bottom out. And his mommy was too sick to be there. So I leaned over him, with my hand on his little diapered butt and the other hand on the top of his head. Gentle pressure so he felt like he was being held without being held. So he could have some comfort without coding on me. And I was off for awhile. When I returned, I worked with adults. He was gone. He went home. He and mom both recovered. I had done a good job. And it affected me so profoundly that I cannot put it into words. And I still wonder what happened to them. So now I am distant. Forgive me for that. I have to be.

5. Last night, I resuscitated a 33 weeker. Zach’s gestational age. I wanted to tell the scared parents that it would be ok. That before they know it, there will be a robust toddler destroying their home. But I can’t do it. Because every baby is different. And just because it was all ok for us doesn’t mean it will be for them. Their baby came out not breathing. About half of Zach’s size. A heartrate low enough that we had to perform chest compressions. And then I start to wonder. Why us? Why them? And I see Zach’s face and I fight, fight, fight. I become over-invested. Because, while our efforts worked last night, there will be times when they do not. Last night could’ve been one of those times, and I know that my soul would’ve been crushed.

6. There are ugly babies. I’m sorry, but there really are. All that matters is the parents think they are amazingly beautiful. I just don’t tell them the truth.

7. We judge you parents. If you are pieces of shit, we know it. When you go out for “fresh air” and come back to your sick baby, covered in the residue of smoke. When you come back positive for drugs. When baby looks nothing like Baby Daddy but mysteriously like Neighbor, who is Baby Daddy’s BFF. When you are overbearing and, though you mean well, you try too hard and impede the necessary medical treatment of your very sick kid. Secretly, I want to take the baby home with me. I want to tell you that you are a piece of shit. But I cannot. We don’t leave the door to the room open so we can “hear alarms”. Those alarms sound throughout the whole unit. We leave the door open to supervise your ass.

That’s all for now. I have to get ready to go to work. NICU again tonight. More later.

 

I Can’t Afford It: The Inevitable Rant About PPACA from the Inside

I don’t usually get all political up in here. It just isn’t my thing. I have read countless comments on Facebook about the Supreme Court’s decision about the Patient Protection and Affordable Care Act. That shit is everywhere. And everyone has an opinion. “Everyone is entitled to healthcare…” Yeah, okay. Great. Kumbaya, and all of that jazz. If you are disadvantaged and need medical coverage, and there is a way for you to get it, I am all for it. We have programs like that in the U.S. We have for decades. Yes, they suck a little more than the insurance one pays for electively. If I am out of food, and I go to a food bank to get food for my family, the items I get, though appreciated, are not of the same quality I would buy if I went to the grocery store and shopped for myself. You take what you can get. I’m sorry to sound so blunt, but it’s true.

I’ve said it before and I am going to say it again: I used to not have insurance. John worked at a job that paid him $8/ hr. and the benefits were almost $700 per month. Evan was a newborn. So I took an eq\ually crappy job as a housekeeper at a hospital where the insurance was about $400/ month. I essentially  worked for the insurance When the income got to be too little, I went to work on a degree that would pay me what we need, both in income and in benefits. And I’m not afraid to give you the straight dope, though it is poor etiquette. I gross over 8 thou a month. I bring home about 4K of that. What???? Why? Well, simple, really. I pay over half of my income on taxes and pesky little necessities like medical, dental, and vision insurance. Right now, that is the lay of the land. It is how the shit falls.

So while I am not too keen on spending even more of my very hard-earned money to support those who did not have the wherewithal to go out and do what I did–find a beter job, better benefits—I simply cannot afford it. I am not living high on the hog. We have one car. My husband rides his motorcycle in good weather to save on gas. We try to limit our dining out these days. I clip coupons. We live in a house that is way below our means because it is cheap despite being in a nice, white-collar neighborhood. And though I am off for my neck and shoulder right now, I work every God-forsaken hour my employer will allow me to work in order to make more, to pay more in taxes…you get the drift. I cannot afford more of my tax dollars to go to support your healthcare. I will take care of you when you are ill. I will risk contracting any infectious disease you are carrying because someone has to. But I am not willing to sacrifice the well-being of my children to pay for you and yours. I’m sorry.

And there are other misgivings I have about PPACA. This part is coming from a healthcare professional who works in the trenches, from someone who is wrapping up a degree in business \with a concentration in healthcare management. Hospitals rely on reimbursement. They do. The naional average for Medicare and Medicaid reimbursement revenue is around 60% of hospital revenue. The hospital I work for receives about 80% of their revenue from Medicare and Medicaid. That’s a big ol’ piece of the pie. The pie that determines the amount they can do for their community, the services they provide to their patients. And guess what! For added fun, those coffers are getting pretty shallow. Hospitals are fighting harder for less dollars. And we can expect more and more of these patients. This would seem like even more reason for the PPACA, right? Nope, and here’s why:
The PPACA also has implications for providers. More stringent guidelines to provide more cost- effective care. Nothing wrong with that. One of the yardsticks with which providers will be measured is their readmission rates. Currently, there are a few diagnoses where hospitals are penalized for excessive readmissions. As a part of the PPACA, four more will be added by 2015. One of these is COPD.

And that is whete the respiratory therapist in me gets all fired up.

COPD. The bain of my existence. My livelihood. But these are the worst patients that CMS can use to penalize hospitals for readmissions. I understand the concept: if we’re doing our job, the patient won’t be readmitted within a certain time frame. The problem is this: while some COPD patients are dream patients, I would say the majority of my patients are non-compliant. They won’t quit smoking while their alveoli fight with each other for every breath. They pick and choose which of their respiratory meds they take and when. (No, inhaled steroids are not going to work if you only take them as needed, and you should not stop taking them just because they don’t work as rescue inhalers.) And toward the end, they could be in and out of the hospital every week. So if hospitals stop getting reimbursed adequately for these admissions, they lose progressively more money as time goes on. That is the same money they use to attract and recruit higher-credentialed staff. The same money they use to provide indigent care. The same money they use to obtain equipment. To maintain equipment.

But my other problem? We all speak of the access to care. Well, if you live in the U.S., you have access to care. If nothing else, you can go to an ER where we have to evaluate you. That is access. What is truly lacking is a way to pay for it.

Is the U.S. healthcare system having trouble? Yep. I don’t blame hospitals or providers. I don’t blame insurance providers. Thete are many pieces of the puzzle, in my humble opinion. Lawsuits. Malpractice insurance. ER abusers ( by this, I mean drug-seekers, etc.). Doctors being forced to practice defensive medicine. (And if you don’t buy that, ask me and I’ll tell you the crackhead story.) Drug patents. And us. Yes, us. We want the latest and best. When a standard x-ray is sufficient, we still want the CT. When a cheap generic drug will work, we want the brand. And doctors are stuck. Patient satisfaction is a reimbursement buzz word, and if they don’t give us what we want, we get upset and don’t stop until we get it. Whatever it is, it may not be the most cost-effective, or even the most effective. We need to leave doctoring to doctors.

So, yes. I am a healthcare professional. I am hopefully a future hospital administrator. And for all of these reasons and more, I am completely against the PPACA. And I will vote accordingly in November.

Things that Hurt When Your Rotator Cuff is Effed Up


So it would seem that, when one is a passenger in a car and is wearing a seatbelt, and the back passenger car is hit with enough force to throw the car sideways into one’s yard and bend the damned frame, one can suffer some pretty major injuries. And at first, it may seem like just general muscle soreness. And it will hurt a little bit when one makes certain movements, much like if one had overdone it at the gym a couple of days prior. Or maybe one lifted a toddler the wrong way. But when one is stubborn and refuses treatment, thinking it is minor and will just go away, one is making a big-ass mistake.

So yeah, that’s me. I should’ve known something waas wrong, as pulled muscles don’t not get better over almost 2 months. And I don’t go to the gym. The only lifting I do, other than random child-lifting maneuvers, is a fork to my mouth. Still, it hurt to lift my arms to the side. I could lift it straight forward, but not to the side. “Abduct” for my A&P cronies. (Hells, yeah, I remember my terms from Human A&P 101!) I knew I was sore from the accident and my ER peeps warned me that it would take awhile for the soreness to go away. And, incidentally, “awhile” is a relative term. “Awhile” as in a week? A month? Maybe two?

But it wasn’t getting better and John and I had justt discussed that I probably needed to get it looked at. The pain wasn’t excruciating. Just a little annoying. But we forget sometimes. We forget that I am the dumbass who, after having my left knee reconstructed, walked my happy ass in the house without crutches because, hey, it didn’t hurt that bad. I am also the crazy one who had 50+ contractions an hour for months with two pregnancies, and only wanted to go to a hospital if the baby was coming out. My pain tolerance makes me no such a good judge of when something is becoming a problem.

So Friday night at work, hell unleashed. Lucifer came out of his underground shell to teach me that I am not invincible. We had 10 codes in about 5 hours, some of which were simultaneous. Most of them were on my pattients in the ICU. The bad news is that, even if they weren’t, if resuscitation attempts are successful, they are coming to me anyway to keep them alive. There were hours of chest compressions, hours of being hunched over a bed, clasping a mask to patient faces while I bagged patients during CPR. There was lots of pushing/ pulling ventilators and other life support equipment, crash carts, etc. up and down hallways. The shit went on for hours. And let me tell you something about CPR if you have been fortunae enough to never have to use the little outdated Red Cross card you have in your wallet–chest compressions? on a real human? They’re quite a workout. I mean, you’re pumping the chest 100 times per hour at a force that is enough to break ribs. And bagging a patient? Whose body has its own agenda? Well, that kind of takes a little bit of force, too. One day, I swear, I will have Popeye forearms.

So after all was said and done, my entire body was sore. And my arm? Well, it was screaming at me. SCREAMING! Still, I popped some Motrin and went to bed. And went back to work. More ICU fun. And by Sunday, I wasn’t worth crap. I couldn’t lift my right arm to wash or brush my hair. I couldn’t lay in certain positions. I couldn’t even lean against the back of the recliner unless I was positioned just so. When I tried to do homework and struggled, it was time and I went to the ER.

Fuck.

The hypothesis–and I say “hypothesis” because we can’t be sure until a specialist sees me–is that my right rotator cuff was injured in the accident. And that, after said accident, my retardation and stubbornness have resulted in a worseniing of the injury. And thus I have to see an orthopedic surgeon tomorrow. But nothing prepared me for the stupid list of things that would hurt, and I was told that, if it hurts, I shouldn’t do it until further notice. So here is a list of the stupid shit I cannot do, and somewhere in cyberspace, there is someone reading this who googled “rotator cuff injury” and ended up on my stupid post. I’ll bet that person is pissed. If that’s you, feel free to leave a comment to let me know.

Bitchypants’ List of Shit That Hurts When Your Rotator Cuff is Effed the Eff UP

Washing my hair

Brushing my hair

Coughing

Liftting a toddler

Picking up a single fucking toy from the floor

Pulling the refrigerator door open

Pushing a anything

Driving

Rotating my torso

Writing-yes, writing–it hurts to push the pen that little amount

Highlighting passages in my text books

Laughing too hard

Putting on a sock and shoe

Getting dressed

Wearing a bra

Reaching for anything

Turning the page of a book

Cutting food with a fork (If you think about it, it involves pushing the fork into the food.)

Laying on my side/ back/ front. I guess I’m supposed to sleep on my head.

Wiping up a spill

Typing for a long period (short bursts are okay.)

…..

I’m sure this list will grow as I try do more and discover whatever it is hurts. I will not be shocked if the orthopedic surgeon immobilizes my arm tomorrow. I will also not be shocked if I end up having my fat ass shoved into the narrow tube of an MRI scanner sometime this week. More later.

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.