On Call, A Timeline

Managing the right staffing levels for your business is key to maximizing profit and maintaining employee satisfaction. I know this because I watched one of the business channels once. Also, I had a subscription to the Wall Street Journal for three months in 1999. For most businesses this isn’t rocket science. Even restaurants that have variable customer flows can track trends and mostly know which holidays and events are going to impact their staffing needs. Hospitals, on the other hand, are the dumpster fire of staffing and resource planning.

In a nutshell you fully staff every floor weeks or months in advance because you have zero idea how many people on a given day will decide to walk into traffic while texting, or will perform the infamous – “hold my beer, watch this” routine. The end result is some days every room in the hospital is full, and some days half your floor is empty.

The hospital is terrified of having to pay for a gaggle of nurses with nothing to do and access to closets full of cool medical supplies. Stedy Stand® jousting tournaments in the hallway, syringe darts, compressed air + tubing + tape + wheelchairs… a MacGyver playground. The chaos and mayhem that would ensue is unimaginable.

The brilliant solution is to wait until about an hour before the next shift starts, realize “oh crap, we have too many nurses” and then then start calling people to put them “on call”. On call means that I get paid approximately 75 cents an hour to sit at home and wait for “the call”. The rule is that when I get “the call”, I have 30 minutes to be at work. You can’t go anywhere and can’t start any type of project in which immediately dropping what you’re doing would be a bad thing.

So the “on call” timeline usually looks something like this:

0530  – Phone rings, you’re officially “on call”.
0530 to 0730 – Happy dance, more coffee, catch up on whatever social media outrage happened overnight, more coffee, renounce all social media, more coffee.
0730 to 0800 – Make serious plans for completing home projects: Laundry, organizing Tupperware drawer, clean-up the workbench and put away tools from some project three weeks ago, replace all burned out lightbulbs and smoke alarm batteries, start writing a best selling novel.
0800 to 0845 – Check social media to see if there’s suddenly world peace and political harmony. More coffee.
0845 to 1000 – Carry load of laundry to basement, get distracted by dog barking and then start watching YouTube videos.
1000 to 1100 – Check the fridge at least four times in case anything new magically showed up. Watch a breaking news story about a grain elevator that collapsed somewhere in North Dakota. Spend 15 minutes Googling grain elevators. Decide the coffee isn’t working and you’ll just close your eyes for a couple of minutes and then start your projects.
1138 – Phone rings, you’re no longer on call and need to go in.

Dammit, how am I supposed to get anything done?

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What I’ve Learned

In my short career as a nurse, I’ve learned a couple of things. Mostly that it’s frightening how much I don’t know. It’s a very interesting thing to throw yourself into something that has such a steep learning curve, but with serious real-world consequences… I’m not sure yet if 12 straight hours being scared to death you’re going to accidently harm someone is good for the blood pressure. Anyway, I have managed to learn me a few things I thought I’d share. For context I work on a neuro-spine floor. Spinal surgery, brain surgery, traumas, strokes, seizures, dementia, Alzheimer’s.

• Your mom was right – wear a helmet. ALWAYS. I’ve been guilty of this. It takes surprisingly little force to cause a life altering injury. Just wear the damn helmet.
• It is possible to only pee once in 14 hours. Not recommended, but achievable with practice.
• Drugs in large continuous quantities tend to be bad for you. Forget Mrs. Reagan’s failed campaign, every junior high class should be forced to take a field trip to my floor to see the actual impact of drug use. Whod’a thunk taking too much meth could cause a stroke? The official term for the resulting brain impact is ‘summer squash’.
• My patient load is 5. That means I get to devote a massive 12 minutes per hour ensuring you’re still breathing or not otherwise declining in a way that would look bad on my record. Let’s just say that the numbers don’t add up, even on the most routine shifts. Somehow it all works.
• People are dumb, frightening animals. I’d estimate that only about a third of the population are what you’d consider normal functioning humans who can cope with daily life. It’s very scary how many people are out walking amongst us who really don’t have any grasp on basic life skills.
• As a society we take too many pain pills. Everyone seems to think there’s a magic pill that will take away all pain… and I’m selfishly choosing not to give it to you. Sorry, but a subdural hematoma and multiple skull fractures is going to hurt. A lot. Yes I could give you more opioids, but I’m pretty sure continuing to breathe is important. I think I read that somewhere in anatomy and physiology.
• Speaking of pills, people have the most bizarre rituals for swallowing ’em. You’ll happily swallow a massive chunk of steak the size of campfire marshmallow, yet swallowing a tiny little pill is like coordinating a moon shot. Water must be the exact right temperature, you must pre-moisten your mouth with exactly three sips, the pill must be carefully placed in the exact right position on the tongue, and you must swallow slowly while staring at the ceiling followed by half a glass of water to wash it down. Could you imagine eating an entire meal the same way you took pills? Dinner would take six hours and you’d drink 2 gallons of water. Considering each patient takes about a dozen pills… you can start to see why the allotted 12 minutes per patient doesn’t add up.
• The various forms of Alzheimer’s are truly one of the most horrible diseases out there and it gets very little attention. The thought of it scares me.
• If you tell me your pain is 10 out of 10 while talking on your cell phone and eating pudding… it’s not. Hitting you in the head with a sledgehammer is a 10.
• No, I’m not going to stop treating the guy in the next room who’s blood pressure just tanked and is getting close to enjoying 300 joules to the chest, so I can get you a warm blanket. You’ll survive.
•  Medical power of attorney. Yes, have one people unless you want to trust aunt Sally to make your medical decisions for you.
• As you get older, think carefully about your code status (do not resuscitate, etc..). It’s not like the movies. The brain doesn’t survive very long without oxygen. There’s a bunch of vital gunk in the brain (I read that somewhere) that controls some important stuff. Even if we get the ticker running again, the outcome isn’t always desirable.

I think the number one thing I’ve learned so far is how fleeting our time here is. Every day I walk the floor surrounded by people who thought they were going to have a regular, boring day until they got thumped by the cement truck they didn’t see coming. You can’t avoid all the cement trucks… but you can do everything possible to enjoy today.

Sworn to Secrecy. And Nachos

My three faithful followers may have noticed that I’ve been radio silent for a while now. Much has happened and I have many stories to share… only I can’t. I am now ruled by the dark overlord known as HIPAA. This overlord commands the manor known as “Ye olde Health Insurance and Portability Accountability Act”. You may be wondering when did the troutdog become an insurance salesman? Or, you may be thinking about cleaning the grout in your shower.

Some time ago I began working at a metropolitan hospital, St. Bacon of Barbecueous. This change of employment is related to a midlife crisis and one late night of too much tequila and poorly cooked fish tacos. Oh, and being accepted into a nursing program. My lawn guy, who’s also an acupuncturist on the side, convinced me that the key to being a good nurse is to, you know, actually work in the healthcare field. Not wanting to dispute such wisdom (the man’s practically a doctor), I went out and got me one of them healthcare jobs.

I have no idea what HIPAA has to do with insurance. What I do know is that I’ve now signed more documents than my last home mortgage – all listing in no uncertain terms that I will be fired, prosecuted, removed from the nursing program, and publicly shamed on Facebook, G+, and Myspace if I ever reveal a single detail of anything I see or hear on my hospital floor. Having no desire to subject anyone to a version of Queen Cersei’s walk of shame, the dude will abide and remain (mostly) mute about what I see. Unless you buy me a beer. Or nachos. I’ll become verbally incontinent for a good plate of nachos.

All this change has made life… complicated. I work nights. I go to school. This means that I pretty much don’t do anything other than work, sleep, study, and eat multiple breakfasts. Coming home from my shift it’s morning, so I eat breakfast. Even though it’s four in the afternoon, what do you eat when you wake up? Breakfast of course. And naturally, what does the hospital cafeteria feature at 2am? Hint, it’s not nachos.

Although I signed an oath (press hard, it’s triplicate) it’s been killing me not to share. There’s too much good stuff that happens on a nightly basis – well, assuming you’re entertained by bodily fluids in frighteningly large amounts and a level of poor personal choices and crazy that I thought only existed in politicians (and Hollywood, but those folks are simply eccentric artists). As Art Mann says, this is TV gold.

We cannot let this dark overlord kill independent troutdog. We will find a way to share. We will dance like a graceful lawyer, pirouetting through the minefields of non-disclosure documents. The troutdog shall not be repressed!

Note: This is a work of fiction. Names, characters, places and incidents either are products of the author’s imagination or are used fictitiously. Any resemblance to actual events or locales or persons, living or dead, is entirely coincidental. The troutdog is  a mythical creature. Comparisons of a popular religions practices of conferring sainthood to a hospital named after pork products was for illustrative and satire purposes only and not intended to offend or incite jihad.