My Patients

I haven’t shared too much about my job here on the blog, but this is a story about my patients.

I can tell you that very often my patients are grumpy, or down right angry. They even cry uncontrollably and unexpected. Most of the time they sleep, right through my prodding them and talking to them. They don’t seem to find it especially important to thank me when I call them beautiful or compliment their long, dark hair and chubby cheeks. They do make interesting faces and most of them have the ability to go from a grimace to an angelic and peaceful repose within seconds.

I know that they wouldn’t want me to share that they burp quite often, or even have a tendency to gag and spit readily. Some just can’t help themselves and fart or poop while I’m with them. Sometimes stuff like that just happens, especially when you aren’t really adjusted to so many changes and hospital rules.

Even though they don’t have much to say I can always tell who is going to be totally bored with my visit, or just as easily the ones who are already wide-eyed and following my every move. I always think that those are the ones I have to watch out for, that those patients will be the ones to purposefully and obstinately refuse to listen. Then they surprise me and I find myself wishing I could spend more time with them as they dismiss me and settle in for sleep.

Some of them try to be helpful. They want so badly to help me detach sensors or ear hugs and it often takes a lot of explaining to them that no, I really do have to tuck their hands back inside their swaddle blankets, but I so very much appreciate all their efforts.

I really can’t tell, even anonymously, any funny or whimsical stories that I hear from my patients. Most of them are just trying to comprehend how their world has turned upside down and why they can’t go back where they came from just hours ago. They’ll have stories for sure, but I won’t be privileged to hear them. I would like to assume that they will be happy and bright and optimistic stories.

Those are the patients that I visit in a quiet room with their loved ones close by.

Some of my patients are alone. I meet them in a large, sometimes noisy, space. Their freedom is tested because they are attached to machines. Many of these patients rarely notice when I stop at their bedside. Of course they hear me remark on their beauty and strength just like all the others. Some will show their displeasure for me with the occasional frown or soft high-pitched cry, but I move forward with my work.

These patients are almost always asleep. If they aren’t they twitch, and appear jittery. I move them about, touch them only as much as is absolutely necessary and watch them startle over and over again. There are some that I come to visit and I have to stop. They tell me that it is too much, too soon and they begin to scream in pain. These are the patients that are telling me their stories over and over and I see at least one every day that I am at work. These are the patients that don’t get to go home wrapped in loving arms at 24 or 36 hours.

These are NAS patients. Rather in severe withdrawal, or on a monitoring hold, these patients were born to mothers who used opiates during pregnancy. Those in withdrawal are given morphine. I work in a small facility. Our NICU can house six patients routinely with overflow for 1-2 more. Very sick babies are transferred to a Level IV facility. Most NAS babies stay with us until they are well enough to go into foster care. Since I began work on September 1st, there has only been one of my shifts without an NAS patient.

The work that I do with most babies is rather routine, and predictable in many ways. However, it will never be routine for me to stand in the doorway of the NICU and see a baby, only hours old, being given another dose of morphine. I could never predict how much an infant can tremble, and twitch and startle, never seeming to find peace and quiet.

I can only wonder what these babies stories will be, what their future will hold. I will not be privileged to hear them. I would like to assume that they will be happy and bright and optimistic stories, because to assume otherwise is too painful.

Advertisements

Revelation

Nothing major, but something that has been growing on me since about mid-September.

I like my job.

I cannot honestly say that I remember the last time I said that. Likely it was years ago when I was teaching childbirth classes. I loved that job. That job felt right. I probably used the word like a few times during my dental assisting career as well, although I suspect that I liked the doing of the actual job more than I ever really liked where I worked.

I also don’t really know why this admission strikes me as rather incongruous. I suspect that we can all find something about our work to complain about. The commute, a co-worker- or two or three, overtime, workplace drama, etc. I would be surprised to find anyone who would say that their career, and the inherent aspects that surround doing that career, is perfect, but I do assume that many/most of us like the path we have chosen or the career we have ended up in. Yet again today, as I spent time educating a father about what I was doing and why, the revelation popped quietly into my head: I really like this job.

Those extra shifts that I picked up when we lost one of our screeners haven’t been a burden at all. I could literally do this job five days a week. I don’t remember feeling this way when I worked at the same job five years ago. Just like the dental career, I liked the doing, but the place and people- no connection, no sense of belonging.

New parents haven’t changed. I meet them when they are bleary-eyed, sleep deprived but high as the sky eager and anxious and terrified humans contemplating the new person in their lives.

Babies certainly haven’t changed. The babies are the most predictable aspects of my job in so many ways…most of the time…until they aren’t. Babies will surprise you when you least expect it. They will force you to adapt and to think on your feet. Their job is to challenge and I am finding that amazing and humbling.

The job really hasn’t changed with the exception of a few procedural differences. Autonomy, self control and responsibility, the aspects that I craved last time around, still give me a sense of purpose, and self-worth, and feelings of capability and ownership in my work.

So with so much the same I wonder why I am so much in like with my job. Could it be because the facility is smaller with a calmer atmosphere, or that the staff is simply more welcoming and so I feel more grounded; more of a team member; perhaps even more valued. I remember always feeling intimidated when I had to enter the NICU to check on or screen a baby. Now, with my desk just 4 feet from the NICU, I am building a rapport with the nursing staff who feel like colleagues rather than strangers. I am greeted regularly by the housekeeping staff and nutrition staff delivering breakfast. I even got a physician (maybe anesthesiologist) who is always there on my shift, to finally smile and tip his head in greeting.

I’m sure that all of this is a factor, but I also wonder what’s different this time around with me. Five years ago I had just ended my career in dentistry because of arthritis. Five years ago I was beginning my role as grandma. Five years ago I knew that my marriage was over, although I had no idea that I would actually come to the decision of divorce. Five years ago it was difficult to take a job that had me working weekend evenings, even though I was beginning to welcome being out of the house more and more. I think in some ways guilt led me to take that job five years ago. I felt a need to still contribute, maybe even to prove something about my place in a marriage where it was becoming clear that my not working was frowned upon, and the reason I stopped working was implausible in the mind of my ex-husband.

Today, I hold this job for myself. I still feel a need to contribute, but the contribution is to my own sense of self, my own well-being, my own desire to learn from and interact with other adults. Of course, I am also contributing to my finances, and I won’t deny that the extra money every 2 weeks is a bonus! Selfish reasons maybe, but there is no burden of proof that is owed to anyone anymore. I get up and go to work on Saturday and Sunday mornings because I want to. Because I like to. Because it is necessary for me to forge a sense of ownership about myself. Because I do not have to think of how my days and nights are, or are not, making someone else happy or content.

I do this job for me, and that makes all the difference.

 

 

What does a “day off” mean?

An interesting call just came in from the coordinator of the hearing screen program. With no fanfare, just a simple and direct, “Tell me again your commitment during the week with your other job. Maranda just gave her notice.”

Maranda is the hearing screener who works during the week at my weekend location. It’s just the two of us, with my boss spending Mondays there, screening and doing administrative work. Five of the remaining six days per week she (the boss/coordinator) is at the larger facility about 10 miles away, screening and overseeing one crisis after another.

There was a moment, before I answered, where I wanted to say, “Why of course she quit. Everyone does in this rather low paying, increasingly stressful job.” But I didn’t, My boss already knows this. It doesn’t take any new hire long to realize that the time and energy involved in this work is likely never going to pay many bills. In this system, as a new hire, you have to have a firm idea when you begin that this job is likely going to be more part-time in nature, even if you work four days per week. It’s simply not a job you can support yourself, or a family, on. Maranda is apparently leaving for that very reason. Maranda lasted about four months.

So a new screener was about to be hired, but she can only work weekends. She’s a student during the week. My boss had hoped that I could move into Maranda’s work schedule and the new person could take my weekends. That can’t happen, although if it was a few years into the future I would have jumped at the opportunity. Team player that I am (?) I made the offer to cover on the two days I am free during the week: Monday and Thursday. Plus I will continue with my weekend schedule. Let’s do the math shall we–

Granddaughters Tuesday, Wednesday and Friday.

Hearing screening Monday, Thursday, Saturday and Sunday.

I believe that equals seven full work days per week. This new arrangement begins the second week of October. It isn’t forever, but, as this system moves at the speed of a very slow mud flow, it will likely be three, or even four months before someone new is fully functional to take Maranda’s place. That’s if the boss can hire someone yesterday.

It was rather ironic that this call came today. I was sitting here, reading a book on my day off and actually feeling rather like I was wasting time. I had these vague thoughts of how much more productive I could be; of how I really didn’t need a full two days off, because I really don’t have all that much to do…

And you know what, it will be okay. Two more days per week will certainly boost my paycheck a bit. My days screening are almost never full days anyway, especially on the weekends. Sitting here on these open days makes me feel pressured to clean my house, over and over, and I barely need to clean it now. I am not a messy person. Fortunately I have a good number of scrubs so I won’t have to do laundry every other day. Both of my jobs are a fairly easy commute and I will likely miss peak traffic times anyway…

I can do this, right?

Will someone, about mid November, just take a moment to remind me what it’s like in the real world where you get a day or two off on occasion. I’m not so sure that I’ll remember what a “day off” means by then.

Too early

It’s about 4:30 AM here right now. I was awake at 4:00. Awake about the same time yesterday morning as well. I don’t have to be up for my new job until about 5:30, but something has me up way before the alarm goes off.

My first day alone yesterday, and even though, at the very last minute, I actually received access to the electronic medical record, there were still issues. Nothing major mind you, but still I think this system needs some improvements when it comes to new employees. I had to wait on a baby anyway and that gave me time to chat with a great tech at the login help desk, Sam or Sebastian…or some S name. He got me access to the EMR that I needed. My fingers are crossed that I can still access it this morning when I go in.

A few observations:

Trendy, young, great couples who want to know everything. I enjoy catching snippets of a couples conversations about parenting,  when they are awake and alert enough to have those anyway. It’s difficult to go into these rooms and not play the role of established expert parent, especially when the couples are young, and you know that for all of their good reasoning now, much of what they feel strongly about doing or not doing with their new child will likely go out the window once they are home and reality sets in.

Babies are really hairy these days. I don’t mean just the peach fuzz lanugo that typically covers much of a newborn. I mean hair, long hair on so many babies. I only remember one of my kids having hair at birth. The little pumpkins that I have screened all have come out needing a haircut. Hair makes for challenging screening so I will always be partial to the bald babies.

Nurses. You know that nurses run the hospital right? Everyone, including the doctors who pop in and pop back out, is lost if a nurse is not visible at all times.

Pico pumps--a new and interesting gadget with claims to be beneficial after surgery (cesareans in this case) but that interferes with my job if mom is holding baby. Medically inclined readers…any comments on this device?

Air conditioning. I refuse to complain about working on the Labor Day weekend when I can be around air conditioning. We are on another hot streak here, with temps over 90 degrees day after day. My shift can go on and on…

 

Off and running

As of today I have been cleared to perform my new job, although as in the last post, I still only partially exist in the system.

I screened babies this weekend, although it was a slow weekend and there weren’t many babies. More babies=more practice before going it alone. I screened four babies today, at two different locations, with my coordinator. Everything went well, much better actually than my last baby Sunday. I was having all kinds of issues, but luckily the screener I was working with is a screening wizard, and pulled out passing results when I thought all was lost.

I have a small notebook full of notes, although I never think to refer to them when I’m in the room with patients. Seems rather anxiety inducing if your screener has to refer to her notebook…although I would if really necessary. I’ve learned a lot since working this job five years ago. Invaluable stuff that no one ever told me before.

Next weekend those babies are all mine…

Front, back or sideways

Whirling dervish…

whirling-dervish-free-performance-13th-october2

That description came to mind with all changes that have happened in just 24 hours and now I feel a little bit like I don’t know what side is up, or down.

I think I shared that I was hired back with the company who employed me about 5 years ago–the medical group that contracts with hospital systems to provide Newborn Hearing Screenings prior to discharge. I became an employee of the local practice on June 30th. I have been waiting ever since to get official clearance by the hospital facility where I will actually be doing the screening. My coordinator, who has been short staffed for months, has been pulling her hair out, waiting to get this onboarding process completed.

She went out on a limb yesterday and had me come into the site to observe, even though technically I was not supposed to be in patient rooms without my official badge. I could only take notes and watch, but at least it was something. Much of the process came back to me rather quickly, although this facility takes a bit of a different approach than my previous position.

Overall, it was great to be back with the babies, even though I couldn’t touch them. It was also a little difficult because this facility still uses the LDRP approach with their moms. Once admitted, moms labor, deliver, recover and spend their postpartum 24-36 hours in the same room. Passing rooms and hearing moms in active labor had my educator/doula motor running on high gear. I wanted to dump the screening machine and offer them labor support. I can imagine that it’s going to be a challenge to have to pass those room in the future.

Anyway, I left there with no news and no idea of how much longer it might be before I could actually begin this job. Being in limbo for 2-3 months is not unheard of I was told early on.

Out of the blue, as I was eating lunch today, my coordinator called. “We can get your badge!” she said into the phone. “They still haven’t assigned you an official ID, but with the badge you can start screening and we will work around using the electronic health record.”

While extremely glad, and also excited that I was finally given the okay to do my job, I knew that much of the stress the other screeners had been facing was now going to be transferred to me. They are/were sick of filling in and covering the holes in scheduling. My coordinator especially has worked 30+ days straight, no time off.

I was rather taken aback though, when she began rattling off day after day this week and early next to do some “hurry up training” with the intention of my taking off on my own by the Labor Day weekend. Ironically, I had been reviewing my notes from yesterday when she called. I had no idea what I wrote or why I wrote what I did on quite a few pages as I was trying to watch, listen, and write at the same time. I think I used to be able to do that…when I was 18. She was talking, making plans, and I was half listening, wondering how I was going to make sense of things with 3 or 4 days training and ongoing restricted access to some vital areas that proved to be a part of those unreadable or illogical notes.

Long story short: I threw on some scrubs, drove to my facility, did part of a hearing screen, again without my badge, to get a little hands-on experience. I then drove to the main facility 40 minutes away in (almost) rush hour traffic to get my badge. I was being prodded to screen a few babies while I was there, for more “training.” I think, perhaps by the look on my face, that it was clear that I wasn’t keen on that idea.

Fortunately, my coordinator stopped, took a breath, and allowed me to give some input. Just that short hands-on time today allowed me to see that I really haven’t forgotten everything, even after 5 years. I know that I’ll be slow again, at first and while being watched, but I can already anticipate being on my own. The autonomy of this job is one of the things that I love. Until I have full access to every process, I’m taking the viewpoint that I just have to roll with what comes, do the parts that I already know and can do with just a little practice, and ask questions when I need to.

We parted with the plan that I will co-screen with two different screeners this coming Saturday and Sunday. I will be shadowed by my coordinator next Monday. If all goes well from both our points of view then I will be on my own September 2nd. I have the option as well to seek more training time, somehow working around my days watching the granddaughters.

The frenetic spinning in my head has slowed. I am remembering to breathe. I am reminding myself that this will all work out. I am reminding myself that I was a competent screener once before, and that I will be again. I am hoping that if the whirling begins again, it will take me to a deep, meditative state where I will lie in an open field and let the sun wash over me and calm will prevail.

I am refusing to think just how close September 2nd is…