December 20, 2015

In which Meriwhen says Yes...

to the psych-medical position.

I decided to withdraw my application from the ED for several reasons, a lot of which I won't go into here...let me just say that I didn't think I was ready for what I was going up against.  And that is true:  I do not have a lot of acute care medical nursing skills.  Maybe in a couple of years, after I get some more medical experience, I'll try again.

I will admit that after I withdrew, I felt at peace with the decision, like a weight was off of my chest.  Perhaps it wasn't meant to be right now.

So this brings me here, to psych-medical and the world's most painless interview:

Manager:  Hi.  Here's the scheduling requirements and the rest of the info.  Any questions?

Me:  No, it looks great.

Manager:  You start in two weeks.

The only reason that the interview was painless was that I had essentially been interviewing with them for the last year.  They've seen me and my work in action so they knew exactly what they were getting.  And I also knew what I was getting into, since I have been working shifts there for the last year.  The interview proper was to make sure I knew the specifics and agreed.

I was hugged by someone when they heard the news.  And I've seen a few excited that I was working my two-week notice.  Granted, I wasn't leaving at the end of two weeks, just becoming permanent staff.  I'll take this as they're happy to have me joining them.

I'll confess:  I was hoping that psych-medical would get back to me before I interviewed with the ED.  The manager got my official application the day after I interviewed fact, the ED manager called her to ask about me.  She was relieved when I had told her that I had withdrawn.

Financially, I'm going to be making roughly the same as I am now, which was a very pleasant surprise.  It actually will be a little less since I'm working just under full-time, but I also have the room to pick up an extra shift per pay period if I so chose.  Benefits (a lot of which I don't need and will decline), PTO, opportunities for growth and advancement, a great working was an offer I could not refuse.

I "start" after the New Year.

My mom is out here for the holidays.  It's weird not to have both parents here.  It hits me at odd times and in odd ways.  No one is going to provide running commentary and give me a hard time as I'm driving.

December 14, 2015

The ED Interview

I'm back home.  Still adjusting to a world in which my father isn't physically here's tough.

So let me tell you about my ED interview.

I had an interview for the ED training program today.  The interviewer was intrigued to see someone coming strictly from psych into emergency.  I explained that while I enjoyed psych immensely, I wanted a change; I wanted a position where I could do something different yet still use psych a lot, and the ED seemed to be a good transition.  I was asked the usual "how do you handle difficult..." questions, where I saw myself in 5 years, strengths and weaknesses, long-term goals...I thought I sold myself pretty well in that area.

My major strike against me is the fact that in terms of acute care medical skills, I don't have a lot of experience. So I told her about the ED nursing class I just took, my preceptorship (she knows my instructor, which is a plus amid the minus), and the fact that I learn and adapt quickly.  I can't say I was as confident about my sell in that area, but let's be real:  I can't (well, honestly, anyway) manufacture experience that I don't have.

She is going to call some references and let me know either way within a week or so.  So at least I will be put out of my misery quickly.

I have not yet heard back on the psych-medical application.

While I'm waiting, I need to weigh the positives and negatives of the position.

Positives:  new experience; diversification; gives me more career opportunities; challenging; opportunities for continuing education and cross-training; world's easiest commute; 3 12s means I can work or 2 days elsewhere.

Negatives:  salary decrease as I'm going from experienced in psych to novice in ED (though the night differential will mitigate some of that); steep learning curve; will not be able to work psych at the organization as it would be OT (I could still work psych elsewhere); won't be working with a great crew anymore; despite wanting a change, I'm nervous about leaving my comfort zone.

And another negative:  the other half is apprehensive.

I asked for his opinion...mind you, whatever that opinion is won't be the sole factor that determines whether I take the job.  But we're a partnership and his point of view does matter to me.

He feels that I have a lot of opportunities in psych and while is supportive of whatever I want to do with my career, he is worries about the learning curve and the finances.  He also thinks it's not a full-time job.  I attempted to explain--several times--that I would not take a position that would not be financially feasible, that it is in fact a full-time paying position albeit at a slightly smaller rate, and that with any change in specialty there is going to be some learning curve.

But he seems unconvinced.  In fact, I get the vibe from him that he rather I DIDN'T go for ED and instead stick with what I know at the better money.  But what he doesn't realize--and which I just realized and need to remind him of--is that I'm making good money because I'm a per-diem.  If I were to take a full-time job in psych, my rate would fact, I'd be making only $4 more than if I took the ED position.  It's the shift differentials that are going to help--hence why I'm only applying for nights.

Anyhow, the discussion descended into a tiff, so things are a little tense.


We'll just have to see what happens.  Of course, I may not even get the ED job and then there won't be any worries.

December 11, 2015

The day after

I did not sleep well all night.  I kept expecting to see him around, in the kitchen making a sandwich, in the living room watching television...

Today, my sister and I drove to the middle of New York State to take care of some business with Dad's side of the family, on behalf of Mom.  It went smoothly, then they wanted to go to the local pub to toast his memory.  Of course we wouldn't say No, so off we went.  His friends joined us, and we learned lots of new things about our father.  It was a nice distraction.

This was also the very first road trip that my sister and I ever took together.  We're so unalike that we never got around to doing these things because we had no interest.  We're so unalike that we had to laugh when the security guard at the hospital referred to us as The Twins when he called to our father's floor to authorize our visit.  She is a blue-eyed tan blonde, whereas I'm pale with dark hair and eyes.  He also couldn't tell which one of us was older, and we responded that we weren't telling.

For the record, it's me.

But the road trip with her went very well, and it was nice.  We really got to talk about a lot of things, including Dad.

In some nursing news, I got an interview for an ED training program that I applied to.  It was a long shot--not the longest shot, but I didn't think I'd be considered.   But consider me they did, so I go during the week to interview with the nurse manager.  I go straight from work to there, so I have to bring a change of clothing and some resumes.

December 10, 2015

And it's done

I slept all right, considering I was balled up in a recliner and woke up every time someone came into the room.  I let my mom and sister have the cot.  They needed it more than I did.  

Dad slept peacefully all night.  At one point, they had to clean him up and change his gown, but he didn't struggle with them as he usually did.  The night crew figured out on their own that I was a nurse...probably because the jacket that doubled as my blanket gave it away.   Plus I kept checking his peripheral pulses and looking at his vitals.

I woke for the day at 0600, went downstairs, had a birthday breakfast by myself.  Not the best breakfast, but it was protein.  And a large black coffee.  That was lifeblood.

Brought coffee up to the room.  Mom and my sister were up and they were getting washed up.  Then I went downstairs with my sister for more coffee, breakfast for her and mom, and a scone for me, because the breakfast really didn't cut it.  And more coffee.

We went upstairs, ate.   No change on him.  He didn't wake up.  His doctor hadn't arrived yet so we're just waiting.

My sister asked for some time alone with him.   She has really been having the hardest time of all...she was in denial.  She keeps thinking that my dad is going to either change his mind about hospice care, or make a miraculous recovery.  So I took my mother downstairs to let her have some fresh air and a cigarette.  She still smokes, and today I wasn't in any mood to lecture her about quitting.   

We sat outside for about 15 minutes, talking, sharing memories, wondering what was going to happen.  I told her that I wasn't upset about it being my birthday because today, he helped me arrived in this world, and that today, I was going to be there when he died.  It came full circle.  My mom said she never thought about it like that.

We're on the way back up when my sister texts:  Come upstairs now.   So we ran upstairs like bats out of hell.  I charged down the hall (dear nurses, I am sorry for plowing through the group of you but I hope you understand) and burst into the room.  The doctor--not his regular one--is assessing him.  My sister is hysterical and saying, "I think he's gone!"

So I check his pedal pulses.  I thought I felt a flicker, but then nothing.    My mom was touching his arm, and said she thought she felt something for a second.  

I looked at his face.  He was gone.

The doctor there called it.

He died before they unhooked all the machines and started the palliative care.  In fact, the doctor had talked to my sister and told her that they were going to get all the equipment to start the care shortly.   But my dad decided to die on his own terms and die quickly, instead of spending the day slowly fading as the treatment team would keep asking "do you want us to do this for him?" with every treatment.

My sister left the room.  She couldn't come back in it at all.

My mother left to comfort her.  So I had some time to talk to him...and I did.  I told him he just had to be stubborn until the very end.  I told him that I had two friends up there waiting up there with coffee and cigarettes, and he can hang with them until we get there.   I told him that I was sorry he wouldn't see little one #2 grow up.  I told him I was relieved that he was no longer suffering and at peace.  And I told him a few other things I don't want to share here.

All of the staff was very kind to us, and so many nurses, doctors, techs, everyone came by to pass on their sympathy.

My sister couldn't take it anymore, so we gave our final kisses and went to my mom's.  Mom needed some time for herself, so my sister and I went upstairs.  We toasted his memory with a glass of ale.   Fitting...and a little twisted since he was a recovering alcoholic.

My mother comes back, so we start making calls and messages to spread the word.  He did not want a service, so he's not getting one.  His wishes were straight cremation, with his ashes to be scattered in the ocean.   And we're doing just that.  Tomorrow, my sister and I have to go to upstate New York to take care of some things for my mom.

Family and friends have been calling and visiting, and we're sitting around drinking (me, coffee) and sharing funny memories of him.   It's nice to laugh and smile right now.

December 9, 2015

The final night...

My father's condition keeps deteriorating, and the decision was made for him to go on hospice care.  The nurses got him into a private room...I had originally thought it was the doctor who made this happen, but I learned that the nurses were the ones who did it.  Right now he's on a BIPAP and morphine IVP as needed.  Tomorrow, they plan to discontinue the BIPAP, start a morphine drop, and focus on comfort care.   Based on how he did with a trial run off the BIPAP, they expect death will happen fast.  The goal is to make it as smooth and painless as possible.

It sucks.  But he has no quality of life right now. And it's not going to get better.  Today, we told him it was OK and gave him permission to let go.

So we're camped with him in his private room.  My mother and sister are asleep.  I'm trying to stay awake and get the paperwork for the preceptorship done.  I'm also trying to stay awake for another 11 minutes because in 11 minutes, it will be my birthday and I'd like a few minutes to myself.   We didn't remind dad about that as we don't want him upset.  My mom is tore up about it as it is--she's convinced that the day will be ruined forever for me.  I told her it is something we have no control over and I would not want to be anywhere else but here with him right now, and that my birthday is very low on the priority list right now.

The nurses here have been fantastic.  They went above and beyond for him, and when they learned he was going on hospice care, they felt our pain too.  It was hard for me not to jump in and be a nurse instead of a family member.  They knew I was a nurse, albeit a psychiatric one.

And man, did I have to use every psychiatric nursing skill I had to get through this day.  My mother and sister are wrecks.  I am not...don't get me wrong.  I hurt a lot right now.  But I made a promise to myself that my father didn't need to see me in hysterics.  I have to reassure my mother and sister and keep them going.  And one of us has to stay calm enough to talk to the doctors and nurses.

December 7, 2015


My dad's condition has deteriorated.  My sister arrived and is going straight to the hospital.  I get in early afternoon tomorrow.  I wrestled with going today, but it's also the little one's birthday today, and I wanted his day to be special.  Birthdays are the world to a kid, and he didn't need to have his saddled with me leaving to see his grandfather who may or may not make it.

My birthday will definitely be while I'm out there, but after a certain point in life, birthdays are great but they also kind of just another day.  Last year I spent my birthday in a hospital too; sitting with little one #2 as we waited to see if he had a concussion.   

Right now, I'm not doing much other than waiting and trying to be optimistic.  My dad has beat the odds a lot of times, so I can only hope he pulls this long shot off.  I'm not doing very well, but I'm trying.

So let me talk about some nursing stuff for a bit.

My ED preceptorship ended...well, it would have ended tomorrow, but I had to truncate it because of the trip.  I discovered that a lot of the skills I learned in nursing school that I don't often perform in psych came back pretty quickly.  My assessment skills and ability to prioritize care has improved.  I'm starting to get the hang of starting IVs.  I've learned a bit about lab work and lab work interpretation.  The MDs here expect you to tell them what you think the patient needs, instead of you telling them about the patient and waiting for them to order everything, so I definitely needed to know a little bit of everything.

And I learned that even with a max ratio of 4:1 (it was usually 3:1), I was still running ragged trying to stay on top of things.  So while I've had great time management skills for an inpatient psychiatric nurse, they were lousy for an emergency department novice.

I have some paperwork to finish up for the class, so my computer is coming with me so I can do that. The last day of class is Saturday.

I decided that I liked emergency nursing enough to try for a position.  My main organization periodically offers ED training for nurses interested in switching specialties.  Usually they ask for 1-2 years of tele/stepdown/med-surg experience, but this most recent posting will take 6 months of acute care experience.  So I applied even though I don't have the 6 months yet.  In addition to telling them about the ED course, I stressed how my psych skills would be very handy in the ED, how I started working with psych-medical patients, and how I go to their ED to do psych assessments so they've probably seen me.   The program starts in January so I'll hear pretty fast either way.

I applied to the ED at the other organization I work at and gave them the same sell, with some modifications, of course.  No idea how long it'll take for me to hear back from them.

We'll see what happens.

I am also applying for a psych-medical position.  I started floating to one a couple of months ago and while it's not my absolute favorite (that is psych ICU), it's very educational and I'm liking it.  One of their staff left and I expressed interest in applying...interest that was received positively by the managers.  I had some questions about the schedule that I'm waiting for answers on before I put in the application.  I may try to do it tonight before I leave.

That's all I've applied to for now.  I am kind of hoping I'll hear back from one of the EDs before I applied to the psych-medical position, but on the other hand I can't string them along--they are short-staffed and need to fill that position.
I have my plane tickets.  More than I wanted to pay, but I am a horrible flyer, so the less hassles I have to deal with, the better.  So it's non-stop, which is good because as soon as I board a plane, into my mouth goes 1-2mg of alprazolam.  That, plus my white noise app to try to sleep through as much of the trip as possible, and I am usually fine.

Didn't break down at work, but everyone could tell something was up.

December 6, 2015

In which Meriwhen gets the call she's been dreading

It's about my dad.  He hasn't died yet, but he is not doing well at all.  His condition hasn't changed much, but he's very depressed, refusing to take his medications, and has lost the will to live.  My mother wants my sister and I to come out for a few days to cheer him up...but I think, in all honesty, it may be to say goodbye.

I knew this day would be coming.  I was hoping it wasn't going to come for a while longer.

I told the other half that I have to go no matter what.  He worries when I fly by myself, but he understands.  And even if he didn't, I'm still going.  I only have one father and I'm going to see him at least one more time.

So I've started looking up flights.  My sister can't only go over a weekend because she works during the week.  I can't go over a weekend because I work weekends.  I don't know what she will do, but I'm looking at flying out during this week or the next.  She's talking to my mom to find out when we should be there...better one of us at a time talk to her.

This means I may end up having to spend my birthday out in New York.

Meanwhile, I have to get ready to go to work.  My eyes are red and swollen because I couldn't help but cry a little, so this should make for a *fun* shift.

December 2, 2015

Almost done...

A couple of more days are left in my ED preceptorship.  During this time, I have learned that I know a lot, and yet I have a lot to learn.  I'd write more, but I'm too tired right now.