A little break

After working a stretch on the psych-medical unit, it was a nice break to be floated to psych stepdown.  I spent the last several shifts wrestling with IV machines, suction and oxygen tubing.  Sometimes all with the same patient.  And all the call bells that go off when the bed alarms are triggered!  When there's a restless patient, it seems like their bell never stops ringing no matter how low we set the sensors to.

I have remembered that I dislike suctioning.  Phlegm is my kryptonite.

In an attempt to accelerate my getting up to med-surg snuff, I got a couple of med-surg reference books for my Kindle.  While I will always be a fan of paper books, the Kindle makes it possible for me to have all of my reference books with me while at work.   Plus I love the fact that I can order it and have it delivered within minutes.

I've also started looking at a few med-surg and LTAC CEUs.  I have to accumulate 150 of them by 2021 to renew my certification, and only 51% need to be in psych; the rest can be in whatever I choose.  So I'm going to kill two birds with one stone there.

Anyhow, back to stepdown.

Loads of manic patients.  The mania is very strong in the air as of late.

I generally tend to get along with patients in mania, though just watching and listening to them wears me out.   The rapid hyperverbal speech, the hyperactivity, the flight of ideas as they jump from topic to topic, the delusions of grandeur…it really is exhausting to keep up with them.  Still, it's a nice change from answering call bells.

It’s frustrating when PRNs don’t slow them down at all, especially when it’s the middle of the night and they’re waking other patients up.  I tell them repeatedly that as long as they can keep it quiet they don't have to return to bed (some of my peers do not agree with this strategy.  I am of the mindset that as long as they are behaving or not in danger of being hurt, I don't have the right to force them into their room).  The problem is that they’ll be calmer and quieter for a minute or two.  Then the voice and energy level naturally starts escalating again.  

At one of my previous jobs, we would utilize that energy for good and have manic patients fold towels or tidy up the common area.  Depending on the patient, they might get a broom and dustpan and be put on sweeping patrol.  Of course, this is if the patient is willing, which they usually were since they had all this energy to burn.

But it’s harder to manage at night.  During the evening, when everyone else is awake and active, having a manic patient or three is one thing.  At night, when the goal is to have all the patients sleeping…well, that’s another. Sometimes the PRNs need to be “strongly” encouraged.  While I hate pressuring patients into taking medications, it's better doing that than to have them wake the psychotic patients who would pose an even  bigger problem if THEY were awake.

For all the exhaustion working with manic patients can provide, one of my favorite things is to listen to two manic patients have a conversation.  They will be discussing two entirely different things at high speed and yet still understand each other perfectly.  It's amazing to watch.

But the manic patients are asleep tonight...for now, anyway.  It's the religiously preoccupied and delusional that are awake and roaming.  I've been lectured once already on how I'm going to hell, which is a nice change from just being told that I'm going to hell:  at least now I'm having the why-I'm-going-to-hell explained to me.  I'm apparently holding another patient hostage.  But at least the patients are being so polite and friendly about it with me.

Psych nurse grieving process...or, it's been a while, hasn't it?

It was a tough few months getting over my dad's death.  I think because his death was expected, even down to the when and where, I think I probably went through the stages of grief in a pretty skewed fashion.  Denial was short.  I think I skipped anger and bargaining, and I came to acceptance really fast.

Depression, on the other hand...well, I've been stuck in that for months.  It came on last, and it's only recently that I feel like I started hitting the upswing and working my way out of it.

I think in the entire time since he passed, I only had one or two days where I broke down and cried.  I don't think it was (is?) dysfunctional grieving; I just didn't have it in me to cry a lot.  I didn't cry the moment he passed, I didn't cry during the holidays...it just took several months before I did break down.

His birthday and Fathers' Day have passed since he did.  Both tough days.  I can't remember the exact day I broke down and lost it, but I'm sure it was on one of those days.

I found an old voice mail from him on my cell phone...rare because I almost never save messages; rarer still that he actually left a recording.  I found it and immediately ripped it to a mp4, then made a backup copy.  Well, copies.  And then locked the ones on my Mac so they can't be deleted.  It's comforting that I will always be able to hear the sound of his voice.  And of course, I have plenty of pictures of him.  He's in no danger of being forgotten by me anytime soon.

I even talked about him with a patient who was grieving the loss of their spouse.  It was nice but it did get both of us sad...so we switched to talking about our dogs to cheer ourselves up.

I sent him back to my mom.  Her grieving has been harder than mine, understandably, and she felt that she needed him back home to feel better.  Within a hour of that phone call, I was at the FedEx store with him, making arrangements to overnight him.  I learned that he's now 11 pounds.  I also learned that FedEx will not ship human cremains.  And that it was incredibly hard to assign a monetary value to dad for insurance purposes.

So I took him to Office Max, got mailing supplies, rewrapped the box in plain brown paper (the nice FedEx people had done a nice job of packaging him for me, but the box had their logo all over it), and sent him overnight by USPS.  Having learned my lesson from FedEx, I listed my dad as "mementos" valued at $100.  

Sorry, Dad.  But I had to get you home.

Of course, my father being my father, he didn't get their overnight.  He got waylaid at a border city.  I told my mother that one of the things that dad wanted to do but never got around to it was to go see Mexico, and so he was making up for lost time.  She thought that was funny.  Then he got stuck in Kansas, and my mother told me, "your father always has to take the long way."  Our family does have a warped sense of humor.

But he eventually made it home, and my mom is much happier.  In a way, so am I.  I think he needed to be with her as much as she needed him to come home.

I'm still working on the motivation and the isolation.  I'm making an effort to be social again, both in person and online.  I started attending the knitting group again.  I need to start going to the nursing forum and doing my work.  They've been very patient with me through all of this and I've grateful, but I feel it's time for me to get back to earning my kibble there.  

I am enjoying nights on the permanent job...not sure if I'll ever return to days.  I still dabble with Job #3 from time to time just to keep my foot in their system.  It's such a tough nut to crack into in the first place, that I'd be a fool to sever all ties with them.  

I know that I can sometimes be slow on the uptake, but only recently that I realized that my main job is the weekend position that I had applied for more than 4 years ago but did not get because I did not have my BSN.  And it is the psych-medical position that I spent an hour alone talking to the director about.  I don't know if she remembers me from that time.  I hesitate to ask.  But here I am, I finally got here...and happened to learn about nursing and about myself along the way.

I'm even started thinking about starting the MSN...decided that I'm going to pursue a general one or one in education.  I decided against becoming a nurse practitioner.  From what I've been seeing, it's mostly prescribing and limited patient interaction.  I'd rather have the patient interaction.

Grieving

I will admit that when my father died, I was the only one who didn't break into torrents of hysterical tears.  I still haven't, though there have been times I've gone misty-eyed and sad.  I was the stoic one who kept an even keel while the arrangements were made, while we got through the holidays, while we helped our mother tie up things with dad's estate.  His remains were sent to me to hold onto to while my mom decided what to finally do with them.  So I've been the literal (figurative?  I always get them confused) rock in all of this...though I've pretty much written off ever enjoying my birthday ever again, at least for the foreseeable future, because now there's too much sadness linked to it.

I find that my grief has been manifesting in other ways.

I withdrew from life quite a bit.  Haven't been talking to anyone I didn't need to.  Slept a lot.  Lost motivation to do lots of things I used to enjoy.  Gained back 10 of the pounds that I lost (though I'm still down about 15 lbs from my starting point so that wasn't too horrible) because I wasn't exercising anymore.  Felt lost, alone, abandoned.   Didn't write here or anywhere for that matter.  Was sketchy in my moderating appearances at the nursing forum.  Threw myself into work because it was the one thing I HAD to do.  In fact, work was a welcome distraction because for most of the shift, I could focus on what I had to do.

At least I didn't drink myself into oblivion or use other forms of self-medication.  My bottle of alprazolam still has a layer of dust on it, its last use being on the flight back here.

The funny thing is, I didn't realize that I was grieving until someone at work asked me how things were going since the death.  She had recently lost a parent too, though her loss was completely unexpected, whereas we knew my dad was going to die on a specific date or the next day.  When answering her, I thought about how I was handling things...and realized all of the previous paragraph.      And when another coworker talked about some of the things he was going through after the loss of his parent, I realized what he was saying sounded a lot like what I was feeling.

*sigh*

I'd love to be able to say that in realizing what I was feeling, that I was miraculously able to overcome it in the course of a couple of days and be back to my normal, chipper self.   And we all know that life isn't THAT easy.

So I continue to chug along, though now I'm making an effort to get motivated to do things.  It hasn't been easy, and I'm taking it a small step at time.

New job starts tomorrow.  I'm enjoying my mini-vacation, which has been nothing but rainy days.  Which is good as rain is sorely needed around here.  Plus, rain like this gives me the perfect excuse to laze about.

I'm doing all right with my father's death.  Christmas and New Year's weren't the same without him.  I eagerly went to work on both days so I'd have something to take my mind off of him, and I didn't want to have to be around my mom.  I know, that sounds horrible.  But I just couldn't cope with her and her mood swings right now...so it was either work or take loads of Vistaril.

The gifts I got him for Christmas are still in the garage.  I don't know what I'm going to do with them.

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 though...in 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 environment...it 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.

The ED Interview

I'm back home.  Still adjusting to a world in which my father isn't physically here anymore...it'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 drop...in 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.

*sigh*

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.

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.