Coming Out of My Shell and You Never Forget Your First

 

Tyler’s Gotta Tyler

It’s been two weeks since I’ve gone back to work, and I’ve started being myself in a big, big way. My coworkers—who were open about their feelings with me—loved working with me because they say that I am fun to work with because I’m entertaining. I can see that about myself. I did a lot of theater and improv in my youth, so performing comes naturally to me. I was also a child of an unreliable alcoholic and addict, so I desperately want the approval of those around me.

This need to please is always there, whether I like it or not. It was there these two weeks and I could only ignore it for one. I went all out as soon as possible. The faces are becoming recognizable. The names?  Still a mystery for the most part. Why not lay some unadulterated Tyler on them?

I started unloading my sarcasm as I always do—right at the top. There’s a young doctor who’s very boisterous and the textbook definition of a ‘go-getter’ (ugh). He asked me to grab him the nosebleed cart. I asked him where it was because the location of stuff is still a problem for me. Him, empowered by youth and stick-to-itiveness, offered to grab the cart himself. I replied with, “Woah, woah, woah, you didn’t go to medical school to push carts around. You pay people to do that for you now.” He stopped in his track and looked at me mouth agape. “Besides,” I continued, not able to control myself, “I don’t think you’re board certified to do that.”

“I don’t mind getting things myself,” he said.

“That’s cool. I respect that. Tell you what. Show me where it is, so I can grab it when your lazier colleagues want me to get it for them,” I said. We both laughed at that one.

I waited an hour to hear from the charge nurse to see if I was going to suffer any repercussions for mouthing off to a doctor. No charge nurse came. I kept going.

People ask my name a lot. They want to know who this big hairy weirdo in their pod is. My stock response is, “My name is Tyler. I’m one of the new travelers so you don’t have to remember my name. I’m just going to leave you.”

Newfound confidence for snark aside, I realized that me being an unknown is helpful for pranks. I met a good partner in crime named Alex. Alex is a nice guy who likes to mess with people too. Alex had a patient die.

Patient deaths are a lot of paperwork and everyone gets notified—the charge nurse, the nurses in the lobby, and the hospital supervisors—so they can help get family to the bedside and spend time with their loved one. A chance to say goodbye. A chance to grieve. A chance to be there at the end. This is what they need and deserve, the human thing to do.

Alex got his patient sent off to the morgue after the family was gone. Alex wanted to get into a body bag and have someone come into the room and he could jump out at them. I loved this plan. I suggested a way to make it happen. I would say that I covered him for a lunch break and that he hadn’t done the paperwork nor tagged the body and I needed help doing that. Everyone would believe me because they had no reason not to. Alex would lay in wait and I’d Peter Piper some poor trusting colleagues into the room to hopefully shit their pants in fear.

Our first target?  The charge nurse Chuck. Chuck seems like a genuinely nice man. He made the effort to learn my name on the first day and has always joked with me. I wanted to see him scream and shit his pants because I am broken inside and love to laugh at others.

Alas, Chuck had gone home. Instead, I lured another charge nurse (who was wise to our trick because she knows Alex well) and this other male nurse. The guy jumped three feet and cussed us out. We all agreed that Chuck would’ve had a heart attack. “Perfect place for it,” I said, getting a laugh. Sharing a laugh over a coworker’s imagined death has bonded nurses for generations and Salem is no different.

Now I present to you, my humble readership, a series of interactions I had:

—————————-

Doctor: Is the patient in 31 yours?

Me: Nope. Not me.

Doctor: (not hearing me by accident or choice, I dunno) Okay, well they’re going to go to the cath lab for a procedure and post op here and then discharge. I’m gonna order a bunch of *blah blah blah* (The doctor goes on and on about important medications and pre-op routines but I’m thinking about if onion rings would be good on a pizza. Probably not but I’d still eat it.)

Me: That’s a lot of important information. I hope you tell a nurse who cares, like the patient’s nurse.

Doctor: Oh, I thought you said it was your patient.

Me: No, sir. I said the exact opposite of what you heard.

Doctor: And you just let me go on and were going to help the patient?

Me: I didn’t go to nursing school to say no to doctors. Doing what doctors say is kinda our only deal.

—————————-

Taylor: Your name is Tyler?  That’s easy to remember. My name is Taylor and that’s close to my name.

Me: And I won’t forget your name because your name is the name of the worst character from Gilmore Girls.

Taylor: *confused look*

Me: Team Jess! *then in a Luke Danes voice* Damn it, Taylor!

—————————-

Transport tech: Hey, Tyler!  Can I take your patient to CT?

Me: You can do whatever you want. You’re a strong, independent woman who don’t need a mans permission to do any goddamn thing.

Transport tech: I really need you to say yes or no.

Me: Stop living in the patriarchy!

Transport tech: Stop mansplaining!

Me: …yes you can take my patient.

—————————-

Nurse: You’re kind of an asshole, aren’t you?

Me: We’ve worked six shifts together. You’re kind of a dumb bitch for not noticing sooner, aren’t you?

Nurse: Okay, you’re a funny asshole.

*We high five*

—————————-

Tyler’s First Death: You Never Forget Your First

Salem gave me a milestone I have been able to dodge in my years as a nurse. I had a patient die unexpectedly. When I say unexpectedly, I do not mean accidentally. I do not mean that there was foul play. I only mean that the patient passed away sooner than the care team expected, but they expected sooner rather than later.

In my nursing career, my patients nearing death always made it to an inpatient setting where they could pass with a little more peace than an emergency department can offer. I think about the family members of patients who die who have to walk through the lobby of people groaning and puking and complaining just to see their loved one a last time. I wouldn’t want that for anyone.

Not only is the atmosphere not conducive to grieving, but ED folks are notoriously busy and even more infamous callous jerks. It’s what we to do to survive. We have to go from the unexpected death of baby to the dental pain next door who thinks that their cavity trumps everything. We compartmentalize because we care. We compartmentalize because we have to or nothing would get done. The misery of others becomes routine. Hate reading memos at work?  We feel that way about your gallbladder attack. There should be some dignity in death if possible. You can’t get a lot of that in an ED.

On to my patient:

My patient was a combative and cantankerous old git. From the moment the medics brought them in, they were fighting me. They were cussing at me. They were asking to leave so they could have a cigarette. They smelled like a human cigarette. Every blood draw, every blood pressure, every interaction was a battle.

“I’m getting killed by an altered shitty patient tonight,” I said to others. Their family showed up and attended to their needs and helped me care for them. They described the patient as cantankerous, opinionated, mean, and had the mouth of a sailor. “No shit,” I said. We all laughed. Even the fucking patient laughed at the trouble they caused me.

I feel for this patient. They were sick. They needed to be hospitalized. They were pushing 90 and their organs were failing. They were DNR which was nice. Their electrolytes were all out of whack from kidney failure. Their lungs were borked from COPD. They wanted to be comfortable. I can provide comfort.

This patient was slated to go to a room upstairs in the hospital but it wasn’t ready when their heart monitor started showing vtach. For all you non-medical readers, vtach is ventricular tachycardia, which is a type of arrhythmia that can be life-threatening if prolonged. I spoke with the doctors on the patients care team who checked with the family. They wanted the patient to be comfortable. They didn’t want to fight the vtach. They insisted that the patient didn’t want extra treatments and procedures.

The doctors ordered some fentanyl and Ativan to give the patient, a nice cocktail for making people comfortable. This was happening at the end of my shift. This was my last patient.

I went in to medicate the patient. The patient was moaning. This moaning was new. They were hurting. They were gasping. It was coming soon. As I touched their arm to inject the medications, the patient pushed me away. This exchange happened:

Patient’s family member: Don’t push him away. Tyler has been a great nurse. He’s been so nice to you. Be nice to him:

Patient: Ooooooooh fuck that idiot!

Everyone in the room—including the patient—laughed at this. Cantankerous indeed.

The moaning lost energy. The patient became much more comfortable. The patient was able to die in as little pain as I could manage to safely alleviate. The patient’s family was at their side as they passed away.

I was able to give the family a more peaceful death for their loved one. The patient?  They got to use their last words to give me shit.

When it’s my time, I hope I am able to antagonize my nurse like they did to me. Life is series of choices and we get to choose what we pass on to the next generation. I intend to pass on a lot of shit, figuratively and literally.

Here’s to you, you cantankerous old git. You were my first and I’ll never forget you. Rest in Pissed Off Peace.