Rough Girls...

I'll shoot it to you straight,

and look you in the eye,

so give me just a minute and I'll tell you why,

I'm a rough boy....

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("Rough Boy", ZZ Top)

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(If my photography looks different it's because I just got some new software for my photographs and I can't resist playing around with it---but I'm probably playing with the pictures too much because some of them are turning out like psychedelic hallucinations....)

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Several times in the last year or so I've been asked to train rookie nurses and/or new hires into the Road Nurse field. The first thing the new ones always ask me is: "What does it take to become a good Road Nurse?"

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And then I always have to bite my tongue before I frighten the rookie to death by saying something ominous like: "Well....uh... it's a rough bunch of girls...." Which sounds very negative and unappealing. But I really don't know what other word to use because it's actually a pretty difficult question to answer. And in my honest opinion, the life of a Road Nurse actually can be pretty "rough" compared to the more controlled environment of a hospital.

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Even if I were to try and be more concrete or descriptive about which "skills" are needed to be a Road Nurse, I'd have a hard time there, too. Because in my experience, it's not so much that a nurse must develop a particular set of skills to be a Road Nurse as much as it's the complete other way around: that there just seems to be certain types of nurses who gravitate toward this field.

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But even when I use the word "rough" to describe the average Road Nurse, that doesn't mean that Road Nurses necessarily "look" rough. Some of the Road Nurses I work with are the sweetest, most angelic-looking little snips you'll ever see---daintily sashaying around in crisply ironed uniforms, color-coordinated clogs, perfectly manicured French-Tip fingernails, the latest snazzy highlighted hair-color jobs and hair cuts---bedecked with sparkly earrings and jangly bracelets to boot. Some Road Nurses look like they just walked off the pages of the "Peaches Nurse Uniform" catalog.

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But don't let those innocent faces fool you...these ain't no Shrinking Violets. Actually, you've definitely got to be a pretty hardy soul to thrive in this business.

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It takes the kind of person who doesn't mind living most of their life in their vehicle, on a fairly dangerous Road, out in the midst of whatever the weather is doing, where every day's events are changeable or unpredictable--- and where a girl has to juggle a vast amount of precise paperwork with the gritty reality of entering all sorts of private dwellings in all sorts of terrain. Road Nurse Companies are well-known for their budget slashing policies, and they routinely schedule an unrealistic amount of work on their nurses. Most of the Road Nurses I know log in countless hours of unpaid overtime---it's just a fact of the job. Thus, an inescapable facet of this profession is that any nurse entering this field will figure out in a very short period of time whether she loves it or hates it--and then decide for her own self whether or not she "fits" into the profession. (I keep using the term "she" since a male Road Nurse is rare--I've seen a few here and there but they always seem to quit--and I really don't know why.)

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And I will concede that some of us most definitely do perhaps look a little rough around the edges....

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Some of us are tattooed, we wear Levi's on our "on-call" weekends (when our bosses aren't looking), and our clothing ensembles contain what resemble Pancho Villa's bandoliers due to our habit of keeping multiple cell phones, beepers and iPods slung along our belts (with iPod ear buds dangling from our ears)---while toting multi-pocketed nurse bags and Hazardous Waste kits over each shoulder. And we might stick our hair up into skewed topknots to keep it out of our way.

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I will admit here that I have tattoos on both of my arms. I have a ring of barbed wire around the biceps of one arm and I have my former Biker Chick Initials displayed on the other arm. (I used to be married to a biker--but I lost the Harley in the divorce, okay?)

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Clothing and tattoos aside, I guess if I were really pinned down about having to define the Road Nurse Personality, I would have to go ahead and admit that there is most definitely a very quirky personality that I see in most Road Nurses. (And notice that I'm using the word "quirky" in order to avoid the words "crazy" or "insane"....)

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For instance, take Belinda. She is one of those small, delicately prissy girls who looks like she'd never blow her nose in public or utter a cussword. She is so sweet and nice that patients' families frequently invite her to lunch or Sunday Dinner. Most of her patients dote on her life so much that they display her child's picture on the same wall that they hang their own children's pictures on--and they all call her on her private cell phone when they have a problem instead of calling the Road Nurse Company. But her slight and ladylike appearance belies her singleminded, dogged determination to get the job done--in whichever way is the most expedient.

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One of Belinda's weaknesses is that she is too soft-hearted to bring herself to nag any of her patients if they don't do what they are supposed to do--and thus they are all spoiled to death. One time she was having difficulty with a stubborn patient who kept carelessly allowing her leg bandage to get wet in the shower--- which was causing the bandage to subsequently fall off and expose the open, infected wound. After the tenth or eleventh time it happened, a frustrated Belinda called me on the cell phone. "Can you come over here and talk to Eunice-Lynn about this wound dressing?" she asked. "I can't get her to take me seriously about keeping it dry and intact."

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"What am I--the Gestapo?" I asked. "I'm busy--I'm in the middle of drawing somebody's blood here. Just put your foot down and tell Eunice-Lynn to keep her damn bandage dry."

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"Just get over here right now--I think she'll listen to you," Belinda persisted impatiently. "You've got tattoos. And besides, she used to be my 6th grade math teacher--- and so she isn't used to one of her students bossing her around. But watch out for her stupid cow when you get here--he's nosy as hell and always sticks his nose out of the fence at me--and he might want to see your tattoos."

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Right off the top of my head I would say that the most noticeable trait I have seen in almost all the Road Nurses I've ever known is irreverence. Road Nurses are the most irreverent people I know. I don't care how sweet and innocent they appear, how quiet, how mannerly, how "Goody-Goody", how church-going, or how professional they look on the surface---dig a little deeper and you'll find a Rebel At Heart who bucks the establishment and loves to clown around. (None of us can ever sit next to each other at church because there is simply no WAY that we can keep a straight face and refrain from giggling like schoolgirls for an entire hour...)

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Most of us are forever getting into trouble for something or other, mostly for our continual horsing around. We start our days in the office by boisterously gathering our clipboards and paperwork, tossing files and medical supplies around as we chatter like magpies while getting ready for the day on the road--- gossiping about whatever happened to us in the night, and griping about our personal lives--- usually until our boss screams at us in exhasperation to "get the hell out of here and go see the patients, dammit!" And then off we go in our various directions--- to ranch country, to horse country, to chicken farm country, or wherever....

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Then later, when we return to the roost at the end of the day, the boss will again try in vain to get us to settle down enough to give professional Case Conference reports--a difficult feat, because by then we're all cracking ourselves up telling and re-telling the day's outrageous Road Stories (usually with great embellishment) and laughing so hard that tears are running down our cheeks. Our patients sometimes do the funniest things--and we just can't resist telling each other about their latest foibles. Last week there was a good story--and it was Jane-Anne who told it.

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"I was at old Mrs. Bindersween's going over her medicines with her," Jane-Anne said. "I asked her what she takes for pain and she said she had a brand new pain medicine that works 'like a charm'. She said she saw it on the TV---and then she whipped out a Ban Roll-On Deodorant from a basket on the kitchen counter. I stared at it like a dummy."

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"Do what?!" I asked.

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(Hickese translation: The expression "Do what?!" is a Texan expression which means "Excuse me??", and is usually uttered in a shocked tone to indicate that you simply can't frigging BELIEVE what crazy thing the person just said to you--- and you'd like them to repeat it just in case you didn't hear them correctly the first time.)

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(Actually, it is a little-known fact that "Do what?!" is actually what the guys at NASA's Mission Control Center replied when the astronauts first radioed them to say: "Houston, we have a problem." )

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"Yes, she showed me a Ban Roll-On Deodorant," Jane-Anne repeated. "She said that it is what she uses for pain. I said 'Do what?!' again and she explained that she saw a commercial on the TV that said that you're supposed to use roll-ons for headache medicine and so she decided to get one for herself. But I don't think she realizes that the commercial she saw was one of those crazy info-mercials."

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"Oh my GOD--- she's talking about that stuff called 'Head On' !" Lu-Lu exclaimed. "I saw that TV info-mercial too! But that stuff is a hoax--somebody analyzed it and proved that it's just wax and isn't really a valid medicine at all."

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"Well...I wonder why in the hell she'd think that just ANY roll-on deodorant was the same thing as what's in that TV commercial?" I asked stupidly.

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"Well, you're not going to believe this," Jane-Anne said. "But she actually KNOWS that it's not the same thing as in the commercial---she just thinks that it's the 'generic' version! And if you want to know my opinion, what could it possibly harm to let her keep on thinking that? She says it works better than anything her doctor ever gave her. So I stopped trying to convince her that it wasn't a pain medicine and just left well enough alone."

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And as far as we know, Mrs. Bindersween is perfectly happy using that Ban Roll-On for her headaches. We haven't gone so far as to write it down on her medication list, but we probably ought to...

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Actually, our end-of-the-day Case Conferences can get pretty raucous sometimes. Patients do and say the nuttiest things, and it all gets discussed at the end of the day. A Road Nurse giving her daily report will usually just prattle along, giving the medical details right along with her patient's comments or her own two-cents worth.

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Here's a sample of some of the comments you might hear during a daily Case Conference:

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"I told Mrs. Denfy that her doctor wanted her to switch to sugar-free pancake syrup and she said that if she had to eat that junk she'd urp. And for the rest of the day I couldn't stop wondering what in the hell 'urping is'?--is it like pukin'?... or burpin'?... or what?"

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"You know how stone deaf Mrs. Janeway is? Well I told her that I had come to change that bandage on her 'private parts' but she couldn't hear me--- and so I kept having to yell it pretty loud--and then finally she suddenly hollered out at me: 'Why don't you just call it a pooty-tang like my momma used to?'"

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"That's nothing. Old Mrs. Renfro calls a 'sponge bath' a 'whore bath'. Why in the hell do all these little old ladies call a sponge bath a 'whore bath'?"

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"I was talking to ole Mr. Swenson about his doc's suggestion that he move to a Retirement Community and he said that the only way he'd ever leave his ranch was when they hauled his cold dead body out of the cow barn."

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"That pervert Mr. Wilson asked me if I knew 'what Burger King and my body had in common'--and I said 'Do what?!' and he answered: 'they both have Whoppers'--and I told him that he shouldn't say stuff that pisses me off like that when I have a needle in my hand, and so he shutted the hell up. From now on I'm not going near that old coot unless his dang wife is standing RIGHT there."

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"I told Mr. Lindy that his doctor was recommending knee surgery and he said 'Forget it, I ain't paying for his damn Mercedes'!"

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"I got the home health aide to help me hold up Mrs. Wrigley's legs so that I could catheterize her and during the whole damn thing she kept yelling: 'What in the hell are you DOING down there, drilling for OIL?'---and it drove me plumb nuts."

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"I was trying to talk Mrs. Benner into going for a female exam but she kept saying that she was too shy to let that doctor see her nekkid---and so I told her 'Oh for heavens sakes, just GO---I've been going to him myself since I was 14 years old, and in fact, he's the first doctor who ever saw my coochie'."

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"I asked our new patient what his dog's name was and he said: 'He ain't gotta name--but why don't you try calling him something and we'll see if he answers to it?' and so I called him 'Dog!' but the dog didn't look at me, and so the patient said 'Well, it ain't Dog, then.'"

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"I asked Mrs. Reese if she'd gone to visit her husband at the nursing home and she said: 'Yes, I did--and that old whore dog grabbed my titty right in front of the nurse'."

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Some of us Road Nurses are are a little sneaky. The neat thing about being a Road Nurse is that you're out of the office at God-knows-where for half the day---and your visits are so varied in their distances from each other, and their time-lengths, that the Road Nurse bosses have no earthly idea how long it really takes you to complete your visits. Thus, Belinda and I are famous for sneaking off in the middle of the day to gossip somewhere. I don't care what we're doing, how many miles away from each other, or how busy we are--we can always find 20 minutes to sneak off to a Dairy Queen or somewhere to catch up on the latest Road Nurse gossip.

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One day we had planned to meet at 1:30 pm in a nearby hamlet at a barbecue place. We knew that nobody we worked with would be out in that direction to catch us goofing off. But at about 12:45 pm my cell phone started ringing madly, the ringtone that I've assigned to Belinda's calls--and when I punched the button to answer it I heard Belinda yelling: "Abort! Abort! The Paramedic Truck just headed out that direction and Lu-Lu's ex is on it!"

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Speaking of goofing off, I am the world's worst. I am forever clowning around and have frequently gotten into a lot of hot water for it. One of my worst faults is that I like to make up stupid song lyrics to sing to the tune of regular songs. (I'm like the nurse equivalent of Weird Al Yankovic that way...)

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In fact, have I ever sung you my version of "The Twelve Days of Christmas"? I call my version "The 12 Days of Narc Counting" . I penned it a few Christmases ago when I was working in Emergency Rooms so as to make the boring chore of counting narcotics at the beginning and end of every ER shift a little more interesting. One night it was quiet in the ER and so I started horsing around by singing this dumb song in my best imitation of the opera singer Maria Callas. I belted out the song not realizing that my evil co-workers had surreptitiously turned on the hospital's PA system during the last stanza---thus enabling the entire hospital to hear the last verse:

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"On the 12th day day of Christmas my Narc Count said to me...

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Twelve Ativans!

Eleven Morphine Sulfates!

Ten Point-Five Xanaxes!

Nine Phenergans!

Eight Loose Valiums!

Seven Hydrocodones!

Six Doctors' script pads!

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FIVE NARCAN VIALS!

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Four Toradols,

Three Stadols,

Two Darvocets,

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AND A LOST TUBEX MEPERIDINE!"

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I've been a Road Nurse in other states before, but things seem a little grittier here in Texas. A Road Nurse here definitely needs to be comfortable with frequently having to leave the main roads in order to four-wheel it through the endless dirt of large cattle ranches and chicken farms in all kinds of weather (and for some reason, we seem to prefer driving the largest SUV's possible---if we could afford Hummers, we'd drive those).

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In this rural area it helps if a Road Nurse is able to do things like stop her daily run to tow a disabled vehicle out of a muddy ditch, be comfortable working among a lot of animals (both IN and OUT of the household), tolerate driving very long distances in a single day---and I will add here that most of us also pride ourselves on being able to shoot a gun as accurately or better than any man around.

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Also, an increasingly large number of our patients do not speak English---being from Mexico, they speak Spanish. Having spent a large part of my younger life overseas, I speak fairly good Spanish, which has always come in handy for my nursing jobs here in Texas. But I learned my Spanish in the various countries of South America---and the slang terms there mean different meanings than those used in Mexico's particular Spanish dialect. And I found that out the hard way one time.

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I was working in an ER and was trying to tell a Mexican couple that I needed to take their baby's temperature rectally, in his 'bottom'. I'd used this phrase a thousand times in that ER without a problem, and so I felt somewhat disconcerted when the father appeared flustered and instructed me in Spanish "that a better word for 'bottom' would be such-and-such word." I complied with the word he desired and didn't think another thought about it. Until later when I mentioned it to one of the ER techs, a Mexican guy. He turned white as a sheet and asked: "You used WHAT word for 'bottom'?" When I told him the word that I'd been using for 'bottom' he doubled over in laughter, explaining between guffaws that the word I'd been using might be perfectly acceptable in South American Spanish---but that in Mexican Spanish it was a street-slang term for 'asshole'...

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And after I got over my embarassment about THAT, I got embarassed all over again---because I realized that I had been using that word in the ER for a solid year, mostly whenever I asked Mexican adult patients to bend over so that I could give them a shot in their "bottom"... ("Please bend over so I can give you a shot in your asshole!" I'd said cheerily, brandishing my needle. NO WONDER those people had all looked frightened as rabbits ....)

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But whether from Texas or any other state, most of the Road Nurses I know are inherently independent (aka stubborn) , completely fearless (aka calculating risk-takers) , and hopelessly optimistic (aka "can I get away with this?") . Inevitably, with this combo of traits, many Road Nurses seem to have very contradictory personalities.

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For example, Lu-Lu's young cousin, Jane-Anne, is a canny and skillfull Road Nurse. I've seen her gun her vehicle mercilessly to see 9 patients in a single day, fill out reams of complicated paperwork on the side of the road while slurping Campbell's Chicken-Noodle Soup out of the can, one-handedly obtain a blood sample in one stick from sick patients with no visible veins while yelling "One Dollar!" with her patient while watching the TV show "The Price is Right" , squat down on a filthy, roach-infested floor to help fix a patient's broken oxygen tank tubing, help an elderly patient stir a boiling pot of chicken & dumplings, change a bloody wound dressing in 6 minutes flat while discussing a hushpuppy recipe with her patient's wife, bring bags of dog treats to toss at her patients' yard dogs--- and then report every single pertinent detail of a patient's condition with precision accuracy to a doctor over her cell phone while driving back to the office.

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And yet.... Jane-Anne is the quintessential innocent, corn-fed country girl---pure as the driven snow, wearing her blonde hair in school-girl pigtails, married her high school sweetheart right out of high school, and flushes bright red whenever anybody cusses within her earshot. It is not uncommon for Jane-Anne to approach a more experienced nurse to shyly ask for advice on how to handle her monthly menstrual cramps or her unruly husband---or to solemnly inform one of us that she has commited some minor "sin" for which she has to ask The Lord for forgiveness.

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(The last time she did this was because she felt guilty for slamming a box of Hostess Honey Buns down on her kitchen floor in anger at her husband--and she was extremely relieved when I informed her that it is every woman's God-Given Right to throw Hostess Honey Buns or any other dang thing down on her own kitchen floor because of her dang husband if his behavior so warrants.)

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(Okay, it might not be said that exact way, word-for-word, in the Bible but I'm pretty sure that it's paraphrased in there somewhere.)

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Actually, Jane-Anne's innocence of worldly matters is astounding sometimes. The other day we were hosting a Blood Pressure Screening at the grocery store and during a lull I went around the circle asking everybody: "How old were you when you found out that there isn't really a Santa Claus?"

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When it was Jane-Anne's turn to tell she related that she had not found out that there was no Santa Claus until she was 12 years old.

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When I heard this little tidbit I couldn't help bursting into laughter so suddenly that I dropped my stethoscope right on the floor by the Ben Gay display. I sat down next to one of my patients and laughed so hysterically that I almost peed my pants. Jane-Anne looked stricken and so Lu-Lu piped up sypathetically and said "Oh hush up, Bohemian! Our family wanted to shield her from the truth for as long as we possibly could!"

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But I couldn't help myself. "Shield her from the truth?" I laughed, hiccuping. "Till she was TWELVE? For Christ's sakes, Lu-Lu, were you guys just going to let her believe in Santa Claus till she was married? Think about it---all the other girls were putting on lipstick and kissing boys under the mistletoe at Christmas---but poor little bird-brain Jane-Anne was hanging her dang stocking up like an idiot and putting out milk & cookies for Santa Claus!"

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"And deer corn for his reindeer," Jane-Anne added.

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After I calmed down, Jane-Anne proceeded to tell me the whole tragic story.

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"It happened one afternoon when my brother and I were in the back horse pasture," she said solemnly. "And he accidentally blurted out that while he was in the barn he had found some hidden boxes that were full of Christmas presents. I said 'Do what?!' and ran to look for myself--and sure enough, there they were! I ran into the kitchen to ask my momma about it and she tried to tell me that Santy Claus had simply put the presents there for safekeeping until Christmas."

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"That's a reasonable explanation," I stated. "So then what made you stop believing in Santa Claus?"

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"Well hell, I ain't no fool!" she replied indignantly. "I knew damn well that Santy Claus wouldn't bring your dang presents in boxes with the dang price tags still on them! I bawled for a week and my mother smacked my brother upside his stupid head for ruinin' Christmas for me!"

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Then she thought for a minute and added: "And please don't tell my momma that I just said the word 'hell', okay?"

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Speaking of contradictory Road Nurses, Lu-Lu is the most contradictory nurse I've ever met. On the outside, Lu-Lu looks like your typical Texan-Belle, similar to the proverbial Southern-Belle, but with a Texan accent. She is beautiful to the point that she is often teased about being a Paris Hilton look-a-like. She is sedate, ultra feminine, unfailingly polite in all situations, never rude, and always respectful to her elders. Patients love her and think she is the epitome of an earthly angel.

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And two months ago she was in a bar fight.

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"I had to defend my honor, dammit," she told us the next day when she showed up at the office looking slightly bruised and ruffled.

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"What in the hell happened to you?" I asked.

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"You remember how I stole my boyfriend, Luke-Henry, from that hussy girl from West Podunk?" she said guiltily. "Well, last night she got drunk and came up to me in the bar and called me a 'low-down-man-stealin'-fake-blonde-idiot'---and so I had to knock her down."

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"You knocked her down?" Jane-Anne asked incredulously. "I thought you gave up fightin' when you graduated from high school. Uncle Dean would kill you if he knew about this." (Lu-Lu and Jane-Anne's Uncle Dean is the owner of our company....)

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"I don't give a rat's ass," Lu-Lu retorted. "Because it's one thing to call me a low-down-man-stealing-idiot. But I ain't gonna let NO HUSSY get away with calling me a 'fake blonde' in front of all the boys! That just ain't right! But then after I knocked that damn hussy down she came up fightin' like a crazy woman---and all the boys started yellin' 'cat fight! and taking bets on who'd win!'"

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"Who did win?" Jane-Anne asked.

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"I did, of course," Lu-Lu said defiantly. "I fixed her little red wagon but GOOD. But now I cain't go back to that damn bar anymore."

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This is also a job where a Road Nurse needs to be completely flexible--because the job involves more than just visiting a "set" list of patients. Some days unexpected issues arise and your boss changes your schedule around so fast that you're literally making U-turns in the middle of the road after she calls you on the cell phone. You learn to keep plenty of medical supplies and a master patient address list in your vehicle for those unexpected lab tests, fall assessments, urine samples, medicine-box set-ups, neuro checks, blood glucose checks, or cuts and bruises.

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Also, there are times when you're not so much helping a patient live as much as you are helping them---and their families--- deal with death. At least three times this year we have gone to the funeral of one of our patients. The last one we attended was a grave-side service where we stood sadly alongside the open grave with the patient's family, in the boiling hot Texas sun, while a minister preached a funeral sermon.

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One thing about the preachers around here is that they never forget to read one of my favorite Bible quotes during funerals, that Biblical promise of what it's going to be like in Heaven: "...and God shall wipe away all tears from their eyes. There shall be no more death, neither sorrow nor crying, neither shall there be any more pain...."

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One of the bad things about this job are the inevitable societal hazards. Since a Road Nurse must work within and among all of humanity's behaviors, good and bad, (and although most of our patients are beautiful, loving, and kind people) it is unavoidable that a Road Nurse must sometimes encounter extremely unpleasant situations. The following are some of the situations a Road Nurse, whether in Texas or any other state, may encounter during her work day:

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- Street gang/drug activity in or around the household she is visiting;

- Domestic violence in the household;

- Hopeless poverty and filth;

- Alcohol or drug-abuse by patients and/or their family members;

- Violent or abusive patients;

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And this job is not exactly the highest-paying nursing job in the country. A full-time Road Nurse must usually work 5 full days a week plus her turn for those dreaded nights & weekends as the "on-call nurse", where she provides an after-hours resource for unexpected events, extra bandage-changes, or blood draws. These hours are frequently much worse than those of other nursing jobs. For example, when I used to work as an ER or ICU nurse, I only had to work three 12-hour shifts a week to qualify as a full-time employee with benefits---and I never had to be "on-call".

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But I guess what attracts me and a lot of other girls to this profession the most is the freedom. For some reason, there's something exhilerating about hopping into your vehicle on sunny Texan mornings--heading out towards ranch country with a big car-cup full of good, rich coffee---not knowing what adventures to expect for that day.....and getting to see a flock of ducks lift off of a beautiful lake.... watching the turtles sunning themselves on the banks of the creeks.... waving at the farmers driving their pick-up trucks.... catching a bite to eat at the Dairy Queen with Belinda.... chatting with charming little patients while watching a game show on the television set.... talking with your patients' animals and getting their point of view.... changing a bandage while swapping recipes with a patient.... laughing with your buddies at the end of the day....

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Hell, I guess it ain't so rough....

(In fact, I'm thinking of getting a new tattoo of a Jeep on my ankle.... )

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