Monday, June 19, 2006

My New Assignment

First of all, I must warn you that I am so extremely fatigued that I may not be my usual self......I am so tired right now that my "get up and go" definitely "got up and left". I arrived at my new assignment Wednesday, but I am only just now getting the strength to post. And I'm really sorry!!! Because I didn't mean to neglect my readers. You have no idea how much I appreciate those of you who read my blog and send me messages! I LOVE getting your messages!!!!! And I truly apologize for my absence this week. But I am totally exhausted--and I literally slept all weekend. And I am melancholy, most likely because I am tired. Please forgive me if I get maudlin. Some thoughts I just have to get out, whether positive or negative. I mean, there are some things about my job that are joyous and funny....and yet there are some things about the job that are sad and haunting. Anyway, I will try and tell you about my new assignment. This assignment means a lot to me and I really want to do a good job for my friend who promoted me. It's hard work, though....hard work.... Okay, here goes. When I told you before that I was going to a town that was even smaller than the town I used to work in, I wasn't kidding! It's a tiny, tiny town---but the surrounding vast farmlands and ranchlands are heavily populated with plenty of patients that I must see. When I first drove into the area, my first sight was these cows:

And what first struck me was this thought: WHY are they all standing around separated, ignoring each other? Is it because there's just so much wide open spaces that they can spread out? Or is there snobbishness going on among the breeds of cattle? If that's the case, we must nip this in the bud as soon as possible. I intend to have a talk with them about "getting along with others". We can't have Herefords, Brahmin's or whatever having "cow attitudes". Oh yes, I think I have my work cut out for me in this new area.

I did try a conversation with the below cows, but as you can see, they turned their backs on me rudely as if to say: "What kind of interloper are you? We've done things the same way for 150 years and we're not about to change now just for you!"

(Well now, we'll just see about that, won't we?.....)

And the ranches in this area are far more rustic than what I was used to in my former town. Many of the farm houses and barns here were built by the owners or their grandparents, and many of them are built out of logs or home-made bricks. Here's the house of one of the richest ranches in the county, built by the owner's grandfather, made entirely out of logs:

And as for the town itself, if you drive down the main drag of the "downtown" area, it's a trip that takes about 2 minutes and 45 seconds. The first time I drove it I couldn't believe my eyes. There are only TWO traffic lights in the entire town!!! Yes, I am telling the truth! Only TWO! There is no such thing as a traffic jam around here. Because there isn't any traffic. In fact, there's no Walmart. There's no Dairy Queen! And for God's sakes, there's not even a Taco Bell!

And....shudder.....I hate to tell you this.....but they also don't have a McDonalds!!!! AAAIIIEEEEE!!!!!! I was panic-stricken when I realized there was no McDonalds. I mean, where am I supposed to eat lunch? Always before, in my old town, I simply drove through the drive-thru lane at McDonalds where Ronald McDonald himself waved me in with a happy smile!

And so, sadly, I will put a picture of him here for sentimentality's sake. I will remember him fondly. (See him there, waving at me in the window? Oh Ronald, my Ronald......wherefor art thou....OH NEVERMIND you stupid clown.....)

Anyway, I know I sound like I'm whining here, but I think it's probably because I'm so exhausted. This particular branch office is short on staff, and most of the field nurses are baby rookies. I've been going to work an hour early and working an hour late, aaarghh.... My Directors expect me to pick up a lot of the slack and train the younger nurses until they can handle a full load. We have no choice because there is a severe nursing shortage in the rural areas of Texas-- and it's particularly serious here. It seems that not many nurses want to be Road Nurses these days.

I will admit a Road Nurse leads a rough life. There's nothing glamorous about it. You are on your own in drastic weather and conditions. The heat was so hot this week that it disabled my glucometer and I couldn't test a diabetic patient's blood sugar until I cooled the glucometer down by holding it in front of my Jeep's air-conditioner vent for 15 minutes. (And vice-a-versa in the winter if it gets freezing cold outside--there have been times where I've had to hold a glucometer or Coagu-Check machine over a stove in the winter, in order to warm it up so that it would work again--the trick is not to cook it so hot that it won't work AT ALL.......)

And you need an expensive 4-wheel drive vehicle to even GET TO many of the places you visit--some of the roads are rockdirt roads with holes 1 to 2 feet deep, and you're sure you've thrown your clutch out completely after bouncing through a couple of them.....which would be a disaster if your cell phone wasn't charged. One of the first and most important things you learn as a Road Nurse is to ALWAYS have your cellphone completely charged every morning--because you definitely don't want to be caught stranded without the use of your cellphone....

Some of you have asked if I get paid mileage for my vehicle. The answer is yes, that we do get a certain amount of money per mile. And let us just say saying anything negative about my company.....that the mileage they pay us doesn't even pay for half of the actual gas we use-- or the vehicle maintenance for blown-out tires, maintenance, or other costs. This job is definitely a labor of love.....

And there's nobody out there in the country to help you should you encounter a problem. You've simply got to be competent at drawing blood, starting IV's, examining wounds, assessing symptoms--and then communicating with the doctors via telephone. These people are mostly poverty-stricken or otherwise cash-poor people who can't even afford an $8 prescription for medicines. Nor can they get themselves to a drug store to pick the prescriptions up if they had the money. Many days I go and pay for the prescriptions myself and then take them out to the patients.

Some of these patients live in homes so dilapidated that you have to hold on to the walls and furniture to keep from tipping over while you're traversing through the home--the homes are literally tilted from settling into the dirt-- and also the floors may be slowly caving in out from under their residents' very feet and furniture.

Few of them can afford air-conditioning, so we bake. Lord, it gets hot. Sometimes I'm so hot that my sweat is literally dripping off of me while I'm taking care of the patients. And the flies will eat you alive, as my patients must keep the doors and windows open to catch the cooling breezes.

One elderly lady I went to see was armed with her trusty flyswatter. She's an expert with that flyswatter. I'd pit her against a ninja warrior anyday. In fact, she can whup out that flyswatter faster than Billy the Kid could with his six-shooters. "Is that a fly?" she'll ask in outrage. Whoosh--whoosh-- SWAT. And that fly is flatter than a fly pancake and deadern' a doornail.

"Fixed his little red wagon," she will say, blowing the smoke off the flyswatter as one would after shooting with a pistol. Don't get near her with a flyswatter--she's at least a black belt....or... er...whatever level expert flyswatters call themselves.

One day I told her: "Ya know what? When I was a little girl, my grandmother would smack me with her flyswatter sometimes when I was bad."

The old lady laughed and said: "Mine did, too! And remember how when she did that you'd have the pattern of a fly-swatter on your leg for 3 days?" That cracked me up and we cackled in laughter over the memory. (Only in Texas can you have a good laugh over the memory of a flyswatter imprint on your thigh.....)

Sometimes a Road Nurse has to deliver bad news to a patient....and it hurts like hell. It haunts you in your sleep. I will never forget the time I went to see a diabetic/renal failure patient after she got out of the hospital where she'd had her second leg amputated because of diabetic/circulation problems. She was my age and I had always liked her. She was getting weaker and her daughters had to hold her cigarrettes up to her lips so she could smoke.

The day I went to see her, I was doing her amputation (leg stumps) wound care when she hesitantly--fearfully-- showed me her hands, asking: "Uh...nurse....what do you think these black spots are?" I took her hands in mine and examined them closely. I was traumatized and shocked when I realized that she had dry gangrene on fingers of both hands. It had happened during the process of the hospital nurses sticking her fingers to check her blood sugar every day---and her circulation simply wasn't adequate enough to heal the stuck places--and the nurses hadn't noticed that gangrene had set in. My anger at that oversight was overshadowed by my shock and pity. I knew that gangrene is life-threatening--and the treatment was further amputation.

I tried so hard not to change the expression on my face....I really tried hard. But she asked me: "Nurse...are they gonna cut more off of me?"

All I could manage to say was: "Uh....I don't know, but I won't lie to you--there is a possibility. And my dear--you need to get in to see your surgeon today. And I mean today. " She went. And he told her. She had dry gangrene on both hands' fingers. She lived for another 3 weeks.

I am haunted by that experience.

Sometimes when times are bad a Road Nurse must make a decision in a split second. You're alone in the country and there's nobody to ask for advice like if you worked in a hospital. The other day a patient's wife called me in a pure panic and said her husband was sick. The symptoms she described to me were dangerous--and I was a half hour away, too far for him to have to wait for me to get there to decide what was going on. I decided he needed to go to the emergency room even though it, too, was a half hour away. But I knew that EMT's could provide oxygen and other emergency measures as soon as they could arrive. So I told her: "Don't wait for me--he needs help as soon as possible--I'm going to call for help."

I quickly pulled over on the lonely country road. I grabbed my "master" patient book where I keep all my patients' information-- and since there is no "911" in this area, I had to call the Sheriff. He then radio'd the nearest EMT service in the next county over. He patched my call through to their radio and I began to tell them what was going on and where my patient was located--and before I even finished saying the patient's name they responded: "Oh yeah, Mr. Hickory-- don't worry, we know where he is. We're on our way."

And they broke every speed limit there is getting there, saving the patient.

Anyway, I am tired--I am more tired than I've ever been before. But I shall work. Because although there may be a shortage of experienced nurses, there is never a shortage of ill patients needing nursing care. And I do love my job.

And my company provides very good training for the nurses they have. Today we had a lecture by an eye doctor on the type of eye diseases that elderly people tend to get. He was very informative, even if he did wear cowboy boots and a silver-studded belt buckle. He looked like a cowboy eye doctor. And the funny thing was, I recognized him as the guy who examined me for my last eyeglasses prescription 35 miles away in a larger town. But apparently, now he is driving "the eyeball van", a traveling eye-exam vehicle loaded with eye-examining gear, visiting the rural areas to help there.

Today, as we nurses were finishing up and getting ready to leave, there were a couple of tears falling from the eyes of a couple of the younger little rookies at how much of a workload we have. Because once we're done with the visits, we have a mountain of paperwork to complete. It is rather daunting sometimes, with no "light at the end of the tunnel". Everybody works overtime for no extra pay--and sometimes people get overwhelmed to a breaking point. More than one person has quit their job because of it.

Today, one young nurse, a friend of mine, called out to the Director: "I'm so far behind in my paperwork that I have ANXIETY!" The Director didn't know what to say. What can you say? So I just said: "Come on, girls, we can make it...."

Because we have to.....we have to take care of the patients.....

So if any of my readers could throw a few prayers our way, it would be greatly appreciated.

(And I promise you I will find out what the scoop is with those snobby cows and straighten that whole situation out....)


Anonymous said...

Vaya con Dios. I will say a prayer for you all.

Anonymous said...

Hang on in there, you're doing such an important job and it's just hard that so much responsibility falls on the shoulders of the few competent people! If you ever get a moment you should write a book, your blog is so good to read.

Anonymous said...

Get your sleep, feed your body healthy food, drink your water!... And ALWAYS remember that you've got a bunch of people who really appreciate all you do, and are very very proud of you and others in your profession. Knit on! It soothes the tired soul.

Anonymous said...

Thank heaven for road nurses who are willing to do the job where it needs to be done!

I'll remember you tomorrow when I'm feeling unappreciated as a toddler teacher!

Beth in MN

Katherine said...

I salute nurses everywhere, especially those who go above and beyond like you and your associates. As the mother of three nurses, one ER, one surgical, and one neuro-trauma care, I know the sacrifices you all make. I also know what it's like to see fatigue on the faces of the nurses who work with you, then to look in the mirror and see the same look on your own face.

Thank you for what you do! Our prayers are with you all.

Anonymous said...

Bless your tired little heart. This post made me cry. I know how it is to have someone so sick, and you have to give them more bad news. We have a road nurse, a visiting physical therapist and a home care aid to give him bed baths. i don't know what we;d do without these wonderful women. Not only do they help care for my dad, who has a feeding tube, nebulizer and oxygen, but they brighten his day with stories and jokes. They don'y pay you enough, and perhaps no matter what they paid you it wouldn't cover the care, the comfort and the affection you all carry to your patients. Thank you.