A day in the life; a day from hell

I am in the middle of a four-day stretch. For those of you who work in hospitals like I do, you know how exhausting that sounds. For the general public: imagine cramming Monday through Saturday into four days.

Now that you have that in mind, let's begin.

0531: alarm. I have nine minutes of snooze time. Nine minutes. I feel like I went to sleep five minutes ago.
0540: get out of bed now or you'll never make it to work on time.
0600: shit, move your ass or you will have to drink the hospital swill instead of real coffee.
0625: out to the car. snarf power bar.
0653: time to clock in.
0700: report. These guys are a mess. All four of them. Going to have to start paging as soon as I'm out. Hypoxic felipe over there, confused felicia in here who is also hypoxic, this felicia in here shouldn't be too bad. And that felicia over there is going to surgery so hopefully she'll be gone awhile.
0800: med pass. Let's hope none of these felicias give me a fight about taking their meds. I'd rather not have to pick spitty capsules off my scrubs today.
0900: the one felipe's oxygen is definitely low, his blood sugar is through the roof and I can barely wake him up. Awesome. Too bad I can't talk to the doctor since he isn't returning my pages. Hopefully he'll be here for rounds soon.
1000: finally getting around to this dressing change. Hopefully this thing we MacGyver-ed will be enough until the wound nurses get here. That stuff needs attention bad.
1100: felipe's oxygen is still low. Finally talked to the doc on rounds. Too bad he's mad at me about something so he didn't want to talk to me, just wrote down a list of things for me to do STAT and set it in front of me. excellent. Oh by the way: finally got orders for the blood sugar. Good luck with the oxygen, though. Fortunately I had the wherewithall to put that felipe on continuous pulse ox because he falls asleep and his sats drop to the 60s, so that's fab.
1200: post-it tasks complete STAT at MD's request. Felicia over there needs pain meds and IV antibiotics. Just found out apparently the doc went to the director of nursing and complained that I am terrible and undermining him all the time. K. Both my felicias who left the floor come back at exactly the same time of course. Frequent vital signs, the one is confused so now I have to convince her to take her pills. Challenge.accepted.
1215: ah well, I tried. I'm just a bitch who's trying to choke that felicia with her anti-seizure meds according to her. I don't have time to fight you today my dear. I chart "refused". Surgery felicia's blood pressure is high. Excellent. Time to treat that.
1230: more insulin for my felipe with the high blood sugar who I can still barely wake up. At least respiratory therapy is on board now. The wife wants to go over labs and why he's so tired all the time and why he's so swollen and why we are changing this, and that his blood sugar is good at home so why is it so high and what else are we doing and how long is he going to be here. Let me go get the computer and we'll go over everything together.
1315: felipe's wife is telling me his CPAP has been broken for months. Maybe that's why he's so lethargic, his body is just so oxygen-deprived. Could also be the blood sugar though. She agrees and thanks me. It's all making sense. The Doctor didn't go over any of that in rounds, she says.
1420: shit I forgot to page the other doctor about surgery felicia. She wanted to come see her.
1430: surgery felicia's MD is here. As long as vitals are stable she can go home. Yay, patient says. Oy, now I'm going to have to figure out how to do a proper discharge at 5pm. Hope she doesn't have any complicated meds!
1500: lunch. finally.
1520: better get back out there. Need to check that guy's sugar again.
1600: felipe's blood sugar is still super high. Another nurse is on the phone with that doc, can I talk to him? I whisper. "OH GREAT" I hear over the phone. I roll my eyes and tell him about the high blood sugar and can we maybe treat it again. "Yea fine, I was just going to go take care of some personal things but yeah that's fine". So I get to put in your orders again. Excellent. Can I confirm the 10 units IV then? "YES JUST PUT IT IN". Hangs up. Eye roll.
1645: surgery felicia can go home. Oh by the way, she needs medication teaching about a shot she has to give herself twice a day that she's never done before. Cool. The patient is surprised by this. Doubly excellent since I have to be sure she knows how to do the shots and have her teach it back to me. And pharmacy closes in 90 minutes.
1720: On the phone with the pharmacist. Copays are going to be really high. This felicia is on a fixed income. Excellent. I hope we can actually do this, she says she's going home regardless.
1725: Bug runs across felicia's table. turns out it's a bed bug. Perfect, been taking care of her for two whoooooooole days. Patient is super upset and crying now, I reassure her that it's not her fault and begin teaching about what to do when you get home with cleaning. Surgery felicia is super overwhelmed. Asks me to come back to teach her about the shots.
1730: Nursing director wants to talk to me about what happened with the doctor and what he said. We had a previous incident, which is why he hates me so much I guess. I tell her maybe I can do it in thirty minutes? have to do 1800 med pass.
1800: wound felicia needs pain meds, felipe's sugar is still high, more insulin, surgery felicia is really getting antsy because she wants to go home. I just got the meds, turns out half of them are filled wrong or missing. They're closed. FACK. The discharging MD isn't even here anymore. Awesome. Guess I'll have to pull out her night time doses and go over the discharge meds really carefully and HOPE that she gets everything squared away tomorrow. Maybe I'll see if I can call her in the morning if I have a minute.
1820: frantically trying to get the medication schedule for surgery felicia right so she understands. She did great with the medication teach-back so I feel good about that. She's standing in the door waiting for me to come in. Fuck. I have to go talk to the director.
1825: director's office. She starts talking about what the MD said about me, that I don't do what he asks exactly when he asks, that there's a hierarchy and I should know my place, and that I don't know how to assess a patient. I have about 93 other things I need to be doing right now and I am so frustrated to hear this that I actually cry. How embarrassing. I never cry. Must be PMSing.
1840: better start this discharge, surgery felicia is REALLY getting antsy. Felipe's oxygen monitor is alarming. Hang on, have to go check. NOOOO CONFUSED FELICIA'S BED ALARM IS GOING OFF STAY IN BED DUDE.
1842: felipe is fine for the minute. so is confused felicia. thank god. I do NOT need a fall at shift change. Just have to make it to shift change. Discharge papers. aaaaaaaand GO.
1920: OH MY GOD I NEED TO BE IN REPORT BUT I'M STILL DOING THIS DISCHARGE.
1925: finally done. she seems like she gets it. I apologize profusely to this super nice night RN who is putting up with me being a HALF HOUR late to report.
1940: done with report. Everyone survived. Now I have to chart. Didn't even print one strip today fuuuuck me. Notes. make sure all my assessments and vitals are correct and in there. My brains is going so slowww. I bet my blood sugar is like 4.
2030: finally done. holy shitballs it's late. oh my god my legs hurt. Did I pee today? I think I'm hungry? who cares I'm too tired. still trying to wipe off mascara, thank god this corner is dark no one can see me I am such a hot mess.
2033: send email to director thanking her for sitting down with me and backing me up. Especially as a traveler I appreciate the hell out of that. Ugh my god I need to get out of here.

Most days are just like this. Minus the bullshit with the doctor. Most days I don't cry. I go to work every day, I put my head down. I don't complain, or at least I try not to. Some days I just gotta. I call it 'venting' but let's be real: I'm whining. I have always been resolved to advocate for my patients, no matter how much flack I take. If I have to page a million times or call the pharmacy back again, or stay an hour past my shift I will. If I have to take a beating from a physician because he thinks I'm incompetent, so be it. I'm not, but if he wants to think that I'm not going to change his mind. I will say that I'm the reason your patient didn't go into DKA, that they didn't go into respiratory failure, that his wife knows what's going on.

Some days I just have to sit in my car and cry like I did tonight. Even when you know you've done nothing wrong, when someone wants to make you feel small sometimes it works. What's the point, I think. I'm killing myself every day only to be shot down by some asshole. I don't need an award or a cookie. Well, maybe a cookie, but the point is: I don't do what I do for the recognition. At the end of the day if the people I'm taking care of are still alive, and they know what's happening, they feel secure, that's all I care about. To hell with the rest of it.

My legs ache. I'm too tired to eat. I should drink some water. Better get to bed, it's already 10:15. I have to be up in 6.5 hours. Time to do it all again.