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The Making and Life of a Blogger: A Truly Never-Ending Story: Chapter Twenty–Critical Care

When I left my previous hospital and came to my new one I had no aspirations for management. However, it became soon apparent that I could not escape that role because during the interview process, I was offered the role of clinical supervisor or charge nurse. After discussing what my salary options were, I realized that I would take a major pay cut if I were to go back to the floor. So economics decided for me. I continued that role for a period of nine months when administration decided to stir the pot up some. They basically fired all the clinical supervisors and replaced them with part-time charge nurses. We all were given the option to stay there but that meant that we would work the floors as regular nurses with maybe picking up a day or two as a relief charge nurse. Well, half the clinical supervisors out and out quit. The rest of us tried other options at the hospital. Within a few months, administration realized what kind of mistake they had made. Not only did they lose a very large number of experienced nurses, they now had a shortage of people willing to even do fill the roles of relief charge nurses. The charge nurses routinely had to cover two and even three medical/ telemetry floors. Even though it has been years since they reinstated the position of Clinical Supervisor, they still have not fully recovered from that policy change. If an RN had did something comparable to this on the floor they would have been immediately fired. Fair or not the administrators responsible received no reprimands what so ever. Like I said before, if something broke in the hospital it became the job of the nursing staff to fix it, or even better we were blamed for it.

I believe this trend to protect the administration is in part due to the “Peter Principle” which states that members of a hierarchy are promoted until they reach a level at which they are no longer competent. Apparently there is a growing acceptance of failures in the corporate world. It is changing the way companies approach innovation. While companies are beginning to accept the value of failure in the abstract—at the level of corporate policies, processes, and practices—it’s an entirely different matter at the personal level. Everyone hates to fail. We assume, rationally or not, that we’ll suffer embarrassment and a loss of esteem and stature. And nowhere is the fear of failure more intense and debilitating than in the competitive world of business, where a mistake can mean losing a bonus, a promotion, or even a job. Is this trend fair, I say no, but I don’t run things. I guess another term for this trend is the “gold old boy club.” I have worked in the corporate field for over 35 years now. I have seen CEOs come and go, however, they never truly disappear they just get shuffled off to other corporations where they just repeat their mistakes all over again. I will include one real life example here. Since the information is in the public domain I will actually use his real name. The CEO at my first corporation that I worked at was Ronald J. Floto. The company was Kash-n-Karry (KnK). It was owned by the parent company Lucky Foods. This was the era of Reaganomics and hostile corporate takeovers. KnK was a highly profitable branch of the company so it was sold off to prevent the whole company from being taken over. We became self owned with Ronald J. Floto still retaining his position as CEO. Unfortunately, we were highly leveraged and could barely stay solvent. It did not happen that one mistake was made after another, eventually Food Lion bought us out, and Floto lost his job.

Super Kmart soon offered him the same position in their Super Kmart which he ran for three years. Does anybody remember Super Kmarts? He was more successful in his next job in Dairy Farm International where he worked there for 10 years. During this time he was involved in a startup called FLT International, LLC where he has been the president for 24 years and is currently still holding that position. I think you should now see the point that I am trying to make, these top level administrators have nine lives. I think this is because they find ways to spread the blame to lower level employees. I believe the term used is “scapegoat.” The Scapegoat theory refers to the tendency to blame someone else for one’s own problems, a process that often results in feelings of prejudice toward the person or group that one is blaming. Scapegoating serves as an opportunity to explain failure or misdeeds, while maintaining one’s positive self-image. I always wondered how I was going to work this information into my memoirs. 🙂

So now that I have gone off on a tangent, let’s get back to the subject at hand. This shake-up gave me the golden opportunity to test the critical care waters again. I asked for an interview with the ICU Director and was granted it. The nursing director liked was she saw and agreed to hire me to the ICU after I completed my eight week critical care course. However, there was a stipulation. I had to agree to work in the IMC for six or so months until they could hire more nurses. I, having no real choice readily agreed to this condition.

The class was a combination of clinical, classwork and self-paced computer courses. The time flew by quickly. I finally finished my course by passing the final exam. To get me acclimated to the IMC floor I was given a couple of weeks of orientation. After eight months went by, I approached my boss about the agreement that was previously made. Unfortunately, the person that hired me no longer worked there. So I had to do some gentle reminding and just a little bit of arm twisting. While they did eventually say yes, they insisted that I take the ICU class over again. I adamantly refused and said that this had not been not part of the original deal, so they acquiesced and I was transferred to the ICU where I have worked till just recently. Where now I find myself in another crossroads. I was fortunate in that my hospital was part of small group of other hospitals. So after nine years, I was able to transfer to a sister hospital so that I could be closer to my new house. I still question the efficacy of this move. After 2.5 years I transferred back to my original hospital where I worked an additional five months before I finally tendered my resignation. I was warned by my previous boss about transferring back. She said it was never the same when you went back. She was so right, however, the facility I transferred from was really not any better.

I, however, can’t totally blame the administration for what happened to these two hospitals. The COVID-19 pandemic has permanently altered medicine and the hospital workplace. I will discuss this matter more in depth in the next chapter.

Prior to my last two transfers, I helped out the administration by doing relief charge nurse work in all the medical/telemetry floors and in the critical care floors as well. I also filled in as a relief for the house supervisor position at nights for over five years. When I made my last transfers, I decided to stop filling in as a relief charge nurse and supervisor. I frankly was tired of working in that capacity. As my career progressed and I aged, I just wanted to simplify my career path. This meant that I only would now take care of my two and sometimes three patients without the added stress of being responsible for other hospital staff. Besides low level and mid level management positions tend to be the least secure positions.

As in my previous chapters, I will now discuss some of my co-workers and a few of the remarkable patients that I had the honor of caring for. One thing that I have noticed as I sort through all of my interesting patients in my head, I find that the list is shrinking. I wonder if it is because I now work in a hospital that is in the outlying section of the city and we simply don’t have the varied pool of patients that I saw in my first Las Vegas hospital?

The vast majority of the staff I worked with over the 12 odd years were stellar and were all hard working. However, only a few stick out as being unique enough to warrant a section in my memoirs. Like I said, this has nothing to do with their lack of merit, it is simply a matter of available space. Over the course of my career, I have worked with hundreds if not thousands of different individuals, so you can see my conundrum. I simply can’t discuss everyone, so if you don’t find your story in my memoirs, I am sorry.

The first nurse I want to talk about is a bit of a world traveler in her own right. She was fortunate enough to start out her career right out of college as a nurse. Which in Nevada is a fairly high paying position. She is just now closing in on her 30-year age mark and finally put her suitcases in the closet for a while to test the marriage waters. She has circumnavigated the globe and has visited and explored over 60 different countries, not to mention an untold number of island chains. While I don’t care for her shotgun and rapid fire style of travel, I do envy her the places that she has seen. I am close to twice her age and I have yet to break the 10 country mark. I guess if I had not gotten married and divorced twice and had started off my career as a nurse, maybe I would have been able to do more international travel. Unfortunately or fortunately you can’t go back and do it all over again. Her early career choice has however, come with a heavy price tag. She has not even reached the 10 year mark in nursing and she is already getting burned out. She ended up resigning a few months before I did. I wish her the best in her career and in her new marriage.

The second nurse I want to discuss is one that I have developed a truly unique relationship with. This nurse is another young woman who is also closing in on the 30-year old mark. She also just quit from my hospital with the same malady… burnout. She is a truly a free spirit and does not have a spiteful bone in her young body. In an idle chat with her, I quite some time ago found out that she worked as a model to put herself through nursing school. So as you can most likely guess she became my model. I do shoots on average of 2 to three times a year with her. She also has over 10 other photographers who she works with. I have been doing cosplay, glamour and nudes with her for over five years now. She is a consummate professional both in nursing as well in modeling. She is simply a joy to work with. Even though I don’t work with her in the medical environment any more, I still do the odd photo shoot with her. As a matter of fact, I have four more shoots planned with her. After which I will close up my studio and shift to other photographic subject matter. I hope she keeps up her nursing career because she is a wonderfully caring individual.

I next want to discuss a mentor of mine, Sal. He oriented me to the house supervisor position. This man is also a true professional in every sense of the word. I have known him for close to ten years. During this time, I have never seen him lose his temper or raise his voice. He has always been helpful and gives amazing advice. It has been an honor working with him all these years and he will be sorely missed.

I also want to take the time to say how much I enjoyed talking to the housekeeping staff in both of these two hospitals I worked at. They are amazingly hard workers and are a joy to work with. They always say hello to me and ask how I have been doing. Considering that they make up some of the lowest paid employees in the hospital, they are among the friendliest group of people you can imagine.

I am only going to discuss two non-COVID patients from my time working in these two hospitals. These cases were two truly unique and amazing cases.

The first one involved a beautiful young lady who had sickle cell anemia. It is truly an insidious disease that if not controlled can ruin any afflicted person’s life. Sickle cell anemia is one of a group of disorders known as sickle cell disease. Sickle cell anemia is an inherited red blood cell disorder in which there aren’t enough healthy red blood cells to carry oxygen throughout your body. Normally, the flexible, round red blood cells move easily through blood vessels.

The cells die early, leaving a shortage of healthy red blood cells (sickle cell anemia), and can block blood flow causing pain (sickle cell crisis).Infections, pain, and fatigue are symptoms of sickle cell disease. Treatments include medications, blood transfusions, and rarely a bone-marrow transplant.

One thing I did not know is that it can affect any race. It, however, is more common in African Americans…occurring in approximately 1 in 365 African Americans.

The first time I met her was as a medical telemetry patient. The nurse caring for her was unable to insert an IV in her, so as a clinical supervisor it was my job to try and start these hard IV sticks or starts. This is how I began my relationship with this amazing young lady. She became a frequent visitor to our floor and I was the one usually asked to start the IVs on her. After I moved on to the critical care unit, I did not see her for some time. Unfortunately, she eventually followed me to the unit which meant that her condition was now worsening. Over the period of the next couple of years, her visits became more frequent and they lasted longer and longer. Eventually her poor little body just gave up and she subsequently passed away. She had just turned 22 years of age. She was a very difficult patient to care for because she was simply so sick and so young that most nurses could only care for her one to two days in a row. It was simply too emotionally and physically draining to do so. I also found it particularly difficult to care for her, especially as her end neared. She had withered away and her legs had withered down to the size of my arms and her arms were the size of toothpicks. It was a sad day when she finally passed away but it was also a godsend because over the last year or so she had enjoyed no real life to speak of.

My other patient was also young. He died just after his 21st birthday. He had Pneumocystis pneumonia (PCP) which is a serious infection caused by the fungus Pneumocystis jirovecii. Most people who get PCP have a medical condition that weakens their immune system like HIV/AIDS, or take medicines (such as corticosteroids) that lower the body’s ability to fight germs and sickness. There were rumors surrounding how he became infected but they are only rumors, so I will not discuss the subject. I never was fortunate to meet him when he was healthy, I only got to care for him at the very end of his truncated life. He was on a special breathing machine that produced very short pulses of air into his lungs, mainly because the lung tissue was so weakened that it could not tolerate the normal expansion that typically occurs during the inhalation and exhalation process. The machine is called a Puff Oscillator. He also had four chest tubes in place to keep his lungs from collapsing. Not to mention he was on a whole slew of IV support medications. As his conditioned worsened, I notified the father who never left his bedside that he only had at the most a couple of hours left. So I let him know this so that he could contact friends or next of kin so that they could pay their last respects. What followed was truly amazing. He must have had a 100 people pass through his room to see him one last time. They all flowed in an orderly fashion two by two. When the line finally ended, he simply faded away. The father had long since made him a DNR, so we did not have to add insult to injury by trying heroic and futile attempts at resuscitation. Since he was my only patient and it was nearing the end of my shift, I asked If I could go home? I told my boss that I was in no shape to care for another patient. Of all the terminal patients I cared for, this young man’s death hit me the hardest.

I will wrap up this section for now with my 20th Chapter which will cover my COVID-19 experiences.

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