I’ve been off of orientation for almost two weeks now but so far working in less acute areas and starting to feel a little angsty to be “up front” - where the sickest patients get roomed. Last night was my chance, and I got my ass kicked. In school we talked all the time about prioritizing: you have eleven plus four hundred things to get done and four patients, how do you decide which must be done first, which can be left until later in the evening? I thought I understood. I thought I was decent at prioritizing. Last night I think I may have made the wrong decision at almost every turn so that by the end of the night, when I had to hand off my patients to the very good and very experienced nurse, I felt like I could barely find my own ass let alone give a coherent account of the four people who I was in charge of keeping alive.

I love Dr. Who. In the newer seasons there is a creature called the Ood. Although it looks horrible, all the Ood wants is to be free and to live with its people. They communicate through the “Song of the Ood”, a haunting sort of a-melodic moaning. One of patients last night was, I believe, trying to communicate with their people via the same song. It is still unclear to me exactly what was wrong with him but for a million reasons he was a time suck. ICU and medicine were arguing over who should take him, and doctors from both floors were putting in orders. Another specialist was insisting that he be put on a hospital bed (instead of the stretchers we have in the ED) because of his wounds. The same specialist suddenly decided the patient may be having a stroke and poof, the patient needed to be taken to CT immediately, and I was wheeling an Ood singing, twitching, sweaty, disoriented patient to a CT scan there was no way they were going to be still long enough to successfully complete.

Craziness.

STABLE caziness.

That patient looked like a hot mess and had MUHHnay problems to be addressed, but he was stable. Blood Pressure, oxygen saturation, temperature, respirations = normal. Heart rate a little fast, not surprising given everything that was going on and not fast enough to indicate imminent demise.

Meanwhile, the patients cycling in and out of my other 3 rooms included a woman whose coronary artery was 90% blocked and she was having chest pain, someone with an almond stuck in her throat and a patient who came to the ED because they had fainted and in the time I was in struggling to get the Ood onto a hospital bed fainted again, had crushing chest pain and shortness of breath and I came out of the Ood room to find the crash cart set up and defibrillation pads on the patient.

NOT stable.

Luckily I work with generous, brilliant nurses who, while I’m sure they were internally cringing as I sped away with the Ood on yet another adventure - this time to an MRI scan which is basically just a giant magnet that will pull everything magnetic on your insides to your outsides, hence a very strict “no metal” rule - FORGETTING to take out the patient’s enormous eyebrow ring, they took care of all my actually sick patients. They spoke to me in calm tones while letting me know things like “your patient is trying to bite off their admission bracelet”, “I started a second IV for you incase she decompensates and needs to go to cath lab immediately” and “they just intubated your guy in 7”. Thank you all. I will pay it forward.

So! Lesson learned. The smile and nod is my go-to move for tonight. Do NOT get caught up in the Song of the Ood. Smile and nod at the doc asking for a hospital bed and prioritize that request to the bottom of the list. Stop. Breathe. Step back and evaluate the situation.

New grad. New nurse. Wishing I was further along than I am. Trying not to beat myself up too badly. Trying to borrow some millennial lingo and look at my “opportunity for growth” instead of my “glaring fuckups”. Despite, or because, of it all, loving the song of my ER peeps.