I worked today too - just got home - and the mood in the place was amazingly nice. Maybe it was just the crew I worked with, but there seemed to be special sweetness in the interactions of people today. All the food no doubt helps a bit - cookies, fudge etc. everywhere you turn! I work per-diem - meaning irregular schedule, no benefits - and I fill in for other people's time off. The nurse who works specifically with the heart surgery patients is traveling, so I get to do her job along with my usual stuff. On a good day, hers is probably the best job around. Pre-op and post-op education for heart surgery patients and their families, and (the really fun part!) keeping families informed of the progress of surgery during a case. So when a surgery is happening, I dress in scrubs and go into the OR a few times to bring families a report on progress and reassure them that their loved one is OK. The approximately 2 times in 100 that a surgery does not go well, you really earn your money in that job. But the rest of the time it's just fun. Families are so grateful for the news that if you just do it competently, they think you are an angel. And to be honest, I'm rather better than just competent at it. I've become a master of calm and reassuring. Every detail matters for an anxious family - showing up when you say you will, having the right expression on your face when they first see you coming, etc. I was working yesterday on a day that started pretty slow, but then a fellow needing emergency bypass surgery turned up in late afternoon — a man rather younger than myself with a large family of children and grandchildren. Those emergency cases are always more tense. The actual risk is somewhat increased and the atmosphere of urgency increases everyone’s tension level quite a bit. It’s a real pleasure and privilege to be able to help make it all a bit less fraught for the waiting family. When I came back in this morning, he’s having some struggles in his recovery — things he will get past, but difficult for him and for his family to watch. Again, I had the opportunity to step in with explanations and reassurance that made it a little easier for them. I’d far rather he was doing great, but it’s satisfying to be able to help the family through this rough patch.
On the other side of the emotional scale, some of the patients I see these days are part of the great, unseen, nearly secret, epidemic of methamphetamine cardiomyopathy — people whose heart function has been largely destroyed by meth. Doesn’t get much press, hardly anyone knows about it. But I see these folks nearly every day I work. My job is teaching them what they need to know to live as well as possible. Things like salt restriction, fluid restriction, activity limits, daily weights. Anybody with cardiomyopathy needs to live their lives with great care — something most meth abusers are uniquely ill-suited to do. So we see them back in crisis again and again. No happiness there.
I never really mind working holidays. As an RN, I knew that was part of the deal when I chose this work, and - as a member of a strong union (!) - I get paid quite well for it. Plus there is a certain camaraderie and shared kindness among those working. I feel sympathy and sadness for people forced to leave their families to work Christmas for minimum wage, but no one needs to feel sorry for me. Another little note: I was reminiscing recently with another old-timer about how much things have changed in Christmas at the hospital. 30 years ago, the patient census would drop by half or more for the whole week from Christmas to New Years. Whole floors would be closed and we'd have a small crew on. Today, the place was essentially full and is likely to remain so. Why the difference? 30 years ago, a large percentage of hospitalized patients were there for elective procedures that are done today as outpatient cases - in in the morning, out in the afternoon. Much of the difference is technological - laparoscopic surgery and the like. Some of it is driven by pressure to cut cost. Some of the difference is much tighter scrutiny by payers on whether someone really needs to be in the hospital. And stays are shorter for most everything. Back in my early days, patients stayed in until really ready to be on their own at home. Now, many are a little bit marginal at discharge and even more are sent to a skilled nursing facility to finish their recovery — so those “easier” patients farther along in recovery just aren’t with us anymore. So today, most of the patients in a hospital are seriously ill. A great many of them are people who would not have survived at all 30 years ago. New drugs, new techniques, more knowledge, have changed their outlook from certain death, to challenging illness. They have illnesses that can't be scheduled, so they come in regardless of the day of the week or day of the year. And we are there to meet their needs. As I expect to be for a few years more.