Of Sinuses and Teen Mania

We at the hospital have core staffing numbers and are expected to use them to keep our productivity at 100% or more all the time. Yes, rewarded for shorting our staff numbers. How this improves patient care, i don't know. It does help the bottom line, evidently. Health care is business. Big business. And so i found myself on an adult unit that was overstaffed with two direct care staff and only 9 patients. I thought i was in luck, as my sinuses were applying drill-like pain into my skull causing inability to think and nausea. Instead, i found myself in the wonderful land of adolescent psych. I was watching a teenager in a manic episode for 5 and a half hours. He was 16, bigger than me, and had been taken off his meds by a fill-in doc. They do that. It makes no sense, but there it is. The lack of meds took him straight to the holy shit end of mania.
Let me stop a bit and explain how unfun that is. Imagine feeling euphoric and like you can take on the whole world. Everything is funny. Every neuron in your brain is on overdrive. You are brilliant. You are godlike. For like a day or three. Then it gets even better. You can't sleep, you can't stop jumping from one shiny thought to another. You shake and sweat. Nothing, and i mean not even two hours on a heavy bag, a hundred situps, pushups, etc., nothing makes it stop. The level of frustration and anger becomes all-consuming. The fun is over, but no one tells your brain. Then you start banging your head into a wall, hitting things, anything to distract your brain and make it stop, even for a second. Nurses and others try to help, but you can't focus enough to hear or process what they are saying. It takes a lot of people to hold you still while meds are injected into your butt. This makes you feel more like the hulk until they finally kick in and you get some sleep. The meds start working again within days of restarting, but the damage takes longer to fix. They have to hit therapeutic levels. And that takes more time that the mania took to rob you of yourself.
I was watching him the day after the head banging hell day. It wasn't a lot better. Good news was that he needed to be away from noise and commotion. He couldn't tolerate it. Neither could i with the drill in my head. So, this proved to be a good thing. Except for the inability to think, which continued to suck. For both of us.
After punching and kicking the bag and then listening to relaxing music and reading, he announced he was bored and couldn't sleep. Very Bad News. The next hour consisted of me staying calm while praying he did not get out of control by following his impulses. The following chronicle may seem funny. Imagine being stuck in his skin during it. Or trying to endure a drill in your brain while staying absolutely focused on keeping him calm during it.
Reading The Lion, the Witch and the Wardrobe (the second book, he is quick to point out) on his bed is interrupted so he can walk to the window, pretend to shoot things, talk into a walkie and dodge bullets. He seems to get hit a couple of times. He belches loudly and laughs. "Must be your superpower," i joke. He then pretends that walls are exploding before him as he lays waste to his universe with his mighty power. Back to the book. Up for a minute to pull a paper out of the trash to look at it and put it back. Jump onto bed. "Do not jump on that bed, please." He considers it. It has no springs. He gets down. Back to reading. "My head hurts." It should, he banged it hard enough yesterday. Off to ask about a cold cloth and get some water. Back to reading. Take cloth off head and start sucking the water out. Run around room doing this pretending to be a dog. "Please try to sit down a little. I know it is hard." He pronounces the cloth drained of fluid and grabs a box of tissues from the chairless desk bolted to the floor next to his bolted down bed. He decides to chew them up and spit them into his paper bag garbage. "They taste good." I try not to react. Less stimulation and adulation is best, but this is not good. He is shaking again. I worry he will escalate to the point he loses control. I wish i could get his nurse to bring him something to make it stop. He starts to act out routines from Jeff Dunham. I can't help it. I join in. We Jef-fah-fah for a bit and talk about his funny bits. My head is killing me. I check my watch and tell him that everyone on second shift leaves in 10 minutes. He has to try to sleep. He gets up and gets more water for him and his washcloth. He lays on his bed, face down, head at the foot of his bed, staring at the floor. He actually yawns. I promise to tell his nurse he can't sleep. He looks so exhausted. My relief comes down and i am off to the nurses station. So ends my night.
Back to productivity. He only has to be watched while awake. There is no staff for nights scheduled to watch him. The model says that he should be asleep. He is awake. The schedule is not designed for humans, only for numbers and productivity rates. It looks like there will be no staff for the other 13 kids tonight unless a miracle happens. Hospitals are not businesses, especially when the mentally ill are involved.

Of Cuckoos and Men

Here we go again. March 18th. Two days to spring and snow coming tonight.
True confessions: I have worked in the mental health system since 1987 and today is my first viewing of One Flew Over the Cuckoo's Nest. I tend to avoid movies that are related to psych because they tend to either piss me off or depress me. For me it is like the computer engineers at RPI with whom I watched Tron when it came out. They spent the whole time critiquing the code and impossibility of the premise. Watching James Bond and Star Trek with engineering students was also an experience. These movies are like that for me.
But i am already in a mood, so why not.
The ovarian area pain started over the weekend, just reminding me more about the upcoming tests and the impressively abnormal test results i just got back. Needed the lortab to sleep Friday. It's not as bad now, but it is still there. My husband thinks i am too stupid and stubborn to call the doctor. I am not. I just know that, unless i am doubling over and vomiting, there is nothing they are going to do except give me pain killers until the tests next week. Women don't get treated like guys for anything less than bleeding from orifices not meant to bleed. Seriously. It sucks, but there it is. We report symptoms that would drop a man and we are given something to placate us and made to wait forever for treatment and tests. Until the threshold of "holy crap" is crossed. At least in urgent care and emergent care settings.
On a totally other note, last night at work we were short staffed again as always. From the personal care/laundry room radio comes "Crazy Train." I am speed walking trying to catch up while doing an airplane impression around a corner (so i look friendlier and stay on the humor side of pissed off). The patient on the phone sees me, i say "good song" and he says "that's why I'm here." Still riding the rail on two wheels so far... But there are moments. Especially with a mixed bag of folks with mental illness, addictions, antisocial and other personality disorders, and the developmentally disabled. We are the only hospital around that takes all of those anywhere around here, so we get everybody's rejects. To be a reject from the island of misfit toys is a whole other level of sad. Psychotic and MR is sad, violent and tricky to manage in the milieu... But then we have the fun moments. Because before and above all else, they are / we are all human beings.

Things that worry doctors

Here i am again fresh off my annual bottle brush exam with the gynecologist. These are always a bit harrowing, as i have had HPV since before i was even sexually active (no idea) and have uterine fibroids, ovarian cysts and scary family history of relatives dying of various rare forms of ultra aggressive uterine cancer and such.
This time my doc actually looks scared and wants to do biopsies as soon as possible without even waiting for PAP results. Something about a heavy 3 week period 8 months into menopause (at 47 - was just getting happy that phase was over and the hot flashes were gone) is Very Bad News. Unfortunately, the soonest is 3 weeks out and two weeks further away than she wanted. My guess is that the cyst triggered something on my ovary that kicked my menses back in. My fear is that it was twice as large during my kidney stone ultrasound than my "what's on my ovary" one a year earlier and that may not be a good thing. A friend of mine just died of cancer last Friday after beating it once. Breast cancer. That crap never dies. It goes someplace for a while and then comes back, hits your brain and kills your ass. Happened to my friend Karen Fonstadt and others and now to Kathleen Elbrecht. Geeky extra credit if you know who Karen is.
In the past 4 months: kidney stone (unconfirmed by imaging, but all else ruled out), bronchitis, pneumonia, ear infection and hit in the head by a patient. Plus 2 coworkers dead. Plus... And i only missed 2 days of work total. But now it's starting to get to me. This is going to be a long 3 week + wait.

One more time and another Presidential email

Got the call from the scheduler of fun that we are on for another week or so with our little old lady. Two more nights chasing a 90 year old with a walker and history of falling and heart problems to the bathroom every time the lasix kicks in. The money is good, but sleeping in her old bed (too high, she can't get into it) while she sleeps in the low twin bed in one of her kids' old rooms is weird. Being stared at by zombie jesus on a cross is also weird. Catholics can freak me out like that. 
I have a point i think. The house is odd, which is good because i have finally figured out the secondary setting for the book i've been playing with for quite a while. Not my fault. I get in about 80 pages and then think it sucks. Keep it, but start in another direction. Still working it out. Anyway, this will help out. Possibly.
I hate working 40 hours a week. Doing 60 is just about killing me, but welcome to the new economy. I got this email asking if i had seen the state of the union and wanting my opinion. I was working. I am treading water. I am pissed off. And i think that Washington DC may need to be swallowed by a sink hole to fix anything. Stupid Presidential emails.
Tired and rambling means signing off until i wake back up.