Code Blue

I never thought this obnoxious recession and the state of our current economic situation would trickle to even the most needed and essential backbone of the healthcare industry, but jobs in the nursing field are feeling the heat right next to those bankers and sales reps. So, as to not become a leeching strain on society by being jobless...again...and in responsible fashion, I printed my resume on the most beautiful shade of ivory paper, and applied for every single position the San Francisco Department of Public Health was hiring for.

And, they called me back. 

The exterior of The San Francisco General medical center is stunning. It still holds a Nineteenth Century-ish facade with large dark stones and ornate detail to the entrances. There was a sense of romance that swept over me when I stood in the front, glancing up at this incredible icon, ambulances blaring by, old men smoking already smoked cigarettes on the steps, gang members exchanging their little secrets in obvious little brown bags, various hands meandering through the corner garbage cans. The enamor continued when I walked in through the double-cracked glass doors and could hear the buzzing of the fluorescent lights overhead, even from the panels where the bulbs were clearly burnt out. The semi-darkened hallways are painted a distasteful teal with a salmon pink border and the worn linoleum, haggard from years of tread, is aching for a wet mop. In the face of all it's much needed improvements, I thought the place was just lovely.

The Emergency Department is tucked away in the back and side, and is housed in a much less dramatic edifice. It is the only level 1 trauma center the city has to offer so you can only imagine the type of happenings that get brought through the busy ambulance portal. As a kid, I saw some pretty appetite decreasing emergencies when I would frequent the ER with my dad at work. One time, a man had been drinking heavily while sitting on the ledge a large bridge. He fell over and cracked his head so far open, that gray matter, also known as his brain, were spilling from his fractured skull. Another night, I was lucky enough to see a dangling thumb from the right hand of a man who was night fishing and was bit by some type of ferocious fish. It was so cool...I thought...as I sat in over sized scrubs, watching my dad stitch-on his opposable appendage in the breaking hours of the early morning.  

So when the ER Nurse Educator called me for an interview, I took the bait with eager anticipation. I wandered onto the unit which appeared to be undergoing some 'renovations' for the past 15 years or so. Dilapidated gurneys laid wheel-less in the corners, wrapped in yellow caution tape as if they were on hold for forensic testing. Which they probably were. Maroon-scrubbed angels (the nurses of course) glided flawlessly in and out of their patients curtained rooms, sometimes parking them right in the hallway to prepare the space for the next in line. Police officers and security guards were on patrol at every doorway and were having a little tiff with the elderly woman who thought the door clearly marked EMERGENCY EXIT, was the ladies room. I didn't see the waiting room, but I assumed it wasn't empty.

The walls were laden with charts and graphs breaking down enthralling statistics. Better referred to as The General, each year this ER sees more patients then the year prior. Something like 58,300. When you remember there are only 365 days a year, that number takes on a larger significance. About 25% of those patients are admitted to the hospital and about 20% of them are children. I recently spoke with my mom and she kindly informed me that this unit has the highest number of HIV needle pokes. (Not a braggable stat when it's your finger getting the sharp end of that mistake.) It has been rated one of the best county hospitals in the entire country and a large chunk of the practicing staff are UCSF trained physicians and residents. I have mentioned this in casual conversation to a few of my current co-workers and they smile and respond like this:

"Those nurses are so badass. Everything goes to the General. You literally see everything. Everything."

"I used to work at the general and one day I overheard a patient talking in the waiting room about how at his last visit, he was so itchy from the 'critters' he had."

"I bet each nurse has to retrieved multiple objects from every possible orifice...like in their first week on the job."

Yes. I totally want to be a badass.

I am shuffled into a small office where two of the managers greet me. One is wearing the same exact brown jacket I have at home, which I wear nearly everyday...I love it so much.  Kiss her ass by telling her how great that thing is...it will increase your odds of getting this job.

"That's a Lucy jacket right? I love it, I have the same one."

She reaches her arms out to examen it as if she had forgotten what she was wearing. "Yeah, it is and I wear it everyday. I keep trying to find another one like it but they stopped making them."

I am beaming in the crunched chair in my corner. "Meeee Toooooo."

So I sit and tell the two ladies why I think I would be a really good addition to the Unit.

"Well, I am really funny. So I would make people laugh. And I get a long with just about everyone so I am drama free. And...let's see what else. I am a hard worker and I don't complain and I help when people need it and I am smart and considerate and passionate about doing what's right. I am honest and dedicated and I study things when I am supposed to. I ask questions concerning things I don't know and always share my food."

They had to interrupt to get in a few words.

"Ok, great. Now tell us some qualities about yourself that you may need improvement on."

"Oh gosh hmmm. Improvements. Hmmm..."

Literally a 4 minute pause. I could not think of one thing that I could gracefully tell them that I sucked at without sounding unqualified or unworthy. Sensitive? You can't be sensitive in the ER. Nervous? Even worse. Sometimes a few minutes late to work? They would be fools to hire me!! Suddenly my palms began to get sweaty and I realized, oh god, this is an interview. Why did you not prepare for this very question asked in just about every single interview that has ever happened? So, I managed to awkwardly mumble a few sentences about how the beauty of childbirth and the sometimes unfortunate circumstances when I got attached to my patients who suffered sad outcomes...and I would take it home with me. 

They nodded, scribbled something down on their notepad and moved it right along.

"Ok, now we are going to ask you a few clinical questions and we just want you to answer the best you can. We can't prompt you, so we will just ask and you just answer."

1.) A 51 year-old man comes in complaining of abdominal pain. His heart rate is 120, he is breathing rapidly and he is very sweaty. Tell us every reason you can think of that may cause these symptoms. 

A 51 year old man? I haven't had an older male patient since nursing school when the 400 pound, severe diabetic who had a trachea tube and rotting flesh for butt cheeks, asked me to scratch his balls when we were giving him a bed bath. 

So I fire off a plethora of causes thinking of everything I can that would involve abdominal pain. (Indigestion, hernia, cracked rib, peritonitis...) I am looking at their faces hoping that any of them are even close to what they are looking for. 

"Again, we can't prompt you in any way. Just list what you think may cause it."  

"Myocardial infarction, diaphragmatic hernia....dengue fever?....ummmmm"

"Again, just list anything that you may believe to be causing this pain." She said it in a way that seemed as if I was missing something huge.  

"Blunt trauma to the belly, stroke, bladder infection, hepatitis C, botulism, mad cow disease, shingles, AIDS...and I guess we could rule out pregnancy? haha?"

"Just think, anything that may be causing this man pain in his abdomen."

Look Bitches. Believe it or not but that is what I am doing

And my list starting dragging. Would they let me know when I have either met the limit are sounded like a complete moron. 

"Umm, indigestion.."

"You said that already," said the one wearing my jacket. 

"Ok." One interrupted. "We can move on." A sly comment is scribbled in her notes. A few more real life scenarios were set and I dug to the depths of my brain, the place I had stored all this info after nursing school, that I thought I would never use in Labor and Delivery unless dire straits were upon us. Who cares about sprained ankles and itchy rashes when you have heads coming out of vaginas?

"Time for the math test."

I was locked in the tiny office and the timer was set. I worked through the drug calculations and drip factors and I was actually having fun. If I didn't get this job at the very least I got to brush up on my arithmetic. I shook all the necessary hands and was given business cards and told "I will be in contact." 

I found my way towards the exit and was nearly caught up in the foot traffic of a line of jailbirds making their way through the hospital. All wearing fluorescent orange garb they were quite a noticeable troupe. But what caught my eye more fervently, was that they were chained together in a line and handcuffed. 

I walked out to a blue sky and sunshine and the words I had spilled in the small office moments earlier echoed in my head. 

"So, Jamie, what makes you want to stop traveling now and work here in the Emergency Department?"

"If you saw the size of my backpack, and felt the sheer volume it can hold, you would see quite clearly why I don't want to repack it just yet. I have been lucky to be mobile this past year and have tested the scene of so many great places. But, there is an appeal here and as I start to plan a future, my specific future, I recognize that developing a foundation and having a sense of stability would be beneficial, especially as I make pertinent decisions regarding graduate school. I am ready to hang-up the travel resume for some time. 

They called me two days later and offered me the job. 

I gladly accepted. 

"Oh wonderful!", the manager said over the phone. "We will finally have someone who will know how to deliver all these babies down here."

So, come mid April I say goodbye to placentas, the world of epidurals and apgar scores and Helllllooooooo to felons and their communicable diseases.

Team Roster

Winter Lineup 2009

Name: Sachiko Yamashiro

Position: Shiatsu Masseuse 

Relevance to my happiness: A small and aging Japanese lady can pack a hidden punch. The knots in my shoulders are tight enough that they could feasibly anchor a large vessel to shore. But nothing seemed too challenging for tiny Sachiko, who jumped up on the table and straddled my low back in order to position herself for what was to come. Surprised that we were going to get so intimate so quickly I was taken aback by her bluntness. Some may coin it another form of torture but I like to think of pressure point massage as a much needed exercise for my ever so tight trapezius muscles. Her midget sized fingers stabbed up and down my spinal column, pressing harder and firmer each time she felt a lump. It was painful. But as I laid naked under the stale white linens, I realized more than ever, that if there is no pain, there is no gain. 

Without breathing or complaining I let Sachiko reveal the wonders of her ancient technique. I wondered if she was legitimately licensed and if she knew what she was doing. Was this slapping and punching on the back of my head proven to relieve muscle tension? Is this the secret to Japanese longevity? About 40 minutes into it I feel her swiftly move her body, like a ninja, so that her knees are circling around the bony prominences of my shoulder-blades. She is now balancing on her own two hands, rubbing my back with her kneecaps. The pressure exploding even from her knees was incredible. She swiftly jerks me over into a sitting posture, allowing all the covers to fall off me (is she a pervert?), and gently removes the hair tie from my ponytail. With fingers of fury, she swiftly starts massaging my head, but not in the way the hairdresser does with soothing and calm intention. Sachiko is literally scratching my scalp off. And I start laughing.  I couldn't help it. It was so awkwardly uncomfortable but it felt so amazing at the same exact time. 

Then, the smooth jazz that escapes from the radio is interrupted by a monstrous grumbling noise sourced from little Sachiko's belly. "Oh excuuuuse me. I drank milk today, which I don't do." And then the silence between us returns and she continues to rub my butt cheeks with her elbows and forearm. You know a place is sketchy when, in this day in age, they only take check or cash. I was so satisfied, I tipped her 20%.

Name: Halina Kaierska-Pepa

Position: Co-worker

Relevance to my happiness: Born and raised in Poland, Halina is your typical Eastern European woman. You know the type. She makes all her own soups with stock from the bones sucked clean during her families previously consumed carnivorous meals. She dons bright pink and red lipstick and wears a not-so-subtle blue eyeliner. She comes from large stock herself and is better known around the unit as "Big Halina" (so as not to be confused with "little Halina" who may be 1/8 her size.) Big Halina was the lucky one chosen to train me; to ready me for all the 2-3 deliveries this hospital does in a day (yawwwwn). Needless to say, after she showed me where the supply closet was and how to order food quicker on your lunch break, we got to chatting about life. She is currently on her second marriage and couldn't be happier. They are due to be officially married in the catholic church this month and she is glad to be living "sin free" soon. 

Halina slyly mentions to me that nearly none of her patients ever get c/sectioned. "What is your secret?" I ask with eyes of wonder. 

"I make them so scared of me, that if they do not push harder, my wrath will be tougher to endure than after effects of the surgery."

Noted. From that moment on I knew not to mess with Big Halina. A small discussion came up about the war in Iraq. Her views differ greatly from mine but I just agreed agreed agreed. When Rush Limbaugh was making a complete Asshole out of himself the other day on national television, she was nodding with endorsement. I simply muttered to her with a smile..."He's so smart."

What makes me so happy though is when she gets a little flustered and she tries to hurry. Her body is so tall and massive, her quick movements just look wrong. She can really hustle though. That is why she made the cut.

Name: Rusty Wells

Position: Yoga Teacher

Relevance to my happiness: Only in San Francisco will you walk into any given yoga class and find more men than women. No shocker there. And you can only imagine the extremity to this when I tell you that the best class that I have found is taught by a spandex loving man in the Castro district.

Rusty's style of teaching is called Bhakti Flow. He starts every class with call and response chanting sung from the pipes of his very own vocal cords. The man can sing. With a tambourine in hand, he enlivens the droves of googly eyed yogis sitting cross legged, only inches away from each other. The room is heated slightly as Rusty moves us into bound poses and balance postures comparable to any vinyasa class. What separates his from the rest is his approach. He is funny and cracks jokes about how everyone, even if they don't want to admit it, is searching for that little Nadia Comaneci inside us all. The petite and graceful dancer just beaming and ready to explode into action. He nods his head back and forth to the beat and rhythm that is expelling from the stereo. The songs: ones likely to find in a transvestite dance club. While doing abdominal work to song with lyrics of "keep your head up girl", he looked straight at me and sang "yeah you, keep your head up girl, keep your head up girl!" 

My abs are still extremely sore and this class was days ago. In addition to plank pose, one of his adjusters looks identical to Richard Simmons; Sandy blond fro, blue butt-hugging shorts and all. My midriff will be swimsuit season ready in no time if I can sustain the ability to laugh as much as I did in this one class.

Name: Fredricka Unufolulo

Position: A patient

Relevance to my happiness: Last Thursday I was given a patient that no one else wanted to take. She was pregnant with her fourth baby and was a severely non-compliant, Insulin dependent diabetic. Which basically means that her blood sugars were so high that is was making her baby grow abnormally large. At just 38 weeks, she would be delivering a 9 pound baby...practically a toddler and three pounds lighter than her last child who takes the prize at a whopping ELEVEN pounds. In addition to the basic sugar problems this infant will embrace while it is only minutes old, she is at risk for serious heart deformities with crazy names like tetralogy of fallot where the heart valves are blocked and oxygenation is proportionately more challenging than in the normal heart, and transposition of the Great Vessels, where the heart develops in the opposite arrangement pumping blood from the Left ventricle back into the pulmonary circulation. In laymen terms, there was a good chance this baby would die.

My eyes were on her like a hawk. The glucose machine was like a third limb, with me at all times. Her insulin cocktail was specialized and so detailed that every meal was scrutinized to obsession. Her admitting sugars were an astonishing 350...that's pretty high. Needless to say, we got to know each other very well. She told me about her Samoan husband, Junior, and how hard it was for her Tongan parents to understand their attraction. Apparently, those two Pacific Islands are not keen on inter mingling their offspring. She was shocked when I told her I was from Utah and not Mormon and I was equally shocked when she told me she was from San Bruno, California and a devout member of...what else...the Mormon church. Garment wearer indeed.

Her finger tips were bruised and full of holes as that is where we poke her each hour for a single drop of her blood. And not even once did she complain. She was funny and amused me with all the swear words she dropped. At one point during the day, I stepped in and she was talking on the phone. I noticed she was missing a front tooth which she hadn't been missing before. I glanced down to her bedside table and against the fake wood plastic that lined the table, lay her retainer...a single tooth molded to the tip (just like your old one Uncle Steve!) I now had to be super cautious as to not knock it on the ground while sliding her sugar free frozen yogurt to a convenient arms length away.

And so it goes. I waltzed with her red tide from a low of 114 to a high of 186 four four days. It was exhausting but on Monday morning, when not-so-little Meleane (Tongan for Maryanne) was born via C/section sans heart problem, I knew my labored hours had come to fruition. The perinatologist and I exchanged high fives as the surgeon simultaneously tied her fallopian tubes. No more Unofolulo babies ever to be had. I stepped in the room to bid them farewell and smiled largely as I glanced at her perfect little flared nostril, breathing regularly, with a normal sinus rhythm. 

Name: Napa Valley

Position: Destination Paradise

Relevance to my happiness: Only a short hour drive away, Napa Valley is an obvious addition to my reasoning for loving Northern California. Wine tasting is like Bar hopping...but with the pressure to be classier and on vineyards. And what is better than wine tasting? I tell you...it is wine tasting for free.

My new friend Andrea is a native of Napa valley and was mine and Erika's' appointed tour guide. She showed us a handful of the most beautiful stretches of acreage my eyes have seen. Even in the dull off-season of a gray February weekend, the bare vines were vibrant. The mustard plants had taken over and their little yellow flowers sprouted in between, under, and all around like a wild, untamable bush. Torrential downpour was frequent but was separated by spurts of bright sunshine, casting a golden light on the green rolling hills. 

A Pinot Noir here, a Merlot there and the next thing I know I am committing three months of my time during the harvest to help 'Richard' pick his family grapes. I think it would be fun and I call it easy. His 20 year experience in the field (literally) seems to think differently as he shoves a shovel in my direction. Really how hard could it be? Pick two, eat one, pick three, eat one. I would love it. 3 months as a nurse...3 months as a grape picker...I am OK with that. 

So now that I am a wine snob connoisseur, I never hold the glass unless it is by the stem and I make sure to swirl it three times, sniff it then sip it. (obviously you amateurs) Feel free to ask me the difference between the 2003 and 2007 late harvest of Cakebreads renowned Chardonnay...the oak makes all the difference. Sonoma has no idea what will hit it when I blow into town...someday.

Name: The Mission District

Position: Current Favorite San Francisco Neighborhood

Relevance to my happiness: It is always sunny in the mission. Really. On days where water falls from the sky like an exploding fire hydrant, the mission will be buzzing with rays of sun indefinitely. I believe we are on day 20 of nonstop rain. Hello? I didn't move to Seattle...what gives? I clearly had no idea this would happen. And I like rain. I do. ( a total lie...I hate it but I don't want to admit is maybe?) I can't ride my bike. Which means I can't get anywhere quickly. Which means I am at the mercy of others. And that is annoying.

But the point here is that the Mission somehow, mysteriously, escapes the bad weather. It is like a black hole vortex that only syphons sunshine. It is weird, but I just eat it right up. I spent hours today wandering through the charming Latin borough, peaking into local produce shops and nick-knack stores that sell metal Mary bracelets, large posters of Jesus Christ (that is pronounced Hey-Zoo-Cree-Stow) and billions of colored and unscented saint candles. The dollar stores are like a dime a dozen and you can easily fill your kitchen with all the essentials for under ten bucks. In between the discount-erias you find darkened, no-windowed bars that lack the marketing tool known as a sign. The most obvious way to know they exist it by the blaring salsa music that blares from the outdoor wired speakers. It truly feels like you are in Central America.

The houses are painted in bright, blaring colors that scream RENT ME! I can't wait until I am in a position to do so. I certainly will choose one lined in yellow or orange because we all know that orange is the color of optimism and when the sun shines around the clock...what is there not to be optimistic about? The tacos are certainly the best around but mark my words...be wary of the chicken as I hear through the grapevine it causes the big D (fluuuuush). Go Black beans or go home. No joke. That fluorescent lighting is sure to hide some salmonella somewhere.

This is just a sneak peak at my growing team. Tryouts are literally year-round so I am recruiting relentlessly for people to move, visit and pass through. My step mom Susan is next to bat and my sister is on deck for the first of April (Nis...don't you FOOOOOOL me). Elizabeth...June right? Mom?? You game?

Come one, come all. Spring season is right around the corner...