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.