Jinx

You really never know who is going to do well in the hospital and who won't. You can guess fairly easily based on vital signs and labs, previous experiences, a person's feeling of well being, and your own instinct, but really all of those things have failed me more than a couple times. People can have massive MI's suddenly, and they are just - gone. Despite your best efforts to stabilize them and get a cardiac rhythm back, you fail, and they are lost to you and their loved ones in an instant. Some people you can expect this of; they have been having chest pain, they have horrible cardiac disease, they look like crap, their mentation changes. But some people give you no warning at all. They come in for shortness of breath which clears quickly with a little lasix, and you send them to the floor with a cardiology consult, never guessing that they will code that night.

In a small hospital with limited ICU beds, we are constantly trying to shuffle patients in and out. There is a lot of pressure to move patients to the floor when we think that they may be (possibly/probably) stable. Many times this is a crap shoot - the truth is, when you only have two patients, you can detect subtle changes that are missed by the floor nurse who has 10 patients. You can see when their respiratory rate goes from 20 to 35, you are there to assist them cough out huge amounts of thick, sticky sputum, you run in when they are starting to throw up and begin to aspirate bile. The floor is a different animal; where questionable patients are left to fend for themselves unless they are aware enough to use the call light, or if someone happens to come into their room at the right instant. It is a toss up, and you just pray that nothing goes wrong with them when it is your call to push them out of the ICU. When I say push, I really mean push by the way. We use gentle pressure on the residents, saying: "We have no ICU beds in the hospital. If there is a code, we have no where to put them. Who can move out? Now." We look at the patients, determine who is the least sick, and send them out, sometimes crossing our fingers. This is the nature of the beast, (and inadequate staffing) and we just hope that everything works out ok.

Through these patient transfer experiences and my own personal adventures, I have found out an amazing thing. I have a gift/curse from God. I have a horrible talent for hexing people via words of reassurance and encouragement. Oh, you good people may scoff at this, but I swear to the higher power that it is true. I incite the fates by trying to tame patient/friends fears, and I have learned that to improve the odds of survival, I must be as noncommittal and vague as I possibly can, for the sake of others. I think doctors and tattoo artists have also learned this lesson, as they will never tell you what you should actually do as a patient/client. They give you scenarios, tell you the odds, but never, ever will come out and tell you what operation you should have, or what colors would work best for the Chinese dragon you want to place on your torso. Always the same damn thing - "These are your options, I can't decide for you, this is what has worked for some other people in your situation, but I can't say it is the right choice for you". They must be jinxes too, and are taught in their schooling the nuances of ambiguity.

So, since I have learned these lessons about myself and the nature of my job, I know a few things that I will never say again in order to protect the safety of others:

"That baby will slide out like a little seal" - Translation: That baby will be born breech and you will be in heavy labor for many hours.

"It's not like you are circling the drain or anything" - Translation: Actually, this is your last night to be alive, you should call your mother.

"God, you look great, you'll probably leave in the morning" - Translation: You look good now, but wait for a couple hours after I leave - not so much.

In the hospital, we are sometimes forced into difficult choices where we have to push the patient out of the nest, to see if they fly or not. Usually this goes off fairly well, other times they come back to us in a day or two. These "repeat offenders" usually will have a hard time ever leaving the hospital, and ultimately may be treated in a palliative fashion, keeping them comfortable, and out of the ICU because we can't actually make them "better". I will not worsen their chances however, by making a generalized, overly positive statement about their condition, which, as we have learned, would mean their demise. Instead, I will take a measured, cautious approach which is noncommittal, but warm - "Hey, I hope you get to leave, but if not, I have lots of jokes and obnoxious commentary to keep you occupied for a few days while we work on it, ok with you?".

Is that better?