Carmen`s Inservice: Part I

This is a story of the marriage between two very different worlds; a modern, cutting-edge cath lab and a gracious classical guitar by the name of Carmen. It also illustrates the value of such a marriage. Of how two such opposite worlds illuminate the other. The hospital, as with any employer, is the financial sustenance of the people who work within its walls. We spend well over half of our waking hours attending to our employer. These hours are taken up with preparation, attendance and recuperation, not to mention the time and effort of learning our trade. Our jobs support the lives we lead and are thus worthy of the time they require. The medical world is indeed a world unto itself. We wear uniforms. We have our own language. The equipment we use daily is unknown to anyone not of our sphere and there is a military thread that runs the length and breadth of this world. When we are at work we are on duty. Our particular 8 or 10 or 24 hours is a shift. I find it interesting that in nursing school, I was informed that we would no longer refer to ourselves as being on duty, the idea being a less formal mindset. Yet 30 years later, this phrase is still the norm. Hospitals have the care and safety of the general population in their hands, and we are there each of the 8,760 hours of the year. These institutions are run efficiently and carefully by many who possess a wide variety of skills. From kitchen duties to cardiac surgery, each service is vital and yet very separate. It is a sterile environment, but sterile out of necessity. Nowhere is the above more true than in a cath lab. Its very reason to exist requires that its tasks be carried out in a precise and exacting fashion. Cath labs are high-tech and high stress. The technology is ever-changing. Nothing is static except blood, catheters and radiation. Oh yeah, and the hours and hours spent standing at the table in a lead apron. If required, we will stand at that table day and night until the work is done. While beepers are our devil and ST-elevation is the deep blue sea, we will rise to that call every time and do what is required. You may have had no sleep and no food, yet you must stand there and solve the cardiovascular problem in front of you. Your stomach is empty and your bladder is full, but you must endure until the task is completed. That is what a call weekend in the cath lab requires endurance. In such an environment, it is easy to become insular. The "us" and "them" springs naturally from our experiences. When I'm exhausted, I'm not interested in ICU's reasons for not having a bed for my patient when I'm ready for it. I want Housekeeping to do a stat MRSA (Methicillin-resistant Staphylococcus aureus) cleanup regardless of their issues. Intellectually I know their obstacles are valid, but if I've been up all night, I just don't care. Therefore, we can find ourselves emotionally isolated from other departments. This is where Carmen comes into the picture. I have, in the past, brought a travel guitar (a husky little guy built to take a bit of knocking about) to work with me for stolen moments to replenish the well. However, because I couldn't bear to leave this guitar alone overnight and because I live in the Pacific Northwest (I was transporting this guitar through the rain on many occasions), I decided to find a guitar that could live in the cath lab. A guitar that would not break my heart if it was stolen or damaged. I searched local secondhand stores and pawn shops but was unable to come up with a six-stringed friend who fit the bill. Then, one day, Dave, a fellow cath lab guitarist, arrived at work with Carmen and a big smile. I have heard that guitars are not found, but rather migrate to those who love them and in this case it surely must be so. This guitar had been sitting amongst a pile of discarded items destined for a garage sale. Sitting and waiting possibly even calling out to Dave as he passed by. Once the call was heard, a quick $40 changed hands and Carmen had a new home. She looked pretty beat up with many scratches and half her strings missing, but we blew the cobwebs out of her body, polished out as many of the scuffs as we could and strung her with a shining set of new strings. After only a handful of chords we discovered that Carmen was an old lady, but a grand old lady with a sweet and keening voice. Carmen hangs on the wall of our lounge (a former dark room), snuggled against a bath towel so the slamming door doesn't add to her various scars. We keep her safe and music-worthy and she, in turn, offers her voice to whatever skill level and style comes her way. She waits for me or anyone who wishes, to steal a few minutes away from their jobs in order to commune with wood and sound waves. It was somewhat of a surprise to learn that Carmen's popularity had begun to spread far and wide. One of the hospital's top bananas (complete with suit, tie and leather loafers) came through the lab to check our inventory against his budget forecasts. He spied Carmen, plucked her off the wall and started in on his tried and true riffs. Afterwards, he announced, to a rather slack-jawed staff, that he was in a gospel trio as a teenager. I was surprised at this glimpse into his life, but also struck by the common thread Carmen had supplied between management and staff. Who knew that we had something in common with one of the big muckity-mucks? Then there was the day Eduardo, the maintenance guy, came to install additional lockers in our lounge. Before we had a chance to warn him to be careful of Carmen, we heard not the sounds of a drill or electric screwdriver, but intense guitar music. We entered the lounge and found Eduardo and Carmen goin' to town. After a 20-minute concert of astonishing music from his homeland, Eduardo dug into his tool box and rigged up a better system to attach Carmen to the wall. He is somewhat of a guitar aficionado and told us all about Dave's $40 guitar. Turns out, Carmen is a damned fine guitar and worth about $200 on the used market! After securing Carmen on her new hook, then and only then, did Eduardo turn to the task of installing new lockers. Carmen's duties in the cath lab are in sharp contrast to her human counterparts. She replenishes a part of what is drained out of us with our toil and maintains a balance between a harsh and technical world. Our ability to perform time and again, to react in, literally, a heartbeat, is honed by this balance. I can keep track of two BMWs, a PT-Graphix wire and two manifolds if I have to. But later in the day, I can also wind through the intro to Jimi Hendrix's Red House. The skills for each task enhance the other, though I admit to being better at scrubbing than jamming to Hendrix. Carmen's other value was to supply the environment for three distinct hospital worlds coming together: cath lab staff, upper management and the maintenance department. If not for Carmen, I would not know of the concerts Eduardo gives in local nursing homes. I would not know that a stolid management type had a garage band as a teenager. When I see these two workers from a world other than my own, we smile or share a greeting. We are linked. We value each other in a way we did not before Carmen came on the scene. Picture a cardiologist, four cath lab techs and a patient all being accompanied by Carmen through the The Battle of New Orleans just before we began a case. And with this rendition of Johnny Horton's classic, Carmen united yet another world in her growing universe. Somewhere out there is a patient who may or may not remember, depending on the amount of Versed, belting out a cool old song just before his angiogram. The value of that type of communion is limitless in the areas of patient care and job satisfaction. Bringing a guitar into the cath lab was a personal endeavor that I did not expect to grow beyond myself. Before Carmen, I did not have a clear concept of the lack of interaction between job classifications. Now when I encounter departments other than my own, Carmen reminds me to wonder what I don't know about these people, what I am missing. A final note: Don't bother stringing a guitar with an .038 guide wire. First off, it sounds terrible and secondly, it isn't strong enough and shreds early in the venture. The medical manufacturing community could learn a thing or two about wires by studying guitar strings. Shirly was in ICU and Surgical LPN nursing from 1978 to 1986, and has been a CVT from 1986 to the present. She can be reached at SCoffey (at) peacehealth. org.

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