6.17.2010

esprit de escalier

The title is French for "spirit of the staircase" or "staircase wit", an idiom for the experience of suddenly realizing what the best thing to say/do was, after the event had already happened.

I experience this a lot after work, and even more frequently when I'm working long hours and/or having my sleep cycle disrupted. The solutions to many of the unsolved mysteries or loose ends from the shift all drift into focus after a couple of hours to decompress and unwind. The best thing to have said in this situation, the technique I should have used for that, and maybe 5-10 things to follow up on and re-evaluate the next day. I had good luck with carrying a small moleskin notebook and jotting down things I have to keep track of. I've never taken notes in my life before this job. Middle-school, high-school, engineering school and nursing school. I graduated from three of those. Nothing about the act of taking a class really required me to write down the things on the power-point slides or the passage read to me from something. That information is in your hand-out, ma'am. Do you want me to read your hand-out or pay attention to your presentation?

I write this stuff down, though. It's actually stretched the limit of how many things I can keep track of at once, an experience I've always associated more with video games than employment. The pages of these little black books get plastered with sticky-notes, nure-to-nurse reports from hospitals, lists of issues to bring up with the MD, particular risk areas or factors, things to follow up on, etc. I've lost three or four of the notebooks in the space of a couple of months. At least one was the victim of our ravenous black lab puppy, Jenny. The rest are probably hidden under some hidden cache of laundry somewhere in this room.

Today I went without the notebook, instead opting for the nursing report sheet. Stapled-together 8.5x11" pieces of paper just aren't quite as portable as a little notebook, maybe I just need bigger pockets.

The fact that the information is so holistic and varied is what makes it interesting to me. Information about skin integrity and GI/GU status just as important as subtle interpersonal relationships between patients, family and staff. Expectation management. Closing. Interdepartmental communication. See, you can even leverage commissioned sales and engineering into a nursing career! You should really consider it, we could use all we can get.

Anyway, the notebook also was used to jot down those ideas that came after work was through, I probably used it that way more than any other if you don't count the disproportional amount of space sticky-notes take up.

I bought notebooks for years without ever writing anything in them. It's probably an appalling habit if you think about it. Lots of different notebooks in different shapes and sizes, different style covers. A considerable amount of money was probably spent, all on notebooks that I'd never use more than a page or three out of. A full notebook seems to have no value to me, since you can't add to it anymore. Reference, what's that?

Lots of the things I jotted down I'll still remember days or even weeks later, not a mean feat for someone who usually has trouble keeping track of what day or time it is. The actual writing is just a back-up, the act of writing, I suppose, is the key.

My hand-writing is hilariously bad. I think I'm more readable than people who scribble in cursive, but more often than not my spidery, frenetic block-printing reminds people of their children and leaves them scratching their heads. Spending so much of my life in front of a keyboard and then suddenly being forced to manually write LOTS of IMPORTANT THINGS nearly ALL THE TIME is an amusing switch. My signature has warped delightfully over the years, many of those years not having signed anything at all.

I guess I found a job that just seems easy, even when it's difficult. Remembering the families and medical conditions of dozens of people sounds absurd unless you consider the effect of actually being interested in them and caring about them. This is actually a pretty easy thing for anyone to convince themselves of, with a little practice. After all, who controls what's important to you? Is it you or some movie you watched? Your bad day? Your car problems?

The ability to be present in our profession seems so fundamental but can also be a challenge to maintain in the face of such a complex data set. Intuition becomes a vital necessity, even though it takes years to develop in these settings. I enjoy the interrelationship between rational and intuitive that this profession has presented me with.

I've been on the staircase, but I'm walking slow, listening for you.