The “Black Cloud” Phenomenon AKA “Shit Magnet”

My last few posts have been pretty heavy, so here’s some lighter reading fare today. The black cloud phenomenon. It’s a real thing, just like Murphy’s law. You know, the one that says if something can go wrong, it just definitely will. The one the Emergency Department runs on. If nothing ever went wrong, we wouldn’t have jobs. 

If you work in a place where the worst is already happening all the time, it takes some really jacked up shit happening over and over to earn the title of the shit magnet. Every unit has one or two. 

A couple weeks ago, the bigwigs were coming to our department to assess our efficiency, among other things. The bigwigs coming is always stressful—you want to perform well, but you’re always angling for more FTE’s—basically more staff allocated into the budget. (You don’t want to look incompetent, but it has to look like you’re overwhelmed enough that you need the staff, or management won’t give them to you. It’s a fine line.)

I wasn’t supposed to work this day. I was supposed to be curled under several blankets in my chair, playing XBox. 

I got moved to this day based on my average shitshow rating of 10/10.

We broke the all time record of admit holds and also the all time census record for holding plus Emergency Department patients. So, I guess it was a good tactical move. We started with admit holds in the hallway and most of the rooms; we didn’t get a single admit bed until 5pm; we ran out of telemetry monitoring and peds had to swoop to the rescue by bringing their ICU transport monitors down; the ortho trauma floor sent techs to help. We made it through—we always do—and I was thanked for my continued service as the Black Cloud MVP. 

Here’s the thing about black clouds and shit magnets—THEY ARE USUALLY UBER COMPETENT AND SKILLED. Two of our doctors share this title with me—I’d rather have either of them when a situation starts going south. There’s one other nurse considered a bad luck charm—we actually met fifteen years ago at a different hospital when she was a paramedic during an absolute fuckery of an event that could never by the law of physics happen ever again.

Other records I’ve shattered in my career—

Most traumas in a shift

Most mass casualty events total

Highest volume seen in a shift

Most patients triaged in a shift

Most critical transfers in a shift

Most code blues in a shift

Most chases through the parking lot in a shift

Most TPA given in a shift

Most crash carts used in a shift on one patient

…You know, things like that. 

Other things that have happened is I’ve had to respond to an abnormally high amount of codes in MRI. Which is the absolute WORST place to have a code. I would rather have one in the parking lot, the cafeteria, the rooftop, the bathroom, anywhere but fuckin’ MRI.  Everyone’s always yelling, and the first doctor to respond has zero resuscitation experience other than classroom or a hundred years ago but feels compelled to direct for some reason. 

During one of these, they announced—after being told for like the eighth time the next step in the ACLS algorithm (the standardized American Heart Association Advanced Cardiac Life Support algorithm that tells you what to do next and that you use at every code, nationwide)—“I AM RUNNING THIS CODE.”

To which I said, “Ok but can you do it good this time.” Because FUCK there is nothing more frustrating than someone trying to do something the other people in the room are experts at. There’s a time for learning and there’s a time for shut the fuck up and let us save this dude and maybe you can study and do it next time. 

Helpful hint, if you’re arguing about a shockable case vs non-shockable cardiac rhythm and you’re sure it is, just go ahead and charge that defibrillator up. Announce you’re shocking the patient and people WILL clear that patient. Or get an unscheduled stress test. It’s their choice. The patient doesn’t get a choice. That’s why you have to advocate for them. Then you’ll shock them and at their next pulse check they’ll have a beautiful organized rhythm with a pulse. (Don’t be a shit about it though. Be smug in your head and not out loud because if you’re an asshole about being right people will remember you being an asshole and not the event.  They have to remember the event so they know what to do next time. That’s a pro tip for you.)

 Back to the black cloud curse. 

I have decided I am the recipient of this poor luck because of the past. When I was a new grad in the ICU, all I wanted was shitshow type stuff. Traumas and codes and all that, ALL THE TIME. And nothing ever happened, for the most part. Until year three. 

Then the gods unleashed. After a couple years more working in the ICU, floating on slow days to the ER, I decided I was really more of an ER nurse. I love mess and ICU nurses definitely don’t. I’d much rather crack a trauma chest in a chaotic bloody mess than a post op chest in an ICU room. I prefer side thoracotomies myself. I like dragging people out of cars rather than turning every two hours. I can’t handle the attachment of caring for a patient and their family for weeks and then losing them. I don’t have the heart to cope with that kind of loss—I struggle enough with patients I’ve never even known. I also do not much like post op stuff very much. Also, I’m just not organized or detail specific—my ADHD thrives on the pace in the ER.

 Since then, I’ve seen some crazy shit. Don’t get me wrong, I love my adrenaline junkie side and the traumas and the codes, but after a few months I would like one day, JUST ONE SHIFT, full of appendicitis and lacerations and normal shit. Not people doing naked jumping jacks on a bed or hulk smashing through doors on PCP or a multi vehicle pile up on the highway. 

This is all punishment for complaining the first two years of my career I never got to do anything or see anything wild. 

It is my curse to bear. 

My favorite doctor to work with is one of the other magnets. We shouldn’t probably work together. We had a few shifts where it seemed like everyone was missing an arm or leg or both. We had a trauma activation that sounded pretty bad a few months ago, I looked at her and said, “they better have all their extremities or I’m going to stop working with you.” 

“Shit, okay, okay,” she said.

They did have all their extremities. 

After that trauma, I looked at her and said, “I guess I should have been more specific and stated all of their organs had to be inside their body too.”

Yeah. We have those kinds of days together. 

It’s also weird stuff. Once I took seven phone calls from a woman screaming at me her parent was in our ER calling for help and no one would help her. Got cussed all the way out several times. Finally, I had to stop taking care of OUR ER patients, to call all the other ERs the woman refused to, to find out the patient was at a DIFFERENT ER. 

“Well, can y’all call her daughter, or can she explain to her daughter WHICH  HOSPITAL she is actually at , because this lady has cussed me up and down for an hour for not answering her mom’s call light,” I asked the nurse on the other end.

“Oh, she doesn’t know which hospital she’s at, she’s high as shit.”

Sigh. 

I have a neat little present from one of our other charge nurses—it’s a piece of shit, on a magnet. 

It’s on my locker. If you can’t change it, own it, right?

Or something. 

— The Midwestern One