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Marian gets a new job at a totally normal hospital with totally normal humans
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"Oh don't worry, he's really nice!"

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"He is," Lucy confirms. "Just try not to stare."

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Mallory swats Lucy's leg. "Don't do that, she's nervous enough!"

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Great! That's not ominous at all! Marian will thank them for the advice and then sit here mentally preparing herself to definitely not stare even if it turns out there's some reason it's tempting to. 

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It seems like just seconds later that Mal says, "Uh, Marian, maybe you should be going up now?" and when Marian looks at the clock another TWO MINUTES have passed and she now has less than a minute to get up to the office.

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Welp okay she had still not been 100% sure if they were going to come get her or if she had to go over there on her own time, and clearly should have clarified that more. 

"- Oops. Thank you." She'll hurry, which - fortunately - is actually pretty distracting from being stressed.

(She reminds herself that the literal worst that can happen is that she interviews terribly and they don't hire her and she has to either stay at Montfort or keep applying to other hospitals, it's not like anyone is going to die if she screws it up. Somehow the prospect of bombing an interview almost feels more stressful than letting a patient die, but that's stupid and Marian's brain should stop it.) 

Is the office door open or does she have to awkwardly knock? 

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She'll have to awkwardly knock, and Carla will open the door a few moments later.

"Right on time. Come on, we'll be using this room over here. How did you find the ICU?" As she speaks, she leads Marian a few doors down to a conference room with a rectangular table in it.

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Three chairs have been placed along one side, and one across from them. In one of the three sits Amanda Adams, who smiles at Marian as she enters.

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Carla goes to sit next to Amanda, while the third seat is taken by a man who must be Doctor Lamb. It's obvious which seat is meant for Marian, and as she sits across from the other three, she notices that one of Dr. Lamb's eyes is a dark grey while the other is so pale it's practically white. 

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Wow that's really cool actually also Marian is DEFINITELY NOT STARING. 

 

...Well, one of the patients she met had fucked-up scars and the other made uncomfortable comments about her out-of-towner status, but Marian has zero complaints about the ICU itself. "I liked it!" It's probably weird and unprofessional to say that it made every other hospital she's worked - not just Montfort, honestly - feel sketchy in comparison. "It's clearly well run and the staff were really welcoming," she settles on. 

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"Glad to hear it. If things work out here, you'll probably end up the break nurse for this shift while you get acclimated, so I hope you got along well with the others." She turns slightly. "This is Dr. Lamb, our head of ICU."

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"Nice to meet you, Marian." His voice is made for radio plays, deep and warm and thick as honey. "I read your application and the notes from your interview, and I have to say you seem like a great fit for Haven. But I'm sure I don't have to tell you that this can be a hard job, sometimes, particularly for those in ICU, and we like to ask new potential hires about their experiences with that side of things. As an example, a good place to start might be your worst day on the job. And there's no need to be nervous; think of this more as us getting to know your strengths and perspective on things, rather than us looking for weaknesses. Alright?"

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(Oh, neat, that actually sounds like a really good way to get oriented on a new unit! Helping colleagues and getting to bounce in and out of their patient rooms is something Marian enjoys a lot and would normally probably be too overwhelmed to do much of when starting a new job.) 

- wow, Dr Lamb has an unfairly gorgeous voice too. Marian can at least appreciate his voice without staring! 

Also: storytime! Possibly this is a weird way to feel about it, but the thing about extremely nightmarish shifts is that they make incredible stories after the fact. She's not not nervous - she's not sure whether to believe the whole "don't be nervous" thing - but recounting it is actually sort of fun. 

 

"...Right, so I think this wouldn't happen here - the hospital I worked before is a lot more, uh, resource-strapped in general. We had a system where one of the nurses would be responsible for the code blue pager and go respond to codes elsewhere in the hospital, but like, you also had a normal assignment on top of that. - and we didn't have break nurses. Anyway, there was one shift where I had the pager and there were three codes in the ER before noon. I think two of them might actually have been simultaneous, there was a lady they found on the beach with a body temp of - sorry, 18 Celsius, I have no idea what that is in Fahrenheit - and they were coding her for, like, over two hours. - she didn't make it. But in the meantime there was another code - pneumonia and sepsis, I think? - and we managed to get her stabilized enough to admit to the ICU and then there was another code, a lady whose potassium was like 9 - at this point I think I'd spent more time over in the ER than I had with my actual patients, they were stable but it wasn't great - we kept having problems with, like, the sepsis lady really needed a central line but the ICU attending and residents were over at the ER with the third code - anyway I eventually handed off my patients so I could admit the lady with the high potassium and start dialysis. And then she coded again. And our only decent IV access was the dialysis line, because there hadn't been time either to do a central line, so we had to, like, rip off the dialysis circuit to use it for meds. We did get her back and I had to give report having done basically no charting, which was pretty embarrassing but I genuinely don't know when there would have been time. ...Oh and at some point I had agreed to stay for a 16h, but thankfully I handed off that patient and took someone's stable uncomplicated assignment for my last 4h, I - was getting kind of frazzled at that point." 

Hopefully that wasn't too rambly? 

"...I think there's a lot I would do differently now – mostly better time management and not dropping balls, this was when I'd been a nurse for less than a year, I was pretty overwhelmed and I definitely got worse at those by the end of the shift. But it - was a good lesson in, like, knowing I can keep going when literally everything is going wrong." 

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"I would be quite proud of any nurse in the hospital who could deal with a day like that without getting down on themselves, let alone having a positive takeaway," Amanda says, and Dr. Lamb smiles while Carla nods along. "I'm curious to know whether there was any sort of feedback loop your hospital engaged in, or anything similar that you thought of to ensure those sorts of more systemic errors didn't happen again? With limited resources in mind, of course, it does sound like everyone was working under a number of constraints."

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"...I mean, I don't know if I had positive takeaways at the time," honestly makes Marian admit. "It was a year ago, I've had time to process it." Also she's pretty sure you're supposed to come up with positive takeaways when answering job interview questions even if it's kind of a stretch. "I did get more careful about agreeing to 16h shifts after that - I think most of the time I can provide safe care for a 16h but I'm not sure I could have if they had kept me with the really sick patient." 

Lol at the concept that Montfort either had functional feedback loops about avoiding systemic errors, or would listen to Marian if she had ideas Marian shrugs slightly. "There was a review process for, like, incident reports, but I'm actually not sure that came up for this shift in particular - it was more if someone reported a specific medical error or near miss, and I don't think 'we were already short-staffed and then a really implausible rate of problems happened' triggered that process?"

Part of why Marian isn't particularly down about herself from this shift is that she doesn't think anything that went horribly wrong was per se because she made a mistake. (She's sure she made a lot of mistakes but they mostly weren't what caused the problems, unless you count 'allowing the doctor to leave her patient's room without putting in a central' line but she's preeeeetty sure that was because someone else was crashing somewhere else, again, and it would have felt like a dick move and not obviously correct to demand they prioritize her patient anyway.) She would have had to answer differently if the question were 'what shift made you feel shittiest about your performance as a nurse'.

"...Honestly, seeing how things are here, I kind of feel like Montfort, like, frogboiled me into thinking that problems from not enough staff are just unavoidable? I did go over it by myself and try to figure out what I should prioritize differently in future, but I try to do that in general, and it - wouldn't really have occurred to me to go to the unit management with any of my thoughts? There's another case where I did, I can talk about that in a minute if you want. Uh, here, If I had I think I would have said we should be more willing to call in extra staff and rejigger assignments in the middle of the day if it's clearly not working - but, uh, I know later that summer the higher management told our unit manager to stop bringing in people for overtime because they were over budget on salaries, so I dunno if they felt like they could have done that." 

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Carla is nodding along while Amanda looks mildly scandalized (on her behalf, probably?). "Keeping an eye out for the worst-case scenarios is part of what we try to do, here, so we're prepared for them. We really do encourage all our staff to let us know if anything happens that might pose a risk, even if it's low likelihood. Someone up the chain might decide it's too low chance anyway, and we don't have infinite money, but I think Lucy and a few of our other imported staff have had a similar... unboiling period, before they realized that even if things are a lot better here than other hospitals, they can still be improved."

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"Not infinite funding, no." Dr. Lamb smiles. "But I've yet to get turned down for anything I consider reasonable, at least. And I would like to hear about that other case, whenever you're ready."

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"Okay." Why was she nervous about this again, it turns out job interviews are just a fun excuse to air all your grievances with hospital management  oh no what if she's rambling and sounding like an idiot though Marian is going to answer the question! She does think it's actually relevant! And will hopefully, in the context of this hospital, reflect well on her rather than making her sound like a really annoying high-maintenance employee. 

"Uh, so we had a patient with pancreatitis and suspected ileus, his abdomen was really distended, and he was deteriorating - decreasing urine ouput, difficult to ventilate - and someone brought up that maybe he had abdominal compartment syndrome, so I looked that up and saw you can diagnose it by checking bladder pressure to approximate intra-abdominal pressure, and it didn’t look very complicated or anything? But we didn’t have it in the official hospital manual of policies and procedures, and the charge nurse basically said I wasn’t allowed to do it and would be risking my nursing license - this was less than six months after I graduated, I was still technically in the internship period, I think I might have pushed back more if it happened later - anyway, I didn’t do it, I tried to print off the instructions and have the doctor do it but that also didn’t happen for some reason, maybe just that everyone was really busy as usual? ...Anyway, the patient didn't end up making it," and Marian is apparently still kind of upset and mad about the whole thing, "but I brought it up with my preceptor and the nurse educator on the unit a bunch more, and they did add it to the policies and procedures doc and do a training, so that particular thing wouldn't happen again." 

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The three of them exchange looks, and Dr. Lamb leans forward slightly to rest on clasped hands as he smiles slightly. "I think our nurse educator is going to like you."

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"Agreed. Can I ask, Marian... and I know this is a hard question to answer in front of strangers, particularly in a professional setting, but... what's your relationship to your emotions like? In general, but on the job in particular. Do you feel like you bottle them up to get processed later, or do you feel like they guide and empower you, or something else?"

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Yay Marian is getting a good grade in job interviews

- wait, what? Is that a...normal...job interview question...? It feels very unfair, Marian doesn't even slightly have an answer prepared for it!

She does fortunately have a script for not having an answer prepared. She smiles. "That's a really good question! I need a moment to think about it, if that's okay?" 

 

 

Okay. Right. What answer do they want from her– ...ugh nevermind, Marian both feels vaguely slimy about that kind of reasoning and also doesn't...know...what the Correct(TM) Job Interview answer is here. She's just going to have to, like, introspect and give them the actual answer and hope it's not terrible. 

"Uh, I - guess it depends on, like, emotions about what?" If the emotion is DYING OF SOCIAL ANXIETY then she feels like there isn't really a better solution than telling it it's stupid and bottling it up. "If I'm really upset because a patient I had gotten attached to didn't make it, or I feel guilty because I missed something and a patient got worse as a result, but I have other patients to focus on, then - yeah, I bottle that up and process it later - my colleagues and I used to go out for breakfast after really rough night shifts and do our processing then. Probably in general I'm more inclined to process after the fact? But, like, some emotions are - useful guidance - like, I have a lot of feelings about whether my patients are comfortable and feel listened to and stuff, people've said I empathize really hard, and I think that's helpful and motivating?" 

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Amanda nods. "Some group processing after a shift is common here too. It's a delicate line to walk, between leaning into that empathy or distancing ourselves from the emotions in the moment, but I think both have their time and place. Either way, it's important to me that our nurses feel supported, whether it's through leaning on each other, or, if they're not comfortable with that, getting access to other forms of emotional care."

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"Loss is often felt pretty keenly in a small town like this. As someone from outside Haven, you'll be a bit insulated from that, for a while at least, but I'm curious to know how often you've interacted with patient families before, and what that's like for you."

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...Huh, yeah, that's a fact about being in a small town where your patients are more likely to be people you know that Marian hadn't really considered yet. Oof. 

"- Uh, a fair amount? It's - I do think of it as part of the job, making sure families are kept up to date and have what they need to feel supported and stuff – especially if their loved one is dying but, like, in general too? Obviously some families are more, uh. Difficult to work with than others. And setting boundaries can be part of the job too. ...I've gotten feedback that I'm good with patients' families, though, uh, with the caveat that it was at the same time as feedback that I would have better time management if I prioritized it less." 

Ugh how much honesty is appropriate here. It's seemed to have mostly gone well when she said things she felt conflicted about saying?

"- Uh, it's also definitely true that - when families are grieving is when it's been hardest for me to keep it together until the end of my shift - but that was mostly when I was in the student care aide program or my final clinical rotation, it - does get easier with practice." 

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"I see the families less often now that I'm heading this place, but I remember a few times it's made some hard days even harder." Normally Dr. Lamb's gaze shifts to whoever is speaking at the moment, and defaults to her when he's speaking to her, so it's not that him watching her is unusual... but there's an extra something in his gaze, as he says, "Empathy is highly valued among our staff, but something worth mentioning, I think, is that Haven is home to a number of less common spiritual belief systems, which can also lead to a few unusual forms of grief. Nothing I think you should be worried about, and of course your own religious beliefs, or lack of them, are your own business, but if you're at all uncomfortable interfacing with less 'standard' spiritual expressions, it may be worth letting others interact with the families for a while, until you have a better sense of what to expect."

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