Wednesday, November 15, 2017

Forty and fabulous

Musing on 40 years since I graduated from nursing school.

What a different world that was.

Nurses caps required at my first job. It sailed off my head when the day supervisor left for the day.
Also a white dress, white stockings, ugly Clinic shoes. Hair up and off neck.  Just like nursing school, only without the striped pinafore.
Metal bedpans and urinals.  Bedpan washer.
Glass IV bottles.
Smoking allowed in patient's rooms.  Emptying the ashtrays part of PM care routine, along with back rubs and changing pillow cases.
Smoking allowed at the nurses station (at night)
No wearing gloves except for sterile procedures, or possibly for a gone-by-the-wayside iced saline lavage for  a GI bleed.
Stryker frames.
Paper documentation.
Med carts and bottles of pills.
Narcotic count.
3 bottle chest tube drainage system
Setting up a science experiment to determine glucose levels in the urine on the ward.
clinitest tabs would turn 10 drops of pee blue, for no sugar or on the normal side.  I loved doing those.
Eyeballing the number of drops per 15 second for a 100 ml per hour IV drip rate. (6, for a 15 gtt tubing by the way).  No pumps.
Patients needing post op narcotic pain meds were given IM injections.  Think about that and the current opioid crises.
Admitting next-day pre-ops between 3 and 5 PM (for cholecystectomy, hyst,  or TURP,  for example), then pre-op teaching, prepping (enemas, shaving nipple to knees on abdominals)
Waking surgicals at 5:30 AM for IV starts.  Or more enemas.  Good morning!
Verbal report from charge nurse.  Led to taped report, and you had to listen to the report on all patients. In a smoke filled room, everyone smoked.
Being forced to take a 30 minute meal break AND a 15 minute coffee break.  Actually go to a cafe or sit down in a nurses lounge and have a break.
The night supervisor was a battle axe.
Being a brand new nurse and in charge of a 40 bed floor 3 months after getting a license.  Because I could.  And I was incredibly lucky.
Being a new ER nurse with 18 months of nursing experience, 8 hours of orientation,  alone on 11-7 with a doctor who was allowed to sleep.  And expected to register patient's to boot.

No wonder I'm tired.








Wednesday, October 18, 2017

Name Game, vol. 3...or 4...or 3. Can't remember

Eyden (pronounced "Aiden")

Karsyn

Salee

Jaxson

Dawna

Kylla (no, it does not rhyme with "Thriller", or "Thrilla" if you are from Massachusetts)

Derec

Jacen

Jaryd

Mycal

Deserey

Kimmberleigh, Kimberlee, Kymberlee.  Ach.

Tabbethya (I pronounced it "Ta-BETH-ee-ya" just for fun.

Please, please, new parents of America, stop this trend.


Monday, October 16, 2017

Nuggets of Awesomeness

There are usually two nurses in triage but I am frequently alone.  Just me against the world.

"You are out there alone again?!", gasps the Queen of Fast Track as I pass her station enroute to the triage area.  "Unacceptable!" she exclaims.  She is there every day.  She sees all, knows all, and it makes her crazy that anyone has to triage alone, especially when it's really busy.

Me:  "Walking the Mile, walking the Green Mile".

After triage each patient is escorted to an open room….as long as there are rooms open.  Thereafter the charts go into the rack for the charge nurse to room, pending bed availability.  I like this system a lot.  But it adds a layer of responsibility for the triage nurse, aside from finding the elusive open room,  to a). assess the acuity level (in general) of the department and find an available nurse who is b). in the rotation for, and willing, to take a patient (another post in itself) and c). provide a bullet report.  This occasionally works seamlessly.  More often than not there is a bit of salesmanship involved, such as, "You love to take care of sick babies!", and "I already did the EKG, and I put in a chest pain order set".   Sometimes nurses just check the board, anticipate the arrival of the patient, tell me "I read the triage note, I've got it".  This is a rare but most welcome occurrence.

My coworkers are a curious bunch and just can't help asking "why".  The most often asked question "why didn't they call their doctor?" The answer to that is one of several stock responses,  1. "they did and were told to go to the ER", 2. "they don't have a doctor", or 3. I respond with a rhetorical question of my own, or create a diversion, such as "Look!  Hayely's Comet!" and then sprint back to my box.  Sometimes I just say, "Why ask why?", usually accompanied by  slight shrug of the shoulders and a wry smile.

Occasionally I say it in French for added amusement.

Often there are requests for "nuggets", little bits of information about patients that aren't really all that important for triage.  Mostly patients are anxious to share every aspect of their illness and when I am really interested/amused/intrigued I like to pass on said nuggets of info.

Like, what was the kid's temperature at home?
"She felt warm to the mother, but I didn't ask to what she compared it.  Warmer than toast, perhaps?  Puppies?  Day old rice?"

What was the exact dose of Tylenol?
"Some.  A bit.  A bunch.  I'm pretty sure there was no tylenol given, actually"

My personal favorite is, "What does the urgent care expect us to do about that?"

Duh.  We get probably 40-50 phone calls daily from various free-standing urgent care type places, Convenient Doc in the Box, Drive Through Care, Taco Doc, etc.  There are lots of them in the area, some are good about faxing such important information as EKG's,  which we repeat anyway, and occasionally we are offered some amusing zebras to ponder.  But our docs like to make up their own minds, perhaps fashion their own zebra hunt.  They are funny that way.

Famiy members love to chime in with nuggets of their own, which is particularly frustrating when they contradict each and every statement made by the patient.

Me: "Do you have any allergies?
Patient: "No, I don't have any allergies"
Well-meaning family member:  "Yes he does, to key lime pie, birch trees and Legos".

Me:  "When did the pain start?"
Patient:  "Oh, about an hour ago"
Well-meaning family member:  "He has had this pain for 6 months!"

Me:  "I see that you have a history of opiod addiction, are you still in recovery"
Patient:  "Yes"
Well-meaning family member:  "No, he is not, he took 4 oxy's today and drank 12 beers".

With these nuggets comes a good bit of he said-she said along with the inevitable arguments, as you can see.

Sometimes I  manage to come up with few bite-sized nuggets to pass along.  Mostly I just give a bullet and run back to my cube to start the next one.

A young girl was sent from an urgent care for a cast on her broken tibia-fibula.  She arrived in a wheelchair.  With the leg hanging.  I was confused and asked the mother why she did not have a splint, an ace wrap, or even a piece of cardboard.

"They don't do casts, that's why they sent us here".  Like I'm the idiot.   Helpfully (not) they sent along a disk with a single view film and not so much as a Tylenol on board.  Poor kid.  Our PA called their PA to rip them a new one and suggest that they need a tutorial on splinting, or failing that  perhaps simply using an ace bandage, a pillow and some duct tape.  Well done.

Here is one more nugget:

"Why is the patient soaking wet?"
"She was having a seizure.  The family poured water on her to stop the seizure"
"That actually works??"
"Only if they are faking a seizure.  Then it works quite well".












Sunday, October 15, 2017

Put That Pig on a Leash….

...is a phrase coined by the husband of a friend of mine.  She had been mowed down at the skating rink by a gal larger than she, thus inflicting bodily harm and a trip to the ER requiring sutures.  He was referring to the mower, not the mowee.  That was about 12 years ago.  It's still funny.

Today I use the term to refer to the pigs who inhabit my world, the patients as well as their families and visitors, cousins, neighbors, acquantances, etc.  Basically anyone who dwells in any part of my ER.  All pigs.  And it's not just the blood and gore, spit, vomit, piss, shit that has turned me into a germophobe.

The waiting room is littered with trash.  Trust me, it's not the staff who does this.  The leavings of fast food fine dining are left on the floor, empty chairs, windowsills.  Coffee cups, soda cans.  Trash bins are apparently sacred oracles to be avoided at all costs.

Masks that coughing patients are asked to don are crumpled and left anywhere.  I can't even speak about used Kleenex and used (usually empty) vomit bags.

We clinical staff , because we don't have enough to do, disinfect and clean the treatment rooms after the patient leaves.  This should only take a few minutes although I try to do a through job cleaning up after my pig patients to make it spiffy for my next pig patients.  But the rooms are generally disasters.  In addition to the aforementioned trash will also be used bandaids and used gauze, used Kleenex and paper towels strewn about.  Meal trays.  Each of 12 EKG electrodes and at least 3 monitor electrodes are  stuck to the bedside table or side rails because the trash, all of 2 feet away, is just too much of an effort.

 I disinfect all the moving parts that touch my patients.  We use the environmental staff only if there is debris on the floor such as body fluids, mud,  or an infestation of bed bugs.  Once it was necessary to have environmental steam clean a room after one of my patients arrived with 3 different infestations of insect and covered in poo.  The poor old soul.  I discarded my scrubs and demanded new ones.  Then I had them steam clean my clogs, otherwise I would have thrown them away.

This is why the germophobe in me gets worse all the time.  I compulsively wash my hands because of people's piggish habits.   I am protecting myself from their germs rather than the other way around, despite the admonitions for staff to do so.  Cute little posters that invite the public to put us on the spot and ask if they don't see us doing so.  Yes I use sanitizer, but consider it a stopgap until I can get to hot running water and soap.  To me using hand sanitizer is the equivalent of taking a deep breath and holding it until you can get away from a stench and take a deep breath of fresh air.

 Unless you live in a permanent bubble, the world is full of germs, every surface you touch in the real world.  In a medical environment where people are casual about excreta it is worse.  And lets just say the bathroom habits of the general public is less than optimum.  There are a LOT of people who don't wash after using the toilet.  Shudder.  Many and many a time I am approached with a proferred full specimen container.  Sometimes it is damp, sometimes it is wet.  In a damp bag.   And people expect me to accept it without putting on gloves.  NOPE.  I disinfect with Lysol any pens  which people sign their admission or discharge patients because scrupulous attention to hygiene seems to have gone by the wayside.  If people are truly disgusting I throw them away.

OK, now I am going to turn you into a raging germophobe too.  After exiting the bathroom, handing me a warm, wet cup of pee (or whatever), people are perfectly happy to go and sit down in the waiting room.  In chairs that are never disinfected.  Eating their doritos and drinking their lattes, handling money, going in and out of the cafeteria.

WITHOUT WASHING THEIR HANDS.

Now, what else are they touching?

Sleep well.

Thursday, August 24, 2017

Science is my religion (or "your delivery sucks, man")

I am not anti god.  I am not anti religion.

Heaven or hell?  Not so much.

I don't praise god for good weather, getting into the college of one's choice, surviving a heart attack.  Neither do I blame god for tornadoes, losing the state championship, or childhood cancer.

Good shit happens, bad shit happens. People are great, or they suck.

There is life.  There is death.

To me, any religion involves drinking the Kool-Aid, which has never been my drink of choice.  I can swim but don't dunk myself in just any old river.

If religion is what floats your boat, gives you a reason for living, brings you comfort,  or helps you cope,  I'm fine with that.

Do I walk out during a Last Rites ritual? No. Do I act insensitivity when my patients ask for clergy, or say "God bless you?" Of course not.  If a patient says they will pray for me, I say "thank you".  If they ask me to pray with them, I will hold their hand.  I have even been known to say "God bless you" when someone sneezes.

I have no problem whatsoever with Nativity scenes on public town squares.  I think saying "Happy Holidays" instead of "Merry Christmas" is PC bullshit.

 I respect that this great nation was founded on Christian values.   I am fine with "one nation, under God", or "In God We Trust".  These mottos are important to the history of the US.  It's not with the Christian values that I have a problem, but with some so-called Christians.

I'm fine with talking to you (but will not debate) about your religious rituals, holidays, beliefs.  It's interesting to me.  I have a problem with people getting all judgey and assuming that theirs is the only point of view that is correct.  Usually it spills over into other aspects of their daily life and belief system, but that is a post for another day.  All I ask of anyone is that you not ram your religious beliefs up my ass.  Or want to chop off my head because I don't believe what you believe.  Mostly, I'm fine with whatever you believe as long as you keep it to yourself and don't come knocking on my door looking for donations or insist that I need saving.

Here is the point of my preamble.  One of my mother's close friends died.  At home, comfortably, with her family surrounding her.  Enviable.

I accompanied her to the funeral and the collation.  Mom is the only person I know who refers to the funeral after-party as such.  I had to look it up, thinking for sure she had misappropriated the word, but nope.  It's a word.  My mother is a Scrabble whiz at 85, and regularly kicks my ass.

If I did believe, I would probably thank god for  the end of the most excruciating homily of the most painful funeral service of my lifetime.

Her friend was a parishioner of St. John of the Autobahn, practically a four lane highway.  Very busy and difficult to park.  I hate to be late to shit, especially funerals.

 The priest was admittedly out of mothballs retirement for the Catholic Mass,  He did not know my mother's friend, and clearly never bothered to ask the family about her.  It would have helped enormously if he had even bothered to read the obituary.  Lots of good stuff there.  He could have extrapolated a minimum amount of information at least.  He never used her name.  Ever.  Not once.

It started badly.  "Funerals",  he intoned, "are the time when we should examine our relationship with God".

Um, well,  me and God broke up when I was 12 and he killed my only sister  took my newborn baby sister home to be an angel.  I just could never see a cold patch of earth in a place as dismal as a cemetery as a better place.  So consider my relationship examined, found wanting, and terminated.

The homily went on and on.  And on.  No mentions of my mother's friend, no friendly words of comfort for the family.  "You must live the life of the righteous, and the kingdom of heaven and eternal life in the house of the lord will be yours.  If you do not feed the hungry, house the homeless, and clothe the naked…..you will dwell forever in darkness and in sin. "

I distinctly heard a quiet, but audible, "What the fuck?', and had a moment of panic when I thought the words had  escaped my thought bubble and exited, unbidden, through my lips.  But no. It was the guy behind me, as gobsmacked as I.

Later, at the collation, the old ladies buzzed about what came to be known as the "Fire and Brimstone" incident.

I felt bad for the family, whose devout wife/mother/grandmother/aunt had done such lovely things in her lifetime had such a crummy sendoff from a church she loved.  Mom said, "She would have been pissed."