Wednesday, May 1, 2019

House of God

I used to work with a doc who would continuously refer to the Rules of the House of God.  This was a novel, written in the 70's.  You should go read it, if it's still in print, it's doubtful it would be published in this day and age.  For non-jaded health care people, it's dark and full of scurrilous behavior. This doc always used to say that it should be required reading for anyone who works in an ER.

 The House of God outlines a set of rules that are still occasionally referenced by people old enough to remember it. Here they are:

1. Gomers* don't die.
2. Gomers go to ground.
3. At a cardiac arrest, the first procedure is to take your own pulse.
4. The patient is the one with the disease.
5. Placement comes first.
6. There is no body cavity that cannot be reached with a #14 needle and a good strong arm.
7. Age + BUN = lasix dose.
8. They can always hurt you more.
9. The only good admission is a dead admission.
10. If you don't take a temperature, you can't find a fever.
11. Show me a medical student who only triples my work and I will kiss his feet.
12. If the radiology resident and the medical student both see a lesion on the chest x-ray, there can be no lesion
13. The delivery of medical care is to do as much nothing as possible

*an acronym for "Get out of my emergency room" - refers unkindly to old or chronically ill patients who used to sit on a resident's service for weeks awaiting placement in another facilityy in the good old days.  Like, the 1970's.

So I was thoroughly shocked to hear one of my current ER docs,  (probably in his mid 40's, sort of a know-it-all and borderline douche) refer to one my zone mates patients as being unable to go home, and needing a nursing home placement (see rule number 5).

"Yeah", he said airily, "that is one of the rules of The House of God.  Are you familiar with that?, probably not. You're too young.  It should be required reading".

Since he was speaking to my colleague who is in her mid-20's, she did not know.  I interjected.

Me:  "Oh, I used to work for a guy who was a med school classmate of the author, Samuel Shem, in medical school back in the 1970's.   He said it should be required reading too".  I proceeded to rattle off almost all of the rules, having been compelled to memorize them years ago.

The kids promptly started looking for the book, available on Amazon.

Dr. Know-it-all, taken aback, who thinks he is a trivia God: "Wow, you remembered almost all of them".

(Wanders away).


Friday, March 15, 2019

A rehab/nursing home sent a demented patient for a fall.  History of many falls, a hip fracture, and of course, on Coumadin.  He hit his head.  Automatic head CT.

His family member arrived 20 minutes after the ambulance, in a mad tizzy, having been left to cool her heels in the waiting room until he could be triaged and assessed for serious injury.  We almost never (aside from parents of minor children) let ambulance-follower family members into the treatment area right away.  Visitors are strictly limited, and are told by the front desk people that it will be about 10 minutes AT LEAST  before they are escorted back.  We largely get the most pertinent information from the EMT's and paramedics that bring in the patient anyway, and you will shortly see why. 

Me: "So what happened today?"

"I told them to put on his hat because it's very cold out, and dress him warmly!  Look at the shirt he has on, that is not the one I wanted to have him wear!"

The patient was talking a merry blue streak about absolutely nothing.  I inquired as to whether this was the normal level of mentation for him, but the wife kept up with the nonsense about the inappropriate seasonal wardrobe choices that had been made on his behalf.

"He had flannel pajamas on earlier, and a turtleneck, but for some reason they took that off!"

Me:  "Can I confirm his medications and allergies with you?":

"I have no idea if he even had breakfast today!  And those are not the socks I put out for him!"

I resignedly moved on to inquire as to the patient's normal level of activity:

"What if he has to go to the bathroom? I don't know if he has had his bowel movement today!"

I gave up.

She followed me out to my work area, asking about when he would have his scan, when he would get lunch, if her doctor had been notified, if he could have a blanket, urinal, glass of water, TV on channel 8, the heat turned up, the lights turned down, a bag for his belongings, does he need to have an IV.

Here is a small public service announcement.

A rehab is not an acute care facility.  The assistants are taking the vital signs, performing toileting runs, and bringing meals.  They do all of the necessary personal care.  The nurses bring meds and do assessments.  The nurses generally don't see the patients all that much on a shift.  That is a good thing.

And I know this how?

I recently had a family member in rehab.  As a nurse, I am pretty hip as to what is needed in terms of day to day medical stuff.  I have a good handle on the care she received as an inpatient in a acute care facility.  Again: rehab (clap)is not (clap)  an acute (clap) care (clap) facility.  After a couple of minor tussles regarding medication on the first day, (thus likely earning me a reputation as bitchy  pushy) I was quite pleased the care.  The aides are polite, pleasant, and do all the things we as RN's signed up to do but don't have time for anymore, such as making people comfortable.

Beating them up because there weren't exactly 16 blueberries on the oatmeal is just being a douche.

My hat is off to these hard workng ladies and gentlemen for making sure my family member got food she could eat, was kept safe, clean, warm, and comfortable.



Monday, December 24, 2018

....and to all, a good night

Christmas rerun while I wait for my Christmas Eve Chinese food.  

It all started on Christmas night.

It was pretty quiet; we were hanging out in the waiting room watching a very boring movie and chatting when I noticed that the ancient, chipped Nativity set on the small table next to me seemed somehow incomplete.

"Hey", I said to nobody in particular, " did this Nativity come with a Baby Jesus?".

Ellen sat bolt upright. "What?! You gotta be kidding me. I put that out myself! Maybe it fell on the floor?"

We searched around, but it was nowhere to be found. "It's really gone! Who would do that? Who would steal the Baby Jesus? Who would be that low?", said Ellen.

"Well, maybe someone just took it for a joke; you know, like those lawn ornament thingies?", suggested Mary.

"You mean garden gnomes; people would pose them in vacation spots and took pictures? Then they sent the people pictures of their gnomes on vacation?", I said.

"Yes, just like that. Maybe someone took Jesus on vacation", offered Mary.

“Why not?" I said, "to quote my daughter K: 'I like to think of Jesus as wearin’ a Tuxedo T-shirt, ‘cause it says,‘I want to be formal, but I’m here to party too.’"


"That is just terrible. I'm very upset about this", said Ellen in a huff.

I just think it is kind of ironic that someone took the very symbol of one of the most holy days of the Christian calendar from a religious hospital. But that wasn't the end of it, which brings me around to the Christmas decoration sweep over the weekend. Not only was the Baby Jesus MIA, but so was the Mary figurine.

Now Ellen is nearly apoplectic.

"Oh, more crime; what kind of person steals pieces of a Nativity scene. REALLY! People will stop at nothing these days, it is so sad."

“Dear Tiny Jesus, in your golden fleece diapers, with your curled-up, balled-up little fists pawin’ at the air…”

But wait! There's more. During the Christmas cleanup it was discovered that the nativity scene was also missing a farm animal.

Where has Donkey gone? Is he on vacation as well?

Donkey: Oh, man! Where do I begin? First there was the time the farmer traded me for some magic beans. I ain't never gotten over that. Then this fool went off and had a party, and they all starting trying to pin a tail on me. Then they all got drunk, and started hitting me with sticks, yelling "PiñataPiñata!" What the hell is a piñata, anyway?

This news nearly puts poor Ellen over the edge until Chris from the lab offered an explanation.

"Oh, that. The head broke off, so since I couldn't find the head, I threw the rest of it away".

It is with some effort that I restrain myself from any comments regarding the business end of a donkey. And we have not as yet received any vacation photos, just saying.

Still, I was a little surprised at the lack of quality of the entire sorry set anyway, it should have been long retired. No manger, just a bunch of wise men, a donkey and the holy family sitting on a TV table in the waiting room. Not even in a place of honor.

When I actually put up a nativity set in my house when my kids were small, it went on top of the piano (which I also no longer have). It was the highlight of the Christmas decorating routine, with my kids placing the figures in various positions which were rearranged on a daily basis.

You may recall that my mother was scandalized when the baby Jesus was found to occupy a position on top of the manger when I was a kid, however, that was normal for my family. Often, the scene was embellished with one of the many dozens of Fisher-Price doll people, as well as Match Box cars, Transformers, plastic toy soldiers, boats, china animals, and a fence from one of the 50-pack plastic farm animal sets, many of which also joined the fun. The 3 wise men were plenty crowded; it was quite a party in there. My mother just shook her head.

My daughter drew the line at the plastic He-Man and other Masters of the Universe that my son J would add. "That's not 'propriate", she would say.

"He's guarding Jesus", J would explain.

Usually, though, at the end of the day Jesus was on the roof, but He-Man was at his post protecting him, and all was right with the world.

Next year I'm gonna bring in that He-Man in case Jesus returns. Just sayin'.

Sunday, December 23, 2018

Well, ok...

That last post was so I could add one more than last year.

But I just wanted to add to my post of a couple of days ago in which my family member experienced the joys of the season in the ER.  She has been admitted to the hospital and doing pretty well.  The family looks to me to be critical, but she has been receiving excellent care.

On the way in to the hospital a couple of days later to visit I encountered a locked door.  I'm not all that familiar with the hospital anymore.  It has been over 40 years since I knew my way around, and it has changed drastically.

Along with the locked door, I encountered a confused older woman with a cane who inquired as to where the main entrance might be.

(I assume I must have some kind of light radiating from me that indicates I am a health care professional and stand at the ready to render assistance).

"I think it's up the hill there", I pointed.  "I came in this door the other day".

"Well, it took me a long time to get here, I'm not going to be able to get up that hill", she looked mildly distressed, glancing around and waiting for someone to save her.

Sigh.  "I'm going to try this door right down this ramp.  I'll come down with you, then check to see it there door is open".

We walked down the incline, and I deposited her on a bench, huffing.  As I clearly saw people walking out the door, I called back to inquire if she wanted me to get her a wheelchair.

"Yes, if you can get someone to push it".

Sigh.  That would be me.

I settled her into the wheelchair and we entered the building.  There was no reception area, only a bank of elevators.   I asked her which floor she would be visiting on.

She looked blank.  "I don't know".

Sigh.  Sigh.  I espied a telephone on a table nearby, and pushed her next to it.  "OK, pick up that phone, dial "o", and ask, the operator will direct you".

Brief conversation ensued.  "X Building, 9th floor", she said with satisfaction, clearly in no rush to find someone other than myself to take her there.  Good thing I was headed to the same building, except I was only going to the 7th.  But first she had to drop the stack of papers she was carrying.  She wasn't going to pick it up.  I couldn't leave it.

So,  I took her in the wheelchair up the elevator  to the 9th.  "I am ok from here", she said as I neared a wheelchair stall around the corner from the nurses station.  "Thank you, and I'll be sure to pay it forward"

"I'm sure someone will be very grateful, have a nice day".

Later, as I was headed to my car in the parking lot, another older, confused appearing woman stopped me.  "Do you know where the main entrance is?"

Sigh.  Sigh.  Sigh.