Tuesday, July 6, 2010

CRNA and Cellulitis

In my youth, about the time that dinosaurs roamed the earth, I had a tendency to be intimidated if I had health care types for patients. Docs and nurses are not the best patients. For myself or my family, I don't (unless I am wearing scrubs) come right out and say I am a nurse with about 1000 years experience simply because it can be intimidating.

Case in point; my husband was admitted last year for a cellulitis in his hand. Since he was being discharged with the need to have IV antibiotics at home he required an IV change (yeah, that one: the one I had put in 2 days earlier). I gave the young nurse 2 tries, then I (nicely) bullied her into fetching me a warming pack and put the damn thing in myself. I really tried to stay out of her way but my husband is a hard stick; I was just looking out for him, not judging the nurse.

So a guy came in over the weekend with a pretty nasty infection; he would require IV antibiotics for a couple of doses, but could come to the ER for his medicine; hey, we're a full service ER.

As I looked over his arms for a suitable spot to place his IV, his wife helpfully shrieked, "You can't put it in that arm, that's the one with the infection!".

Um, ok. Gee ma'am, don't know what I would have done without that useless bit of information. I quickly intuited that she was some sort of health care person and she wanted me to know it.

In my experience, the degree of effort expended by an individual to inform me in some roundabout way that they are in health care:

a. is inversely proportional to their level of experience or years of practice

b. has no relation to the level of acuity said individual practices

c. is a clue that they are either a student or an LNA


d. just want me to know that while they may not be a kick-ass ER nurse like me, they are indeed a kick-ass school nurse, office nurse, camp nurse, etc.

Second case in point: the aforementioned unhelpful wife, once I had decided on my target vein and was moving in for the kill, asked, "will you put in a butterfly since he has to come back tomorrow? They are so much smaller".

This tells me that unhelpful wife is an idiot since a butterfly, while small and perhaps really useful for short term use (ie, minutes) under direct supervision is inappropriate for longer term use. People who exhibit health seeking behaviors such as migraneurs who capriciously use the ER for their chronic pain condition will often ask for a butterfly. I usually don't make an issue out of it, but explain that those are METAL needles which are not good for extended use. Then I promise to use a baby needle, usually inserting something like a 20 gauge. This is a good size stick and certainly not a baby sized needle unless the baby is a full grown adult. Which they are.

I decide to ignore unhelpful wife and address my comments to the patient who was being very quiet. I explained that the site I had chosen in the middle of his arm would not be as compromising to his lifestyle as one in the hand or the crook of his elbow.

"Oh, he knows all about it, he's a CRNA"

Ah. A nurse anesthetist. Cool. Scary damn specialty, though. Too much chemistry and opportunities for it all to go horribly, tragically wrong.

Mr. CRNA looked up at me and mused, "How am I going to work tomorrow?"

"Well, I'm pretty sure you have sick time; use it".

"Oh, he never takes any sick time", said unhelpful wife.

"Well, think about it, do you really want to go into the OR with this raging cellulitis? Hmmm? Is that a good idea?" I asked, hanging his bag of IV antibiotic.

"Guess not".

Unhelpful wife accurately intuited that I had lost interest in her and chose to regale me with tales of her horrible experiences in ER's. This not only bores me, but in most cases, this sort of discussion is about as tactful as telling me about the time you farted in church. It tells me a lot more about the kind of person you are than "scaring" me into believing you are an astute health care consumer or that you have any native intelligence at all.

To his credit, the CRNA patient was cool. Maybe he knew he was kind of screwed with that albatross of a wife.

"So, what what do you do for work?", I asked unhelpful wife, "are you a CRNA as well?". I knew she wanted me to ask. Really.

"Well, I work in dermatology".

"Wow, really, you're a dermatologist; that's great" I gushed, knowing damn well she was not. It is less than full disclosure, sort of like me saying I'm in MEDICINE; I work in the medical FIELD, but to say I work in medicine might lead one to believe that I was a physician. You can see my point, I'm sure.

Unhelpful wife squirmed noticibly and replied, "Oh no, I work in a dermatology OFFICE".

I moved in for the kill; "Oh, so what do you do there?"

"I'm a med tech, but I run the appointment desk".

Uh huh. Thought so.