Telephone caller: "Hi, would it be possible to get rabies shots there?"
Me: "For humans or animals?" (I wasn't being a wise ass, really)
A while later, a woman came in who stated that she had been bitten by a skunk; well, that got my interest.
The middle-aged woman had been raking in her back yard and didn't notice the mangy, dirty skunk until it was right beside her. At that point, she was too afraid to move and scare it into spraying her. Unbelievably, the skunk sort of rolled on her foot; then bit it. It wandered off and then sprayed.
Not normal skunk behavior for sure, and it occurred at 4 PM when it was still daylight.
Fortunately, the patient was wearing a heavy boot at the time; the skunk never broke the skin, luckily for her. She skated off without getting rabies prophylaxis after our doc got some advice from the state Board of Health.
The skunk was not found according to police.
Saturday, April 23, 2011
Friday, April 22, 2011
What?
For some reason, I had a high school student intern one day last week. I thought it was very odd since high schools are usually trying to accomplish internships early in the school year. Plus, my boss Jane was on vacation so I had no idea she was coming.
She was very quiet. Painfully quiet. It was an effort for her to get out her name.
"Annette", she whispered after I had begged her to repeat it three times; she looked about 12 years old.
"So, are you planning on going to nursing school?" After thinking for awhile, she responded with a barely audible, "Medical school".
It was a long four hours. She did not initiate conversation; she only responded to my questions after struggling to come up with an answer. I have never met anyone so pathologically shy. I found out she is going to Big Boston Institution of Higher Learning, (BBIHL) having achieved early acceptance. Talk about jumping into a shark tank wrapped in a Lady Gaga meat suit.
I took her into triage with me a few times, but since it was a pretty quiet night (as it usually is when we have a student) I just stopped trying after awhile and read a journal. I was kind of relieved when she left. I always ask students what the most interesting part of their experience was in order to put it in some kind of perspective, or get some of my own as to how to improve the experience for the next student. Annette responded: "Nothing".
Jesus tap dancing Christ.
Jane and Second in Command and I were finishing up a little business at the start of the shift and Annette came in; crap, not again. I greeted her and introduced her to Jane; I directed her to put her things in our back room.
Jane looked at me quizically; "Who was that?"
Me: "Student. She was painful the other day, could barely get a word out of her"
Jane: "She looks like she's about 12! Is she even in high school?"
Me: "Yep, graduating in June. She's been accepted to BBIHL and she wants to go to med school"
Jane: "Holy Crap! She'll get eaten alive!"
Me: "I know, she will never survive orientation"
Nothing rattles the Talker. Usually.
There are always exceptions. He is good with teaching, but I could see that he was having difficulty conversing with Annette.
"So, is any one in your family in medicine?"
"No".
"So, what made you decide to think about med school?"
After thinking for about 20 seconds, "To help people?"
He asked a lot of the same questions I did, and I had to squeeze my lips together to keep from answering for her, it was that uncomfortable. It was a little busier so we at least had some things for her to see.
We had her watch the Talker put an orthoglass splint on a little girl with a fractured wrist. He explained everything, showed her what he was doing, gave her a piece of orthoglass play with. She was silent; the Talker just looked helpless.
I had a thought that maybe her guidance counselor should have given us some kind of heads up on this one; not all fragile people come equipped with a "Handle With Care" stamp.
Annette planned to spend her final four hours of her mini-internship at the Mother Ship. Yikes.
She was very quiet. Painfully quiet. It was an effort for her to get out her name.
"Annette", she whispered after I had begged her to repeat it three times; she looked about 12 years old.
"So, are you planning on going to nursing school?" After thinking for awhile, she responded with a barely audible, "Medical school".
It was a long four hours. She did not initiate conversation; she only responded to my questions after struggling to come up with an answer. I have never met anyone so pathologically shy. I found out she is going to Big Boston Institution of Higher Learning, (BBIHL) having achieved early acceptance. Talk about jumping into a shark tank wrapped in a Lady Gaga meat suit.
I took her into triage with me a few times, but since it was a pretty quiet night (as it usually is when we have a student) I just stopped trying after awhile and read a journal. I was kind of relieved when she left. I always ask students what the most interesting part of their experience was in order to put it in some kind of perspective, or get some of my own as to how to improve the experience for the next student. Annette responded: "Nothing".
Jesus tap dancing Christ.
Jane and Second in Command and I were finishing up a little business at the start of the shift and Annette came in; crap, not again. I greeted her and introduced her to Jane; I directed her to put her things in our back room.
Jane looked at me quizically; "Who was that?"
Me: "Student. She was painful the other day, could barely get a word out of her"
Jane: "She looks like she's about 12! Is she even in high school?"
Me: "Yep, graduating in June. She's been accepted to BBIHL and she wants to go to med school"
Jane: "Holy Crap! She'll get eaten alive!"
Me: "I know, she will never survive orientation"
Nothing rattles the Talker. Usually.
There are always exceptions. He is good with teaching, but I could see that he was having difficulty conversing with Annette.
"So, is any one in your family in medicine?"
"No".
"So, what made you decide to think about med school?"
After thinking for about 20 seconds, "To help people?"
He asked a lot of the same questions I did, and I had to squeeze my lips together to keep from answering for her, it was that uncomfortable. It was a little busier so we at least had some things for her to see.
We had her watch the Talker put an orthoglass splint on a little girl with a fractured wrist. He explained everything, showed her what he was doing, gave her a piece of orthoglass play with. She was silent; the Talker just looked helpless.
I had a thought that maybe her guidance counselor should have given us some kind of heads up on this one; not all fragile people come equipped with a "Handle With Care" stamp.
Annette planned to spend her final four hours of her mini-internship at the Mother Ship. Yikes.
Thursday, April 21, 2011
Walk This Way
The Lady on Elm St. has been suspiciously quiet lately. There are some ER docs that she just doesn't like. Let's see, that's....everyone except Cripes and Henrietta.
Lady arrived by ambulance with her usual abdominal pain complaint. She was brought to us in spite of Lisa's advising them over the radio that "Dr. THE TALKER strongly advises that this patient go to the Mother Ship for evaluation".
That is because Lady and the Talker do not get along. The Talker finds it necessary to tell it like it is; Lady finds it necessary to take offense. The Talker has been known to remind Lady that her morbid obesity is a hazard to her health; Lady has written complaints about the Talker since her morbid obesity, in her opinion, is none of his business.
Whatever the Talker said this time caused Lady to storm out of the ER; if a person of her sizable girth and wearing a nightgown, robe, and fuzzy slippers can storm anywhere.
Lisa waited awhile and then, when she didn't return, called the police to see if they could see her. It was a long walk to Elm St. Surprisingly, she had called someone to pick her up and it wasn't an ambulance.
The Talker expects another letter of complaint. I expect Lady to come in on my next shift.
Lady arrived by ambulance with her usual abdominal pain complaint. She was brought to us in spite of Lisa's advising them over the radio that "Dr. THE TALKER strongly advises that this patient go to the Mother Ship for evaluation".
That is because Lady and the Talker do not get along. The Talker finds it necessary to tell it like it is; Lady finds it necessary to take offense. The Talker has been known to remind Lady that her morbid obesity is a hazard to her health; Lady has written complaints about the Talker since her morbid obesity, in her opinion, is none of his business.
Whatever the Talker said this time caused Lady to storm out of the ER; if a person of her sizable girth and wearing a nightgown, robe, and fuzzy slippers can storm anywhere.
Lisa waited awhile and then, when she didn't return, called the police to see if they could see her. It was a long walk to Elm St. Surprisingly, she had called someone to pick her up and it wasn't an ambulance.
The Talker expects another letter of complaint. I expect Lady to come in on my next shift.
Wednesday, April 20, 2011
What, Me Worry?
You have probably noticed the "Days 'til Gradution Ticker" to the right over there. Yes, I am finally, actually, really finishing. My course ends officially on May 4, but I expect to have all the necessary work finished before then. It is a PAINFUL course; Holistic Professional Nursing. Really, it is just Public Health Nursing redux. Same book with the same professor; and the same no-nonsense attention to detail.
Bwa-haha-hah-hah-hah-hah-hah!
It is an 11 week course. I have, on average, two discussion questions weekly and an installment of the Capstone Project. To date, I have passed in every single assignment late, copied and pasted the same response to a discussion four times (with minor tweaks), and lifted entire sections of papers I had written previously to fulfill an assignment. I have a 100% average in this class in spite of copying the Gettysburg Address and citing Alfred E. Newman and Mad Magazine as a reference. "Great job! Keep up the good work!". Yikes.
The entire class is in the same boat; we are all suffering from, dare I say, Senioritis. My kids know what it is like to be a SEEEEEEEEEEEEEEEEEEEEEEENIOR. I guess we are all grateful that we have the most laissez-faire instructor on the planet for our final course
About friggin' time.
Mr. Ednurseasauras, my biggest cheerleader, is thrilled (we really haven't talked about grad school). My boss is overjoyed (she is encouraging grad school, but I think for now I prefer to get my kitchen renovation completed and tackle that next fall/winter). Nana wanted to go to my graduation (in June, in Georgia, where it is very hot) but thought she would enjoy staying home and minding Tina instead; they get along great, and Tina LOVES going to visit Nana). My kids, K and J, having finished college 8 and 4 years ago respectively, have always been in my corner, gave back to me those words of encouragement I spoke to them when they were taking their academic journey:
Bwa-haha-hah-hah-hah-hah-hah!
It is an 11 week course. I have, on average, two discussion questions weekly and an installment of the Capstone Project. To date, I have passed in every single assignment late, copied and pasted the same response to a discussion four times (with minor tweaks), and lifted entire sections of papers I had written previously to fulfill an assignment. I have a 100% average in this class in spite of copying the Gettysburg Address and citing Alfred E. Newman and Mad Magazine as a reference. "Great job! Keep up the good work!". Yikes.
The entire class is in the same boat; we are all suffering from, dare I say, Senioritis. My kids know what it is like to be a SEEEEEEEEEEEEEEEEEEEEEEENIOR. I guess we are all grateful that we have the most laissez-faire instructor on the planet for our final course
About friggin' time.
Mr. Ednurseasauras, my biggest cheerleader, is thrilled (we really haven't talked about grad school). My boss is overjoyed (she is encouraging grad school, but I think for now I prefer to get my kitchen renovation completed and tackle that next fall/winter). Nana wanted to go to my graduation (in June, in Georgia, where it is very hot) but thought she would enjoy staying home and minding Tina instead; they get along great, and Tina LOVES going to visit Nana). My kids, K and J, having finished college 8 and 4 years ago respectively, have always been in my corner, gave back to me those words of encouragement I spoke to them when they were taking their academic journey:
K: "Mom you are so close!"
J:" Just think about how good it will feel when you are done!"
K: "Party!"
J: "No more college tuition"
K: "Now you are a SEEEEEEEEEEEEEEEENior!"
J: "I guess you will be wanting your Kindle back" (I let him borrow if for an extended period while I finished school; it was a distraction otherwise)
I plug away, and look forward to not having anything hang over my head in a couple of weeks. So close, so close. But first, I must write up the intervention on a family I made up for Smoking Cessation; although made up of various people, they are not a family. The matriarch really did light up a butt while she was on oxygen, hilarious hijinks ensue. Not. I think I will throw the Bill of Rights in the middle of it and cite Wikipedia just to see if my professor is paying attention.
K: "Now you are a SEEEEEEEEEEEEEEEENior!"
J: "I guess you will be wanting your Kindle back" (I let him borrow if for an extended period while I finished school; it was a distraction otherwise)
I plug away, and look forward to not having anything hang over my head in a couple of weeks. So close, so close. But first, I must write up the intervention on a family I made up for Smoking Cessation; although made up of various people, they are not a family. The matriarch really did light up a butt while she was on oxygen, hilarious hijinks ensue. Not. I think I will throw the Bill of Rights in the middle of it and cite Wikipedia just to see if my professor is paying attention.
Tuesday, April 19, 2011
Parenting is Only a Part Time Job
We were having a nice, steady night with Brian. Brian works quickly and unfailingly manages to get all of his dictations done right after he finishes with the patient's care. This strategy assures that when 11 PM rolls around and there are no patients, he is out the door. Works for me.
We had already sent two patients with abdominal pain down to the Mother Ship for CT scans and seen three garden variety frequent flier dental paineurs who got antibiotics and Percocet (the only thing I really don't like about Brian....it's like feeding squirrels, they always come back for more). He had put Orthoglass splints on two little girls with buckle fractures and it was only 5 PM. Wham, bam, thank you ma'am. In and out.
My next triage was a plus-sized young woman with 10/10 abdominal pain that she had been having for the better part of a year. No other symptoms. No insurance. She was supposed to have followed up with her gynecologist, but apparently paying for her artificial nails, her IPhone, and her Coach bag were more important.
Me: So, what is different about your pain level today?
Pt:: I just thought it was time to do something about it.
Me: Uh huh.
The woman had with her an adorable 3 year old whom she consistently parented poorly.
"Sit down. Sit down! SIT! RIGHT NOW! What did I tell you? Do you want mommy to spank you? I told you...no, Aaron, don't do that! Get down off there! What did you...did you just put something in your mouth? Spit that out! How many times do I have to tell you to....come here....come over here right now.....AARON! GET OVER HERE! You are such a pain! I can't take you anywhere! AARON! Are you listening to mommy?"
Clearly he is not.
Aaron continued to terrorize the treatment room, and all we could hear was mom yelling at him behind closed doors. Brian ordered some of the usual tests; pregnancy test, urine, etc, but I knew the pelvic exam was coming, and I tried to mentally prepare myself. I was having some trouble with that, though.
To Brian: " I would rather have you professionally poke out both my eyes with an 18 gauge needle than chaperon you with that pelvic exam".
Brian, laughing: "I know, I'm not looking forward to it either".
When the time came, Aaron had parked himself on the stool at the business end of his mother. He could not be budged, not even with the Beanie Baby that we keep for emergencies. Brian got tired of coaxing darling Aaron, so he finally picked him up and deposited him on a chair; he immediately scrambled out and stood, again, in a posture of interest in front of his mother's crotch.
Me (to Brian): "Is he trying to crawl back into the womb?"
Brian finally just nudged him out of the way and did what was necessary.
She left with Vicodin. Yikes.
I understand that not everyone who gives birth is an ideal parent, in fact some are downright appalling as evidenced by the number of screwed up kids in the world. But this just bothered me. Having children is enough of a crap shoot as it is even with good parenting. I just couldn't help but think that this kid is doomed.
We had already sent two patients with abdominal pain down to the Mother Ship for CT scans and seen three garden variety frequent flier dental paineurs who got antibiotics and Percocet (the only thing I really don't like about Brian....it's like feeding squirrels, they always come back for more). He had put Orthoglass splints on two little girls with buckle fractures and it was only 5 PM. Wham, bam, thank you ma'am. In and out.
My next triage was a plus-sized young woman with 10/10 abdominal pain that she had been having for the better part of a year. No other symptoms. No insurance. She was supposed to have followed up with her gynecologist, but apparently paying for her artificial nails, her IPhone, and her Coach bag were more important.
Me: So, what is different about your pain level today?
Pt:: I just thought it was time to do something about it.
Me: Uh huh.
The woman had with her an adorable 3 year old whom she consistently parented poorly.
"Sit down. Sit down! SIT! RIGHT NOW! What did I tell you? Do you want mommy to spank you? I told you...no, Aaron, don't do that! Get down off there! What did you...did you just put something in your mouth? Spit that out! How many times do I have to tell you to....come here....come over here right now.....AARON! GET OVER HERE! You are such a pain! I can't take you anywhere! AARON! Are you listening to mommy?"
Clearly he is not.
Aaron continued to terrorize the treatment room, and all we could hear was mom yelling at him behind closed doors. Brian ordered some of the usual tests; pregnancy test, urine, etc, but I knew the pelvic exam was coming, and I tried to mentally prepare myself. I was having some trouble with that, though.
To Brian: " I would rather have you professionally poke out both my eyes with an 18 gauge needle than chaperon you with that pelvic exam".
Brian, laughing: "I know, I'm not looking forward to it either".
When the time came, Aaron had parked himself on the stool at the business end of his mother. He could not be budged, not even with the Beanie Baby that we keep for emergencies. Brian got tired of coaxing darling Aaron, so he finally picked him up and deposited him on a chair; he immediately scrambled out and stood, again, in a posture of interest in front of his mother's crotch.
Me (to Brian): "Is he trying to crawl back into the womb?"
Brian finally just nudged him out of the way and did what was necessary.
She left with Vicodin. Yikes.
I understand that not everyone who gives birth is an ideal parent, in fact some are downright appalling as evidenced by the number of screwed up kids in the world. But this just bothered me. Having children is enough of a crap shoot as it is even with good parenting. I just couldn't help but think that this kid is doomed.
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