I thought some of those tough old Yankee birds were a trial when I lived in Massachusetts; they were nothing compared to these stubborn NH Yankees.
I got a 70 something year old man by private car for "trouble breathing", who needed a wheelchair assist from the door. He was gasping like guppy; his O2 sats were in the 60's. According to his daughter he had been having increasing shortness of breath for about a week. He wasn't eating or drinking, and couldn't get off the couch for the last couple of days. His daughter said "He has emphysema and his inhalers aren't working. He has refused to come to the hospital, and wouldn't let us call an ambulance; I had to call my brother to help me get him out of the house when he finally relented".
No shit. He was frail and cachectic, a bearded, grizzled old guy. He was not on home oxygen. He did not have nebulizers. And he continued to smoke (until a few days ago).
"He refused nebulizers and oxygen, well, he is a smoker so even if he didn't refuse it he would probably blow himself up or start a fire".
We managed to turn him around without intubating him, but it took awhile and he was pretty tired. I assumed he would go to the ICU, but apparently the hospitalist didn't think it was necessary. WTF. The doc was a stubborn as the patient
Our doc was Arnie,who only works with us one or two shifts per month; in four years I have probably worked with him maybe 7 or 8 times. I appealed to Arnie that, c'mon, he needed a higher level of care than can be provided on the medical floor. "I think he'll be ok".
Yeah, right; time for an end-around.
I called the nursing supervisor and told her that even on 100%, he desatted to the 80's with minimal exertion and in my opinion, nurse to nurse, (code for the doc doesn't see it that way) he was not appropriate for the floor. She agreed. But, since nurses are considered idiots who can't make decisions at this joke of a hospital we had to play games; nursing supervisors at this religious institution being all female don't have much influence.
We decided to have the hospitalist see the patient in the ER but still keep him a direct admit. Cripes was the doc downtown and was also given the heads up. His wife is a nurse and he is one of the few who actually thinks nurses have anything to contribute.
"He's going to the unit", said Cripes. "Cripes, he's on a non-rebreather!"
Yep.
I took the shotgun approach to report and faxed it to everyone; the ER nurse I talked to.
"Oh yeah; he's going to the unit".
Like I sad.
Sunday, April 24, 2011
Saturday, April 23, 2011
This Could have been bad
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.
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.
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.
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