Kids Eat, but it Ain't Free

Tonight was my night to wrangle kids with lacerations.

I hate restraining kids.  In fact, I really don't even like kids all that much.  Actually, I take that back; the kids are fine, it's the parents who suck.  That was why I stopped school nursing.

Kid 1:  2 years old and screeching blue murder.  He had a wooden splinter in the bottom of his foot.  It took Henrietta 20 minutes to get it out.  It was near the big toe.  Even wrapped in a sheet with both parents sitting on him and me holding down the foot, that big toe just couldn't be immobilized; it was like trying to nail Jello to a tree.  At least his parents were intelligent, helpful beings with realistic expectations.  They were tremendously helpful.  I stuck a Cars bandaid on his foot and he seemed happy with that.

Kid 2: 10 years old with a teeny, tiny laceration on her thumb from the top of a dog food can.  Crying, crying and crying, albeit silently.  2 stitches.  Had to work around mom who threw herself onto the stretcher like it was an open casket.  Made a WAY bigger deal out of it than necessary.  The little girls older sister was more of an adult than the mother.

Kid 3: 18 months old with a chin laceration.  It was 50/50 whether it needed sutures or not.  Clearly, this child had never heard "no" a day in his life.  Mom was busy getting out a picnic basket full of snacks and drinks in triage.  I warned her not to feed him ( they cry so hard they usually vomit) but she would have none of it; "how else am I going to keep him occupied?". (Um, I don't know, read him a book, play a game of Parcheesi?). We were busy, it was about an hour before we could take care of him.  I refused to put him in the room until Henrietta was ready to see him the minute he went in,  By that time mom had moved through the picnic basket and was feeding him a Kit Kat.  Mom was, predictably, less than helpful.  I wrapped him in a sheet and as soon as Henrietta put in the local he screamed so much he vomited like Mt. Vesuvius.  Surprise, surprise.  This is why we tell you not to feed them. 

But wait, there's more.  The kid kept screaming, but in a kind of "It makes me feel better to make noise", self- soothing kind of way.  Mom sang, really badly although you could tell she was thinking she could really sing, "The Wheels on the Bus".  Only when she got to the "round and round" part, it sounded like a cat in blender.

"The wheels on the bus go MMMMRRRRRRRREEEEEEEEEEEOUUUWW and round,
MMMMRRRRRRRREEEEEEEEEEEOUUUWW and round,
MMMMRRRRRRRREEEEEEEEEEEOUUUWW and round...."

and the kid would MMMMRRRRRRRREEEEEEEEEEEOUUUWW in his own way at the same time, so he sounded like
MmmmmmmmmmMMMMMMMMMMMMMMMMM  MMMMRRRRRRRREEEEEEEEEEEOUUUWW
MMMMRRRRRRRREEEEEEEEEEEOUUUWW

MmmmmmmmmmMMMMMMMMMMMMMMMMM 

Mom naturally wanted 4 pounds of antibiotic ointment and 100 bandaids upon discharge. Um, yeah.

Kid 4:  Little girl, 5 years old.  An older sibling had shut her index finger in a door, avulsing the nail.  Both parents, two other kids, grandparents, aunts, uncles, and an endless parade of concerned general citizens came and went.  By this time Gil had come in to work and he rapidly did a digital block since the kid was screaming like a banshee.  Mom yelled at him because after he injected one side of the finger, he said "another pinch, dear".  "DON'T TELL HER WHEN YOU ARE GOING TO STICK HER!!!  IT DOESN'T HELP!".  Oh, ok.  She had about 300 questions, none of which had anything to do with her daughters aftercare instructions.  She was very pissy, mostly I think because she had absolutely no control.

Kid 5: Dental pain, 7 years old. Really??  Seen by the dentist yesterday.  Given antibiotic.  Not Magically Better pills don't seem to be working because it's 10 PM and he can't sleep.  Mom gave him Tylenol.  Yesterday.  Are you serious?  A dose of Tylenol and OTFD*.  Sorry, we do not give out prescriptions for Common Sense in a Bottle^TM



*Out the fu**ing door

Riveting TV

Now that I am no longer a slave to schoolwork, you would think that I would have so much more time to add blog entries. 

Not so.  I am finding that when I am home of an evening, instead of being on my computer I am actually starting to watch some of the programming that has captivated Mr. Ednurseasauras during my academic incarceration.  Not just sporting events, mind you, although  I have written hundreds of papers while watching many a Red Sox, Bruins, or Patriot's game. More accurately, I was mostly pretending to watch, usually it is just white noise.  Mr. EdN is an inveterate channel surfer and is addicted to the Discovery and History Channels as well as some of the political and economic pundit programming.  He has a tendency to avoid the fluff; you know, premium channel train-wreck TV so ridiculous you just can't turn away.  This is anything on MTV or VH1 (unless it is a movie like "Eddie and the Cruisers" or "The Buddy Holly Story").  He abhors anything having to do with Jersey Whores, Kardashian Krap, 257 Kids and Counting, or Kate Plus 8 and Jon Gets the Gate.  I confess that in contrast, I never miss an episode of Toddlers and Tiaras.  Ultimate train wreck CRAYZEE parents, which makes you feel good about raising normal well adjusted kids without spray tanning, fake eyelashes and big hair.

Instead of being shackled to my online classroom, I have been enlightened by such riveting shows as Swamp People, Swamp Logger's, and Ice Road Truckers.  Then there's Pawn Stars, Billy the Exterminator, Dual Survivor, The Alaska Project, Everest Beyond the Limit.....etc., etc,. etc.    Tonight we watched two hours of Navy Seal shows dedicated to the killing of Osama Bin Laden.  That was pretty interesting, but what I really wanted to watch was True Blood.  That's OK; the magic of On Demand allows me watch it in the morning while I have my coffee.

Most of these shows are pretty ridiculous, but one in particular I must single out as being the most pointless in pursuit of the loftiest goal.  Whale Wars.  Yep.  Now, don't get your panties in a wad.  I love animals and on paper it might seem like a grand idea to participate in the high seas equivalent of poking a hornet's nest with a stick in order to save whales from being harvested by the Japanese.  I am not taking a stand on the legal issue of commercial whaling here; oh no.  Whaling in pursuit of scientific research apparently IS legal; the Japanese emphasize that their activities are legal by holding up signs on their deck as they process their kill that announce "We're Weighing Stomach Contents"or "We're Taking Tissue Samples".  In English.  So the helicopter can see it. What boggles my mind is that the captain and crew of the Sea Shepherd are bumbling idiots. Referred to by some as "eco-terrorists", or "vigilantes", they roam the waters off the coast of Antarctica attempt to disrupt their "enemy" by taunting, cutting across their bow, throwing stink bombs, and tampering with their propeller .   And sometimes getting rammed in order to indignantly cry "foul".  Their actions just seem juvenile and impulsive while being more of a threat to human beings than actually seeming to accomplish whale salvation.  I find myself rooting for the Japanese, frankly.   

Without a doubt a more effective option than the Jackasses of the High Seas would be to put the Navy Seals in charge of disrupting whaling activities.  Yeah.

One for the Bucket List

So, last weekend I graduated.  The culmination of countless (but probably millions) of hours in front a computer; countless (at least a hard-drives full of) papers, essays and projects; weight gain and lack of exercise; many thousands of dollars; working at a less than optimum job for far less than optimum pay to make time for study; spending less time with my family, especially when sequestered for weeks at a time for some courses; ignoring the laundry and most other household tasks.  While all my family supported me, only Mr. EDNurseasauras was able to make the trip with me, and he watched with pride as I walked across the stage to accept my diploma.  It was only fitting since he was, above all, the one who bore witness to my daily struggles, frustrations, and personal achievements of the last four very long years.

From others, I heard an endless chorus of comments:  "are you STILL in school?", "what are you going to do with your degree?", "are you going to get any more money?", and "is it worth it?".

The short answers are: yes, teach I don't know, probably not, and yes. 

I had second thoughts about attending graduation, it was a lot of money I thought I probably shouldn't be spending.  Airfare.  Hotel.  Rental car.  Meals.  A recent out of town family wedding that, while a wonderful occasion, meant more travel in only a few weeks time.  And, we just had our kitchen remodeled as well. 

But, I did go, and it was worth every penny to have taken the opportunity to celebrate.  I would not have experienced the joy, personal satisfaction and sense of achievement by simply opening a large white envelope
containing my diploma.

There were maybe 350 graduates in total, but only 75 nurses; it was about half and half MSN graduates and undergrads.  My early flight on Friday morning allowed me to attend the pinning and hooding ceremony shortly after my arrival in town.  It gave me an opportunity to connect with some of my fellow graduates in a more intimate setting, some of whom I had "met" in classes.

First was Bill, who had been in my Ethics class and hailed from Arkansas; I had enjoyed his sense of humor in the online classroom, and he was wickedly funny in person.  Of course he was an ER nurse.  He watched with envy as the Masters degree candidates milled about, carryng the hoods which were soon to be placed around their shoulders and remarked, "That's going to be me some day".

He had already started taking his courses in January; "Well", I said, "Mine will not be in nursing, if I do continue on for my master's.  If I never take another nursing theory course I will die happy.  If I was younger I would go to law school".  Bill, Erica who was a local, and I  talked about what we would do with our shiny new degrees, the merits and challenges of a graduate degree, and when we would be receiving our honor cords for commencement.  We wondered if there was any food around since it was mid afternoon, and most of us had been traveling since early morning.  "They could at least have thrown us a couple of granola bars", Diane complained.  She was a  nurse I had gotten to know in Nursing Research; she was from Chicago.  "I HATED that course", she said. "That instructor was brutal, then with two weeks left she up and quit!"

"I actually thought that was one of my better courses", I said, "but I took it right after statistics so I think it made more sense to me.  I had one instructor who had a family emergency, but he was replaced right away so it didn't disrupt class.  That is miserable to have an instructor quit like that".

Bill commented, "I took statistics at a ground school, and I did really terrible in it".  The three of us discussed the challenges of online math courses, the reason my GPA was 3.91 and not 4.0.  Diane had required a tutor for College Math; somehow I taught myself Intermediate algebra (there are rules, imagine that!) AND statistics. 

Other classmates included Donna from Atlanta who was considering going on to be a nurse practitioner, but who's husband had died about 8 months ago; it was a bittersweet moment for her, and she was clearly trying to make the occasion as joyful as possible.  Mark from Tennessee was an OR nurse manager who didn't have much to say until he found out I came from the northeast; turns out we grew up about three towns away from each other.

The pinning ceremony was presided over by the Dean of the College of Nursing, who introduced the other nursing movers and shakers of the University.  Her comments were personal and inspiring and made me really appreciate my nursing education, both my diploma program and the RN to BSN program that I had completed.

"Tomorrow, you will march in with your fellow graduates from a variety of different programs.  Commencement speakers usually address their remarks to young men and women who have not yet begun their careers, however you, as nurses, are already experts in your field.  Continue to learn, grow, and mentor others".   

I didn't mind that I was 4th from the end to receive my diploma, it was worth waiting for.

Thanks for the Access

I was already suspicious when the patient listed Ultram and Tramadol as allergies (same thing).

Yet, today was the day that she decided to be seen in the ER for her long standing pelvic pain for which she had already been worked up.  She had the pain for months and months.  Her pain was no different than it had been for the last months even though she routinely took absolutely nothing for it.  She had never called her primary care or GYN for follow up since her last million dollar workup for the exact same thing (without finding) nine months ago. Since she had a generous insurance plan paid for by you and me she obligingly submitted to the usual battery of tests:

Urine test=normal
Lab tests=normal
Pregnancy test= negative
Pelvic exam= some vaginal bleeding although she claimed she "didn't know she was bleeding since she had her period last week"
Pain relief with Toradol=not so much

The next plan was to send her to the Mother Ship for the obligate and gratuitous ultrasound which we do not have available on evenings.  Or weekends.  Or Mondays.

Although it is the SAME facility and we are merely an extension, for some reason we are required to do transfer paperwork.  The nurse do this.  And because we do NOT have electronic charting in this turn of the century (20th century) state-of-the-art health care environment, we have to copy everything.  When we are also caring for other patients, this takes a chunk of time.  Lastly, we have to call the nurse at the other ER for a report on everything we have done; safe Hand-Off.  All this takes a good 15-20 minutes. 

We usually leave the IV in place, just, you know, in case.  The patient left with a boyfriend that apparently had waited in the car for all of the festivities. 

Two hours later a call from the Mother Ship nurse: "Hey, that patient never showed up".

I HATE when they leave with the IV still in and none of their phone numbers work, and their address doesn't exist.  It just creates paper work.  I should have listened to my spider sense, it is rarely wrong.  Damn.

"Can It, You Nit!"

It as absolutely not, not, not necessary to relay every single, solitary, minute detail of your medical history when you come to the ER.  It is also not necessary for us to know your background, education, likes and dislikes, job history, the kind of car you drive, ability to speak a foreign language, or if you are able to sign your name with your toes within the first 2 minutes of your visit.  Trust me, if we want to know we will ask.  During triage the information that is required is need-to-know.  That is to say the information that I NEED, not necessarily what the patient is compelled to tell me.  I am speaking about that all-important first bit of information the REASON FOR YOUR VISIT.  It is most beneficial to be as succinct as possible, and least likely to piss me off. 

New Cathy and I spent 15 minutes jointly trying to triage a woman who WOULD NOT SHUT UP. All we knew is that we had to haul her ass out of a minivan (and she was not a light weight...are they ever?) because of a knee or leg or foot or ankle injury.  We had no idea because, again, she WOULD NOT SHUT UP, this bag of wind, bigmouth, blabber, blowhard, chatterbox, gasbag, jabberer, motor-mouth, etc, etc, etc..you get the picture.

Me: What did you injure exactly?
Verbose Patient:  Well...(I am always wary of responses that begin witht this) THIS is my bad knee, I have had surgery on this one, well both of them really, but this one was never as good as the other one since I was hurt at work I am, well, was, a nurse and I worked in (can't remember what type of nursing she did) until 2 years ago so this was originally a work injury, but I have some arthritis in my back, but I've been getting around pretty good even though I can't work anymore....
Me ( interrupting) Excuse me, what is it exactly that you have injured TODAY?
Verbose Patient: My knee.
Me: Which one?
Verbose patient: Well I was looking for Windex, we are visiting my son and his family, we are on from Florida and like I said I was getting around pretty well lately, we made the flight from Florida fine, no problem, so the Windex was on a shelf but the shelf was down a few stairs and I didn't see the stairs and next thing I know I was in space and fell.

This went on for 15 minutes.  I pride myself on being able to triage something like a knee sprain in no more than 6 minutes, and that includes individuals with 75 different meds and an equal number of allergies.  Of course, her allergy list was predictably long and included aspirin, tramadol, all 'cillins, sulfer, six different antidepressants, milk, whey, strawberries, kiwi, any medication beginning with the letter "Q" or the number "7", snakes, air, dirt, rum, black magic, pirates, and clouds.  All of which were, thankfully, on a computer printout that included every doctor's visit for the last 3 years so I didn't have to wait for her long-winded explanation on any of them.

I was fast running out of patience so I finally blurted, "you know, you're delaying your own care!  You're the only patient in the department and  could have seen the doctor 10 minutes ago....and already had an xray by now!  Let's just have the Reader's Digest version for now, okay?"

Her husband burst out laughing; "Guess she told you!  You always talk too much!  Just answer the questions!".  Little did I know that he was a windbag as well.

We eventually shipped her off to xray.  The husband chose to stand in front of our desk and give us a 15 minute commercial for their over-fifty community where they reside.  The golf, the hospitals, the restaurants; the types and prices of every house available, and on and on and on and on.  I eventually excused myself and went out to the desk where I called New Cathy, just so she wouldn't have to talk to him anymore. 

The wife was given a knee immobilizer, crutches and a prescription for Vicodin for her knee sprain.  The Vicodin because she only brought exactly enough of her own Vicodin to last exactly the number of days she expected to stay in town.  Oh goody.

At 6:00 PM I went in to fit the knee immobilizer, assess her crutch walking technique and give her discharge instructions, a task that should take no more than, oh, ten minutes being generous.  Even for a completely uncoordinated yutz.  I said to New Cathy, "It's six o'clock; I'll bet I won't be done with this discharge until 6:45 PM.  At the earliest".

It was exactly 6:40 PM when I shut the door of her minivan, two hours from start to finish.  She would have been in and out in less than an hour from start to finish if she would have just SHUT UP.  Thank you.