Cuts and Cutting Remarks

New Hampshire hospitals have been scrambling to come up with millions of dollars in budget shortfalls.  The state legislature in its infinite wisdom voted to cut Medicaid reimbursements along with many other cuts to state and local agencies and programs.  The impact to hospitals involves money that had been counted on during budget planning for the coming year, but now the rug has been pulled out from under. 

The state  taxes hospitals 5.5 percent on  patient revenues, but returns the amount of the tax in matching federal Medicaid funds so they effectively lost no money.  That's out now, and hospitals have been cutting jobs all summer, the latest round of layoffs occurring about a week ago. 

We lost a number of positions, none of which were clip board personnel or Suits in Charge of Stupid Shit, not surprisingly.  I get to keep my job.  But there were several LPN's who lost their jobs.  Just axed.  Some genius in the public relations department of another hospital, who also cut their LPN's, justified cutting them  since, "LPN's are really just glorified nursing assistants".  Really??  Talk about adding insult to injury.

I have never worked in a hospital that employs LPN's in the ER, but I have worked with my fair share in many other areas.  Some were good, some were great. 

The first one I ever worked with was Mrs. Maccaione.  I don't know if she had a first name, you either called her Mrs. Maccaione, or "Mac".  In 1973 she had to be in her mid-sixties.  Mac wore whites from the top of her starched cap to the polished perfection of her white Clinic shoes.  She was as broad around as she was tall, and at 5 feet was an imposing and intimidating poster child for Crusty Old World War II Nurse.  With her rolling bandy-legged gait and the whoosh! whoosh! of her pudgy thighs in their snow white support hose, she bore down on me and the other two nursing assistants like a ship under full sail; usually with guns a-blazing.   She was NO NONSENSE in the flesh.  She really did try and bounce quarters off of draw sheets.  Mac was well known for her scrutiny of top sheets for precise hospital corners.  Woe to you if you were caught resting a pillow under your chin to apply a pillow case.  You would hear about it in spades if your patients weren't  bathed in a timely manner or their immediate environment was not spotlessly clean.  We were scared to death of her.

In the early 1970's, day surgery was non-existent.  If you had a cholecystectomy or appendectomy, you were in the hospital for about a week.  A tonsilectomy?  Two nights.  Wisdom teeth?  That involved checking in to the hospital the night before your surgery and staying all day.  Sometimes patients went home, sometimes they could "elect" to stay another night, like if they were vomiting or whatever. 

Mac always greeted the patients and oriented them.  This was a job that needed to be DONE RIGHT.  She strode into the room and  stood at parade rest. 

"Good afternoon!  Welcome to Unit F.  I'm Mrs. Maccaione-call me Mac.  You are scheduled for _____surgery tomorrow at 0800 hours.  Today, you will be getting a visit from the anesthesiologist and having whatever testing may be deemed necessary, if any.  You will be signing a surgical consent if you have not already done so.  For today, you will be given a regular supper, served between 5 and 5:30 PM along with a light snack at approximately 8 PM. Visiting hours conclude at 8 PM, so plan accordingly.  At this time, the switchboard will not put through any incoming phone calls to the rooms.  Lights out in this unit is generally between 10 and 11 PM; you will be needing your rest.  At 12 midnight, you will be NPO: Latin, Nothing By Mouth until after your surgery.  You will be awakened at 5:45 AM to prepare you for your surgery.  Questions?"

This monologue was delivered  rapid-fire.  I'm sure most patients didn't dare ask questions of Mac. Most of the doctors were scared of her. 

But you should have seen her in action when it came to encouraging a fresh post-op and making them feel cared for.  Or getting another 6 feet of corridor out of a tired newly ambulatory patient with a big belly wound (remember Scultetus binders?).  There was nothing she couldn't get from the kitchen staff if she thought it would entice a finicky eater to take nourishment.  For all her brusque and bossy affect she was a hell of a nurse; you would want her to take care of your family.  I learned a hell of lot from her. 

Just a "nursing assistant"?  Oh, HELL no.

From Out of the Blue

Sherry was curious about a little kid she had sent to the Big City Kid's Hospital with a forearm fracture from a few nights ago.  We rarely get any follow up on people we transfer to other places unless we call them, or they have some kind of complaint or lost a slipper or some shit.

The parents, who were very, very anxious, were thrilled with the excellent care at Big City Kid's where he had a closed reduction under sedation.  It was a long night, but he did well.  They were also grateful for the care he had received at our facility.  He was, however, almost out of pain medicine.  Long story short, Cripes, who had seen the kid the other night was willing to write a 'script for the same pain medicine to tide the kid over for another day or two. 

Dad came in to pick up the prescription and had this to say.

"Thank you for taking such good care of us the other night.  You can't know everyone's story and what's gone on in their past.  I just wanted you to know that how you treat people really does make a difference.  Fifteen years ago, I had a son who didn't make it.  I walked the halls at Big City Kid's.  You remember the people, the doctor's and nurses, who reached out and tried to make a connection, a kind word.  Some encouragement.  Or helped us prepare for the worst.  How you treat people matters.  I was back walking the halls like I have for the last fifteen years.  Thank you for caring about us".

I never cry at work.  This made me cry.

Stop Bugging Me

"I think I have  a bug in my ear", said the guy in triage.  "I was mowing my lawn and brushed against a rose bush and it feels like something is in my ear canal.  I didn't dare poke it with a Q tip"

Good plan.  Every time I get someone with a complaint like this, I think of the old Night Gallery episode hosted by that creepy guy Rod Serling.  Some guy gets and earwig planted in his ear which then proceeds to munch its way through the brain (being unable to reverse direction), reducing the poor bastard to a shrieking mass of agony until it crawls out the other side.  Whereupon the doctor informs him that it was, in fact, a female....which had laid eggs. Shudder.  All of which is myth.

OK, I'm being dramatic.

So the guy wasn't having any particular difficulty while I was triaging.  As I a walked him to registration, he freaked and started screaming.

"Ah!!  Ahh!!  AAAAAHHHHHHH!!!  SOMETHING'S BITING  ME IT'S BITING ME!  AAAAAHHHHHHHHH!!"

I grabbed him by the t-shirt and dragged him into the nearest treatment room.  Kate went to grab some lidocaine to immobilize whatever was in his ear.  Suddenly, the guy stopped screaming and  froze.

"It stopped". 

No shit.  "Let me see if I can see anything", I told him.  As I pushed back his longish hair, I saw it: a GIANT Japanese beetle sitting in his outer ear.  "Don't move for a second", I said.  Trying not to either panic the guy or lose sight of the bug I reached for a glove or 4x4 gauze on the counter behind me.  In the nanoecond I took to glance behind me, the beetle...was gone.

"Did you see anything?  Is there anything there?  Is it a bee?  Did you get it?"

Shit.  No, wait!  There it is up on the very tip of his little, pointy elfen ear!

WHACK!  I smacked the flap of his ear with my hand.  Yes, I struck my patient.  A first for me.

The beetle crawled on the floor unconcerned.  I scooped it up with a wad of 4x4's.

"Oh, thankyouthankyouthankyou!  You saved my life!"

Gil wandered in and wanted to know what all the shouting was about.

"This brave nurse saved my life!  She got a beetle out of my ear, I thought I would go crazy!  She's a genius"

Gil:  "Oh, that's great!  Did you use lidocaine?"

Me: "Nope.  I just told it to go to the light, so it did"

Gil: "Hahaha!"

Two More Reasons to have a Crappy Attitude

1.  Mandatory flu shots, or wear a mask from December 1 to the end of March for every employee whether they work in a clinical area or not (note: the docs are not employed by the hospital).  It's not that I object to getting a flu shot per se,  I simply have a problem with authority.

2. My co-workers have decided to do the schedule through MID JANUARY, so as to get their holiday requests in.    I can't stand it.  I am boycotting the schedule until Halloween.

Genius

I got a phone call from one of the adult overnight dormitory staff at Wicked Expensive Alternative Prep School around 9:00 PM.  He wanted to know if it was appropriate to bring one of the boys for dental pain.

Sure, come on down.  No, we don't have a dentist "on call".  No, I have not idea what treatment he will get. Yes, he will be fully evaluated by the physician.  No, I can't tell you how long the visit will be.  Yes, we have some medicines available for patients to use until the pharmacy is open.  Yes, in most cases we can call in a prescription provided you use a pharmacy that has an overnight answering machine.  No, I do not have the power to order the pharmacist to open the store for you.  Just get off the phone and get the kid here, huh?

Wicked Expensive Alternative Prep School has kids from all over the country and a large contingent of international students.  There is a nurse who lives there, but I guess they give her a night off every once in a while.  I think that along with the usual college prep courses, the kids are encouraged to pursue other interests not usually found at regular schools.  Like, if they wanted to learn unicycling or something, or pottery, or start a social networking site or learn to juggle.  Whatever, good for them to encourage independence and exploration.  They are big on tapping into the genius of the faculty for ideas and guidance for their students' pursuits.  I guess they figure the parents are paying enough money for the expertise, if they want to learn tie dyeing or candle making, fine.

Not impressed with the dorm guy, though.  He forgot all the kid's paperwork that included parental permission to treat him.  He wanted to know if we had someone on staff who could speak Mandarin (??).  The very sweet young man spoke perfect English and oh, by the way, was KOREAN.

Does anyone but me find it disturbing that when he finished the registration process, the dorm guy wanted to know "where we put the Chinese kid?"