We Are Going to Need Some New Monkeys

This is a picture of a fenestrated drape.  It is sterile and, among other things, comes in a suture set.  It is made out of a kind of heavy paper towel type of material.  

The whole thing is sterile and kind of extends a sterile field.  If placed over say, a laceration that has been prepped and anesthetized, the laceration would poke through the middle.  This ensures that the suture material doesn't become contaminated by anything.  They are generally supplied by a manufacturer.  See that nice, neat, carefully centered hole in the middle?

Note that I said "middle".  Now, see this?

The hospital has been trying to save money by using making their own fenestrated drapes.  Clearly there are some employees unclear on the definition of "middle".

"Send this down to central supply with a note for the manager", said Gil.  "This is the 3rd one of these I have gotten today, that is so annoying".

To: Central Supply

Re: Fenestrated Drape

Houston, we have a problem.....

Cat and Mouse 2.0

Note: No mice have been hurt in the writing of this post

Our daytime secretary happened upon the newly placed mouse trap provided by the facilities people (not IT) and found...shriek!...A MOUSE.  She hyperventilated for awhile, then came up with an action plan.  Leslie picked up the trap wearing two pairs of gloves and stepped out the ambulance bay door into the shrubbery adjacent to the ER all the while saying Ew!  Ew!  Ew!  Ew!  While she felt a bit squeamish about rodent rescue, especially before she had her coffee, she didn't want it dead or suffering.  At first, she gingerly shook the trap to dislodge the mouse off the sticky stuff at the bottom of the trap.  When that didn't work, she shook a bit more vigorously.  Finally she managed to get the lid off and tossed the live mouse into the brush; Leslie was shrieking, the mouse fairly silent as it ran off into the woods probably to warn the rest of his mousey friends.  Traumatized, Leslie made herself a cup of coffee and sat down with a bagel.  I don't know about the traumatized mouse.  It has been at least 3 weeks since the traps were placed, now long forgotten by facilities.  These traps are apparently going to be there forever.  Naturally we have had a little bit of fun with them.

Helpful hints

No mice have been even remotely attracted to this.  

Meet Pull-Toy

I have another student.  Yes, the powers-that-be have given me another young mind to mold and shape as I desire (insert evil laugh).  Bless her little heart.  It is pretty much a 2 month job shadow, but I can probably at least get her to change beds and fill ice packs.  Fun.

Last time I had a high school intern for more than a day she spent about 6 weeks mostly doing her homework; rather, she doing hers and me doing mine.  On her second to last night I gave her a syringe and a couple of 10ml vials of normal saline and taught her how to draw it up and remove the bubbles, etc.  She wore out the syringe doing it over and over and over; it kept her busy for about 2 hours.

Her final critique of the experience: "EDNurseasauras taught me how to put water in a syringe with a needle and take out the bubbles.  It was the best thing".  She had a whole little presentation on it.  I am famous at the high school.

Sigh.  (sniff).  They grow up so fast.

My new little pull-toy hasn't decided on nursing or medicine or what the hell-all she wants to do, which is great.  Her mind is like a fresh batch of cotton candy.

Pull-Toy wants to see and do it all and have lots of experiences.  I reminded her to journal and pick out the best and worst stuff of every night mostly because I thought I should be able to give someone some homework for a change; yeah I know, power trip.  Actually it would make her life easier when she has to do a presentation at the end of the year for her class.

Most of the doc's are pretty good with students, and when it isn't really busy will let them watch suturing and stuff.  I thought I would start Pull-Toy off with watching me apply a finger splint and went off to the closet to fetch it.  When I came back, Mac was quizzing Pull-Toy about which joint she thought would be proximal and which one distal.  I sent her off to look for tape instead.

Me: "Mac, maybe we should teach her the bones first before we worry about joints"
Mac: "Oh, yeah sure, wouldn't you learn that in nursing school before you start clinical exposure?"
Me: "Yeah, probably, but she doesn't graduate until June"
Mac: (astonished) "Eight months or so from graduation and she hasn't finished anatomy?? How can that be?"
Me: "Um, well she's a high school student"
Mac: "Ohhhhhhhh.  Ok.  That's cool"

Dewshe Bagghe of the NIght

In the middle of an absolute shitstorm  I became aware of the smell of....smoke.  Electrical?  Burnt popcorn in the microwave?  Wednesday thinking too hard?

No.  It's...cigarette smoke.

Where is it coming from?

Cardiac guy just sparked one in the bathroom.  While waiting for his telemetry bed downtown, his 3rd admission in a month.

Really?

Mac confronted the guy; tells him that his decision to light up in the unventilated bathroom was a selfish decision which has made the  environment toxic for patients and staff.

I was furious.  It is one thing if you have a death wish and want to poison your own body, have at it.  But please.  In a hospital, dude?  You could have gone outside which was a lot closer than the bathroom.

Mac: "He said he was sorry"
Me: "He can stick his sorries in a sack.  What a douche"

Smokey: "Hey!  Can I get some more of that dilaudid before I go in the ambulance?"

Dear facilities, I would like to request that a smoke detector be placed in the bathroom.....

A Sarcastic (no sh*t!) Open Letter

Dear Parent,
We are happy to provide you and your child with care today.  If there is anything we can do to make your visit extra-special or answer any questions, please ask any of us; we work as a team and automatically know the intimate details of your history, allergies, medications, and exactly how long the wait will be.  Feel free to ask our secretary and radiology tech also because they all have instantaneous access to this information as well as everything you have told the 3 nurses who have taken care of you today.  They are not at all inconvenienced by your requests for extra blankets and pillows, pain medicine, hovering at the nurses station or in the doorway in spite of having been given a call button and closing your door.  Patient privacy apparently just means YOUR privacy, so think nothing of it.

I know you are concerned about your son.  It is just awful that he stepped on a nail while wearing his tennis shoe, but forgive me if I need a little guidance in finding the puncture wound.  No, it neither appears red nor swollen to me as I have scrubbed it twice with antiseptic solution.

I do apologize for the 2 1/2 hour wait today, as you can see every room is filled.  I am reasonably sure that your son will not get "blood poisoning".  Thankfully you have kept such an eagle eye on it checking and updating us every 10 minutes about your observations, any trifling concerning redness and elevating it on the three pillows.  I can't say for certain, because I am just a stupid nurse, but I can tell you with some assurance that at the moment he does not have flesh eating disease.  Yes, I would bet my children on that.

I am happy to provide you with 6 warm blankets; no, I don't mind at all that you have used them all for your healthy 12 year old and that my 80 year old patient next door is now cold and without.  Not a problem; I have given her my fleece jacket, so it's all good.

Of course I think it is reasonable to wheel your son back and forth by wheelchair to the bathroom and to the snack machine in the lobby, after all, who knows what damage he may have done walking around (and from the parking lot) in the 3 hours since he injured himself; I'm sure it wasn't easy walking around at the high school football game.  It is absolutely not a problem that you prefer he be taken to xray that you insisted on by gurney because "he would be more comfortable";  I don't know how I could be so dense as to suggest that he could go by the wheelchair you have commandeered this afternoon for your son's exclusive use.  Perhaps I could now put the gentleman with cellulitis in it.

I am so heartened by your devotion, steadfastly sitting by his bedside and stroking his hair the entire time, it made the chunks rise up brought tears to my eyes. The only time you left was to make one of 20 phone calls and to smoke a cigarette or 10 during your wait.

Of course we will provide you with your son's first dose of antibiotic that you also insisted upon.  I understand how inconvenient it is that we don't have chewable tablets.  Yes, a lot of 9 year olds can swallow pills and some 12 year olds can't.  No, he shouldn't chew a capsule, I'm sorry that is all I have in that antibiotic.   I don't have "any chocolate chip ice cream lying around" and available for him to try and slide the capsule down.  I know that the pharmacy is open for another hour, but  of course it is reasonable for me to delay the EKG on the 65 year old woman with chest pain and send the hysterical mom with the 14 month old febrile seizure to the waiting room while I call that in for you.  It will "just take a minute".

Here are your discharge instructions.  A dressing will consist of a band aid.  Change it every day.  Watch for signs of infection.  Post-op shoe for comfort.  Wear it as long as you want.  Call your doctor tomorrow for recheck.  Antibiotic as written.  I promise I will not leave this room until you understand each and every word.  Really, I have time.

I completely understand that the post-op shoe is ugly but that is the only style it comes in: "ugly", small, medium and large.  The doctor sincerely believes that Tylenol with codeine is not appropriate for this injury, but here is one for you to take with you for tonight "just in case".

Finally, I think I would have just let him walk on the post-op shoe since it didn't really hurt, but if you want to get a hernia giving your 12 year old a piggy back, be my guest.

Until next time,
EDNurseasauras