Saturday, October 30, 2010

Friday, October 29, 2010

Dr. Handsome Throws a Fit

I transferred from the ER to Preop holding and Recovery almost a year ago. I have come to appreciate the ER doctors I worked with, the vast majority of whom were quite competent, respectful, and team oriented. On occasion we would deal with surgeons in the ER, but these were typically fairly brief encounters. Now that I am working with surgeons on a daily basis I have learned that these guys (they are predominantly male, at least at this medical center) are a different breed. Even the "nice" ones can be jerks. The other day I literally had to step into the restroom for a moment to keep from crying, something I had not done since being on orientation right out of nursing school. 
I am starting to toughen up though. Witness the case of Dr. Handsome. I had heard of Dr. Handsome in the ER, but had only met his partners not him. An orthopedic surgeon, Dr. Handsome has women talking about his good looks throughout the entire hospital. I could not wait to see this guy.  His photo in the hospital directory was distant and grainy, not giving a clue as to what this Adonis looked like. I was working in preop and had a patient scheduled for a hip fixation by  Dr. Handsome. I waited with baited breath. To my disappointment it was only his Fellow that showed up to mark the patient's hip and sign and fill out the dozens of forms that spell out repeatedly exactly what the surgery is, who the patient is, and which limb is being repaired. The woman went off to surgery and I assumed it would be another failed attempt to glimpse the famous Dr. Handsome.
To understand this story I have to explain the computer system where I work. We are in the process of moving from an old outdated system to a more state of the art one. So, our tasks are scattered between both systems and then a third system that is just for the surgical area. So just keeping track of the various passwords is a pain, much less remembering how to do everything. So, this lady has been in surgery for over an hour and one of the OR nurses runs out wanting to know how to print out a medication reconciliation form, a fairly new required form, which allows the surgeon to see the patient's list of home meds. Then he can  specify on the form which if any of these drugs should be continued in the hospital. I tried to explain the process, and she left. Then I received a frantic call from my friends in Recovery. They said the OR nurse was unable to print it out and asked me to do it. So of course at this time the Preop computer decides not to cooperate. So I rush over to Recovery to use their computer.
I walk in to see Dr. Handsome. I knew it was him. He was so gorgeous in his surgical green scrubs. However his beautiful face was in kind of a snarl. He was ranting on and on threatening to call the Nursing Supervisor. Apparently when no one printed out his form in a timely manner, he started spewing threats. He insulted the staff's intelligence a  few times while I got into their computer. He continued to threaten to call the nursing supervisor. "Maybe SHE could figure it out" he said. I finally managed to print the damn thing out and hand it to him. He calmed immediately. "Thank you" he said.  He continued writing on the chart. HE WASN'T EVEN DONE with his notes. He had been yammering on and on about how we were delaying him and he was not even done with his other charting. Then when he got what he wanted he was instantly pacified. It reminded me of my 1 year old child. Like he was threatening to call his Mommy, the supervisor, if he didn't get his treat and then immediately settled down when he got his candy or blanket or binky or whatever. I just had to laugh (to myself of course). I think from now on when a surgeon is spewing threats or dissatisfaction, I will picture him as a little one year old having a fit and smile to myself.

Sunday, October 24, 2010

Typical RN Problems

Hit Man: Outta the way! There is a contract out on him

Nurse: No! This man is my patient. To shoot him you'll have to shoot me first.

Hit Man: Have it your own way sister!    *******


Yeah...this happens to me at work allll the time.

Monday, October 18, 2010

It's Not a Freaking Spider Bite

When I first started in the ER, I was surprised at how many patients came in every shift with "spider bites". These bites seemed to have a special affinity for the buttock, breast, and armpit areas and tended to be teeming with pus. The patients usually insisted that a brown recluse spider had bitten them. Eventually I figured out that these were not in fact spider bites. They were abscesses caused by a staph infection, usually MRSA. The doctor or nurse practitioner would cut open the abscess and push, prod and dig until all the visible pus was evacuated. I learned how to properly irrigate, pack, and dress the ensuing wound, then hand the patient their prescription for Bactrim.
After a while as I became a more jaded RN, I started to get annoyed with the patients who were adamant that they had been bitten by a spider and were often quite offended and insulted at the insinuation that they actually had a staph infection. Apparently other staffers were getting tired of it too. One of our docs (my favorite) copied a news article and tacked it up in the wating room. It was about the geographic location of the brown recluse spider, ie. nowhere near where we were. Patients would still leave shaking their heads and insisting that the doctor had misdiagnosed them and their "spider bite".
Now I am out of the ER and in the surgical area. I assumed there would be no more spider bites. However, now patients coming in for an I and D of their abscess under anesthesia are telling me about their spider bites preoperatively, as I start their IV Vancomycin.
I had to roll my eyes the other day as my family was watching the show Dr. G on Discovery Health. Dr. G, a Medical Examiner in Orlando, Fl was describing the events leading to the death of her next subject. As soon as I heard the words "he was concerned about a spider bite on his back", I was like "For God's sake, Dr. G. You don't even have to do an autopsy. he died of MRSA". My kids were so impressed when the report of autopsy backed up my hypothesis :) The young man had neglected to see a doctor for his fever and malaise, not linking these symptoms with his "spider bite". The poor guy died of a treatable infection.
I hope I don't sound too much like a bi%$#, but just a little vent.

Monday, October 11, 2010

Man's Best Friend

Ok. This is not about my usual passions, nursing and food. This is another love of mine, dogs. I have a dachshund who is a spoiled princess, no not even a princess...she is the queen. I lost my beloved German Shepherd a year ago and still miss having a big dog around. A coworker who knows my love of big dogs offered me a dog she rescued 5 months ago. This nurse is moving into an urban apartment in another part of the country and is getting rid of both of her dogs :(  This dog is roughly 6 months old,  housetrained, up to date on shots, loves other dogs and kids, travels well, knows basic obedience, and loves to go on walks. She is also very cute. Perfect, right? Well, I'm not sure. I have a small child, and this dog is possibly a pure bred Pit Bull. I have heard all the stories of kids being mauled by Pit Bulls. I have also met people whose Pit Bulls would lay down their lives for the children of the family. I am very confused.
When I worked in ER and Urgent Care, I took care of many patients with dog bites. I never took care of any mauled by Pit Bulls. Maybe because they were in the morgue already? Sorry that is bad nurse humor. I met many people bitten by Chihuahuas. Seriously. The worst bites I ever saw were from a Golden Retriever of all things. Of course the lady waited a few days before seeking treatment, so the wounds were grossly infected, needing debridement and packing of pretty much her entire leg.
I really need some input on this. I have met the dog before, who seems very gentle and sweet. Is the backlash against these dogs justified? I would certainly get her spayed and never subject her to cruelty or dogfighting. Please tell me your thoughts.

Sunday, October 10, 2010

A Weighty Matter

No offense meant to anyone, but as long as obesity, especially morbid obesity, is common, I will always have a job. I am the first to admit that my body is not perfect. I could stand to lose 5 to 10 pounds. I often eat too much sugar and processed foods and get too little exercise. However, it is the population that is 100 or more pounds overweight to whom I am referring. We have had to acquire special hospital beds for the morbidly obese, special wheelchairs, special operating room tables. We have one orthopedic surgeon who has literally made a fortune providing knee replacements to obese patients. We take care of so many people having toes feet, legs amputated because of obesity related diabetes. I am fortunate to have only gotten a few aches and strains from lifting/maneuvering obese patients. I have had coworkers develop severe and chronic back, neck, shoulder, and elbow problems from assisting super heavy patients. Many of these patients are on Medicaid, so everyone else is collectively footing the bill for their numerous medical procedures and quite extensive care. These patients are getting younger and younger. The other day I had a 24 year old female patient who literally could not wipe her own butt. When I asked her what she did about it at home, she replied that her husband did it for her. I have seen ICU patients with trachs for an inability to maintain their own airway and breathe solely due to their morbid obesity. My uber conservative husband makes statements like "Oh, just cut off their food stamps". Somehow I don't think that would get the job done. I don’t know what the solution is. Do you?

Friday, October 8, 2010

Food History

If I were a 1950's woman, would this look appetizing to me? Would I be recommending it as a healthy meal choice? My 75 year old Dad loves Veg All.

Thursday, October 7, 2010

Cool

Things like this reinforce my belief in a higher power. It was the middle of the night in Recovery . We had 2 nurses tending to a patient who had just come out of a complicated emergency bowel resection and was going south very quickly. She was feverish and having respiratory distress. Of course not being able to breathe well was scaring the patient. Adding to the anxiety was the fact that she did not understand the English being spoken to her. She was a native of Haiti and spoke only Creole. No one could locate a patient rep who spoke Creole. Her family had gone home to rest. She was crying, making her struggle to breathe even worse. The Respiratory Therapist was setting up a ventilator. The anesthesiologist was preparing to start a central line.
 A housekeeping supervisor interrupted the chaos, politely asking if we would be there much longer- the floor needed waxing- and if we had any additional needs for housekeeping to address. This man had light brown skin but no trace of any accent. One of the nurses looked up from the gasping patient.
“You don’t happen to speak Creole, do you?” she asked in a semi sarcastic tone.
“As a matter of fact, I do” he replied.
Holy crap! We had a translator dropped into our laps. He spoke to the patient in soothing tones. She lit up upon hearing her native language. He explained to her what we were doing and why. She immediately calmed down and her oxygen saturation went up several points. When her anxiety lessened, her breathing improved. No vent needed after all. The central line was put in, and she was taken to the ICU.
Cool.

Tuesday, October 5, 2010