Thursday, December 15, 2011

Solid Gold

I had an elderly female patient in PACU yesterday, who had just gotten a knee replacement. As she was being hooked up to the PACU monitors, her gown got a little sideways, briefly exposing her nether regions. We immediately covered her with a warm blanket as she burst out laughing. "Girls" she cackled "you best not show that to the crowd. It'll blind them. It is solid gold!"

Wednesday, November 16, 2011

Family in the Recovery Room

Does your hospital allow family members to visit patients in the Recovery Room/PACU?

My hospital does, and some nurses really do not approve. It is all that I have ever known, so I am used to it. I absolutely think that parents of young children should be back there. Also when we have had confused or developmentally disabled adults in PACU, a familiar face and voice truly helped them calm down and relax. However, if a patient is asleep or we have not yet gotten their pain under control, I would rather wait to bring a family member back. What do you think?


Thursday, November 10, 2011

Quote of the Day- Political Version

I was talking to a cardiothoracic surgeon yesterday. He was discussing the controversy regarding presidential candidate Herman Cain and the several complaints of sexual harassment lodged against him. Bear in mind this is the surgeon who when he saw me dressed up for my interview with the PACU, told me that he would give me a glowing recommendation based on how I looked in my dress.
His take on the Cain/sexual harassment controversy:

"Well, I don't see what the big deal is. Now if the media was showing a picture of him with two naked strippers with his hands up both their twats....now that would get my attention."

I'll bet it would, Sir, I'll bet it would.

Friday, October 21, 2011

Calling All Dermatologists/ Dr. House Where Are You When I Need You?


What is this stuff? I used to see rashes all day in ER and urgent care, but this is a new one. I first thought it was a ringworm, fungal type of thing, but I'm not sure that the mild antifungal cream did a whole lot. It has been on the legs, top of feet and now very prominently on the back. I finally took the little guy to the Nurse Practitioner, who was not sure what it was and prescribed a combination antifungal/steroid cream. The Medical Assistant who triaged us  in the office was positive she knew what it was and it looked like she had been around a looong time and had seen a lot of kids, but the Nurse Practitioner would not commit to a Dx. The cream seemed to do the trick. He has has not had the cream applied for several days now, and the rash is still gone. Opinions?

Saturday, September 17, 2011

Urology News

Eel enters man's penis in spa treatment, is surgically removed


Ewww. That is so not my idea of a day at the spa. Can you imagine the urologist's response when informed of the patient's chief complaint?

Saturday, September 10, 2011

Question of the Day

This question was posed to me by a brand new nurse, but is something that I have also wondered about in the past.


"Why do so many Respiratory Therapists smoke?"


Any ideas?

Sunday, August 7, 2011

Acronym of the Day

Hospitals have an obsession with abbreviations and acronyms. Every hospital where I have worked or trained has had a list of unapproved abbreviations in order to facilitate patient safety. For example QD, used to state "once daily", could be mistaken for QID, which is "four times daily", or even OD, something to do with putting medicine in one of your eyes or some such thing. Somebody could theoretically get really discombobulated and give their patient their once a day med 4 times in their eye. Just kidding...hopefully that would not happen. But as you can see, that could get confusing, so writing out potentially misreadable stuff  makes sense in that whole "do no harm" kind of way. In times of yore, before the list of forbidden abbreviations existed, patients actually did get harmed from such confusion. Now that that's taken care of, we just have to worry about gathering round the chart and taking a poll on what the doctor has actually scrawled out in his or her funky handwriting.
But I digress. Hospitals and the agencies that oversee them really do love to make up their own abbreviations and acronyms. Some examples:
SCIP=Surgical Care Improvement Plan
CAT=Crisis Assistance Team
PCAT (pronounced "pee-cat") =Pastoral Care Assistance Team
and so on.
Our latest at my hospital is "OAT", which stands for Organization, Attitude, Teamwork. Our management came up with this gem in response to patient dissatisfaction with staff attitudes, "communication between staff members", and "timely response to patient needs". In other words, our Press Gainey scores are in the toilet.
Our managers are running around like chickens with their heads cut off, trying desperately to improve our patient satisfaction scores. All of our managers have started threatening staff with discipline if they have any unsatisfied patients. There have been loud chewing outs in front of other staff, and now actual firings of some pretty good nurses, who for one reason or another did not measure up to their manager's personal definition of "OAT".
So, I have created a new acronym of my own. I call it VOMIT, to describe the latest panicked attempts by the higher ups to fix our staff and resurrect our scores. It stands for:
Violent     Obnoxious     Mean       Intimidating     Tactics

Do you like it? Should it be vicious instead of violent? I wasn't sure.








Tuesday, August 2, 2011

I Don't Remember this one from Religious Studies Class

Each patient at my hospital has a demographic sheet in their chart. It lists their name, address, emergency contacts, etc.
Last week I glanced at a patient's demographic sheet and noticed an interesting detail.
His religion was listed as "Caucasian".




Tuesday, July 26, 2011

Ultra Cool

You can take the nurse out of the ER, but sometimes you just can't take the ER out of the nurse.  Check these out :
http://jalopnik.com/5823167/the-ten-coolest-ambulances/gallery/1

Sunday, July 24, 2011

Green Tea?

Last night our break room microwave had completely quit working. So, I ventured into the surgical waiting room to get some hot water for my tea. Some family members of a patient saw me and struck up a conversation. As I was heading back to work, they asked me what I was drinking. I told them that I was drinking green tea.
The woman literally turned up her nose at me. "Hmmph" she said and turned to her daughter "She looks like the kind of person who would drink green tea".

    ****What does that mean?****


Saturday, July 23, 2011

A Family in Need

Some friends of friends of mine are going through a very tough time. Their first baby was a big girl at 9.2 pounds. Her shoulder got stuck during delivery and caused her to have a prolonged, rough delivery. She had a lengthy resuscitation, including induced hypothermia. Madeline is responsive, but still in NICU, fighting for her little life. Her parents are by her side every day, so along with hospital costs, they are dealing with lost wages and their usual bills. At http://sommerfamilydonations.blogspot.com/ you can donate some money straight to her parents. 100 % of the money will go to them. I know most of you are probably solidly in the middle class like me, but even a couple of bucks would be most appreciated, I'm sure. If you are not able to donate financially please pray, chant, offer good thoughts, work on her aura, send good vibes, light a candle, whatever floats your boat. I can't even begin to imagine what this family is going through. You can read about Baby Maddie at the family's blog:
 http://babymaddiebelle.blogspot.com/

Thank you!

Saturday, June 18, 2011

Really, Sir?

I did not realize that using a urinal was so complicated. My rather healthy young adult male patient assured me that he genuinely needed my assistance to urinate in the ubiquitous plastic container. He was not in any way paralyzed. He was not one of those males so obese that he needed help locating his penis. He simply wanted me to position and hold it in place while he used the urinal. That would be a no.
Of course he later used the urinal successfully all by himself.

Wednesday, June 8, 2011

Europe and the USA

Apparently this photo is from 2004, long before I entered the blogosphere. So, bear with me if you have seen it before. I admit that I do eat fast food sometimes. Working 12 hour shifts and shuttling kids to activities sometimes makes the drive thru  inevitable, but I can definitely appreciate the humor.

Saturday, June 4, 2011

Good Times

I was floated to the floor this week. This rarely happens, as I am an ER, Preop, and Recovery nurse with little floor experience. However, desperate times call for desperate measures, I guess, so off I went to take care of some inpatients.
A gentleman in his 80's a couple days out from neck surgery was having trouble urinating. I got an order to straight cath him, which I did. He put out about a liter of urine and was much more comfortable afterwards.
I returned a while later, asking him how he was doing. he informed me that he had been able to urinate on his own.
"Are you having burning when you urinate, Sir?" I asked him.
"No, Maam," he replied "and I can tell you I don't have VD."
"Well, that's good to know," I said
"But you know I had the clap once" he started reminiscing, smiling dreamily. "Actually I had it twice when I was in the army. Back in Japan, you know. Goop just started dripping everywhere. Come to think of it, I recall I had the clap three times. Those were some good times, I tell ya" .

Sunday, May 29, 2011

Misleading Headline of the Day

Found on Fox Health. A typo in the headline raises all kinds of interesting images.

Derma Sciences Foot-Wound Rug Shows Promise

Published May 27, 2011
Derma Sciences Inc said foot ulcers in 85 percent of diabetic patients healed completely after being treated with its experimental drug at the end of a 24-week trial, improving its chances of licensing the drug to potential partners.
Shares of the company, which specializes in wound-care products, jumped 25 percent to a more than three-month high of $11.65 in afternoon trade on Wednesday on Nasdaq.
The data will help the company in outlicensing ex-U.S. rights of the drug, codenamed DSC127, to a potential partner, Chief Executive Edward Quilty said in an interview.
Rodman & Renshaw analyst Michael Higgins said, "I think, the 24-week data increases Derma's negotiating power with potential collaborators."
Higgins, who has a "market outperform" rating on the stock, said he was most impressed by the drug's ability to heal wounds 13.5 week sooner than the placebo.

*************************************************************************************
And  so on.....
My favorite comment echoed my thoughts. Yes! I want to read about this amazing wonder rug too!
Can we get it at Macy's. Maybe Bed Bath and Beyond?



Read more: http://www.foxnews.com/health/2011/05/27/derma-sciences-foot-wound-rug-shows-promise/#ixzz1NmLz1QgH

Saturday, May 21, 2011

Wednesday, May 11, 2011

Interesting

 I would be very interested to hear everybody's thoughts on this situation that occurred in the UK.

 

 Woman Dies After Being Sent Home From Hospital Twice

Published May 10, 2011
| The Sun
A woman who died 10 minutes after arriving home from hospital for the second time in a one day was not even seen by a doctor, a coronial inquest has found.
June Owen, 63, died after visiting Stawell Hospital in the United Kingdom. 
Janice Campbell said it was shocking a doctor had not seen her mother, who was in pain and suffering breathing difficulties.
Coronial findings made by magistrate Richard Pithouse last week had left her family "confused."
"It still leaves many questions unanswered, and it contains no recommendations on changes that need to be made to prevent this happening again," Campbell said.
On the day of her death, Owen contacted Rural Ambulance Victoria four times, and was twice taken to Stawell Hospital.
She first visited the hospital at 5 p.m. January 21, 2008 with abdominal pain, and a nurse gave her two codeine pills and sent her home.
At 10.15 p.m., Owen arrived by ambulance again and a nurse phoned on-call doctor Briandha Jeremiah, who decided not to attend to examine her.
Jeremiah told the nurse to give her a Demerol injection, to relieve her pain, but the inquest heard conflicting reports on how long Owen should be monitored afterwards.  
Owen was released from hospital 40 minutes after her injection.
An autopsy found Mrs Owen, who suffered heart and lung disease, had died from an enlarged heart.
Stawell Regional Health acting chief executive Claire Letts said after Mrs Owen's death, triage, assessment and pain management policies at the hospital had been reviewed, and minor changes had been made.

Follow Fox News Health on Facebook!
Read more: http://www.foxnews.com/health/2011/05/10/woman-dies-sent-home-hospital-twice/#ixzz1M328HLuX

Monday, April 11, 2011

Busy!!!!!!!!!!!!!!!!!

Sorry I have not posted lately. I am taking my hospital's critical care course, which has classroom, computer, and practicum components. The computer part is the ECCO curriculum, which the instructors warned me would be time consuming. I didn't believe them, but I do now. The cardiovascular lesson took hours! And the test was actually kind of hard. My kids were like "Mom, how can it be hard? You can look at your notes while you take it."
I said "Well, yes, but the questions can be complicated. You actually have to think." 
"Thinking! Ewwwwww!" they said. I have to agree : )

It is also mandatory education time at the hospital. This is where the employees have to take about a hundred tests online about various topics, ranging from preventing falls to disaster management to radiation safety. You used to be able to take the test without actually reading the learning material. They fixed that though, so now one must wade through the lesson before taking the test. Why I have to know the routes of transmission for Ebola, I'm not sure. And learning how to prevent surgical fires when I'm not an OR nurse? Hmmm.
I liked this answer option regarding what do do if you are passing by a room and see that an elderly patient on fall precautions is struggling to get out of their bed: "Close the door and go to lunch". The correct answer was probably "stay with the patient and call for help", but I really liked the other one better.

Yesterday one of the doctors told me that I looked like Juliette Lewis. I'm not sure if that is a compliment or what. She has played some really crazy characters. I asked him if he thought I was psycho. He said that he thought that she and I had some similar features and that he hoped that I would refrain from psychotic behavior, at least at work. I told him I would try.

Later on in the day, a patient was waking up in the PACU. I explained to him that his surgery was over. He said "Really? I thought you were an angel!"

Sweet talker.

Friday, April 1, 2011

Beauty Contests

This is not a medical post, but something really bothered me yesterday. Berate me if you want. Call me naive. Call me a bad mother. But several months ago I let my 12 year old daughter get her own Facebook page. I know her password. I keep track of her activity. If someone tags her in a photo, I am notified. In fact, this is what happened a few days ago. I noticed that a photo of my daughter was tagged on a profile with an obviously fictitious name, which was comprised of the name of her middle school and then the word smexys as the last name.
Smexy, according to my friend's 17 year old daughter and some who-knows-how-reputable websites such as internetslang.com and yahooanswers.com, means smart and sexy or possibly lip smackingly sexy.
So, I'm thinking smexy really should not be associated with middle school in any way. However, when I checked out the link, I found out the purpose of the profile. It consisted of dozens of different posts, each  containg two photos. Each photo was of a middle school kid, fully clothed, only one bikini pic, thank God, with various poses and expressions ranging in provacativity from a sunny smile while holding a puppy to the pouty duck lipped face of a girl in a low cut tank top. In the name of gender equality there was even a section for the young dudes of the school. First names of the kids are shown. In the captions the site's followers are invited to vote for who is the smexier of the two.
I think my daughter is gorgeous, the most beautiful, precious young woman on earth. The voters, not so much. She got three votes. The other girl got about a dozen. I know it is so, so  shallow, but this broke my heart. The typical middle school girl's spirit is delicate, easily crushed. They so desire to be loved and admired, especially by their peers. I could tell her all day long that she is beautiful, but a compliment or insult from a fellow student makes an exponentially larger impact. My sweet girl looks a little like I did when I was her age, tall and really skinny, huge eyes, long neck, big lips. But when you grow out of the gawky phase and into your features, these attributes become tall and slender, big eyes, graceful, swan like neck, full lips. Middle school kids can't see much past today though. They can't see the beauty and grace they will grow into.
More importantly, however, as this contest illustrates, they tend to not pay attention to anything past physical beauty. For example, I know my daughter loves animals, hates math, adores her baby brother, believes in a loving God, wants to be a famous author, and will bake a cake at 9 o clock at night just because she and I think some chocolate sounds yummy. I want to hope as these kids get older they will start to appreciate other aspects of their peers besides their looks. Will that happen? My daughter is a quiet, "good girl" at school. When you get to know her, the real giggly, silly, talkative nature emerges. But that involves actually taking the time to get to know her.
She didn't tell me about the Facebook profile. Typically she only keeps things to herself that bother her or that she is ashamed of. There is no shame in wanting to be considered attractive. I just pray that she eventually appreciates the other parts of her lovely self. Of course I do encourage her to take care of her physical body, exercise, eat something on occasion besides junk food, wash her face at night, we give each other manicures etc. That is just healthy and balanced. It is a lot, though, to expect middle school society to embrace inner beauty, unrealistic when I was there and unrealistic now as well. It is my job, however to nurture her spirit, her soul and to help her blossom into a beautiful person.
Now as a parent, often objectivity is out of the question. One can be too close to a situation to really see it clearly. Do I bring up this facebook profile in conversation? What do you think of these beauty contests, harmless or hurtful?

Friday, March 25, 2011

The Froggy Test

                                                 A South African Clawed Frog



The other night I had a patient in her mid 70's who had been a lab technician in a hospital for 40 years, having just retired in 2007.  I like to make small talk while starting an IV, so I asked her about her job while I stuck her in the arm. "You must have seen a lot of changes during your career." I told her as I hooked her up to some normal saline. She mentioned that one of the most interesting changes was in the area of pregnancy testing. She still found it amazing that pregnancy tests were now sold over the counter with results in minutes. I asked her if there had really been a rabbit test. She affirmed that there had been, but stated that the test in her hospital's lab had involved a frog. I definitely had to hear about this, so I asked for details. The patient described the testing process: obtaining the potentially pregnant woman's urine, injecting it into the frog, and then waiting.
"Then what?" I asked her.
"Why then you catheterize the frog, of course"
Wow. I have cathed 90 year old ladies and elderly men with ginormous prostates, but a frog? Now that is some delicate work.
I thought this was pretty interesting, so I googled it when I got home. Indeed frogs had been used for pregnancy testing up until the 60's in the US and 70's in some other parts of the world. Many of the Google results, however, had a modern twist. Several species of frogs are dying off today as a result of the pregnancy testing from decades ago. The ideal frog for these tests was the South African Clawed Frog, which was subsequently exported all over the world. Apparently a nasty froggy fungus circulated around the world with it. Now other frog species who are not immune to this funky fungus are dying off all over the place. Who knew?

Thursday, March 17, 2011

Taking Notes

I was working in Preop Holding the other day when another nurse emerged from one of the rooms with a large spiral notebook in her hand. "Someone left this behind" she said. We decided we would try to reunite the notebook with its owner later, but also noticed that the notebook was opened to a page filled with scribbled notes on the patient's care. I'm not sure why the note taker wrote all this stuff down. To understand the care of their loved one? For ammunition in future lawsuits? Who knows. But it was pretty interesting. The notes went like this, spelling and all:

Socks on bed  nightgown on bed  plastick bag on bed Put clothes in plastick bag
Sine paper
Start hose in hand
Lactade Richard's in hose
Vankamyson 4 Mercer in hose
U want warm blankit   6 minutes to get warm blankit
Nurse won't let u drink water
Tony come to sit with us
Tony want warm blankit   8 minutes to get warm blankit
Nurse won't let u chew gum
Anastisiologist talks to us say u will get pain med
6 minutes to get pain meds fetanil
Dr come to room to rite on arm
U ask if u can get fed meal after   Dr say yes
Nurse come to take cpap to recuvery room for after
Lisa and Michelle come to sit with us want to take some more socks home
Ask for more fetanil nurse say she cant give u more
U go to your sergery
*******************************************************************


Was it Chili's or Applebees that used to have the timers at tableside where if your meal was not delivered in 30 minutes, it was free? I guess this person had the same concept in mind.

Saturday, March 12, 2011

Mercy or Murder? Who Decides?

As I have mentioned in the past, whenever I work in Preop Holding, something strange or confusing seems to happen. One night last week it involved a hip repair on a 90 year old. Hip repairs or pinnings are something we see everyday, typically in elderly patients after a fall. However, this particular situation brought some very strong opinions out into the open.

Anyway, a couple hours before the scheduled surgery, I called the patient's floor nurse for a report.  Instead of reciting the usual vital signs and statistics, the nurse stated that she was unable to give me report. She told me that the patient's daughter refused to give consent for the operation and had just left to go home.  The floor nurse explained to me that the patient had advanced Alzheimer's and was therefore unable to give informed consent and all that legality nonsense. 

So, since I've been in Surgical Services awhile now, I immediately understood what was the most pressing concern here. Thus I let the OR charge nurse know the situation, so that the surgeon would not be kept waiting. Surgeons, I have learned through various tirades, really, really do not like to be kept waiting.  So now that I had my priorities straight, I could move on to other things, such as maybe finally getting to pee nine hours into my shift. But that was not to be. The orthopedic surgeon in question, with resident in tow, came storming into the unit, demanding answers that I did not have. I had gotten the daughter's phone number from the floor nurse, so I handed it to him and suggested he call her. Before he made the call, he ranted for a while about how the patient was being sentenced to death by her daughter, the patient would be dead within a week without the surgery, that this was the most ridiculous situation he'd ever encountered in his twenty years as a surgeon, etc, etc. His face beet red with fury, the surgeon stomped out of the room to call the patient's daughter.

The resident, left behind by his leader, was muttering about euthanasia being illegal while he checked his Facebook. I went into the OR office for an update. The OR team for the hip repair was enjoying their unexpected leisure time in the office, along with another team in between cases. All were loudly vocalizing their opinions on the daughter's decision, which had ignited a fiery debate on the meaning of suffering and end of life care.

"It's murder" said one nurse "I heard someone was gonna call the police and have the daughter arrested"
"She just doesn't want her Mom to suffer more" said a scrub tech "we all talk about people being kept alive for too long. The daughter is doing the right thing"
"She'll suffer more if she doesn't get her hip fixed" chimed in the resident, who had gotten lonely and wandered into the office, still looking at his Facebook.
"I'm with the daughter. I wouldn't want to live if I was bedridden with Alzheimer's" asserted the charge nurse, a twenty year OR veteran "I put my dog to sleep when he was eleven years old and needed a second knee replacement. I didn't want him to go through that. Why don't humans get that right?"
"This is not a dog. It's a human being. Hellooo! I think the daughter is no better than a murderer. She's cold" said a scrub tech.
"Check it out" said a nurse "this is how healthcare rationing is going to start. You know...the death panels. The elderly won't be able to get surgery anymore. They'll just have to die"

 At this point I went back to my little area of the hospital and started preparing the charts for the next day...no paperless system here yet! Soon the orthopedic surgeon came back, and the resident stopped playing on his iPhone and started paying attention.  The surgeon explained that he had managed to make the daughter feel guilty enough that she okayed the operation for her Mom. He told me to get the patient downstairs ASAP and "Chop, chop". Yes, he actually said chop, chop.

We sent for the patient. I called the daughter to obtain a telephone consent. When I spoke with her, she impressed me as a caring, kind person. She was friendly and cooperative on the phone. Another nurse and I witnessed the consent. Then the daughter spoke with the anesthesiologist to agree to rescind the DNR order during the surgery. It was done in less than ten minutes. The patient was prepped and whisked off to the OR within twenty.

The patient had been unable to speak, but groaned and lashed out with her arms when I got her vital signs and hooked her up to some fluids. She got extremely agitated when I pulled TED hose onto her nonoperative leg. She did not seem oriented in any way.

I had mixed feelings about the whole situation. It is too rare that a family has actually discussed the patient's wishes before illness either creeps up slowly or slices into their lives with devastating suddenness. I have witnessed these talks only a couple of times, but felt privileged to see them. It takes courage and love to bring this stuff up. It is so much easier to live in denial, not wanting to think about our loved one being weak or ill, much less close to death. Declining a vent or feeding tube strikes me as a very common sense option when a loved one is terminally ill and unaware of their own identity or situation. Declining a hip repair, I'm not as sure. On a 90 year old with advanced dementia, maybe that's reasonable. But love and fear of loss can make it hard to think logically. I don't know what I would do if that were my parent. What would you do?

I'm sure as budgets are cut and healthcare costs continue to rise, money will also become more of an issue in these decisons. Studies have shown that a huge proportion of healthcare dollars are spent on end of life care, often prolonging lives by only days, and not happy days either. I think there are certainly many times that hospice is a better option than aggressive, invasive medicine. Often these patients are vented in the ICU  while their families are hoping the next, newest miracle drug or treatment will fix them. A 90 year old is one matter. What if the dying patient is a child?  It is heartbreaking for all concerned. I know it is incredibly hard to let go, but unfortunately as the money dries up, the healthcare systems may start making that choice for us.

We see patients on a daily basis with tubes in every orifice, decubitus ulcers, and a grim prognosis. We meet families who want everything done, rib fracturing chest compressions, tube feedings, rectal tubes, endless blood and platelet transfusions, every antibiotic under the sun, painful, but futile treatments to add a little more time to a life whose quality has declined to almost nothing. We grumble about how we want DNR tattooed on our bodies and sigh as we carry out the family's wishes.

Wednesday, March 9, 2011

Self Diagnosis

When asked if he understood the the procedure he was getting (repair of prolapsed rectum), the patient responded:

"All's I know is that they better be fixing my a$$. My a$$hole keeps falling out, you know."

Monday, March 7, 2011

Mean People Suck




My oldest child is a middle school girl. Unfortunately I have recently noticed some "Mean Girls" type of activity going on at her school. This kind of behavior is pretty typical of adolescence. I'd like to think that most of these kids will grow out of it and mature into secure, compassionate, productive citizens. I have met too many petty, backbiting adults to take this for granted though. I would also like to think that nurses would be above this kind of childish behavior. In nursing school I heard the saying that nurses eat their young, blah blah blah. I figured I was too nice and too hardworking for anyone to want to eat me up. Wrong. I've encountered a few cannibals in my time, but I'm not so young anymore, not so vulnerable.
I talked to a nurse the other day, however, who reminded me of this issue. I FINALLY took the 12 lead class I have meant to take for like five years. When I walked in, there were already about ten people seated in the auditorium. I smiled in my generally smiley way at everybody, and only one nurse smiled back at me. I recognized her as an RN who used to work on our Orthopedic post surgical floor. I had encountered her in the past when bringing patients to her from PACU. She had struck me as extremely hard working, smart, and helpful. A couple of us had suggested she come to the PACU, but she would need some other experience first, either ER or ICU. So, as I talked to this woman, we'll call her Nicenurse, she told me how she had transferred to the ER to get some experience there in order to hopefully eventually work in the PACU.
I have to explain: like so many others across the country, our ER is a zoo. It is a chronically understaffed, inner city, outdated, underbudgeted, overburdened mess. Staff turnover is horrendous. It hemmorhages nurses like a torn aorta. I know several agency nurses who refuse to go back. They seem to get a new Nurse Manager on at least an annual basis. I already liked Nicenurse, but I know how chaotic our ER can be. Now my respect for her has gone up substantially.
 She is so discouraged, though, she tells me. She has been in the ER for ten weeks and has no intention of quitting, but she says that the other nurses and the techs treat her like crap. This puzzled me, as I know she is hardworking and smart. Nicenurse told me that fellow ER staff criticize her positive attitude and are making bets on when she will quit and who can get her to quit. Apparently other staff have refused to help her at times and have told her incorrectly where items were located. I had no reason to doubt her story, but I just don't get it. In my mind more staff = good. I would want a decent nurse to come on board. Maybe if they could retain some more staff every nurse would not have to have 6 or 7 patients, including ICU holds.
I hope things improve for her. Do other professions treat themselves this way?


Friday, March 4, 2011

What Can I Say?

Diabetic Oregon Man 'Doing Fine' After Dog Eats Toes

Published March 04, 2011
| Associated Press

A diabetic man from Oregon who awoke to find that his dog had eaten three of his toes says he is recovering and hopes to leave the hospital soon.
Nathan Jones told The Associated Press on Friday that he is "doing fine" and resting, but he declined to speak further.
Jones called 911 on Tuesday to say his dog had eaten part of his right foot while he was sleeping, including three toes.
The hospital says Jones is in fair condition and was expected to go home Friday.
Jones had no feeling in his feet because of diabetes.
Roseburg veterinarian Alan Ross says the dog may have been trying to rid his owner of dead tissue, which is not uncommon.
The dog is at an animal shelter.


***Wow. First we started using leeches to help with grafting reattached limbs. Then maggots to debride dead tissue. Now dogs to gnaw off dead toes. I know some vascular surgeons who may feel very professionally threatened by this dog. With rising healthcare costs, this may be a medical breakthrough. With so many worried about little or no health insurance coverage and possible rationing of care, could canine assisted procedures be the answer? But why is the poor dog in an animal shelter? He may have possibly prevented an entire below the knee amputation with his proactivity. The doggy might have saved his owner from descending into full blown sepsis. Maybe his owner is getting some instruction in the hospital on how to properly manage his diabetes, dare we hope?

What?

Courtesy of themockdock.com

Friday, February 25, 2011

Social Commentary Courtesy of peopleofwalmart.com

I am obviously addicted to peopleofwalmart.com. Apparently this shopping list was discovered at a Walmart in Virginia. I'm not sure if it reflects more poorly on the American diet or on our educational systems. I do, however, have a pretty good suspicion that the authors of this list may need some cardiac care in the near future.

Wednesday, February 23, 2011

The Scary Dad

Whenever I work in Preop Holding, something weird or confusing seems to happen. Last week I had a patient coming from our ER.  The patient was a 4 year old boy who had stuck a tiny Lego bit up his nose. The ER doctor and the ENT on call had been unable to retrieve the errant Lego in the ER, so surgery was scheduled for the little guy. Fishing out foreign bodies from various bodily orifices is a pretty common activity in the surgical suite, so as is the routine I called the child's ER nurse for a quick report. The nurse was obviously an intelligent woman, giving me an excellent detailed report. Now I admit I am biased towards ER nurses. They do it all, do it fast, and often do not get the repect they deserve. I started out in the ER and still see pretty much everything through that perspective. But this nurse went off on a lengthy tangent that freaked me out a little bit. She started talking for a while about how the father of the child was a militant "foreign" Muslim who hated white women and was disrespectful to the female nurses. "You know how they are." she said about male followers of Islam.
  It was an unusual way to end the report, so I figured this guy must be a real terror. I immediately pictured a bearded man screaming in a foreign language at the staff. Imagine my surprise when the man in question turned out to be a pretty ordinary looking guy who spoke English well. The little boy was an absolute cutie pie. As I was getting him and his mountain of paperwork ready, I kept waiting for the dreaded misogynistic outburst from the Dad. I waited and waited. I am half Latina, with my Mom's pale Irish skin and my Dad's crazy frizzy/curly hair. So, maybe I did not count as an actual white woman. However, my coworker is a 100% lily white, sweet as pie platinum blonde Southern girl, so maybe he would direct his ire at her. Nope. He was complimentary and gracious to her as well. As I escorted him to the wating room, he thanked me and told me I had a nice personality. Religion was not mentioned by anyone at anytime. I really couldn't figure it out. I simply treated him as I would want to be treated if I brought in my child with a Lego up his little nose. Had the guy undergone a total personality change between the ER and Preop Holding? Had the otherwise smart ER nurse misinterpreted his behavior? I didn't know what was going on. It was weird.

Wednesday, February 9, 2011

What Would You Do for a Beautiful Butt?

We have had several of these cases in South Florida, where someone illegally and dangerously practiced "cosmetic surgery". However, often they have preyed on our large Spanish speaking population. These women purposefully flew here from England to get this done. Very sad.   Interesting how the others just went on to their party.

As for me, my butt is big enough. In fact, I would happily donate some adipose tissue to anyone that needs some !

 

From the Philadelphia Inquierer

U.K. woman dies after illegal buttocks-enhancement injections in Phila.

Two women from the United Kingdom flew into Philadelphia on Saturday looking to improve their physiques with buttocks-enhancement injections.
Only one survived.
The other died at a Delaware County hospital Monday, and Philadelphia homicide detectives are now seeking two women who provided the syringes and unknown drugs in a hotel room near the airport.
Their clients were part of a group of four women, all in their 20s, who arrived Saturday. The two who did not receive injections were on their way to a party in New York City, said Detective Lt. John Walker.
Late Tuesday, police confirmed that the dead woman was named Claudia Adusei, 20. British news reports said she was from London. Police said that the other woman told them the women thought they were being injected with silicone. The autopsy will show whether the substance was in fact silicone, police said.
Buttocks-enhancement injections, often involving silicone gel or liquid, are illegal but widely available. Dozens of women have reported injuries, according to federal health agencies, including infections, kidney impairment, and, in rare instances, death.
Walker said the victim checked into the Hampton Inn on Bartram Avenue and sometime over the weekend received the injections. She was taken to Mercy Fitzgerald Hospital at 1:30 a.m. Monday after complaining of chest pains and experiencing shortness of breath.
She died later that day. Fredric Hellman, Delaware County medical examiner, said a preliminary cause of death will not be released until the victim's relatives are notified. The second woman, who received injections to her buttocks and hips, has not been hospitalized, police said.
Legitimate buttocks enhancements using silicone implants are relatively rare - about 5,000 were done throughout the nation last year. There is a large illegal underground market for the sale and injection of silicone even though it has been decades since any product has been approved by regulators for reshaping a body part.
"Silicone injections used to be done years ago to make breasts bigger . . . but that has not been done, legitimately, for 40 or 50 years," said R. Barrett Noone, a Bryn Mawr plastic surgeon who serves as executive director of the American Board of Plastic Surgery.
The FDA, on its website, says the agency has "prohibited the injection of liquid silicone or silicone gel to fill wrinkles or augment tissues anywhere in the body." It has been blamed for autoimmune disease and physical disfigurements.
Collagen injections, using a substance made from protein, have been approved by the FDA to fill small imperfections, typically in facial areas. Some clinics in the United Kingdom offer buttocks and breast injections with a different processed protein, but the cost is about $4,500.
Last month, federal agents in New York City charged a woman with illegal distribution of silicone imported from the Dominican Republic. She was accused of administering illegal injections of liquid silicone for cosmetic purposes as part of a business run out of her Bronx home, allegedly charging up to $1,000 for a round of shots.
Last year, Essex County, N.J., prosecutors brought criminal charges against a professional model who allegedly offered women a series of injections to enlarge their buttocks. Six of her customers later sought medical treatment at local hospitals, said Katherine Carter, a spokeswoman for the county prosecutor. "They all had serious bacterial infections that required them to get surgery," Carter said.
They paid $600 to $1,000, allegedly to Anivia Cruz-Dilworth, 28, of New Brunswick, who was indicted for delivering illegal injections of a substance called "Hydrogel."
More famously, a former Miss Argentina, Solange Magnano, died after a buttocks-enhancement procedure at a medical clinic in Buenos Aires. She spent three days in critical condition after suffering from a pulmonary embolism. The Associated Press reported that sources described her procedure as a "gluteoplasty," which usually involves implants. But a friend said Magnano also received injections.

Saturday, February 5, 2011

Bariatric Sensitivity Training

   Our hospital, in an effort to become a Bariatric Center of Excellence or some such nonsense, is requiring all staff, including physicians, to attend a bariatric sensitvity course. Now I will be the first to say that I could lose a few pounds. I have a "healthy" BMI, but am at the top end of normal, so three or four more pounds and I would be officially in overweight territory. So I am not some skinny girl hating on anyone heavier than me. I could definitely use more exercise and less sugar, no doubt about it. And of course everyone from Michelle Obama to Elmo is talking about America's obesity issue on television. However, I have to say that this class was by far not the most productive hour of my week.
   We spent the first half of the course covering points that hopefully those of us who are not complete a#%holes already knew. Obviously we should provide a larger bed for a larger patient, so they don't fall out.  Another example: when weighing an obese patient, we should not rudely holler out their weight so loudly that the entire unit can hear it. We also should not yell out "Hey Joe, we need to get the Big Boy wheelchair for this one", an actual example from the power point presentation.  We were also instructed to always provide an extra large gown for our bigger patients, which of course we would do anyway.
   Some of the other points, however, confused and disturbed me a little bit. We were instructed, in an effort to be sensitive, to not weigh a patient if they are uncomfortable about being weighed. Really? Many meds are weight based. An accurate weight is pretty helpful. A CHF patient often needs daily weights to determine if they are retaining fluids or not. This is a more complicated issue than it would seem.
   Another idea that seemed a little out of hand was to only discuss the patient's weight if the patient brought the subject up and wanted to talk about it. Apparently there have been a rash of patient complaints lately in which the patient was offended that a doctor or nurse had the temerity to advise that some weight loss might be a good idea if the patient wanted to live a few more years free of strokes, heart attacks and other not so pleasant things. This just flies in the face of common sense. Isn't prevention of health problems what we are going for (ideally) ? Are we not going to tell the chronic alcoholic with the cirrhotic liver that they should quit drinking? Do we not tell the diabetic who neglects their insulin that if they don't start taking care of themselves that little foot wound could result in an amputated leg? There are patients in our ICU right now who would not be there if not for their morbid obesity. That is a fact.
   We have extra large OR tables. We supposedly have "lift teams".  We have a special private preop area for bariatric surgery patients. We generally speaking are not jerks. We don't typically go around  making fun of anyone's weight. Sure, I know the patient probably aleady realizes they need to lose weight. Yes, I know many people would simply choose to ignore our advice. But damn...if we can't even talk about it in a sensitive manner, even raise the subject of possibly trying to lose some weight, how does that help anyone?

Monday, January 31, 2011

The Things you Learn at Work

  For reasons unknown to me two coworkers were having a debate over whether cinnamon was an aphrodisiac or not. An intrepid CRNA listening into the conversation googled the matter on his iPhone. He almost immediately discovered a list of supposed culinary aphrodisiacs. Oysters were there of course, as well as chocolate. Honey and almonds were listed, so a bowl of Honey Bunches of Oats in the morning could possibly have some interesting consequences. There were certainly some surprises, at least for me. Asparagus was on the list, said by a 17th century herbalist to "stir up passion in both man and woman".  Avocados were also listed. Apparently the Aztecs called avocado trees "testicle trees" due to the  testicular appearance of the pairs of avocados hanging from the branches. In fact, avocados were banned by Spanish Catholic priests due to their sexual nature. I thought garlic was an interesting, odorous choice, but apparently it has the ability to vasodilate and increase blood flow. Bananas, figs, and basil were also on the list, but no cinnamon.  I suggested alcohol, but nobody paid any attention to me.

Thursday, January 20, 2011

Shocker!

Headline on foxnews.com:

"Merck Clot Preventer Linked to Bleeding Risk"
No way!!!! Really!?!?

Monday, January 17, 2011

Nurse loses license for 20 years over sex with hospice patient | NewsOK.com

Nurse loses license for 20 years over sex with hospice patient | NewsOK.com


Wow. Never been tempted to have sex with one of my patients. Of course often they have been elderly, toothless, stinky, drunk, on drugs, or all of the above. Anybody ever have any issues with this? I don't know what this gentleman looked like, but I suppose that is really irrelevant. He was a patient, a married patient. The nurse is stating the sexual contact occurred after he was no longer a patient. Do you think that makes a difference? I guess I don't often think about dying hospice patients even still functioning sexually, which is biased on my part. What are your opinions on this article and the nurse's situation?

Friday, January 14, 2011

Random Musings Again



I saw a ten year patient in for a minor orthopedic procedure the other day who had just gotten over Pertussis (Whooping Cough) after months of illness. The parents still do not believe in vaccines. I know it can be scary to subject your newborn infant to a bunch of immunizations, but if you don't get your child vaccinated by the time they are ten...that just seems ridiculous.

I had an elderly patient the other night who was plesantly confused. She knew who she was and who her family members were. However, time and place were nebulous concepts for her. She vacillated between it being "two thousand something" and sometime when Lyndon Johnson was president. She usually knew what city she was in, but not which hospital or exactly why she was there. Her family noted that she had agreed to stop driving several years ago and they had sold her car at that time. She refused, however, to get rid of her guns. Apparently Grandma still has a 38 caliber pistol next to her bed and a shotgun in her closet. I totally support our second amendment rights, but WOW!

Why are the online programs for filling out incident reports so complicated? If an incident has occurred, you are already traumatized, pissed off, worried, embarassed, annoyed or all of the above. It makes it worse when it is next to impossible and practically takes a committee of nurses to figure out how to complete the report.

I met a 54 year old patient who had just had his third child (he was getting a vasectomy). I also met a 57 year old woman who had several great grandchildren.

I was in phase II recovery getting a patient ready to go home. One of the things we do is make sure they can tolerate liquids by mouth. This lady was not interested in the usual hospital beverages, juice, ginger ale, or generic cola. She had missed her morning coffee and wanted to get some caffeine into her system immediately. Understandable. So I asked her how she liked her coffee. Did she take sugar, Splenda, creamer? "Creamer" she replied. Did she like it light or dark? "Oh" she said "About Barack Obama".

One of the great things about being a nurse is getting to know your patients and learning from them, right? Last week I met a patient who told me all about their former occupation, meth lab owner. I learned about all the steps of making meth. Fascinating. This gentleman had recently been forced to close down his operation after he lost his home to forclosure. "Damn bank" he said.

Tuesday, January 11, 2011

Piano Students and Astronauts

   I had the pleasure right before Christmas of going to my two daughters' first piano recital. They hadn't been taking lessons long. I had just picked up our $250 piano off Craig's List in October, so they were still newbies. A large audience of parents and friends watched as kids ranging in age from roughly 5 to 15 with various skill levels approached the stage in the modest, old church and sat down to play their music. Towards the end of the recital, a student named Shirley was announced. I thought "Shirley... Hmmm you don't see many kids named Shirley these days". It turned out Shirley was in fact not a kid. Shirley looked to be at least well into her 50's and she played a beginner/early intermediate piece very nicely. I noticed some of the audience members kind of smirked at the older student. However, as I thought back on the recital later that night, I realized that I was pretty impressed. It takes courage and initiative to learn a new skill as an adult, especially in front of an audience.
   A little over a year ago when I was still working in the ER, I had a patient on New Year's Eve who had been hurt badly in a fall. She was a local college student who, while attempting to climb from one 3rd floor balcony to another in the dorms (apparently a common activity), fell onto the concrete below. She had not been drinking, later confirmed with a negative serum ETOH. We'll call her Jane. Jane had multiple fractures in her left arm and left lower leg. Her head CT amazingly showed no damage. She had several lacerations, only one of which needed suturing. Her vital signs were stable. An orthopedic surgeon was called in to fix her fractures up. A general surgeon was to evaluate her as well for any possible internal injuries. My other patients were all waiting on rooms at that time, so I actually had a chance to talk to Jane and get to know her a little bit while she waited for the OR. She told me that she was in the Navy ROTC at the college. She wanted to be a fighter pilot and maybe even an astronaut. She was concerned because she said the orthopedic surgeon wanted to fix her limbs with metal hardware and apparently fighter pilots can't have metal in their bodies. She told me that the surgeon mentioned she may be able to get the hardware removed at a later date, so that she could be eligible to be a pilot. Soon she was whisked off to Preop and the OR. The last I heard of her she was going back into surgery for a lacerated spleen and then up to the ICU. With all the orthopedic surgery and the possibility of a splenectomy, I assumed her dream of being a Navy pilot and astronaut was over.
   Fast forward to this past week. I was in Phase II Recovery with one other nurse. I had just discharged a patient and was tidying up the bay. Through the curtain I could hear a conversation between the nurse next to me and her patient, who was getting ready to be discharged. As I was listening to them talk, I realized the patient was Jane. I mean how many young female patients do we get who had a bad accident and want to be Navy pilots? At my hospital at least, not that many. I peeked around the curtain, and there was Jane. I introduced myself. Of course she did not remember me...I had given her a fair amount of morphine in the ER. She told me that she had been in surgery that day to remove the last of the hardware in her body. She was eligible to meet the physical requirements to pursue her dream career. The general surgeon had been able to repair her spleen without removing it. She was currently training for a 5k. Unbelievable.
    Now bear with me here...I know a middle aged woman learning how to play the piano and a college senior wanting to join the Navy don't seem to have a lot in common. However, these women both struck me as being very courageous in their own ways. They were not content with simply maintaining their status quo. I'm over in my little corner of the world wondering if I should go back for my long overdue BSN or if it's too late, too hard, too expensive, etc. When I look at Shirley and Jane, I wish I were more like them. I want to go out on a limb, but am scared to venture out of my treehouse.

Saturday, January 8, 2011

War Stories

Twice this week I encountered patients whose medical issues stemmed from the US government's use of Agent Orange in the 1960's and early 1970's. The United States military used the herbicide/defoliant, Agent Orange during the Vietnam War, spraying it on many of the region's heavily forested areas in order to deprive the guerilla enemy fighters of cover. However, the chemical, nicknamed for the orange barrels in which it was transported, eneded up being extremely toxic and had other unfortunate effects on the soldiers and the Vietnamese civilians. Agent Orange has caused various cancers, neurological and skin disorders, and devastating birth defects.
One of my patients was a Vietnam veteran who was having major cancer surgery. He did great. The surgeon thought he got all of it out, so chemo will be minimal if even necessary.
The other patient was actually the grown son of a Vietnam veteran. He had been born with a relatively mild form of spina bifida, as well as some pretty serious urological problems. At almost 40, he is still undergoing procedures due to these issues.
Amazing how a policy decision about a chemical decades ago is still affecting these veterans and their families.

On a lighter note, one of our neurosurgeons tends to mumble. He is from the deep south, so with the drawl and the mumbling sometimes he is tough to understand. He rolls his eyes and says "You girls" (the nurses are always "you girls") when we ask him to repeat himself. I love to read his H & P's, though, because he often includes interesting little personal details about his patients. I was looking at one yesterday and realized the dictation voice recognition software might have been thrown off by the doctor's manner of speaking. It read

"Patient is a World War Two veteran. He suffered multiple injuries while invading Iceland in the Pacific"

Now my historical and geographical knowledge isn't the best, but something about that just isn't right.

Tuesday, January 4, 2011

Inspirations

    Apparently I showed an aptitude for nursing at an early age. I found a preschool progress report from when I was 4 that stated I liked to "play nurse" and "fix the other kids' boo boos".  In kindergarten I proudly drew a picture of a stick figure nurse witha big white cap adorned with a red cross when asked about what I wanted to be when I grew up. Plus, I grew up on fabulous reruns of the 1970's TV show Emergency! (the exclamation point is crucial), where I was introduced to the lovely Nurse Dixie, shown above.  Nurse Dixie always remained calm and cool, no matter what the situation, even when the hospital was burning down! I'm sure Nurse Dixie knew RACE and PASS. Hell, maybe she invented them! I did not have beautiful blonde hair like Nurse Dixie, but I thought maybe, just maybe I could grow up and work with cool, good looking paramedics and ER doctors like she did. I did end up being an ER nurse, however, I have still not managed to get my mascara to ever look as good as hers did.  What the heck?
   Also in my youth one of my brothers brought me home a box of Cherry Ames books from a used bookstore.
 The Cherry Ames series started out by introducing Cherry, a wholesome, Iowa born World War II era student nurse. The books follow her through nursing school to graduation and on to her various jobs, including flight nurse, jungle nurse, dude ranch nurse, army nurse, rural nurse, rest home nurse, boarding school nurse, veterans' nurse, and pictured above, cruise ship nurse. Geez, did Cherry have trouble holding down a job or what? In her off time Cherry solved mysteries and had all kinds of wacky hijinks and adventures with her really sweet, perfect friends. There was never any mention of bedpans or blood in the books, however, so I'm not sure how much work Cherry actually did. Maybe she just had really awesome techs who did all her dirty work. Of course I have not yet become a dude ranch nurse or a department store nurse, but there is still time. Jungle nursing, here I come!

Who or what inspired you to pursue your career?

Saturday, January 1, 2011

Happy New Year

South Florida is definitely the first area in which I have worked where a surgical team was called out on New Year's Day to fix a fractured hip, injured while the patient was intoxicated and water skiing.


Happy New Year! I hope it is a healthy and peaceful one.