A Quick Comment on Nurse Managers

A Nurse Manager who wears scrubs to work = Nice

A Nurse Manager who will step in and take patients when things are crazy = Priceless

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?

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.

Happy Halloween to my Friends in Obstetrics

A nurse friend sent me this

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.

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".

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

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?****

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.

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" .

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.

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.

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.

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?



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.

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?

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?

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.

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.

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.