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.

Do Unto Others...

   The other night I was in Phase 2 Recovery. This is typically a piece of cake gig, a short stopover before the patient gets to go home. It is kind of like working Fast Track in the ER, all about moving patients in and out as quickly and as happily as possible. You only get stable patients from the main Recovery Room, or with some minor procedures, straight from the OR. Phase 2 has recliners, warm blankets, and yummy stuff to drink. It even has a fancy menu, ie. saltines, graham crackers, and broth. Each small bay has a chair for a family member to sit and visit with the patient until it is time to go home, typically after 30 minutes to an hour or so.
   I was breaking down a chart when I heard some commotion from the other side of the room. A very experienced Recovery nurse was telling a new nurse she was going to call the doctor "right now". I walked over to see if they needed help. The patient was on a stretcher. He was a male in his 40's, vacantly staring into space. I tried calling his name and doing a sternal rub with no response. We got him on the cardiac monitor and pulse ox. He had loud, irregular, snore like respirations. I attempted a head tilt chin lift to open up his airway more. His neck and jaw were stiff and uncompliant. I noticed his sheets were soaked through with urine. A CNRA arrived, inserted a nasal trumpet and started to bag him. I got the code cart. The Anesthesiologist got there and had me give the patient an amp of Narcan with still no response. The code team burst into the room and got to work. The Intensivist and the Anesthesiologist conferred on the situation. The patient's pulse was getting fainter and fainter. The Nurse Manager walked into the bay and informed me that I was going to need to take care of the patient's crying wife.
   Holy crap. In the ER we had patient reps who sat with family members. On day shift we had chaplains.  I looked at this pale, scared woman and thought that I would rather do a thousand chest compressions than try to comfort her. So, I walked over and put an arm around her, leading her out of the crowd gathered around her husband.
   I felt completely helpless and inept. She was crying and asking me if he was going to be okay. All I could say was that the team was doing all that they could. We prayed together. We talked about how they had met. She kept repeating "I can't lose him. I can't lose him". I held her hands, and we prayed some more. I could hear them starting chest compressions. I heard someone talking about PEA and V-tach. I heard the distinct sound of a defibrillator charging. When she heard a doctor yelling "Clear", her face drained of all color and she ran back to the bay with me in tow. One of the doctors present told me to get her into another room. Not everyone in the hospital is on board with family presence at codes.
   This woman obviously loved her husband very much and started to become agitated when she was advised to step out of the area. Right at this time Dr. J walked in. He was a partner of the surgeon who performed this patient's very minor procedure. Dr. J  was on his way to Preop to see a hip fracture patient. He immediately took in the situation and acted quickly with no hesitation. He could have just passed through with no comment as another partner had done. However, he headed straight for the patient's wife. Doctor J took her hand and introduced himself. He explained to her in simple terms what the team was doing and why. He sat with her for several minutes while she cried on his shoulder. He escorted her to her husband's side when the intensivist was about to call the code. She sobbed and cried for her husband to come back to her. Doctor J held her hand and then brought her back to me when he had to leave for the hip surgery.
   The patient's wife retreated to a private room to make phone calls, with me and her husband's surgeon occasionally checking on her. The actual surgeon was deeply shaken, stating he had never lost a patient before. The anesthesiologist who had been the first doctor on the scene looked devastated. He asked me if the wife knew that they had done absolutely everything they could. The patient's wife came out briefly to let us know that she was declining to pursue an autopsy, that she wanted her husband's body "left alone". She told us that her son was on his way to get her and take her home.
    Dr. J returned to the area briefly after a very quick hip pinning. He went with the wife to see her husband's body one last time before she left the hospital. Some staff were complaining that before he took her over to see her husband, Dr. J had removed the endotracheal tube from the body. However, since no one, including the Medical Examiner, wanted an autopsy, I guess maybe it didn't really matter. I believe that he was trying to make the situation easier for her to bear. An et tube can be a jarring sight when protruding from the mouth of someone you love.
   When the adult son arrived, the patient's wife gathered her things. She asked us to make sure her husband had a blanket, that he hated being cold.
    I said goodbye with a hug and a "God bless you".
   The next evening I saw Dr. J again. I thanked him for his help and told him that for a surgeon, he was a pretty good guy. He appeared genuinely perplexed by this and asked why. When I explained how much his involvement had meant to the patient's wife, he still looked puzzled. He stated "It's what I would want someone to do for me". I smiled and thanked him again before he left for the night.

Vintage Bedpans

 I think every nurse sometime in their career, usually many times in their career, has provided a bedpan to a patient. Or held an emesis basin while it was filled up with vomit. Or at least hopefully, if the patient did not miss and get the nurse's shoes instead. The crisp white uniform and cap have (at least in the U.S.) gone out of style, but some aspects of nursing are definitely timeless.

I'm No Paula Deen, But...

These are seriously the best things I have ever eaten. I took them to my work, and they disappeared in minutes. I had never made anything from scratch in my life, but it was not even that hard. Trust me. I am no expert chef, but I love to EAT. And don't get upset that I'm promoting obesity in our already overweight and sedentary society. Just don't eat them all yourself. Share with a buddy. Moderation, people! Awesome stuff.




Symphony Brownies
Yield | 12 brownies

Ingredients
4 ounces unsweetened chocolate; coarsely chopped
3/4 cup butter
1 ½ cups white sugar
3 eggs
1 teaspoon vanilla extract
¼ teaspoon kosher salt
1 cup all-purpose flour
2 (4.5 ounce) Symphony Chocolate bars; broken into squares

Directions
1. Preheat oven to 350 degrees. Line an 8×8 inch baking pan with foil and spray with nonstick cooking spray.
2. Microwave chocolate and butter or margarine in large bowl at medium (50% power) for 3-4 minutes or until butter is melted.
3. Whisk until chocolate is melted. Stir in sugar and add in eggs, extracts and salt. Gradually add in flour and stir until just combined.
4. Spread ½ the batter into prepared pan. Add an even layer of Symphony Chocolate squares and cover with remaining ½ of brownie batter. Bake for 30-35 minutes; do not over bake.
5. Remove to cooling rack. Allow to cool completely before cutting.

Inspired by Paula Deen and adapted from allrecipes
mybakingaddiction.com

A Wiggly, Licking Homecoming

At the Holidays when you are cozy in your home with your family, remember those who are away from their loved ones doing an often thankless job, dedicated to keeping their country safe.

Alert and Oriented x 1

A patient wakes up in the Recovery Room
"Where am I" he asks.
"You are at the hospital. Your surgery is all done" I say to him.
"Where am I?"
"You're at Crazyland Medical Center" I say.
"But, where?"
"Gigantic City, Florida" I tell him.
"Is this Earth?"

The Original Christmas Story via Facebook

I hope my Non Christian friends will excuse a brief foray into the origins of Christmas, as told through Facebook. I thought this was quite clever and sweet.