I'm baaaaack

School's about to start, and I need my outlet again. So, here goes:

August was table saw month. Slow for our usual stuff, but a TON of finger amps and near amps. What does cutting off a finger earn you? A week in a 90-degree "warm" room while the revascularization surgery "takes." Assuming it does.

If it doesn't? Then you get a week in a 90-degree warm room with between one and four unrefrigerated sausages.

Either way, it's really hot and you're on morphine--maybe even dilaudid. Lots of it. Which will almost make up for the fact that the nurses come in every hour to poke your finger and ask you to move it. Sleep deprivation + insane heat + ugly smells + big pain. I'm always a little surprised Amnesty International doesn't start a letter writing campaign against us. And how do you document that? Cognition, impaired, secondary to massive freakin' discomfort, as evidenced by repeated marriage proposals to Dave, the ex-Army medic? On the other hand, it has been my one chance to be That Nurse: the one who shows up, lays a cool cloth on someone's forehead, and gets called their "angel" for the rest of the week. Me and Dave, of course.

*Sigh*

Soon school will be back on, and I'll be working a lot less. How I'll miss those moments. If not changing a bed in a 90-degree room. At least I know that table saw season will come again next year, sure as the sparrows returing to San Juan Capistrano, or the undergrads descending on Boston...

Happy Solstice!

It's officially summer -- yay! Time for cookouts, beach trips, camping, and a thousand other opportunities for your disaster and my paycheck. Here are a few happy thoughts and guidelines for the upcoming months, because believe it or not, I really do believe the world would be a better place if I had less work:

1. Bonfires and acccelerant don't mix.
2. Bonfires and accelerant and alcohol REALLY don't mix.
3. It's only funny to think about burning your butt until you really do it.
4. If there's something wrong with the lawnmower, turn it off first.
5. If it won't turn off, don't try to stick anything in it.
6. And for that matter, lawn mowing and alcohol don't mix, either.
7. Yes, they can replant it, yes it will involve leeches, and no, no that's not as cool as it sounds when you're the one getting the critter stuck on your digit.

That's all for now. But for those of us who like to debate evolution, here's a purely anecdotal clinical observation: I've seen very, very few people who lost their eyes in a fire. You squinch shut in time, so unless you're exposed for a very long time, your own body works to clamp down and save the eye. In my experience, however, the same, unfortunately, does not hold true for the rectum. What does that say about the species?

Survival before dignity. Of course, the fact that Christie Brinkley ever procreated with Billy Joel says the same thing, but the clinical anecdotes are more fun (if not grosser).

Your boyfriend is hot.

You heard me. I think he's a major hottie, and I'm going to move in on that action.

That's why I keep coming in every four hours to check his "vital signs." Believe me, on the old fat guys and the women I never even bother to get a blood pressure. If you can't tell by the way I monitor and record his heartrate, pulseox, temp and bp, maybe you can tell by the way I squeeze his drains. Every shift, whether they need it or not. And have you noticed that when he asks for pain meds, I get them for him within a reasonable amount of time for any pain >4/10? You don't even want to think about what I'd do to him if he arrested, or exsanguinated, or dehisced.

Yeah, honey, you should feel threatened. In fact, would you believe that every nurse on this floor would do the exact same thing? That's right, even the men. We sit around all day asking ourselves how we can provide patients the best care possible. Brash, huh?

So I can see why you have to stay in the bed with him. I can see why you have to engage in baby talk and softcore displays of affection every time the nurses walk by. I can see why you have to "test" me to make sure I'm not forgetting anything, but only in front of him. If you weren't there watching him like a hawk every waking moment, I'm sure we'd snatch him and his massively infected, stinking, well-Kerlixed wound right up, wouldn't we?

Well, if not him, at least the MRSA.

Debridement

It finally happened. The anonanurse equivalent of the perfect storm. New patient with splatter burns, superficial but with a large surface area. A "normal" patient; which is to say not normal: no history of addiction, no mental illness, nice to the nurses. Female. My age. It's a very painful burn. She's pregnant. She can't take much for pain meds if she wants the baby to be okay. And someone has to take down her huge, partly open blisters. On one mg of morphine. In a substantial woman. I can't even pretend that it wasn't too bad; I can only know that it sucked more than I can imagine. And she didn't scream. She didn't yell at me. She barely even cried.

After the worst I gave her a hard choice: do as much as possible now and hopefully save some pain later, or stop and rest for the day. She let me keep going, but I almost wished she had asked me to stop. I'd had enough. It was a busy day. No time to cry after. No time to throw up. So I just went down to get my coffee and took the stairs the whole way back up to the floor afterward, breathing hard and sweating.

I know how you feel

It's okay, really.

You came in for prophylactic surgery and reconstruction. You were lucky enough to have a few anatomical quirks that made the reconstruction even easier. You woke up afterward and you felt lousy. Yes, a lot of people do. Maybe you whine a little. Maybe you're a little weak. Maybe if it were me, I wouldn't complain as much.

Maybe you just knew what no one except some lonely guy down in the path lab could have known. That in the midst of a routine operation, your surgeon found an odd little node. It was in the way, so, like a good surgeon, he cut it out. The node shouldn't take it personally; that's just what surgeons do. It's their nature to cut things. The other thing they do is send anything they cut out to pathology. That's not part of their nature, but JCAHO seems to insist on it. And then, since you were still here, groaning over your body, a few days longer than we expected, you were also here to get the diagnosis when it came up from path.

It's back. Not only is it back, but it probably never went away. And here, at he Best Damn Infirmary in the world, no one has ever seen anything quite like it. Medically, you're screwed.

I feel your pain.

Right.

It's funny: I've seen nurses on our floor deal brilliantly with those whose vital young loved ones are suddenly hanging precariously between death and a life unlike anything they ever imagined. But where I feel safely surrounded by experts on all sides for nursing and trauma issues, the other nurses seem as lost as I am when confronted with cancer. I don't think that the there-there pats on the back we offer are quite healing.

Man, and it almost started out as a good day today.
Maybe tomorrow I'll finally get to clean some stool.

Real Nursing

I've been a Real Nurse orienting as a Real Nurse for two weeks.

I haven't cleaned up any poop yet. Not once.

If you a) aren't a nurse or b) live under a rock you may not be aware that the folks on a Certain Well Known Nursing Board like to argue about whether or not nurses are "too well educated" these days to clean shit. Mostly it's young nursing students who think that flinging poo is somehow beneath them. Often there are folks who think that every nurse worth his/her chux should be ready to step up to the plate and help the CNA in the midst of a serious Code Brown.

I've gotta tell you, I'm not with any of them. I'm too ashamed to admit it on the board (power of my convictions, take that!), but I think that cleaning up poop is a nursing job. Having someone else remove the stool that you spread all over your butt because you couldn't a) control your bowels, b) get out of bed in time, and/or c) do so much as reach over to clean yourself means that you need someone working with you who knows how to maintain your dignity. And while I don't doubt that there are CNAs and others out there -- who knows; maybe even a few physicians -- historically only nurses have that sort of training. We don't all have it; we can't all do it. But to me, it's part and parcel of nursing, and, like knowing how to snap up a hospital gown in <5sec, should be part of every student nurse's final exams.

So on weeks like this, with no stool cleaning, no bed baths, no suctioning, I almost feel like I'm not doing my job. Hanging antibiotics and charting good effect from PCAs is great fun, but nothing makes me feel as if I accomplished something like a clean, well-dressed patient who might otherwise not have been able to get clean or dressed. (Okay, nothing except for picking over and dressing a really grody wound on someone who won't be clean for another two months, but you get my drift....)

Give me debrideing, or give me stool!

Real Nurse

Wait a second.

I just figured out what happened.

I got demoted.

They tried to hide it by paying me more, but I know a demotion when I see one.

I used to come in to work at 7am, do lots of dressing changes, get to know the patients, stick my fingers in gross stuff, and go home at 7pm. Or the same for 7-3. Or 3-11. If I was lucky, I could go hang out in the ICU and help with bed changes there, or maybe -- on a really good day -- do a few unit dressing changes.

Now I come in at 6:45pm and leave at 8am. I scramble to get report from a tape, a person, and a computer, plus maybe read the chart. I get vital signs, delegate someone else to do the goopy grody stuff, and begin alternating between being a paper pusher and a flak magnet. And that's just while I'm on orientation! In a few more weeks, I'll get REAL paperwork and a giant baseball mitt to catch it coming off the fan.

If I hadn't grown up with the Army, I'd never have been able to imagine that moving up in the world meant doing *less* of what you're best at and *lots, lots more* of what one well executed computer program could accomplish in half an hour. Whew. Good thing I was prepared, huh?

Diagnosis: Sunny chirpiness, impaired, secondary to bullshit impaction, related to have a merry-fricking-sunshine day yourself, I'll be sleeping until my next 7p-7a.