Messadventures Galore

I'm baaaaack

2006-09-07T01:05:00.000-04:00

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!

2006-06-21T22:42:00.000-04:00

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.

2006-06-14T13:16:00.000-04:00

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

2006-06-07T22:34:00.000-04:00

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

2006-06-06T22:52:00.000-04:00

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

2006-06-02T09:58:00.000-04:00

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

2006-06-01T09:31:00.000-04:00

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.

2006-05-24T18:06:00.000-04:00

Some days, it's just too freaking exhausing to lead a fully actualized life.

So here I am, eating old Girl Guide cookies and microwave sausage for dinner, ignoring the gym, and pfutzing around on the Internet. Because it's all I can do to drag my sorry butt from the computer to the microwave and back. Who would think that 4 hours of sitting in a classroom learning how to "activate the [pick your code: pink, red, blue or "disaster"] system" would be more taxing than 12 hours on the floor?

I can't wait to get back in there. It's not that I think I'm too cool for orientation (well, of course I am!). I'd just rather make mistakes on the floor and learn there than open my skull and insert knowledge beforehand. If I screw up now, my preceptor will see it, take me behind the barn, and then I'll never forget. If I learn something in a classroom now I'm apt to do it right the first 50 times and then forget when it counts.

This is all meaninless blather, of course. All I really want is to lie down in front of the TV with a frozen mudslide and American Idol. Unfortunately, I'm apparently too "actualized" to know how to make a mudslide or what channel, time, or night AI is on. I'm not really even sure I have cable anymore. Stupid counterculture.

Omens

2006-05-22T22:09:00.000-04:00

It was one of those days. Woke up five minutes before the alarm went off. Sun shining, birds literally singing outside my window. Got to work without a hitch. No line at the hospital coffee shop. The minor deities of the Alllmighty Scrub Exchange smiled on me and exchanged, grudgingly, all three sets of scrubs I'd brought with me. I walked into the locker room and immediately found my black Dansko clogs from among 500 of their nearly but not quite identical twins.

It was impossible for it not to end badly.

Oh, I oriented all right--three discharges, an admission, and a surgical case; not bad. Then, at about half an hour before the end of the shift, we all started watching the monitor that had been broadcast across the floor like Fifa in Italy. If you had been there, waiting for a loved one or hanging out with the other moderately well sick people on the floor, you probably wouldn't have noticed. I'm not even sure how we noticed. But at around 6:20, suddenly all the medical and nursing staff had one eye on the ICU monitor.

One QRS complex was slowly leveling. The P and T waves were essentially gone. The pressure on the monitor had been in the low 40s over 30s for at least an hour and now, slowly, both it and the heartrate were dropping. Busy taking care of the well sick, no one on the floor went into the ICU (it was fully staffed, anyhow), but we all watched the heart slowly dying, broadcast across both sides of the floor. For this patient it was inevitable; the family was perhaps not ready to say goodbye but also no longer prepared to force life on a body unable to cling for itself.

This is not a floor where we often let patients go gently. This is a floor, usually, full of young people with whom we fight viciously through to either recovery or the kinds of ends that TV feeds on: jacked up on pressors and defibrillators and great muscular chest compressions. It's unusual to watch someone go like this and it feels both peaceful and somehow against our nature. You're trained to fight, fight, fight --- rightly so, in most trauma --- but sometimes the fighter has to hold back. You flip from being a fighter to being a guide who can take the patient thus far, but no further; take them to the point from which they can only proceed themselves.

Luckily for me, I can look forward to at least a year of not dealing directly with many codes---hopefully not any. But I'm beginning to notice that nurses are almost as superstitious as baseball players, and it didn't pass unnoticed that a patient coded on my first day, right before I left. Personally, I'm not superstitious. But I admit I'll be grateful if I don't wake up to birdsong and easy coffee tomorrow.

Booyah

2006-05-17T01:09:00.000-04:00

Back from vacation, tanned (not), relaxed (so not) and ready to go (uh-huh), I now have five days until I start my First Real Nurse Job (TM). The FRNJ is to be on the same floor where I've been working, so at least I know where the meds, computers and bathrooms are. That doesn't change much, except that now I have one less place to pass the buck. Wait, that was my only place to pass the buck.

Oh, well.

Some things are better entered into with both eyes squinched shut and a loud scream. Here goes nuthin!

Great Googly-Moogly

2006-05-01T01:33:00.000-04:00

Two years down, one to go.

In roughly twelve more months, me & the vast majority of my cronies will be nurse practitioners. People will expect us to diagnose and treat. People will expect us to diagnose and treat their children.

This presents a number of problems.

I won't go in to any of them, because one day you, or your child, may be treated by a new grad nurse practitioner. And I think you'd like to sleep at night in the meantime.

I should clarify that I'm not worried about our education as NPs per se. I think all health care providers exit their programs of study entirely unsure of which orifices are designed to receive tubes and which are for fingers, not to mention which tubes or whose fingers. And that's just primary care; you should see what happens when more invasive procedures are involved. Or maybe you shouldn't.

Ultimately it doesn't matter much, because there's always someone there to tell the poor new grad what to do, even if the patient never actually sees him or her. What I fear is that new NPs too often find their way into positions where that someone else shows them how to follow an approved algorithm rather than giving guidance for independent decision-making. There's nothing wrong with protocols and algorithms per se, and as a huge fan of evidence-based medicine--in principle--I can't exactly complain. But in my (so very!) humble opinion, protocols and algorithms are tools to be used in practice, not its foundation. Sometimes you have to be able to make a snap judgment. Sometimes you have to be able to deal with a patient who doesn't fit into the algorithm. Sometimes you have to deal with the fact that the protocol just isn't working.

It's like making dessert: I don't want to cook from the mix. But you don't get to be the pastry chef the minute you step into the Cordon Bleu. You have to do lots of other stupid stuff--stuff that has nothing to do with making pastry, by the way--before you get there. Not because chopping fruit teaches you how to be a good pastry chef; fruit has nothing to do with flour and fat and water. It's about getting good enough at chopping fruit that you can do it without thinking, so that you can watch what everyone around you is doing and learn how the kitchen works. Learn how the pastry chef handles the dough, how the team functions to turn out its product. And there's no way to get that except through experience and scut---if you're trying to make baklava on your first day, you may never be able to develop a rhythm and really watch what goes on around you.

So my misgiving right now, at 2am after a mediocre shift, is that we're trying to get around the messy, lengthy Cordon Bleu model by turning out Betty Crocker healthcare. Maybe that's better than what we've been getting. Maybe not. Maybe I'm just hungry, tired and in need of a nap.

Uh, oh....

2006-04-27T23:19:00.000-04:00

Oh, dear. I overdid. For the tiny few people who know me on this blog, it's Thursday night, and you know what I overdid. Unfortunately, even if you don't know me, you may have already guessed. Occasional major life-altering problems with good old EtOH run rampant in my family, but never affected anyone I come directly in contact with. So I may just occasionally assume that I hit the genetic jackpot (but I did in so many other ways, didn't I??!!?) and just go nuts anyhow. As kind of a way of giving thanks that, when I want to, I can totally overdo the good stuff and not pay the REAL price. Oh, I'll hate tomorrow morning, for sure, but it's the end of the semester, so I'll pass my classes, I'll keep my job, and my family will never know (except, of course, for whatever merciless teasing they give me tomorrow afternoon).

Which is why it's only 11:30 and I'm posting like this.

Oy vey.

Sounds like it's time for blueberry blintzes and bed!

24 out of 32

2006-04-24T00:18:00.000-04:00

I was walking home tonight---Sunday night, at midnight---and this guy jogs past me. Not in an "I'm in a hurry" way, but in a "I'm all decked out in my sweats and jacket and jogging" kind of way. Sick. The first thing that went through my head was, this is so obviously pathological. Some kind of obsessive compulsive thing that he's using to cover up a deeper problem.

And then I remembered: I'm walking home at midnight because I volunteered to double back and THEN work a double. Because it was really busy. But not because anyone really, really needed me to be there. Except maybe, of course, for me. And frankly, a pathological need to jog might just be a better signal of overall mental health than a pathological need to poke at gross stuff.

But oh, the gross stuff I poked today.
[contented sigh]

Nursing my health...

2006-04-17T22:00:00.000-04:00

One paper down. That makes one paper, one final, and one assignment left to go this semester. Which means that

A) I could get cracking right now and get ahead, so I don't panic this Thursday.

Or

B) I could go drink a Guinness.

Guinness, if you're wondering, is a nutrition shake made by the Irish for women who have just delivered babies, factory workers who have labored over long hot workdays, and good little nursing students who have completed one third of their work for the semester/week. So, though my friends have abandoned me (are you really all working? on school stuff?) I go, to replenish my depleted system alone. Ah, the sacrifices I make for the sake of my physical fitness.

Past lives

2006-04-17T10:34:00.000-04:00

----------------------
This is my old life:
----------------------

Me: me.
Him: I don't know much about him, except that he says 19, he's new to the drop-in center for homeless teens where I'm doing HIV counseling and testing, he has a number of very public gang and prison tatoos, he's ten times bigger than me, and I think he looks scared.

Me - what made you decide to get tested today?
Him - oh, you know; I saw you were here, and I want to take care of myself...
[snip]
Me - do you feel safe where you're staying right now?
(and if you don't, what can I do about it? take you home with me? buy you a condo in midtown?)
Him - Not really.
[snip]
Me - Have you ever been in a sexual situtation that you did not want, or been forced to be sexual in any way?
Him - ... yeah.
Me - Have you been able to talk with anyone about it?
(please say yes, please say yes, I haven't done this before)
Him - No.
Me - Do you want to talk with someone?
(Oh, no, what do I do; the social worker's not with me tonight, help help help)
Him - Yeah. I guess I can talk to you....
Me - ... (Lord, help me)
[snip]

-----------------
This is my new life:
-----------------

Me: me
Him: I know everything about him, from his birthday to his blood sugar to his living situation to the last time he took a dump. Can't publish any of that here, of course. But if you insist: two days ago.

Me: Ready for the dressing change?
Him: Yup!
Me: So, how about those Sox?
Him: aaaaaaaaaaaaaaauugh
Me: Why don't I go get your nurse to give you more pain killers?
Him: Okee-dokee!
[snip]
Me: Ready to start again?
Him: Sure!
Me: Sure is a nice day out.
Him: [stifled groans]
Me: You're doing great!
[snip]
Me: Look how great that looks!
Him: Is that.....my leg?!?
Me: It sure is! You're just healing up super fantastic!
Him: ...
Me: Why don't I just wrap that up so no germs get in, okay?
[snip]
Me: You're all done! Wasn't that easy?
Him: Sure was! Thanks a million, honey bunch!

-------------
Moral of the Story:
Nursing school hasn't made anything easier, but it sure makes it a whooooooooole lot different.

Vivitrol

2006-04-14T10:12:00.000-04:00

Looks like Vivitrol is official now. It's basically just extended-release naltrexone, but that won't stop some folks from talking about it like it's a new drug. It'll probably also get people talking about alcoholism and addiction again, too, which can't be bad. It's obviously doing that to me, so who am I to talk?

I don't know much about naltrexone, though I probably should. I know that Rubio et al. found it more effective than relative newbie drug acamprosate (Alcohol & Alcoholism, 2001 36(5) 419-425), and that it's pretty old school. I hear that it's very helpful when used along with psychosocial support and counseling. Some people who desperately want to get sober can't get honest enough with themselves to benefit from support and counseling, and I suspect that it's pretty appealing to them, too.

But two things really scare me about Vivitrol; one medical, the other mostly philosophical. First, it's long acting. That means that if you show up on the floor, with, say, half of your arm burned off, two days past your last injection, I don't know what we can do for you for pain relief. No narcotics, thanks to Vivitrol, and I suspect that ibuprofen won't quite do it for you. Forgive me for letting on that other people's pain bothers me, but I'm not happy with that. And I know that you won't be happy with that.

Philosophically, I dislike the name. Vivi-trol? Sounds like somebody at Alkermes needs a little Alanon. Plus, I just don't know that much about it. I assume that it also antagonizes endogenous opioids. Which makes me think about my day yesterday. I was high as a kite. I was running for no reason, skipping publicly, I looked about 20 times hotter than usual (in my head, at least), I was smiling and chatting with random people, doing things I don't usually do and going places I don't usually go. It wasn't drugs, it wasn't mania, it was just SPRING. Do you lose that with naltrexone? Is random, wild joy the price of kicking an addiction?

I've lived with an addict, been enmeshed with an addict, and I have a sense of addiciton's price. But I always thought that one of the great motivators to seeking recovery was rediscovering -- or, sadder yet, discovering -- what real joy is. Maybe real joy really is too big even for endogenous opioids; maybe it's one of those rare places where mind and soul collide and even naltrexone can't touch it. But I'm skeptical.

This is all too much for my poor little head. I'm going back to writing my paper now, which suddenly seems much easier than it did half an hour ago!

Your favorite nurse solves it all....

2006-04-12T14:43:00.000-04:00

So, let's say that it's 1 in the afternoon on Friday. You've been feeling kind of cruddy all week, and now you have a cough. And it's hard to breathe while you walk. And, oh, yeah, come to think of it, you haven't been sleeping so well lately. The sleeping thing has been a bit better since you started sleeping in a chair, though. As long as you're almost upright, you can sleep. And maybe your chest hurts from time to time a little, too.

What do you do? Unless you've been living under a rock for ten years, you know what to do. You wait at least another 36 hours so you can show up in your local metro emergency room at 4am on a Saturday night, that's what you do. Preferably right after a big baseball game.

For some reason, this makes many people unhappy; most of them wearing monocolor cotton pajamas with stethoscopes around their necks. If I were you, I wouldn't trust them. I would bypass those suspicious-looking people with the alpahbet soup after their names and go straight to the

ANONANURSE E.D. GLORY HOLES.

Yes, folks, I have solved the ED dilemma for patient and staff alike. All you need is a good thick wall with a surplus of holes, all of varying height and diameter. Patients insert their appendage of choice for blood pressure, O2 sat monitoring, large-bore IV, and, should the appendage appear dusky, an ABG while we're at it. A number of holes may be installed directly above the floor for found-downs dropped off by EMS. First-year residents may complete part of their scut requirement by actually going from the provider side of the wall to the patient side to separate out glory holers whose appendages do not offer readings or labs compatible with life, whose appendages appear to be bleeding profusely, or who think that "appendage" involves anything other than a limb.

Voila. Everyone's happy except for the first year residents, who don't expect to be happy and who, in fact, usually feel like they've done something wrong when they're happy. And are usually right.

And to think they called me a misanthrope....

Oops. Bad nurse. :-(

2006-04-09T22:24:00.000-04:00

Confiteor Deo omnipotenti...
quia peccavi
nimis cogitatione, verbo et opere:
mea culpa,
mea culpa,
mea maxima culpa.

Translation: I done wrong. Consider this my public confession, since I'll never be able to apologize to the injured party directly.

A.N. is a gorgeous little 4 year old girl who acts exactly like you want a 4 year old girl to act. She's inquisitive, she's a little shy, she's friendly with people she knows she can trust, and she glows with little kid perfection. That's saying a lot, especially since I'm not a big kid person (I like kids, but I'm not unconditionally nuts for them, like I am for, say, pandas or Great Dane puppies).

So I'm seeing A.N. during her annual physical, and we're having a great time. I listen to her heart, then I let her put my stethoscope on so she can listen herself. I listen to her belly, she listens to her belly. We talk about the dangers of garden gnomes, elves, and little birdies crawling into the ears at night while I do the otoscopic exam. We make faces at each other while my preceptor talks with Dad. She's my buddy.

Right in the middle of my best pop-eyed-fish impression, I hear my preceptor mention that since it's almost her fifth birthday, we'll be doing the s-h-o-t-s this visit, after all. Oh, shit.

Three minutes later, per the clinic's de facto protocol, I'm holding my screaming ex-buddy down and giving her a blast of MMR to her miniscule left deltoid. Meanwhile, my preceptor gives her the rest of her immunizations.

What has A.N. learned? That people in white coats suck. That grownups who make friends with you may still hurt you. And that you can expect to lose your autonomy and your dignity even when you're in a supposedly safe place. Maybe we'll all luck out and she won't get all that from just one experience. But I'm sure checking my immunization recoreds a little better before I make best buddies with any more little four-year old princesses or princes. A.N., I'm sorry. I hope a million kinder lessons than mine come your way before you come back for your next s-h-o-t.

Furuncle

2006-03-23T21:59:00.000-05:00

Furuncle. There's a great word. Like sisyphean, or liminal, or hepatosplenomegaly. The best thing about "furuncle," in my opinion, is that while hardly onomotopoetic, it sure sounds every bit as gross as it is. That, and a little bit dirty.

Furuncles are infections of the hair follicle usually caused by Staphylococcus aureus. Furuncles are also a great reason why, if you work in healthcare, you should shower repeatedly -- and maybe set yourself on fire or bathe in Chlorox -- before you wax. Do not, do not, do not ever stumble home after a 7p-7a shift and think to yourself, "what a great time to to whip out the Nair and open the hair follicles in my pits." That goes double if your scrubs come from the scrub exchange.

[Gentlemen: in the interest of equal-opportunity nursing blogging, I should point out that even if you don't wax, it would be a good idea to cut your fingernails about .25cm past the quick before scratching your junk after a day on the floor. There are worse places than the pits for furuncles.]

But what do you do if it's too late, and you couldn't resist firing up the Epilady at 1am after a 3-11? Find a good book. Make a list of chores you've been meaning to check up on. Rent a few Blockbuster videos. Because, as I'm sure you know, sometimes a furuncle is just a furuncle. But sometimes--very rarely, of course--it's a gaping Staph A entry port into your body. It's the harmless little boil that turns into a raging cellulitis. Maybe a little necrotizing fasciitis? Either way, you'll be up all night worrying at it. Besides, who can resist a nodule? Not you, or you wouldn't be in this line of work. So you might as well throw LoTR in the DVD player and finally watch the whole sucker. Cuz I know who's not sleeping tonight....

Kiss My Boo-Boo

2006-03-18T21:24:00.000-05:00

I've had a naRsty eczema-related booboo on my index finger for, like, weeks now. Between CalStat and handwashing (help, help--I'm visibly soiled!) I figured that ugly was never going to get better.

Until this, the best Band-Aid on earth.

Four patients today, three dressing changes, oodles of CalStat, and ONE--yes, ONE--bandaid change. Bandaid stayed on. Bandaid did not saturate with alcohol-based funky handwash solution. Bandaid did not fall off in patient dressing. Booboo did not sting like a mofo everytime I sanitized my hands. Oh, I think I'm in loooooooove. 'Scuse me while I go buy some J&J stock.

My job is hard. [serious face]

2006-03-11T18:27:00.000-05:00

We had a new admission today that required input from nurses on another ICU. They came, helped, and departed paying the usual social curtesy: "I don't know how you guys do it." Our team returned, saying, "we don't know how you do it." And all is well with the world.

But here's the real truth: you really don't know how we do it. You have no idea. So I'll tell you.

Lots and lots of
THIS
every day.

It's okay. The charting can wait until you're done.

Different outrage...

2006-03-07T15:36:00.000-05:00

As if Sunday night wasn't bad enough on its own, this came on the late news:
Local Homeless Man Set on Fire

Obviously, shit like this really pisses me off. (Everyone feels for the little guy, right?). I'm sorry to admit that I hadn't even heard more than a few words on the news before I formulated my own story--probably a couple of upper-middle/rich white kids with nothing better to do on a Sunday night. I was wrong. I was wrong before I found out I was wrong, though. If I had superpowers, narrative would be my kryptonite. No matter how smart I get, I keep thinking I can create a narrative around someone else's life. I do it with people on the news, I do it with coworkers, I do it with fellow students. No one enters my consciousness without risking becoming part of one of my inner short stories. As an academic I might have wondered who was worse: the youth who set the guy on fire, or me, who hijacked his narrative.

The nice thing about nursing is, I get to think in black and white sometimes. Let me practice that here. The youth were worse. No question. I can hijack narrative all I want; no one ends up in the hospital for it.

Or do they? Here's the other thing: I doubt that this is just a case of individual pathology. Crazy people do crazy things, and bad people do bad things. But none of it is done ex nihilis. When two assholes think someone matters so little that they can set him on fire, that's not just a sick person, that's a sick society. When someone foists their internal narrative on someone else -- by basing their actions not on the reality they've experiened, but on the novella they prefer to that reality, that person increases society's risk for illness. Systematic racism is probably the most obvious (and "safest") example of this aggressive narration. A few less safe examples include denying equal marriage rights, trying adolescents as adults, and refusing to offer the same coverage for mental health as physical health. Moral waters can be extremely murky and often harbor catfish. I'm really sorry to say that I'm still figuring out how to navigate them, but I've figured out this much: where my narrative is taking over what I've seen, heard, tasted, or smelled, I'm in danger of stomping on a cat, for sure.

Outrage! Righteous Indignation!

2006-03-06T22:48:00.000-05:00

I hate the IRS. I never knew it was evil before; sure do now.

Let's say you kind of accidentally married a man who turns out to be a pretty scary guy with serious anger issues. Then let's say that you move out, because being scared all the time gets old after a while. You probably don't want him to know where you live, right?

Depends on who you're more scared of: him, or the IRS. Because if you file married (divorce=1 year of legal headache), separately, you miss out on a few things, like these gems I found:

1) No educational deduction. If you needed to go to school in order to leave your H, don't expect the deduction you would have had if you stayed with the sumbuck.
2) No Roth contribution. Unless you can survive on less than $10,000 a year. And if, heaven forbid, you made that contribution before you got the heck out, you can expect to pay for it, bigtime.

The implications are really upsetting. Women with the guts to leave an abusive husband can pretty much expect to be punished financially anyhow; they don't need the IRS joining in. Ooo, now I'm grumpy!

Case Study

2006-02-28T20:25:00.000-05:00

Just came back from the most amazing case study, from interdisciplinary grand rounds (PT, OT, SLP, nursing, medical). Followed a patient with traumatic brain injury. It was amazing and inspiring--both in terms of how the family coped with the entire rehabilitation process and how they interacted with PT, OT, and SLP as a team to give him the best care and most supportive environment possible. Nice.

So, what's the really amazing part? From what I could tell during the presentation, as soon as he entered rehabilitation, this patient --though comatose--must have monitored his own vital signs, cleared his own secretions (by suction, since he sure couldn't cough), cleaned his own bed, turned himself q2H, and ordered all his own labs and meds. Not one nurse or physician from his team was there to speak. Their input to the team passed unnoticed. I'm glad that PT, OT, and SLP work together so well, but this grand rounds made them sound more like Heathers....

naaaaaaaaaaanda

2006-02-28T01:13:00.000-05:00

Warning: up-past-my-bedtime ravings ahead.....

If you're not a nurse, or if you didn't become a nurse in the last, say, 30 years, you may (blissfully) not know what NANDA is. NANDA's [rhymes with PANDAS] primary function is to make it look more like nurses diagnose without actually having to change anything about our training. Of course, nurses do diagnose, all the time; we just don't do it officially or document it. After all, you never know when the patient will refuse to wait for a doctor to come before they throw that clot, so it helps to know what a pulmonary embolism looks like. Same goes for heart attacks, compartment syndrome, strokes, C. diff overgrowth, crotch rot, trench foot, and all the other stuff you know by smell before you even get a chance to page an official diagnostician.

The point here isn't macho I-am-nurse-hear-me-diagnose posturing. It's that somewhere out there in nursing academia, someone really believes that these diagnoses will improve our credibility somehow. That by noting that the blue tinged COPD patient who can't brush his teeth in bed without collapsing has "Activity tolerance, impaired," or by actually charting "Electromagnetic field, imbalanced" we'll gain the respect we so richly deserve. (Sh#t. Maybe they're right. But I like to think that we deserve a little better than that.)

I don't have any research for this. I don't have anything better to back me up than a late-night, 1am, I-haven't-slept-5-hours-in-3-days feeling. But I have a funny, sneaking suspicion that maybe nursing would get more respect if we would get off our butts a little more. Oh, wah. I know nurses work really hard everywhere. I don't mean work harder. I mean get up. Get up, and say: I'm sorry. I need to go somewhere where all this overpriced, overgeneralized education will work for something. And leave. And go to work with some couch-surfing homeless kids in SF. Go work with some ex-tweakers in Kansas who are trying to get their lives together and who, impossibly, improbably, already have their kids back. Take a sabbatical from school nursing at Scarsdale Middle School and give a 17-year-old on Rikers—Rockerfeller laws, baby—an HIV test after he gets raped. Remind people that there was a time when where there was no one else—Crimea, frontier Kentucky, the Lower East Side at the turn of the other century—there were nurses. Never enough then, either, but at least there were some.

It's not that we're in a bad place right now as nurses (but I won't deny that, either). It's that if what we want is more respect, maybe we should start looking at what we really want the profession/trade to be---not how we can manipulate everyone else's impression of us.

Give yourself a hug and push with your heels.

2006-02-27T14:19:00.000-05:00

This is dedicated to my comrades-in-chucks: the "smart" kids who thought we were too smart, too ambitious, too logical, and maybe a touch too cool to spend our days slinging poop. The B-school thoughtfuls, the LSAT acers, the MCAT pummelers who somehow, sometime, thought that they'd just look into nursing. Probably the NP part, since that's smarter. Cleaner. And now what are we doing?

Slinging sh#t and grinning, sisters. Humming a little tune while while we switch NG tube canisters. Sizing up veins at the supermarket. Making up lyrics to the vent alarms. You know who you are. If you'd have been as smart as the nursing students who actually went out occasionally in undergrad instead of trying to get published, or amplify RNA, or achieve world peace, you'd have it made right now. You could be laughing at the sorry biochemist-turned-RN-student desperately asking the toddler outwhy he doesn't want his shots now. Instead, you have the great privilege of being overeducated AND overemployed (if perhaps grossly underpaid).

You may not stay here in RN land. You may keep going through for your NP. I may, too. But if you've made that fateful transition--from thinking of cleaning other people's bodily fluids as a menial task to seeing it as one of the many parts of the most trusted, literally privileged jobs in the world, this is for you.

As always, curious lookers-on, gaping crowds, and obnoxious interjectors are welcome. I have a strong preference for dialogue over narrative. There will be nursing, healthcare, literature, scatology, and plenty more to keep everyone (well, me at least) entertained and maybe just a little creeped out.

Join the messadventure, but keep your emesis basin handy, and mind yer junk!