Sunday, December 21, 2008

Spoke my mind

Sent to me via email:

[Click image to zoom]

If you created this image, lemme know so I can credit you.

Be careful when taking walks

One of our ER docs told me this story:

Many years ago, when I was doing my residency near The Other Big City, police brought this elderly gentleman in to the ER. They said that they'd found him wandering around and when they stopped to question him, he responded with incoherent words and neither one of the officers could figure out what the man was saying.

And neither could we. His vitals weren't normal but they weren't off the wall either. One of the nurses thought she detected some AoB (Alcohol on Breath) but for the most part this guy appeared benign. Lungs clear, good heart sounds, no apparent signs of trauma.

Then, one of the cardiology residents who happened to be down on a consult happened to pass by the ER room while we were trying to figure out what the hell to do. He stopped, poked his head in and asked one of the nurses what was going on. Upon being told the gist of the story; the resident shook his head and said: "He's not mentally confused or unstable. He's speaking a different language. I don't know what it is but I know it's not gibberish." Apparently this cardiology resident was of Indian extraction and had heard it before.

This set of a flurry of activity... and before long, they managed to find an Indian-American nurse who was called down to help translate.

Apparently, this gentleman had recently arrived in country; visiting his son's family for the holidays. He'd had a glass or two of wine in the afternoon and had decided to stretch his legs with a walk and take in some fresh air. That was when the police found him and the poor man spoke not a syllable of English. Fearing that he'd been injured/lost and wanting to make sure he was ok health-wise, the police brought him in and that's where all the fun started.

Wednesday, November 26, 2008

What's in your RSI box?

Nurse K posted a random bleg a while ago about RSI boxes. I must admit that when she mentioned that her ED didn't have a RSI (Rapid Sequence Induction) box, I was slightly surprised. I thought all EDs had something similar - I mean, having one makes a lot of sense.

But then again, my old hospital's ED didn't have one either.

So Nurse K, here's what we have in our ED:
- Meds in the box:
* Atropine Sulfate (1 mg/10 ml) prefilled syringe X 1
* Etomidate (2 mg/ml) 10 ml vial X 1
* Ketamine Hydrochloride (50 mg/ml) 10 ml vial X 1
* Lidocaine Hydrochloride 2% (100 mg/5 ml) prefilled syringe X 1
* Midazolam (2 mg/2 ml) vial X 2
* Succinylcholine (20 mg/ml) 10 ml vial X 1
* Vecuronium (10 mg) vial X 1

- Dilutants:
* Sterile Water for injection (10 ml) vial X 2

- Tools:
* 60 ml syringe X 1
* 20 ml syringe X 2
* 10 ml syringe X 2
* 3 ml syringe X 3
* BD 18G 1.5 inch IV needle X 2
* Easy Cap II Carbon Dioxide detector X 2 (no longer used. Now part of intubation bag)

- Misc:
* Alcohol swabs x 15
* Controlled substance documentation form

Some piccys:

RSI Box against a standard computer keyboard (to provide scale for sizing).

Closer view of RSI (notice the red pharmacy lock indicating a stocked, ready to use box).

Naturally, no nursing job can be complete without "documentation". A typical pharmacy use/waste form. Two RNs (or an RN and Pharmacist) to initial waste/use before restocking and locking the box.

We have 3 such boxes in our ED. Our airway/intubation kits are separate (they usually hang out in the trauma/code rooms near our crash carts). A while ago we decided to switch out CO2 detectors from the RSI boxes to the airway boxes. There are separate kits for peds intubation (in separate boxes as well). We also have our own anti-platelet/thrombolytic boxes (tPA, tnkASE, Integrilin).

Once a box has been used, a nurse (or tech) walks the box down to pharmacy and it gets re-stocked.

So, what's in your RSI box?

Sunday, October 5, 2008

The Vent

Quoting another ED nurse:

Ok,..was gonna try to stay out of this,.but I just can't help myself! I agree that this is a great place to vent. This is supposed to be a safe place to vent. A place to let out all my frustrations away from patients and co workers. A place to verbalize all those thoughts that I would NEVER, EVER say to someones face while at work! A place to voice my opinions to other health professionals who understand where I'm coming from.

I don't expect solutions to my frustrations. I don't expect someone to tell me how to fix everything and make my job a day at the park. It just makes me feel better to write it all down and get it out! It makes me feel better for someone who understands to say "yeah, I'm with you there!". If occasionally I learn something in the process of venting then good for me! If commenting to someone else's vent makes them chuckle or breathe a little easier that's great.

I've been a nurse for a long time and I do understand that those who aren't in the medical field don't always understand what I'm venting about. I've often whined about something to my husband (a non medical person) that seemed like an obvious situation to whine about and he looks at me like I'm crazy! I then have to go into more detail about my complaint and sometimes he will understand.

That's why I come here! I shouldn't have to explain to any of my fellow nurses how it makes me feel when a 22yr old tells me he has abd pain 14/10, can't keep anything down, while eating Cheeto's and coke, talking on his cell phone! There is no need to explain my initial thoughts when he then tells me he has no medical hx, takes no reg meds and is allergic to Tylenol, toradol, haldol, vistaril, naprosyn, ultram, and phenergan!

I come to this site because we are all in the same boat. We are all caring, compassionate, well educated, professionals who are trying to do the best we can for our pts. We get frustrated when, because of situations beyond our control, we can't do our jobs!

I would never, ever, tell a new Mom, who is worried about her 8mo olds 2hr temp of 102 that she is wasting my time and resources by coming to the ER instead of running to walmart to buy some tylenol! I would never, ever tell the man with back pain for "about 2yrs now, no one can figure out what's causing it" that he needs to loose 100lbs and find a family doc to take care of these "flair ups".

BUT,.when that same Mom comes up to the triage desk and complains that they have been waiting "almost an hour" and "people who came in after us have already gone back" and then gets nasty with me when I explain that the sickest pts go first, I'm gonna come to allnurses and VENT! I would so love to take that Mom by the hand, take her back to Rm 3 the 6yr old who was found in the bottom of the pool, then to Rm 5 the 18yr old unrestrained driver of a roll over MVI who was ejected, then to Rm 8 the 60yr old who suddenly couldn't speak and has a L sided facial droop, Rm 24 the 22yr old ruptured ectopic with a BP of 54/20 who is bleeding out faster than we can put it in and of course OR is full! I would so love to put everything in perspective for that Mom,..but alas,..I can't,..I won't.

I come to this site to vent to other nurses! To those that know exactly what I'm feeling. I don't vent to my neighbor or my hairdresser. I'm not directing my vent to any patient or family member. I'm here to talk to other like minded professionals!

If you have stumbled in to this site as a non medical person, just looking for an interesting read, or free medical advice you should be prepared for what you might see. Nursing can be a very unpleasant job at times. We see people at their worst. We see things on a regular bases that most people will never witness in their lives. We are expected to leave the room of a dead 3yr old and smile and ask Mrs Jones if "there's anything we can do for her, I have the time".

We are expected to understand that when the doc orders 100 of Morphine, he really meant Fentanyl. We understand why our pt with SOB really does need an 18g in the AC. We understand why a pt with abd pain must stay NPO. We know how to do our jobs and we do understand that non medical people don't understand!!

I find it insulting for a non medical person to make judgments on how I do a job that they couldn't do. I don't argue with my mechanic about the best way to fix my car. I don't argue with the electrician about how to fix my furnace. WHY WHY do people think it's ok to not only argue with us, but accuse us of being cold, and uncaring when we are doing a job that many people say they could never do?

I must stop,..if you are a non medical person and are offended by what is said on this nursing site,'s simple,...see that little red box with the white X in the top right corner of the screen? Click it!

You ROCK lady!

Tuesday, September 30, 2008

Apparently I'm a libertarian...

Saw this little "test" over at Respiratory Therapy 101 and decided to give it a shot.

You are a

Social Liberal
(88% permissive)

and an...

Economic Conservative
(80% permissive)

You are best described as a:


Link: The Politics Test on Ok Cupid
Also : The OkCupid Dating Persona Test

Friedrich Hayek's Road to Serfdom and - it's where it all started folks!

- Spook (proud Paul-ite)

Saturday, September 27, 2008

Paul Newman has passed on

Ya know, I'm not usually one to get all weepy and mopey about celebrities.

But I've always enjoyed Newman's work - be it something silly like "Slapshot" or iconic such as "Hustler" or "Cool Hand Luke". He was a humanitarian to boot with charities benefiting children.

So long Mr. Newman and thanks for the fond memories.

Friday, September 19, 2008

Healthy ER abusers are a "myth"

A recent article in Slate claims that the uninsured without a PMD and the insured folks who have PMDs both visit the ERs (or ED if you are Dr. WhiteCoat ;-)) in roughly the same proportion:

If you believe the conventional wisdom, the E.R. abusers of our nation are especially responsible for many problems in health care. They fill up E.R. waiting rooms and because they can't (or won't) pay their medical bills, the insured patients who prudently wait for weekday appointments to see their doctors end up bearing the costs of the abusers' in the form of higher insurance premiums. The oft-repeated claim is that if we can just find a way to get the abusers out of the E.R. waiting rooms, we'd eliminate many of the high costs associated with health care in the United States.

The problem is that this story of the healthy, cavalier, uninsured E.R. abuser is largely a myth. E.R. use by the uninsured is not wrecking health care. In fact, the uninsured don't even use the E.R. any more often than those with insurance do. And now, a new study shows that the increased use of the E.R. over the past decade (119 million U.S. visits in 2006, to be precise, compared with 67 million in 1996) is actually driven by more visits from insured, middle-class patients who usually get their care from a doctor's office. So, the real question is: Why is everybody, insured and uninsured, coming to the E.R. in droves? The answer is about economics. The ways in which health information is shared and incentives aligned, for both patients and doctors, are driving the uninsured and insured alike to line up in the E.R. for medical care.

Click here for the full article


Sunday, September 7, 2008

The "Nursing School" Car

I worked two jobs during nursing school. I bought a beat up 1995 Plymouth Neon - stick shift and a pretty decent radio. It had 2/40 air conditioning (2 windows rolled down driving at 40 mph). The only thing I cared about was the heater, since I lived in Buffalo.

The gauges worked when they felt like it. I once drove an entire stretch from Ohio through Illinois with a non-working instrument panel - I had no idea how much gas I had left or if the engine was overheating etc. The only thing that worked faithfully was the tachometer - so I used to guesstimate my speed based on engine revs and which gear I was in (e.g.: 1800-2000 rpm in 5th gear was roughly 35 mph).

Since the instrument panel worked erratically, the odometer didn't always run either. I had no idea about the true mileage of the car. These things sorta start to matter because you start to imagine scenarios like where your pistons ram through the camshaft because of a timing belt that wasn't replaced at the 'appropriate mileage' or busting a strut because of not having a safety inspection done at the 'appropriate mileage' so on and so forth...

It took me on several 1000 mile trips (and helped me move between two apartments. How I managed to cram my clothes, utensils, computer, stereo system and books and transport them thousands of miles, I alone know). It lasted through some of the worst winters Buffalo threw at us. It saved my ass during a real bad 75 mph spin out on the I-55.

That piece of junk lasted till 2007. I was driving home after my 4th 12 hour night shift in a row. I entered a school zone and with kids around, hit the brakes to slow down. Pedal went all the way to the floor but the car kept going. I used the gearbox to slow down to the point where I could yank the emergency brake. Thankfully, it worked and I was able to stop the car. By then I was wide awake and terrified.

I upgraded to a Honda within 2 weeks after that incident.

So, that was my "school car". What was yours?

Thursday, August 28, 2008

Secret Santa

Yeah, I know it's a little "early" to be making posts about Santa Claus and Christmas, but I just ran across a post from Terry over at Counting Sheep (check her out y'all) that reminded me about something.

You see, I do not observe the holiday, but it sure is important to most of my coworkers.

I have the exact same opinion about this holiday. I'm not a religious person and don't observe any religious holidays - the only holidays I actually care about, for sentimental reasons are Independence Day and New Years...

...And my birthday - well, it's not recognized as a holiday just yet but I'm working on it :-p

But I know how important this holiday (and Thanksgiving) is for many of my co-workers. My experiences with my first job at a Mennonite hospital in a smallish town in the middle-of-nowhere-midwest-America just solidified the whole thing.

So I always volunteer to cover someone else's shift for Christmas and Thanksgiving - even if it's not my turn.

The way I see it: I get paid time and a half and someone gets to stay home and spend that time with their family/loved ones.

It's a win-win solution as far as I'm concerned. :-)

The more I think about it...

... the more I realize what an awesome thing it was for me to push off from "The Toxic Environment" (aka Old Job). The people I worked with were awesome but the job in itself sucked the life outta me.

I sit here nursing a beer, thinking about all the amazing things I've done since I left that job - all the while knowing that I've barely scratched the surface! I sit here thinking about how I'm working a much busier and more intense environment (my feet hurt like they've never hurt before) and yet don't feel as desolate and run down as I used to.

There exists a greater scope for teaching - be it patients, new grads or EMS students - something that I greatly enjoy.

I'm challenged here - both physically as well as mentally/professionally and I'm surprised to find that I like that. More is expected of me and I find that a little exciting.

So yeah, I guess I ought to thank my sister-in-law (was her idea for me to come down here).

Tuesday, August 26, 2008

Only in the ED?

ER Nursey blogs about "The naked man in the church" and discusses her sentiments about the episode, wondering if her years in the ED (Hey! I'm learning Dr. Whitecoat!) trenches haven't dulled her sensibilities to shocking human behavior.

Her story reminded me of a shift barely 3 nights ago. Along with the rest of the ED staff, I was treated to the spectacle of a drunk busy jerking off despite being placed in a visible room for observation because of 'suicidal ideation'. He knew he could be seen by others but he just didn't care (no, he wasn't that drunk either).

By the end of the shift, drunk guy and frequent-flyer-drunk-screamer-bitch girl in a near by hall close view bed were overheard sharing tips on scoring easy dope and evasion tactics. One of the senior ED nurses stopped and said (in a voice dripping with sarcasm): "Awww! Love is in the air. Those two are hooking up. Isn't that sweet?"

Of course, what I'd witnessed was within the confines of the ED while ER Nursey's was on decidedly more public (and if you wish 'hallowed') grounds. Still, I couldn't help but think .... "only in the ED."

Sunday, June 8, 2008


I don't like creepy crawlies.

It's not like I get freaked out over 'em.
But they do disgust me.


Over the past few weeks, I've been noticing a few creepies around my apartment. And the incidents seem to be increasing each week...

Usually, I simply find a sandal and quickly squash 'em to death. And then dispose of 'em.
But it annoys me that I have to do this.

Again - I DO NOT like creepy crawlies.
I know they serve a purpose in nature and all that - but they can serve their purpose outside my apartment thankyouverymuch.

Ugh! Blech! Urk!

Saturday, June 7, 2008

Working short handed...

We had six call-ins today.

With a heat-wave passing through the region, I kinda figured it was gonna be "rough" today anyway... but with the call ins ... man! Heat stroke, chest pains, MI, severe dehydration and others ... you name it, we got it.

At times I was tackling 10 patients at a time.
And I'm just a rookie!!
If it weren't for the expert (and often silent) assistance of my preceptors and colleagues; I'd have never made it through the day! I'm SO in awe!! There's a couple of 'em especially that... someday... y'know... if I ever become 1/10th the nurse they are; I'd consider my nursing career in the ER a success.

Know everything.
Seen everything.

Can do anything...

Wow! And I mean "WOW!"

Friday, June 6, 2008

Feeling hot hot hot!

Was a rather hot day today and it's only gonna get worse over the weekend.

I suspect a rash of AMI/heat strokes to pay us a visit.

Only gonna get busier...

Gallows Humor

911 Doc over at MDOD made a post about the O sign, the Q sign and the dotted Q sign.

Reminded me of this list:

Most of the definitions on the following lexicon of medical slang appeared a few years ago in the National Lampoon. Some of the definitions are funny. Most are sick. All are used in respected hospitals.


BOBBING FOR APPLES: Using the finger to unclog a severely constipated patient.

F.L.K.: "Funny-looking Kid."

F.L.P.: Parents of an F.L.K.

CRUMP, GORK, VEDGY: A patient requiring intensive care, incapable of movement, and apparently unaware of his surroundings.

HORRENDOPLASTY: A difficult and time-consuming operation.


CROCK: Hypochondriac.

MARRIAGEABLE MONSTER: A young female patient who has successfully undergone major plastic surgery.

GOMER: A senile, messy, or highly unpleasant patient.

FASCINOMA: A "fascinating" tumor; any interesting or amusing malignancy.

DROOLER: A catatonic patient.

CUT AND PASTE: To open a patient, discover that there is no hope, and immediately sew him up. Well, almost immediately. Sometimes young surgeons practice surgical techniques for a while first.

FOUR F-ER: A gallbladder patient. "Fat, forty-ish, flatulent female."

PINKY CHEATER: Latex finger cover used in gynecological and proctological examinations.

ROAD MAP: Injuries incurred by going through a car windshield face first.

A HOLE-IN-ONE: A gunshot wound through the mouth or rectum.

THE "O" SIGN: The letter O as formed by a patient's gaping mouth.

THE "Q" SIGN: A patient giving the O sign with his tongue hanging out.

THE DOTTED Q: The "Q" sign, with a fly on the tongue.

SIDEWALK SOUFFLE: A patient who has fallen from a building.

LOOSE CHANGE: A dangling limb in need of amputation.

BULL IN THE RING: A blocked large intestine.

GONE CAMPING: Reference to a patient in an oxygen tent.

EATING IN: Intravenous feeding.

BORDEAUX: Urine with blood in it.

SCRATCH AND SNIFF: A gynecological examination.

ANGEL LUST: A male cadaver with an erection.

HIT AND RUN: The act of operating quickly so as not to be late for another engagement.

CAPTAIN KANGAROO: Chairman of a pediatrics department.

ROOTERS: Indigents and hangers-on who gather in big-city emergency rooms in order to be entertained by legitimate cases.

SHORT-ORDER-CHEFS: Morgue workers.

LOOP THE LOOP: Flamboyant surgical rearrangement of the intestines.

BUGS IN THE RUG: Pubic lice.

HEY DOCS: Alcoholics handcuffed to wheelchairs in big-city medical wards who, at the sight of a white coat, bleat out in chorus, "Hey, Doc!"

BLOWN MIND: Gunshot wound to the head.

ICING ON THE CAKE: Lethal tumor discovered in the X-rays of a heart attack victim.

THE GARDEN: Neurosurgical intensive care ward, so called because of the "vegetables" found there.


THE DEEP FRY: Cobalt therapy.

ROASTED GOOBER: A tumor after intensive cobalt treatment.

HEALTHY GOOBER: A dead patient.

BURY THE HATCHET: Accidentally leaving a surgical instrument inside a patient.


SQUASH: Brain.

GAS PASSER: Anesthesiologist.

CRISPY CRITTER: A patient with severe burns.

There! I just gave away our trade secrets! :-p Y'all got any more additions?

And as usual there were some folks who couldn't:
1. Read
2. Take a hint

... and complained about what a bunch of evil, uncaring bastards we were.


Saturday, May 31, 2008

I think I'm gonna like it here

Pt. came in c/o of severe vag bleeding over the past 2 months or so. Was feeling weak, nauseous and generally "ill". ER doc talked to OB and had pt. put on their list. She was going to be admitted to OB.

As I am still orienting, I asked my preceptor "C" for help as I was about to go into the pts. room. As I was about to enter, a lady walked out and in passing told me, "Oh, her pads were soaked. So I cleaned her up a bit and changed her".

As I'm setting up supplies to draw more blood for lab work, I casually asked C "So, who was that?"
"Dr. O. She's an OB attending".

*Blink Blink*

"Did you say attending?"
"Yeah. Why?"
"Nothing", I stammered; "I'm just not used to having docs - especially attendings - clean up patients... I guess".
C shrugged her shoulders, "It's different down here".

I guess it is. I think I might actually like working here...

Speaking of different and cleaning people up, The Chief Complaint of the day award goes to:

"Soiled himself. Here to be cleaned up".

No, it wasn't my patient and I wish I had the time to look up further details [or not. HIPAA violation, non?]- but that really was the "Chief Complaint" as entered by the triage nurse into the system.

And no, I'm not making that up...

Saturday, May 17, 2008

The Things They Carry

"Hey Spook! You're back so soon?", teased J.
I snort. "I live here. I eat out of the vending machines and shower in the ER decon room. Didn't you know that?"
J rolls her eyes. "Yeah right! Seriously though, you need to take it a little slow. Don't be no hero Spook. I don't want you burning out on me".

I chuckled at that. Those were the exact words I used to admonish J, chiding her for working too much overtime.

It wasn't that simple - or maybe it was and we were just too young, too naive and too dumb to see it. Working night shift on our floor was dreadful - since we were always understaffed, constant calls from managers and charge nurses begging us to work an extra shift (or two or three) was "routine". Neither one of us bothered to make out a schedule since it kept getting changed every other day. Nor did we bother asking for time off because we'd be treated to the whole pouty, whiny drama of our chronic staffing problem. In fact, staffing is so bad that over 90% of the time, HALF the nurses working nights on the floor were float pool nurses.

"Yeah well, not before your wedding anyhow. I mean, someones gotta eat all that ice cream!"
J poked her tongue out and made a face. We both laughed.

I took a quick look at the assignment sheet and compared with the patient board. We were both split and had patients all over the floor. Not only that, but I saw that the patient assignment was patchy - people had simply been put into whatever room was available. I let out a short whistle, "Wow! This is nuts. Musta been really busy today"

RM, one of the second shift nurses answered in a tired monotone without looking up from the computer screen, "15 surgicals, 14 discharges so far Spook. We're not done yet, since 3 of 'em are still down in PACU. It was a freaking revolving door up here today".

"Damn! We're full." I sigh. "I bet that makes the suits happy... wait! MS is back??! Didn't she just get discharged last week?"
CM, another evening shift nurse looks up and says "she was my patient. Didn't listen to report yet? Just want me to give a verbal?"
"Yeah sure. Lemme grab my stuff and I'll be back".

I hurry over to the staff room and get ready. CM plops down on the chair in front of me. She looks beat. Tired. That’s a bad sign – no matter how bad the day got, she was usually very cheerful.

“C, hang on a second”.

I get up, go over to the counter and get a glass. I fill it with cool water and hand it to C.

“Here, drink this”.

She looks at me. Her mouth forms no words but the gratitude in her eyes is genuine.

Glass of water never felt so good huh? When was the last time you had an uninterrupted 10 seconds to have a glass of water? Musta been a real bad day…

“C, listen to me. I want you to give me report, put your stuff in your locker and go straight home. Don’t worry about if you did this or that. Leave it to me. Clear?”

C nods her head, too tired to argue or protest.
Quietly, I take report.

There’s a lot to be done. 3 dressing changes and two IVs that need to be started... besides the other assorted "usual stuff" - assessments, med passes, chart checks etc. etc. etc.

A couple of hours into the shift and progress was bitter and slow. Soon as I finish one job, two more seem to appear. It seemed more and more likely that I wouldn't be able to leave on time at shift change.

I was scurrying back to the nurses station to gather supplies to try and start a line on someone else’s patient when I passed MS’s room. I thought I heard quiet, muffled sobbing. The door was barely ajar and the room was dark. I paused.

There it is again! What’s going on? I knock softly and tip toe into the room.

MS is lying in bed, with tears streaming down her face. Crying and sobbing. The trained professional part of me quickly analyzes her for any obvious signs to explain her discomfort. I see no obvious signs. I quietly walk over to her bed and sit down at the edge. I take her hand in mine and give it a gentle squeeze.

We exchange no words. I sit quietly while she cries.
Finally, she blows her nose on a tissue and looks at me with bloodshot, tired eyes and a worn, haggard face.

“I’m sorry”.
“For crying? Don’t ever be. Human beings cry.”
“I’m scared. I’m hurt. I don’t know what to do”.

Silence. A pause.

“I just got off the phone with Dylon. My older son. We had a fight…”
The tears begin again.
“We had a fight and he hung up before I could soothe things over. It was over *sob* a stupid cell phone bill. *sob* Now I’m trying to call him and he won’t answer his phone. I just want to tell him that it’s OK. That I still love him. I want to hear him say it. I want hear him say it. I want to hear him say that he still loves me.
I’m lying here and my kids are by themselves out there. I’m such a bad mother!”

She’s crying again. I don’t say a word. Just slowly stroke her arm. My pager starts vibrating. I hurriedly turn it off.

“MS, kids are resilient. He’ll turn around.”
“I know he will. He’s my boy after all”. A wry smile. “But will I have time?”
We both look at each other. The anguish on her face is unmistakable. I lean over, wrap my arms around her frail, disheveled body and give her a gentle hug.

And I just sat there as big fat tears rolled down her cheeks and wet my shoulder as MS cried her heart out.

After what seemed like an eternity, she slowly pulls away and wipes her tears.
“M, nobody knows the answer to that question”.
A wan smile. She nods. “Yes. That’s true, isn’t it?”

“Thank you for sitting with me. I know you have other patients who need you”.
I squeeze her hand and smile. “I’ll be in shortly to check on you, OK?”

I slowly turn around and walk out that room.

Here lies MS. A woman barely into her 40s. Trying bravely to raise her children the right way, all by her lonesome self in this world full of people. Who has just been told today that her cancer is terminal and has spread to her liver, lungs, pancreas, stomach, intestines … everywhere. Who despite her constant physical pain and the suffering brought about by cancer treatment, still worries about being a bad mother.

A tear rolled down my cheek.
Then a second.

How wretched is human suffering!

I walked to the desk on autopilot and sat own. Put my face in my hands and closed my eyes; trying to clear my head. Somewhere in the distance, a part of my brain is trying to tell me the phone is ringing but I’m powerless to act.

I feel a hand on my shoulder and look up.
“You ok, Spook?” asks J.
I smile and nod my head. “Allergies”, I lie.
She smiles. She knows it’s a lie and that I have no allergies, but lets it fall for now.

Deep breath. A shake of the head.
Back to work…

Update: MS finally passed away on September 8th. She was at home, with her family and friends.

Friday, April 4, 2008

Reap as you sow

Had to happen, sooner or later.

It is the 410-bed hospital in Blue Island that nobody wants. Even for free.

In a stunning development underscoring the plight of non-profit hospitals struggling with the increase in uninsured patients, the Catholic ownership of St. Francis Hospital & Health Center on Wednesday said it will shutter the hospital because nobody would buy it.

The religious order of nuns that oversees St. Louis-based SSM Health Care said it could not even give the hospital away to other health facilities "for free."

Saddled with tens of millions of dollars in losses from uninsured patients who could not pay their medical bills, St. Francis would be abandoning its core mission of caring "for the people of its communities regardless of their ability to pay." SSM will seek a closing application with the state, a process that could take several months.

This particularly strikes close to my heart because the earlier institution I was working for was a not-for-profit institution. Supported by an extensive parish and network of churches.

Brings me back to the argument that as bad as things are, who really loses if hospitals continue to run in the red? The answer obviously is "we all do". Not only are employees laid off, but now the community has to travel farther in search of health care.

TANSTAAFL - There Ain't No Such Thing As A Free Lunch.
Immutable law of economics.


A fact all those clamoring for "universal care" (etc.) do not seem to understand: you can't force someone to provide anything - be it a product or a service - for free. The insurance boondoggle is bad enough as it is... without the added stupidity of government rationing (which is what will happen under socialized medicine, er sorry; "single payer healthcare").


Photobucket Dr. WhiteCoat at WhiteCoat Rants. Y'all head over there and check it out...

Monday, March 31, 2008

First impressions

Took a "quick look" around at my new job site today.

Patients lining the hallways. Folks bustling about, in and out. Didn't notice the phones going off the hook constantly. Seemed chaotic but orderly at the same time.

Welcome to the ER? I guess.

Still have paperwork and stuff to do. Orientation doesn't start for a couple weeks.
Everyone's warned me - this place ain't no cake walk. Very busy. Sees a high volume of patients all the time.

I understand the concern, but deep down inside, I'm confident. As long as I have adequate support, I'm confident I can hack it. I know there's lots of "adjustment" and "learning" I have to go through; and I'm willing to give it all I've got.

The good thing is that everyone seems to like working there, as busy and chaotic as it gets. Hope I fit right in :-)

Moving is a pain in the butt


It took me a freaking week to clean up my one bedroom apartment, load all my crap into my car

and drive it all over 1500 miles to my new job.

Oh and there is one thing I re-learned (I guess I forgot after my last move) - when driving long distances, there is only so much music you can listen to! Sheesh! Talk about boredom!

And speaking of car - I love me new car! :-) After driving a 14 year old, crotchety Plymouth Neon with non-working guages worn out brakes and tires and pathetic fuel economy... me likey the power, zip, handling and 500-miles-to-the-full-tank aspects of the new car. Not to mention safety features and gizmos up the wazoo!

Getting back travelling: I will say this though - if one is so inclined to go "off the beaten path" every once a while, this wonderful country will reward you. Not only did I get to see breath taking scenery on the way, but I also had the pleasure of running into some absolutely outstanding folks on the way: from the owner of a breakfast diner who gave me a meal on the house after looking at my tired, bloodshot eyes and weary face to the kind folks who let a complete stranger (me!) into their home (and outta the rain) so that I could stop someplace dry till the weather cleared up.


I couldn't fit everything into my car, so I packed some of it and sent it with UPS. Still awaiting some of my boxes to show up. Staying with extended family for now.

Time to find an apartment, yes?

Thursday, March 20, 2008

Stuff White People Like

I about wet my pants laughing. Photobucket Photobucket

NOTE: It is 'humor' of a different kind. Not for the overly sensitive or bashful. It's definitely not PC. Don't say I didn't warn you...

Monday, March 3, 2008

D minus 11 and counting...

March 14th, 2008.
My last day working my soul killing job.

I need to haul ass and start cleaning up my apartment ... and stuff. But I just don't have the motivation ... for now. I just want to relax, take a deep breath, catch up on some sleep.

But yeah, it was like a huge weight being taken off my shoulders. Actually manage to smile and be cheerful at work these days.

And in other news, I met someone who kinda said and did something that totally made my shitty week seem less shitty. Stay tuned for that story...

Friday, February 22, 2008

The 2 weeks from hell

Man! Shitty assignments all around. Really sucks at work right now. My ass is dragging trails in the snow.

Plus the two teeth I did my root canals on last December have been hurting like a son-of-a-mother. I've been popping Motrin like crazy. I can't get an appointment at the dentist sooner than next month (perfectly coinciding with what I anticipate to be my moving time to my new job. Super!)

The last time this happened, I had a colossal infection in my gums and needed 3 weeks worth of antibiotics to clear up. I am really not looking forward to a repeat episode...

Not that it makes any sense - I thought when you did a root canal, the root is desensitized - permanently. How the hell can it possibly hurt there, I'll never know.

All I know is that even a sip of "below room temperature" water sends shooting streams of agony throughout the jaw and the right side of my face ... and this being winter, I can't even let cold air hit that side of my face. I've been warming everything up and tilting my face to the left and drinking/eating in small morsels at a time.

Bah! I can't eat. I can't drink. Hell, even breathing cold air through my mouth hurts.
Tooth aches and ear aches suck! Suck! Suck! :-(

I'm beat. I'm back tonight for another 12 then I'm conking out. I'm gonna turn my phone off this weekend and go on a real bender. I hurt and ache in places I didn't know existed.

Thursday, February 7, 2008

Woo Hoo! Go me!

I got that ER job I was looking for.

It's in a different state, so I need to transfer my license. And while that's going on, I'm still going to continue working (hey! I need the money!)

It means I have to re-locate (again!).

But it also means I won't be working my soul-killing, strength sapping job anymore!

My charge nurse was absolutely devastated when she found out I'd found a new job. Guess the old saying "you don't know what you've lost till it's gone" is true after all! Now if only they'd appreciated my work all along, this might never have come to pass. Oh well!

I feel a twinge of guilt for leaving some of my work buddies behind. I'll miss them.
I'm a little nervous about moving - will I make it? Will I be able to hack it?

Truth be told, I'm sorta looking forward to it. It's been kinda lonely here in the boonies.

Sunday, January 13, 2008

Why the hell didn't I do this sooner?

I updated my resume on Monster.

Within like a day or so, I have concluded 4 different interviews for jobs ranging from ED to ICU and OR. I even spotted an opening for a flight nurse out in Juneau, Alaska!

Left me scratching my head - why the hell didn't I do this any sooner? I was so dumb for sticking with my stressful, deadbeat job. For some stupid reason, I wasted months trying to change departments in my hospital - never occurred to me to look elsewhere!

I think I just overcame my resistance to moving again (I've been here just a year and half). Health and sanity won out over temporary comfort and aversion. Besides, I've been thinking about it - I need to go back to school and get my masters (or beyond!) I need to get cracking - or life's just gonna pass me by.

No time for losers, You make the call
Believe in yourself, Stand tall!
Another day, it's in your hands
You can be the winner, in the end.

Keep runnin' don't look back
Keep movin' paint it black
Keep goin' don't ever stop
There's time to rest the day you'll drop
-- Klaus Meine, Mark Hudson

Ciao! Of to watch the Sabres game I recorded on DVR (whilst I was busy making sure confused old ladies with new hips didn't injure themselves falling out of bed).

Monday, January 7, 2008

A Day in the life


What a WEEK!

Tuesday noc (noc=night)- 16 hour shift. 7 patients (6 post-ops + one confused/agitated, non-restrained patient). One tech.
Wednesday noc - 16 hour shift. 7 patients (3 post ops + 2 admits + same confused dude). NO TECH!
Thursday noc - 16 hour shift. 7 patients (5 post ops + 1 admit + still same old confused dude). One tech (who is so useless, might as well be considered NO tech!)
Friday noc - 12 hour shift (I was scheduled for an 8). 6 patients (5 post ops + confused and now "combative" dude). NO TECH!

And to top it all - we have no "charge nurse" for night shifts.



Tuesday night was the first time the Day Shift charge nurse (we have charge nurses from 7a-7p) handed me the "charge nurse phone and keys". Floor nurses carry pagers and narc keys ("narc keys" are used to unlock PCA (Patient Controlled Analgesia = patients get to push a button when they think they need some pain medication and a pump set up within controlled parameters delivers medication as needed) pumps. Charge nurses carry a phone accessible by anyone and from anywhere in the hospital and special set of keys (for elevators, supply cabinets, sure med, crash cart alarm unlock etc).

Turned out to be a good thing too. Because we ended up having to call a "Rapid response" (instantly call upon an RT [Respiratory Therapist] and an ICU nurse with standing orders and leeway to treat patients) on a freshly admitted patient from PACU [Post Anesthesia Care Unit ... where folks who've just had surgery are stabilized before being sent up to the surgical floor] - who ended up becoming "unresponsive" just as she was being wheeled out the elevator to the floor.

Wait, it gets better. I marched over to assess situation. It was tense, but we were handling it... but I had an uneasy feeling about the whole deal. Clinically, the patient was in "distress" but my gut was sending me all kinds of funky signals.

So now, of course; patient chooses to slip into "unresponsive to pain" status....

R-Triple-D! {Army talk for "Really-Deep-Doo-Doo}.

Called a Code Blue. Ran over and dragged the damned crash cart all the way across the floor and by the time I reached the floor, RT and the ER doc were there. Hung around to document till House Supervisor showed up (poor girl, was already tied up with a Rapid Response on medical floor!) Handed over charge to her and then raced back to pass meds on my post-op patients (Antibitiocs, HS {HS= Latin for 'Hora Somni' = bedtime} meds, Accuchecks {checks blood sugars} and HS insulin) all the while fretting about my confused dude. Mercifully, he was confused and naked but apparently had decided to stay put in bed for the moment.

By the time I got done with all this, my code patient had been successfully intubated and revived. I arrived just in time to see her being wheeled down to ICU.

Naturally - this left me playing catch up all night long. I don't know how I managed, but I managed to stay on top of patient care (while neglecting charting) till I could tape report.
Ohhh, did I mention that I had to go to a staff meeting at 0730 in the morning? And at this TWO HOUR (#*&&*^Y$) staff meeting, we were literally "read" power point slides. What a colossal, monstrous waste of time! Did they really think we couldn't read from handouts? What is this, grade school??!! Here I am, atleast 2 hours of charting ahead of me, wasting time listening to this nonsense! &*!^&$@!#!

I managed to stay awake through charting and somehow drove home. I don't remember what I ate (or if I ate at all! I was beat!) but I do remember that I couldn't sleep - damned lawn mowers kept me awake!

I finally managed to sleep 3 hours - and I was back that night.
Other than the fact that there was no "code" or "staff meeting", my night was a repeat of the night before. Too many sick patients, not enough staff.

Once again, dragged myself home.

Thursday night, post 4 hours of sleep. Not entirely bad - except for one of my post op patients who has some kind of weird fixation with his Codeine allergy. Pt. is a fresh Total Knee Artho (total joint replacement of the knee), with a measly Femoral block in place running Ropivacaine 0.2% @ 10/hr. Naturally, he starts complaining of pain into the noc. I try to convince him to take the MSO4 (Morphine) PCA as ordered. He refused - along with refusing the Dilaudid, Fentanyl and Toradol. He became infuriated with the "scheduled" med times and proceeded to fling a book across the room in anger, called me an "good for nothing, idiot SOB who doesn't know a thing in the world", threatened to leave AMA and/or sue/complain about the hospital and his "substandard level of care".

He wasn't thinking rationally nor clearly. He wasn't altered mentally in anyway - but it was patently obvious he had received little to no pre-surgical counseling (and given his surgeon, I was not surprised!) or he was a general insufferable idiot "know it all" (or a combination of the two).

I was close to blowing a fuse myself, but somehow maintained control, managed to calm the pt. He ended up calling the surgeon's office in the morning and lodging a personal complaint! Long story short, I made sure I documented the heck out of that incident and made sure I had collaborating evidence of my numerous attempts at making him "try" alternative medication for pain control (along with supporting statements from other floor nurses).

During all this time, did I mention the fact that I had 6 other patients? Including Mr. ConfusedandIwouldlovetoclimbouttabed ? Who did, end up rupturing one of the lines in his dual lumen PICC thanks to his constant meddling and poking?

Dragged myself home. Got about 6 hours sleep. Back on Friday noc.
Thankfully had "just" six patients. 3 post-ops and 3 others. One tech to stay with mr. confused.... which meant no tech for the floor. But I didn't care. Had to go down to the CCU (Critical Care Unit) and insert a foley in a patient and set up a CBI because apparently none of the nurses there (nor the house supe(ervisor)!) knew how to set up a foley with CBI (links to a PDF document) infusion! Most bizzare!

That's about my story of the week. Just had to get it off the chest.
Been super stressful.

Oh - and work wanted me to consider "coming in for 4 hours to cover 7p-11p". I practically told them to 'shove it' (politely of course!)

Wednesday, January 2, 2008

What it is....

I've been a fan of Mark Knopfler and "Dire Straits" for longer than I can remember.

In fact, Dire Straits' album: "Making Movies" - was the very first rock album I heard (even before "Dark Side of the Moon").

I've always appreciated the songwriting/storytelling nature of their work (e.g. Private Investigations, Telegraph Road, Tunnel of Love, News, You And Your Friend, Local Hero, Single Handed Sailor, Brothers in Arms etc.)

What/who was the first artist you remember listening to as a youngster (an artist you have formed a life long affection for?)