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

Bugs

I don't like creepy crawlies.

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

Mightily.

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.

Six.
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.

Cool.
Collected.
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.

BAG, BOX, COOL, STIFFEN, X: To die.

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.

BOOGIE, GOOBER: A tumor.

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.

SILVER GOOSE, SILVER STALLION: Proctoscope.

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.

Meh!

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.

[RANT!]

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").

[END RANT!]

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