The mysterious boomboom

I decided not to go out and get wasted tonight as I promised. Sleep troubles and after-dinner espresso (a lovely night on a rooftop patio, complete with cider beer and dinner) last night caused me to be up until 3 am. I woke up at my usual time for work in a state of delirium having to acutely evacuate my bladder, experiencing non-alcohol-related dry heaves. WTF?

I was ready for bed at 2000 this evening, but I've been chugging along as to not disrupt my sleep schedule. I can't watch TV and stay awake. TV on=Nurse K's brain insists on sleeping.

What I'm saying is that my insistence on staying awake coupled with my perceived inability to do anything that requires physical exertion or excessive physical inexertion (ie TV) will allow me to write one more post.

Girlvet is now posting as "boomboom." It's okay to change your handle. No big whoop. However, yesterday someone named 'boomboom' posted a comment on this post.

boomboom said...

I would love to talk to them and knock some fucking sense into them at the same time. They deserve a good beat down. They are nothing but Marx loving communists who want to turn this country into a socialist state. Nurse K, good luck on getting wasted. You deserve it after dealing with these money sucking morons!

June 28, 2007 10:47 AM

Hm. Interesting potential for analysis here. Girlvet changes her handle after she shuts down her blog because of me, doesn't tell me it's her and writes an encouraging crass comment in a voice dissimilar to her usual (a voice consistent with a drive-by commenter who'd never read my blog) that comes out in support of...fiscal conservatism and beat-downs (a couple of my favorite things)?

You're still welcome here, Ms. Girlvet. No need to hide from 'ol Nurse K. No need to change your handle or voice or whatever.

I don't bite....hard. Well, okay I do, but that's none of your business.

Public service announcement

Girlvet's blog appears to be...back?

You people need to get over yourselves and get a f*cking life.

Yes ma'am.

Welcome back, Girlvet!

Signage for Monkeygirl

Monkeygirl says:

Oh. My. God. Do you have a neon sign somewhere that says "Crayzees come here ========>"?I swear, you attract 'em like flies!

June 29, 2007 9:54 AM

Why yes, in fact I do, Monkeygirl, thanks for asking. I wonder if having this hang in my window is contributing to the problem.

NURSIN THUGS HAD TO REG-U-LATE

NURSIN THUGS be linked hardcore by Kevin, M-Dizzle today. Anonymizzle commenterz be trying to STRAIGHT TRIP all up in my comments like they own da joint, noamsayne? When peeps be runnin they's moufs, Nurse K has to reg-u-late. This is my hood between the 21 and Lewis, and I's gots ta keep the trash from fallins out the can, noamsayne?

Sixteen in the clip and one in the hole
Nurse K is about to make some bodies turn cold

It's on now, Gs. I got a firm grip on da BANDAGE SCISSORS 'o DEATH, and I done decided that I only allowzin' non-anonymizzle comments from now's on. You's gots to git a Blogger Log-In. You can calls yo-self "NURSEKSUX" if you's want, juss so you get yo-self a handle. In fact, if you chose NURSEKSUX I'd think it wuz kinda funny, and I'd laff wiff you, not atchu.

NURSIN THUGS BE REGULATING. Fo yo infomizzle, the next stop is the Eastside Motel. Bess not be tryin' to be all anonymous up in there too.

Today's fun fact

It's a little dated [see info under the heading 'Welfare and Poverty'], but I found this somewhat interesting and is consistent with what I've been saying about the 'dependant class' we've created in this country:

There is evidence that welfare itself may prevent people from moving out of poverty. Richard Vedder and Lowell Galloway, for example, found that only 18.3 percent of poor people receiving welfare benefits in 1987 moved out of poverty, while 45 percent of poor people who never received welfare escaped poverty.(15)

This is from a 1992 study:

(15) Richard Vedder and Lowell Gallaway, "The War on the Poor," Institute for Policy Innovation, Lewisville, Tex., June 1992

Hm. Those who took it upon themselves to get out of poverty....got out of poverty? Odd logic there.

Ineffective Individual Coping

Woooahhhhah.

Be sure to listen to my personal favorites (1) The Incontinent Rag (2) The Girl With Emphysema and (3) Scabies.

All songs safe for work; in fact, why not fire 'em up around 4 am tonight?

Doc, your work-ups are shredding my will to live like cheese to a grater

His work-up tends to be head-scratchingly detailed and take up a lot of staff resources and time relative to the presenting complaint, so much so that I often have to ask the doctor if he ordered tests on the wrong patient. We even have a made-up word we use to lovingly indicate his work-up is in process.

I don't want to complain too much because I like our pseduonymous Dr. Marvin, but here's a doozy fer ya:

A 30-something otherwise healthy lady comes in with what appears to be musculoskeletal back pain, of which she has a chronic history. The UA micro to rule out kidney infection is negative except for something like 2 RBCs detected (it was the smallest number that would make the speciman "not negative". Tapping on her back caused no significant increase in back pain.

2 RBCs: That means she needs a CT of her kidneys to rule out a pyelo or other cause for the RBCs. There is no simple work-up.

Then Dr. Marvin reminds the medical student to be sure to write "microscopic hematuria" on the "conclusion" section of the paperwork so that "the hospital gets paid for the CT."

Have we really come to the point where a 30-something patient with 2 RBCs seen microscopically needs a CT scan for that reason alone? I know I'm not a doctor, but....come on, now.

This simple back pain case was in the ER....4 hours.

While we're at it, I'll tell you the most head-scratching Marvinizing work-up of all time in my experience.

18-year old comes in with malaise, mildly elevated fever and body aches. Her head hurt a bit, her belly was a little sore, and her legs were achy along with her back and other muscles. Nothing beyond a couple of days off of work and a little extra sleep.

Work up/treatments:
Head CT to rule out head bleed or tumor
Bilateral venous dopplers to rule out DVT due to sore legs in an 18 year old with no risk factors and no leg swelling
Abdominal CT with PO contrast to rule out...whatever because it was a little sore diffusely
2mg of dilaudid IV push, yes 2 mg (I gave 0.5 only, thanks)
Fluids
Zofran
Full panel of labs
Chest XR
Urine sample

I try to not argue with the doctors TOO much, but I really got into it with Dr. Marvin over that particular work-up.

If only they were all like Little Man

I picked my kid up from daycare today and he had that somber look on his face...the one that I see only with the malaise of childhood illness.

I feel like I'm gonna throw up. And I have a headache.

I got him home, perched him on the couch in front of Spongebob and he laid there quietly.

I put the thermometer in his mouth and midway through he started crying while simultaneously trying to keep his mouth closed around the thermometer.

What's wrong?

I think I'm going to throw up!

And, yep, he didn't make it to the toilet. Imagine peppermint bon-bon diluted with water. [He denied recent ice cream or "bright green food" consumption]

Of course, Little Man isn't melodramatic and isn't playing to a crowd. He looked like an actual sick individual...pale, sparse spontaneous conversation, mental energy focused on not puking.

A little later, after a few more peppermint barf-barf episodes: Little man, do you want to cuddle with mom?

"No thanks, Mom."

Would you like some juice?

"No thank you, Mom."

Would you like some soup?

"No thank you."

Would you like to go to bed early?

"Yes, ma'am. I don't want to read a story tonight. I think you should give me a garbage can."

Poor Little Man. While he's not a 'patient' because I'm his mom and not his nurse, I just wish all patients were as polite as he is, even while feeling crappy.

Note: His PUBLIC charter school got him going on the yes ma'am business. There's a waiting list a mile long to get in. hehe.

Note to drug addicts and people with poor coping skills

Licking Fentanyl patches will kill you.

Guess what? If your resp rate of 4 is cured with narcan, I will keep asking you what you took until you admit it and I'll look under your bosom for patches whether you like it or not.

I must say, being aware of the new trend in drug abuse--Fentanyl transdermal patch abuse--allowed me to ask her specific questions like, "Were you using heroin? No? Licking Fentanyl patches today?" Um...."Were you licking Fentanyl patches today?" Um...."We're not the cops, and all of your information you provide me is confidential....were you licking Fentanyl patches today?" Yes, Yes I was.

In the timespan of 1 hour, she went from doing laundry to unconscious with a respiratory rate of 4. Don't frickin' lick Fentanyl patches.

Whenever someone calls me a bigot, I can't help thinking about you....I have to get out of that habit somehow

High school graduation day, 1998


Dear Connie,

Yeah, so I have two Tylenol PMs on board and I can't sleep. I don't sleep well these days, so I'm stuck with an hour to two extra each day to think about stuff.
I'm sorry I wasn't there when you died. Really, it bothers me a lot still, and it'll have been 6 years in exactly 1 month. Wanna hear a secret? I miss you. My life sucks, I mean, not that badly, but I wish you were here to help me like you always did. Bethanie emailed me this past weekend out of nowhere asked if I knew your dad's phone number so she could check up on your daughter and see how she is, so after that happened, I started thinking about you again. Hi Bethanie!

Me? I suck. I haven't called your daughter or your sister for a LONG-ASS time. I'm sorry.

I still think I see you in crowds. I'll hear a song that we used to sing together in our apartment and wish that you were here to sing badly with me now....but I can't really say that I remember your voice. I still think you'll appear one day, looking tattered and stressed and apologetically confess to me that you'd planned an elaborate escape from...something and hadn't really been dead. I mean, it's not like there isn't precedent. You know what I mean.

What the Hell is wrong with me? You've been gone a long time now.

Love,

Your best friend, that bigoted honky white-trash bi-zatch ;-)

Crass-Pollination confession booth

I'm actually quite quiet at work most of the time, unless I'm educating my patients or discussing--gasp--patient care.

Unless it's night shift, then I'm making fake poop and crackin' jokes.

Day shift: All business. Fear of paper nurses prevalent.

Night shift: Nurse K comes alive. Lack of supervision leads to comedy.

Double espresso with steamed milk and 2 packets 'o sugar please

When I was in nursing school, we had some sort of feel-good-about-yourself management class where you learned how to be a "professional" nurse. One of the topics had to do with some sort of time usage or time management or something to that effect. Some professor somewhere had developed a scoring system to determine how many hours per week someone actually "worked" when you counted things like your job, child-rearing, school, etc. and each activity was given a score.

We filled out questionnaires on what all we did in a week, how many hours you worked outside of school, how many credits you were taking, how old your children were and did some sort of other survey on stress and grades and whatnot to see if more hours worked correlated with poor school performance or whatever it was they were looking for. Each person got a score. After everyone had their score, everyone stood up and then were asked to sit down when their score was announced, starting with the lowest scores (I didn't realize so many people didn't have a JOB during college---how do you live?).

Must to my surprise, I was the second-to-the-last one to sit down. I worked nearly full-time, went to school full time, had a "house" (read: Ramshackle mobile home) and a young child. It turned out, according to their calculations, I was working like 90 hours per week, and I think that was pretty accurate. That's not the important part of the story. The one who was left standing, the hardest-working girl in the class, was a chick whose speaking voice was about double normal volume and who constantly talked about her affliction and how horrible it was having this disease...

What was her affliction?

Wait for it.

Chronic fatigue syndrome.

[MonkeyGirl's cats reminded me of this story]

An ER two-fer

There are always people coming in at all hours of the day or night for their clinic visit....hey, my knee hurts and I have this weird taste in my mouth and my vision is blurry and I've been coughing for a month straight despite switching to light cigarettes and I want a pregnancy test and I vomitted once last week and blah blah blah.

Recently, we had the uninsured young man who signed in as "high fever, foot pain". The foot had been "rolled" while at a party, and he'd been walking on it for a few days. Although, that wasn't the primary concern: It was the pesky fever of 104 degrees.

He joked, he offered no specific complaint that would direct our work-up. No cough, no sore throat, no painful peeing, just general malaise. His ankle was bruised and swollen, but, like I said, he was walking on it. His parents and he were obviously not in the upper eschelons of socioeconomic status, but were nice. The hygiene talk for the whole group would have been appropriate.

Anyway, we had a good ER two-fer. Unrelated complaints of ankle pain and fever.

Final diagnosis:

Fractured Ankle
Pneumonia

I love my job.

NURSIN THUGS BE TRYIN' TO MOVE PRODUCT UP IN THIS MOFO

Yo, my bizatches. When you wizark in the E to the Rizzle, yo goal be to MOVE PRIZODICT. We stabilizzle and transfer or treat and strizeet, noamsayne? NURSIN THUGS be gettin all anxious 'n sh*t when docs be all up in they provizzerbial 6-4s doin' da gansta lean on they's leisurely Sunday drive chizillin' when we want them to be peelin' out in dat 6-4 gettin these peeps dispo'd 'n sh*t. Yo 6-4 should always be BOUNCIN', noamsayne? Move PRIZODICT.

Shadowfizzle be tellin you chumps how to move product and you BESSS be lissnings cuz them's be GOOD SUGGESHIZZLES.

When you be orderin' SCRIZEENING UAs on every MOFO up in the department whether they'd there fo chronic knee pain or fo chest pizzle, we think that order is BUNK and we be HOPIN dat you forgit that you ordered it cuz it be a lot of unnecizzary work be doin' that sheezy. I don't want to be takin' my patient off DA MONITA to walk thems to the bafroom for dat if they's don't have to gi-zo on they's own cuz that's when YOU KNOW gramma be havin' ST-elevization or brizadycardia...when they's in da bafroom gittin dat unnecessary UA. Thems tests also be tyin' up my department and keepin' me or my aide from doings IMPOH-TANT stuffs.

If you be ordering a CHEST C-Tizzle on every 30 year old femizzle who juss want a G to the Izzle Cocktizzle fo they's heartburn to check fo PE cuz they's be on birf contrizzle, I be grippin my BANDAGE SCISSORS o DEAF ready to strizike at any time. If they's be thowin' clizots cuz of they's birf contrizzle, they have some respiratory comprimizzle, noamsayne? 100% sats on Room Air. No PE wizorkups, please. DON'T MAKE ME STEP.

Also, don't be CALLIN every frizickin' doctor in da hood about a patient you's dischargin'. If you want fizollow-up, the PATIENT can call on they's celly fo they's follow up unless the fizollowup be URGENT like they's need to follow up in the MO-NING or sumfin. You don't needs to be tellin' the patient's M to the Dizzle that they's WILL be callin' fo follow up appointmizzle sometime dis week cuz it's 3 am in the mizorning and the doctor don't care that they be calling fo follow up. Dat sheezy just be wastin' time, ma neezies.

Listen to my neezy SHADOWFIZZLE and we won't think you's FRONTIN like a chump.

Purple Jesus

Assistant nurse manager on prison nursing:

We had standing orders where we could give the prisoners Tylenol, Motrin or Percogesic, and they'd say stuff like, "I have a head cold, can I get a perco--whateverthehellit'scalled?"

After awhile, people starting calling it 'Purple Jesus' as in "I got a headache, can I get a PURPLE JESUS?"

Either the patient was touched by God or he was full of sh*t

Triage, charge, and one of the floor nurses all, in succession, alerted me to the fact that the character in the lobby had been previously removed from the hospital for theft on at least a couple of occasions. His chart of ER visits rivaled my work schedule for number of appearances in ERs. Dozens of pain-related visits. And, of course, the designer allergy list.

The patient signed in as "fall from 4 stories".

Ohhhh....major trauma. Better get out there quickly after I refill my coffee.

The story was that he was doing some construction-type work on scaffolding and fell hand-first from the 4th story. This supposed event occurred 3 hours prior. When I asked how he got to the ER, he said his boss told him that they'd deduct gas money from his paycheck if they had to drive him to the ER. I said it was quite rude of his boss to leave him writhing in agony from a potentially life-threatening injury to find his own cab ride to the hospital.

Somewhere in between this major trauma and his arrival at our facility, he was able to consume a few cocktails according to the smell of his breath.

I put him in one of the psych rooms with the least amount of stuff to steal, in wheelchair, seemingly unable to bear weight. A careful external exam revealed no bruising, cuts, nor abrasions.

I thought I felt Him. God was here. A 4-story fall with no external evidence thereof.

We did numerous X-rays and a CT of the belly to rule out internal bleeding. I gave him 0.5 of dilaudid IV.

Then we waited. Tick tock. Xrays revealed no fractures.

Another sign of the divine. This young drug seeker had been caught by the hand of God.

Amazingly, after administration of the narcotic, he was able to walk nonchalantly up to the nurses' desk on a few occasions and ask for more "shots". Another miracle....he could WALK!

No. No more shots.

Tick tock. We waited.

CT result was negative! The most negative workup from a 4-story fall in the history of mankind. This leads me to believe:

Either the patient was touched by God or he was full of sh*t.

Please, drug seekers of the World: If you are just wanting pain meds, do not add a fanciful story of major trauma so our facility has to waste tons of dough on CTs and the like. You have some decency left, don't you?

Tragedy strikes local drug-seeker, film at 11

We have a patient around my age who everyone knows by name, including at least one of her known aliases who has TERRIBLE back pain. TERRIBLE I TELL YOU. She has a custom-designed allergy list that leaves options open for (1) dilaudid or (2) Tylenol. At some point, I counted all of her ER visits since adulthood and it was nearly 300. Her paper ER chart included 6 volumes of ER visits (each volume probably has 8-10 visits). Note that paper charts are taken to the "warehouse" after 2 years and are unavailable to ER staff on an emergent basis.

I heard around the campfire that she was in AGAIN (she'd been in a couple of days ago and seen her here a day or two before that) for "whatever" and wanted dilaudid of course. This is just a rumor, but I heard that somehow she pissed off the ER doc enough to obtain an IM dilaudid. And, holy God on Earth....she had a rash after the administration thereof. One person said "hives" another merely said she'd had a "rash". The stories differ.

You know what that means....she got a reaction to dilaudid after the start of the computerized charting where her allergies are documented for eternity and now dilaudid was added to the list, leaving, you guessed it...Tylenol.

The story from, supposedly, the nurse right there at the bedside included an animated demonstration of her crying, saying, "Don't take my dilaudid away from me!!!!"

WOOHA. WOOOHAHAHA. WOOOHAHAHAHHAAHHA. WOOOAHHAHAHAHAHAHOAHAOOOHWOAHWHAHAHAH. WOOHAHAHAHHAHAHHAHAAHHAHAHAHHHAHHAHAHAHAHAHAHAHHAHAHAH!

Rememba to check yo weapons at the gate, THUGS

When I went to da place to get me a new ORDER of PROTECSHIZZLE, the rent-a-cop done made me put my purse on the X-Rizzle machine to check 'fo weapons. I done put my purse all up on there and she do say, "You got sumfin in yo purse I's gonna hafta check."

She done took out my BANDAGE SCISSORZ 'o DEATH. Them's my stainless stizzle badass bandage scissors wiff ONE FLAT side to not damage da skin and anudda one to cut up some gauze or EKGizzle strips LIKE A M*DDAF*CKA.

I checked 'em like a chump, but my homegirl at the Xrizzle machizzle done put 'em up in a manizzle envilizzle so I done retrieved 'em when I was done. Whew! Close one. I thought my weapon be gone fo-eva!

I fronted and made sho' she think I juss a regular nurse who be forgittin' to puts her scissorz up in her locka when she done wid work 'o some lame-*ss sheezy like dat. I neva let on dat I was a NURSIN THUG and dat them's scissors was there cuz I be PACKIN LIKE A BADA*S.

NURSIN THUGS FO EVA BE FRONTIN' TO PRESERVE DA PEACE.

Socialists are okay at least temporarily when they're frickin' hilarious

Be sure to watch Grahamazon's self-made video describing eyes-only expressions in the OR. I saw the "#6" during this awful event, for example.

From the little experience I have with this sort of stuff, it seem the usual response to a #6 (the "Oh Crap" eye expression) is to lift your eyebrows and bug your eyes out and lean your head forward about a centimeter (perhaps in concert with a barely detectable shoulder shrug) to say "What, what is it?"

The doctor will then use his eyes (while not turning his head if possible) to aim the eyes in the direction of the "oh crap." The eyes may be bugged out a little bit as well to indicate a lingering sense of "oh crap." It is then the duty of the recipient of this message to figure out what the 'oh crap' is all about. Of course, if a serious 'oh crap' moment existed, the doctor would just say "hey, could you resuscitate the patient for me, Nurse, I'm sterile" or whatever.

Simple things to get whacked out mofos to give you a UA for drug of abuse

Since I'm talkin about the urine DOA screen (scalpel called it a UDS), may as well tell y'all the magic words to say to get someone who is refusing a UA drugs of abuse screen to piss in a cup for you. It's nothing other than obviousness, but I'll tell y'all anyway.

1) Give urinal to drunk patient. Don't mention DOA screen. Save piss. DOWNSIDE: 50-50 chance he'll pee all over your floor too. Many drunks or whacked-out mofos will vehemently refuse to pee in a urinal as well, causing a big argument.

2) If #1 doesn't work: Smile, be all friendly, ask about which bars are his favorites. Drunks LOVE giving shout-outs to their favorite bars. You'll be their new best friend. I used to be a cocktail waitress at a bar frequented by many people of all ages in my area, so I ALWAYS mention that too if it'll make 'em pee in a cup. Offer urinal for a sample right about the time they ask for your phone number because YOU THE PRETTIEST GIRL IN THE WORLD.

"I'm not giving a urine sample!"

Nurse K [smiling]: "Oh, don't worry, we're not the cops. If it's positive, we don't call the cops. We're just healthcare professionals. We have to make sure no one slipped anything in one of your drinks, noamsayne? It's a big problem these days...people coming in with THINGS IN THEIR DRINKS."

That almost always works because #2 gives them a built-in cover.

3) If they're really just belligerently f'd up, screaming, kicking and whatever else, you're going to have to do 4-points, an IM and perhaps a Foley, but sweet-talkin' is always a good choice.

If you want to step to a NURSING THUG, you gets a fine, probation, and serial UAs

Dass da penaltizzle for da Ex who be tryin' to lift my stuffs and come up in my crib and start yellin and carryins on. You don't get ta makes da rules. Da judges be on da side of peoples who juss be tryin' ta SURVIVE and live deys life in da hood as bess deys can, noamsayne? Of course da judge be thinkin' ahead and done issued a NO CONTACT order fo his sorry ass too. You be tryin' to be all up on my lawn? Then you be put 'cross da hood of da sqaud car. You be tryin' to call me and trash talk me? I report yo ass to da 5-0 and you juss get free room and bizzle at the cop shop.

Good luck on da UAs, pal.

Things that my dad and I did on Fathers' Day

My dad and I usually sit around, drink non-alcoholic beverages, eat crap-food and watch American Chopper in HD or SurvivorMan or other similar shows. Today was going to be no different.

Today, I:

• Delivered my father one (1) Quarter Pounder with Cheese from McDonald's (no fries, no soda)
• Told him it was a dumb idea to pay to join Angie's List when Craigslist and Servicemagic are free and have decent, low-priced contractors
• Watched a survival show which wasn't SurvivorMan where a guy was cooking and eating a turtle after being dropped in the everglades with nothing more than a bottle of water and flint
• Talked about the phenomenon known as drive-in hamburger joints like A&W in the 1960s where the streets had to be re-routed specifically to accomodate all the cars full of teenagers and traffic associated with people wanting to drive in to just see who was there and drive away and the constant unofficial "car shows"
• Listened to Tibetan throat music c/o my dad's suggestion
  
• Told my dad I was required to blog that I muted American Chopper to listen to Tibetan throat music on Father's Day
  

Monkeygirl has to buy Scalpel a pizza

Guess who's back!? Here's a quoteable quote from someone important for you to chew on with your Fathers' Day steaks and brats.

No wonder the best nurses have left nursing.

heh. That means all you people who are still in nursing are the sub-prime nurses. You're the silver that's painted to look like gold. The good nurses are the ones that have already gone on to bigger and better things like...anything not related to nursing.

The analysis of this quote leads me to believe: Real nurses are mediocre at being real nurses and not-real nurses are the best real nurses. Interesting logic.

Very frail ex-nurse daughter of very very very elderly old man gives nursing staff advice

I'm not allowed to give ages even though it's a pertinent part of this story, but the daugher, who used to be a nurse, of the frail elderly patient-in-question was easily in her 80s. I wasn't ALL up in the mix on this patient, but all I hear is this little paraphrased snippet of conversation:

Distinctively elderly female voice: Oh, Dad got IV contrast dye?
Nurse: Yeah, so we could see his lungs better.
Distinctively elderly female voice: Well, you know he's [insert age here] years old, so I think you should give him a bolus of normal saline to protect his kidneys, honey. That IV dye is brutal! I wouldn't want him to go into acute renal failure, dear.
Nurse: Sure, I'll ask the doctor.
Extremely elderly patient (yelling, of course, to overcome age-related hearing impairment): Yeah, I didn't like that dye! Made me feel like I peed my pants!

[Nurse summarizes elderly daughter's concerns]

Doctor (only partially in jest): Just. Do. Whatever. She. Wants. Anything. Whatever she wants. She asks for it, I'll order it. Got that? Whatever she wants.

You ever hear an 80-something year old woman talk about boluses of normal saline and "acute renal failure"? No, me neither.

How to make a nurse nervous

Last time we were here, when he was having his heart attack, he had to be poked TEN TIMES and NOBODY in the department could start an IV, so you only get 2 tries, then you have to call a professional [note the implied dis--I don't view you as a professional].

Nurse K stares at the ginormous hand vein not even really needing a tourniquet. Nurse K affixes tourniquet to patient's hand above wrist. Hand vein palpated. Spring-spring-spring.

He doesn't like getting his hands poked. Why do nurses think they can poke people in the hands?

"Ma'am. I can assure you that ER nurses are among the best IV starters in the hospital. If our staff was unable to start an IV, it was not due to lack of skill. I can try other places, but this is an emergency, and I'm going for that large vein right there. I do this stuff all day, every day."

Well, remember, you only get two tries. After that, it's enough and you won't be allowed to try again.

"Ma'am, this is an emergency, and I'm fairly confident I'll get this vein, but if I don't, we may need to try more than 2 times otherwise it may cause harmful delays in care."

[Note that the previously conversant elderly male patient has not yet said a word to me, and is willingly holding out his hand for me to poke]

Well, I'm not trying to be mean, but you still will only get 2 tries.

Nurse K numbs skin with lidocaine. I note that my hands are starting to shake as the wife breathes over my shoulder. Nurse K slides #20 in without problem, attaches various accessories to vein to hold it in place.

Oh, you're good!

Note: If you'd have kept that up, anxious wife...the Nursing Thugz would've sprung into action. You bess not be keschinnin' my MAD NURSING SKEELZ cuz I's here to keep the chest pizzle to a minimizzle.

Quite possibly the nastiest thing you'll ever hear

Since we were talking about trich and neisseria earlier...

From the comments here.

William the Coroner: I once saw a postitive Trichomonas and Nisserea culture from a colostomy stoma. THAT is not just wierd, that's totally disgusting.

Etotheipi: Wm. the coroner's comment:
I've had two cases of STDs related to colostomy sites: one HPV related warts and one Herpes.

Nothing gets me hotter than banging some stoma!

Don't think about it, don't think about it....puppy dogs, ice cream, lemonade, flowers...don't think about it....

[RALLLLPHHHHHHHHHHH] Damn, I thought about it.

We be thuggin' til da day we die!

Heh.

Yo, my peeps. We be chi-zillin' under the tree next to da BIG OL WATERFOUNTAIN outside the hospizizzle. All we's trying ta do is drink a fo-ty ounce Pepsi and get out of the fray, noamsayne? It be bizzay up in this mofo. I got me my stethoscope 'o death and we be cruisin' fo a bruising. Who wants a piece? I can throw dis wid da velocity of a bullet through yo skizill. I wearin' my cullaz too--ciel blue on da top and da bottom. Paula and Sherry and Mary and Laurie and Barb. Them's my girlz, noamsayne?

We is da nursing thugs. You wanna step?

Oh, hold up, my babydaddy be callin' me on my celly. Thugginz gonna have to wait fo a minute.

Allergy list

Today, I saw the mother of all independently pathologic allergy lists. Here it is, as best as I can remember from memory:

Toradol, ultram, aspirin, ibuprofen, celebrex, naprosyn, all NSAIDS (as if the previous 6 allergies didnt' indicate that), nubain, trazodone, haldol, fluoxetine, penicillin, mirtazepine, compazine, robaxin, erythromycin, all SSRIs

Wow.

Quiz

Question #1 (read the wordage under my blog title for a big hint): What do you offer this patient for pain?

Answer: A choice. Either 1 or 2 extra strength Tylenol.

Question #2: What are her two likely diagnoses, knowing nothing else about the patient?

Answer: Hypochondria and/or drug-seeking behavior/drug dependance.

'We don't want you'

I overhead a pretty good female resident [not an ER resident, a non-ER resident rotating through] vs. nurse pissing match. I'll deliver the story to you in skit format.

We Don't Want You
A skit by Nurse K, RN, BSN

Scene:

Elderly male chest pain patient is whisked into the room. Nurse Pam arrives first and the female resident arrives soon thereafter.

Pseudonymous nurse Pam starts hooking the patient up to the monitor and going through the usual questions one asks of chest pain patients: When did the pain start, what were you doing when it started, have you ever felt pain like this before, what does it feel like...

Resident [to the patient, interrupting Nurse Pam]: Look at me, I'm more important now. I have some questions I need to ask you.

Nurse Pam, to the resident: Well, I was in here hooking the patient up to a monitor and starting an IV so I could give this patient nitro. Here is the IV tray. You can start the IV yourself and give the aspirin and nitro yourself--it's in the lockbox [Nurse Pam unlocks bedside emergency medication lockbox for resident]--it'll be good practice for you.

Nurse Pam exits the room, exasperated at her comments.

At some point, the patient apparently confused the female resident for a nurse.

Resident, visibly angry, leaving room and going towards nurses' station where Nurse Pam is seated [after having started IV and given aspirin and nitro herself]: That patient mistook me for a nurse!

Nurse Pam: Well, there's worse things you could have been called than 'nurse'. Being called a nurse is not an insult. Besides, you did a whole bunch of very important things nurses usually do, like starting an IV and giving pain relieving medication. Did you chart all those IVs and meds? You did it, you chart it.

Resident: [Obviously pissed off at this point, huffing] Well...I'm a doctor and I wish people would treat me like one. I don't know how to do your charting.

Nurse Pam: Okay, I'll be happy to call you doctor. We don't want you anyway.

Fin

Nurse: 1
Resident: 0

Names given to me by the drunk I sent to detox

Part of nursing is to take verbal abuse from patients. Patients aren't all those white-haired WWII vets with their pants up to their armpits who are dying of horrifically painful metastatic cancer who ask you for a cracker please or may I use the restroom please ma'am?

No, part of nursing is to take verbal abuse from patients. In no other career do you have to stand there and be nice to someone who calls you:

• Fuckin' cunt
• Bitch
• Fuckin' whore
• Bitch
• Fuckin' ho-bag (I liked that one, in fact)
• Bitch

It's just like being married again! Sure, I can stick security on them, but security doesn't take the initiative to give the drunk a urinal when he asks the fuckin' bitch to give him one. Nope, he'll yell that out until the fuckin' bitch, me, comes in and gives him the urinal. Which means, irritatingly, I have to respond to 'fuckin' bitch'.

He threatened to kick my ass, kill me, stab me, hunt me down and kill me and 'oh, can you get me a sandwich?' Hey pal, do you really want a sandwich from someone you just called a fuckin' bitch and threatened to kill? You just sit right there, sir, and I'll get you a tasty sandwich from the "special" stock of sandwiches for people just like you. Then I'll kindly place a phone call on your behalf for a ride so you can get out of here. Deal?

The greatest nursing pleasure, I believe, is watching the medics escort these douches out, cussing and screaming, to the windowless underground dungeon in some forgotton building somewhere known as COUNTY DETOX. There's your ride outta here, pal, just like I promised. Have a good day. Thanks for visiting.

The Hygiene Talk

That smell. You know that smell.

Clothes reeking of BO mixed with cases of cigarettes with a bad breath chaser. Greasy hair, greasy faces, scuffy shoes, teeth that are rotting out of one's skull on a bi-weekly basis. Lice!

Once I saw a white chick that had a rather noticeable colony of fruit flies mating in her dreadlocks.

How can people be like this in an age where toothpaste, toothbrushes, soap, and shampoo can all be purchased reliably from the dollar store or provided to you by nearly any charitable organization in the city if you are unable to afford $5 per month for personal hygiene? Homeless shelters have showers and any public bathroom features sinks where you can at least wash up with a little creativity.

Dood, I've been 'po. Real 'po. In nursing school, I lived in a leaky-roofed mobile home and had to support my son and my drunk, useless, unemployed husband, and go to school full time on a nearly full-time waitress' salary. Our minimum credit card payments were twice my monthly income alone. I used to make my own toothpaste (mix baking soda and whatever mouthwash you have lying around into a paste--it works pretty well). I bought my stuff from the dollar store. I sold every item of value that I'd possessed. We had oatmeal for breakfast and pasta for dinner. We heated the place with the oven since the furnace didn't work and couldnt' afford the $1300 to have a new one put in. Our neighbor who hunted gave us deer meat, and Idiot Ex's dad gave up bird and deer meat too. Being 'po sucks balls. Never went on weh-fare 'do. Too proud for that.

No matter what though, I washed my dang clothes and purchased $5 worth of shampoo and soap per month. I, however, was not using methamphetamine, mentally ill, nor otherwise chemically dependant. The worst is meth. Meth rots your teeth and keeps you awake for 3 days straight where basics like eating and bathing just don't happen for whatever reason. Mix a little mental illness in there and your personal hygiene is screwed.

Sometimes, people are just dir-tay though. Maybe a touch of mental illness or a touch of PTSD coupled with a low IQ and the dir-tayness will come out.

This is when pseudonymous Night Nurse Kori comes in.

Night Nurse Kori is an experienced nurse with a killer deadpan sense of humor. She also has a special duty that she takes on when she works: She gives the Hygiene Talk.

"Nurse K, you see that girl there? She's one of our regulars. She's homeless, not very bright, but she's always well-groomed when she arrives. It didn't used to be that way. About 2 years ago, I sat down and told her about the utility of soap and how she had to take a shower EVERY DAY. I asked her if she could tell me some places where she could take a shower. She knew about the homeless shelter, a friends house, and all that. I told her every day she needed to plan where she was going to take a shower. She told me her mom only washed her and her clothes when they were really dirty and really smelled bad. I told her that clothes and bodies need to be washed every day and clean bodies should go into clean clothes. I then gave her a care package of soap, shampoo, deodorant, a toothbrush and toothpaste (all available in travel sizes in the ER). Now, look at her. Her hair is decent, she doesn't smell. This was an immediate turn-around after The Hygiene Talk. It seems her version of 'dirty' was just not the same as society's, but now it is...after The Hygiene Talk."

So, if someone regularly shows up in the ER with minimal healthcare needs and maximum hygiene needs without appearing to be on drugs nor drunk, I asked Nurse Kori to do "The Talk." She usually complies, but, I'm sure, eventually someone will complain and she'll get written up. She's been doing it for years apparently.

In addition, one of our staff members also manages a little store with apartments over it. This store is subsidized by the government to give "at-risk young adults" job skills. The young adults (usually 18-22) live in the apartments over the store. The manager/our staff member has given The Hygiene Talk to many of these youths. Many of these kids were abused physically or sexually, were runaways, or had drug-addicted parents who didn't do much for them and for some reason, they never got into the Culture of Hygiene. Each one has to pass a hygiene "inspection" each morning. No smelly pits, no dirty/wrinkled uniforms, no raggedy hair.

The Hygiene Talk. Use it. Love it. See results.

Update: I should elaborate on the fact that The Talk should be given sparsely and, just like with tPA, there are many absolute contraindications such as:

• Patient is very sick
• Patient is intoxicated, rude, or disruptive
• Patient is a first-time patient to your facility, not a regular
• Patient has bad rapport with the nursing/medical/support staff
  
• Patient may be polite but appears to be narcotic-seeking
• Patient is a vulnerable adult, such as a mentally retarded or demented individual (chronic, terrible hygiene in these populations should be reported to the state agency in charge of vulnerable adult reporting)
  

So, the perfect patient for The Talk is a young adult who is down on his or her luck who comes to your facility for things like earaches, toothaches, and throat pain. She asks the nurse for her advice on what to do in various situations. She may know a nurse or two by name. It's best that the triage nurse unofficially screen patients for The Talk and unofficially assign them to the nurse who is most adept at The Talk, such as Nurse Kori so the nurse can build rapport throughout the visit. Also, The Talk appears to be most successful if the patient is given a care package of hygiene items. This reduces the steps needed on one's initial steps to cleanliness, also, people would feel more obligated to do what someone says if they're given a "gift", however small. Finally, any nurse who feels the Talk would insult the patient or make them uncomfortable should avoid The Talk.

Sumdood reveals himself to Monkeygirl

The infamous 'Sumdood', shape-shifting right-hand-man of Satan hath revealed himself to Monkeygirl. You never know where you'll see Sumdood, but when you do, get out your cross, your garlic, your sword, your Kelly clamp (aim for the eyes so he can't see your soul), and your nunchucks and be prepared for anything.

What, you don't have these in your locker next to your old CEUs, Motrin and army of blue pens? You really need to think ahead. If Sumdood hasn't been to your facility yet, he will be sometime.

It seems Monkeygirl got away unscathed, thank God.

Update Since Monkeygirl referenced it in the comments, here's a Sumdood anecdote I wrote in the comments of her linked post. Take notes for someday this may save your life.

I once looked Sumdood right square in the eyes on the street, and he started to come at me. I didn't have my nunchucks on me, so, in an act of desperation as my life flashed before my eyes, I opened my purse and flashed my health insurance card...that made his skin slough off and he ran away into the night. Apparently, Sumdood can't hold nor possess a health insurance card.

Also, it may be pertinent to mention that Blue Cross and Blue Shield was so named because possession of their card could substitute for the aforementioned anti-demon cross and it shielded you from attacks as I just described. I'm kinda screwed because our hospital doesn't use BCBS, so I still have to carry the cross along with a competitor's health insurance card.

If you're unfamiliar with Sumdood, make sure to read this as a primer.

I couldn't help myself

A chick comes in with the smallest rash known to mankind, perhaps even made larger than its original "really really small"/undetectable by her scratching it constantly. She also starts rattling off symptomatoloygy that is unrelated to the 1 inch long area of light pinkness.

Here are two examples of her littany of miscellaneous symptoms associated with the tragedy of the centimeter of erythema arriving on her arm this morning:

• "Funny taste in my mouth"
• Vision changes

I asked for elaboration on the "vision changes", and I kid you not, I started laughing after she said her response....I couldn't help it. I hear tons of BS all day and successfully avoid laughing, but this was the cream of the crop of BS.

"Tell me about these vision changes."

"Well, they started this morning when I woke up and noticed the animal bite."

"What's your vision like?"

"Well it's blurry, real blurry...."

"Okay."

"Well, I DID lose my glasses right before I went to bed. Do you think that might have something to do with it?"

She was serious. New onset blurry vision status post losing her glasses. She also mentioned that she attempted to use someone else's glasses and her vision got "worse" after using the other person's glasses. I mentioned that if the glasses weren't made especially for her that they wouldn't work for her. She seemed befuddled by this concept.

Then, I asked her about the "funny taste" in her mouth. I didn't really want to get into it, but I had to.

"Well, yeah, there was a funny taste in my mouth when I woke up this morning too."

"What was that like?"

"Well, my mouth was real dry and I drank some water and then it was fine."

Dry mouth relieved with ingestion of water. This chick was on a roll today. It was nice outside too...drink some ice tea and barbeque a damn hamburger. Why come to the ER???? WHY????

WHYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYY?

Bladder pain causes neuropraxia such that a healthy female patient is suddenly unable to pull up her own pants and walk

A 40-something year old patient in status dramaticus who complaints of a little bit of this and a little bit of that (including inability to walk normally due to the SEVERE bladder-area pain) decides that she can no longer pull up her own pants after taking a leak without the assistance of a trained nursing professional.

"You pulled them down, you can certainly pull them up yourself. You told me you went to the bathroom 6 times in the lobby on your own."

"I can't! It hurts too much!" Note that the pants are elastic-waistband workout pants, and they are sitting just under the buttcheek, so all she'd have to do is lower her left upper and right upper extremity to their natural at-rest positions and use the opposable thumb that humans evolved over the course of millions of years in concert with her other fully functioning digits to grip said elastic-waisted pants and use her bilateral bicep muscles to lift them to their appropriate waist-area position. She had used a similar but completely opposite movement just 2 minutes prior to lower these pants in order to void clear yellow without the assistance of a single highly-evolved being.

This is the long way of me saying...she was whining and overly dependant and my damn wrist and arm hurt and she could do it herself and asking a gimp to do it for her was abusive and inappropriate.

"You need to try to do it yourself. I know you can do it; all you need to do is try."

"BUT. IT. HURTS. TOO. MUCH!"

"Well, I have this wrist problem, so you're going to have to try, at least on the left side there."

Luckily, the patient didn't ask me how I'd managed to pull my equally as elasticized scrub pants up earlier that morning.

Magically, after I evoked the power of the wrist splint, the patient effortlessly pulled her pants AND drawers up without incident and I wheeled her back to her room because, of course, how could I expect her to walk with such bad, um, bladder pain?

ER beauty contest today

Female patient, just discharged, dressed and ready to go: Gawd, I look like total crap right now.

Nurse K: You don't look bad, but, for future reference, if you look good, there's a decent chance you don't need to be in the Emergency Department.

Donate to Nurse K: Buy some stuff you need anyway!

Click it now to buy crispy new scrubs!

Quick bleg: If anyone needs to buy scrubs or clogs or medical paraphenelia or whateva at any time, please do so by first clicking my Jasco Uniform picture link to the right. I'll get hooked up PHAT by Jasco if you do. You won't pay any more, but I'll get some lunch money out of it!

Totally stealing that line...

A doc gets the results of a young man's CT scan which shows acute appendicitis.

Doc, entering patient's room:

Sir, it looks like your appendix is no longer playing for your team.

Slightly used coffin for sale

http://minneapolis.craigslist.org/fur/345156160.html

Great to keep around for the unexpected.

Heh. I need a new coffee table, but I think I'll pass on that one.

It's worth it

I'm sure you guys can think of one house in your neighborhood where the lawn is overgrown and weedy and your property values are jacked because of it.

Well, that's my house, at least in the backyard. When I bought the house, it was a jungle, and I thought we'd pay someone to put it back to its original glory.

That was 3 years ago. So, I've been the owner of a jungle for the last 3 years. Looking at it depressed me. The bushes are overgrown and mostly dead. The sidewalks are new; there's a nice deck overlooking the jungle where I fantasized about inviting people over to barbeque and hang out, but the embarrassment and overall safety hazard of the jungle prevented me from doing so. I only invite people over if it's dark outside and I know them really well. I don't allow my son to invite friends over because of the Jungle. The Jungle is totally jackin' my existence.

I got some estimates: $3800, $4100, $3650 just to dig it up and either re-seed or sod with some paltry plants. Keep in mind that I live in the middle of the city, and my lot is tiny. Those prices were far out of my budget, so I waited.

Right now, there are two cute frat boys who sound like they've been hanging around Southern California too much and one Mexican back there digging the place up for $1400 incluidng hydroseeding and adding some curb appeal to the front yard.

Can't afford it but my new Sugar Daddy whose name is Capital One Mastercard can.

Danglers and near-syncope

Every nurse has something that makes them a little queasy or that they'd at least prefer to have another colleague deal with. Sure, we do it all, but there's always that one thing that we avoid if possible. For many, it's suctioning of purulent sputum, for others, it's that distinctive smell that comes with GI bleeds.

For me, it's avulsed fingers. Yeeks.

Near-syncope has occurred no less than 3 or 4 times from the act of unwrapping a partially dangling finger.

Normally, in the urgent care, simple laceration repairs are done, but we got two rather dangly danglers today, one of which was not triaged (hey, we're busy, would you mind seeing this finger-cut guy right away since he'll be coming to you anyway?), and another whose finger was pretty badly mangled but not necessarily dangling. I am lost for terminology sometimes, but it was F-ed up like if you started at the tip with a jagged knife and just sawed the surface off so the thumb looked like ground up meat glued to intact bone. The non-triaged one needed the OR and IV antibiotics.

Luckily, for me, when you unwrap and it's flopping in the urgent care, you can just wrap it back up and tell the PA that "the patient is inappropriate for urgent care". I didn't have to look at it extensively nor clean it nor anything else.

By the way, if you're a nursing student, be sure to tell your dangly dangler patient to NOT look at their fingers when you unwrap them. The patients faint or nearly faint routinely; make sure they have an actual bed to lie on. If I'm the nurse, make sure I have one available as well. Kick family members out of the room if possible or encourage them to look the other way because they faint just as often and there's nowhere for them to go but the floor.

Crass-Pollination, now with more generic!

With everyone in the med field getting in trouble for their blogs as of late, I've decided to make myself more anonymous. I'm going underground, baby. Now, I'm 'Nurse K, Generic ER Nurse'.

If you have a blog link to me with my real name on it (since my real name used to be in the title), please just change it to Crass-Pollination or something to that effect.

Between the 2 of us, we have 2 good arms

If you scroll down a bit, you'll note the post about the crazy 4-point restrained manic chick. She f'd up my wrist while I attempted to affix a locked restraint to her flailing extremities while she called me a fuckin' bitch. It was sore and painful to move thereafter, but I thought it would go away.

Well, it didn't. So, I'm now a gimp-nurse. Back in the urgent care section (a good place for gimp nurses with braces to go) was me and an aide, both of us sporting the left wrist braces to limit wrist movement. She'd also hurt her wrist wrestling a patient. I finally decided after working a double yesterday to be seen quickly for work comp in my department after the entire arm started to hurt and just moving my wrist a little bit was painful enough to make me not want to move it at all.

Hopefully I'll be de-gimpified soon.

Why one of the attendings wears a suit

One of our Internal Medicine attendings, as of late and seemingly out of nowhere, has been parading about the hospital in nice black or grey suits-and-ties. No white coat. No stethoscope. Just the suit and a nametag. Hair neatly coiffed. Never looks haggard nor stressed out. It is not common, at least in my facility, to see docs parading around in suits; maybe when JCAHO comes by or something, but not otherwise.

Secretary to attending: What's with the suits?

Attending: When I'm rounding in a suit, patients never ask questions, they never disagree with the treatment plan. Apparently people trust my opinion more in the suit, so rounds go by quickly. Dr. Such-and-Such (his partner, not the gay kind, the business relationship kind) doesn't wear a suit and the guy is stuck in every patient's room for an hour and half being bombarded with questions and demands for explanations from family, the patient, the nurses...everyone. The suit takes care of all that.