Thursday, October 30, 2008

The non-medical benefits of medical tape

I live in Canada and its getting progressively cooler, yet until recently I had no winter coat. My last coat had been reduced to nothing but a polyester shell of its former snuggly existence. So off I ventured into a crowded mall (places with a large amount of people now freak me out for some reason - I think someone might fall down the stairs and on my next shift I’d see them wincing in pain) to troll through numerous stores and aisles. My venture was met with success – I walked away with a stylish, warm and grossly overpriced coat. However when I attempted to get through the entrance to the subway, my bag got caught in the revolving door and it ripped leaving my shiny new purchase exposed for all to see. That’s when I started to dig around my oversized bag for a roll of tape and then realized that in an attempt to temporarily shed my nurse identity, I cleared out my bag and left all my supplies at home. Medical tape would have been greatly helpful in patching up my now extremely ghetto looking shopping bag. Lesson of the story – don’t ever leave your house without wallet, keys, phone and tape.

Tuesday, October 28, 2008

Boy nurse: I think my little old lady tried to sexually harass me!
Nurse 2: What the hell? How?
Boy nurse: She tried to grope my ass when I turned to hang her antibiotics!
Nurse 2: She is demented though – maybe she was just flailing her arms and one hit you.
Boy nurse: Then why did she wink at me?

A wicked case of crotch rot

My charge nurse handed me a 16 year old girl who was transferred over from one of our affiliate hospitals for pelvic inflammatory disease accompanied by her boyfriend who looks just like a gangsta wanna-be would in a place where his greetings of ‘s’up muthafuckahs’ are met with disdain – like a stray puppy who’s angry at being placed in a kennel for the night. The girl herself was pleasant enough – actually she was quite sweet. I did my assessment and then set up the room for one of the residents to do a speculum exam while explaining the process to the girl. So along comes the resident and starts doing the exam. Now I know this guy a little bit and he knows that I’m new so whenever we’re working together he tries to get me to see as much as possible, which is always appreciated. Usually he explains the procedure as he’s doing it but this time he asks me to come to his side and pass him an instrument while looking at me somewhat funny. This of course makes my spidey-sense tingle and I quickly walked over to his side. When I looked at the vajayjay area I was horrified. I had never seen that much curdled cottage cheese like discharge from an area that small before! The resident took out the speculum and it was dripping with the aforementioned discharge! I can’t even begin to describe the smell. Meanwhile the girl is asking ‘what smells funky?’ That would be you honey. When we explain what we saw, she says, ‘But I’m not a slut! I’ve only been with a couple of guys! Did you put the thing in the right hole?’ What we saw shouldn’t be coming out of any hole. We were concerned about the boyfriend as well so we brought him to another room to chat with him. Turns out he was admitted a little while ago for the same problem but he had been compliant with his meds – the girl hadn’t. She ended up getting a gram of vanco for chlamydia in the ED before being admitted to gyne. Needless to say she needed a LOT of health teaching and perhaps a swift kick in the ass for thinking unprotected sex with ‘only a couple of guys’ guarantees protection from STIs!

A testicle is worth 4 hours more than an ovary

28 year old woman walks up to triage looking obviously distressed and in pain. She complains of severe 10/10 LLQ pain. Blood work is drawn and sent to rule out appendicitis and ectopic pregnancy. While waiting for the blood work, she drops the bomb on us – “I had a right salpingo-oophorectomy because of ovarian torsion and I’m afraid the same thing is happening again”. The docs and residents went into panic mode and started calling imaging for a stat ultrasound. The radiology residents said that they would not do an ultrasound unless they get the hCG levels to rule out ectopic pregnancy. Maybe this time around radiology got stuck with a bunch of residents who have shit for brains since an ultrasound provides the definitive diagnosis of pregnancy/structural gynecological issues. Understandably the staff ER doc and ER residents went ape shit and finally got a hold of the staff radiologist who then screamed at his residents for being incompetent buffoons. In the end, it took the poor woman FOUR hours after presentation to get to the OR. Last I heard was that the surgeons found the ovary with arterial blood supply compromised but venous flow uninterrupted. They left the ovary in to see if it might heal. This woman has been wanting to have children since she got married several years ago and felt that now the time was finally right. What kills me is that when a man presents with testicular torsion, a white coated army descends down into the ER faster than you can place a page. I realize that ovarian torsion is much less common than testicular torsion but the woman has a history and records. Why anyone would want a pointless blood test to perform a test that can see the source of the problem directly is beyond me. I really hope this woman’s ovary heals and she can have children. If she decides to sue the hospital, I wouldn’t be surprised – hell, I’d probably support her.

Wednesday, October 22, 2008

The difference between a few centimetres

I walk over to triage and rummage through charts that have been assigned a less urgent/non-urgent score and pick one up that says groin laceration. I call the patient (who happened to be an incredibly good looking man) and start to lead him to the suture room and notice he is walking very carefully. I read over the chart but I wanted to get the story myself. Turns out he was playing hockey, tripped and then got a cut in his right groin from another player who tripped over him. It wasn’t a horrible laceration – no profuse bleeding, no signs of hypovolemia and no pain. In fact, most of it was quite superficial except for a 0.5 cm area that was bleeding very very slowly. He ended up getting a souped up bandaid, a tetanus shot and a good luck before being discharged. One of the residents summed the case up very nicely – “a couple centimetres more medial and… ooohhhh” (as he crossed his legs and winced in pain).


An aggressive drunk guy in restraints thrusting his pelvis at all the female staff in his line of vision and screaming, “Suck it baby! Blow me hard!” The doc walks over and tells him, “not gonna happen tonight” before giving him IV diazepam. Good times.

Mean Girls

Yesterday morning at around 0630 (why an hour before shift end? Why?) I got assigned to a mean girl (with her mean girl posse in tow) complaining of carbon monoxide poisoning. So I dragged my mildly nauseous, severely bleary eyed self to the exam room and started my assessment. Each question I asked was met with the trademark mean girl death stare from her and her posse before she managed to spit out an answer. I started by asking her what made her think she had carbon monoxide poisoning to which she replied, “my friggin carbon monoxide detector like totally went off so like whatever”. Right. I just couldn’t resist so I asked her, “did it ever occur to you on your long drive over that maybe the detector isn’t working well?” I was met with the death stare and another “whatEVAH”. So I carried on my assessment and asked her if she was feeling lightheaded, dizzy, nauseous, short of breath, feeling better outside the building rather than within, other people in the building complaining of the same symptoms or any flu like symptoms. Did I mention that her vital signs were unremarkable and her O2 sat was 100% on RA? She denied any symptoms and then asked “what the fuck does the fucking flu have to do with carbon monoxide poisoning? Gawd, are you like a fake nurse or like a tech or something?” Normally I put on my professional face and try to be as diplomatic as possible but I just shot back with my own death stare and told her that the doctor will probably need an arterial blood sample. When she asked where she’d get the needle, I couldn’t resist and told her that normally it’s obtained from the wrist but if he can’t get the artery, he might need a sample from the groin. Her shocked look of horror made my night but unfortunately it wasn’t enough to stop her bitchy remarks. While the resident was getting the sample, I had a bag filled with ice and a requisition prepared so she didn’t have to stay a minute longer than necessary. The mean ditz then told the resident to “check over her shit cuz she asked me like the dumbest fucking questions”. Luckily for me the residents and staff docs I work with are extremely nice and understand that I’m new so he too shot her his own frighteningly effective death stare before saying, “my coworkers are among the best in the country so I don’t need to double check their work” before walking out. Turns out her carboxyhemoglobin level tested at 0.0000 which pissed her off even more but there was nothing more that we could (or wanted) to do. She dramatically told us that it would be our fault if she died before calling us retards and storming out. Another chart in the discharged pile.

Tuesday, October 21, 2008

BIG babies

I love working in the fast track area. I get to see lots of patients, usually end up fixing their problem and then sending them home. It’s a great feeling mostly because they don’t stay long enough to start grating my nerves. That however was not the case during my last shift. I got an extremely rude and entitled 40-ish year old guy who came in complaining of back pain. Of course he was in obvious pain but he was well looked after. He got 6 mg morphine IV push initially and got settled into the stretcher. And that’s when he started. “Maha, I still hurt. Do SOMETHING”. “Maha, get me another pillow”. “Maha, I’m thirsty again but I don’t want the pitcher of water. I just want the little cups for each sip with filtered or vitamin enhanced water”. “Maha, my IV feels weird. I think I need more pain meds. Didn’t I already tell you to do something?”

What I wanted to say to him was, “You just got 6 mg morphine half an hour ago. You’re not getting any more from me for a while even though I’d love to see your respirations drop at this point. We’re severely short on pillows so thank your lucky stars that I rummaged all around the unit to get you one while the doc was getting pissed at me for not helping out more quickly for a conscious sedation as well as having to look after 10 other people. NO you can’t get a fresh new paper cup for each little sip of filtered and/or vitamin enhanced water you inconsiderate jerk! It’s bad for the environment and look around you – this isn’t a 5 star restaurant and I’m not your waitress here to kiss your monkey ass so you’re getting the giant pitcher with good ol’ ice water! If you keep picking at that damn IV I swear I’ll use a 16 gauge in the smallest vein you’ve got and then smack your dumb ass with the IV basket before giving you more meds!”

What I ended up saying was, “Sir, you can’t get more morphine for at least another 2 hours. Try deep breathing instead. Unfortunately we don’t have any more clean pillows on the unit. We’re an environmentally conscious hospital so we try not to create unnecessary waste. And the government does not give us enough money to buy vitamin enhanced water – we usually spend our money on equipment and medications. Please stop picking at your IV because if it comes out, we’re going to have to re-site it which as you know hurts.”

Not to be a total bitch about pain (because it hurts after all) but it’s really irritating to see people in moderate amount of pain being assholes making idiotic demands while someone in unimaginable pain thanks you profusely for everything you’re doing for them while suppressing a sob. Needless to say I wheeled him out after his discharge with a huge smile.

Shift End Pages

“Whoever took 4 mg of morphine from resus and did not sign it out, please walk over and sign with your head hanged in shame for making me stay past shift end. Thank you.”

Saturday, October 18, 2008

BD Passive Shielding Blood Collection Needle

ER nurses have to collect a lot of blood. Many times it’s from patients that are either acting like total douche bags or from HIV/Hep C positive patients. My unit also uses a lot of butterflies to collect blood. I have also used my fair share of butterflies because they are really easy to manoeuvre but I can never activate their safety feature with one hand. I’m of course reluctant to put my hand near a used needle to try to cover it up. I also find that sometimes I can’t draw blood fast enough even when I see flash in the chamber. On top of all that, half the time the lab sends back a report that tells me I need to draw up another set of INRs/PTs because the first sample did not yield adequate results. Patients really love me when I have to tell them that they’ll have to wait for at least another two hours and that I’ll have to poke them again. But then I discovered the passive shielding blood collection needle. I freaking LOVE this thing! I get the vein EVERYTIME, get my blood drawn super fast and don’t get back angry lab reports. The passive shielding needle is a bit harder to manoeuvre than the butterfly but once you get the hang of it, you can’t go back. Best of all, as soon as you withdraw the needle, the safety shield clicks in automatically which means I have no chance of getting a needle stick when someone flinches their arm away or decides to have a seizure in the middle of venipuncture. I’m still working on my dexterity with this, but I think I’ll be reserving the butterfly for really tiny veins and smaller people.

I realize that this post sounds like a total testimonial for the BD folks, I (unfortunately) was not paid to write this. Its just something I now love! And yes, I’m a big time nerd.

Friday, October 17, 2008

Abscess from HELL

I had a lady come in complaining of pain in her butt. Literally. She said that it hurt to sit and it felt like there was a pimple there that was pushing out other tissue. Sure enough there was a giant abscess and was right in the middle of her butt. In case you're wondering what it looked like, here's a picture of an abscess on a leg. Imagine that on your bum. Ouch. I was surprised as hell when one of the docs (who knows I’m a complete newbie) asked me to assist during the I&D but nonetheless jumped at the chance to see something gory and bloody. I was not disappointed. When the doc made the first incision, I gasped at the amount of pus that started to gush out of the abscess. I think it had to be about 50 cc. I haven’t consulted literature regarding average pus volumes in abscesses but that seemed like a lot. Apparently this woman had a history of abscesses in that region. Trying to critically think about why that could be, I started talking to her and found out that she used harsh soaps and scrubbed extra hard to “get rid of the bacteria”. Poor woman – she just kept breaking down her skin and letting the bacteria get in. Moral of the story; be kind to your behind.

Thursday, October 16, 2008

From nursing student to NURSE

It has been a long time but I’m back – with a nursing degree and a (temporary) license! After finishing my consolidation, I landed a job in an ER right smack in the middle of the big city! I’ve been working there for a little over a month and so far, it’s not too shabby. The first couple of weeks were spent in orientation which included some mind-numbingly boring sessions (but paid and with free breakfast) on hospital philosophy and policies on CBG testing.

Currently, I’m ‘buddy-shifting’, meaning that I’m following different nurses around trying to get the hang of things. Some of those nurses understand that I’m a new grad but I need to learn so they let me try to run things and help out when I need it. In fact, a couple of shifts ago, I was pretty much running the fast track area. I actually felt like a NURSE instead of a scrub clad monkey with opposable digits. On the other hand there are some nurses that just make me feel like crap. For example, yesterday I was working in the fast track area with a nurse who kept telling me that I’m insanely slow and that I can’t keep up with the patient load. She was right that I couldn’t keep up but I think it was partly because she kept slamming me with new patients every 10 minutes. When I worked the fast track area previously, I discharged at least 2 patients before bringing another one in so I could keep a stretcher free in case a lol (little old lady) with a query hip fracture is brought in by EMS. When I explained my reasoning to her, she just looked at me like I was a total moron and started giving me report on 4 new patients. There are some days when I get really pissed at myself because I keep forgetting the details about patients. I still feel like I’m having the hardest time remembering who is going for what test at what time. I feel like an idiot giving report while realizing I forgot about a test or a new set of orders.

Another shock to my (nursing) system was the sheer number of patients I can see in a given day. When I was consolidating on the floor, I memorized the patient list, admitting diagnoses and med times within a week. I got sick of handing out the same pills every day. In the ER, I can see up to 30 patients a day presenting with everything ranging from abscesses in the ass crack (its true) to bleeding eyes and insane joint deformities. Throw in the Friday and Saturday night Drunky McDrunkingtons (my pet name for the drunks requiring a B&B) and I’m well on my way to climbing the steep learning curve.

I really hope that I don’t screw up and get tarred and feathered out of the ER. Now that I’ve had a taste of the autonomy nurses can have, I really don’t want to go to another unit. Attaining competence, confidence and beyond is my biggest goal – I really hope I get there sooner rather than later.