Swine Flu – My Two Cents

“Six swine flu cases confirmed in Canada”

“US declares public health emergency as swine flu spreads”

“Critically ill Canadian denied re-entry from Mexico”

“WHO calls swine flu a public health emergency”

“Mexico quiet as 103 deaths linked to swine flu”

These are only some of the headlines that swine flu has been making and it comes as no surprise that the nursing and medical administrators are calling staff meetings to keep everyone updated and informed. I know a few other med blogs have posted about the swine flu so the only thing I’m going to say is that I’m praying and hoping that it’s nothing like SARS (which it doesn’t seem to be so far). I was doing my undergrad in Toronto when SARS broke out and it was not a pretty place. The fear was palpable in my university as three of my professors were quarantined. China town looked almost abandoned whereas prior to SARS, it was a bustling area day and night. There were talks of cancelling classes being taught by medical faculty who worked in the surrounding hospitals. Nurses Neila Laroza, Tecla-Lai Yin and Dr. Nestor Yanga were the health care workers who died from SARS. Nurse Laroza had taken stringent precautions to avoid contracting SARS. Canada and Toronto have learned much since the SARS outbreak and those lessons were applied intensively to nursing and medical curricula since then but I do not want to be in another SARS like situation, and this time as an ER nurse.

The above picture was taken at Toronto General Hospital from http://www.life.com/image/1956554

Something to Think About…

It seems as if it has been months but I’ve finally had a weekend off from work and I couldn’t be more thrilled. Not only do I have four days off from work, it’s four of the most gorgeous and sunny days to grace my cold ol’ city in quite a while. So imagine my surprise when I woke up and found my siblings watching Life After People, a doomsday-esq documentary on the History Channel (I come from a fairly geeky family) rather than enjoying the beautiful weather. The premise of the documentary was a thought experiment chronicling what would happen to the planet if all humans suddenly vanished (the documentary does not dwell on the reasons behind humanity’s disappearance). What was nice about this documentary is that it bypassed all the doom and gloom of a possible apocalypse and focused on simply on what would happen to the planet if humans were simply taken out of the picture. The CGI effects detailing how the world’s major cities (and most notable landmarks) would eventually crumble were simultaneously creepy and fascinating. While some could argue that the documentary was melodramatic, it does a fine job of examining humanity’s place in the universe. Towards the end, the narrator states, “there was life before humans and there will be life after humans”. Ultimately, our life is too short and too precious to waste trying to destroy each other and/or ourselves. As for myself, I will be getting dressed in a few minutes and taking a very leisurely walk around the city, enjoying everything the day has to offer, being thankful for everything I have and not dwell on the things I do not.

Oblivious People or Why Call Bells Should Not Always be Within the Patient’s Reach

For the most part, I try my darndest to be super-duper nice to old people. After all, it’s not a pleasant experience to be an adult relying on others for your basic bodily functions. However, when a call bell is placed at your side in the EMERGENCY department (you know, where life threatening emergencies are treated), this does not mean that it should be used incessantly for trivial concerns such as, “I need another pillow”, “my blanket crinkled again”, “when can I get the next dose of peccocet/morphine/dilaudid” (after the medication schedule has been explicitly explained in great and painfully accurate detail several times) or “I need to use the bathroom” (when you’re perfectly capable of using your walker/wheelchair without assistance).

I had the most irritating shift because of one such elderly lady. She had a fall at home and sprained her ankle. However, due to other social issues, she was awaiting a placement at a nursing home. Every 20 minutes she would ring the call bell – incessantly. I helped her eat her breakfast, I changed her bedding twice, I got her a soft mattress so her back wouldn’t be sore and I even set her up for a bed bath! Yet despite all of my efforts to do right by her while juggling 5 other patients (one of whom was actively hallucinating and almost sucker punched me while the other kept screaming “BELIEVE in the Lord” with 8 mg Haldol on board) she just would NOT stop using the call bell. At one point, I had to pry the damn wire out of her clammy, Kleenex stuffed hands and tell her that she is NOT in a hotel and I am NOT her wait-staff. She just stared uncomprehending at me for so long that I thought she had a damn stroke. Rather, she just could not understand the concept of no. Then of course her children had to come and try to boss me around (where the fuck were all of you when mommy needed to be lifted 50 times??) by barging into OTHER patients’ rooms! By the end of that shift, I could barely contain the deluge of profanities aching to break free from my mouth.

As I write this post, my blood pressure is substantially lower than what it was during the course of that shift, my back ache has been greatly relieved by ward stock ibuprofen and I realize that there were moments (more like hours) during which I was excessively bitchy, but during the course of the shift, I would have liked to do nothing less than to utilize PFT* for this patient and her family.

*PFT = Pillow to Face Therapy. Another term coined by our crazy residents and crazier senior nursing staff.

Professional Communication

A 50-ish something man comes in with severe alcohol withdrawal, tremors from hell and the highest fever I’ve ever seen. I get him some Tylenol and help him to the bathroom. When I go back to the nursing station, a bewildered doc is looking through the charts and asks me, “where’s the shake n’ bake from exam 5?”

After a moment of silence, I couldn’t help but laugh very loudly at the doc’s very clinical description of the patient! Nursing theorists would be disappointed in me.

What’s in a name?

Ill informed patient: I’m allergic to ibuprofen.
Me: What happens when you take ibuprofen containing medications?
Patient: I get really bad hives and I feel gross.
Me: But you said earlier that you took Motrin for your pain?
Patient: Yeah, Motrin not Ibuprofen. Are you not fucking listening to me?
Me: Motrin IS ibuprofen.
Patient: No its not. I didn’t get hives.
Me: Then perhaps you’re not really allergic to ibuprofen.
Patient: You’re retarded. You’re just a nurse. I AM allergic to ibuprofen so get me some Percocet bitch!
Me: Security!

Moral of the story: If you’re a drug seeker, it would benefit you to know the trade and generic names of your drugs so you don’t look like a bigger jackass than you really are. Oh and I'm not 'just a nurse'. I'm your nurse and I'm not going to 'advocate' to feed your addiction.

Polticking at 0230

When the waiting room is holding 70 people in the middle of the night and every bed has someone in it, the ED’s priority becomes treat ‘em and street ‘em or move the freaking meat. When moving the meat means getting an admitted patient to the floor ASAP, I expect that the floor will take the patient and not bitch at me for not starting their work. Carrying out admission orders (especially those that involve giving medications that we may not keep in stock or ones that the floor keeps in adequate quantities) is the responsibility of the floor. Anything I can get started in the ER is out of professional courtesy, not obligation. While I realize that floors can get incredibly busy in their own way, they have to accept patients when a bed is assigned – it’s part of the job. This is why I don’t expect a nurse from a medicine floor telling me that he can’t accept the patient from the ER until we put in the Foley catheter and start his lasix drip because that should be done in the ER. I believe his exact words were, “we don’t do that up here”. W.T.F?? Those are very basic nursing skills! After all, we have the same nursing license so I don’t understand what rationale he was using to try to persuade me that he was incapable of putting in a Foley catheter. On top of all that, the patient was in a hallway, which is NOT an ideal place to be sticking tubes down people’s genitals! I tried to tell him this and he called me an idiot before hanging up on me. Needless to say, the ER charge nurse was mighty pissed – he and I ended up filling out a giant incident report for the floor and ER nursing manager. I ended up having to put in a foley in the hallway while two other nurses held up sheets as makeshift curtains while other (squeamish) patients looked on in horror making the poor man feel like a freak. Needless to say I received a very chilly reception when I finally transferred the patient onto the floor.

This should not have been an issue. Normally I call the floor up and let them know that I’m bringing up a patient. If they request a few minutes to get prepped then I really don’t see that as a problem unless something atrocious is happening in the ER. Refusing to accept a patient that needs some ‘work’ is completely unprofessional. The charge nurse and I should not have wasted an hour over whose responsibility it is to carry out admission orders in the middle of a very very busy shift. I later found out that the floor in question was overstaffed and had 6 empty beds.

Stupid Crap I’ve Done and Not Been Fired For

This is my 6th month of being a nurse so in lieu of my 6 month anniversary, I thought I would think back to all the dumb crap I’ve done and thank my lucky stars that I haven’t been fired and labeled a danger to the public. Here it goes in no particular order:

1. Hanging up a bag of D10W on a hyperglycemic patient (I let out a miniature scream of horror when I realized that was not NS and nearly ripped the lock out of the guy
2. Forgetting to inflate the balloon of a foley catheter on a patient who was VERY agitated
3. Confusing ceftriaxone for cefazolin (and being absolutely convinced that Ancef was ceftriaxone)
4. Not keeping IV diazepam on me when I was taking care of a post-ictal patient – who seized at the precise moment when I realized that I didn’t have diazepam with me
5. Arguing extensively with a drunk guy about the merits of IV fluids
6. Forgetting to give gravol with a massive dose of morphine – I console myself with the thought that puking probably hurt less than it would have without the morphine :S
7. Drawing blood cultures AFTER two rounds of antibiotics infused. Fuck.
8. Leaving the IV tubing clamped on a bag of stemetil
9. Being exceptionally pleased with myself when a bag of NS infused really well only to realize that the patient had ripped out the lock and the bag infused into his sheets.
10. Forgetting to leave the call bell near a patient who received a massive tap water enema – I literally walked into a room where shit hit the proverbial fan

For the sake of optimism, I tell myself that those mistakes were made when I was very newly unleashed into the world of nursing and I’ve learned a whole lot since then. Nonetheless I'm cringing at my list right now.