Monday, August 31, 2009

Organic Bitterroot Juice is not an Approved Treatment for HHNS

I don’t think any nursing text book will actually publish this but I think the biggest challenge to a new nurse is how to deal with stupidity in all of its jaw-dropping manifestations while keeping a straight face. The latest round of battles were fought with the family, specifically, the wife of a portly elderly man in rip roaring HHNS who decided that his poorly controlled diabetes could be ‘cured’ with organic foods and bitterroot juice. As expected, he stopped taking his oral anti-glycemics along with his BP meds. From the second I started to do my assessments and place lines in him while trying to make sure I heard the correct dosages from the doc, the wife kept badgering me with conspiracy theories about how ‘the suits’ are trying to create dependence on pharmaceuticals to maintain and increase profits. She also insisted on knowing whether or not the fluids and meds were organic. Judging from her ‘humph’, ‘sterile’ wasn’t a good enough answer for her. At one point, she started to sob hysterically about how we were polluting her beloved’s body with ‘chemicals of the apocalypse’. I wanted to stab her with a 10G filled with Ativan.

Now before I get flamed for hating on organic foods, let me explain something. I’m a HUGE proponent of nutrition as part of an overall healthy lifestyle. Eating wholesome foods (including some organic foods) on a consistent basis is going to be a lot better for one’s health than eating over-processed and fatty foods. However, when a medical condition starts to spiral out of control, some heavy duty medications are needed to help the person. Drinking organic bitterroot juice is not going to ‘fight the free sugar in the body’ when a patient is barely alert.

When I finally got a chance to ask the wife why she brought him to the ER if she didn’t believe in western medicine, she sheepishly replied, “His daughter is an internal medicine resident here and she said she’d call the police and have me thrown in jail if I didn’t bring him over”. I tried to explain to her about the importance of controlling his blood sugar and hypertension in conjunction with proper nutrition but she just accused me of not being as enlightened as her. My forehead hurt a lot from consistently being in high impact contact with the walls for the rest of the day.

Sunday, August 23, 2009

Abusing STAT

There’s a new resident on the GI service who LOVES to write STAT for everything.

Lytes, BUN, Cr, Glucose – STAT


Trial clear fluids – STAT

Stool samples for C&S – STAT (But…but… she hasn’t made a doody yet!)

AM blood work – STAT (umm – that’s in 7 hours from now. I’m confused.)

Even when he’s asking for some mundane piece of equipment (ex: 10 cc NS flush), he will add STAT to his command. Granted that his ubiquitous and unnecessary use of the word stat makes me chuckle without fail, but I really want to tell him that he’s in the ER – everything is stat! However, I’ll hold off for a bit just to see what other not so stat orders get the stat treatment from him.

Monday, August 17, 2009

If You Can’t Take the Heat…

Today was a hot, humid and hazy nightmare of a day. It absolutely sucked. I had to forgo my regularly scheduled hot caffeinated beverage for an iced variety, which turned warm within a matter of minutes. Walking to and from the train station promptly transformed me from a bleary eyed nurse to an uncouth sweat drenched bewildered monstrosity. Moisturizer melted. Hair simultaneously frizzed and fell flat. Skin sizzled. It was literally too hot to live – which is just what one of my dingbat patients stated as his chief complaint. He said he had been feeling suicidal lately so he decided to check himself in before he hurt himself. Fair enough. However, my fierce assessment skills revealed his diabolical plan. The air conditioner in his apartment broke down so he figured that he would express suicidal ideation, get placed in a mandatory psychiatric hold in air conditioned quarters for the next several days, while not having to cook, clean and most importantly, not go to work. At first, I was quite impressed with his thought process, but when the caffeine kicked in, I was left feeling like I was punked. What an effin waste of resources. I passed along my newly acquired information to his doc, however, my shift ended before I could witness the (likely) anti-climactic conclusion to the patient’s drama of poorly concocted lies and deceit. Hopefully, he gets placed on the psychiatric hold in a unit that has faulty air conditioning.

Tuesday, August 11, 2009

Why I’m in Love with Vincent Lam

I was recently re-arranging my bookshelf when I found my copy of Vincent Lam’s Bloodletting and Miraculous Cures. I immediately started to leaf through it and I once again realized how much some of his stories resonated with me. Lam’s stories revolve around the lives and changing perceptions of a group of medical students as they go through school, residency and eventually become full-fledged doctors. In Eli, a story that I found to be one of the most compelling in the collection, a doctor’s encounter with a prisoner brought in by the police is simmering with moral and ethical dilemmas that develop at a lightening pace. In yet another story featuring the same doctor, this time in a SARS isolation ward during the height of the epidemic, Lam delicately but authoritatively draws out what it means to the characters to be a doctor. In the last story of the collection, Lam describes a typical night shift which I found to be a wonderful ending to the collection as it highlights how confident yet weary he has become.

I’ve heard that every time a book is read, it is read by a different person. When I first read this book, I was stunned and fascinated by how the characters managed to hold dichotomous world views. On the one hand they were doctors – a profession defined by healing – on the other hand, at times they were deeply ambivalent, if not downright hostile towards their patients. I was also frustrated because I felt that the stories did not offer enough exploration or closure. Rather, I felt like I was being given selected glimpses into the characters’ lives. Lam based the stories on his experiences as an ER physician; now that I too work in an ER and only catch glimpses into patients’ lives, who sometimes present with situations that manage to deeply unnerve me, I am much more at ease with what Lam has left unwritten. I am greatly looking forward to his next book and in the meantime, I strongly recommend that Bloodletting and Miraculous Cures be in your reading list.

Disclaimer – I haven’t been paid by the publishers or the author to write this post (although the extra income would be greatly welcome).

Wednesday, August 5, 2009

Generalized Mean-Spirited Disorder

After finishing a shift on a Saturday morning, I somehow managed to make my way over to the train station and await my subterranean chariot home when a youngish man in his early 20s walked onto the platform and loudly announced, “Guys, I’m sorry to bug you but I desperately need $9.25 to pay for my train home. I got smashed last night, I acted like an ass and my ride left me here. All I want to do is go home so please please spare me some change”. Some people got uncomfortable and left, some just ignored him and a few gave him some coins. I got the feeling that this guy was genuinely just looking to get home. True, he could have called a cab home, but if he lived really far away, that would be an expensive endeavour. Likewise, he was asking for a very specific sum instead of ‘some spare change’. Myself and another passenger gave him a toonie* each before he walked to the other end of the platform where he asked other people. That’s when I saw two guys throw some coins at him and told him to pick them up if he wanted the change. He bent down to pick up the change while the two guys laughed and swore at him. I was disgusted by that entire exchange. It was incredibly unnecessary, needlessly cruel and unbelievably mean-spirited. What was the point of belittling a stranger in distress? My granny once told me that one should judge a person’s character on actions that they don’t think are being seen. If that’s the case, those guys are vile. I really hope that what goes around really does come around and the stranded guy got home.

*Two dollar coin in Canada. The name is dumb but endearing. The coin has a picture of a polar bear on one side and Queen Elizabeth on the other side. I like the polar bear side better.

Monday, August 3, 2009

I'm Tired

For the past two weeks I’ve been consistently getting my ass kicked every minute of every hour of every shift I’ve worked. Usually I’m fairly organized and timely but last week was just a god-awful mess. After the first two shifts, I couldn’t even bring my C game to work, let alone my A game! Lately the department has been getting inundated one major after another. Everything from stabbings, substance misuse, old people falling and breaking various bones, people with fairly complex medical histories circling the drain and of course drunks. It’s never a normal night without a couple of drunks. I’m lucky to work in a department that’s extremely well staffed for the most part but for I’ve worked almost 11 hours without a break for several shifts and stayed overtime for two of them.

A particularly memorable shift included a patient who kept desatting down to 75% on a non-rebreather mask – sure he had lung CA but 75% is still not a number I like to see. The woman next door to him went into a v-fib arrest only to be replaced by a tachycardic/hypotensive MVA who needed surgery ASAP. Of course all the surgeons were already swamped so she got transferred to the hospital next door. The cherry on the crap sundae that was my shift was an ashen looking LOM with a Hb of 47 who experienced a horrible transfusion reaction. I came back after only getting 4 hours of sleep to get a psychotic patient who needed elephantine doses of haldol. He just had to develop extra-pyramidal symptoms right when I see the monitor showing full blown tombstones on another one of my patients. I almost missed the drunk-tank. Almost.

By the time I finally made it home, all I wanted to do was to crawl into a little blanket covered hole and die. But no – I couldn’t sleep the entire day and my neck hurt! If the next set of shifts is as crazy as the last set, I may have to start self-medicating – or seriously consider switching over to retail :P